“The Clinical Advantage” ™ NEW Music-Assisted Therapy For the Biodex Gait Trainer 3

Harness the Power of Music for Movement Disorders Music-Assisted Therapy combined with biofeedback technology revolutionizes treatment of movement disorders.

www. biodex.com/musictherapy In partnership with music therapists Neurologic music combined with technology brings music-enhanced BIODEX therapy to the plan of care. www.biodex.com 1-800-224-6339 Int’l 631-924-9000 Music-Assisted Therapy For the Biodex Gait Trainer 3

The Science of Sound Driving Functional Movement Based on decades of research Music-based therapy is well researched for its powerful showing the power of music in effects in treatment of movement disorders. With the treating movement disorders, rate of Parkinson’s, and diagnoses on the Biodex brings Music-Assisted rise, so is the need for better treatment options. We Therapy to the Gait Trainer 3. equipped the Biodex Gait Trainer 3 with neurologic music compositions written and performed by music I new RESEARCH STUDY therapists to help more patients find their stride using to your right music: a the power of music.

randomized controlled trial on This revolutionary music Fit the music to the patient. Select the correct tempo (bpm) to the novel use of treadmill plus integration provides an accommodate patient’s step speed or steps per minute (spm). music in Parkinson’s disease effective tool for physical therapists, occupational therapists, and neurologists to enhance treatments and drive faster outcomes. The advanced technology built into the Gait Trainer 3 documents

:68 bilitation (2019) 16 euroEngineering and Reha Calabrò et al. Journal of N Patients with 2984-019-0533-9 https://doi.org/10.1186/s1

Open Access progress, proving the value of treatment. RESEARCH a randomized Parkinson’s exposed alking to your right music: W e of rolled trial on the novel us cont ’ disease ill plus music in Parkinson s treadm 1 1 2 na Billeri , 1 i , Massimo Pullia , Lua 1 1* o Naro , Serena Filon 3 to rhythmic auditory n i tore Calabrò , Antoni 1 o and Placido Bramant Rocco Salva 1 orenzo , Concetta Tomain 1 ona Portaro , Giuseppe Di L Provvidenza Tomasello , Sim

ct ythmic Abstra e loss of automatic and rh AS) can compensate for th nisms ic Auditory Stimulation (R neurophysiological mecha Background: Rhythm ease (PD). However, the idiopathic Parkinson’s dis echanisms sustain gait cueing (RAC), patients with ying which m movements in tood. We aimed at identif RAS are still poorly unders underlying the effects of RAS gait training. nts with PD who practiced ait ement in a cohort of patie nt modalities of treadmill g improv mly assigned to two differe ts with PD who were rando We measured clinical, ods: We enrolled 50 patien 8-week training program. Merge Music-Assisted Therapy with Technology Meth AS (non_RAS) during an rainer3 with and without R training using GaitT it trainings. gical effects of both the ga (p < 0. ematic, and electrophysiolo ), Tinetti Falls Efficacy Scale kin l Gait Assessment (p < 0.001 improvement in Functiona 0.001) following RAS than esults: We found a greater rall gait quality index (p < administered by the R 0.001), and ove otor n Disease Rating Scale (p = ncrease within the sensorim 001), Unified Parkinso ed a stronger EEG power i the RAS gait training induc centroparietal/temporal _RAS training. In addition, er improvement of fronto- non he gait cycle, and a great ed to specific periods of t rhythms relat ing. than the non_RAS gait train ing consists of electrode connectivity g strategies during gait train hat the usefulness of cuein iming With our exclusive instrumented deck, of our study suggest t toring the internal t onclusions: The findings temporal connectivity. Res C and fronto-centroparietal/ y depends on a of sensorimotor rhythms ing gait performance, likel a reshape r rhythmicity, thus improv -based nerate and control moto create patient-tailored, RAS Gait Trainer 3 with t ge to mechanisms tha ese mechanisms is crucial llum. Finally, identifying th contribution of the cerebe pproaches in PD. rehabilitative a spectively registered. ered 15 February 2018, retro ation: NCT03434496. Regist Trial registr tion, GaitTrainer3 , Rhythmic auditory stimula real-time biofeedback and sophisticated n, Parkinson’s disease Keywords: Gait rehabilitatio the t dopamine levels within ssibly because of deficien po 3, 24, 60]. Indeed, Music-Assisted network [2 Introduction cortical-striatal locomotor hmicity of movements in ments with external s of automaticity and rhyt synchronize their move The los PD) has been humans ing process athic Parkinson’s disease ( gh an innate internal tim patients with idiop es, rhythmic cues throu - f different gait abnormaliti ]. This process involves dif related with the presence o rhythmic entrainment) [81 cor ilure, and freezing (i.e., auditory, pre- analytics, the Gait Trainer 3 is the ideal ation fa cluding g shuffling steps, gait initi ontoparietal networks, in includin ation challen- ferent fr e connected all make the gait rehabilit areas [4, 8, 37], which ar of gait [33], which and motor, and motor d The loss of automaticity (BG)-thalamo-cortical an g in these patients [12]. ss complex basal ganglia gin ent of the cerebral acro ks, as suggested Therapy, exhibit pairm networ icity may depend on the im -thalamo-cortical motor rhythm rhythm [28], cerebello ormalities in generate a regular walking ity studies showing abn mechanisms that by some connectiv t- ty within frontoparietal ne ral activity and connectivi neu 63, 76, 79] li.it th PD. [4, 27, 46, 62, spondence: salbro77@tisca S.S. works in patients wi platform for integrating music-assisted * Corre lermo, Contrada Casazza, 1 nino Pulejo, via Pa IRCCS Centro Neurolesi Bo 24 Messina, Italy 113, 981 the end of the article formation is available at ribution 4.0 Full list of author in f the Creative Commons Att istributed under the terms o d pen Access This article is d estricted use, distribution, an © The Author(s). 2019 O /by/4.0/), which permits unr to sustained gait ecommons.org/licenses e source, provide a link tional License (http://creativ the original author(s) and th Interna u give appropriate credit to in Dedication waiver in any medium, provided yo tive Commons Public Doma reproduction anges were made. The Crea herwise stated. s license, and indicate if ch able in this article, unless ot the Creative Common plies to the data made avail /publicdomain/zero/1.0/) ap (http://creativecommons.org therapy. Using the Gait Trainer’s intuitive improvements over interface, belt speed can easily be adjusted to Calabrò et al. Journal of other treatment match the patient’s steps per minute (spm). NeuroEngineering and methods. Music tempo in beats per minute (bpm) can be Rehabilitation (2019). 16:68. managed to influence gait components. 1. Select appropriate song from library Biofeedback quantifiably displays step length, step speed (spm) and step symmetry to Finalist at the encourage patient progress. SXSW 2018 Interactive While the repetition of gait training encourages Innovation Awards lasting effects through neuroplasticity, neurologic music is composed to facilitate correct movement. The Gait Trainer includes compositions created by music therapists that 2. Adjust tempo can be adjusted to a range of bpm without degrading music quality – even accommodating lower bpm for late stages of Parkinson’s. Genre-preferred music can also be downloaded from the internet and tempo-adjusted (bpm) to an individual’s walking speed (spm).

