[WEB] Music Therapy and Virtual Reality Boost Post-Stroke Function

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 caregiver stress.

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

Source

[WEB] Soft robo-glove can help stroke patients relearn to play music

By Mischa Dijkstra, Frontiers science writer

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.

---

Read original paper

Download original paper (pdf)

---

“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.

Source

[ARTICLE] Virtual Reality Music Instrument Playing Game for Upper Limb Rehabilitation Training – Full Text

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.

Continue

[WEB] Next-generation neurotherapeutics

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.

Learn More

30,000 hours of clinical experience

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.

.

In-Person Services

World’s first prescription music platform

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.

.

Passionate team

We are powered by a team of passionate, dedicated leaders who are committed to our culture and mission.

• Clinical expertise – we know what works
• Technical expertise – we know how to build it
• Business expertise – we know how to get it into patients’ hands

Join our team

About Us

[Abstract] Wired for sound: The effect of sound on the epileptic brain

Abstract

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.

Similar articles

• Mozart K.448 and epileptiform discharges: effect of ratio of lower to higher harmonics.Lin LC, Lee WT, Wu HC, Tsai CL, Wei RC, Jong YJ, Yang RC.Epilepsy Res. 2010 May;89(2-3):238-45. doi: 10.1016/j.eplepsyres.2010.01.007. Epub 2010 Feb 2.PMID: 20129759
• Abstracts of Presentations at the Association of Clinical Scientists 143^rd Meeting Louisville, KY May 11-14,2022.[No authors listed]Ann Clin Lab Sci. 2022 May;52(3):511-525.PMID: 35777803
• Study of the Mozart effect in children with epileptic electroencephalograms.Grylls E, Kinsky M, Baggott A, Wabnitz C, McLellan A.Seizure. 2018 Jul;59:77-81. doi: 10.1016/j.seizure.2018.05.006. Epub 2018 May 9.PMID: 29763803
• [Epilepsy, Mozart and his sonata K.448: is the «Mozart effect» therapeutic?].Hernando-Requejo V.Rev Neurol. 2018 May 1;66(9):308-314.PMID: 29696618 Review. Spanish.
• Music in epilepsy: Predicting the effects of the unpredictable.Rafiee M, Istasy M, Valiante TA.Epilepsy Behav. 2021 Sep;122:108164. doi: 10.1016/j.yebeh.2021.108164. Epub 2021 Jul 10.PMID: 34256336 Review.

See all similar articles

Source

[Abstract] Toward applying a device to reduce motion artifact during imaging: a randomized controlled trial

Abstract

Objective: One of the most critical problems in different types of medical imaging modalities is unwanted patient movement during imaging procedures, which mainly occurs because of stress, anxiety, and restlessness in patients, resulting in poor image quality and decreased diagnostic accuracy.

Methods: This prospective, randomized, double-blinded, controlled trial comprised 267 patients who underwent MPI, randomly divided into three groups; Group I: streaming music with a special binaural beat frequency (MBB); Group II: streaming simple music (SM) and Group III: control group. Anxiety level was determined by the Depression Anxiety Stress-Scale (DASS) questionnaire and heart rate was monitored.

Results: Stress and anxiety scores were significantly lower in the MBB group compared with both SM and control group (P˂0.0001). Additionally, a significant decrease in heart rate of patients who were in the MBB group in comparison with the SM (p = 0.005) and control group (P = 0.018) was observed. The study revealed a significant decrease in motion artifact in the MBB group compared with the SM (P = 0.003) and control (P˂0.0001) groups.

Conclusions: Using the proposed device capable of streaming special binaural beat frequency embedded music can cause a significant reduction in anxiety level, heart rate, and consequently motion artifact.

Source

[WEB] Stroke Rehabilitation Through Music > Researchers are exploring how musical cues can help stroke patients regain motor functions -Videos

By MICHELLE HAMPSON

The researchers used different training modes such as having music continuously played, with the tone or pitch changing as the person moves the limb.  AALBORG UNIVERSITY

Stroke and other serious brain-related injuries can often require a long road to recovery, with countless hours of rehabilitation to regain motor function and other abilities. Various research groups have been exploring ways to make the rehabilitation process more efficient and engaging by providing auditory feedback to patients as they move, indicating—quite literally—whether the movement was a step in the right direction.

