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The use of auditory stimuli in rehabilitation to target walking has been evidenced in persons with neurological conditions. The methodologies focus on the synchronisation of persons' steps to auditory stimuli showing that the type of stimuli and tempi significantly affect the synchronisation. However, the dynamic of the interaction over time between the motor system and the auditory stimuli, i.e., when steps are aligned (termed as locking) and not aligned (termed as unlocking) to the beat of the stimuli, remains unclear. Quantifying these dynamics would assist in the development of personalised rehabilitation. Nevertheless, it is currently challenging given the variability of responses per individual over time. We propose a methodological solution to quantify the dynamics of the step-to-beat coupling over time within an experimental paradigm where healthy (n = 7) and neurological impaired (n = 6) participants walk three minutes to music and metronomes at various tempi. We applied window partitioning within the time series to account for the changing pattern. To classify data into locked and unlocked events, features of fluctuation and trend were derived on which two statistical tests (circular statistical test and slope test) were done, respectively. Based on the ground truth, the performance of our proposed method yielded high accuracy (91%), precision (90%) and recall (97%). The standard deviation of the inter-step intervals was then modelled across the label and experimental factors. The proposed method is suitable for quantifying fine-grained observation of the dynamics of auditory-motor coupling in adult healthy and neurological impaired participants, with the potential of designing personalised rehabilitation., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Fayyad et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Many persons with multiple sclerosis (MS) are confronted with fatigue and difficulties with walking and even more so in persons with progressive subtypes of MS. Task-oriented training, and more specifically in the form of auditory-motor coupling, where persons are asked to synchronise their steps to beats in music and metronomes, is promising. However, it is currently not known whether persons with progressive MS (PwPMS) can synchronise their steps to beats in music and metronomes and if they can adapt their gait to slower and higher tempi., Methods: The study is a case control study where participants with progressive MS (PwPMS) and healthy controls (HCs) were asked to synchronise their steps during overground walking to beats in music and metronomes at five different tempi, ranging from slow (-8%, -4%), baseline (0%) and high (4%, 8%) while synchronisation, spatiotemporal parameters and gait dynamics were recorded. Mixed model analyses were performed on synchronisation outcome measures and spatiotemporal gait parameters. Additionally, a regression analysis was performed to identify clinical factors such as cognition and motor function influencing synchronisation consistency., Results: In total, 18 PwPMS (mean age = 52.4, median EDSS = 4.24) and 16 healthy controls (HCs) (mean age = 56.5) were included in the study. Results show that both groups were able to synchronise their steps to beats in music and metronomes, but highest synchronisation consistency was reached for metronome conditions compared to music conditions and for HCs compared to persons with progressive MS. Highest synchronisation consistency for persons with progressive MS was found at -4% and 0%. Additionally, more variability in inter-step-intervals and thus a more anti-persistent gait pattern was found for metronome compared to music conditions. Last, lower performance on the Timed Up & Go Test negatively impacted synchronisation consistency., Conclusion: PwPMS are able to synchronise steps to beats in music and metronomes. Overall, more consistent synchronisation is seen for metronome conditions. All participants are able to adapt their cadence to all tempi, yet, PwPMS struggle to adapt gait speed to high tempi. Noteworthy, participants walk with more random inter-step-interval fluctuations when walking to metronome compared to music conditions. Last, dynamic balance significantly impacted synchronisation consistency. These results show the potential of using auditory-motor coupling for walking related rehabilitation for PwPMS, however, tempo and auditory stimulation should be carefully considered., Competing Interests: Declaration of competing interest The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024. Published by Elsevier B.V.)

Developmental coordination disorder (DCD) presents challenges in motor control. DCD affects tasks such as walking and running and is characterized by poor interlimb coordination and increased spatiotemporal variability compared to typically developing children (TDC). While auditory rhythm synchronization has shown to have benefits for gait performance in adults, its impact on children with DCD during walking and running remains unclear. This study investigated auditory-motor synchronization and interlimb coordination during walking and running in children with and without DCD. Twenty-one DCD and 23 TDC participants aged 8-12 years walked and ran to two different auditory metronomes (discrete and continuous). Synchronization consistency was the primary outcome, with interlimb coordination and spatiotemporal variability as secondary outcomes. Results showed that children with DCD exhibited significantly lower synchronization consistency than TDC, particularly during running. The metronome structure did not influence synchronization ability. Additionally, interlimb coordination differed significantly between DCD and TDC during running and was not impacted by auditory-motor synchronization. Spatiotemporal variability was higher in DCD during both walking and running than in TDC, and accentuated during running. Variability of cadence was influenced by the use of continuous metronomes, which may offer potential benefits in reducing cadence variability., (© 2024 The Author(s). Annals of the New York Academy of Sciences published by Wiley Periodicals LLC on behalf of The New York Academy of Sciences.)

