I LVVZVW‘, ~L k r ~;~ u 1 4-9 .. , Br? Y" ‘9": i i ‘ 3“ 'c-bl.““."u ..'-. ,— ‘- _D l V‘s! .47., «'3 " I Y“. '1 : ,- r ‘1' . ~. ”Iv-tw- - A “a.“ I“. ‘“’ s'aa‘. t' I r F This is to certify that the dissertation entitled THE USE OF AUDITORY RHYTHM AND RHYTHMIC SPEECH TO AID TEMPORAL AND QUANTITATIVE MUSCULAR CONTROL IN CHlLDREN WITH GROSS MOTOR DYSFUNCTION presented by MICHAEL H . THAUT has been accepted towards fulfillment of the requirements for Ph. D. degree in Music Mai/2w Major professor Date November 11, 1983 AISU is an Affirmative Action/Equal Opportunity Institution 0- 12771 MSU LlBRARlES “ RETURNING MATERIALS: Place in book drop to remove this checkout from your record. FINES will be charged if book is returned after the date stamped below. all. (In a In.“ 1 Q WI. I - -~ ‘43:... .-J"" .u 3-. 'r~ my ‘~ - - Aggro gaps ciao a 77.“ ud-u-u.’ 4..— ui‘ -7, Copyright by MICHAEL H. THAUT 1983 THE USE OF AUDITORY RHYTHM AND RHYTHMIC SPEECH TO AID TEMPORAL AND QUANTITATIVE MUSCULAR CONTROL IN CHILDREN WITH GROSS MOTOR DYSFUNCTION By Michael H. Thaut A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Music 1983 Mr“ In -- f)‘ (I 4 THE USE OF AUDITORY RHYTHM AND RHYTHMIC SPEECH TO AID TEMPORAL AND QUANTITATIVE MUSCULAR CONTROL IN CHILDREN WITH GROSS MOTOR DYSFUNCTION by Michael H. Thaut This study examined the effectiveness of auditory rhythm and rhythmic speech to aid temporal and quantitative muscular control in children with gross motor dysfunction. The importance of timing in skilled motor performance has been widely accepted in the research literature. In this study, rhythmic aids were used to facilitate motor control in a remedial context over three treatment sessions. The effective- ness of rhythmic cues for temporal muscular control was proposed in a model of rhythmic auditory-motor integration based on a neuropsychologi- cal approach. Subjects included 24 male children, ages 6.0 to 8.11 years, with gross motor dysfunction as identified by the Bruininks-Oseretsky Test of Motor Proficiency. All subjects participated in the screening test and three experimental sessions over a period of three weeks. The children were taught to perform a gross motor sequence consisting of alternating carried out: (1) measures of motor rhythm accuracy with auditory rhythmic and rhythmic speech present; (2) measures of motor rhythm accuracy after auditory rhythm has been faded out; (3) measures of synchronization and time interval conformity between motor rhythm and external rhythm, Michael H . Thaut measures of tempo maintenance under two different treatment conditions; (4) measures of quantitative muscular control with auditory rhythm and rhythmic speech present; and (5) measures of quantitative muscular control after auditory rhythm has been faded out. Data were gathered through the graphic recording of voltage coded sensor signals. The sensors responding to surface contact, were attached to the children's hands and feet. Results The data were analyzed through a multivariate repeated measures analysis of covariance. The results showed that subjects aided by auditory rhythm and rhythmic speech performed with significantly better motor rhythm accuracy, at the .05 level of confidence, than the control group using visual modeling for proprioceptive control only. Once the auditory rhythm was faded out, no performance difference between treatment and control conditions was found. However, the motor rhythm deviations between both treatment conditions decreased significantly as a function of time. Gains in synchronization, that is, the coincident motor response to the external beat, correlated significantly with gains in motor rhythm accuracy. Quantitative muscular control measures remained uninfluenced by rhythmic aids. However, a significant age trend emerged, displaying better inhibition of erroneous or redundant movements with increasing age. Modified applications of the recording system to measure aspects of motor performance, as well as clinical applications of the findings in this study were discussed . To the Memory of my Father Dr. Rudolf Ernst Thaut (+1982) His Wisdom and Courage ii ACKNOWLEDGMENTS I would like to express my appreciation and thanks to my dissertation advisor, Dr. Dale Bartlett, and to the dissertation committee, Drs. Dale Bonge, Crystal Fountain Branta, Robert Erbes, Richard Houang, Theodore Johnson, and Robert Unkefer for their support and guidance throughout the preparation of this dissertation. A special acknowledgment is due Dale Bartlett, Crystal Fountain Branta, and Richard Houang for their particular commitment, counsel, and constructive feedback through each step of this endeavor. I also wish to thank Robert Wells, engineer at the Center for the Study of Human Performance, for his assistance by preparing the technical equipment for this study as well as his continuing advice throughout the data collection phase. Additionally, I would like to thank Mrs. Renata Black for assisting me during the treatment sessions. A special thanks goes to all the children and their parents who participated in this study. Without their help and cooperation this study would not have been possible. I am also deeply grateful to my parents, Dr. Rudolf E. Thaut (+1982) and Mrs. Irmgard Thaut—Shostak, for their unceasing love, enthusiasm, and encouragement throughout my doctoral program. iii LIST OF TABLES LIST OF FIGURES .............................................. TABLE OF CONTENTS Chapter I. II. III. INTRODUCTION ......................................... Purpose ................................. . ...... . . . ...... Background ............................................. The Problem: Its Theoretical Background and Practical Implications ............................................ Research Hypotheses ..................................... Importance of the Study .................................. Assumptions ............................................. Limitations ............................................... RELATED LITERATURE .................................. Aspects of Motor Behavior ................................ Gross Motor Impairment, Diagnosis and Remediation ....... Rhythm and Motor Response .............................. Motor Rhythm and External Rhythm ..................... Neurophysiological Aspects ............................. Automatization of Movement Patterns ................... Temporal Predictability and Response Anticipation ....... Muscular Fatigue and Recovery Time ................... Auditory Feedback and Proprioceptive Control ........... Rhythmic Speech as Internal Movement Control ........... A Model of Rhythmic Auditory-Motor Integration ......... Rhythmic Materials as Remedial Tools ..................... METHODOLOGY Subject Selection and Characteristics ..................... Performance Item ........................................ Rhythmic Materials ....................................... Setting and Apparatus ................................... Treatment Procedures ................................... Pilot Study ............................................... Recording Procedures ................................... iv Page vi viii 17 17 21 25 28 32 35 4O 41 43 45 47 53 58 59 60 64 67 7O Chapter Page Measurement of Dependent Variables ...................... 71 Motor Rhythm Accuracy ................................. 71 Motor Rhythm Synchronization ........................... 72 Quantitative Muscular Control ........................... 72 Dependent Measures .................................... 73 Statistical Analyses ........................................ 74 IV. FINDINGS ................................................ 77 Analysis I: Motor Rhythm ................................ 77 Analysis 11: Motor Rhythm under Faded Conditions ........ 85 Analysis III: Background Measures ...................... 96 Analysis IV: Quantitative Muscular Control ................ 104 Analysis V: Quantitative Muscular Control under Faded Conditions ........................................ 111 V. CONCLUSIONS ............................................ 118 Analysis I: Motor Rhythm ................................. 118 Analysis 11: Motor Rhythm under Faded Treatment Conditions .............................................. 121 Analysis 111: Background Measures ........................ 123 Analysis IV: Quantitative Muscular Control ............... 126 Analysis V: Quantitative Muscular Control under Faded Treatment Conditions .............................. 128 Summary ................................................. 129 Recommendations ......................................... 130 APPENDICES .................................................. 133 A. Parental Consent Forms ............................... 134 B. Sensors and Encoding Circuits ...... . ................. 136 C . Sample Printout of Movement Recording ................ 138 REFERENCES ................................................ 141 Table 10. 11. 12. 13. 14. 15. LIST OF TABLES Subject Characteristics According to Age Group, and Percentile Rank .......................................... Mean Percentile Rank for Gross Motor Composite by Age, Treatment and Control Conditions ...................... Double Classification Analysis of Variance of Gross Motor Test Standard Scores for Different Age Levels, and Treatment and Control Conditions ........................ Time Development for Treatment and Control Group During Experimental Sessions ......... . ........ . ....... . . . ....... Development of Motor Rhythm Deviations in Hundredths of a Second Through 6 Cycles ............. . ............. Measurements of Dependent Variables .................... Multivariate Analysis of Covariance--Analysis 1: Motor Rhythm ......... . ........................................ Multivariate Analysis of Variance--Effect of Time for Four Time Points ...................................... . ....... Multivariate Analysis of Variance--Effect of Time for Three Time Points ................................ . ...... Multivariate Analysis of Covariance--Analysis 11: Motor Rhythm under Faded Conditions ........ .. . ............... Multivariate Analysis of Variance--Effect of Time for Four Time Points ........................ . ..................... Multivariate Analysis of Variance--Effect of Time for Three Time Points .............................................. Multivariate Analysis of Variance--Treatment Present versus Treatment Faced ..................... . ............ Measures of Motor Rhythm Synchronization ............... Measures of Time Interval Conformity .................... vi Page 57 58 58 66 7O 73 82 83 85 89 90 91 95 97 99 Table 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. Measures of Tempo Maintenance ........................ Multivariate Analysis of Covariance--Analysis IV: Quantitative Muscular Control .......... . ................ Multivariate Analysis of Variance--Effect of Time for Four Time Points ........................................ Multivariate Analysis of Variance--Effect of Time for Three Time Points ..................................... Multivariate Analysis of Covariance-~Analysis V: Quantitative Muscular Control Under Faded Treatment Conditions ..................... ............ Multivariate Analysis of Variance: Treatment Present versus Treatment Faded ............................... Motor Rhythm Development of Mean Deviations .......... Motor Rhythm under Faded Conditions-—Development of Mean Deviations ..................................... Synchronization Time Interval Conformity Tempo Maintenance--Development of Mean Deviations ........... Quantitative Muscular Control--Mean Development in N umber of Errors ..................................... vii Page 101 106 109 109 114 117 120 122 123 127 Figure 1. A Model of Rhythmic Auditory-Motor Integration ........ 2. Motor Rhythm Performance Profiles of Treatment and Control Group ......................................... 3. Motor Rhythm Effect of Time on Treatment and Control Group Combined ..................................... 4. Motor Rhythm Performance Profiles of Treatment Group with Treatment Present and Treatment Faded .......... 5. Effect of Time on Tempo Maintenance .................. 6. Quantitative Muscular Control. Effect of Age on Treatment and Control Group Combined ................ 7. Quantitative Muscular Control. Effect of Time on Treatment and Control Group Combined ................ 8. Quantitative Muscular Control. Effect of Age and Time LIST OF FIGURES on Treatment under Faded Conditions and Control Group ................................................. viii Page 46 81 84 94 103 108 110 115 CHAPTER I INTRODUCTION Purpose The purpose of this study was to examine the use of auditory rhythm and rhythmic speech as an aid for the temporal organization and quantitative muscular control of a gross motor movement sequence. The effectiveness of these rhythmic aids was evaluated over three consecutive treatment sessions using children (ages 6-8 years) with a diagnosed gross-motor impairment based on test scores from the Bruininks-Oseretsky Test of motor proficiency. The study compared the effectiveness of auditory rhythm with concomitant rhythmic speech to proprioceptive and visual control mechanisms upon learning to perform a complex movement sequence, with an even motor rhythmic timing of its subcomponents. Secondly, the study investigated if rhythmic speech, as an internal movement control, had an effect on the ability (1) to sustain an even motor rhythm, and (2) to maintain the same performance tempo once the external rhythm had been faded out. Thirdly, the study examined the effect of rhythmic rehearsal strategies over time on the ability (1) to synchronize body movement with an external auditory beat, and (2) to adjust the time duration of successive movement acts to the time intervals between auditory beats within a rhythmic grouping, regardless of coincident motor response. Fourthly, the effectiveness of auditory rhythm and rhythmic speech on quantitative muscular control, that is, inhibition of erroneous or redundant movements, was inve stigated . Only a few studies, most of which were nonquantified, report the use of rhythmic materials to aid in certain aspects of motor control. Most studies in the relation of motor rhythm and external rhythm use limited movement responses in a noncomparative, one-shot response testing situation. This study tried to investigate the effectiveness of rhythmic materials on the actual performance of a gross motor task sequence in a remedial context, over a period of three week's sessions . Background Finding effective and efficient remedial teaching methods for gross motor impaired children is an ongoing concern to physical educators, therapists and parents, and is crucial to the future of the children themselves. Motor impairment hampers the development of physical abilities and acquisition of specific motor skills which the children need to perform appropriately in their environment. Affected areas range from sports or leisure activities to types of motions needed for actual vocational skills. Furthermore, considering physical abilities as one component of the child's developing personality, motor . impairment also interferes severely with normal social and emotional development . Bloom (1956), Krathwohl (1964), and Harrow (1972) have developed a widely accepted scheme of commonly recognized human behaviors which allow one to gain a more detailed picture of the interrelationship between motor development and other areas of human development. Their taxonomy of educational objectives classifies three domains of behavior: cognitive (intellectual skills), affective (feelings, opinions, attitudes, values), and psychomotor (physical abilities, general neuromuscular functioning). It is of great importance to understand, however, that these separated behavior domains occur in reality only in an integrated framework of cognitive-affective-psychomotor interrelationships. Gallahue (1976) has developed a theoretical model which delineates how the development of movement abilities and physical fitness influences affective and cognitive development. Some conclusive research has been generated in the last thirty years investigating the relationship between movement skills and aspects of affective development such as self-concept, peer rela- tionships and social status. A child's self-concept, the feeling of own worth, seems to be closely related to the degree of ease and efficiency with which the child can engage in physical activity (Gallahue, 1982). Although research in the area of movement and self-concept is hampered by methodological problems, such as how to construct valid measures of self-concept, Wallace and Stuff (1983), Johnson (1968) , Clifford and Clifford (1967) , and Collingswood and Willett (1971) have shown that specially designed motor training programs can positively influence measures of self-concept. It may be concluded from these that movement experiences can influence body image, experiences of success, and social experiences, and thus exert a desirable impact on self-image and experience of self-worth. Studies by Tuddenham (1951), Cratty (1967), and Martinek and Zaichowsky (1977) indicate also that levels of movement skills have an influence on social status and acceptance of children among their peers. Less conclusive is the relationship between psychomotor functioning and cognitive development. The euphoria of advocators of perceptual- motor programs (Delacatao, 1959; Getman, 1952; Kephart, 1971) to remediate or enhance academic abilities has not been substantiated scientifically through research in the past fifteen years (Gallahue, 1982). It can be safely stated, however, by referring to the nature of cognitive-affective-psychomotor interrelationships, that the influence of a poor self-concept on the learning process can be significant (Brookover, 1967) . Thus, the research literature indicates that teaching and learning strategies which improve and facilitate movement abilities have an impact on the child's developing personality beyond the immediate focus on deficient motor performance. On this conceptual background for remedial motor activity, several methodological problems arise in the search for effective treat- ment strategies. Sherrill (1976) points out that such a search goes through a sequence of steps integrating several areas of knowledge at each level. The adapted physical educator or therapist needs to focus on (1) analyzing motor performance, (2) identifying the problems of motor performance, (3) determining the factors contributing to the problem, and finally (4) designing an intervention program that uses efficient cues and teaching strategies to ameliorate the problem. This study investigated the effectiveness of rhythmic aids on improving temporal and quantitative muscular control in a gross motor sequence with children (age 6, 7, 8 years), who performed below age- expected levels on a gross motor test. Four areas of knowledge con- verged in this study: (1) the nature of a movement act and movement patterns as a series of movements organized in a particular time-space sequence, that is, an organized series of time-space related movements; (2) the relation of auditory rhythmic stimuli to motor responses; (3) the diagnosis and remediation of gross motor impairment; and (4) the use of rhythmic materials as remedial tools. Each of these areas will be discussed separately in relationship to documented research efforts in order to develop a theoretical model on which the research hypotheses of this study can be based. The Problem: Its Theoretical Background and Practical Implications This study investigated whether auditory rhythm and rhythmic speech can aid children with gross motor impairment in the temporal organization and quantitative muscular control of a gross motor sequence. This problem was broken down into the following research questions: 1. Can auditory rhythm and rhythmic speech facilitate an even gross motor rhythm, that is, an evenly timed performance of gross motor acts, within a serially organized movement pattern? 2. Can auditory rhythm and rhythmic speech decrease erroneous, redundant or extraneous motions during the performance of a gross motor sequence? 