Elsevier

Human Movement Science

Volume 37, October 2014, Pages 147-156
Human Movement Science

Listenmee® and Listenmee® smartphone application: Synchronizing walking to rhythmic auditory cues to improve gait in Parkinson’s disease

https://doi.org/10.1016/j.humov.2014.08.001Get rights and content

Highlights

  • Two portable devices for auditory cueing in Parkinson’s patients are presented.

  • The effects on gait of Listenmee®, and Listenmee app® were analyzed.

  • The use of Listenmee® resulted in significant improvements in gait performance.

  • Results support its use as a co-adjuvant treatment option in PD.

Abstract

Evidence supports the use of rhythmic external auditory signals to improve gait in PD patients (Arias & Cudeiro, 2008; Kenyon & Thaut, 2000; McIntosh, Rice & Thaut, 1994; McIntosh et al., 1997; Morris, Iansek, & Matyas, 1994; Thaut, McIntosh, & Rice, 1997; Suteerawattananon, Morris, Etnyre, Jankovic, & Protas , 2004; Willems, Nieuwboer, Chavert, & Desloovere, 2006). However, few prototypes are available for daily use, and to our knowledge, none utilize a smartphone application allowing individualized sounds and cadence. Therefore, we analyzed the effects on gait of Listenmee®, an intelligent glasses system with a portable auditory device, and present its smartphone application, the Listenmee app®, offering over 100 different sounds and an adjustable metronome to individualize the cueing rate as well as its smartwatch with accelerometer to detect magnitude and direction of the proper acceleration, track calorie count, sleep patterns, steps count and daily distances. The present study included patients with idiopathic PD presented gait disturbances including freezing. Auditory rhythmic cues were delivered through Listenmee®. Performance was analyzed in a motion and gait analysis laboratory. The results revealed significant improvements in gait performance over three major dependent variables: walking speed in 38.1%, cadence in 28.1% and stride length in 44.5%. Our findings suggest that auditory cueing through Listenmee® may significantly enhance gait performance. Further studies are needed to elucidate the potential role and maximize the benefits of these portable devices.

Introduction

One of the most debilitating motor symptoms of Parkinson’s disease (PD) is gait dysfunction (Jankovic, Nutt, & Sudarsky, 2001). However, despite the benefits of current pharmacological and surgical therapies for patients with PD, treatment effectiveness and options for gait difficulties remain limited. Evidence supports the use of rhythmic external auditory signals to improve PD patients’ gait (Cottam and Sutton, 1986, McIntosh et al., 1994, McIntosh et al., 1997, Quintyn and Cross, 1986, Suteerawattananon et al., 2004, Thaut et al., 1997) suggesting that the use of auditory cues may increase gait stride length and regulate gait cadence. Based on such approach, devices that synchronize over-ground walking to rhythmic auditory cues have been created achieving limited long-term success, mostly due to impractical, uncomfortable, and not portable models (Baram et al., 2002, Ferrarin et al., 2008). One issue with traditional auditory cueing devices is that they employ open-loop strategies; that is, they impose a sensory signal on the patient, which is generated by an external fixed source that is not affected or directed related to the patient’s own movement and velocity. Examples are fixed-velocity visual cues (Arias & Cudeiro, 2008) or environmental rhythmic auditory cues (Willems et al., 2006). In contrast, of the few portable prototypes commercially available for the patient’s daily use, none allow for individual programming options to select the sound itself, its intensity, or cadence.

We analyzed the effects on gait of an original device, Listenmee® a portable pair of glasses with a 64 GB SD card able to produce 100 different sounds (Fig. 1). Listenmee® generates auditory rhythmic cues matching the patient’s step frequency to improve walking in PD patients. Listenmee® allows the patient the possibility to select sounds manually, including the desired cueing rate (number of sounds delivered in a period of time; beats/min) using the Listenmee app® (Brainmee™, Madrid-Spain [www.brainmee.com]) that was developed to allow users to choose an individualized auditory cues. The employed technology is simple and easy to use. Users can access it through a direct touch screen control system with commands such as “PLAY” and “PAUSE” through a circle type interface on the screen. The user is able to use the mobile touch screen to increase (clockwise) or decrease (counterclockwise) the cueing rate (Fig. 2). The application has different cueing rates as follows: very slow (0–50%), slow (51–100%), fast (101–150%), or very fast (151–200%). The applied tones can vary between 60 and 480 Hz. Together, patient and physician can choose the sound set and cueing rate that is best suited for the patient.

Listenmee® and Listenmee app® come with an online store where users are able to download sounds. It has 4 special categories identified as: “environmental”, “drums”, “electronics”, and “voices”. Furthermore each category has 25 different sounds, for a total of 100. In addition, the application allows the possibility to use Bluetooth (with the glasses or any wireless headphones) to provide comfort by keeping the phone in a pocket. It also has a statistical analyses software that shows walking improvement in distances and times. The user’s outside walking route performances can be recorded daily, monthly, and annually by integrating the application with Google monitor maps (GPS). Furthermore the physician can access the patient scores data through Internet at all times.

Section snippets

Patients and methods

Idiopathic PD patients diagnosed according to the clinical diagnostic criteria of the United Kingdom Parkinson’s Disease Society Brain Bank were recruited from local PD support groups and the Movement Disorders Clinic within the Centro Integral de Movimientos Anormales y Dolor (CIMAD) in Bogota, Colombia. Inclusion criteria were: (1) PD patients with gait difficulty, frequent episodes of falling and/or freezing; (2) ability to stand independently and walk without an assistive device; (3)

Results

Assessment of gait performance in this study included three major dependent variables: walking speed (meters per second), cadence (steps/min) and stride length (The distance between 2 successive placements of the same foot) in meters. All patients demonstrated a significant improvement difference in gait performance independently of the use of DBS or not and the condition of freezing of gait. When the device was turned on the mean improvement on the three major variables was: walking speed

Discussion

Gait disturbance is one of the cardinal symptoms in patients with PD. Generally, PD patients walk slowly with dragging steps and decreased arm swing while maintaining a flexed posture. Such gait disturbance and postural instability limits the patient daily living. The aim of this study was to explore the role of giving an external stimulus through a portable device to improve the quality of gait of people with Parkinson’s disease.

It is well documented that patients with PD can improve their

Acknowledgments

We would like to thank Camilo Turriago, Astrid Medina, Fernanda Arbelaez for Gait Analysis Laboratory and Krzysztof Kucharewicz for helping on the developing of the smartphone application. Pendent patent: PCT/IB2013/058949 International Bureau of the World Intellectual Property Organization.

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