Technology-Assisted Solutions to Enhance Auditory-Motor Synchronization During Walking in Progressive Multiple Sclerosis

Abstract

Background Studies show that beat-based cues from music and metronomes benefit gait in persons with progressive multiple sclerosis (PwPMS) during short walking. While useful for controlled assessment, prolonged walking better reflects real-world function. Adaptive beat-alignment algorithms using biofeedback may enhance synchronization and benefit gait dynamics but their effects in PwPMS remain unknown.Aims To investigate the effect of walking with and without an adaptive beat-alignment algorithm on synchronization consistency during 8 minutes of walking compared to walking in silence, and its effects on gait. We also examined how clinical factors like dynamic balance and cognition affect synchronization consistency during walking with music and metronomes, with and without adaptive beat alignment.Methods Healthy controls (HCs) and PwPMS walked for 8 minutes under 5 conditions: silence, music, and metronomes, with or without adaptive beat alignment, at their preferred pace. The algorithm adjusted phase and tempo in real time to restore baseline cadence. We measured synchronization, gait parameters, dynamics, and clinical outcomes.Results Twenty-one PwPMS and 18 HCs participated. Adaptive beat-alignment improved synchronization consistency and gait dynamics compared to fixed-tempo walking. Cognitive flexibility and working memory explained 10% of variance in the non-adaptive and 6% in the adaptive conditions, while dynamic balance (40%) impaired synchronization across both algorithms. Auditory cues resulted in slower walking and shorter strides compared to silence.Conclusion This study demonstrates the feasibility of adaptive beat-alignment strategies enhancing synchronization consistency and gait dynamics in PwPMS; however, cognitive flexibility, working memory, and dynamic balance influenced synchronization performance.