More recently, a group of researchers in Denmark has taken this auditory feedback approach one step further, with a new system that uses synthesized music to guide patients through their rehabilitation exercises. The new musical biofeedback system—and the results of pilot tests of the system with volunteers who have experienced stroke—is described in a study published 10 January in IEEE Transactions on Human-Machine Systems.

Whereas simple sound effects may be fatiguing and lack meaning, musical feedback is a way to enrich the rehabilitation experience and tap into humans’ natural affinity for moving to the beat.

Prithvi Ravi Kantan is a Ph.D. student with the Department of Architecture, Design, and Media Technology at Aalborg University Copenhagen who helped design and test the new system. The project is a result of his own experience with both music and rehabilitation.

He has been heavily involved in music performance and production over the past 15 years and was working full-time in audio signal processing in Mumbai when his father suddenly contracted viral encephalitis. The infection left his father paralyzed on one side, and Kantan witnessed first-hand the lengthy rehabilitation process.

“Given the impact that this had on me and my family, it was a revelation when I discovered music therapy, as it gave me a way to channel my professional skills towards a cause that held some personal meaning to me,” Kantan explains.

When he arrived at Aalborg University Copenhagen in 2018, he began working on the new musical biofeedback system with colleagues. It involves wireless motion sensors that are strapped to the patients’ ankles, back, or both, which monitor their movements. A software program then synthesizes music to match the patients’ movements, as they go through different physical rehabilitation activities (for example, walking, balancing, or transitioning between sitting and standing positions).

The system offers different musical-feedback training modes. For example, one method is when the body itself creates music. In this scenario, no sounds are made if the person is still. But if they move a foot forward, a musical tune is synthesized; the tone becomes louder as the foot moves forward faster.

Here’s an example with guitar strings that play as the user extends the leg from bent to straight. A bell rings if the user overextends the knee:

In another training mode, music is continuously played, and the tone or pitch changes as the person moves the limb:

Lastly, the researchers developed a training mode that provides negative feedback if a person does a movement in a way that deviates substantially from the goal. For example, the music may become more dissonant if the person slumps forward too much:

After developing the different training modes, Kantan and his colleagues tested the new musical biofeedback system with six study participants (four men and two women) who were recovering from stroke and had weakness on one side of the body. As well, several clinicians and musical therapists observed the rehabilitation sessions and were surveyed on the feasibility of the system.

The results showed that, in general, the musical cues were an effective means for conveying information related to movement–many of the volunteers were able to respond well to the musical cues and adjust their movements as needed. Two of the volunteers increased their pace significantly as the training progressed.

There were several challenges with the approach, however. For example, one volunteer had trouble hearing the musical cues, and sometimes the dynamic and layered sounds of the music were difficult for the volunteers to decipher.

“Patients need to be at a cognitive level where they can understand the feedback and act upon it,” says Kantan, noting that it’s easy for neurologically impaired people to get overstimulated by complex sounds. As well, the training mode that involves negative feedback was discouraging for some of the volunteers.

The clinicians and musical-therapy experts involved in the study noted that the suitability of the approach might depend on the severity and location of the user’s brain injury. For example, they recommended that stroke patients with cerebellar or lower brain-stem strokes may be better candidates for musical biofeedback therapy.

Although the results identified some limitations, the data suggest that musical biofeedback therapy is a feasible approach to rehabilitation and could open new avenues to recovery for people with brain injuries.

Notably, Kantan’s team designed its musical biofeedback system using a low-cost motion-sensing system and open-source tools, making it an easy tool to replicate and implement broadly. Their aim, Kantan says, is to accelerate the development and adoption of music-based feedback tools in rehabilitative practice.

“It would be extremely rewarding to contribute directly or indirectly to improving rehabilitation outcomes for patients,” says Kantan. “Although there is a lot of research to do before we see the widespread adoption of musical feedback in clinical practice, we at Aalborg University are determined to bring present efforts in the field to fruition in the coming years.”

