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Optimizing Gait Outcomes in Parkinson's Disease with Auditory Cues: the Effects of Synchronization, Groove, and Beat Perception Ability

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Optimizing Gait Outcomes in Parkinson's Disease with Auditory Cues: the Effects of Synchronization, Groove, and Beat Perception Ability Western University Scholarship@Western Electronic Thesis and Dissertation Repository 7-30-2019 2:30 PM Optimizing Gait Outcomes in Parkinson's Disease with Auditory Cues: The Effects of Synchronization, Groove, and Beat Perception Ability Emily A. Ready The University of Western Ontario Supervisor Grahn, Jessica A. The University of Western Ontario Joint Supervisor Holmes, Jeffrey D. The University of Western Ontario Graduate Program in Health and Rehabilitation Sciences A thesis submitted in partial fulfillment of the equirr ements for the degree in Doctor of Philosophy © Emily A. Ready 2019 Follow this and additional works at: https://ir.lib.uwo.ca/etd Part of the Occupational Therapy Commons, Physical Therapy Commons, Physiotherapy Commons, and the Psychology Commons Recommended Citation Ready, Emily A., "Optimizing Gait Outcomes in Parkinson's Disease with Auditory Cues: The Effects of Synchronization, Groove, and Beat Perception Ability" (2019). Electronic Thesis and Dissertation Repository. 6443. https://ir.lib.uwo.ca/etd/6443 This Dissertation/Thesis is brought to you for free and open access by Scholarship@Western. It has been accepted for inclusion in Electronic Thesis and Dissertation Repository by an authorized administrator of Scholarship@Western. For more information, please contact [email protected]. Abstract This dissertation explores a common, rehabilitative strategy for mitigating gait impairments in Parkinson’s disease (PD) called Rhythmic Auditory Stimulation (RAS). The effects of this intervention on gait in PD are well documented but highly variable, which poses difficulty for appropriate therapeutic application. Part of this variability may be related to individual musical abilities, such as beat perception accuracy, as most RAS interventions involve synchronizing with a beat. However, music is complex and variable. Therefore, factors inherent in the music itself may play a role in these differences, such as how much the music makes you want to move (groove) or how familiar it is. The studies in this thesis address these questions by examining the effects of different musical features (e.g., groove, familiarity) in auditory stimuli on the gait of different populations (younger adults, older adults, people with PD). The immediate effects of instructions to synchronize or to walk freely to the auditory stimuli on spatiotemporal gait parameters were compared between those with good beat perception and with poor beat perception in each of the populations. This research supports overall that high groove music and metronome cues have markedly different effects on spatiotemporal gait parameters than low groove cues, and that low groove cues have the potential to hinder spatial and temporal gait parameters. This indicates that music in RAS should be carefully assessed before use. This thesis also supports that synchronizing to RAS may be helpful to maximize the effects of cueing on temporal gait parameters across healthy adults and the PD group. However, these studies also highlight the various ways in which synchronizing can potentially compromise gait (e.g., shortening strides, increasing variability) and that this is not necessarily dependent on how well one can find a musical beat. Further research is required to understand what additional factors can be manipulated to best individualize music-based RAS for optimal gait management in clinical populations. Keywords Parkinson’s disease, gait, rhythmic auditory stimulation, auditory cueing, beat perception, synchronization, groove, music ii Summary for Lay Audience This dissertation explores a common therapy for managing walking patterns in Parkinson’s disease (PD) called Rhythmic Auditory Stimulation (RAS). Clinically implementing RAS can be challenging, as walking patterns do not always change consistently with RAS. Many RAS interventions involve people walking with the beat in music, therefore individual musical abilities (such as how well a person can find a musical beat) may contribute to this variability. However, music itself is complex and variable. Therefore, factors inherent in the music itself may play a role in these differences, such as how much the music makes you want to move (groove), or how familiar it is. The studies in this thesis address these questions by examining the effects of different musical features (e.g., groove, familiarity) in music on the walking patterns of different groups (younger adults, older adults, people with PD). The immediate effects of instructions to synchronize or to walk freely to the music on walking patterns were compared between those with good beat perception and with poor beat perception in each of the groups. This research supports overall that high groove music and metronome cues have markedly different effects on walking patterns than low groove cues, and that low groove cues have the potential to hinder how people walk. This indicates that music in RAS should be carefully assessed before use. This thesis also supports that synchronizing to RAS, or walking in time to the beat, might help people to adapt their walking patterns. Importantly, these studies also highlight that synchronizing can potentially compromise how a person walks (e.g., taking short steps, fluctuating step length and speed) and that this is not necessarily dependent on how well one can find a musical beat. Further research is required to understand what additional factors can be manipulated to best individualize music-based RAS for the most optimal walking patterns in clinical populations. iii Co-Authorship Statement All data chapters were completed in collaboration with, and under the supervision of, Drs. Jessica Grahn and Jeffrey Holmes. Chapters 3-5 will be submitted for publication. Drs. Jessica Grahn and Dr. Jeffrey Holmes will be co-authors. Dr. Lucy McGarry contributed to experimental design of Study 1 (Chapter 3). For Chapter 5, Dr. Andrew Johnson provided input on statistical analyses. Dr. Mary Jenkins provided input on clinical measurements and study recruitment. iv Acknowledgments In completion of my dissertation, I would like to thank Drs. Jessica Grahn and Jeffrey Holmes for their endless guidance, support, and patience during these challenging past five years. I will be forever grateful to have had two supervisors that strive to be such exceptional mentors and teachers. Thank you. Dr. Mary Jenkins and Dr. Andrew Johnson provided their valuable input during the project development and analysis stages of my dissertation. I am grateful to have had two committee members who are so overtly passionate about what they do, about sharing their knowledge, and who so kindly expressed an open door policy. In addition, I owe Mary endlessly for welcoming me into her clinic and for sharing with me her clinical expertise. I am particularly grateful for the many Grahn Lab research assistants without whom this research would not have continued smoothly during the clinical years of this combined program, in particular to Alexis MacIntyre and Shaily Brahmbhatt. Additionally, I am thankful for all the knowledge, advice, and encouragement received from the exceptional graduate students and post-doctoral fellows in this Lab. I owe particular thanks to Dr. Lucy McGarry, whose guidance in the initial stages of my work was crucial. I am thankful to the Parkinson Society of Southwestern Ontario and Rock Steady Boxing for graciously allowing me to recruit participants at their events and to the Parkinson’s community that participated in this research. I can never thank you enough for your time and for sharing your experiences with me. Last, but not least, I owe so much of this accomplishment to the people in my personal life who have supported me on this journey: My East Coast friends and family have been endlessly supportive, patient, and encouraging. I owe a debt of gratitude to my incredible parents and sisters. Thank you for supporting me in every step of my academic career (even when I didn’t call home enough), for being an unconditional sounding board, and for always encouraging me to do what I love. v To the friends that have become family in Ontario: Research can be isolating experience, but the friendships and working relationships I’ve built here have given me more support than I ever anticipated. Each of you motivates me to be a better person and academic, and for that I am grateful. And to Jeff Martin: Thank you for always having the perfect balance of grounding me, pushing me to achieve my goals, and patiently supporting me during the most difficult part of this process. vi Table of Contents Abstract .......................................................................................................................... ii Summary for Lay Audience ........................................................................................... iii Co-Authorship Statement ............................................................................................... iv Acknowledgments ........................................................................................................... v Table of Contents .......................................................................................................... vii List of Tables ................................................................................................................ xii List of Figures .............................................................................................................. xiii List of Abbreviations...................................................................................................
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