Vibroacoustic Therapy in Parkinsonian Patients. A Complementary Approach to Improve Rehabilitation Outcome

Research Article

Phys Med Rehabil Int. 2023; 10(1): 1208.

Vibroacoustic Therapy in Parkinsonian Patients. A Complementary Approach to Improve Rehabilitation Outcome

Dolciotti C1, Della Ragione R2, Gabrielli G3, Stampacchia G4 and Bongioanni P4*

1Spinal Cord Injuries Section, Azienda Ospedaliero-Universitaria Pisana, Italy

2Neuro Care Livorno onlus, Italy

3Neuro Care onlus, Italy

4Spinal Cord Injuries Section, Azienda Ospedaliero-Universitaria Pisana, Italy

*Corresponding author: Bongioanni P Spinal Cord Injuries Section, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa, 2 - 56124 - Pisa, Italy

Received: December 30, 2022; Accepted: January 25, 2023; Published: January 31, 2023


Background: Parkinson’s Disease (PD) is a chronic progressive neurodegenerative disorder with motor and non-motor symptoms. Rehabilitation represents an adjuvant intervention to pharmacological and surgical therapy. Our study aim was to investigate the effectiveness of the Vibroacoustic Therapy (VAT) according to the Metodo Magic Music combined with conventional Training (Tr) versus Tr alone in improving motor symptoms and postural control in PD patients.

Methods: Twenty-four patients with idiopathic PD were enrolled. They were randomly assigned to the Tr-VAT or the Tr group. Total intervention time was 40 min (Tr) and 60 min (Tr-VAT) 3 times a week for 3 months. Both groups carried out at baseline and follow-up clininetric scales and tests to assess clinical outcome. Speed of postural transitions and gait parameters (endurance and comfortable and fast speed) have been measured.

Results: Follow-up evaluation showed in PD patients from the Tr-VAT group as compared to those from the Tr group an improvement of postural control assessed with Berg Balance Scale (p = 0.054) and Timed-Up and Go test (TUG) test (p = 0.058). Moreover, significant (p < 0.05) differences between groups were found for comfortable gait speed (p = 0.004) and speed of postural changes - from right side to supine (p = 0.03), from supine to right and left side (p = 0.01), from supine to prone (p = 0.002) and supine to sitting (p = 0.005), respectively.

Conclusions: Our study demonstrated the effectiveness of VAT as complementary treatment with conventional rehabilitation approaches, by improving mobility, agility and motor flexibility in PD patients.

Keywords: Parkinson’s Disease; Rehabilitation; Complementary Treatment; Vibroacoustic Therapy; Training; Metodo Magic Music

Abbreviations: 3-MWT: 3-min Walking Test; ABI: Acoustic-Based Interventions; BBS: Berg Balance Scale; BT: Balance Training; CGS: Comfortable Gait Speed test; FGS: Fast Gait Speed test; H&Y: Hoehn &Yahr; L.E.D.: L-DOPA Equivalent Dose; M.M.M.: Metodo Magic Music; PD: Parkinson’s Disease; QoL: Quality of Life; RAS: Rhytmic Auditory Stimulation; Tr: Training; TUG: Timed-Up and Go test; TW: Treadmill Walking; UPDRS-III: Unified Parkinson’s Disease Rating Scale - Section III; VAT: Vibroacoustic Therapy; WBV: Whole Body Vibration


Parkinson’s Disease (PD) is a chronic progressive neurodegenerative disorder, first described by James Parkinson in 1817 as “shaking palsy”. It is accompanied by both motor and non-motor symptoms, due to loss of striatal dopaminergic and non-dopaminergic neurons [1]. PD symptoms include tremor, bradykinesia, rigidity, postural instability, freezing of gait and motor coordination dysfunction. The disease is characterized by non-motor symptoms too, such as hyposmia, sleep disorders, depression and/or anxiety, bowel dysfunction (frequently constipation), progressive cognitive decline and dementia. Patients often complain of other disturbances, such as early muscle fatigue and pain [2].

