The use of rhythmic auditory stimulation for functional gait disorder: A case report

Issue title: Advances in Rehabilitation for Functional Neurological Disorder

Guest editors: Victor W. Mark

Article type: Case Report

Authors: Hebb, Caitlin^{a; b; *} | Raynor, Geoffrey^c | Perez, David L.^d | Nappi-Kaehler, Jill^e | Polich, Ginger^f

Affiliations: [a] MedRhythms, Inc., Boston, MA, USA | [b] Spaulding Rehabilitation Hospital, Boston, MA, USA | [c] Department of Psychiatry, Brigham’s and Women’s Hospital, Boston, MA, USA | [d] Department of Neurology and Psychiatry, Massachusetts General Hospital, Boston, MA, USA | [e] Wingate University, Wingate, NC, USA | [f] Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Brigham’s and Women’s Hospital, Boston, MA, USA

Correspondence: [*] Address for correspondence: Caitlin Hebb, MedRhythms, Inc., Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston 02129, MA, USA. Tel.: +1 617 952 6200; Fax: +1 617 952 5939; E-mail: [email protected].

Abstract: BACKGROUND:Functional gait disorders (FGD) are a common and disabling condition. Consensus-based rehabilitation techniques for treating FGD and other functional neurological disorder presentations at large utilize a variety of therapeutic strategies, including distraction, novel approaches to movement, entrainment, stress/hypervigilance modulation, and psychotherapy. CASE REPORT:Here we present a case of a 24-year-old woman with a complex history of anxiety, depression, left frontal astrocytoma, postural orthostatic tachycardia syndrome (POTS) and FGD. During a multidisciplinary inpatient rehabilitation stay for FGD, the patient underwent rhythmic auditory stimulation (RAS) delivered by a neurologic music therapist in conjunction with physical therapy, occupational therapy, and psychotherapy. RESULTS:The RAS intervention appeared to play a significant role in symptom resolution for this patient. Improvement in the patient’s truncal displacement, foot dragging, and well as overall gait speed occurred following serial RAS trials performed over a single treatment session. Benefits persisted immediately following the intervention and upon subsequent reassessment. Although at four-year follow-up the patient’s FGD symptoms remained resolved, fatigue continued to limit her ambulatory capacity and overall endurance. CONCLUSION:RAS represents a unique therapeutic approach for treating FGD, complementary to existing consensus-based rehabilitation recommendations, and may warrant further consideration by the field.

Keywords: Functional neurological disorder (FND), functional gait disorder, rhythmic auditory stimulation (RAS), neurologic music therapy (NMT), gait training

DOI: 10.3233/NRE-228005

Journal: NeuroRehabilitation, vol. 50, no. 2, pp. 219-229, 2022