Effect of rhythmic auditory cueing on gait in cerebral palsy: a systematic review and meta-analysis

Abstract

Auditory entrainment can influence gait performance in movement disorders. The entrainment can incite neurophysiological and musculoskeletal changes to enhance motor execution. However, a consensus as to its effects based on gait in people with cerebral palsy is still warranted. A systematic review and meta-analysis were carried out to analyze the effects of rhythmic auditory cueing on spatiotemporal and kinematic parameters of gait in people with cerebral palsy. Systematic identification of published literature was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and American Academy for Cerebral Palsy and Developmental Medicine guidelines, from inception until July 2017, on online databases: Web of Science, PEDro, EBSCO, Medline, Cochrane, Embase and ProQuest. Kinematic and spatiotemporal gait parameters were evaluated in a meta-analysis across studies. Of 547 records, nine studies involving 227 participants (108 children/119 adults) met our inclusion criteria. The qualitative review suggested beneficial effects of rhythmic auditory cueing on gait performance among all included studies. The meta-analysis revealed beneficial effects of rhythmic auditory cueing on gait dynamic index (Hedge's g=0.9), gait velocity (1.1), cadence (0.3), and stride length (0.5). This review for the first time suggests a converging evidence toward application of rhythmic auditory cueing to enhance gait performance and stability in people with cerebral palsy. This article details underlying neurophysiological mechanisms and use of cueing as an efficient home-based intervention. It bridges gaps in the literature, and suggests translational approaches on how rhythmic auditory cueing can be incorporated in rehabilitation approaches to enhance gait performance in people with cerebral palsy.

Keywords: ataxia; balance; entrainment; hemiplegia; rehabilitation; spastic diplegia.

Figure 1

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart for inclusion of studies.

Figure 2

Risk of bias across studies.

Figure 3

Forest plot illustrating individual studies evaluating the effects of rhythmic auditory cueing on gait velocity in people with cerebral palsy. Notes: Negative effects indicate reduction in gait velocity, positive effects enhancement in gait velocity. Weighted-effect sizes – Hedge’s g (boxes) and 95% CI (whiskers) – demonstrate repositioning errors for individual studies. The diamond represents pooled effect sizes and 95% CI. Negative mean differences indicate favorable outcomes for control groups, positive mean differences favorable outcomes for experimental groups. Abbreviations: A, adults; C, children.

Figure 4

Forest plot illustrating individual studies evaluating the effects of rhythmic auditory cueing on stride length in people with cerebral palsy. Notes: Negative effects indicate reduction in stride length, positive effects enhancement in stride length. Weighted-effect sizes – Hedge’s g (boxes) and 95% CI (whiskers) – demonstrate repositioning errors for individual studies. The diamond represents pooled effect sizes and 95% CI. Negative mean differences indicate favorable outcomes for control groups, positive mean differences favorable outcomes for experimental groups. Abbreviations: A, adults; C, children.

Figure 5

Forest plot illustrating individual studies evaluating the effects of rhythmic auditory cueing on cadence in people with cerebral palsy. Notes: Negative effects indicate reduction in step frequency, positive effects enhancement in step frequency. Weighted-effect sizes – Hedge’s g (boxes) and 95% CI (whiskers) – demonstrate repositioning errors for individual studies. The diamond represents pooled effect sizes and 95% CI. Negative mean differences indicate favorable outcomes for control groups, positive mean differences favorable outcomes for experimental groups. Abbreviations: A, adults; C, children.

Figure 6

Forest plot illustrating individual studies evaluating the effects of rhythmic auditory cueing on gait-dynamic index in people with cerebral palsy. Notes: Negative effects indicate reduction in gait-dynamic index, positive effects enhancement in gait-dynamic index. Weighted effect sizes – Hedge’s g (boxes) and 95% CI (whiskers) – demonstrate repositioning errors for individual studies. The diamond represents pooled effect sizes and 95% CI. Negative mean differences indicate a favorable outcome for control groups, positive mean differences a favorable outcome for experimental groups. Abbreviations: A, adults; C, children; H, household dwellers.