Multidisciplinary Delphi Panel on Rehabilitation Approaches and Unmet Needs for Chronic Stroke Walking Impairment and the Role of Rhythmic Auditory Stimulation.

Introduction: Walking or gait impairment is a common consequence of stroke that persists into the chronic phase of recovery for many stroke survivors. The goals of this work were to obtain consensus from a multidisciplinary panel on current practice patterns and treatment options for walking impairment after stroke, to better understand the unmet needs for rehabilitation in the chronic phase of recovery and to explore opportunities to address them, and to discuss the potential role of rhythmic auditory stimulation (RAS) in gait rehabilitation.

Methods: A panel of eight experts specializing in neurology, physical therapy, and physiatry participated in this three-part, modified Delphi study.

One-year budget impact of InTandem™: a novel neurorehabilitation system for individuals with chronic stroke walking impairment.

Chronic stroke walking impairment is associated with high healthcare resource utilization (HCRU) costs. InTandem™ is a neurorehabilitation system that autonomously delivers a rhythmic auditory stimulation (RAS)-based intervention for the at-home rehabilitation of walking impairment in adults in the chronic phase of stroke recovery. This study was conducted to estimate the budget impact of InTandem in comparison with currently available intervention strategies for improvement of gait/ambulation in individuals with chronic stroke walking impairment.

Validating the Safe and Effective Use of a Neurorehabilitation System (InTandem) to Improve Walking in the Chronic Stroke Population: Usability Study.

Background: Persistent walking impairment following a stroke is common. Although rehabilitative interventions exist, few exist for use at home in the chronic phase of stroke recovery. InTandem (MedRhythms, Inc) is a neurorehabilitation system intended to improve walking and community ambulation in adults with chronic stroke walking impairment.

Feasibility and Proof-of-Concept of Delivering an Autonomous Music-Based Digital Walking Intervention to Persons with Parkinson's Disease in a Naturalistic Setting.

Background: Reduced motor automaticity in Parkinson's disease (PD) negatively impacts the quality, intensity, and amount of daily walking. Rhythmic auditory stimulation (RAS), a clinical intervention shown to improve walking outcomes, has been limited by barriers associated with the need for ongoing clinician input.

Objective: To assess the feasibility, proof-of-concept, and preliminary clinical outcomes associated with delivering an autonomous music-based digital walking intervention based on RAS principles to persons with PD in a naturalistic setting.

Cortical Tracking of Speech in Delta Band Relates to Individual Differences in Speech in Noise Comprehension in Older Adults.

Objectives: Understanding speech in adverse listening environments is challenging for older adults. Individual differences in pure tone averages and working memory are known to be critical indicators of speech in noise comprehension. Recent studies have suggested that tracking of the speech envelope in cortical oscillations <8 Hz may be an important mechanism related to speech comprehension by segmenting speech into words and phrases (delta, 1 to 4 Hz) or phonemes and syllables (theta, 4 to 8 Hz).

Better late than never (or early): Music training in late childhood is associated with enhanced decision-making.

Decision-making is critical to everyday life. Here we ask: to what extent does music training benefit decision-making? Supported by strong associations between music training and enhanced cross-domain skills, we hypothesize that musicians may show decision-making advantages relative to non-musicians. Prior work has also argued for a "critical period" for cross-domain plasticity such that beginning music training early enhances sensorimotor brain regions that mature early in life.

Audio-Visual and Meaningful Semantic Context Enhancements in Older and Younger Adults.

Speech perception is critical to everyday life. Oftentimes noise can degrade a speech signal; however, because of the cues available to the listener, such as visual and semantic cues, noise rarely prevents conversations from continuing. The interaction of visual and semantic cues in aiding speech perception has been studied in young adults, but the extent to which these two cues interact for older adults has not been studied.

Exploratory decision-making as a function of lifelong experience, not cognitive decline.

Older adults perform worse than younger adults in some complex decision-making scenarios, which is commonly attributed to age-related declines in striatal and frontostriatal processing. Recently, this popular account has been challenged by work that considered how older adults' performance may differ as a function of greater knowledge and experience, and by work showing that, in some cases, older adults outperform younger adults in complex decision-making tasks. In light of this controversy, we examined the performance of older and younger adults in an exploratory choice task that is amenable to model-based analyses and ostensibly not reliant on prior knowledge.

Effect of explicit dimensional instruction on speech category learning.

Learning nonnative speech categories is often considered a challenging task in adulthood. This difficulty is driven by cross-language differences in weighting critical auditory dimensions that differentiate speech categories. For example, previous studies have shown that differentiating Mandarin tonal categories requires attending to dimensions related to pitch height and direction.

Enhanced cognitive and perceptual processing: a computational basis for the musician advantage in speech learning.

Long-term music training can positively impact speech processing. A recent framework developed to explain such cross-domain plasticity posits that music training-related advantages in speech processing are due to shared cognitive and perceptual processes between music and speech. Although perceptual and cognitive processing advantages due to music training have been independently demonstrated, to date no study has examined perceptual and cognitive processing within the context of a single task.

Elevated depressive symptoms enhance reflexive but not reflective auditory category learning.

In vision an extensive literature supports the existence of competitive dual-processing systems of category learning that are grounded in neuroscience and are partially-dissociable. The reflective system is prefrontally-mediated and uses working memory and executive attention to develop and test rules for classifying in an explicit fashion. The reflexive system is striatally-mediated and operates by implicitly associating perception with actions that lead to reinforcement.

Dual systems of speech category learning across the lifespan.

Although categorization is fundamental to speech processing, little is known about the learning systems that mediate auditory categorization and even less is known about changes across the life span. Vision research supports dual-learning systems that are grounded in neuroscience and are partially dissociable. The reflective, rule-based system is prefrontally mediated and uses working memory and executive attention to develop and test rules for classifying in an explicit fashion.

Effect of musical training on static and dynamic measures of spectral-pattern discrimination.

Both behavioral and physiological studies have demonstrated enhanced processing of speech in challenging listening environments attributable to musical training. The relationship, however, of this benefit to auditory abilities as assessed by psychoacoustic measures remains unclear. Using tasks previously shown to relate to speech-in-noise perception, the present study evaluated discrimination ability for static and dynamic spectral patterns by 49 listeners grouped as either musicians or nonmusicians.