Background: Children with developmental coordination disorder (DCD) exhibit reduced interlimb coordination compared to typically developing children (TDC) during complex tasks like running, which requires dynamic postural control. However, the extent of interlimb coordination difficulties in DCD during tasks that demand minimal dynamic balance, such as self-paced and externally auditory-paced tasks, remains unclear. This study aimed to compare interlimb coordination and auditory-motor synchronization between children with DCD and TDC during a seated antiphase coordination task of the lower limbs, which has minimal postural control requirements. Methods: Twenty-one children with DCD and 22 TDC performed an antiphase knee flexion and extension task while seated, in three conditions (baseline silence, metronome discrete, and metronome continuous), for three minutes. The interlimb coordination, synchronization, and spatiotemporal movement parameters were analyzed using a mixed model analysis; Results: Children with DCD displayed less coordinated interlimb movements compared to TDC ( p = 0.0140), which was the result of the greater variability in coordinating antiphase knee flexion-extension movements ( p < 0.0001). No group differences in spatiotemporal movement parameters were observed. Children with DCD, compared to TDC, had a lower synchronization consistency to metronomes ( p = 0.0155). Discrete metronomes enhanced interlimb coordination compared to the baseline silence condition ( p = 0.0046); Conclusions: The study highlights an inferior interlimb coordination and auditory-motor synchronization in children with DCD compared to TDC. Implementing metronomes with a discrete temporal structure improved the interlimb coordination of both groups during the used fundamental seated interlimb coordination task, supporting theorical frameworks of event-based timing.

Background: A different interlimb coordination and higher variability in movement patterns is evident in children with Developmental Coordination Disorder (DCD). The impact of DCD on interlimb coordination during walking and running is unknown., Aim: To assess interlimb coordination and spatiotemporal variability during overground walking and running in children with and without DCD., Methods: Children with DCD and typically developing children (TDC), from 8 to 12 years participated. Children were equipped with portable sensors. Participants walked and ran for 3 min in an oval-path at their comfortable pace. Interlimb coordination, expressed by the phase coordination index (PCI), and spatiotemporal variability (coefficient of variance (CoV)) were collected., Results: Twenty-one children with DCD and 23 TDC participated. During walking, PCI showed similar values in both groups, but a higher spatiotemporal variability was observed in children with DCD. During running, PCI was higher (reduced coordination) in children with DCD than TDC and a higher spatiotemporal variability was shown., Conclusions and Implications: Only during running, interlimb coordination of children with DCD was lower than TDC. During both walking and running tasks, spatiotemporal variability was higher in DCD. Current results implicate that difficulties in children with DCD is more prominent when motor coordination is more challenged., What This Paper Adds: This paper adds to the literature on coordination and gait pattern in children with Developmental Coordination Disorder (DCD) through a cross-sectional analysis of interlimb coordination and variability of spatiotemporal measures of overground walking and running. Overground walking and running were performed in a large oval-path allowing the assessment of coordination and gait patterns in an ecological valid set-up. Our results indicate that during a more demanding task, namely running, children with DCD display a less coordinated running pattern, expressed by a significantly higher phase coordination index, than typically developing peers. During walking, the interlimb coordination was similar between both groups. The current result is in accordance with the hybrid model of DCD that states that motor coordination difficulties in DCD are dpendent on the interaction of the task, individual and environment. This highlights the importance of implementing running assessments in children with DCD and the need for task-oriented running training in clinical practice The study also supports previous findings that children with DCD show a higher variability in their gait pattern of both walking and running, expressed by higher coefficient of variance of spatiotemporal measures, than typically developing peers. Further understanding in the normal development of interlimb coordination during walking and running from childhood into adulthood will enhance interpretations of the phase coordination index in children with and without DCD., Competing Interests: Declaration of competing interest This study was supported by the Flemish Fund for Scientific Research (FWO Vlaanderen, 11K8622N, 1295923N) and the Special Research Fund of Hasselt University (BOF21INCENT27)., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: Cerebellar impairment (CI) manifests from different etiologies resulting in a heterogenic clinical presentation affecting walking and mobility. Case-reports were reviewed to provide an analytical clinical picture of persons with CI (PwCI) to differentiate cerebellar and non-cerebellar impairments and to identify interventions and assessments used to quantify impact on walking and mobility according to the International Classification of Functioning, Disability and Health (ICF)., Materials and Methods: Literature was searched in PubMed, Web Of Science and Scopus. Case-reports conducting physical rehabilitation and reporting at least one outcome measure of ataxia, gait pattern, walking or mobility were included., Results: 28 articles with a total of 38 different patients were included. Etiologies were clustered to: spinocerebellar degenerations, traumatic brain injuries, cerebellar tumors, stroke and miscellaneous. The interventions applied were activity-based, including gait and balance training. Participation based activities such as tai chi, climbing and dance-based therapy had positive outcomes on mobility. Outcomes on body function such as ataxia and gait pattern were only reported in 22% of the patients., Conclusions: A comprehensive test battery to encompass the key features of a PwCI on different levels of the ICF is needed to manage heterogeneity. Measures on body function level should be included in interventions.

