In April 2022, the American Parkinson Disease Association (APDA) hosted a webinar on walking with music as a part of the “Let’s Keep Moving” series.  Physical therapist Dr. Tim Nordahl noted that audible cues can improve movement.  This is best and most easily done through the use of a metronome or music.  Dr. Nordahl addressed the benefits of walking with music for people with Parkinson’s Disease (PD), and different device options to be able to do so.  

Walking difficulty is a common symptom of PD, and can manifest as slower speed, shorter stride, smaller steps, and shuffling.  Walking is often a requirement for those with PD to join social engagements and other activities that increase quality of life.  In this webinar, the speaker discussed strategies to help with walking.  

Please note that if you have trouble with balance, you may want to consider a different exercise besides walking, such as using an exercise bike or an assistive device like a cane or walker.  Consult with your doctor or physical therapist for the best treatment for you. 

The speaker discussed rhythmic auditory stimulation (RAS) as a solution to walking challenges.  RAS is any sound-based cue that helps keep accurate timing while walking.  This can usually be done through a metronome or music with a specific beat.  In order to apply RAS, determine your optimal cadence, which can be done with a physical therapist, then learn to use a metronome or make a playlist. 

Research has studied both a metronome and music as a rhythmic cue, and has found similar benefits.  The beat from a metronome is more obvious and can be easier to walk to.  On the contrary, music may be more motivating and fun, however there is the risk of the beat shifting during the song, and some beats may be difficult to hear.  Self-singing is another option, such as singing “row row row your boat” in your head at a brisk cadence.

To find a PD-knowledgeable physical therapist, please contact the APDA Information & Referral Center near you. 

If you happen to live in Northern or Central California, please contact the Stanford APDA Information & Referral Center

The webinar recording can be viewed here

Please see below for notes on the April webinar.

Regards, 

Joëlle Kuehn

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“Let’s keep moving with APDA:  Walk to the beat!  How music can help your walking”

Speaker:  Tim Nordahl, DPT, physical therapist, Center for Neurorehabilitation, Boston

Webinar Host:  American Parkinson Disease Association (APDA)

Webinar Date:  April 21, 2022

Summary by:  Joëlle Kuehn, Stanford Parkinson’s Community Outreach

 Walking and PD:

• Walking difficulty is common in PD:  Issues such as slower speed, shorter stride, smaller steps, and shuffling
• Walking is a major priority for those with PD:  Walking is often needed for social engagements and other activities related to quality of life
• Automaticity of walking is reduced:
  • PD may not remove ability to walk, but people find that in order to walk their best they have to concentrate on walking
  • Doesn’t happen automatically like it used to
• Important to engage in walking and keep it up over time  
• PD also causes an increased variability in steps and walking pattern from one step to the next
• Having the right strategies to help with your walking can make a big difference on moving around
• If you have trouble with balance, you may want to consider a different exercise other than walking, such as using an exercise bike or an assistive device like a cane or walker
• Consult with your doctor or physical therapist for the best treatment for you

Rhythmic auditory stimulation (RAS):

• Any sound-based cue that helps you keep accurate timing while walking
• Research has been done using metronome or music for walking.  Has found that RAS can be helpful for walking changes
• Based on neuroscience and clinical research:
  • Research says it works well because it connects auditory centers in your brain with areas that control and refine movement such as your pre-motor cortex, cerebellum, and the basal ganglia
  • Brain is faster at processing auditory cues than something like a visual input, making music helpful
  • It is why it is easier for people to adjust to a beat while walking rather than step on cues like visual lines on a floor
  • It is a cue that requires less of your attention
• Improvements in walking speed, step size, and consistency of stepping
• Can help some people with freezing of gait 

Applying RAS with a metronome:

• 3 steps
• Step 1: determine your optimal cadence, which is how many steps you take in a minute
  • Start by going on a 10-20 minute walk and see if you can keep the beat the whole time
  • Meet with a physical therapist to see the best beat for you
• Step 2: Learn how to use your metronome
  • The idea is that you take a step with every beep from the metronome
• Step 3: Get walking! 

Metronome vs. Music:  Does it matter?

• Research has studied both a metronome and music as a rhythmic cue
• Similar benefits between music and a metronome
• The beat from a metronome is more obvious and can be easier to walk to 
• Music may be more motivating and fun 
• Benefits of metronome:
  • You know exactly what you are going to get
  • The beat is always exactly what you set it to and it stays that way until you change it
• Pro of music:
  • Most people find it more enjoyable to walk to music rather than a constant-beeping metronome
  • A playlist of songs you love can be more motivating
• Cons of music:
  • If walk to music, depending on the song, the song may shift up and down in tempo when you walk
  • Some songs may be difficult to hear the beat, especially if you’re not well trained in music

Applying RAS using music:

• There are playlists on Spotify that consist of songs with the same beat
• Determine your optimal cadence:  A physical therapist can help you find it
• Learn how to find music at the beat that matches your walking cadence.  For example, look for playlists
• Self-singing is another option.  For example, singing “Row row row your boat” in your head at a brisk cadence
• Remember to be mindful of safety concerns:
  • Make sure you pick a flat area to practice this
  • If you balance problems, have someone with you and avoid big crowds and distractions while exercising

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Question and Answer:

Question:  What type of music should someone listen to to get started with this RAS?

Answer:  There’s not necessarily one right answer to this question, but it may be best to find something where the beat is prominent and you can tune into the beat.  Specific songs depend on what you find the most motivating.

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Question:  Is there a significant difference in the efficacy of walking on a treadmill vs walking outdoors?

Answer:  If you are on a treadmill, make sure that the beat matches the speed you are walking at.  It may be good to have a physical therapist keep an eye on that for you so you don’t drift up and down the treadmill to keep up with the beat. 

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Question:  What are some ideas to adapt the idea of walking to a beat to those who have to remain in chairs or need to hold on to the chair for stability?

Answer:  It can also be used on an exercise bike.  It can be used to help time many other movements.

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Question:  In what cases do you recommend people stick with the metronome rather than music? 

Answer:  There is no one right way to do this.  Some people like the thought of having more control of what the sound will be and what to expect.  If that is something you value a bit more, there is nothing wrong with keeping up with a metronome.  Metronomes are great if you prefer it.

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Question:  Is self-singing in their mind a good idea?

Answer:  I think it’s really helpful.  Some of my clients use it for freezing.  It is mobile, because you always have your mind, but you may not have your phone at all times.  You don’t have to take the time to get your phone out and put headphones on every time.