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Rhythmic Auditory-Motor Entrainment of Gait Patterns in Adults

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RHYTHMIC AUDITORY-MOTOR ENTRAINMENT OF GAIT PATTERNS IN ADULTS WITH BLINDNESS OR SEVERE VISUAL IMPAIRMENT A DISSERTATION IN Music Education and Psychology Presented to the Faculty of the University of Missouri-Kansas City in partial fulfillment of the requirements for the degree DOCTOR OF PHILOSOPHY by DELLA MOLLOY-DAUGHERTY B.M.E., University of Kansas, 1992 M.M.E., University of Kansas, 1997 Kansas City, Missouri 2013 © 2013 DELLA MOLLOY-DAUGHERTY ALL RIGHTS RESERVED RHYTHMIC AUDITORY-MOTOR ENTRAINMENT OF GAIT PATTERNS IN ADULTS WITH BLINDNESS OR SEVERE VISUAL IMPAIRMENT Della Molloy-Daugherty, Candidate for the Doctor of Philosophy Degree University of Missouri-Kansas City, 2013 ABSTRACT The following study investigates the impact of a rhythmic cue on the observational gait parameters of a population of adults with blindness or severe visual impairment. Forty- six adults who had sight loss significant enough to require the use of a long cane for mobility purposes participated in the study. Participants were between the ages of 18 – 70 years. The study design was a within-subjects, repeated measures design with two levels for the independent variable of the metronome (uncued versus cued) and two levels for the independent variable of tempo (normal walk versus fast walk). Dependent variables of cadence (steps per minute), velocity (meters per minute), and stride length (cadence ÷ (velocity ⁄ 2)) were recorded. Within-subjects repeated measures statistical analyses identified a main effect for the independent variable of the metronome; subsequent analysis revealed that the metronome had a significant effect on the dependent variable of cadence. iii The presence of a rhythmic cue seemed to improve observational gait parameters for many of the study participants. A more in-depth investigation reveals the complex interrelationship of gait parameters, as well as the need to differentiate between the clinical importance of the study and the need for additional basic scientific research. While compelling clinical inferences can be drawn from this study, there continues to be a need to establish rhythmic auditory-motor entrainment as a sound theoretical framework upon which further research and clinical protocol development for this sample population can be based. iv APPROVAL PAGE The faculty listed below, appointed by the Dean of the School of Graduate Studies, have examined a dissertation entitled “Rhythmic Auditory-Motor Entrainment of Gait Patterns in Adults with Blindness or Severe Visual Impairment,” presented by Della Molloy- Daugherty, candidate for the Doctor of Philosophy degree, and certify that in their opinion it is worthy of acceptance. Supervisory Committee Deanna Hanson-Abromeit, Ph.D., Committee Chair Division of Music Education and Music Therapy Diane Filion, Ph.D., Co-Chair Department of Psychology Robert W. Groene, Ph.D. Division of Music Education and Music Therapy Lindsey Williams, Ph.D. Division of Music Education and Music Therapy Melisa Rempfer, Ph.D. Department of Psychology v CONTENTS ABSTRACT ..................................................................................................................... iii LIST OF TABLES .......................................................................................................... vii LIST OF ILLUSTRATIONS ......................................................................................... viii ACKNOWLEDGMENTS ............................................................................................... ix Chapter 1. INTRODUCTION ........................................................................................................ 1 2. REVIEW OF LITERATURE ....................................................................................... 7 3. METHODS ................................................................................................................. 40 4. RESULTS ................................................................................................................... 66 5. DISCUSSION ............................................................................................................. 81 Appendicies A. FACILITY PERMISSION LETTER ......................................................................... 94 B. PARTICIPANT SOLICITATION SCRIPT............................................................... 95 C. NARRATIVE SCRIPT .............................................................................................. 96 REFERENCES ............................................................................................................... 97 VITA ............................................................................................................................. 