Studies show music therapy and virtual reality reverse “neurologic neglect.”
KEY POINTS
“Neglect” is a neurological disorder impacting stroke survivors’ motor skills and critical perceptual domains.
Several studies show improved task performance and brain activity through music therapy and VR interventions.
Music therapy combined with virtual reality may be a more engaging neglect rehabilitation approach.
By Andrew Danso, Ph.D.
Did you know that after a stroke, nearly one-third of survivors face a challenging condition known as “neglect”? This neurological disorder significantly impacts a stroke survivor’s rehabilitation, affecting their motor skills and critical perceptual domains, such as spatial awareness.
Visuospatial neglect (VSN) is particularly notable, where patients struggle to identify objects in areas of their visual field, often on their left side (though not exclusively). This often leads to increased risks of falls and heightened caregiverstress.
Traditional rehabilitation can be tough on both patients and therapists, leading to issues with patient and diagnostic challenges for therapists. The lack of a standardised treatment for VSN and neglect exacerbates this issue, leading to recent research efforts focused on developing treatment solutions.
Two recent studies (study 1 and study 2) have pointed out the promise of using music therapy and virtual reality (VR) as potential treatment experiences for VSN patients.
In music therapy, a practice known as Musical Neglect Training (MNT) involves patients actively participating in musical exercises. In these exercises, patients are instructed to play musical patterns (that can be melodic or rhythmic) on different musical instruments, which extend to the neglected visual field (commonly their left side, but not exclusively). A music therapy study showed promising findings in this area.
article continues after advertisement
VR has also shown promise in this area. Recent studies have demonstrated its effectiveness in the diagnosis and assessment of VSN, as well as in motivation. The studies highlight core advantages of VR treatment for VSN, including
Customisable treatment experiences
Immersive patient experiences
User testing the virtual reality application
Additionally, a research team found evidence of an increase in brain activity regions of neglect patients after using a VR intervention, linked to improvements in their saccadic eye movements—a rapid eye glance from one point to another.
A recent study attempted to combine a MNT and VR intervention. The initial findings of this combined approach were promising. Across various patient measures, patients showed varied results in engagement and response. A few patients reported improvements in task performance, suggesting a VR and MNT combined exercise could positively impact rehabilitation. Another study currently in peer review found promising results in VSN patients’ engagement and positive feedback while using a custom-made VR application for treatment. In addition, they found one patient’s task response time might have improved considerably with the use of audio cues.
These studies provide glimpses into the future of tailored rehabilitation and are promising in the ongoing development of rehabilitation treatments for stroke and neglect.
Andrew Danso, Ph.D., is a postdoctoral researcher at the Music Therapy, Centre of Excellence in Music, Mind, Body and Brain, University of Jyväskylä, Finland.
References
Danso, A., Leandertz, M., Ala-Ruona, E., & Rousi, R. (2022). Neglect, Virtual Reality and Music Therapy: A Narrative Review. Music and Medicine, 14(3).
Danso, A., Nijhuis, P., Ansani, A., Hartmann, M., Minkkinen, G., Luck, G., Bamford, J.S., Faber, S., Agres, K.R., Glasser, S., Särkämö, T., Rousi, R., & Thompson, M. R. (2023). Virtual Reality-Assisted Physiotherapy for Visuospatial Neglect Rehabilitation: A Proof-of-Concept Study. arXiv preprint arXiv:2312.12399.
Ekman, U., Fordell, H., Eriksson, J., Lenfeldt, N., Wåhlin, A., Eklund, A., & Malm, J. (2018). Increase of frontal neuronal activity in chronic neglect after training in virtual reality. Acta Neurologica Scandinavica, 138(4), 284–292.
Heyse, J., Carlier, S., Verhelst, E., Vander Linden, C., De Backere, F., & De Turck, F. (2022). From Patient to Musician: A Multi-Sensory Virtual Reality Rehabilitation Tool for Spatial Neglect. Applied Sciences, 12(3), 1242–1242.
Kang, K., & Thaut, M. H. (2019). Musical neglect training for chronic persistent unilateral visual neglect post-stroke. Frontiers in Neurology, 10, 474.
