Musical motor feedback (MMF) in walking hemiparetic stroke patients: randomized trials of gait improvement

Abstract

Objective: To demonstrate the effect of rhythmical auditory stimulation in a musical context for gait therapy in hemiparetic stroke patients, when the stimulation is played back measure by measure initiated by the patient's heel strikes (musical motor feedback). Does this type of musical feedback improve walking more than a less specific gait therapy? Design: The randomized controlled trial considered 23 registered stroke patients. Two groups were created by randomization: the control group received 15 sessions of conventional gait therapy and the test group received 15 therapy sessions with musical motor feedback. Setting: Inpatient rehabilitation hospital. Subjects: Median post-stroke interval was 44 days and the patients were able to walk without technical aids with a speed of approximately 0.71 m/s. Main outcome measures: Gait velocity, step duration, gait symmetry, stride length and foot rollover path length (heel-on–toe-off distance). Result: The test group showed more mean improvement than the control group: stride length increased by 18% versus 0%, symmetry deviation decreased by 58% versus 20%, walking speed increased by 27% versus 4% and rollover path length increased by 28% versus 11%. Conclusion: Musical motor feedback improves the stroke patient's walk in selected parameters more than conventional gait therapy. A fixed memory in the patient's mind about the song and its timing may stimulate the improvement of gait even without the presence of an external pacemaker.