Listenmee® and Listenmee® smartphone application: Synchronizing walking to rhythmic auditory cues to improve gait in Parkinson’s disease
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.
References (24)
- et al.
Functional architecture of basal ganglia circuits: Neural substrates of parallel processing
Trends in Neurosciences
(1990) - et al.
A measure of kinematic limb instability modulation by rhythmic auditory stimulation
Journal of Biomechanics
(2000) - et al.
Personality traits modulate neural responses to emotions expressed in music
Brain Research
(2013) - et al.
Evidence for motor learning in Parkinson’s disease: Acquisition, automaticity and retention of cued gait performance after training with external rhythmical cues
Brain Research
(2010) - et al.
Effects of visual and auditory cues on gait in individuals with Parkinson’s disease
Journal of the Neurological Sciences
(2004) - et al.
Rhythmic facilitation of gait training in hemiparetic stroke rehabilitation
Journal of Neurological Sciences
(1997) - et al.
Effects of rhythmic sensory stimulation (auditory, visual) on gait in Parkinson’s disease patients
Experimental Brain Research
(2008) - et al.
Walking on virtual tiles
Neural Processing Letters
(2002) - et al.
Conductive education. A system for overcoming motor disorder
(1986) - et al.
Effect of optical flow versus attentional strategy on gait in Parkinson’s Disease: A study with a portable optical stimulating device
Journal of NeuroEngineering and Rehabilitation
(2008)
Emotional response to music: The need to consider underlying mechanisms
Behavioral and Brain Science
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