Moon, H.-S., Shin, S.-W., Chung, S.-T., & Kim, E. (2019). K-CBS-based unilateral spatial neglect rehabilitation training contents utilizing virtual reality. 1–3.
Schwab, P. J., Miller, A., Raphail, A.-M., Levine, A., Haslam, C., Coslett, H. B., & Hamilton, R. H. (2021). Virtual Reality Tools for Assessing Unilateral Spatial Neglect: A Novel Opportunity for Data Collection. Journal of Visualized Experiments, 169.
Wagner, S., Preim, B., Saalfeld, P., & Belger, J. (2019). Crossing iVRoad: A VR application for detecting unilateral visuospatial neglect in poststroke patients. 1–2.Morereferences
The soft smart hand exoskeleton. Image credit: Dr Maohua Lin et al
Researchers have developed the prototype of a comfortable and flexible ‘soft smart hand exoskeleton’ or robo-glove, which gives feedback to wearers who need to relearn tasks that require manual dexterity and coordination, for example after suffering a stroke. The present study focused on patients who need to relearn to play the piano as a proof-of-principle, but the glove can easily be adapted to help relearn other daily tasks.
Stroke is the most important cause of disability for adults in the EU, which affects approximately 1.1 million inhabitants each year. After a stroke, patients commonly need rehabilitation to relearn to walk, talk, or perform daily tasks. Research has shown that besides physical and occupational therapy, music therapy can help stroke patients to recover language and motor function. But for people trained in music and who suffered a stroke, playing music may itself be a skill that needs to be relearned. Now, a study in Frontiers in Robotics and AI has shown how novel soft robotics can help recovering patients to relearn playing music and other skills that require dexterity and coordination.
“Here we show that our smart exoskeleton glove, with its integrated tactile sensors, soft actuators, and artificial intelligence, can effectively aid in the relearning of manual tasks after neurotrauma,” said lead author Dr Maohua Lin, an adjunct professor at the Department of Ocean & Mechanical Engineering of Florida Atlantic University.
Credit: Dr Maohua Lin et al
Whom the glove fits: custom-made ‘smart hand’
Lin and colleagues designed and tested a ‘smart hand exoskeleton’ in the shape of a multi-layered, flexible 3D-printed robo-glove, which weighs only 191g. The entire palm and wrist area of the glove are designed to be soft and flexible, and the shape of the glove can be custom-made to fit each wearer’s anatomy.
Soft pneumatic actuators in its fingertips generate motion and exert force, thus mimicking natural, fine-tuned hand movements. Each fingertip also contains an array of 16 flexible sensors or ‘taxels’, which give tactile sensations to the wearer’s hand upon interaction with objects or surfaces. Production of the glove is straightforward, as all actuators and sensors are put in place through a single molding process.
“While wearing the glove, human users have control over the movement of each finger to a significant extent,” said senior author Dr Erik Engeberg, a professor at Florida Atlantic University’s Department of Ocean & Mechanical Engineering.
“The glove is designed to assist and enhance their natural hand movements, allowing them to control the flexion and extension of their fingers. The glove supplies hand guidance, providing support and amplifying dexterity.”
The authors foresee that patients might ultimately wear a pair of these gloves, to help both hands independently to regain dexterity, motor skills, and a sense of coordination.
AI trained the glove to be a music teacher
The authors used machine learning to successfully teach the glove to ‘feel’ the difference between playing a correct versus incorrect versions of a beginner’s song on the piano. Here, the glove operated autonomously without human input, with preprogrammed movements. The song was ‘Mary had a little lamb’, which requires four fingers to play.
“We found that the glove can learn to distinguish between correct and incorrect piano play. This means it could be a valuable tool for personalized rehabilitation of people who wish to relearn to play music,” said Engeberg.
Now that the proof-of-principle has been shown, the glove can be programmed to give feedback to the wearer about what went right or wrong in their play, either through haptic feedback, visual cues, or sound. These would enable her or him to understand their performance and make improvements.
Picking up the gauntlet for remaining challenges
Lin added: “Adapting the present design to other rehabilitation tasks beyond playing music, for example object manipulation, would require customization to individual needs. This can be facilitated through 3D scanning technology or CT scans to ensure a personalized fit and functionality for each user.”
