[ARTICLE] The Use of Rhythmic Auditory Stimulation to Optimize Treadmill Training for Stroke Patients: A Randomized Controlled Trial – Full Text

Abstract

The use of functional music in gait training termed rhythmic auditory stimulation (RAS) and treadmill training (TT) have both been shown to be effective in stroke patients (SP). The combination of RAS and treadmill training (RAS-TT) has not been clinically evaluated to date. The aim of the study was to evaluate the efficacy of RAS-TT on functional gait in SP. The protocol followed the design of an explorative study with a rater-blinded three arm prospective randomized controlled parallel group design. Forty-five independently walking SP with a hemiparesis of the lower limb or an unsafe and asymmetrical walking pattern were recruited. RAS-TT was carried out over 4 weeks with TT and neurodevelopmental treatment based on Bobath approach (NDT) serving as control interventions. For RAS-TT functional music was adjusted individually while walking on the treadmill. Pre and post-assessments consisted of the fast gait speed test (FGS), a gait analysis with the locometre (LOC), 3 min walking time test (3MWT), and an instrumental evaluation of balance (IEB). Raters were blinded to group assignments. An analysis of covariance (ANCOVA) was performed with affiliated measures from pre-assessment and time between stroke and start of study as covariates. Thirty-five participants (mean age 63.6 ± 8.6 years, mean time between stroke and start of study 42.1 ± 23.7 days) completed the study (11 RAS-TT, 13 TT, 11 NDT). Significant group differences occurred in the FGS for adjusted post-measures in gait velocity [F_{(2, 34)} = 3.864, p = 0.032; partial η² = 0.205] and cadence [F_{(2, 34)}= 7.656, p = 0.002; partial η² = 0.338]. Group contrasts showed significantly higher values for RAS-TT. Stride length results did not vary between the groups. LOC, 3MWT, and IEB did not indicate group differences. One patient was withdrawn from TT because of pain in one arm. The study provides first evidence for a higher efficacy of RAS-TT in comparison to the standard approaches TT and NDT in restoring functional gait in SP. The results support the implementation of functional music in neurological gait rehabilitation and its use in combination with treadmill training.

Introduction

About 60% of all stroke patients (SP) have difficulties with walking (1). These are often caused by hemiparesis and/or sensory deficits of the lower extremity and/or trunk and are also due to uncoordinated movements. In addition to motor and sensory dysfunctions, symptoms such as spasticity, somato-sensory neglect, and cognitive malfunctioning may further impede walking. Thus, the restoration of gait is often a key focus of rehabilitation efforts, enhancing not only physical activity but also autonomy and participation in everyday life (2, 3).

Treadmill training (TT) with and without body weight support has been shown to improve functional gait in stroke patients effectively. A meta-analysis comparing 44 trials (n = 2,658 patients) revealed clear therapeutic effects on gait velocity and walking endurance, the latter only for TT with body weight support (1). However, the improvements were identified only for independent walkers while patients who walked with assistance did not show an additional benefit from TT (1). Lee’s work (4) provided evidence that TT with a high walking velocity at the beginning of training is more effective when compared to a stepwise increase in velocity.

Rhythmic-auditory stimulation (RAS) is defined as a therapeutic application of pulsed rhythmic or musical stimulation in order to improve gait or gait related aspects of movement (5). It has been demonstrated that SP are able to synchronize their gait pattern to auditory stimulation using music with an embedded metronome (6–8). This led to immediate improvements in stride time and stride length symmetry as well as weight bearing time on the paretic side, while EMG showed a more balanced muscular activation pattern between the paretic and non-paretic sides (6). Training effects of RAS for SP were confirmed in a meta-analysis comparing 7 randomized controlled studies (n = 197) that showed improvements in functional gait performance (velocity, cadence, and stride length) (9). This work also gave evidence, that a musical stimulation is more effective in improving gait velocity and cadence then the metronome (9). Hayden et al. found that RAS became more effective when it is implemented earlier in the rehabilitation program. This provides evidence that the variation in time of the RAS-training during the rehabilitation process may affect the success of the treatment (10). The application of RAS on the treadmill (RAS-TT) was evaluated over a 3-week training period by Park et al. In that study metronome stimulation was used for 9 patients with chronic stroke. The results were compared with a group of 10 patients performing over ground RAS walking training (11). The RAS-TT group experienced greater improvements in gait velocity (11).

While RAS and TT have proven to be effective for gait training in SP, the efficacy of its combination (RAS-TT) in the early course of rehabilitation in SP has not been investigated to date. Therefore, we hypothesized that RAS-TT in the early course of rehabilitation would improve the clinical efficacy of TT for SP. The purpose of the present study was to investigate the functional improvements of gait using a rehabilitation therapy combining RAS and TT in order to assess its clinical efficacy for patients suffering the aftermaths of a stroke.