Source

[ARTICLE] Therapeutic Instrumental Music Training and Motor Imagery in Post-Stroke Upper-Extremity Rehabilitation: A Randomized-Controlled Pilot Study – Full Text

Abstract

Objective

To investigate the potential benefits of three Therapeutic Instrumental Music Performance (TIMP)-based interventions in rehabilitation of the affected upper-extremity [UE] for adults with chronic post-stroke hemiparesis.

Design

Randomized-controlled pilot study

Setting

University research facility

Participants

Thirty community-dwelling volunteers [16 male/14 female; ages 33-76; mean age =55.9] began and completed the protocol. All participants had sustained a unilateral stroke > 6 months prior to enrollment [mean time post-stroke =66.9 months].

Interventions

Two baseline assessments, a minimum of one week apart; nine intervention sessions (3x/wk for 3 wks), in which rhythmically-cued, functional arm movements were mapped onto musical instruments; one post-test following the final intervention. Participants were block-randomized to one of three conditions: Group 1 – 45 minutes TIMP; Group 2 – 30 minutes TIMP, 15 minutes metronome-cued motor imagery (TIMP+cMI); Group 3 – 30 minutes TIMP, 15 minutes motor imagery without cues (TIMP+MI). Assessors and investigators were blinded to group assignment.

Main Outcome Measures

Fugl-Meyer Upper-Extremity (FM-UE); Wolf Motor Function Test- Functional Ability Scale (WMFT-FAS)

Secondary Measures

Motor Activity Log (MAL) – Amount of Use Scale; Trunk Impairment Scale.

Results

All groups made statistically significant gains on the FM-UE (TIMP, p=.005, r=.63; TIMP+cMI, p=.007, r=.63; TIMP+MI, p=.007, r=.61) and the WMFT-FAS (TIMP, p=.024, r=.53; TIMP+cMI, p=.008, r=.60; TIMP+MI, p=.008, r=.63). Comparing between-group percent change differences, on the FM-UE, TIMP scored significantly higher than TIMP+cMI (p=.032, r=.57), but not TIMP+MI. There were no differences in improvement on WMFT-FAS across conditions. On the MAL, gains were significant for TIMP (p=.030, r=.54) and TIMP+MI (p =.007, r=.63).

Conclusion

TIMP-based techniques, with and without motor imagery, led to significant improvements in paretic arm control on primary outcomes. Replacing a physical training segment with imagery-based training resulted in similar improvements; however, synchronizing internal and external cues during auditory-cued motor imagery may pose additional sensorimotor integration challenges.

Introduction

Among all neurological disorders, stroke contributes the largest proportion of disability-adjusted life-years (42.2%)¹. As millions of individuals cope with functional health loss, the economic burden due to post-stroke care continues to rise². People living with the effects of stroke score consistently low on life satisfaction, perceived health, and health-related quality of life³.

While a stroke may generate a number of disabling conditions, the most common sequela is motor impairment⁴. Volitional movements are often segmented, slow, and indirect⁵. If a functional threshold of recovery is not achieved, the affected individual may resort to compensatory movements⁶, and paretic learned non-use may ensue⁷.

Rehabilitation is thought to modulate motor recovery by interacting with underlying biological processes primarily during the first six months following a stroke⁸. Many individuals at the chronic stage no longer receive rehabilitation services; however, evidence is growing of significant treatment benefits during this phase^9-11. It is critical for persons at the chronic stage to continue to engage in rehabilitation that focuses on effective learning and training strategies, because behavioral experience has been shown to modify functional alterations in spared regions of the brain.¹² These strategies may include enhanced movement feedback, and opportunities for more independent training allowing for higher intensity rates. The music and imagery-based techniques in this study have been shown to address these needs^13,14 but have not been researched in integrated applications. Our study tries to address this gap by studying music-based interventions alone and in combination with imagery-based motor training.