3. Provide gait training biofeedback with bpm = spm music-assisted therapy Create new pathways to movement

How Music-Enhanced Therapy Impacts Rehabilitation APPLICATIONS Those affected by debilitating neuropathologies respond favorably to Music-Assisted Therapy can be used in rhythmic auditory cueing (RAC) and rehabilitation and medical settings to improve functional movement, treating such musical elements carefully chosen to conditions as: enhance functional movement. Music is shown to jumpstart the brain’s Parkinson’s Disease neuroplasticity, reorganizing neural Multiple Sclerosis pathways to help patients regain motor Cerebral Palsy function that had been lost to brain injury Stroke or disease. Orthopedic Dysfunction Fitting the music to the patient synchronizes gait for entrainment. Walking can be aligned with rhythmic auditory cueing to improve temporal (step speed), The right music, the correct special gait (step length) and left/right stride deviations (step symmetry). The beats per minute (bpm) and qualitative component of what is done musically is quantified and documented by gait repetition help enhance the system’s computer. The pretest, comparison to normative data, and posttest An Exercise Summary Report shows need, progress neuroplasticity and get patients and outcome of therapy. results are presented objectively. better, faster. Documented.

Clinical Application Biodex provides a manual, rehabilitative performance plan, and other clinical application tools to help you understand which compositions are best suited to various clinical categories, for example:

Neurologic Diagnosis: • Extreme gait impairment • Moderate to severe gait impairment coupled with cognitive impairment

Orthopedic Diagnosis: • No cognitive impairment The Gait Trainer 3 provides real-time biofeedback and The Music-Assisted Therapy quantifiably displays step length, step speed (spm) and step Package offered for the symmetry. Biodex Gait Trainer 3 is accessed via USB flash drive that activates the music player software. A library of neurologic music Sound Bar shown beneath the Gait Trainer 3 display. 950-413 Music-Assisted Therapy Package compositions, as well as Compatible with Gait Trainer 3 various metronome beats and featuring Windows OS. tones are provided. For those fortunate to collaborate with a music therapist, Includes music library and sound bar with input for headphones and microphone. the Gait Trainer 3 also accommodates custom recordings. BIODEX Music Library – recorded among top performers The Music-Assisted Therapy Package contains a library of recordings produced at historic and internationally renowned studios, known for high commitment to sound integrity and technological excellence. Locations include Premier Studios, New York City, NY, where industry artists such as Madonna have recorded, and Bismeaux Studio, Austin, TX, which has seen the likes of Ray Benson and Asleep at the Wheel, Willie Nelson, George Strait and many others.

Silvery Moon Medley © is a music therapy arrangement that has a clear, Also available in complementary playback structure for walking patterns. Available in tempo Music Library: ranges from 90-140 bpm. Original arrangement from The Center for Music Therapy, Inc. Non-neurologic compositions of Street Walking © is an original music therapy-informed composition provided various genres and bpm at two different tempos between 60- and 140 bpm, each with a different Wide range of metronome tempos arrangement, and geared toward specific movement needs. The composition and sounds provides a clear, complementary playback structure for walking patterns that are well below normal gait ranges. Composed by The Center for Music Therapy, Inc.

Animals Everywhere © is an original music therapy-informed composition provided at five different tempos between 45- and 130 bpm, each with a different arrangement and geared toward initiation and continuation of gait at extremely impaired levels of spm or bpm. Composed by The Center for Music Therapy, Inc.

These songs are in 4/4 time signature, with distinct, consistent down beat, without the confusion of non-complementary instrumentation for gait training. Street Walking © and Animals Everywhere © were recorded in DXD format as is used in SACD, (Super Audio CD) for Full Analog Bandwidth.

Studies show listening to music you love releases more dopamine. Once the kinematics of gait are re-established using neurologic music, patients can switch to their preferred music genre at the right tempo.

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www.biodex.com/musictherapy

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FN: 19-313 8/19