Materials and methods

Design

The study protocol was approved by the state authorization association for medical issues in Brandenburg, that determined on the 21st of January 2010 that no formal ethics approval was required. Patients gave their informed consent according to the Helsinki declaration.

The study was designed as a prospective, single center three arm clinical study with parallel groups. We enrolled patients who performed either RAS on the treadmill (RAS-TT) or treadmill training alone (TT). A third group that received neurodevelopmental treatment following the Bobath approach (NDT) served as a control group. The patients were randomly assigned to the three training interventions by a person not involved in the study using a block randomization (software randlist). Allocations were placed in sealed sequentially numbered envelopes and were not opened until the actual study inclusion. Thus, the patients, the responsible doctor, the assessing physiotherapist, and study manager were not informed beforehand regarding the group assignment.

We included stroke patients with a hemiparesis of the lower limb (at least 1 muscle group with muscle strength grade <5 as defined by the British Medical Research Council) or with an unsafe and asymmetrical walking pattern (by assessment of a physiotherapist). The patients had to be able to walk independently with assistive devices if necessary for at least 3 min.

Criteria for exclusion were the following: significantly disturbed language perception (marked by either the Aachener Aphasietest or Token Test), cognitive impairment (Mini Mental Status Test <26), major depression or productive psychosis, adjustment disorder with a need for medical treatment, peripheral arterial occlusive disease with walking distance <100 m, and coronary heart disease (instable angina pectoris).

After having passed the diagnostics patients underwent a screening session on the treadmill. There they had to demonstrate a stable and sufficiently ergonomic gait. Candidates with insufficient quality of gait on the treadmill (multimodal neglect or spasticity as assessed by a physiotherapist) were postponed and re-screened every week (Figure ​(Figure11).

Figure 1
Patient flow chart of study design. RAS-TT, rhythmic auditory stimulation on treadmill; TT, treadmill training; NDT, neurodevelopmental treatment.

[…]

Continue —>  The Use of Rhythmic Auditory Stimulation to Optimize Treadmill Training for Stroke Patients: A Randomized Controlled Trial

[WEB SITE] Music Therapy Can Rewire a Broken Brain – Videos

Photo credit: Ali Eminov / Flickr (CC BY-NC 2.0) and ElisaRiva / Pixabay (CC0 1.0)

Nothing brings out the grinch in some like the early debut of seasonal music when the season hasn’t even started. Reactions can of course go the other way — people weep with joy at memories attached to a song from their past.

Whatever the reaction, music is powerful. Now, a small company in Massachusetts is trying to harness that power to help people with traumatic brain injuries talk again. And scientists say music is actually rewiring patients’ brains.

It is well documented that those with Alzheimer’s disease can benefit from hearing and singing songs they remember from earlier in life — but research into music’s ability to create new pathways in the brain to combat impairment of language abilities (aphasia), hemineglect, and loss of movement is relatively new. Hemineglect is when brain trauma leads patients to lose the ability to pay attention to one side of space. For example, ask them to draw a clock face and they will only draw half of it, ignoring the other side and leaving it completely blank.

The branch of rehabilitation called Neurologic Music Therapy (NMT) helps patients who have suffered terrible brain injuries regain function — through singing and playing percussive instruments.

When brain injuries affect the left side of the brain, patients can struggle with aphasia because the language function is all held on the left side. Music is different. The fine motor skills necessary to appreciate and make music are a mix of the creative skills found on the right hemisphere, and the mathematical and linguistic aspects found on the left. Playing music has also been shown to strengthen the part of the brain that links between both hemispheres, the corpus callosum. NMT can build a new language area in the right hemisphere, as the late Dr. Oliver Sacks said while speaking about one of the most high-profile brain injury success stories — that of former Rep. Gabby Giffords. “Nothing activates the brain so extensively as music, to be possible to create a new language area in the right hemisphere.”

This is the science that NMT triggers — and that NMT companies like Medrhythms are trying to put to use. It is one of only a handful of neurological rehabilitation companies in the country, created to meet the demand witnessed by its CEO and founder Dr. Brian Harris in the early stages of his career.

Like most of the small number of music therapists in the US, Harris started off as an employee of a hospital working at a stroke and brain injury unit. In fact he was the very first music therapist at Spaulding hospital in New England.

“Within just a few weeks of me being there people were getting better faster, with greater results, and very quickly the demand for these services outgrew our ability to supply them,” he told WhoWhatWhy. He saw an opportunity, and started his company as a way of meeting that need. At first it was a lot of hard, lonely, yet rewarding work.

“It was me, working at the hospital eight hours a day. And then I was going to people’s homes in the evenings and weekends doing in-home care. Then we started hiring some other therapists and we quickly grew.”

Despite there being so few practitioners in this new field it seems as though demand for more NMT therapists will rise as news of its benefits spread.

This week’s videos are a demonstration of a patient’s progress thanks to NMT sessions, and a fun cartoon showing just exactly what happens to the brain when playing music.