“But several challenges in this field need to be overcome. These include improving the accuracy and reliability of tactile sensing, enhancing the adaptability and dexterity of the exoskeleton design, and refining the machine learning algorithms to better interpret and respond to user input.”
REPUBLISHING GUIDELINES: Open access and sharing research is part of Frontiers’ mission. Unless otherwise noted, you can republish articles posted in the Frontiers news site — as long as you include a link back to the original research. Selling the articles is not allowed.
To examine the feasibility of stroke survivors receiving music-based rehabilitation via a mobile app.
Materials and Methods
We recruited ten chronic stroke survivors who were community-dwelling with mild-moderate upper extremity (UE) paresis. Participants were encouraged to exercise their paretic UE with a commercial instrument training app, Yousician, with a piano keyboard at home for three weeks. The feasibility of the training was measured by: (a) the acceptance of using the app to receive in-home piano training (e.g., daily usage time, exit interview) and (b) the effects of the app functionality as a rehabilitation tool (e.g., participants’ motor improvements after training).
Results
Our small sample size of participants demonstrated general positive feedback and self-motivation (e.g., interest in extended training time) about using a mobile app to receive in-home, music-based UE training. Participants showed no trend of declined usage and practiced on average ∼33 min per day for 4–5 days per week during the 3-week participation. We also observed positive results in the Fugl-Meyer Assessment, Action Research Arm Test, and Nine Hole Peg Test after training.
Conclusions
This study provided insight into the feasibility of delivering music-based interventions through mobile health (mHealth) technology for stroke populations. Although this was a small sample size, participants’ positive and negative comments and feedback provided useful information for future rehab app development. We suggest four ways to further improve and design a patient-oriented app to facilitate the use of a mHealth app to deliver in-home music-based interventions for stroke survivors.
IMPLICATIONS FOR REHABILITATION
Stroke survivors showed acceptance and positive feedback on receiving in-home music-based training via a mobile app.
mHealth technologies may allow positive effects of music-based interventions in motor performance and home practice compliance.
Further developments in the co-design process with patients, caregivers, and therapists are needed to design a patient-oriented app to deliver better in-home music-based interventions for stroke survivors.
The motor function of the upper limb is typically impaired in stroke patients; as a result, rehabilitation exercise is crucial to regaining muscular control. While encouraging patients to continue with long-term exercise using standard rehabilitation training methods may be difficult. To deal with this dilemma, virtual reality (VR) games are introduced to motivate patients to take part in therapy. Meanwhile, music therapy has been proven to be extremely beneficial in the early phases of stroke recovery. These activities inspire us to include musical instrument play like xylophone and drums, in the design of VR games. By striking the xylophone’s highlighted keys or the flying notes aimed at the drums, the impaired upper limb functions can be strengthened. Early user evaluations demonstrate that the developed games are straightforward to use and appeal to patients’ desire for more exercise.
1 INTRODUCTION
Tangible games are widely utilized to motivate patients and track their performance to support therapists better [9, 10, 11], while some recent research studies also adopt virtual reality (VR) games in redesigning upper limb exercises. VR games and actual movements can be integrated together to motivate patients in rehabilitation exercises. Rose et al. [7] reported that patient enjoyment and willingness to participate were concluded in healthcare plans incorporating VR due to its immersive, entertaining approach to improving performance. However, some VR games may provide repetitive, intense, and task-specific training to enhance neuroplasticity [8]. In order to mitigate this issue, music therapy, which has been demonstrated to aid in both physical and mental rehabilitation, has been proven to be extremely beneficial in the early phases of stroke recovery [4]. Both sorts of engagement can benefit stroke patients, but generally speaking, low-cost methods have more real-world use. The price of VR-based headset has been extremely expensive in the past. With the improvement of technology, a few cost-effective VR devices are launched in the market, such as PICO4 (an all-in-one device around $425 as shown in Fig. 1), which creates more opportunities for VR game development. In this study, we focus on rhythm-based upper-limb training exercises by incorporating musical instrument playing into VR game design. As a result, the two musical instruments, i.e., the xylophone and drums, are applied to the game design with tactile, auditory, and visual feedback.