3. Does age influence the level of temporal and quanti- tative muscular control? In an additional step, the study examined the effectiveness of rhythmic speech as an internal control mechanism to maintain the timing and quantitative control of the movement sequence once the external rhythmic signal had been faded out. This research aspect was considered to be of major importance for an evaluation of this study's results regarding educational and therapeutic practice. The transfer of the effect of external timing cues into a system of internal timing control would, indeed, be most beneficial for the development of the children's movement control independent of the presence of external conditioning. This problem was broken down into the following research questions: 1. Can rhythmic speech facilitate the maintenance of an even gross motor rhythm once the auditory rhythm has been faded out? 2. Can rhythmic speech facilitate the maintenance of performance tempo, that is, the average performance time of one movement component, once the auditory rhythm has been faded out? 3. Is there a relationship between maintenance of performance tempo and maintenance of gross motor rhythm once the auditory rhythm has been faded out? Furthermore, the study examined possible factors underlying the relationship between external auditory and internal motor rhythm. The relationship of motor rhythmic responses to an external rhythm condition can be measured in two ways. First, the synchronization between movement and external rhythmic signal can be measured. This measure yields whether the completion of a movement act actually coincides with the onset of the rhythmic signal. Second, the average time one movement act takes to be completed can be compared with the time that elapses between the onset of two subsequent rhythmic signals regardless of coincident motor response. This time lapse between two rhythmic signals, if consistently even for an extended pattern of auditory beats, actually determines the tempo of that pattern. A movement response thus could have the same average performance time or tempo as the auditory rhythm but still be con- sistently out of synchronization. In this specific case, the moving child would not be able to follow the actual beat with his individual motions, but would adapt the overall performance time of this movement sequence to the tempo superimposed by the external rhythm. This adaptation process could be expressed through the conformity between rhythmic signal speed and overall performance time. Both measures, synchronization and conformity, can be under- stood as presenting different factors in the relationship between motor rhythm and external rhythm. Chyatte and Birdsong (1971) , in a study investigating motor rehabilitation in brain injured patients, discussed overall performance time as an index for functional rehabili- tation in motor performance whereas the timing of individual motions, in a complex movement sequence, would indicate the degree of actual neuromuscular control and recovery. Glencross (1970) differentiated between positional and serial timing in a movement task. Positional timing, similar to the previously used term "synchronization," refers to the coincident motor response to an external signal. Serial timing refers to the time relationship of successive muscular motions in a movement pattern which can be expressed in an average overall performance time. Serial timing thus refers to the factor of movement within the previously discussed con- formity relationship between signal speed and performance tempo. Serial timing within a movement sequence can conform with the rhythmic signal speed and, at the (same time, the movement's positional timing can yield a considerable amount of variability. Two factors are sug- gested at this point to account for that discrepancy: (1) the subject's motor response comes consistently too late due to inadequate perceptual- motor integration, or (2) the child cannot perform successive body motions with an even timing due to insufficient neuromuscular control but is able to compensate, for example, for slower motions with subse- quent accelerated motions to retain an externally paced performance tempo. In the latter case, it would seem that the child responds to the perception of an overall time structure rather than to actual time signal events. Many studies (Ashton, 1953; Groves, 1969; Beisman, 1967; Couper, 1981; Nelson, 1963) have investigated the influence of nonspecific rhythmic /musical background stimuli on the rhythmicity of a movement task. This study, by measuring both synchronization and time interval conformity of muscular activity to external timing signals in relation to gross motor rhythm, investigated the differential effect of both factors on temporal organization of successive movement patterns. Applied to teaching or therapy practice, this investigation should provide further insight into the effectiveness of rhythmic acoustic stimuli, superimposed as a nonspecific time structure, or as a cue for conscious and deliberate perceptual motor matches, expressed as coincident motor responses, when trying to facilitate evenly timed all movement performance. Thus, the problem was broken down into the following research questions: 1. Can movement synchronization to an auditory rhythm and time interval conformity between performance time and external rhythm be improved through rhythmic rehearsal strategies, repeated over a period of time? 2. Is there a relationship between gross motor rhythm and measures of synchronization and time conformity, respectively? Research Hypotheses The research questions presented in the previous section were examined in this study through an analysis of each child's * Four examples of a child's performance measures may illustrate the practical use of such examination: (1) Synchronization and gross motor rhythm do not improve, but time interval conformity does improve: this would suggest that the child cannot perform coincident motor responses with an even motor rhythm, but learns to adapt his performance tempo to the external time structure (functional compensation of deficient motor control). (2) Synchronization does not improve but motor rhythm and conformity do improve: this would suggest that the child cannot perform coincident motor responses but the perception of an external time structure has been extended to perceiving regularly recurring, evenly spaced, time events. In this case the synchronization or positional timing of the child's movements would show a fairly con- sistent time delay. (3) Motor rhythm and synchronization improve, whereas time interval conformity does not improve. This would suggest that the child's deliberate attempt to perform coincident motor responses contributes to the improving motor rhythm regardless of performance time. (4) Synchronization and time interval conformity do not improve, whereas motor rhythm improves: this would suggest that the child disregards external timing cues in favor of developing his idiosyncratic movement tempo. The facilitating influence of exposure to rhythmic stimuli on movement rhythm could be verified only against control group data without treatment. in movement recordings displaying temporal and quantitative muscular control in relationship to auditory rhythm and rhythmic speech. Analysis I examined the effects of age, treatment and time factors on the accuracy of motor rhythm performance. Analysis 11 examined the effect of age, treatment under faded conditions and time factor on maintenance of motor rhythm, maintenance of performance tempo, and their mutual relationship. Analysis 111 examined the effect of age and time factor within one treatment modality on synchronization, time conformity and their relationship to motor rhythm performance. Analysis IV examined the effect of age, treatment and time factor on quantitative muscular control. Analysis V examined the same variables as Analysis IV, but for treatment under faded conditions. The follow- ing research hypotheses were formulated accordingly: Analysis 1: Motor Rhythm Accuracy 1. The treatment group (T) will perform with greater motor rhythm accuracy than the control group (C). 2. Age differences will occur in motor rhythm accuracy for both T and C. 3. Both T and C will improve their motor rhythm accuracy over time. Analysis II: Motor Rhythm Under Faded Treatment Conditions 1. The treatment group under faded conditions (TF) will perform with greater motor rhythm accuracy than C 2. Age differences will occur in motor rhythm accuracy for both T and C. 3. Both T and C will improve their motor rhythm accuracy over time. 4. The time differences in motor rhythm accuracy of T and TF will decrease over time. 11 Analysis III: Background Measures 1. 2. 3. Motor Rhythm Synchronization a. Synchronization measures of T will improve over time. Age differences will occur in synchronization measures. Synchronization measures will show a positive relationship to improvement of motor rhythm accuracy in T. Time Interval Conformity (TIC) a. b. C. TIC measures of T will improve over time. Age differences will occur in TIC measures. TIC measures will show a positive relationship to improvement of motor rhythm accuracy in T. Maintenance of Performance Tempo (MPT) a. b. C. MPT measures of TF will improve over time. Age differences ill occur in MPT measures. MPT measures will show a positive relationship to improvement of motor rhythm accuracy in TF. Analysis IV: Quantitative Muscular Control 1. T will perform with better quantitative muscular control than C. Age differences will occur in quantitative muscular control for both T and C. Both T and C will improve their quantitative muscular control over time. 12 Analysis V: Quantitative Muscular Control Under Faded Treatment Conditions 1. TE will perform with better quantitative muscular control than C. 2. Age differences will occur in quantitative muscular control for both TF and C. 3. Both TF and C will improve their gross motor rhythm accuracy over time. 4. The error difference in quantitative muscular control of T and TF will decrease over time. Importance of the Study The field of music therapy, that is, using music and music- related activities to attain specific therapeutic goals, is a relatively young discipline in which continued and clinically oriented research efforts are needed greatly. Music therapists are becoming increasingly aware of the need to thoroughly document effectiveness of implemented music therapy methodology. Although therapeutic work with physical or orthopedic handi- caps had always been a field of music therapy practice, it never stood in the main focus like practice with psychiatric conditions or with the mentally retarded. In a recent monograph series on music therapy for handicapped children (Lathom and Eagle, 1982), however, one separate volume is dedicated to orthopedic handicaps, thus documenting a renewed therapeutic effort of music therapy in this field. These new efforts have partially evolved in response to new legislation during the last ten years regarding educational and therapeutic services for handicapped children. 