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via Music Therapy Can Rewire a Broken Brain – WhoWhatWhy

[Conference Proceedings] Rhythmic Entrainment for Hand Rehabilitation Using the Leap Motion Controller – Full Text PDF

Abstract

Millions of individuals around the world suffer from motor impairment or disability, yet effective, engaging, and cost-effective therapeutic solutions are still lacking. In this work, we propose a game for hand rehabilitation that leverages the therapeutic aspects of music for motor rehabilitation, incorporates the power of gamification to improve adherence to medical treatment, and uses the versatility of devices such as the Leap Motion Controller to track users’ movements. The main characteristics of the game as well as future research directions are outlined.

Full Text PDF

via Rhythmic Entrainment for Hand Rehabilitation Using the Leap Motion Controller | Kat Agres

[BLOG POST] Art and music therapy after TBI offer a creative outlet – and bring joy, too!

Discovering How Art and Music Therapy Can Bring Healing After TBI

OCTOBER 1ST, 2018

I’m always careful to keep in mind that there are TBI Survivors who will never fall into certain categories – this is one of those times. Although there can be creative outlets for a large percentage of Survivors, there will always be limitations for some. Since every brain injury presents its own challenges, I wanted to acknowledge that first and foremost. Let’s explore how art and music therapy after tbi can make a difference!

Creative music and art therapy provide help for recovery, recuperation and cognition through listening to music, learning to play an instrument, or through creative art and writing. Music is powerful in the way it can conjure memories of a certain time or place in a person’s life. It also can stir emotions through the song’s structure and words. Learning to play music can create a free flow that comes to a person effortlessly (it seems, at least), or it can be tedious and frustrating to others. Either way, it builds memory in different ways – either by repetition and learning, by building retention and memory capabilities…or by listening to music. This can bring a feeling of “knowing” that is like no other – knowing the song, or knowing it sounds familiar, knowing the words, and also having memories flood back that may relate to another time in a survivor’s life. All of these things can be helpful, but all may not bring positive memories. Nonetheless, remembering things can bring a certainty that “all is not lost”, and can provide a foundation on which a new life can be built, and new memories can be made and added in the days ahead.

The Department of Defense website offers information from the Centers for Disease Control and Prevention saying that about 1.5 million people in the United States have a TBI each year and that 85,000 people have long-term disabilities. That’s a lot of people, and in turn, a lot of rebuilding of lives.

Music is a Healer

Here is an excerpt of an article about TBI recovery that illustrates how music and art therapy are being used in a military setting (Here’s the link to the story  Brain Injury Sufferers Find Benefits in Music Therapy Program )

“The Creative Forces music therapy program assists with the needs of military patients and veterans who have been diagnosed with TBI, as well as their families and caregivers,” said Danielle Kalseth, 673rd Medical Operations Squadron creative arts therapist/music therapist. “Not only do we provide clinical services, we want to provide patients and their families access to the arts in the community.”

The music therapy program currently helps 30 patients rehabilitate from TBI, with new referrals every week. Patients who receive music therapy can participate in group or individual sessions, or a combination of both.

The program enables TBI sufferers to engage in a meaningful activity with others who are experiencing the same issues.

“Music therapy helps with more than just my memory; it helps with my mood too,” Young said. “On days when I’m in a bad mood, playing the guitar is a great way to change that.”

Art therapy is one of many treatment modalities used daily with brain injury patients throughout Brooks’ continuum of care. Art aids in the recovery process by allowing survivors to do something they enjoy. When utilizing art therapy as a treatment intervention, Brooks clinicians are working on various functional skills such as fine motor skills, gross motor skills, standing tolerance, endurance, communication, expression of feelings, relaxation, socialization, memory and problem-solving skills. (*end of excerpt)

You Gotta Have Art

Using art as therapy is also a great way to treat the effects of TBI and helps fuel recovery. When used as a therapeutic approach, it…

• helps eye-to-hand coordination (motor skills),
• strengthens a person through standing or sitting up,
• improves communication through personal interaction with others,
• helps memory and expression of thoughts/feelings.

Creating artwork also can be rewarding – bringing a feeling of accomplishment, and even relaxation. In short, it’s just a great outlet for sharing thoughts AND feelings in a creative way that builds coordination, self-awareness, and confidence.

Music Strikes A Common Chord For People

When it comes to music, it turns out that you don’t have to play an instrument to reap the benefits of cognitive improvement. Listening to music as therapy creates positivity, an improved mood, better focus, and better behavior.

Here’s a great excerpt from an article by Shantala Hegde on the Frontiers in Neurology website. Music-Based Cognitive Remediation Therapy for Patients with Traumatic Brain Injury.  It’s an in-depth, clinically-based story about Music-Based Cognitive Remediation Therapy for Patients with Traumatic Brain Injury.

