Rhythmic auditory stimulation for reduction of falls in Parkinson's disease: a randomized controlled study

Objective: To test whether rhythmic auditory stimulation (RAS) training reduces the number of falls in Parkinson's disease patients with a history of frequent falls. Design: Randomized withdrawal study design. Subjects: A total of 60 participants (aged 62-82 years) diagnosed with idiopathic Parkinson's disease (Hoehn and Yahr stages III or IV) with at least two falls in the past 12 months. Intervention: Participants were randomly allocated to two groups and completed 30 minutes of daily home-based gait training with metronome click-embedded music. The experimental group completed 24 weeks of RAS training, whereas the control group discontinued RAS training between weeks 8 and 16. Main measures: Changes in clinical and kinematic parameters were assessed at baseline, weeks 8, 16, and 24. Results: Both groups improved significantly at week 8. At week 16-after the control group had discontinued training-significant differences between groups emerged including a rise in the fall index for the control group (M = 10, SD = 6). Resumption of training reduced the number of falls so that group differences were no longer significant at week 24 (M-experimental = 3, SD = 2.6; M-control = 5, SD = 4.4; P > 0.05). Bilateral ankle dorsiflexion was significantly correlated with changes in gait, fear of falling, and the fall index, indicating ankle flexion as a potential kinematic mechanism RAS addresses to reduce falls. Conclusion: RAS training significantly reduced the number of falls in Parkinson's disease and modified key gait parameters, such as velocity and stride length.