13 When the client is primarily handicapped in physical function- ing abilities, music therapists work in such a manner as to assist in bringing about increased mobility, greater muscle strength, smoothness of movement and other physical and emotional improvements. Research efforts in these areas of functioning are vital to clinical success and professional credibility. Currently, there is still much methodological reliance on work with mentally retarded clients using music in three main directions: (1) as background accompaniment during psychomotor tasks (e.g. , Sternlight, 1967; Goodnow, 1968; Cotter, 1971; (2) as contingent reinforcement for certain motor behaviors (e.g., Hanser, 1974; Holloway, 1980); and (3) as a motivating tool to elicit nonspecific movement responses (e.g. , Clark, 1968) . Very little available research exists on the objective oriented use of music to aid in the remediation of specific motor problems. To understand better the contribution musical materials can make to facilitate or regulate movement abilities, the psychological and physical properties of musically organized acoustic stimuli and related activities need to be viewed within the framework of functional and neural mechanisms for motor behavior. An analysis of those mechanisms following a neuropsychological model, as, for example, proposed by Sage (1977) , would evaluate the specific impact of musical stimuli on the neurological processes underlying motor behavior. Reception of stimulus properties, selective attention and arousal, perception of stimulus cues, their translation into a motor program, and their command and feedback function in controlling the motor program would 14 be foci of investigation in this evaluation process. In this respect, two aspects have been subject to much research outside of music therapy, although they have invaluable importance for an assessment of musical materials in clinical practice: (1) the effect of acoustic stimuli on motor neural activity, that is, the physiological basis for all motor behaviors; and (2) the effect of the temporal structure of acoustic events on, and the importance of the auditory modality for, the temporal discrimination process in the central nervous system. Music as a complex temporal organization of acoustic events, perceived mainly through the auditory modality, possesses inherent qualities which may be used to aid in very specific aspects of motor behavior. Gallahue (1982) discusses these temporal qualities regard- ing motor development in children. Temporal awareness is intricately related to the coordinated interaction of various muscular systems and sensory modali- ties . . . . Rhythm is the basic and most important aspect of developing a stable temporal world . . . . Rhythmic movement involves the synchronous sequencing of events in time. Rhythm is crucial in the performance of any act in a coordinated manner. . . . We must recognize the rhythmic element in all efficient movement, and in doing so be sure that we duplicate the rhythmic component of all movement. . . Activities that require performing movement tasks to auditory rhythmic patterns should begin with young children and be part of their daily lives (pp. 307-398). This discussion may serve to influence the research direction of music therapists, i.e. , a multidisciplinary approach. Several physical therapists, music therapists, and adapted physical educators contacted during the study stated frequently that they use music/rhythm-related methods; but when asked which aspect of movement abilities, and to what extent these methods actually aid, they were uncertain. Rather 15 than assuming a method to be effective, music therapists need to scrutinize to the greatest degree possible the methods and materials for actual effectiveness, not only to justify current clinical practice, but to open new and more beneficial therapeutic avenues in a compre- hensive music therapy methodology. This study, in investigating a clinical technique and gathering related research evidence to develop a theoretical model, tried to acknowledge the importance that work with motor dysfunctions has attained for clinical practice in music therapy. Assumptions For the purpose of this study, the following assumptions were made: 1. The Bruininks-Oseretsky test of motor proficiency, gross motor composite, is a valid and reliable screening instrument to identify male children, age 6-8, with subnormal gross motor develop- ment. 2. None of the children participating in the study had a gross motor impairment associated with a specifically diagnosed clinical orthopedic handicap, mental or emotional impairment. 3. The gross motor impaired children selected were a repre- sentative sample of the 6.0 to 8.11 year old male population for the greater Lansing, Michigan, area with comparable reported characteris- tics. 4. The movement task used in this study constitutes a developmentally appropriate gross motor task using large muscle activity in time and space. 16 5. The wide range of motor behavioral characteristics associated with the broad term gross motor dysfunction is accounted for through randomized assignment of subjects to treatment and control groups. Limitations 1. Results of this study cannot be generalized beyond the following group characteristics: male, ages 6.0 to 8.11, gross motor proficiency scores 40th percentile and lower (as measured by the gross motor battery from the Bruininks-Oseretsky test of motor proficiency) and residents of the greater Lansing, Michigan, area. 2. This study does not intend to examine causal factors, specific diagnostic categories, or etiological groupings found in children with gross motor dysfunction. 3. While attention and motivation are important factors in gross motor performance, these factors are not examined directly in this study. 4. The results of the study are limited to the specific per— formance task, a movement sequence consisting of successively alternating sidesteps and arm movements, the parameters of the rehearsal method, and the specific characteristics of the treatment materials (rhythmic stimuli). Generalizations beyond these limitations will be indicated as such in the text. CHAPTER II RELATED LITERATURE Aspects of Motor Behavior The term motor behavior has become increasingly popular as evidenced by its usage in the research literature in connection with describing behavior expressed by bodily movement, as opposed to cognitive or affective behavior domains (Singer, 1980) . The term "motor" by itself refers to muscular movement which may range from merely reflexive movement to performances involving highly cognitive and perceptual processes, such as one detection, evaluation, and decision making. The emphasis, however, lies always on bodily move— ment and movement control as a physical response in a complex receptor-effector feedback process (Marteniuk, 1976). Motor activities can be categorized into abilities, thought to be traits of a more general nature and affected by both learning and heredity, and skills which are specific to given tasks (Fleishman, 1972). Gallahue (1982) differentiates between physical fitness abilities, such as cardiovascular and muscular endurance, muscular strength, and flexibility, and motor fitness, such as coordination, balance, speed, agility, and power. Researchers in physical education have related general abilities, e.g. , balance, to motor skills, e.g., dribbling a soccerball, as basic constituents underlying each a variety 17 18 of specific motor skills, but in a manner specific to the situation in which the skill is practiced. Motor skills and motor patterns can be differentiated, as well. A motor pattern, such as locomotion, consists of an extensive group or series of single motor acts. Motor activity consists of movements based on muscular activity in time and space, elements common to all motor types. Coordinated or skillful movement encompasses (1) the selection and stimulation of appropriate muscles, thereby changing the position of the body from one place in space to another (spatial control); (2) the activation of muscles at the right time sequentially or simul- taneously (temporal control); and (3) gradual muscle inhibition (quantitative control) (Singer, 1980). The development of spatial, temporal, and qualitative muscular control in motor performance seems to be most dependent on the coupled and interdependent development of movement forces, such as speed, agility, and power and movement control mechanisms, such as balance and coordination. While both balance and coordination require a strong amount of spatial and kinesthetic control abilities, coordination contains additional elements of temporal control mechanisms. Gallahue (1982) explains: Coordination is the ability to integrate separate motor systems with varying sensory modalities into efficient patterns of movement. The more complicated the movement tasks, the greater the level of coordination necessary for efficient performance. . . . Coordinated behavior requires the child to perform specific movements in a series quickly and accurately. Movement must be synchronous, rhythmical, and properly sequenced in order to be coordinated (p. 278) . 19 The structure of time relationships in movement patterns described by Gallahue as synchronization, rhythm and sequential ordering, is an important description of motor coordination. Temporal control is intricately related to the coordinated interaction of various muscular systems and sensory modalities. Gallahue (1982) continues: "The individual with a well-developed time dimension is the one that we refer to as coordinated. One who has not fully established this is often called clumsy or awkward" (p. 307). Many workers have emphasized the importance of temporal organization in movement as a fundamental motor ability required for skillful performance. Bartlett (1958) points to the importance of accurate timing between receptor and effector functions within their serial organization as crucial in skilled performance. Provins (1956) points out that timing of muscular contractions is displayed in any movement where several muscles act serially or alternately. Differences in timing between unskilled and skilled performance have been demon- strated by comparing performance of preferred and nonpreferred hands (Provins, 1956; Provins and Glencross, 1968). Smith, McDermid and Shideman (1960) have used the term "neural timing" for the complex temporal organization of human gait. Glencross (1970) differentiates two aspects of timing in move- ment, positional timing which governs the coincidental response when a signal appears, and serial timing which refers to the timing of successive movement patterns. Glencross writes: 20 Serial timing refers to the consistency with which a regular event occurs in an ongoing cycle of movements. Specifically serial timing relates to the consistency of the cycle length between successive force peaks. The skilled subject apparently is able to construct a consistent temporal pattern, whereby the time interval between principle events remains very constant (p. 234). If a movement pattern consists of a succession or pattern of regularly recurring, serially organized gross motor events in time and space, the term motor rhythm has been used to describe this quality (Huff, 1972; MacDougal, 1902; Seashore, 1926; Thomas and Moon, 1976; Schwanda, 1969) . Good motor rhythm is dependent on the ability to be in a specific point in space at a specific point in time and also dependent on the ability to maintain this temporal structure in a periodic succession of muscular events in space. Both aspects, the immediate rhythmic accuracy and the maintenance of accuracy in an ongoing cycle of movements, are contingent upon the development of spatial and temporal accuracy of motor rhythmic performance. In summary, based on the presented literature and theoretical implications, it may be concluded that: 1. temporal control is one of the three main character— istics of a movement act; 2. skilled movement possesses good temporal control; 3. a series or grouping of motor acts requires a specific type of temporal control which may be called serial timing, referring to the temporal control of serial muscle contractions; 4. a series or grouping of motor acts constitutes a regularly recurring pattern, such as in an ongoing cycle of movements, with its components of immediate and maintained rhythmic accuracy, the term 'motor rhythm,‘ has been used to describe this quality. 