Here’s the excerpt:

From a neuroscientific perspective, indulging in music is considered one of the best cognitive exercises. With “plasticity” as its veritable nature, the brain engages in producing music indulging an array of cognitive functions and the product, the music, in turn, permits restoration and alters brain functions. With scientific findings as its basis, “neurologic music therapy” (NMT) has been developed as a systematic treatment method to improve sensorimotor, language, and cognitive domains of functioning via music. A preliminary study examining the effect of NMT in cognitive rehabilitation has reported promising results in improving executive functions along with improvement in emotional adjustment and decreasing depression and anxiety following TBI. (end of excerpt)

Don’t Write Things Off – Write Them Down!

In the world of a TBI Survivor, one of the most personal and reflective ways to share thoughts, feelings, desires, goals, progress, concerns, hopes, dreams (and more) is through writing and journaling. By sharing their thoughts through writing, a TBI Survivor can make huge strides toward healing (physically, mentally and emotionally). It brings self-awareness, self-expression, and can help rebuild after “loss of self” through reinvention and creativity. Journaling can be done individually, in a group or with assistance from caregivers or family. (Here is an excerpt from Journaling After Brain Injury, Written by Barbara Stahura, CJF)

Some good ways to start off writing a journal can start with these basic prompts:

• Today I feel…
• I feel stronger when…
• I’m proud of myself because…
• If I could change…
• Even though now I can’t (fill in the blank),

I can still…

• I am grateful for…
• I feel powerful when…
• I want my life to include…
• One year from today…
• When I was 10 (or some younger age), I…
• When I am 60 (or some age older than you are now),

I…

Remember, don’t worry about the “rules” of writing.

Just let your pen move across the page and let the words

flow. Be kind and don’t judge yourself or what you write.

Conclusion

Journaling is a very helpful practice after a brain

injury, both for the person with the injury and family

caregivers and members. Writing down your thoughts

and feelings about what is happening in your life can help

you develop safe ways to cope with change and create a

healthy new life.

(Excerpt from Journaling After Brain Injury, Written by

Barbara Stahura, CJF, and Susan B. Schuster, 2009, ©, All rights reserved – used with permission of authors)

Working To Find Therapeutic Healing Through Art and Music

Visual/Fine arts can be quite rewarding and can bring out the best in a person’s creative expression. It can help a TBI Survivor in many different ways, including the development of creativity, dexterity, motor skills and coordination, technique, and self-expression. In the book “Reinventing Oneself After Loss,” by Hilary Zayed, the author explores her meaning of loss, her search for a new identity, and the reinvention of her “new self” with her new self-awareness. Art became her vehicle for self-exploration as she struggled to build a new identity and move forward.

Hilary is a great example of a person who was quite different after her TBI, and her motivation and determination to take her life in a new direction resulted in finding a new passion for writing and art. Working primarily as a painter and mosaic artist, Hilary found that her new direction was a natural fit and that it was rewarding in many ways…although it was completely different from her previous life as a teacher, horseback rider, and accomplished flute player. She had lost a lot of memories of her life before TBI. She struggled with loss-of-self but decided to forge ahead and pursue what she felt were the gifts that had replaced her former abilities. Her journey took her to a new place, with a better sense of self – and a new identity. One that brought her joy and a sense of accomplishment. Although this is a best-case scenario, many Survivors can take Hilary’s lead, and find things that help complete their lives – even small things that make them happy, such as journaling, poetry, socializing, board games, crossword puzzles or word searches, etc. It all depends on what appeals to them! If they find that art is an interest, adult coloring books are fun and relaxing. If they want to draw, a sketchbook and pencils (or colored pencils) is an inexpensive and easy way to see if that’s their strong suit. The point is to help them search for the thing(s) that suit their desires, talents, and abilities. Creating art, writing and music can propel people to new heights of healing and cognition.

Maybe this will inspire you (as a Survivor) or as someone who loves and assists a TBI Survivor…find inspiration, and in turn, find your new self, or inspire someone to aspire higher!

 

via Art and music therapy after TBI offer a creative outlet – and bring joy, too!

[ARTICLE] Music meets robotics: a prospective randomized study on motivation during robot aided therapy – Full Text

Abstract

Background

Robots have been successfully applied in motor training during neurorehabilitation. As music is known to improve motor function and motivation in neurorehabilitation training, we aimed at integrating music creation into robotic-assisted motor therapy. We developed a virtual game-like environment with music for the arm therapy robot ARMin, containing four different motion training conditions: a condition promoting creativity (C+) and one not promoting creativity (C–), each in a condition with (V+) and without (V–) a visual display (i.e., a monitor). The visual display was presenting the game workspace but not contributing to the creative process itself. In all four conditions the therapy robot haptically displayed the game workspace. Our aim was to asses the effects of creativity and visual display on motivation.