Sensorimotor synchronization strategies have been frequently used for gait rehabilitation in different neurological populations. Despite these positive effects on gait, attentional processes required to dynamically attend to the auditory stimuli needs elaboration. Here, we investigate auditory attention in neurological populations compared to healthy controls quantified by EEG recordings. Literature was systematically searched in databases PubMed and Web of Science. Inclusion criteria were investigation of auditory attention quantified by EEG recordings in neurological populations in cross-sectional studies. In total, 35 studies were included, including participants with Parkinson's disease (PD), stroke, Traumatic Brain Injury (TBI), Multiple Sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS). A meta-analysis was performed on P3 amplitude and latency separately to look at the differences between neurological populations and healthy controls in terms of P3 amplitude and latency. Overall, neurological populations showed impairments in auditory processing in terms of magnitude and delay compared to healthy controls. Consideration of individual auditory processes and thereafter selecting and/or designing the auditory structure during sensorimotor synchronization paradigms in neurological physical rehabilitation is recommended., (© 2023. The Author(s).)

Neural entrainment, defined as unidirectional synchronization of neural oscillations to an external rhythmic stimulus, is a topic of major interest in the field of neuroscience. Despite broad scientific consensus on its existence, on its pivotal role in sensory and motor processes, and on its fundamental definition, empirical research struggles in quantifying it with non-invasive electrophysiology. To this date, broadly adopted state-of-the-art methods still fail to capture the dynamic underlying the phenomenon. Here, we present event-related frequency adjustment (ERFA) as a methodological framework to induce and to measure neural entrainment in human participants, optimized for multivariate EEG datasets. By applying dynamic phase and tempo perturbations to isochronous auditory metronomes during a finger-tapping task, we analyzed adaptive changes in instantaneous frequency of entrained oscillatory components during error correction. Spatial filter design allowed us to untangle, from the multivariate EEG signal, perceptual and sensorimotor oscillatory components attuned to the stimulation frequency. Both components dynamically adjusted their frequency in response to perturbations, tracking the stimulus dynamics by slowing down and speeding up the oscillation over time. Source separation revealed that sensorimotor processing enhanced the entrained response, supporting the notion that the active engagement of the motor system plays a critical role in processing rhythmic stimuli. In the case of phase shift, motor engagement was a necessary condition to observe any response, whereas sustained tempo changes induced frequency adjustment even in the perceptual oscillatory component. Although the magnitude of the perturbations was controlled across positive and negative direction, we observed a general bias in the frequency adjustments towards positive changes, which points at the effect of intrinsic dynamics constraining neural entrainment. We conclude that our findings provide compelling evidence for neural entrainment as mechanism underlying overt sensorimotor synchronization, and highlight that our methodology offers a paradigm and a measure for quantifying its oscillatory dynamics by means of non-invasive electrophysiology, rigorously informed by the fundamental definition of entrainment., Competing Interests: Declaration of Competing Interest The authors declare no competing interests., (Copyright © 2023. Published by Elsevier Inc.)