21 Gross Motor Impairment, Diagnosis and Remediation Diagnostic and remedial techniques for children with gross motor dysfunctions focus on the spatial, temporal and quantitative characteristics of gross motor activities. A number of diagnostic tools, such as motor proficiency tests, have been developed to identify and assess impaired motor development. Remedial strategies, however, are far from absolute since the term "motor dysfunction" seems to describe a disability with a wide and diverse background of possible causes. A variety of diagnostic labels reflect the assumption of some kind of underlying neurological problem, including labels like organic brain dysfunction, minimal or diffuse brain damage, organic drivenness, cerebral dysfunction, and cerebral dissynchronization syndrome (Cratty, 1975) . Other diagnostic labels limit themselves to reflect the behavioral consequences of observed dysfunctions, e.g. , clumsy child syndrome, hyperkinetic syndrome, etc. Etiological insights remain scanty and preliminary in the research literature. Developmental delays due to diseases, minimal trauma to the nervous system, inherited disadvantageous physical problems such as cardiovascular or endocrine conditions, lack of practice, emotional problems, diffuse brain damage, obesity, could all be found or suspected to cause an identified motor impairment. Goellnitz (1976) suggests a diagnostic model of organic brain symptoms which differentiates three groups of severity: (1) unspecific vegeta- tive symptoms, such as affective and vegetative lability, weak cerebral control, hyperkinetic restlessness, and attentional problems; (2) specific organic brain symptoms, such as psychomotor retardation, 22 visuomotor dysintegration, and performance inconsistency; and (3) localized organic brain symptoms, such as apraxias, or agnosias. A frequent incidence of attentional problems, lack of concen- tration, hyperactivity or learning disorders can be found in children with motor dysfunction (Cratty, 1975) . This overlap of dysfunctions, although not given in every child with motor ineptitude, may compli- cate remedial strategies considerably. It is a useful distinction, how- ever, to differentiate between motor problems based on known causes and defined clinical pathologies, such as different types of cerebral palsy, orthopedic handicaps, muscular dystrophy or neuro-physiological problems, e.g. , infantile autism, and motor problems not readily asso- ciated with a clinical pathology. Haubenstricker and Seefeldt (1974) have given diagnostic characteristics of the movement performance of the latter group: 1. inconsistency when performing a specific gross motor task; the children vacillate in proficiency from stage to stage with repeated trials; 2. perseveration; the children continue their motions after the performance should be completed; 3. mirroring during visual modeling; the children exhibit an inability to separate their directional movements from those of the leader; 4. asymmetry in the performance of motor activities which require bilateral use of limbs; 5. loss of dynamic balance; the children exhibit an inability to maintain postural control of the body in relation to gravity when moving in space; 6. falling after comgletion of a specified motor task; 7. extraneous motions during the execution of gross motor activities which disrupt efficient spatial- temporal organization of the movement; the children 23 might pursue a limb motion beyond its range of efficiency or add redundant motions to the movement sequence; 8. inability to maintain a pattern or rhythm imposed internally or externfiy; 9. inability to control force; the children apply inappro- priate force (too much or too little) when executing a motor task; this characteristic actually might disrupt attempts to establish a pattern in a motor activity, thus being closely related as a possible causative factor to the previous characteristic; 10. inappropriate motor planning, as exhibited through misapplication of force, the delay or prematurity of a motor response, or the inability to adequately integrate sensory input and plan motor responses in a complex stimulus-response sequence. Some of these features may be linked causally to a delay in the developmental process and in skill attainment. Other character- istics may be more likely associated with an underlying neurological dysfunction. The overall performance impression of these children is that of being clumsy, awkward or uncoordinated. However, the motor skill development of children with gross motor dysfunction follows essentially the same sequence exhibited by their "normal" peers. Therefore, a more precise description of their movement deficiencies is possible. Haubenstricker and Seefeldt (1974) elaborate: It is inadequate to identify children with gross motor dysfunction as clumsy or awkward, since the movement characteristics which precipitate such labels are specific and identifiable. The first step in remedial motor educa- tion is to identify the level of skill development and the particular movement characteristics displayed by the child. Only then can adequate prescriptive activities be planned to meet the needs of each child (p. 5). Specifically, then, the temporal and quantitative control of movement might have a particular importance for those motor impaired children, 24 since the spatial control is not pathologically affected as in a spastic _ or muscular dystrophy child. A child with gross motor problems usually has the physical ability to reach every available point in space but might not do it at the right time, use appropriate force or consistently use the correct limb. Remedial motor therapy, thus, is really concerned with developing and applying teaching strategies to improve a person's motor functioning. Current remedial motor therapy works twofold, improving basic physical abilities, e.g., muscular strength, endurance, coordination, balance, and agility, and improving fundamental motor skills, e.g., catching, throwing, and running, within the perspective of a developmental continuum. Other, more specialized applications, may be needed. For example, activities for daily living skills for more severely involved clientele or techniques for relaxation and reduction of hyperactivity are among those applications. It is well accepted that there exists no type of prescriptive movement exercise which improves range of motion, strength or coordination of serial muscular activity by affecting only peripheral mechanisms, such as the functional state of joints and muscles themselves. For all exercises, devised mainly for the purpose mentioned, some reeducation of the central nervous system mechanisms is involved to various extents (Fisher, 1958). Cratty (1975) summarizes the goals and clinical avenues in the field of remedial motor activities: (1) real modifications within the central or peripheral nervous system, (2) a change of strategies from the inappro- priate to the more appropriate wl'Ten attempting to execute some difficult motor task, (3) adoption of constant and efficient work methods, rather than continual experimentation 25 with those methods of executing a motor task which are often inefficient, (4) improyegent in what might be termed motor planning, the more efficient analysis of newly con- fronted physical tasks, and the discovery of sequentially analyzed steps in their solution, (5) improvement of physical strength which permits the child to tolerate better the stresses and strains of problems such as those represented in balance tasks, (6) a compensatory circumvention of difficult-to-remediate motor problems, standing with the legs farther apart when throwing, affording greater stability, for example, to "get around" a balance problem (p. 8) . A clinical technique, designed for use with the particular population described in this chapter, thus has to work on one of the problem areas associated with gross motor impairment. Insufficient temporal and quantitative control are among the factors underlying the motor problems of this population. A proposed clinical technique, furthermore, has to address itself to components of fundamental motor pattern or basic physical abilities which are in the treatment focus of remedial motor education. Lastly, such a clinical technique has to facilitate the execution of peripheral movement mechanisms as well as central nervous system learning processes through the selection of teaching cues, balance of modeling and practice time, and the amount of repetition needed to secure newly learned patterns. The treatment design of this study tries to incorporate all three of these principles. Rhythm and Motor Response Considering the importance of timing and temporal discrimina- tion processes in movement, it is not surprising to find a huge array of research on the relationship of external rhythm, body rhythm and movement performance. The assumption that rhythm is a factor in learning and performing motor skills has often been taken for granted 26 among educators and researchers concerned with various aspects of physical performance. However, no general agreement has emerged in the research literature about the exact nature of this rhythmic factor, the extent of its influence on motor ability, or the ways it is related to motor educability. An additional, complicating factor is the generally accepted notion that rhythm can be perceived in various ways, since all of the senses are capable of experiencing a rhythmic organization of sensations (Bond, 1959) . Timing ability in movement performance has often been hypothetically related to rhythmic sense. Schwands (1969) summarizes research efforts in this direction: That a relationship exists between the sense of rhythm and movement performance has been suspected for some time. Many efforts have been made to discover the value of this supposition, but a substantial relationship has not yet been discovered (p. 567). This state of uncertainty may be due to a lack of agreement in the literature on the nature or perceptual modality of the sense of rhythm. The term rhythm has been used to include a variety of events, both individual and universal in nature. Experimental psychology has looked at rhythm in terms of several distinct aspects: (1) the nature of objective rhythmic stimulation and its impact on the human organism; (2) the nature of subjective rhythmic perception; and (3) the nature of rhythmic motor experience. Barsch (1967) differentiates between fundamental types of rhythm: (1) cosmic rhythm as a cyclic nature of the universe; (2) biological rhythm as the physiological pattern regulated by the autonomic nervous system; (3) perceived-reproduced