Methods

In a prospective randomized single-center study, healthy participants were randomly assigned to play two of the four training conditions, either with (V+) or without visual display (V–). In the third round, the participants played a repetition of the preferred condition of the two first rounds, this time with a new V condition (i.e., with or without visual display). For each of the three rounds, motivation was measured with the Intrinsic Motivation Inventory (IMI) in the subscales interest/enjoyment, perceived choice, value/usefulness, and man-machine-relation. We recorded the actual training time, the time of free movement, and the velocity profile and administered a questionnaire to measure perceived training time and perceived effort. All measures were analysed using linear mixed models. Furthermore, we asked if the participants would like to receive the created music piece.

Results

Sixteen healthy subjects (ten males, six females, mean age: 27.2 years, standard deviation: 4.1 years) with no known motor or cognitive deficit participated. Promotion of creativity (i.e., C+ instead of C–) significantly increased the IMI-item interest/enjoyment (p=0.001) and the IMI-item perceived choice (p=0.010). We found no significant effects in the IMI-items man-machine relation and value/usefulness. Conditions promoting creativity (with or without visual display) were preferred compared to the ones not promoting creativity. An interaction effect of promotion of creativity and omission of visual display was present for training time (p=0.013) and training intensity (p<0.001). No differences in relative perceived training time, perceived effort, and perceived value among the four training conditions were found.

Conclusions

Promoting creativity in a visuo-audio-haptic or audio-haptic environment increases motivation in robot-assisted therapy. We demonstrated the feasibility of performing an audio-haptic music creation task and recommend to try the system on patients with neuromuscular disorders.

 

Background

Following a stroke, 80-90% of patients suffer from arm paresis, which remains chronic in about 30-40% of all cases [1, 2, 3]. Task-oriented, intensive, and motivational training is important to increase arm function post-stroke [2, 4, 5, 6, 7, 8].

Intensity is recognized as a key feature of successful rehabilitation therapy [9]. Robots in neurorehabilitation allow for highly-intensive, task-oriented training and have the potential to be superior to conventional therapies (i.e., physical or occupational therapy) in improving motor function post-stroke [10]. Robotic therapy may embed functional training tasks into computer games to facilitate motor learning and to stimulate motivation [11].

Autonomy, competence, and relatedness can be regarded as the main components of intrinsic motivation [12, 13]. While extrinsic motivation can be described as a goal-directed drive towards an externally provided reward (e.g., a score in a game), intrinsic motivation is a process oriented and internally provided reward due to a satisfying, interesting, meaningful or enjoyable activity [14, 15]. The knowledge regarding the meaningfulness of an activity is a positive determinant of patient motivation [7]. Thus, for patients, an activity should not only be enjoyable, but also lead to a rehabilitation progress. Furthermore, patient engagement is related to the expected reduction of impairment during game-based therapy in stroke [16].

Activities with a close relation to intrinsic motivation are frequently associated with activities promoting creativity [17, 18, 19]. This might be because activities promoting creativity involve one’s own accord, active decision making, and a resulting product, thus satisfying the need of autonomy, competence, and relatedness [12, 20, 21, 22].

In addition to encouraging creativity, music is a promising stimulator for intrinsic motivation in the context of rehabilitation [23, 24]. Music effectively promotes post-stroke recovery in motor and cognitive functions, and furthermore in emotional and social domains [25, 26, 27, 28, 29, 30, 31]. Studies that compared conventional therapy forms to therapy tasks embedded in active music making revealed that music-associated training increases the level of motivation significantly [24, 32].

Auditory displays have already been determined to be effective for navigation within complex systems [33]. Accordingly, sound is an audible source for navigation through the execution of a task in virtual scenarios without the need for a visual display unit, the advantage being that the visual focus can be on the trained limb rather than a graphical display, thus promoting visuo-motor control [34, 35].

We developed tasks for robot-assisted training of the arm that aim to increase intrinsic motivation with a focussed stimulation of the two aspects: creativity and music. To investigate whether a music condition promoting creativity influences motivation differently than a music condition not promoting creativity, we compared motivational effects of both versions. We investigated the effect of the presence or absence of a visual display for both conditions regarding promotion of creativity. As the training goal of the presented gamified task is to induce high intensity during exercise, the game is operated by repetitive horizontal movements.

For this current study, we designed audio-haptic tasks in a way that they can be performed either with visual display (i.e., a monitor presenting the game workspace) as an audio-visuo-haptic environment or without a visual display as an audio-haptic environment only. To reduce the cognitive load of the participants and have more cognitive resources for creation and decision making processes, we designed the visual display and the haptic environment such that they both presented the same game workspace [36]. Accordingly, the visuals were not essential to complete the audio-haptic task.