Studies have shown beneficial effects of music interventions on motor control. The provision of structured temporal auditory information has been shown to lend significant stability to kinematic parameters during hemiparetic arm reaching^15,16. Studies in mapping functional movements on musical instruments found significant gains in hemiparetic arm rehabilitation¹³. The Neurologic Music Therapy technique¹⁷ used in this study, Therapeutic Instrumental Music Performance (TIMP), was developed through two research streams: Rhythmic Auditory Stimulation, which provides predictable anticipatory rhythmic cues to entrain movement^18,19, and Sonification, which provides augmented auditory feedback by mapping sound on kinematic parameters²⁰.

MI activates motor regions in the brain similar to physical practice²¹ and is widely used in sports training, but applications in neurorehabilitation have been more limited. For example, researchers found enhanced treatment efficacy when modified constraint-induced therapy was followed by MI practice^14,22. MI training offers many advantages, including more autonomous training time, potentially increasing the rate and intensity of therapy applications without additional physical load. However, a frequently reported shortcoming refers to reduced motor imagery abilities associated with decline in cognitive function. Thus, effective MI may need to be paired with a physically active component that produces a robust and stable representation of movement retainable during mental rehearsal. Combining a novel, music-based motor intervention with MI presents a potentially attractive means to enhance and extend the effectiveness of rehabilitation. TIMP may be such an intervention due to its augmented spatiotemporal structure and its rich sensory-based feedback-feedforward environment.

Therefore, the central goal of this study was to investigate if TIMP paired with MI and TIMP paired with cued MI (cMI), in which a rhythmic auditory cue used during active training was retained during imagery, showed better motor outcomes than TIMP alone. The effectiveness of all three conditions against no training was investigated by comparing intervention outcomes to a stable baseline control, determined by comparing two baseline measurements before interventions commenced. Based on previous research findings (e.g. ^14,22), it was anticipated that there would be greater reductions in impairment and improvements in functional capacity using MI in conjunction with active TIMP practice. It was also anticipated that cMI, retaining an auditory timing cue, would yield superior results to MI without an external cue.[…]

Continue

[WEB] How Listening To Music Benefits Your Brain

It’s long been said that music is mind medicine. Advances in neuroscience and brain imaging are revealing what’s happening in the brain to prove this true.

Research shows that listening to music can reduce anxiety, depression, blood pressure, and pain as well as improve sleep quality, mood, memory, increase some cognitive functions, enhance learning and concentration, and ward off the effects of brain aging. Music is so good for your brain because it is one of the few activities that stimulates your whole brain. Because music is structural, mathematical, and architectural based on relationships between one note and the next, it’s a total brain workout.

When you listen to music, much more is happening in your body than simple auditory processing. A recent imaging study found that music activated auditory, motor, and limbic brain regions no matter whether people were listening to Vivaldi or the Beatles. Research determined that the motor areas process rhythm, the auditory areas process sound, while the limbic regions are associated with emotions.

Music Reduces Stress and Depression

A meta-analysis of 400 studies validated the many health benefits of listening to music including lowering of the stress hormone, cortisol. In one study reviewed, patients about to undergo surgery who listened to music had less anxiety and lower cortisol levels than people who had taken drugs. The analysis determined that music had documented positive effects on brain chemistry and associated mental and physical health benefits in four areas:

• Lift mood.
• Stress reduction.
• Boosting immunity.
• Aids social bonding.

Listening to music triggers the brain’s nucleus accumbens, responsible for releasing the feel-good neurochemical dopamine, which is an integral part of the pleasure-reward and motivational systems and plays a critical role in learning. Higher dopamine levels improve concentration, boost mood, and enhance memory. Dopamine is the chemical responsible for the yummy feelings you get from eating chocolate, having an orgasm, or achieving a runner’s high.

Science shows that music can help alleviate depression and help a person feel more hopeful and in control of their life. There is even evidence that listening to music can aid in rewiring trauma in the brain. Playing music with others or enjoying live music gets the brain hormone oxytocin flowing increasing feelings of connectedness, trust, and social bonding.

One study found that listening to music reduced chronic pain by up to 21 percent and depression by up to 25 percent, and other research showed that music therapy significantly improved depressive symptoms.

How Music Enhances Cognition

Music has the power to improve specific higher brain functions and really can make you smarter.  In particular, science has shown that listening to music enhances reading and literacy skills, reasoning, and mathematical abilities.