2 RELATED WORKS
Projects like TangiBoard demonstrated how sensory technology and tangibles can generally enrich learning and training experience in upper limb rehabilitation [5, 6]. In recent years, many projects aimed to tackle similar problems using VR technology by picking up and positioning objects in the virtual environment at specific places [6]. For example, the Bimeo gadget provided a VR environment to encourage patients to rehabilitation exercise, as well as support therapists to oversee and manage the exercise [1]. The ArmeoSenso system [5] similarly used VR and inertial measurement unit (IMU) for video game-based training and assessment of upper limb functions. VR games have been explored as tools in rehabilitation training.
Playing therapeutic instrumental music assists patients in regaining functional movement patterns and damaged motor functions [3]. Connie Tomaino, the director of the Beth Abraham Music and Neurologic Rehabilitation Institute, states that “focusing attention on rhythmic instruments can increase movement in individuals such as those with Parkinson’s disease or stroke rehabilitation patients” [2]. In music therapy, drums and xylophone are very popular instruments since people without prior knowledge can quickly learn how to play. In fact, stroke rehabilitation patients may exercise more if they concentrate on rhythmic instruments [2]. As a result, we decided to build a rhythm-based VR game using drums and xylophone play for rehabilitation exercise.
3 CONCEPTUAL DESIGN AND GAME PROTOTYPING
We observed patients performing arm-reaching exercises while conducting field research at a local rehabilitation facility, Suzhou Municipal Hospital, by moving a wooden instrument on the table. This exercise is vital to inhibit muscular contraction in the initial stages of stroke recovery. Patients moved from one posture to another as directed by therapists verbally. Even under the care of therapists, patients were quite inactive, although they could exercise independently. To sum up, we identify the design opportunity as providing a low-cost training device that motivates and guides patients through active exercising tasks. Meanwhile, therapists should be able to monitor multiple patients simultaneously and record their performances.
As a result, we created a VR game concept utilizing PICO4 to encourage them to complete the practice. The stroke patients held two controllers that weighed 185 grams each while wearing headsets. Through gripping the controllers, users can play virtual music instruments for upper limb reaching, stretching and extension. PICO4 device can mirror the VR display from the headsets to other devices such as televisions, computers, and smartphones. With this screen mirroring capability, clinicians could not only provide guidance and assistance to patients, but also monitor their gaming performance in real-time. Two distinct game modes are primarily designed: ‘Xylophone Play Mode’ and ‘Drums Play Mode’ to support appropriate upper limb functional training. Two iterations of VR game design are explored to facilitate arm reaching, shoulder extension, wrist and elbow rotation exercises.
Figure 1: PICO 4 Device
3.1 First Edition
In the ‘Xylophone Play Mode’, patients move virtual mallets by arm movement to strike the keys. A melody can be generated by pointing, rotating the wrist, and moving the mallet up and down to strike the keys. This game can improve upper limb-eye coordination and fine motor control.
In the ‘Drums Play Mode’, the rhythmical notes fly and move directly towards the corresponding drums with the background music. Patients use the virtual drumsticks to catch those notes above the drums, and successful strikes are rewarded with points. Clinicians can gauge the patients’ progress based on the scores received and decide whether they can move on to more challenging levels. For user-intuitive feedback, a successful note-catching would trigger a drum beat sound with controller vibration and an explosion effect. We tested our VR game in Suzhou Municipal Hospital Rehabilitation Center and received the following therapist response. Task-driven functionality, such as highlighting particular keys on xylophone to guide users exercise, should be included in the ‘Xylophone Play Mode’. The flight speed of such rhythmical notes in the ‘Drums Play Mode’ is too quick, which causes much miss catching in the exercise. As a result, two difficulty levels are designed for this mode in the revised version: basic level and standard level.
Leveraging the power of music and technology to redefine what’s possible in brain health
Millions of people live with persistent walking deficits.
We exist to positively impact the lives of those living with these deficits around the world.
Walking disability significantly decreases independence, reduces quality of life, increases falls, and adds to healthcare system burden. In the U.S. alone, over 100 million people have a walking disability caused by a neurologic injury or disease. But it doesn’t have to be this way. MedRhythms exists to rewrite this story by developing transformative and innovative therapeutics through the combination of advances in neuroscience and technology.