Given these related works, the primary hypothesis was that a gamified task promoting creativity embedded in a task for motor therapy increases intrinsic motivation more than a gamified task not promoting creativity. Our second hypothesis was that a gamified task in motor therapy without visual display increases intrinsic motivation more than a gamified task with visual display. Moreover, we hypothesized that promoting creativity and omitting a visual display would increase total training time, free movement time and perceived product value. We further hypothesized that promoting creativity and omitting a visual display would reduce energy expenditure, relative perceived training time and perceived effort.[…]

 

Fig. 1ARMin arm rehabilitation robot. Additionally for this study, a keyboard was placed close to the participant’s left hand so that the space bar could be used as input device

Continue —>  Music meets robotics: a prospective randomized study on motivation during robot aided therapy | Journal of NeuroEngineering and Rehabilitation | Full Text

[BLOG POST] Therapy for Brain Injuries: Facing the Music

Therapy for Brain Injuries: Facing the Music

July 31, 2018

“Music gives a soul to the universe, wings to the mind, flight to the imagination and life to everything.” ― Plato

 

I recently attended a very interesting workshop delivered by Chroma, which focused on the important role that music therapy can play in the rehabilitation of those who have suffered brain injuries.

Chroma is a national provider of art therapy, music therapy and drama therapy.  Their team of therapists works with a range of organisations and professions, including solicitors, to deliver their services.

The workshop touched on the different holistic approaches to rehabilitation that are available to those who have suffered both traumatic and acquired brain injuries ― but focused mainly on a specific type of music therapy known as Neurologic Music Therapy (NMT).

Ref: https://merrymakers.org/music-brings-memories-back-to-injured-brain/

Music Therapy

Dealing with a brain injury can cause increased stress and difficulties for those who are affected.  Because music evokes emotion and memories in people, it can help them to deal with their anger, anxiety or depression by increasing positive emotions.  It can even help improve concentration and coordination, and can assist with basic abilities such as speech and physical movement.

Neurologic Music Therapy

NMT is an advanced type of music therapy, which uses recognised techniques to treat the brain using music and rhythm.  NMT can help brain injured patients by using the musical part of the brain, which is undamaged, to encourage them to achieve goals such as re-teaching language or re-learning how to walk.

 

When merged with other, more traditional therapies (such as physiotherapy and speech and language therapy), NMT is seen to have quite incredible results.

• NMT and language

For instance, where someone has suffered loss of speech due to a stroke, music can create new ways of learning how to verbally communicate again.

To illustrate how this can be achieved, we watched the following short clip showing Peter’s story:

Peter’s progress is a clear example of the positive impact NMT can have on speech and language in even a short period of time – just 5 months in his case.

• NMT and mobility

Where someone’s mobility has been impaired as a result of a brain injury, music can also help to improve their ability to walk, particularly when combined with physiotherapy.  This is because rhythm accesses movement centres of the brain.

Here is another clip demonstrating the power of NMT – focusing on mobility this time.

As you can see, George was only able to walk for 40 ft with a walking stick at the start of the session.  After just one session, he was able to walk 250 ft, without the aid of the stick and at a much quicker pace.

Costs Benefits of NMT

The above examples demonstrate how effective NMT can be when combined with conventional therapies.  Because clients respond to NMT so quickly and with such improved outcomes, the overall rehabilitation costs are often greatly reduced.  When combined with traditional rehabilitation treatments, NMT is therefore a cost-effective therapy for clients with either an acquired or traumatic brain injury. 

Who can access NMT?

NMT can benefit people with traumatic brain injuries (caused as a result of trauma or a blow to the head) or acquired brain injuries (present since birth or as a result of conditions such as stroke, encephalitis, brain haemorrhage or tumour).  NMT can also help people with neurologic disorders such as Parkinson’s Disease, dementia, and multiple sclerosis.

How can we help?

At Bolt Burdon Kemp, we are constantly looking for new and innovative treatments that can help our clients.

If we have supportive evidence from an independent medical expert to say that you suffered a brain injury due to negligent medical treatment and that you could benefit from music therapy, then we can look to recover the costs of the therapy as part of your compensation.

Even while the claim is ongoing, we will do everything that we can to obtain interim payments from the Defendant to pay for this therapy.  This means that even before your case has concluded, we can obtain a payout of some compensation to be able to cover the costs of your therapy.  This can allow you to access rehabilitation early on in the claim and means you can fund therapies (such as NMT) which may not be freely available on the NHS.

Kate O’Brien is a solicitor in the Adult Brain Injury team at Bolt Burdon Kemp.  If you or a loved one is concerned about the treatment you have received, contact Kate free of charge and in confidence on 020 7288 4814 or at KateO’Brien@boltburdonkemp.co.uk.  Alternatively, complete this form and one of the solicitors in the Medical Negligence team will contact you.  Find out more about the Adult Brain Injury team.

via Therapy for Brain Injuries: Facing the Music – Bolt Burdon Kemp

[ARTICLE] Let’s Improvise! iPad-based music therapy with functional electrical stimulation for upper limb stroke rehabilitation – Full Text

In plain language

In the western world, stroke has been identified as the leading cause of disability in adults. Impairment to the arm/hand and depressive symptoms seem to be among the most frequent resultants of stroke. This article describes a collaborative occupational therapy and music therapy intervention for post-stroke arm/hand recovery.  The intervention itself combines principles of music therapy with tablet technology and functional electrical stimulation. The implementation of this novel intervention, described in this clinical case report, has implications for benefits to physical and motivational aspects of rehabilitation. Recommendations for further research of this intervention are also discussed.