rhythm, consisting of perception of a rhythmic stimulus and subsequent reproduction of the stimulus pattern; 27 and (4) performance rhythm consisting of a consistent replication of a movement pattern with both spatial and temporal accuracy. The two last types of rhythm have been considered an important factor in the development, performance, and learning of motor skills. Research in motor development has dealt with the role of perception in motor learning thereby focusing .mainly on perceptual processes through vision, kinesthesis, and equilibrium. Auditory perceptual processes, e.g. , through language or music, have been given lesser attention. These are reported as tools for motivation or unspecific accompaniment of movement experiences. However, a study by Smith (1970) indicates that temporal discrimination processes develop earlier through the auditory modality than the visual and that there is transfer from the auditory to the visual but not the reverse. The potential effect of auditorily perceived rhythmic stimuli on temporal accuracy in movement can be put forth quite logically, at least in theory, if the superior temporal discrimination process in the auditory mode can be translated into temporal muscular control. This translation process, which shall be called auditory- motor coordination or integration at this point, has been investigated from very different viewpoints and with very different methodological approaches in the neurophysiological and behavioral research literature. General models which relate these different research foci to each other and describe the utilization of auditory-motor integrative processes in motor learning or remedial motor education have not been found in the literature. Therefore it seemed necessary to provide a systematized discussion of neurophysiological and psychological research providing 28 evidence that, and in which way, auditory rhythmic materials can aid motor performance . Motor Rhythm and External Rhythm Motor rhythm usually refers to the temporal organization of serial muscle response, observable as the consistent and regularly recurring grouping of single motor acts. Numerous studies have tried to investigate a possible relationship between external rhythm and motor rhythmic responses mediated through various perceptual processes, depending on the nature of the rhythmic stimulus. Rhythm, in this connection, shall be defined as the periodic succession or regular recurrence of events in time which constitute the organization of temporal relationships. Auditory rhythm refers to the perception of a series of acoustic stimuli as a rhythmic pattern. The nature of the perceived grouping is influenced by objective characteristics of the stimulus series, e.g. , intensities of its components, duration, temporal spacing (Woodrow, 1951). Two main approaches seem to have emerged to measure rhythmic perception. One approach measures the ability to maintain a steady tempo (Drake, 1957) or to discriminate differences in rhythmic patterns (Kwalwasser 6 Dykema, 1930; Seashore, 1919) via verbal responses to auditory stimuli. The other approach measures various small muscle motor responses such as finger tapping (Buck, 1936; Seashore, 1926), or foot tapping (McCristal, 1933) to auditory or visual stimuli and locomotor patterns (Ashton, 1953; Haight. 1944; Lemon 6 Sherbon, 1934; Simpson, 1959). Studies that have tried to 29 correlate verbal and motor responses have overwhelmingly shown that the ability to perceive and discriminate rhythmic stimuli on verbal tests has no substantial relationship to the degree of motor rhythmic abilities (Bond, 1959; Lemon 6 Sherbon, 1934; Huff, 1972; Smith, 1957; Schwanda, 1969). The study by Huff (1972) showed instead that skilled athletes and dancers, although not superior on perceptual and rhythm discrimination tests, performed a gross motor sequence synchronized to an auditory rhythm more accurately than normal college students. These results indicate that the ability to synchro- nize motor rhythm patterns to an external rhythm forms a separate skill entity which seems to be dependent on training and exposure to rhythmic stimuli and movement. These results clearly contradict earlier notions that perception of rhythm is directly related to rhythmic motor responses because a kinesthetic or motor factor is already present in the perceptual process itself (MacDougal, 1902). The presented literature leaves no other conclusion than that the kinesthetic or motor factor in the perceptual process still needs to be shaped or translated into a temporal muscular control scheme coordinated with external rhythmic stimuli before motor rhythmic per- formance can appear. However, the effectiveness of motor rhythmic training over time on temporal movement control and the ability to synchronize motions with external rhythms has not widely been investi- gated through quantifiable data. Groves (1969) reported that rhythmic training consisting of a nondirective technique with emphasis on rhythmic stimuli incorporated in a tonal setting had no measurable influence on scores on a motor rhythm synchronization test. Since 30 the treatment is not further specified, an evaluation of the presented data remains inconclusive. Mikol and Denny (1955) reported that a synchronous metronome stimulus improved the performance accuracy in a rotary pursuit task when compared to synchronous music, no music, asynchronous music, or asynchronous metronome conditions. Most other studies testing for accuracy of motor response in relation to rhythmic signals have used single testing situations without comparative data, measuring motor rhythmic and perceptual abilities based on limited movement types. Two other questions are of concern in the relationship between external and motor rhythm. The first question, subject to much research, deals with the effect different sensory modalities in which the stimulus is presented have on the quality of the motor rhythmic response. Numerous studies have consistently shown that the auditory modality produces motor rhythmic responses less variable than the visual, tactile or combined auditory [visual presentation mode (Gault 6 Goodfellow, 1938; Haight, 1944; Huff, 1972; Lhamon 6 Goldstone, 1974; Rosenbusch 6 Gardner, 1968; Thomas 6 Moon, 1976). The results of the study by Thomas and Moon (1976) measuring motor rhythmic abilities in children led the authors to conclude that, although the underlying mechanism is not clearly understood, the young child initially attempting performance tasks of a time-space rhythmic nature with a movement pattern accuracy component should be encouraged to rely on audio cues. These results might be better understood in the light of work by Smith (1970) , which indicates that temporal discrimination processes develop through the auditory 31 modality before the visual system and that there is transfer from the auditory to the visual but not the reverse. Cooper (1982) tape recorded the sounds of movement patterns of selected sport skills in outstanding performers. The sounds made by these performers were transcribed into rhythmic notation illustrat- ing that a recordable rhythmic element was present. In most instances the foot sounds were the most audible and were the ones used in recording the action. These rhythmic patterns were beaten out on a drum in several teaching situations with beginners. The observed results led to the conclusion that beginners can benefit from adapting an efficient performance rhythm, making the correct foot movements at the proper rate and with the proper emphasis, etc. The rhythm of even a very skilled performer was found to be not smooth or uneven in tempo but always consistent in pattern. It seems that the most beneficial presentation mode for rhythmic stimuli is in the auditory modality since it is most intimately related to the timing sense in man. The second question is concerned with the development of rhythmic ability regarding perception of and motor response to audi— tory rhythmic stimuli. Studies by Van Alstyne 6 Osborne (1937), Rosenbusch 6 Gardner (1968) and Smoll (1974) have indicated an increase with age in the temporal accuracy of children's motor responses to auditory rhythmic stimuli. Smoll (1974) investigated development of spatial and temporal elements of motor responses to auditory rhythmic stimuli for children 5 to 11 years of age. The findings indicate a reduction of error in spatial and temporal accuracy with increasing age. The biggest improvement appeared between the 32 8 and 9 year old children. Rosenbusch 6 Gardner (1968), investi— gating the same rhythmic tasks with children 5 to 13 years of age, found a linear improvement of temporal error scores in the auditory modality which also proved to be superior to the visual rhythmic pre- sentation. In summary, it appears that motor rhythmic synchronization to an external rhythm is a skill entity which (1) is affected by train- ing and teaching, (2) produces best responses in the auditory modality, and (3) is influenced in its growth by developmental mechanisms . N europhy siological A spects Sound stimuli, and in particular rhythmic stimuli, exert an influence on the motor system in man which can be detected through electrophysiological measurement devices. The most noticeable inter- action between the auditory and motor system in man is the startle response (Landis 6 Hunt, 1939). The more frequent response types are usually more subtle than the startle response. Paltsev and El'ner (1967) have reported that nerve pulses induced by sound signals travel not only along the pathways ascending to the cerebral cortex, but simultaneously spread to the spinal cord. For a strong sound signal, these impulses raise the excitability of the motor nuclei of the spinal cord. By the time of the appearance of supraspinal influences at the segmental level, the excitability of the corresponding spinal structures has become already sufficiently high so that they are ready to be brought into action under these 33 influences. This process results in a shortening of the latent period of voluntary muscle reaction to strong sound signals. Rossignol (1971) reported a two-fold increase of excitability induced by musical sound patterns in the spinal motor neuron pool. This report suggests that musical stimuli, at the spinal level, might influence the timing of motor responses. The results indicate also that there is a tendency for the increased motor neural activity to be timed to repetitive auditory stimulation in a synchronized manner. This synchronization (or timing) makes best use of the audio-spinal effect, electromyographic facilitation, for muscular response patterns. Rossignol and Jones (1976) have conducted a series of experi- ments showing that sharp transient sounds, not intense enough to induce startle responses, facilitate an increase in excitability of spinal motor neurons. The increase of excitability was accompanied by a low habituation rate and a delay of the peak facilitation by the audio— spinal latency and conduction time. The peak facilitation of the motor neural pulse potentiation was also found to depend on the intensity of the sound stimulus. Tones of 30 to 110 db were found to double the measured motor neural activity. The duration of the facilitation also indicates that there is a minimal time interval between two successive sounds for which motor neural potentiation can still be observed. Unlike with sounds inducing the startle response, no inhibition was found following the period of facilitation. This lead the authors to the conclusion that the potentiation is the predominant feature when using nonstartling sounds and this might in turn potentiate whatever movement is synchronized to the incoming sounds. 