Publication Date

2013-03-25

Availability

Open access

Embargo Period

2014-09-16

Degree Name

Master of Music (MM)

Department

Music Education and Music Therapy (Music)

Date of Defense

2012-02-02

First Committee Member

Shannon K. de l'Etoile

Second Committee Member

Teresa Lesiuk

Third Committee Member

James Moore

Abstract

The purpose of this study was to examine the immediate effect of rhythmic auditory stimulation (RAS) on gait in children with spastic cerebral palsy (CP). Moreover, the study aimed to investigate the consistency of the immediate effect of RAS on gait in children with spastic CP. Eleven children (5-12 years old) with spastic CP participated in the study, and data from nine participants were included in the analysis. Each child participated in one individual session per week for three weeks. In each session, participants performed four walks. In Walk 1, participants walked without rhythmic cueing at a comfortable speed. In Walk 2, they walked with rhythmic cueing matching the cadence in Walk 1. In Walk 3, participants walked with rhythmic cueing set 5% higher than the initial cadence. In the last walk, participants walked without rhythmic cueing again. A mixed design analysis of variance (ANOVA) was used to examine the effect of cueing, number of sessions, and level of gross motor functioning on gait parameters, including cadence, velocity, and stride length. The results showed that cueing had a significantly positive main effect on velocity and stride length. The significant increase in velocity was possibly due to improvements in stride length, that is, participants may have improved walking speed by taking longer steps. Moreover, the effect size for cueing on velocity, stride length, and cadence was large, indicating that improvements in cadence, velocity, and stride length due to cueing are large changes. Number of sessions showed a statistically significant positive main effect on cadence. The increase in cadence from session to session may reflect a learning process through which RAS gradually helped children with spastic CP gain better movement control. The effect size was also large in regard to number of sessions on cadence and velocity, suggesting that children with spastic CP may improve cadence and velocity from session to session in actual, RAS clinical practice. Further, level of gross motor functioning showed a statistically significant main effect on cadence and velocity. The post-hoc analysis showed that participants with higher levels of gross motor functioning (i.e., Level I and Level II of the Gross Motor Function Classification System for Cerebral Palsy) showed significantly faster cadence and higher velocity than participants with a lower level of gross motor functioning (i.e., Level III of the scale). Level of gross motor functioning also showed a large practical effect on cadence, velocity, and stride length, indicating large differences in these gait parameters between participants with higher levels (i.e., Level I and Level II) and a lower level (i.e., Level III) of gross motor functioning. No interaction effects emerged between cueing, number of sessions, and level of gross motor functioning on any gait parameters. Therefore, children on all three levels of gross motor functioning seemed to respond similarly to cueing and number of sessions. In other words, not only children with higher gross motor functioning ability but also those with lower gross motor functioning ability appeared to benefit from RAS. Limitations of the study include a small sample size, an uneven number of participants on each level of gross motor functioning, different types of spastic CP, an uneven age distribution, and no control group. Improvements in methodology would be necessary in future research. In terms of theoretical implication, the research provides insight into how rhythmic cueing influences movement. In terms of clinical application, the research supports the use of RAS in children with spastic CP with various gross motor functioning abilities.

Keywords

rhythmic auditory stimulation; RAS; rhythm; gait; spastic cerebral palsy; CP

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