Our Technology Platform
MedRhythms is pioneering the development of next-generation neurotherapeutics designed to improve walking, mobility and related functional outcomes via a proprietary, patented technology platform.
30 years of academic research show potential for RAS to improve walking
In the last three decades, over 50 clinical research studies have been published supporting the efficacy of music to improve movement by harnessing the potential of RAS to promote clinically meaningful changes in functional outcomes.
Our clinicians have used RAS and other evidence-based music interventions to deliver over 30,000 hours of direct patient care. In 2017, the company recognized an opportunity to leverage technology as a significantly more scalable modality, in view of growing demand from people suffering from neurologic gait disorders and the limited number of trained clinicians.
MedRhythms has entered into a collaboration with Universal Music Group to provide patients using our platform with access to the most diverse and culturally rich collection of music ever assembled.
This study aimed to investigate the effects of listening to Wolfgang Amadeus Mozart’s “Sonata for two pianos in D major, K448” and Johann Sebastian Bach’s “Brandenburg concerto No. 4 in G major, BWV1049” on the heart rate, blood pressure, and autonomic nervous activity. Seventeen healthy young adults were recruited as participants. All participants underwent a 10-minute rest, a 10-minute load test, and a triplicate 8-minute music listening process. Electrocardiograms were continuously measured from the measurement onset to completion. Moreover, the high-frequency (HF) component was extracted from the heart rate variability analysis as a measure of the parasympathetic nervous activity and the ratio of low frequency (LF) to HF as a measure of the sympathetic nervous activity. Blood pressure was also measured. There was a significant decrease in the heart rate after listening to both K448 and BWV1049, as well as in the silence state. Blood pressure did not significantly change in either case. Further, the LF/HF ratio significantly decreased after listening to BWV1049. Nevertheless, HF did not change after listening to either music. In conclusion, this study suggests that listening to K448 does not affect the heart rate, blood pressure, or autonomic nervous activity, whereas listening to BWV1049 may suppress the sympathetic nervous activity in healthy adults. […]
Based on PRISMA 2020, articles on music therapy intervention in PSD were first identified through the Web of Science, PubMed, EMBASE, CNKI, Weipu, and Wanfang databases.
Music therapy could lower scores on the Hamilton Depression Rating Scale, the National Institutes of Health stroke scale and self-rated depression scale for patients with PSD. Music therapy was also shown to improve the Barthel Index for Activities of Daily Living and treatment efficacy of PSD patients.
Music therapy did not reduce the incidence of adverse reactions in PSD patients.
Abstract
Background
The clinical application of music therapy and research into its use and effectiveness are common in Western countries. The physiological role of this type of therapy is to stimulate the central nervous system through music, which may have a sedative, analgesic effect, and reduce negative emotions. Previous studies have confirmed that music can be effective for a range of psychological disorders, including post-stroke depression (PSD). There is, however, a lack of systematic evaluation of its effectiveness, and variability in sample size and in the quality of research has detracted from the persuasiveness of findings.
Methods
Based on PRISMA 2020, articles on music therapy intervention in post-stroke depression were identified through the Web of Science, PubMed, EMBASE, CNKI, Weipu, and Wanfang databases. The retrieval time was taken from the establishment of the database to October 18, 2022. Two researchers conducted a stringent evaluation of the quality of the articles and extracted the data. They then used RevMan5.3 software for meta-analysis.
Results
Twenty articles were listed, involving 1625 patients. Meta-analysis results showed that music therapy could lower scores on the Hamilton Depression Rating Scale (HDRS/Ham-D), the National Institutes of Health stroke scale and self-rated depression scale for patients with PSD. Music therapy was also shown to improve the Barthel Index for Activities of Daily Living and treatment efficacy of PSD patients. However, music therapy did not reduce the incidence of adverse reactions in PSD patients.
Conclusion
Music therapy has benefits in improving HDRS/Ham-D score and symptoms of PSD patients, and could be more widely applied.