Upper limb intention tremor in persons with multiple sclerosis (pwMS) affects the ability to perform activities of daily life and is difficult to treat. The study investigated the effect of peripheral upper limb cooling on tremor severity and functional performance in MS patients with intention tremor. In experiment 1, 17 patients underwent two 15 min cooling conditions for the forearm (cold pack and cryomanchet) and one control condition. In experiment 2, 22 patients underwent whole arm cooling for 15 min using multiple cold packs. In both experiments, patients were tested at four time points (pre- and post-0, -25 and -50 min cooling) on unilateral tasks of the Test Evaluant les Membres supérieurs des Personnes Agées (TEMPA), Fahn's tremor rating scale (FTRS), Nine Hole Peg Test (NHPT). In experiment 1, the mean FTRS ranged from 13.2 to 14.1 across conditions. A two-way ANOVA showed mainly time effects, showing that cooling the forearm significantly reduced the FTRS, the performance on the NHPT, and three out of four items of the TEMPA, mostly independent of the cooling modality. In experiment 2, the mean FTRS was 13.1. A repeated measures ANOVA showed that cooling the whole arm reduced the FTRS and time needed to execute two out of four items of the TEMPA. These effects occurred immediately after cooling lasting at least 25 min. Cooling the whole upper limb led to a clinically noticeable effect on tremor severity and improved functional performance, which was pronounced during the first half-hour after cooling.

Background and Purpose: Regular physical activity (PA) helps to reduce the severity of physical and mental symptoms and improves quality of life in people with multiple sclerosis (PwMS). Based on current evidence and expert opinion, the recent multiple sclerosis guidelines recommend at least 150 minutes/week of PA. This study presents the results of a survey analyzing whether and how PwMS met the guidelines before and during the pandemic., Methods: We developed and disseminated an international online survey between December 2020 and July 2021, investigating changes in self-reported PA type, duration, frequency, and intensity due to the COVID-19 outbreak in PwMS with differing disability levels., Results: Among respondents (n = 3810), 3725 were eligible. The proportion of those who conducted at least one activity decreased with increasing disability level at both time points (pre and during). Overall 60% of respondents met the guidelines before the pandemic (mild: 64.43%; moderate: 51.53%; severe: 39.34%; χ 2(2) = 109.13, P < 0.01); a reduction of approximately 10% occurred during the pandemic in all disability groups (mild: 54.76%; moderate: 42.47%; severe: 29.48%; χ 2(2) = 109.67, P < 0.01). Respondents with higher disability participated more in physical therapy and less in walking, cycling, and running at both time points. Most respondents reported practicing PA at a moderate intensity at both time points; frequency and duration of sessions decreased as disability level increased., Discussion and Conclusions: The percentage of those meeting the guidelines reduced with increasing disability level and during the pandemic. PA type and intensity varied widely across the disability categories. Interventions accounting for disability level are required to enable more PwMS to reap the benefits of PA.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A415 )., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Academy of Neurologic Physical Therapy, APTA.)

