Hello!
Welcome to my capstone site. I hope you find the information and materials helpful to your current and/or future practice as a physical therapist.
Throughout our physical therapy education we have been exposed to many different approaches to gait training. Sensory cuing is one group of interventions which therapists can utilize. However, most clinicians do not have access to the expensive equipment that some sensory cuing interventions require. In addition to my desire to provide clinicians with a low-cost intervention, my musical background also contributed to my interest in auditory cuing. In the following module I present rhythmic auditory stimulation (RAS) as a low-cost, effective means of gait training. Clinicians and students will be introduced to RAS and its theoretical basis as well as taught how to implement RAS.
In the future I hope to expand the resources to provide clinicians with a library of songs that can be used to provide cuing. The addition of music to the metronome beats will likely increase patient enjoyment as well as motivation.
Rhythmic Auditory Stimulation and Gait Training Presentation
Resources
To facilitate the use of RAS in the clinic I also designed a handout to serve as a quick overview of RAS and reference for implementation. It describes indications and contraindications while also walking the clinician through determining the appropriate pace of cuing. Additionally, more details concerning population, intervention, and outcomes can be found in the evidence table addressing RAS and stroke.
Rhythmic Auditory Stimulation and Gait Training Clinic Reference
Rhythmic Auditory Stimulation Evidence Table
Multiple metronomes are available on the internet at no cost.
- Metronome Online: www.metronomeonline.com/
- Web Metronome: www.webmetronome.com/ – Mobile app available
- Best Metronome: www.a.bestmetronome.com/ – Mobile app available
Quiz Time! 
To test your comprehension of the above materials please feel free to complete the quiz.
Rhythmic Auditory Stimulation Quiz
Rhythmic Auditory Stimulation Quiz Answer Sheet
Feedback
In order to continue to tailor the materials to best serve the needs of students and clinicians, I would greatly appreciate your feedback. Thank you in advance for your input.
Rhythmic Auditory Stimulation Module Evaluation Form
A special thank you to my committee members Karen McCulloch, Renee Hamel, and Vicki Mercer!
11 Responses to “Rhythmic Auditory Stimulation and Gait Training”
skauk
Hi Vicki and Kmac,
I have uploaded an updated version of the presentation with citations to the specific studies. Initial training should begin at or near the individual’s comfortable speed and cadence. The speed calculation is more important for setting treadmill speed. Overground training really just needs the cadence calculation. Thank you for the great feedback. I will continue to edit to improve clarity for implementation. I want to make this as accessible and helpful as possible.
Thanks again!
Sarah
skauk
Hi Mike
Very good point. In that case it may actually be “safer” to skip the unilateral and move straight from bilateral to no cuing at all. Or, if music with beats was being used, the therapist could start with bilateral beats and then transition to only using the music. Also, I know of a few therapists who use this idea to encourage increased cadence for runners.
Thanks!
Sarah
Vicki Mercer
Hi Sarah,
Really nice job on this project! I like the way you have integrated information on the web page with the PowerPoint, handout, quiz, and other materials. I agree with kmac’s idea about references. Also, I think a little more explanation about how to use the walking speed calculation versus the cadence calculation would be helpful, both in the PowerPoint and the handout. Should the metronome be set close to the comfortable cadence for initial training? How do you use the information about fast cadence? Vicki
jlkowals
Sarah,
I love what you’ve done for your project! As a music lover, I completely feel (and believe in) the important connection we have to sound. The information you provided in your presentation helped me understand how to use these principles in the clinic. Like the others have said, those conversions are so helpful! Thank you for including them! I would be interested to see how RAS works with pediatric patients, particularly those with autism and higher level coordination impairments. Great job!
Jesse
afay
Sarah,
I remember at the beginning of this year, you telling me about your potential capstone while we are running and I was really excited about it. Fun to see if all completed! I have seen RSA used for PD, but no other conditions. Your handout is fantastic! Thank you for including the conversions, that will make it so much easier to figure out how to set the metronome in the clinic. What a great idea!
Michael Lewek
Nice presentation Sarah
A thought: It is important that if you want to train for improved symmetry to use bilateral stimuli (beats for every step). If you do the unilateral approach, you are assuming symmetric timing of steps between limbs.
Have you thought about the application for runners?
Well done.
Mike
skauk
Hi Kmac,
Thanks for the feedback and suggestions. I will go back and include the specific references. And, I would definitely be willing to continue with this project for the neuro course. Keep in touch.
Thanks!
Sarah
skauk
Hi Alicia and Aisha,
Thanks for the feedback. Like you both mentioned there may be some individuals for which this sort of training will be too complex. I tried to provide a few guidelines, but I definitely think one will have to have a trial-and-error approach to this intervention.
Thanks again,
Sarah
Karen McCulloch
Hi Sarah, Nice job on the project…Vicki and I were talking the other day about how we might want to include info about this when we talk about ambulation/gait training in the 784 class in the fall. Although we haven’t gotten to PD yet in that course, I think your module and quiz would be an easy pre-lab assignment – then we could have a little scenario in balance/gait lab that requires folks to make a calculation and try out using a metronome for therapy.
One suggestion on the powerpoint. I think it would be best to include the key citations for pages where you are providing evidence of the effects of use of this intervention. You can do that either at the bottom of the slide or in smaller font at the title, for instance (Kauk, 2012; Other esteemed author, 2010) so people know where those results came from vs. trying to guess when they get to the end of the presentation. Small modification that I think would improve the links between source and evidence you share.
We should talk some more, if you’re interested in pulling this module together for that class purpose, there are a few other things that we’d need to do…..
kmac
aishaj
Sarah,
I agree with Alicia! Great project! All of your materials were very informative and easy to read, especially your handout. This project reminds me a little of LVST BIG therapy, which uses auditory and tactile cuing to improve movement amplitude in patients with Parkinson’s disease. I’m sure you ran into it during your research for this project. I always wondered about the effect of this type of training on patients with stroke. I assumed auditory and tactile cuing may be too complex during initial treatments in the stroke population. But auditory cuing seems like a great method to enhance gait training without overstimulating the patient.
Aisha
akinsey
Sarah,
What an interesting project! Your powerpoint was informative, very easy to read, and fascinating. This is definitely something I would be interested in using with patients. Thank you for actually doing several calculations. That makes it a lot easier to just plug in my own numbers to your equations.
It was also interesting to think about this being used in populations such as CP and TBI. That is an area I never would have thought to apply it. I would definitely like to try this with the next patient I have with Parkinson’s!
Great job 🙂
Alicia