1. Introduction
Stroke is a serious manifestation of a variety of cerebrovascular diseases (ischemic or hemorrhagic), and become the foremost cause of death in China.1 Stroke has a serious impact on multiple functional areas, usually leading to disability. It affects the quality of life of patients and produces negative emotional states.2 Post-stroke depression (PSD) is the most common of these.3 Lv et al.4 found that about 33 % of stroke patients suffer from depression. The onset of depressive symptoms depends on the interaction of psychological and genetic factors, general vascular damage, stroke severity and disability, cognitive impairment, and comorbidities.5 In most cases, PSD occurs in the first month after a stroke and tends to become chronic, which interferes with functional recovery.6 PSD is mainly manifested as pessimism, low self-worth, sleep disorders, fatigue, inattention, and suicidal tendencies.7 PSD has a significant negative impact on physical, cognitive and functional rehabilitation, which reduces the survival rate after stroke and delays the recovery of patients.8
The pathogenesis of PSD is still unclear. At present, most scholars believe that monoamine neurotransmitters, neurotrophic factors, inflammatory factors and social psychology are closely related to the occurrence and development of PSD.4, 9, 10 The relatively mainstream theory of monoamine neurotransmitters that post-stroke brain monoamine neurotransmitters such as 5-hydroxytryptamine (5-HT), norepinephrine and other abnormal expression caused by functional defects, and then neuronal conduction dysfunction for PSD.11, 12 Selective serotonin re-uptake inhibitors (SSRI) are effective in clinical practice and are often recommended as first-line drugs.13 However, there may be adverse reactions, withdrawal reactions and drug resistance.14 There is, therefore, an urgent need to seek other complementary and alternative therapies.
Music therapy has a long history, has been widely researched and is common in clinical application in Western countries.15 Its physiological role is to stimulate the central nervous system, creating a sedative, analgesic effect, and reducing negative emotions.16 Previous study17 have confirmed that music is effective for a range of psychological disorders, such as depression and anxiety. Music has also been used to treat motor and speech dysfunction after stroke.18 Music therapy can also improve cognitive functions, including verbal memory, attention, concentration and behavioral disorders.19 Listening to music, therefore, would seem to be an effective treatment for reducing PSD and increasing rehabilitation efficacy.16, 20 However, there are few clinical studies on music therapy for PSD and there is no unified conclusion on the effect of music therapy for PSD. This study used meta-analysis to evaluate the value of music in the treatment of PSD patients, and provides evidence for clinical music therapy services for PSD patients.[…]
By Daniel Thomas, managing director at Chroma Therapies
What is Neurological Music Therapy (NMT)?
NMT is a model of music therapy, guided by research, to address functional changes for people with neurological disorders.
It involves a collection of techniques that use the perception, production and performance of music to stimulate, shape, and change movement dynamics, speech and language skills, and cognitive skills.
Who can benefit from NMT?
NMT can help improve the quality of life for those living with:
an Acquired Brain Injury (ABI) such as a haemorrhagic stroke
a Traumatic Brain Injury (TBI)
amputees
the elderly (especially those prone to falling)
and those living with a neurological condition that affects function or speech.
The purpose of NMT is to help the brain relearn, and the way in which it does this is by creating new neural pathways and bypassing the damaged area of the brain. Through these new pathways, the brain uncovers a new way to enable someone to perform a task such as speak or move.
NMT techniques to aid speech development
The musical properties of melody and rhythm immediately help the brain find new neural pathways to bypass the damaged areas of the brain.
Exercises may include sound warm ups. The client sings different sounds up and down the scale and using different rhythms. Then using a keyboard, the therapist can play different chords – each chord representing a word. When the chord changes, the client then changes the word. This allows the client to work on specific vocabulary, using well-known tunes from songs. This is especially effective in haemorrhagic stroke victims.
Oral Motor and Respiratory Exercises (OMREX) is a technique designed to enhance articulatory control, respiratory strength and the function of speech apparatus often with wind instruments. It uses a mixture of familiar music and improvisation, allowing the client to work on breath control and increase the duration of play, both of which play a vital role in speech development.
NMT techniques to aid walking ability
Rhythmic Auditory Stimulation (RAS) is a scientific walking technique that uses rhythm and musical cues as a facilitating stimulus for training optimum gait. Essentially, when someone links neurologically to a beat and tempo, it aids walking practice.
