Music stimulates muscles, mind, and feelings in one go

Gait and gait related mobility are among the most important factors for the quality of life of patients suffering from Parkinson's disease (PD). In most patients gait and gait related mobility will first lead to patients having to undergo physiotherapy. For gait training in PD there are a variety of evidence-based and well-established therapies. Among such therapies are Nordic walking, treadmill training, dancing, and amplitude training. All of these have proven to be effective in randomized controlled studies (Tomlinson et al., 2013). One approach that was among the first that had been studied clinically is rhythmic auditory stimulation (RAS). RAS is a therapeutic training technique derived from the concept of neurologic music therapy. In this methodology, music or acoustic stimuli are used and shaped in order to enhance bodily functions such as cognition, speech, or movement (Thaut and Hoemberg, 2014). In RAS rhythmical stimuli or music are used to address and improve gait and gait related issues (Thaut and Rice, 2014). Music with embedded metronome pulsation has been shown to be most effective in cueing movements. In comparison to single-pulse rhythmic stimulation (like from a metronome) response variability and synchronization offset are markedly reduced. This applies to the frequency range 60–120 bpm, which is relevant for gait training and also other gross and fine motor functions (Thaut et al., 1997). In an experimental study PD patients exhibited spontaneous improvements in gait velocity, cadence, and stride length through the use of functional music with an embedded metronome. A close synchronization between rhythm and step frequency suggested that there was evidence of rhythmic entrainment (McIntosh et al., 1997). Thaut and colleagues demonstrated in 1996 the effectiveness of a 3-week home based training protocol. Thirty-seven PD patients (at Hoehn and Jahr, 2.5) had been randomly assigned to either RAS with functional training music, self-pacing gait training or no training at all. RAS training consisted of 30 min of daily gait exercises (walking on a flat surface, stair stepping, stop-and-go) with functional music. Music tempo was increased twice within each session by 5–10%.The initial tempo which was derived from the patients normal cadence (100 steps/min = 100 bpm) was also set 5–10% higher every week. The limit for tempo increase was set to 130 bpm. The RAS group improved significantly in velocity (25%) and step cadence (10%) compared with the self-pacing training group (velocity increase of 7%; Thaut et al., 1996). To this day …