Abstract

This retrospective clinical case report will examine the implementation of a novel intervention combining a Functional Electrical Stimulation (FES) protocol with an iPad application. A 74-year-old female retired pianist and Professor of Music was admitted to a rehabilitation hospital following a left pontine stroke. On assessment, she was unable to use her right upper limb functionally. Conventional occupational therapy commenced soon after admission and consisted of functional retraining, including FES to the wrist and finger extensors. At week 4, the Registered Music Therapist (RMT) and Occupational Therapist (OT) collaborated to commence a trial of forearm FES in combination with an iPad-based music making application; ThumbJam. This application was used to encourage the patient to participate in touch sensitive musical improvisation using the affected hand in an attempt to promote engagement in complex motor patterns and non-verbal expression. Within 3 weeks, the patient was able to use ThumbJam without the FES, progressed to the keyboard in 4 weeks and has since commenced independent scales on the piano at home (21 weeks), as well as successful use of the upper limb in Activities of Daily Living (ADLs). On follow up (7 months), the patient reflected on the motivating elements of the intervention that helped her to achieve a functional outcome in her upper limb. This retrospective clinical case report will review the evidence with regard to FES and music therapy, outline the treatment protocol used and make recommendations for future research of “FES+ThumbJam” in upper limb stroke rehabilitation.[…]

Continue —> Let’s Improvise! iPad-based music therapy with functional electrical stimulation for upper limb stroke rehabilitation | Australian Music Therapy Association

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[ARTICLE] Home-based neurologic music therapy for arm hemiparesis following stroke: results from a pilot, feasibility randomized controlled trial – Full Text

Abstract

Objective:

To assess the feasibility of a randomized controlled trial to evaluate music therapy as a home-based intervention for arm hemiparesis in stroke.

Design:

A pilot feasibility randomized controlled trial, with cross-over design. Randomization by statistician using computer-generated, random numbers concealed in opaque envelopes.

Setting:

Participants’ homes across Cambridgeshire, UK.

Subjects:

Eleven people with stroke and arm hemiparesis, 3–60 months post stroke, following discharge from community rehabilitation.

Interventions:

Each participant engaged in therapeutic instrumental music performance in 12 individual clinical contacts, twice weekly for six weeks.

Main measures:

Feasibility was estimated by recruitment from three community stroke teams over a 12-month period, attrition rates, completion of treatment and successful data collection. Structured interviews were conducted pre and post intervention to establish participant tolerance and preference. Action Research Arm Test and Nine-hole Peg Test data were collected at weeks 1, 6, 9, 15 and 18, pre and post intervention by a blinded assessor.

Results:

A total of 11 of 14 invited participants were recruited (intervention n = 6, waitlist n = 5). In total, 10 completed treatment and data collection.

Conclusion:

It cannot be concluded whether a larger trial would be feasible due to unavailable data regarding a number of eligible patients screened. Adherence to treatment, retention and interview responses might suggest that the intervention was motivating for participants.

Introduction

A total of 80% of stroke cases result in hemiparesis,¹ and half this number experience persistent lack of arm function.² Effective interventions are lacking, and evidence to support those that are accessible is insufficient.³ A clear need has been identified for long-term support in the community for people with stroke, but services are limited and few studies have examined home-based interventions and provided sufficient detail of the protocols used.⁴

Music interventions may be beneficial for improving arm function following stroke,^5,6 and a strong rhythmic stimulus embedded within music may enhance motor performance more than the use of a rhythmic stimulus alone without music.⁷ More research is needed to establish the effects of music interventions on arm function, and with the majority of rehabilitation being delivered in patients’ homes it is useful to determine the feasibility of home-based treatment delivery and research. This article reports on the feasibility of conducting a randomized controlled trial where a music intervention, for which there was a clear protocol based on published guidelines,^8,9 was delivered in a variety of home environments.

Continue —>  Home-based neurologic music therapy for arm hemiparesis following stroke: results from a pilot, feasibility randomized controlled trialClinical Rehabilitation – Alexander J Street, Wendy L Magee, Andrew Bateman, Michael Parker, Helen Odell-Miller, Jorg Fachner, 2018

[WEB SITE] Music Training and Neuroplasticity

February 25, 2013

With our multi sensory brain, music harnesses powers of nature, culture, and mind. How much is the brain changed by the effects of music training and neuroplasticity?

Music is one of the most demanding cognitive and neural challenges, requiring very accurate timing of multiple actions, precise interval control of pitch not involved in language, and multiple different ways of producing sound. Auditory and motor actions influence each other in a constant interplay, which is largely unknown.