RAS uses strong, predictable rhythmic patterns to guide the sensori-motor movements required for walking. Predictable rhythmic structure allows the sensori-motor system to move ‘in sync’ with the beat.
Stroke patients have reported improved stride length and symmetry with RAS. Similarly, there is a reduction in falls in the elderly when using RAS as it increases muscle strength, gait and walking speed. It is all in the music.
Music with high beats per minute (BPM) promotes movement, good cadence and walking speed. Walking speed correlates with functional ability and balance confidence. BPM strongly correlates to step cadence, and therefore walking speed. Improved walking speed equates to improved balance.
Patterned Sensory Enhancement (PSE) exercises are often implemented for pre-prosthetic lower limb amputees. They isolate specific hip movements and promote development of greater hip control ensuring the stump remains straight, in a neutral position and preventing any compensatory actions. This helps prevent the client walking in an unnatural manner with their prosthetic.
NMT for core strength development
Therapeutic Instrumental Musical Performance (TIMP) exercises focus on reaching toward an instrument to:
challenge core strength
improve sitting balance skills
and extend range of movement.
The importance of NMT
These are just a handful of specific NMT techniques that enable Neurologic Music Therapists to support those living with neurological conditions, work towards achieving their functional goals.
NMT can be implemented as a stand-alone treatment but typically forms an integral part of a multidisciplinary team. In doing this, every aspect of the patient/clients rehab is enhanced.
NMT techniques help support:
speech and language therapy
physiotherapy
and occupational therapy goals.
Implemented as a team effort, NMT serves to improve all rehab outcomes.
Sound waves are all around us resonating at audible and inaudible frequencies. Our ability to hear is crucial in providing information and enabling interaction with our environment. The human brain generates neural oscillations or brainwaves through synchronised electrical impulses. In epilepsy these brainwaves can change and form rhythmic bursts of abnormal activity outwardly appearing as seizures. When two waveforms meet, they can superimpose onto one another forming constructive, destructive or mixed interference. The effects of audible soundwaves on epileptic brainwaves has been largely explored with music. The Mozart Sonata for Two Pianos in D major, K. 448 has been examined in a number of studies where significant clinical and methodological heterogeneity exists. These studies report variable reductions in seizures and interictal epileptiform discharges. Treatment effects of Mozart Piano Sonata in C Major, K.545 and other composer interventions have been examined with some musical exposures, for example Hayden’s Symphony No. 94 appearing pro-epileptic. The underlying anti-epileptic mechanism of Mozart music is currently unknown, but interesting research is moving away from dopamine reward system theories to computational analysis of specific auditory parameters. In the last decade several studies have examined inaudible low intensity focused ultrasound as a neuro-modulatory intervention in focal epilepsy. Whilst acute and chronic epilepsy rodent model studies have consistently demonstrated an anti-epileptic treatment effect this is yet to be reported within large scale human trials. Inaudible infrasound is of concern since at present there are no reported studies on the effects of exposure to infrasound on epilepsy. Understanding the impact of infrasound on epilepsy is critical in an era where sustainable energies are likely to increase exposure.
Major advances in music neuroscience have fueled a growing interest in music-based neurological rehabilitation among researchers and clinicians. Musical activities are excellently suited to be adapted for clinical practice because of their multisensory nature, their demands on cognitive, language, and motor functions, and music’s ability to induce emotions and regulate mood. However, the overall quality of music-based rehabilitation research remains low to moderate for most populations and outcomes. In this consensus article, expert panelists who participated in the Neuroscience and Music VII conference in June 2021 address methodological challenges relevant to music-based rehabilitation research. The article aims to provide guidance on challenges related to treatment, outcomes, research designs, and implementation in music-based rehabilitation research. The article addresses how to define music-based rehabilitation, select appropriate control interventions and outcomes, incorporate technology, and consider individual differences, among other challenges. The article highlights the value of the framework for the development and evaluation of complex interventions for music-based rehabilitation research and the need for stronger methodological rigor to allow the widespread implementation of music-based rehabilitation into regular clinical practice.
TBI Rehabilitation 