In studies with people who listen to and play a lot of music – professional musicians’, brain scans reveal noticeably more symmetry, larger areas of the brain responsible for motor control, auditory processing, and spatial coordination, and more developed callosum. The corpus callosum is the band of nerve fibers that connects the two sides of the brain to each other, allowing communication.

Learning to play a musical instrument is one of the best things you can do for your brain, at any age. One study showed that just four years of music lessons in youth improved certain brain functions in tests 40 years later!

However, if you’re not a musician, just listening to music for enjoyment has positive effects too. Seniors who listened to specific types of music showed increased processing speed and improved episodic memory. Other tests revealed that listening to background music can increase productivity and enhance cognitive performance and creativity on some tasks.

Be careful, though. The type of music and task matter here. Certain music, like popular tunes with words, asks your brain to multi-task and can interfere with reading comprehension and information processing and is best used during breaks.

Music Boosts Memory

Your brain is hard-wired to connect music with long-term memory. Specific brain regions linked to autobiographical and episodic memories and emotions are activated by hearing familiar music. Listening to music has been shown to significantly improve working memory in older adults.

Even for persons with Alzheimer’s or severe dementia, music can tap deep into emotional recall. Personal music favorites can often calm chaotic brain activity and enable the listener to focus on the present moment and regain a connection to others. Research showed that scores on memory tests of Alzheimer’s patients improved after they listened to classical music.

Science has also confirmed that it’s possible to use music to help a young brain retain information and enhance learning.

Giving Your Brain A Musical Boost

Research is showing  that music therapy can improve health outcomes in a wide variety of populations, from premature infants and children with autism, ADHD or developmental and learning disabilities, to people with emotional trauma, substance abuse problems, brain injuries, physical disabilities, acute and chronic pain, depression, Parkinson’s disease, and more.

Science has recorded measurable changes in the brain following music therapy. Music therapy can involve working with a trained professional or completing a self-paced online program. You can also achieve benefits on your own by introducing children to music.

About a decade ago, I included music therapy from Advanced Brain Technologies as an integral part of the rehabilitation tools I used to heal from a serious brain injury. I still enjoy listening to their music today to relax and facilitate my meditation practice. Companies like Advanced Brain Technologies allow anybody to use music easily to improve their brain and life.

Advanced Brain Technology’s The Listening Program is a sound based program using the science of music to better your brain. The Listening Program trains your brain to improve how you perceive, process and respond to all of the sensory information your brain is bombarded with every day.

For more than a decade, The Listening Program has helped hundreds of thousands of children and adults with cognitive, behavioral, and emotional difficulties. People have used The Listening Program to think, speak, read and write better, prepare for college entrance exams and athletic events, improve productivity, learn new languages and musical instruments, and just to relax and sleep better. Learn more here.

Source

[Abstract] Music in epilepsy: Predicting the effects of the unpredictable

Abstract

Epilepsy is the most common serious neurological disorder in the world. Despite medical and surgical treatment, many individuals continue to have seizures, suggesting adjunctive management strategies are required. Promising effects of daily listening to Mozart K.448 on reducing seizure frequency in individuals with epilepsy have been demonstrated. In our recent randomized control study, we reported the positive effect of daily listening to Mozart K.448 on reducing seizures compared to daily listening to a control piece with an identical power spectrum to the Mozart piece yet devoid of rhythmic structure. Despite the promising effect of listening to Mozart K.448 on reducing seizure in individuals with epilepsy, the mechanism(s) underlying such an effect is largely unknown. In this paper, we specifically review how auditory stimulation alters brain dynamics, in addition to computational approaches to define the structural features of classical music, to then propose a plausible mechanism for the underlying anti-convulsant effects of listening to Mozart K.448. We review the evidence demonstrating that some Mozart pieces in addition to compositions from other composers such as Joplin contain less predictable rhythmic structure in comparison with other composers such as Beethoven. We propose through both entrainment and 1/f resonance mechanisms that listening to musical pieces containing the least predictable rhythmic structure, might reduce the self similarity of brain activity which in turn modulates low frequency power, situating the brain in a more “noise like” state and away from brain dynamics that can lead to seizures.

Source