115 vi LIST OF TABLES Table 1. Summary of Participant Demographics ........................................................... 71 Table 2. Categorization of Participants’ Vision Loss Conditions .................................. 72 Table 3. Means, Standard Deviations for Normal Walk ................................................. 73 Table 4. Means, Standard Deviations for Fast Walk ...................................................... 73 Table 5. Means, Standard Deviations for First and Last Uncued Walk ......................... 78 vii LIST OF ILLUSTRATIONS Figure 1. Data Collection Form ...................................................................................... 60 Figure 2. Illustration of means for all dependent variables ............................................ 74 viii ACKNOWLEDGMENTS Thank you to the many individuals who helped throughout the process of completing this research project. Beginning thirteen years ago with a small clinical research study, and culminating with the completion of this dissertation research document, many colleagues, facilities, college training programs, family members, and friends have contributed significantly. The University of Kansas Alicia Ann Clair, Ph.D. Kansas State School for the Blind Madeleine Burkindine, Superintendent; Monique Jamerson, P.T.; Paul Clary-Archuleta, C.O.M.S. University of Missouri-Kansas City Sheri Robb, Ph.D.; Deanna Hanson-Abromeit, Ph.D.; Diane Filion, Ph.D.; Kathy Goggin, Ph.D.; Melisa Rempfer, Ph.D. Texas School for the Blind and Visually Impaired Housekeeping Department; Susan Matteson; Vicki Weston; Shelly Allen; Linda Locke; Bill Daugherty The Criss Cole Rehabilitation Center Rosanne DeMoss, Director Center for Biological Research in Music, Colorado State University Corene Thaut, MM, MT-BC; Michael Thaut, Ph.D.; Blythe LaGasse, Ph.D. Music Therapy Colleagues Allison Ebberts, MME; Jeremy Coleman, MM, MT-BC; Elizabeth Merz, MME, MT-BC My mother, Pam Clayton, editing assistance My husband, Bill Daugherty, editing assistance ix DEDICATION This is dedicated to my two children, Lauren and Isaac. We did it! I love you both…more! x CHAPTER 1 INTRODUCTION Demographic data collected by three government agencies provide a recent snapshot of the number of adults and children in the United States who have a level of vision loss that impacts daily functioning. The National Center for Health Statistics (NCHS) survey (2011), found that approximately 21 million adults, or 9% of the adult population, reported to have vision trouble, defined as “trouble seeing, even with glasses or contact lenses” (Schiller, Lucas, & Peregoy, 2012, p.7). This includes adults with total blindness (no light perception), adults with legal blindness (20/200 visual acuity with best correction, or a visual field of 20 degrees or less), adults with severe visual impairment (a visual loss significant enough to interfere with daily activities such as reading, working, attending school, or travel), and adults who merely report having significant trouble seeing (Huebner, 2003). The American Printing House for the Blind maintains an annual register of children age birth through 21 years who meet the definition of legal blindness. Their 2012 annual report stated that 59,193 children in the United States met the criteria (American Printing House for the Blind, 2013). The 2011 American Community Survey (ACS) within the United States Census Bureau found that 518,382 children age birth through 18 had vision difficulty in the United States (United States Census Bureau, 2013). This number includes the children who qualify as legally blind, totally blind, or severely visually impaired (B-SVI). The number of individuals who are B-SVI seems small in proportion when compared to the 12% of Americans reported to have a disability (United States Census Bureau, 2013). However, the impact sight loss has on an individual can be profound. Visual disabilities 1 impact two areas of daily life in a major way: Access to print information, and independent travel within one’s environment. Locomotion, the ability to move safely and freely from one place to another, presents a major challenge in the daily life of a person with B-SVI. Locomotion at its most fundamental level refers to safe, fluid, and efficient movement. Individuals with B-SVI may use a long cane, dog guide, or human guide when walking from one point to another. Locomotion involves additional skill sets to ensure safe movement from place to place. A person with B-SVI must detect and navigate obstacles in their path and have vigilance to auditory surroundings, such as crosswalk warning signals and traffic sounds. They must also create mental mapping for places of importance (e.g. the relationship of the restroom to the classroom) and be able to walk on changing
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