RHYTHM IN LIFE
Have you noticed that the rhythm in your movements has gone for a toss. For instance,
Your one hand does not swing in sync with your other hand or your legs don’t move in the symmetrical pattern when you walk.
Your handwriting and signature have gradually changed.
You are not able to type as fast or precisely as you used to do before.
You are now facing difficulty in buttoning shirts or tying your shoelaces.
These difficulties are commonly faced by parkinsons patients due to abnormal internal timing.
INTERNAL TIMING is the key mechanism that precisely times and coordinates every movement in our body. In Parkinson’s Disease, this irregular timing causes disturbance of co-ordinated rhythmic walking which might result in imbalance leading to a fall. Providing an external rhythmic cue is likely to compensate for the impaired internal generation of rhythm.
One such method of providing external cues is METRONOME THERAPY.
It is a synchronized beat which repeats at a set frequency (60-150 bpm). Movements are to be performed in coordination to this beat. This therapy has been already applied on various neurological conditions like traumatic brain injury, children with mixed motor and cognitive impairment, stroke and also in Parkinson’s disease.
METRONOME + COORDINATION EXERCISE= BETTER MOVEMENT
It has shown various beneficial outcomes in patients diagnosed with Parkinson’s like:
- Symmetry of muscle activation in legs and arms, as well as diminished timing variability, both of which result in more stable walking
- Parkinson’s patients with more severe symptoms (Hoehn & Yahr stage III) experienced significantly fewer and shorter freezing episodes than before stimulation
- Improvements in gait velocity, cadence (steps per minute) and stride length (step distance) thus reducing the short shuffling walking pattern.
- Benefits in co-ordinated upper limb movements and also in cognitive functioning like attention, coordination and motor planning.
HOW TO USE IT:
METRONOME is an android or iOS application which can be easily installed in the phone or you can play it on youtube.
It has a speed limit which has to be set according to individual patient. Patient has to walk at their normal pace for a minute and count the number of steps they take per minute(e.g 60 steps per minute). Set the beats per minute(bpm) near about to a similar count for week 1 of exercises i.e 60bpm, gradually in week 2 and 3 the count can be increased by 5%-10%bpm. Use earphones for better voice reception.
EXERCISES TO BE PERFORMED :
- STEP UPS :
Find the staircase near you preferably with a railing support on the sides. You have to step the alternative right and left leg on the first step by coordinating with the beat . This exercise will help you to walk more coordinated and reduce the short shuffling gait
- STAR MARCHING:
Make a star on the floor with a temporary marker or just imagine a star. Stand in the center . With the beats you need to step forward and come back to the center and repeat it with all the direction . You can modify it by performing right side directions with right feet and similarly with left. This exercise is beneficial for improving dynamic balance.
- SQUARE WALKING :
Mark a square figure starting with a bigger size gradually reducing the size as you master at it . You need to walk on the line and complete the path following the beats. This exercise is useful for patients who face difficulty in twisting and turning in narrow spaces.
- TAPPING FEET(SITTING) :
In this activity have the patient listen closely and tap the feet on the beat. This exercise can be challenged by asking someone to increase or decrease the beats per minute as you perform the exercise. This is a great workout to practice attention, focus and motor planning.
- MILITARY WALK:
Lift alternate hands and leg as high as you can and try to march on the spot, this would help in bringing back the walking coordination.
- BALL DROPS :
This activity involves dropping a ball on a target in rhythm. The task can be made difficult by reducing the target size or reducing the ball size. You can have it bouncing off a wall . This exercise would be great for attention, coordination and motor planning for upper limb muscles
- SEPARATION ANXIETY :
You have to take any one type of pulses/lentils(20 in number) preferably which is bigger in size and have 5 number of containers placed in front. Coordinating with the beats you have to drop single pulse in each container. Great one to work on fine movements and quick reflexes
- MAKING DOT:
One more for your fine motor control practice and hand strength. You can draw any favourable shape and start making dots along the shape on the metronome.
Safety Tips:
- All exercises have to be performed within one’s functional limit.
- Please use any assistive device like a stick if needed or do the exercise in supervision of your family member.
- Set the metronome beats speed according to your comfort level.
- Following the rhythm is more important than how fast you perform.
- All the exercises in the video are performed at 60bpm. You can set your own speed limit.
References:
- V. Cochen De Cock,1,2,3 D. G. Dotov,3 P. Ihalainen, Rhythmic abilities and musical training in Parkinson’s disease: do they help? NPJ Parkinson’s Dis. 2018; 4: 8
- Arim Kim, MSC, OT,1 Hye-Sun Lee, MSC, Effects of interactive metronome training on postural stability and upper extremity function in Parkinson’s disease: a case study. J Phys Ther Sci. 2017 Jan; 29(1): 168–171.
- Cristina Nombelaa, Laura E. Hughes b, Adrian M. Owenc, Into the groove: Can rhythm influence Parkinson’s disease? Neuroscience & Biobehavioral Reviews, Volume 37, Issue 10, Part 2, December 2013, Pages 2564-2570