Brain Lesion Effects on Music

All brain imaging is done in a time scale of seconds, but the brain functions in the scale of milliseconds. Imaging studies do not really correlate exactly to mental states (see post on limits of imaging). Because of this limitation, a major way to study specific regions of brain related to music has been study of brain lesions.

• A lesion in the auditory cortex causes “amusia” where a patient can speak and understand everyday sounds, but cannot notice wrong notes in tunes, or remember melodies.
• Another case, a 71-year-old cellist, had encephalitis and lost ordinary memory, but remembers music. 
• Patients with a lesion in right temporal can lose pitch perception.
• Damage to right temporal lobe can distort sound to have negative response to music.
• Patients with lesion in right temporal can lose pitch perception.

But, recent research shows that when studying infants these differences do not necessarily exist. In infancy there is much more overlap of music and language in the brain.  

What Is Known About Music in the Brain?

Perhaps some generalizations can be made:

Timing – some think timing is organized in the cerebellum (center of motor memory and learning.) Purely auditory perception has been observed in the cerebellum, but a single region does not control it.

Pitch – Different factors of a tune -contour, specific interval size, duration of notes, ratios of tones – are processed in different circuits throughout the brain. The right hemisphere does tonal processing.

Musical imagery is analyzed in regions of the frontal lobe.

Singing is dominant in right temporal lobe, while syntax of speech and music is left dominant.

The motor processes involve pre motor cortex, supplementary motor cortex, cerebellum, and basal ganglia, but in different amounts for different tasks.

Rhythm, Melody and emotion work in different parts of the brain

There are multiple different streams of neuronal activity for auditory processing pathways – the dorsal and ventral streams are important but especially dorsal with parietal and premotor cortex.

All neural systems – motor, sensory, emotional and analysis – are active in both performers and observers. Listening, as well as performing, use both motor and sensory systems, since observers trigger the muscles that are being utilized by the performers and dancers they are watching.

Recent studies show that learning absolute pitch, a very measurable skill, occurs only with genetic ability plus training before 12 to 15.[…]

 For more visit site —> Music Training and Neuroplasticity

[ARTICLE] Home-based neurologic music therapy for arm hemiparesis following stroke: results from a pilot, feasibility randomized controlled trial – Full Text

 

Abstract

Objective: To assess the feasibility of a randomized controlled trial to evaluate music therapy as a home-based intervention for arm hemiparesis in stroke.

Design: A pilot feasibility randomized controlled trial, with cross-over design. Randomization by statistician using computer-generated, random numbers concealed in opaque envelopes.

Setting: Participants’ homes across Cambridgeshire, UK.

Subjects: Eleven people with stroke and arm hemiparesis, 3–60 months post stroke, following discharge from community rehabilitation.

Interventions: Each participant engaged in therapeutic instrumental music performance in 12 individual clinical contacts, twice weekly for six weeks.

Main measures: Feasibility was estimated by recruitment from three community stroke teams over a 12-month period, attrition rates, completion of treatment and successful data collection. Structured interviews were conducted pre and post intervention to establish participant tolerance and preference. Action Research Arm Test and Nine-hole Peg Test data were collected at weeks 1, 6, 9, 15 and 18, pre and post intervention by a blinded assessor.

Results: A total of 11 of 14 invited participants were recruited (intervention n = 6, waitlist n = 5). In total, 10 completed treatment and data collection.

Conclusion: It cannot be concluded whether a larger trial would be feasible due to unavailable data regarding a number of eligible patients screened. Adherence to treatment, retention and interview responses might suggest that the intervention was motivating for participants.

Introduction

A total of 80% of stroke cases result in hemiparesis,¹ and half this number experience persistent lack of arm function.² Effective interventions are lacking, and evidence to support those that are accessible is insufficient.³ A clear need has been identified for long-term support in the community for people with stroke, but services are limited and few studies have examined home-based interventions and provided sufficient detail of the protocols used.⁴

Music interventions may be beneficial for improving arm function following stroke,^5,6 and a strong rhythmic stimulus embedded within music may enhance motor performance more than the use of a rhythmic stimulus alone without music.⁷ More research is needed to establish the effects of music interventions on arm function, and with the majority of rehabilitation being delivered in patients’ homes it is useful to determine the feasibility of home-based treatment delivery and research. This article reports on the feasibility of conducting a randomized controlled trial where a music intervention, for which there was a clear protocol based on published guidelines,^8,9 was delivered in a variety of home environments.[…]

Continue —> Home-based neurologic music therapy for arm hemiparesis following stroke: results from a pilot, feasibility randomized controlled trialClinical Rehabilitation – Alexander J Street, Wendy L Magee, Andrew Bateman, Michael Parker, Helen Odell-Miller, Jorg Fachner, 2017

Figure 1. Study flow diagram. Data collection occurred at weeks 1, 6, 9, 15 and 18. Cross-over analysis required data from weeks 1, 6, 9 and 15.