Background: The COVID-19 pandemic has led to reorganization or reduction of neurorehabilitation services for people with multiple sclerosis (PwMS). The aim of this study was to explore the changes in the organizational framework and technology usage in physiotherapy services for PwMS during the COVID-19 pandemic., Methods: This international cross-sectional survey study was designed, developed, and disseminated by RIMS European Network for Best Practice and Research in Multiple Sclerosis Rehabilitation. Physiotherapists from nine countries (Australia, Belgium, Czech Republic, Ireland, Israel, Italy, Norway, Spain, Turkey) who provided physiotherapy services to PwMS, were invited to complete an online survey to compare physiotherapy delivery to PwMS prior to and during the pandemic period., Results: The survey was completed by 215 physiotherapists. Accessibility, the average number, length and perceived effectiveness of physiotherapy sessions provided to PwMS were significantly reduced during the COVID-19 pandemic (p=0.001). Physiotherapists increased the advice of mobile apps, recorded videos for rehabilitation and exercise websites during the pandemic (p<0.001) while the use of telerehabilitation and virtual reality technology did not change., Conclusion: There was of a reduction in the number, duration and perceived effectiveness of rehabilitation sessions for people with multiple sclerosis during the COVID-19 pandemic while use of remote technologies for physiotherapy did not change. To ensure the continuity of physiotherapy for PwMS with complex healthcare needs also during pandemics, the provision of guidelines and training in telehealth technologies in professional education becomes crucial., Competing Interests: Declaration of Competing Interests The authors declare that there is no conflict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: To investigate the impact of the COVID-19 pandemic on physical activity in persons with multiple sclerosis (PwMS)., Design: Multicenter international online survey study., Setting: The survey was conducted within 11 participating countries. Each country launched the survey using online platforms from May to July 2021., Participants: This was an electronic survey study targeting PwMS (N=3725)., Intervention: Not applicable., Main Outcome Measures: The survey ascertained physical activity performance and its intensity, the nature of the activities conducted, and the use of technology to support home-based physical activity before and during the pandemic., Results: A total of 3725 respondents completed the survey. Prepandemic, the majority (83%) of respondents reported being physically active, and this decreased to 75% during the pandemic. This change was significant for moderate- and high-intensity activity (P&lt;.0001). Activities carried out in physiotherapy centers, gyms, or pools decreased the most. Walking was the most frequently performed activity prepandemic (27%) and increased during the pandemic (33%). A total of 24% of those inactive during the pandemic had no intention of changing their physical activity behavior post pandemic. A total of 58% of the respondents did not use technology to support physical activity during the pandemic. Of those who did use technology, wearables were most used (24%). Of those currently nonactive (25%) expressed a preference for an in-person format to conduct physical activity post pandemic., Conclusions: Physical activity performance, especially activities at moderate and high intensities, decreased during the pandemic in PwMS compared with prepandemic. Walking and using wearables gained popularity as ways to stay active. As we move toward an endemic COVID-19, a call for action to develop interventions focused on walking programs with specific emphasis on increasing physical activity of PwMS is proposed., (Copyright © 2022 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Given the prevalence of motor and cognitive functions in persons with multiple sclerosis (PwMS), we proposed that the theoretical framework of embodiment could provide a rehabilitation avenue to train these functions as one functional unit. PwMS (n = 31) and age- and gender-matched healthy controls (n = 30) underwent an embodied learning protocol. This involved learning a cognitive sequence while performing it through bodily stepping movement under three feedback conditions (melody, sound, and visual). Cognitive and movement performance was assessed by a delayed recall 15 min after undergoing the embodied learning protocol. Half of participants correctly recalled the sequence in all three conditions, while 70% of healthy controls achieved correct recall within the melody condition. Balance impairment predicted the speed of executing the sequence irrespective of learning, most apparent in the melody condition. Information processing speed predicted the speed of executing the sequence in the melody and sound conditions between participants as well as over time. Those who learned performed the sequence faster in the melody condition only and overall were faster over time. We propose how embodied learning could expand the current context of rehabilitation of cognitive and motor control in PwMS., (© 2022 New York Academy of Sciences.)

Background: The impact of the COVID-19 pandemic on physical therapy services for people with multiple sclerosis (pwMS) is unknown. Therefore, the Special Interest Group for Mobility (SIG Mobility) of the European Network for Best Practice and Research in Multiple Sclerosis Rehabilitation (RIMS) has undertaken the initiative to examine the impact of the COVID-19 outbreak on physical therapy services and physical activity participation in pwMS across Europe, Israel and Australia., Objective: To describe the impact of the COVID-19 outbreak on physical therapy practice from the perspective of the therapist., Methods: An online survey was developed and conducted from December 2020 to July 2021. The survey (50 questions), included multiple-choice questions and open-ended responses., Results: In total, 215 physical therapists (PT's) from 9 countries (Australia, Belgium, the Czech Republic, Ireland, Israel, Italy, Norway, Spain, and Turkey) participated in the study. The therapy most affected during the pandemic was aerobic training/conditioning exercises; 33.5% reported that these activities were either reduced or unavailable. In contrast, 15% of the PTs reported increased use of relaxation/mind body techniques and/or fatigue management programs during the pandemic. PTs reported a mixture of positive and negative feelings about the therapeutic sessions offered during the pandemic. Most reported positive feelings included "positive" (26.5%), and "optimistic" (24.7%). Negative feelings most frequently reported included "worried" (30.7%), and "hesitant" (20.9%). The PTs reported a 10% decrease in the use of hands-on techniques and a 10% increase in the use of oral instructions when treating moderately and severely pwMS during as compared to before the pandemic., Conclusion: The COVID-19 pandemic has affected physical therapy services in pwMS internationally in terms of content, frequency of use and format., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: In a case report of a progressive multiple sclerosis with cerebellar impairments, we reported that synchronisation of steps to beats was possible only at -12% of usual walking cadence during 1 minute of walking., Objectives and Methods: Here, we investigate the effect of synchronisation using two different alignment approaches on the patient's gait pattern over 2 minutes of walking, compared to walking in silence., Results and Conclusion: This proof of concept showed that the adaptive approach was successful resulting in an improved gait pattern compared to the other conditions, providing preliminary evidence to support a full-scale intervention study.