Episode Overview

Episode Title: DDSIG: Bonus Episode- CSM 2025 Platform Award: Amplifying walking activity in Parkinson’s Disease through autonomous music-based rhythmic auditory stimulation – with Franchino Porciuncula
Host: Ken Vanaco, PT, Outpatient Neuro Clinic, Brown University Health, DDSIG Podcast Committee
Guest: Dr. Franchino Porciuncula, Research Assistant Professor, Boston University
Release Date: May 31, 2025
Main Theme:
A deep dive into the award-winning research on autonomous music-based rhythmic auditory stimulation (RAS) for amplifying real-world walking activity in people with Parkinson’s disease (PD). Discussion touches on innovation in rehabilitation technology, study design, clinical implications, and future directions.

Key Discussion Points and Insights

1. Background & Purpose of the Study

• Dr. Porciuncula’s group at Boston University investigates approaches to optimize rehabilitation in Parkinson’s Disease and stroke, with a focus on gait improvement (01:08).
• The featured project examined an autonomous, closed-loop music-based RAS device integrating real-time stepping performance with music cues, hypothesizing enhanced walking intensity, amount, and reduced gait variability in PD (01:45).
• Prior feasibility studies showed RAS to be safe and effective in concept; this was the first RCT to test effectiveness versus brisk walking without cueing in a community setting (02:10, 02:48).

2. What is Rhythmic Auditory Stimulation? Open vs Closed Loop

• Rhythmic auditory stimulation (RAS): Uses auditory cues (like beats in music) paired with stepping to immediately improve gait in PD/stroke (03:53).
• Traditional (open-loop) RAS:
  • "Fixed cues, or manually adjusted cues, independent from what the person’s doing." (05:14 - B)
  • Risks accumulation of error and loss of benefit if patient cadence changes, requiring manual clinician adjustment (07:25).
  • “You can't easily take this open loop approach out of the clinic because of the dynamic nature of walking” (07:25 - B).
• Closed-loop (autonomous):
  • "Closed loop basically refers to ... the person's performance is being taken into account by how cues are being delivered... a sensing component... allows more flexibility.” (08:05 - B)
  • Uses wearable sensors to adapt music beat to current gait, adjusting automatically for daily/inter-stride variation (08:40, 09:56).
  • Enables real-world, independent, and potentially habitual use outside the clinic.

3. Study Methods and Population

• Design: RCT; 8-week trial with middle-aged and older adults with PD, mild-to-moderate severity, generally “higher ability” community walkers; excluded moderate/severe freezing of gait (10:35–11:19).
• Groups:
  • AMP PD (experimental): Closed-loop RAS device (MedRhythms), 5x/week, 30 min, 6 weeks, community-based (15:30).
  • Active control: Brisk walking, same frequency/duration, no music/cues (15:30, 22:02).
• Both groups received paper logs and weekly PT check-ins for adherence/adverse event monitoring (16:51–17:14).
• Instructions prioritized safety and environmental awareness (e.g., bone conduction headphones used) (18:46).

4. Findings: Primary and Secondary Outcomes

• Walking Intensity & Adherence:
  • Step intensity: “Significantly higher moderate intensity minutes in favor of the AMP PD group...” (22:36–23:32).
  • Adherence: “Good to excellent adherence rates... the AMP PD group had slightly better adherence, maybe about 80% compared to the active control” (25:16).
• Sustained Effects & Durability:
  • Benefits waned after device removal; returns to baseline step intensity (20:08, 23:32).
  • “If you take away the intervention, they are unable to sustain the activity because this intervention is what is allowing them to tap into latent capacities.” (23:32 - B)
• Gait variability:
  • “Our post assessment on gait variability was done without cues and we saw a reduction in variability during uncued walking.” (20:37 - B)
• Participant enjoyment:
  • “Themes that were related to enjoyment, structure, [and] gait improvements... they felt like they were walking better” (24:41 - B).

