Objective: Describe outcomes from a 12-week home-based rhythmic auditory stimulation (RAS)-enhanced walking program completed by Veterans with Parkinson’s disease (PD); 1 with subthalamic nucleus deep brain stimulation (STN-DBS), and 1 without.

Background: STN-DBS is an effective treatment for motor symptoms of PD due to mitigation of beta oscillations. RAS-enhanced gait training is known to improve gait and motor dysfunction in PD through external cueing but has not been well-studied in DBS. This combination may potentially contribute to further mitigation of beta oscillations and therefore confer enhanced benefits, given internal cueing from DBS coupled with external cueing from music.

Method: Participants were instructed to walk 30-45 minutes, three times per week, while listening to a personalized RAS-enhanced music playlist and wearing a FitBit to track activity. Weekly phone calls were made by an exercise coach to assess safety and compliance during the intervention. Motor and neuropsychological assessments were collected pre- and post-intervention.

Results: The MDS-UPDRS Motor III Subscale score improved by 54% in both participants (59 to 27 in DBS; 37 to 17 in non-DBS).Timed Up and Go (TUG) improved by 19% in our DBS patient and 8% in our non-DBS patient. The seven-day average Total Step Count reported by the FitBit increased from 8000 to 12,000 (69% improvement) in our DBS patient, and from 4000 to 6000 (62% improvement) in our non-DBS patient. Self-reported scores in the Activities-Specific Balance Confidence Scale (ABC Scale) increased by 17% in our DBS patient and 9% in our non-DBS patient.  Pre-intervention, cognitive processing speed measured by the Symbol Digit Modalities Test (SDMT) was in the normal range for the non-DBS patient and was in the mild impairment range for the DBS patient; post intervention, only the DBS patient improved in processing speed (Z score pre: DBS -1.8, non-DBS 0.3; Z score post: DBS -1.4, non-DBS 0.35).

Conclusion: A 12-week home-based, personalized RAS-enhanced walking program was safe and contributed to an improvement in motor function in both DBS and non-DBS PD Veterans, while increasing overall activity. Our DBS patient demonstrated superior overall improvements on TUG, ABC scale, SDMT, and overall activity suggesting potential enhanced benefits of DBS plus RAS-enhanced gait training.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-a-rhythmic-auditory-stimulation-enhanced-walking-program-on-veterans-with-parkinsons-disease-with-and-without-subthalamic-nucleus-deep-brain-stimulation/