AUDIOMOTOR INTEGRATION AND CORTICAL PLASTICITY IN THE APPLICATION OF RHYTHMIC AUDITORY STIMULATION (RAS) IN POST-STROKE PATIENTS

Abstract

Gait impairment remains one of the leading causes of long-term disability after stroke, significantly limiting community mobility and quality of life. Despite advances in task-oriented rehabilitation, restoration of temporospatial gait symmetry and motor coordination remains challenging due to disrupted sensorimotor integration and impaired cortical network dynamics. Rhythmic Auditory Stimulation (RAS), grounded in the principles of auditory–motor entrainment, has emerged as a mechanism-based intervention targeting temporal organization of movement. Unlike purely biomechanical or peripheral stimulation approaches, RAS is hypothesized to modulate central neural timing mechanisms and promote adaptive neuroplasticity.

This study aimed to provide a comprehensive synthesis of recent evidence (2021–2025) regarding the clinical efficacy and neurophysiological mechanisms of RAS in post-stroke gait rehabilitation, with particular emphasis on auditory–motor integration and cortical plasticity.

Neurophysiological findings indicate enhanced functional connectivity between auditory and motor cortical areas, increased activation of premotor cortex and supplementary motor area, and elevated corticospinal excitability in the affected hemisphere following RAS training. EEG-based studies revealed modulation of alpha-band activity and improved sensorimotor synchronization, suggesting stabilization of neural oscillatory timing mechanisms.

When compared with robotic-assisted gait training, functional electrical stimulation (FES), and virtual reality (VR)-based interventions, RAS exhibits a distinct temporal-organizational mechanism. Robotic systems primarily enhance movement repetition and biomechanical alignment, whereas FES targets peripheral motor activation. VR interventions predominantly engage visuospatial and motivational pathways. In contrast, RAS directly influences internal motor timing and auditory–motor coupling, potentially serving as a central synchronizing framework that can be integrated with other modalities. Emerging closed-loop and real-time auditory feedback systems further support the feasibility of personalized, adaptive entrainment strategies in ecological walking environments.

Current evidence supports RAS as an effective, scalable, and neurophysiologically grounded intervention for improving gait performance after stroke. Beyond symptomatic gait enhancement, RAS appears to induce measurable changes in cortical network organization and sensorimotor integration. Future high-powered mechanistic RCTs incorporating multimodal neuroimaging and standardized dosing protocols are required to optimize patient stratification and define long-term neuroplastic effects. Integration of RAS within multimodal rehabilitation paradigms may enhance functional recovery by targeting the temporal architecture of motor control.