The 2 populations most benefited by the effects achieved by signaling or auditory rhythmic stimulation as a method of gait rehabilitation are patients with Parkinson's and cerebral vascular events because they increase their speed, stride length, and cadence. However, in one study it was found that using 110% of the patient's cadence is the best frequency as an auditory rhythmic signal to improve the stride length, cadence and gait speed due to the aforementioned mechanism, that this signal frequency achieves on the motor control system. Generally, 3 different stimulus frequencies are used for auditory cueing 90%, 100% and 110% of the patient's cadence. The auditory-motor coordination is better if the stimulus frequency is close to the patient's preferred rate, therefore the efficiency of the acoustic rhythms in symmetry, fluidity, and gait adaptability will also be greater. ![]() The decrease in this period of time reflects a better auditory-motor coordination 1 Therefore, the farther the frequency of the metronome from the patient's cadence is, the patient will require more steps to synchronize his footsteps with the beat The time it takes the patient to synchronize their footsteps with the rhythm, will be shorter if the frequency of the metronome is closer to the patient's preferred rate. While the variability in relative time, i.e. This is explained by the dynamics of the coupled oscillators that describe that the derivation phase, which means the period of time it takes to match the footstep to the stimulus, will be longer for the metronome speeds slower than the patient's preferred rate. Studies have shown that if the rhythm of the metronome is slower than the rate that the patient can maintain, patients anticipate the rhythm with their footsteps. Knowing the ability of auditory-motor coordination of a patient allows the physical therapist to modify the metronome to achieve the most optimal coupling between gait and rhythm and therefore obtain better results in the modification of gait parameters through acoustic rhythmic stimulation. The way in which gait adjusts to the acoustic stimulus is called auditory-motor coordination. Auditory-motor coordination (rhythm-linked-step) ![]() The effect that the acoustic rhythm has as a feedback stimulus in gait is achieved by increasing the excitation in the subcortical nuclei that adjust the balance with the bilateral movement of the trunk and proximal muscles, which makes possible the reactive motor coordination is driven by the stimulus feedback. In addition, some studies suggest that increased excitability on this pathway decreases muscle reaction time to improve walking speed. The rhythmic auditory signals activate the motor neuronal spinal nuclei through the reticulospinal pathway, this makes it possible to train the coordination of axial and proximal movements by motor commands. Consequently, the regulation of the skeletal muscles by the central nervous system can reinforce the coordination between agonizing-antagonist muscles. A constant auditory stimulus at a frequency of 110% of the normal cadence of the patient, increases the accuracy of the central motor impulse and therefore the impulse force of the nerve over which the command is issued. It has been shown that the highest auditory rhythmic signaling, i.e. Mechanism of action in the motor control system ![]() In addition, the ability to modify the gait with the acoustic rhythms depends on how well the gait is linked to the rhythm and the effectiveness of the acoustic rhythms to modify the gait depends on the speed of the metronome. ![]() To achieve gait, inputs are required from various levels of the motor control system: cerebral cortex, brainstem, cerebellum, and central nervous system.
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