5. Participant Engagement: Freezing of Gait, Music Choice & Habit Formation

• Some with mild freezing of gait found cues helped “overcome episodes... when they felt like freezing... was going to come on” (11:53).
• Real-world baseline walking was fairly high (8,000–9,000 steps/day), but moderate-intensity bouts were low, showing capacity for improvement (13:05–14:47).
• “They were able to choose the genre of music... basically these songs are curated based on the therapeutic value of the song and beat salience.” (26:55)
• Music selection enabled culturally relevant, enjoyable sessions, likely boosting adherence (27:52–28:04).
• “This is kind of like grounded on habit formation... both groups reported improved habits at the end of eight weeks.” (26:15)

6. Clinical and Research Implications

• Autonomous closed-loop RAS appears to address gaps in current gait interventions for PD, especially for intensity, continuity, and variability (28:54).
• Recent FDA Class 2 approval for the MedRhythms device for Parkinson’s expands clinical access (31:32).
• “No intervention out there... targets this array of gait deficits... We feel that this has potential.” (28:54–29:13)
• Next Steps: Plans for a larger pivotal RCT (more severe PD, inclusion of ‘freezers’, longer follow-up) to assess long-term sustainability and broader impact (30:39).
• “Developing technologies that utilize closed loop approach... demonstrates that there is a lot of potential in developing technologies that utilize closed loop approach, independent of the device that we are specifically studying right now.” (30:49–31:14)

Notable Quotes & Memorable Moments

• On adaptation:
  “Closed loop basically refers to... the person's performance is being taken into account by how cues are being delivered... [This] allows the system... to determine where they are in their cadence and then scale either higher or lower…” (08:05 - Franchino Porciuncula)

• On patient autonomy:
  “It would be so great if that’s autonomous... which maybe you could speak a little more to, get at that approach.” (06:57 - Ken Vanaco)

• On the limits of ‘open-loop’ systems:
  “You can't easily take this open loop approach out of the clinic because of the dynamic nature of walking...” (07:25 - B)

• On the impact of music:
  “If you’re not liking the music, who wants to be walking or dancing to music that they don’t like. It’s the same concept in this approach.” (27:52 - B)

• On generalizability:
  “Even if they were walking at these relatively higher amounts of steps per day... they had very minimal levels of sustained moderate intensity walking... there’s an opportunity for us to... further optimize the benefits of walking by walking at higher intensities.” (14:17 - B)

Timestamps for Important Segments

• 00:00–01:08 – Host intro, guest introduction, episode setup
• 01:08–03:28 – Dr. Porciuncula’s background, research background, description of closed-loop RAS
• 03:53–06:12 – Defining RAS: open-loop vs closed-loop
• 07:25–09:56 – Clinical limitations of open-loop & advantages of closed-loop, adaptation to real-world walking
• 10:20–11:40 – Study population, exclusion/inclusion criteria
• 13:05–14:47 – Baseline activity, moderate-intensity step patterns
• 15:30–18:46 – Intervention and control groups, safety/implementation, device details
• 20:08–23:32 – Durability/carryover of intervention effects, intensity results
• 24:41–25:57 – Participant feedback, adherence rates, ongoing use
• 26:09–27:52 – Habit formation, role of music choice
• 28:54–31:32 – Clinical implications, FDA designation, next research steps
• 34:49–35:14 – Personal interests of guest
• 33:03–34:27 – Acknowledgment of collaborators and team

Tone and Language

• Friendly, informative, and clinically practical.
• Conversational with real-world vignettes and humor, e.g., anecdotes about patient experience (06:12).
• Reflective: multiple “that’s a great question” and “really encouraging” moments.
• Emphasis on interdisciplinary collaboration and continuous improvement.

Conclusion

This episode masterfully unpacks the evolution and practical promise of autonomous, closed-loop rhythmic auditory stimulation for Parkinson’s Disease. Through deep discussion of a rigorously designed RCT, Dr. Porciuncula and Ken Vanoka lay out the science behind the intervention, operational details, patient experience, clinical takeaways, and an exciting horizon for technology-driven neurorehabilitation. The episode brims with actionable insight for researchers and clinicians—especially those eager to bring innovative, patient-centered approaches to PD gait rehabilitation.