Summary: Cerebral palsy is a neurological disorder that affects many children worldwide, leading to difficulties with movement, communication, learning, and social interaction. Traditional therapy focuses on physical limitations, but Rhythmic Auditory Stimulation (RAS) is emerging as a promising adjunct therapy that promotes a holistic approach to therapy. RAS involves the use of rhythmic cues to synchronize movements and improve gait and stability, and it provides several benefits, including enhanced motivation and learning, emotional well-being, neurophysiological benefits, posture improvement, reduced need for assistive devices, and enhanced motor planning and execution. RAS also provides a creative outlet for expression and improves social skills. RAS has shown significant promise in enhancing the overall quality of life for individuals with cerebral palsy.
Among every 10000 children in the world, 16 live with Cerebral Palsy. (1) Cerebral palsy (CP) is a lifelong condition that presents in babies and toddlers whose brains are damaged while they are still growing. CP can cause difficulty swallowing, intellectual disabilities, problems with bowel-bladder control, visual impairment, hearing impairment, and intellectual disability. 1 in 4 individuals with CP can not talk while 1 in 3 can not walk. (2)
Walking normally requires the precise coordination of around 30 muscles, which is challenging for those with CP. (3) They may exhibit abnormal gait patterns such as short stride length, asymmetrical gait, slowness, lack of coordination, and unnecessary body movement. (4) These challenges significantly limit their ability to participate in physical and social activities from an early age. In addition, communication difficulties, learning problems, and social awkwardness can make it difficult for children with CP to participate in social activities and make friends. These challenges can continue into adulthood, as individuals with CP often experience declining physical abilities and increasing social isolation. Most adults living with CP report a decline in their ability to walk as they age because of pain, reduced balance, and fear of falling. (5)
Despite significant rehabilitation efforts during childhood, individuals with CP experience changes in their bones and muscles that lead to a decrease in their ability to carry out day-to-day activities. (6) Although drug therapy, nerve injections, and orthopedic surgery are often used to improve gait performance in individuals with spasticity, no single treatment has been identified as the most effective in reducing movement problems. (7) It is extremely crucial to discover novel methods to help people with CP improve their physical abilities and also have fun and connect with others. Music, Dance, and Rhythmic Auditory Stimulation (RAS) have emerged as promising adjuncts to traditional physical therapy.
What is RAS?
RAS is a type of therapy that uses auditory cues, such as music or metronome beats, to help improve movement and coordination in people with physical disabilities. The rhythmic cues provided by the music or beats can help regulate and synchronize movements, resulting in improved gait and stability.
Why RAS?
Holistic approach: RAS can benefit individuals with cerebral palsy (CP) by providing opportunities for creative expression while improving their physical and social abilities. Traditional therapy tends to focus primarily on an individual’s physical limitations but dance as an art form can transcend that and offers opportunities for engaging in social activity while providing significant therapeutic benefits.
Enhanced motivation and learning: Engaging in artistic activities such as music and dance can create a pleasurable atmosphere that enhances recovery and motivation to participate in therapy. These activities improve communication skills, facilitate learning, and provide positive emotional experiences. (8)
Emotional well-being: Living with CP can be painful and often frustrating. RAS therapy can improve the emotional state by providing a sense of accomplishment and increasing self-confidence through creative expression, social interaction, and physical progress.
Neurophysiological benefits: Music-based interventions in therapy promote repetition, organization, and reinforcement, leading to beneficial effects on rehabilitation. These interventions enhance motor control by leveraging neurophysiological processes like priming and entrainment. (9) Dance movements can be broken down into basic elements that can be combined to create meaningful sequences. These sequences can be used to improve everyday functional mobility and have rehabilitative benefits.
Posture improvement: Individuals with CP often struggle with maintaining proper posture. RAS can help improve posture by providing a beat to move to, which helps individuals with CP to stay more upright and maintain a better center of gravity. Additionally, RAS can help align the body, reducing the risk of scoliosis and other musculoskeletal disorders that often develop due to CP. (10)
Reduced need for assistive devices: RAS can help individuals with CP to reduce their dependence on assistive devices, such as crutches, walkers, and wheelchairs. By improving their balance, gait, and coordination, RAS can help individuals with CP to move more independently and confidently. (12)
Enhanced motor planning and execution: RAS can improve motor planning and execution by providing a rhythmic structure for movement. This structure can help individuals with CP to better organize their movements and execute them more accurately and efficiently. RAS can also help with the timing of movements, which is often a challenge for individuals with CP. (8)
Regulated movement patterns: Individuals with CP often have movement patterns that are irregular or uncoordinated. RAS can help regulate these movement patterns by providing a consistent beat to move to. This can improve the smoothness and fluidity of movements, as well as the overall coordination.
Increased muscular activation: RAS can increase muscle activation in individuals with CP, leading to improved strength, range of motion, and control over movements. Different musical elements, such as pitch variation, rhythmic pattern, tempo, meter, volume, and harmony, can be utilized to elicit various types of movement, strength, and speed variations.
Improved joint movements and coordination: By providing a rhythmic structure to movements, RAS can help individuals with CP to better coordinate their movements and improve the overall range of motion in their joints.
Enhanced walking ability: RAS can improve the walking ability of individuals with CP. By providing a rhythmic structure to movements, RAS can help individuals with CP to better coordinate their movements and improve their gait. This can lead to faster walking, better pelvic and hip movements, and better gait control. Individuals undergoing RAS have been noted to walk faster, take more steps per minute, take longer steps, and have better joint and body positions. (13)
RAS therapy can have positive effects on the physical and emotional functioning of people with cerebral palsy, leading to an improved quality of life. It offers an opportunity for creative expression, social interaction, and learning to walk better. While the effectiveness of this therapy may vary depending on the person and type of training, it generally has favorable outcomes for both children and adults. RAS therapy has the potential to enhance body functions and personal artistic development, as well as increase participation in multiple contexts. Overall, the use of dance and RAS therapy provides a promising approach to improving the lives of individuals with cerebral palsy.
References
https://pubmed.ncbi.nlm.nih.gov/35952356/
https://cerebralpalsy.org.au/our-research/about-cerebral-palsy/what-is-cerebral-palsy/how-cerebral-palsy-affects-people/
https://pubmed.ncbi.nlm.nih.gov/17645385/
https://pubmed.ncbi.nlm.nih.gov/17645385/
https://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.2009.03429.x
Taylor, E (1993). Cerebral palsy: hope through research. In K. Bellenir (Ed.), (1997), Congenital disorders sourcebook, Vol 29 (pp. 119-177). Omnigraphics.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4344110/
https://pubmed.ncbi.nlm.nih.gov/25224999/
https://actaorthop.org/actao/article/view/7170
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8534581/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7923168/#:~:text=An%20intervention%20with%20rhythmic%20auditory,cadence%2C%20and%20improving%20static%20balance
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5746070/
Written by: Dr.Manognya Chekragari