34 Furthermore, to investigate the latter assumption, the time course of this audiospinal facilitation was superposed over the electro— myogram events during hopping to a simplified musical stimulus. The presumed electromyographic facilitation period induced by the "on" and "off" beats of the stimulus apparently synchronized with the peak upwards acceleration of the electromyographic activity. Rossignol and Jones (1976) elaborate: The mode of synchronization was not indeed arbitrary but followed a fixed pattern. One can obviously hop at the same frequency without auditory cues and other factors such as vestibular, neuromuscular, or even energetic could certainly contribute in fixing the preferred frequency. However, when hopping at the preferred frequency with music, the mode of synchronization of the motor events and auditory events is very suggestive of a purposeful use of audio-spinal facilitation. . . . It is not known yet which changes occur in the transmission of pathways mediating the present audio- spinal influences during hopping but one can imagine that man could have learned to use his endowed subcortical startle mechanisms as a pathway through which to generate subtle sensory-motor interactions such as needed when dancing to music (I). 90). With this mode of synchronization, the timing of the beat pattern of the musical stimulus would be suitable to potentiate the electromyo- graphic events related respectively to the peak upwards acceleration determining the take off and to the landing. Thus, it could be inferred that during a synchronized fixed movement pattern to rhythmic auditory stimuli, the motor events are timed in phase with the audio-spinal facilitation period. In summary, auditory signals exert various neurophysiological effects on the motor system. Of specific concern for motor performance are the effects of motor neural potentiation through audio-spinal processes and the effect of repetitive stimulation. Measurements of 35 both effects strongly suggest that when one is synchronizing repeti- tive movement patterns to rhythmic auditory stimulation, such as in music, the motor events would benefit from this facilitation regarding the timing of the motor response if the proper sensory-motor inter- actions can be generated. Automatization of Movement Patterns Highly skilled movement performance seems to be associated with a preconceived, well—developed movement plan, established in the brain areas which are responsible for execution and control of motor activities (Singer, 1980). For example, a beginner needs to go through the steps in performing a task very consciously, attending to the various components of the movements and to all external guiding cues present. Conversely, an experienced performer seems to be able to complete the same sequence "unconsciously" without heavy reliance on external cues. A well-developed movement plan seems to provide built-in mechanisms for control and continuance of required activities. The skilled performer does not need to repeat the trial- and-error process once a movement plan is established. The performer rather calls on a plan well-constructed beforehand. It is then assumed that the specific skill which is based on a movement plan or program becomes automatic and reflex-like (Isaacson, Douglas, Lubar 6 Schmaltz, 1971). In the development of the brain areas responsible for the control of motor behavior, the cerebral cortex plays an important role in any type of voluntary movement, and obviously in learning complex 36 movements, e.g. , athletic skills; whereas the cerebellum offers an automatic control function, being responsible for smooth, coordinated movement and for the execution of reflex-like movement patterns. Well-learned motor patterns, presumably not requiring conscious con- trol anymore, might indeed have become almost like reflex acts then. This development would be connected to a shift in cortical areas from the cortex to the cerebellum as being responsible for execution and control. lsaacson et a1. (1971) suggest that a given area might be necessary for the trial-and-error process of mastering a given motor skill but will not be involved any longer once the skill has become automatic or reflex-like. This change would also account for the finding that very complex motor behavior often remains intact after extensive damage to prime motor areas in the cortex. Despite a sug- gested change in involved brain areas, it has to be emphasized, however, that the cerebellum and cerebrum work closely together, though to various extents, on all forms of coordinated motor acts. Different approaches have been taken to investigate the development and manifestation of automatization in motor patterns. A more recent approach, of considerable pertinence to this study, has required the subject to process dual streams of information. The proficiency of a secondary task has been used as an index of auto- matization of the primary task. The majority of studies support the notion that the degree of anticipation displayed by the subjects per— forming the task is an important factor in the process of movement 37 response automatization. Anticipation, however, seemed to be a variable depending on the predictability of external response cues. Schmidt (1968) reported that predictable tasks cued by external stimuli seemed to be learned better when a concurrent secondary task was required to be performed. Schmidt suggests that a task which can be anticipated, in terms of serial ordering and reaction time, will require decreasing conscious control and attention over time, thus becoming automatized. Adams and Chambers' (1962) findings represent the results of a number of studies employing two concurrent tasks, each time- cued by simultaneous visual or auditory stimuli. Task performances cued by the predictable stimulus were superior to those in the unpre- dictable condition. The auditory stimulus always proved to elicit better responses than the visual. These findings support the data that show the superiority of the temporal discrimination process in the auditory modality over the visual. Auditory cues, or sound events, if rhythmically organized, are predictable timing cues since they fall into consistent patterns even if the time intervals between the onsets of each sound event are not all of the same length. It is logical to assume, then, that auditory rhythmic stimuli can serve as predictable timing cues which facilitate the anticipation of a motor response, and thus, that this response pattern gradually becomes automatized. A similar view, but on a neurophysiological basis, has been developed by Jones, Watt 6 Rossignol (1973) and Jones 6 Watt (1971). Anticipatory patterns of electromyographic activity during stepping 38 and hopping movements seem to indicate that the entire motor act, as a sequence of muscle contractions and inhibitions programmed and dispatched from higher cortical centers, becomes automatized. When exposed to an auditory rhythmic signal, the audio-spinal, vestibulo- spinal and muscle afferent responses seem to contribute to the automatic maintenance of the ongoing cycle of movement events. Temporal Predictability and Response Anticipation Another quality of temporally predictable stimulus groups, besides their effect on the automatization of a response pattern, can be found in their impact on reaction time and quality of the particular response. A shortening of the latency for volitional motor responses has already been suggested in the section on neurophysiological aspects. Conrad (1956) has found that individuals, when given a choice, tended to organize response cues, presented at random time, in a con- sistent temporal structure. The influence of temporal consistency of the signal on the quality of response was statistically positive. Schmidt (1968) , in surveying the literature on anticipation and timing in human motor performance, points out that anticipation and timing can be learned and that temporal and spatial predictability of the response cues seems to be the most potent determiner for anticipation. Furthermore, temporally predictable stimuli produced better response quality (Cross, 1966; Trumbo, Noble 6 Swink, 1967) and shorter response times (Adams 6 Boulter, 1964). 39 Wilson (1959) reported that the reaction time for rhythmic signal presentation was significantly faster than for non-rhythmic presentation. Movement time, the travel time of the particular limb from initial muscle response to target contact, was not influenced by the presentation mode. Thus the study indicates that the response improvement occurred during the time after stimulus presentation and between stimulus perception and response initiation, while the quick- ness of the muscular motions remained unaffected. Wilson attributes the faster speed of reaction under the rhythmic compared with non-rhythmic conditions mainly to differences in the foreperiod in which a state of mental and physical readiness needs to be established. Thus, if the foreperiod is too short, the subject may have no time to attain the optimal state of readiness. If the foreperiod is too long, the subject's readiness may fade away. The physical state of readiness, according to Wilson, is characterized by a tensing of muscles which execute movement during the fore- period. The reaction can occur quicker as the tension is higher at the end of the foreperiod. The tension is apt to be greatest when the foreperiod is regular and of optimal length. In a rhythmic series, the length of all single foreperiods can be optimal, unlike in a non- rhythmic series where many of the individual foreperiods would necessarily be different from optimal. The aspect of rhythmicity, however, influences the state of mental readiness as well. Wilson put forth that the mental readiness can be raised optimally at the respec- tive reaction points if it is known just when a possible stimulus can occur. This premeditation of reaction is not possible in a non-rhythmic 40 series of stimuli. Wilson's findings and model of explanation seem to reinforce, indeed, the view on movement