The “gold standard” pharmacologic PD treatment is represented by L-DOPA. Whereas dopaminergic medications can effectively manage motor symptoms, drug resistance and L-DOPA-induced side effects following long-term use are common problems [3]. L-DOPA introduction has changed PD management: however, it soon became apparent that pharmacological treatment offered mainly a symptomatic relief and poorly affected the underlying pathophysiology. On the other hand, chronic use of drugs was associated with several dose-dependent effects [3]. Current therapeutic management seeks to delay long-term complications of drug therapy for as long as possible, introducing also complementary interventions.


Research has suggested that a regular physical activity can also be added to drug therapy to limit disability and improve Quality of Life (QoL) of PD patients [4]. In the recent years, novel treatment approaches have demonstrated benefits for both motor and non-motor symptoms. Growing number of evidence suggests that endurance exercise (particularly, high-intensity exercise) modifies disease severity in de-novo patients with early onset or mild/moderate disease [5]. As intensive aerobic exercise, in the latest decade, treadmill training has been frequently used in rehabilitation protocols and described as improving gait parameters in PD patients: especially, clinical evidence shows that a personalized high-intensity Treadmill Walking (TW) program not only improves gait parameters, but also may favorably influence non-motor symptoms and QoL [6].

On the other hand, more recent combined rehabilitation protocols, integrating aerobic exercise with task-oriented circuit training and postural training, seem improving not only gait and balance performance, but also patients’ QoL, because of a positively translation into the functional daily ability [7,8].

Furthermore, one should not neglect also the positive impact of short-term and long-term effects provided by recent innovative intervention approaches, such as the application of Whole Body Vibration (WBV) [9] and the Acoustic-Based Interventions (ABI) implemented as Rhytmic Auditory Stimulation (RAS) or the Vibroacustic Therapy (VAT) [10].

Regarding WBV, a 2014 literature review [11] reported mixed results in its favour for improving postural stability: anyway, it mostly suggests a benefit in mobility and balance, but not significantly higher than the more conventional active intervention approaches. A recent survey shows that, despite the favorable WBV effects on mobility and postural stability in PD patients, only few studies have an appropriate methodological quality [9].

ABI may be effective in promoting not only wellness, but also in maintaining physical and cognitive health, as long as possible, in PD patients. In this regard, clinical evidence highlights the potential effect of music, as complementary treatment, in relieving non-motor symptoms, such as depression, anxiety, neuropathic pain and stress: advanced studies of brain imaging gave information regarding the mechanisms of brain response to music stimulation [12]. Furthermore, other studies provided evidence of a close relationship between auditory neurons, basal ganglia and cerebellar areas [13]. Currently, preliminary studies of ABI with RAS and VAT performed by patients with extra pyramidal motor symptoms provided interesting results, supported also by brain imaging findings and neurophysiological studies [10].

Vibroacoustic Therapy (VAT)

We are focusing more specifically on the VAT, because of its integration in our rehabilitative program, with a novel method and protocol, in comparison to previous clinical experiences. VAT is a treatment method using sinusoidal low-frequency sounds in 30-120 Hz range, complemented by music for therapeutic purposes [14]. The origins of VAT come from the studies of Skille: he used in an experimental protocol deep vibration in subjects suffering from various disabilities [15].

VAT exploits frequencies within the hearing range, but at a specific pitch where the vibrating effect of the tone can be felt as a sensed vibration in the body: any sound vibration works on the principle of sympathetic resonance, where an object has a resonant frequency at which it vibrates in sympathy with the sound [16]. Currently, VAT is indicated for use in spastic cerebral paralysis and in other disorders of the central nervous system, as it helps to enhance rehabilitation intervention and improve motor skills and brain functions, connectivity, through oscillatory coherence [17].

Given the effectiveness of intensive training and use of acoustic and sound vibrations as drug therapy-associated treatment in improving motor symptoms in PD patients, our main purpose was to test a complementary rehabilitation program, combining aerobic exercise and postural task with VAT. To this aim, we have studied changes of clinical outcomes overall, by evaluating gait performances, static and dynamic balance parameters and execution speed of postural transitions in PD patients receiving two different interventions (with and without VAT).

Patients and Methods

Study Design

The present study was randomized, observational-interventional and prospective. Patients were randomly sorted into two groups, the former as control one - referred as Training (Tr), and the latter one - referred as Training-VAT (Tr-VAT) group, depending on the type of intervention (Figure 1). Experimental design included two phases, the baseline (t0) for enrollment and randomization procedures, and the follow-up (t1), spaced by at least 3 months.