Effects of rhythmic auditory stimulation on functionality in Parkinson’s disease

Azevedo, Izaura Muniz; Gondim, Ihana Thaís Guerra de Oliveira; Silva, Kássia Maria Clemente da; Oliveira, Cleysiane de Araujo; Lins, Carla Cabral dos Santos Accioly; Coriolano, Maria das Graças Wanderley de Sales

doi:10.1590/fm.2021.34116

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ORIGINAL ARTICLE • Fisioter. mov. 34 • 2021 • https://doi.org/10.1590/fm.2021.34116 copy

Effects of rhythmic auditory stimulation on functionality in Parkinson’s disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Functionality is affected by the clinical characteristics and progression of Parkinson’s disease (PD).

Objective:

Assess the effects of a therapeutic exercise program associated with music-based rhythmic auditory stimulation (RAS) on the Activities and Participation Profile (APP) related to mobility of people with PD.

Methods:

Intervention study investigating people with moderate PD recruited from the Hospital das Clínicas of the Federal University of Pernambuco and the Parkinson’s Disease Association of Pernambuco. The APP related to mobility of the participants was assessed based on the International Classification of Functioning Disability and Health (ICF). The APP contains 23 activity/participation items scored from 0 (no problem) to 4 (complete problem). The intervention consisted of 10 outpatient sessions of a therapeutic exercise program associated with music-based RAS, applied using a smartphone application (ParkinSONS®), performed twice a week, with an average duration of 50 minutes per session. Given the metric nature of the variable and its non-normal distribution, Wilcoxon’s test was applied, considering p < 0.05.

Results:

In the sample of 8 patients, there was a significant decline in APP scores after intervention (p = 0.018*), indicating a positive change. Scores for all the APP activities decreased following the intervention, except for “transferring oneself to the left side while lying down”.

Conclusion:

In this study, a therapeutic exercise program associated with music-based RAS had a positive effect on the APP related to mobility of people with moderate PD.

Keywords:
Auditory stimulation; ICF; Music; Parkinson’s disease; Physiotherapy

Personal variables	n (%)
Age (years)
≥ 60	6 (75)
51-59	2 (25)
Sex
Male	5 (63)
Female	3 (37)
Clinical variables related to eligibility	Mean (standard deviation)
Mini-Mental State Examination	29 (02)
Beck Depression Inventory	11 (10)
Clinical variables related to Parkinson’s disease	n (%)
Disease stage
HY2	5 (63)
HY3	3 (37)
Disease duration (years)*
1 a 5	2 (25)
6 a 10	5 (63)
>10	1 (12)
Side of symptom onset
Right	6 (75)
Left	2 (25)

APP item	Assessment (before intervention)			Reassessment (after intervention)
APP item	Score x (±)	Min-Max	Interpretation	Score x (±)	Min-Max	Interpretation
1. Sitting	0 (0)	0-1	No problem	0 (0)	0-1	No problema
2. Lying down	1 (1)	0-2	Mild problem	0 (0)	0-1	No problem
3. Roling over
3.1 To the right	0 (1)	0-1	No problem	0 (0)	0-1	No problem
3.2 To the left	1 (1)	0-2	Mild problem	0 (0)	0-1	No problem
4. 2. Transferring oneself while lying down
4.1 To the right	1 (1)	0-3	Mild problem	0 (1)	0-1	No problem
4.2 To the left	1 (1)	0-3	Mild problem	1 (1)	0-1	Mild problem
5. Crawling	1 (1)	0-2	Mild problem	0 (0)	0-1	No problem
6. Kneeling	0 (1)	0-1	No problem	0 (0)	0-0	No problem
7. Bending	1 (1)	0-2	Mild problem	0 (0)	0-1	No problem
8. Transferring oneself while sitting	1 (1)	0-3	Mild problem	0 (0)	0-1	No problem
9. Standing	1 (1)	0-2	Mild problem	0 (0)	0-0	No problem
10. Squatting	1 (1)	0-3	Mild problem	0 (0)	0-1	No problem
11. Kicking	0 (0)	0-1	No problem	0 (0)	0-0	No problem
12. Pushing with lower extremities	1 (1)	0-1	Mild problem	0 (0)	0-1	No problem
13. Walking short distances	0 (0)	0-1	No problem	0 (0)	0-0	No problem
14. Walking long distances	1 (1)	0-4	Mild problem	0 (0)	0-1	No problem
15. Walking on different surfaces	0 (1)	0-2	No problem	0 (0)	0-0	No problem
16. Walking around obstacles	0 (1)	0-1	No problem	0 (0)	0-1	No problem
17. Climbing	0 (1)	0-2	No problem	0 (0)	0-1	No problem
18. Moving around within the home	0 (0)	0-1	No problem	0 (0)	0-0	No problem
19. Moving around within buildings other than home	0 (1)	0-2	No problem	0 (0)	0-1	No problem
20. Moving around outside the home and other buildings	1 (1)	0-2	Mild problem	0 (0)	0-1	No problem
21. Using private motorized transportation	1 (1)	0-2	Mild problem	0 (0)	0-0	No problem
22. Using public motorized transportation	1 (1)	0-2	Mild problem	0 (0)	0-0	No problem
23. Driving motorized vehicles	n/a	0 ou 9	n/a	n/a	0 ou 9	-

APP item	Percentage (%) of patients with a “problem” per item
APP item	Assessment (before intervention)	Reassessment fter intervention)
1. Sitting	13	13
2. Lying down	50	13
3. Roling over
3.1 To the right	38	13
3.2 To the left	38	25
4. 2. Transferring oneself while lying down
4.1 To the right	63	38
4.2 To the left	50	50
5. Crawling	50	13
6. Kneeling	38	0
7. Bending	50	25
8. Transferring oneself while sitting	25	13
9. Standing	38	0
10. Squatting	50	25
11. Kicking	25	0
12. Pushing with lower extremities	50	13
13. Walking short distances	25	0
14. Walking long distances	38	13
15. Walking on different surfaces	25	0
16. Walking around obstacles	38	25
17. Climbing	25	25
18. Moving around within the home	25	0
19. Moving around within buildings other than home	25	25
20. Moving around outside the home and other buildings	50	25
21. Using private motorized transportation	38	0
22. Using public motorized transportation	38	0
23. Driving motorized vehicles	n/a	n/a
x (±)	36 (14)	14 (14)*

Patient (No.)	Total score		Score reduction
Patient (No.)	Assessment (before intervention)	Reassessment (after intervention)	Score reduction
1	27	7	20
2	1	0	1
3	3	0	3
4	3	3	0
5	18	2	16
6	45	11	34
7	1	0	1
8	7	5	2
x (±)	13 (16)	4 (4)*	9

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[1] * Correspondence: ihanafisio@hotmail.com