response patterns to rhythmic stimuli as discussed in the section on neurophysiological research. The observed rhythmicity of motor neural potentiation to auditory rhythms seems to support the notion that an optimal move- ment response time can be achieved best in a rhythmic presentation of auditory stimuli. In summary, it is apparent that the auditory presentation mode produces consistently faster reaction times and better response qualities than the visual, tactile, or combined auditory lvisual presenta- tions . Muscular Fatigue and Recovery Time Many studies have investigated the influence of the presence of musical stimuli on endurance in physical performance. There seems to be general agreement suggesting that physical endurance may be enhanced if movement is rhythmically coordinated with a musical stimulus. Bushey (1966) and Widdop (1968) have both reported that musical accompaniment enhances the muscular endurance in dance per- formance. Movement synchronized to the pace of musical stimuli has been shown to benefit in terms of speed (Harding, 1933) and cardio- vascular endurance (Anshel 6 Marishi, 1978). Nelson (1963), using musical background stimuli without response synchronization, failed to disclose better strength or endurance in motor performance. Stull 6 Kearney (1974) found a shortened recovery time of muscular strength after a 3-minute rhythmic isometric grip-flexion exercise compared to 41 the same exercise when sustained for 1 minute, without rhythmic organization. Explanations for the advantageous effect of musical accompaniment on physical activity have been set forth by Marteniuk (1976) who suggests that, due to the process of selective attention, the subject's perception of a pleasant auditory stimulus predominates over the attention to the less pleasant stimuli of physical exertion, and by Hernandez-Peon (1961) who offers a neurophysiological model for apparently the same process. He contended that pleasurable sensory stimuli can facilitate electrical activity in one sensory pathway while blocking the transmission of other afferent pathways. Thus music may prolong physical endurance in the organism because it inhibits psychological feedback associated with physical exertion and fatigue. However, the importance of rhythmic organization of physical exercise to muscular endurance as emphasized by Anshel and Marishi (1978) and Stull and Kearney (1974) and possible underlying causal factors might deserve a more in-depth look in future research. Auditory Feedback and Proprioceptive Control External auditory cues have been used successfully in a number of studies as an auxiliary feedback system for, or contingent reinforcement of , muscular control. Non-rhythmically organized acoustic stimuli, however, do not pertain directly to the temporal ordering process necessary for a motor rhythmic performance. They have been used instead to facilitate various other aspects of motor learning, mainly in terms of quantitative muscular control or as response feedback for short term motor retention. Adams, Marshall 42 and Goetz (1972) reported the use of combined auditory, proprio- ceptive and visual feedback for learning and recalling a movement. The biggest retention loss was found for the condition with the least feedback present. Thus the authors conclude that the various sources of feedback contribute to the strength of the perceptual trace which secures retention of a movement task. Carlsoo and Edfeldt (1963) have used auditory stimulation to aid proprioceptive control in achieving stable activity from a single motor unit as displayed on an oscillograph screen. They found that proprioception can be assisted by external stimuli in achieving motor precision, whereby auditory feedback produced better results than visual. Even a slight auditory stimulus showed greater effect on performance than a very pronounced visual stimulus. Sachs and Mayhall (1972) reported that auditory feedback as contingent reinforcement improved the pursuit motor performance of a cerebral palsied adult. Auditory feedback has been successfully used to reduce foot dragging in a cerebral palsied patient (Spearing 6 Poppen, 1974) . Contingent auditory feedback has been used to control jaw movement and thumb switching (Hefferline 6 Kennan, 1963; Hefferline 6 Perrera, 1963), to modify poor posture (O'Brien 6 Azrin, 1970) , and to acquire proper head posturing control in cerebral palsied children (Wolfe, 1980). Auditory and visual feedback facilitated improvement and retention of dorsiflexion twice as much when compared to conventional therapy (Basmajian, Kukulka, Narayan, 6 Takebi, 1975), helped in controlling various other muscular functions in spastic conditions 43 (Basmajian, 1979) , and facilitated the attainment of upper and lower limb function in a hemiplegic patient (Nafpliotis , 1976) . The perceptual motor system obviously is sensitive to auditory stimulation, and the effectiveness of auditory feedback for the achievement of muscular control especially in populations with various motor handi- caps is well documented. Rhythmic Speech as Internal Movement Control A crucial aspect in motor therapy is the maintenance of therapeutic success in addition to an immediate effect of a clinical technique. The question of concern is, whether the individual can maintain the motor rhythm accuracy once the cue is removed, after having learned to adjust the respective motor performance to an auditory timing aid. In this regard Luria's (1961) investigations about the role of speech in regulation of behavior patterns is of great importance. Luria carried out a number of experiments where be investigated the development of the regulatory role of speech in the formation of a child's behavior. In the first stage the child under- stands and uses the speech of others to direct its own behavior. Later the role of these external signals is assumed by the child's own overt speech but its regulatory influence proceeds not from the con- nection of semantic content of speech to behavior pattern, but rather from the direct, impellant or initiating action of speech itself. It is only at a third stage where the impellant action of speech is replaced by a regulatory influence based on semantic connections produced by speech. At a last stage, internal speech, closely bound to the 44 formation of the mental processes of abstract thinking, becomes the dominant instance to direct thought and volitional action. Meichenbaum (1977) has used verbal-instructional training, based on Luria's theories, to modify behavior in hyperactive children. His training program progresses through five stages: 1. An adult model performed a task while talking to him/herself out loud (cognitive modeling); 2. The child performed the same task under the direction of the model's instructions (overt, external guidance); 3. The child performed the task while instructing him/ herself aloud (overt self-guidance); 4. The child whispered the instructions to himself as he/she went through the task (faded, overt self- guidance); 5. The child performed the task while guiding his/her performance via private speech (covert self-instruction). Cotton (1965, 1974) reported on the technique of "rhythm intention" which uses chants to direct and control volitional movement patterns in cerebral palsied children. These children talk through their motions to enhance cortical control over their volitional movement attempts. Each chant is structured in a rhythmic pattern to emphasize the temporal frame of each motion, that is, a starting point, a point of completion and a regularly recurring grouping and ordering of the motions involved, even if the performed rhythm might be far from even. Rhythmic speech, e.g. , in chant-form, really seems to serve two purposes in regard to movement control: (1) it regulates the desired motor behavior through either the initiating action of speech itself or through semantic connections between movement and verbal accompaniment, depending on the deveIOpmental level of the individual; 45 and (2) it regulates the timing of the movement, that is, the correct serial ordering and time relationship of the motor acts involved, through its rhythmic structure which can be anticipated as regularly recurring information. A Model of Rhythmic Auditory- Motor Integration A model is now introduced to summarize the findings of the previous discussions (Figure 1). This model depicts several research factors as possible constituents of a relationship between auditory rhythmic stimuli and motor rhythm performance underlying auditory- motor coordination processes. Auditory rhythm and rhythmic speech, the two treatment stimuli in this study, are suggested to aid temporal and quantitative muscular control of successive gross motor patterns through various psychological and neurophysiological processes. These processes constitute an auditory-motor integrative relationship as displayed in the model. The hypothesized relationship can be summarized as follows. Auditory rhythmic signals as external stimuli can facilitate temporal and quantitative muscular control of movement patterns by: 1. influencing timing and potentiation of motor neural discharge ; 2. decreasing muscular fatigue sensation; 3. facilitating automatized movement performance through the temporal predictability of its timing ones: 4. improving reaction time and response quality through facilitated response anticipation; and 5. providing auditory feedback for proprioceptive control mechanisms. 46 cofimummfi: Homo—14:33:33.. 2855—: we :60: _ 355.83; 55.3: 332 _ i ll .|\I ll. --, i ll: . .9355 3:25 .3258: 03332395 uncommon can :3me 33: . 39:93—25 £25.50..— 052. .5326: Lo P83325533< 3.3252 335:; ”cozaafizct. amp—came: ”3:355:32; Samson. c9523: _l|m_=:w_m 285»: 2 33:5 < L 49 Illa! «:2. E: Ifi >.. I. . . A! m+ 9+ IIIII 3:5.- =_._ao £52 3232::— 3:555 . a. v5. 1:2 333:: CK - I L «1...: :0.— Lua—r—3Ju-z 3“ i, i- In” >52: All I‘ll! IIAA :lll LN v8~= 5.2 3.53 I I! 52:: En:— \\ 3- Fusing // ”U :5... :9.— l . AA ] VENN v— ONN . ll\\ I. A HI||IL H I .5: IA 5:... E2: _ JHIullu if! e all” :5 is: A .AA . 1.5.3.52: APPENDIX C SAMPLE PRINTOUT OF MOVEMENT RECORDING 138 139 b co 1 A.“ M33“ Rhythm N‘DIUUAb ‘ I 2 Syntluouxulua... ' 3) but: I‘ hose» 1] luau: BA Movement/boat Lunu Len (Lead: l-uul flight (Support) bout Arms Lil Movement ”atoning. d Fl “capuuuc ‘2 It)“. 8.) “.514 a Tm I m hsuts I J 314;: _ Step cu.» m Motions, ngh. Subways I-oct Nov-bum L! to! 5 than: ”DUh-N' "3;“: "Must. 140 23 hsecs £5 hsecs Arms Down Len (Lead! Foo! L 77 hsecs l l J_‘ Clap Hands Above Head Slap Thighs Step Sideways 32 hsecs Erroneous Manon = Rngm Fool Moves "l P" "Mum "51“" REF EREN CE S 141 REFERENCES Adams, J. A., 6 Boulter, L. R. Spatial and temporal uncertainty as determiners of vigilance behavior. Journal of Experimental Psychology 1964, y, 127-131. Adams, J. A., 6 Chambers, R. W. 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