Posts Tagged Music therapy
Guidelines in stroke rehabilitation recommend the use of a multidisciplinary approach. Different approaches and techniques with music are used in the stroke rehabilitation to improve motor and cognitive functions but also psychological outcomes. In this randomized controlled pilot trial, relational active music therapy approaches were tested in the post-acute phase of disease. Thirty-eight hospitalized patients with ischemic and hemorrhagic stroke were recruited and allocated in two groups. The experimental group underwent the standard of care (physiotherapy and occupational therapy daily sessions) and relational active music therapy treatments. The control group underwent the standard of care only. Motor functions and psychological aspects were assessed before and after treatments. Music therapy process was also evaluated using a specific rating scale. All groups showed a positive trend in quality of life, functional and disability levels, and gross mobility. The experimental group showed a decrease of anxiety and, in particular, of depression (p = 0.016). In addition, the strength of non-dominant hand (grip) significantly increased in the experimental group (p = 0.041). Music therapy assessment showed a significant improvement over time of non-verbal and sonorous-music relationships. Future studies, including a greater number of patients and follow-up evaluations, are needed to confirm promising results of this study.
[ARTICLE] Improvement in Stroke-induced Motor Dysfunction by Music-supported Therapy: A Systematic Review and Meta-analysis
To conduct a meta-analysis of clinical trials that examined the effect of music-supported therapy on stroke-induced motor dysfunction, comprehensive literature searches of PubMed, Embase and the Cochrane Library from their inception to April 2016 were performed. A total of 10 studies (13 analyses, 358 subjects) were included; all had acceptable quality according to PEDro scale score. The baseline differences between the two groups were confirmed to be comparable. Compared with the control group, the standardized mean difference of 9-Hole Peg Test was 0.28 (−0.01, 0.57), 0.64 (0.31, 0.97) in Box and Block Test, 0.47 (0.08, 0.87) in Arm Paresis Score and 0.35 (−0.04, 0.75) in Action Research Arm Test for upper-limb motor function, 0.11 (−0.24, 0.46) in Berg Balance Scale score, 0.09 (−0.36, 0.54) in Fugl-Meyer Assessment score, 0.30 (−0.15, 0.74) in Wolf Motor Function Test, 0.30 (−0.15, 0.74) in Wolf Motor Function time, 0.65 (0.14, 1.16) in Stride length and 0.62 (0.01, 1.24) in Gait Velocity for total motor function, and 1.75 (0.94, 2.56) in Frontal Assessment Battery score for executive function. There was evidence of a positive effect of music-supported therapy, supporting its use for the treatment of stroke-induced motor dysfunction. This study was registered at PRESPERO (CRD42016037106).
Stroke is a multifaceted and complicated condition. Stroke disease is one of the major causes of long-term disability and one of the leading causes of death worldwide1,2. The time frequency and functional source analysis of the signals facilitate the quantification of the functional changes occurring in the brain in association with motor tasks after stroke and the detection of damage to neuro-motor functioning3. The personal burden of being a stroke survivor is often devastating and has major consequences for the patient’s quality of life4. Rehabilitation of upper-limb motor dysfunction and total motor dysfunction have been revealed to improve the quality of life of patients after stroke5 and are safe and effective methods for restoring social and occupational functioning.
Motor dysfunction therapy relies on both pharmacological6 and non-pharmacological treatments7. Currently, pharmacological therapy is essentially symptomatic and does not have a satisfactory impact on symptoms related to the progression of neurodegenerative diseases. Therefore, several health institutions recommend the development of non-pharmacological complementary interventions as a first-line treatment. For example, intensive motor therapy can improve important motor functions. However, the effectiveness of standard physiotherapeutic approaches in stroke rehabilitation has been found to be limited8. In the human brain, one of the most powerful sources of auditory stimulation is provided by music9. As a result, more attention has been given to the effectiveness of non-pharmacological approaches in dysfunction therapy, including a growing interest in music therapy and music-based stimulation10.
The power of music and its nonverbal nature make it an effective medium of communication when language is diminished or abolished, though the curative effect of music is still uncertain. Music easily elicits movement, stimulating interactions between perception and action systems11. Thus, music-making may be an effective way to induce plastic changes in the motor system. Music-supported therapy is a prospective new series of therapy programs, and comprehensive research suggests that it could be useful because of its promotion of relaxation and of cognitive and motor improvement in post-stroke rehabilitation12. Therefore, music-supported therapy has been developed with the aim of improving motor recovery after stroke. The definition of music-supported therapy is not only hearing the music but also singing and playing rhythm and percussion instruments and is based on four principles: (i) massive repetition and exercising of simple finger and arm movements; (ii) auditory-motor coupling and integration and reinforcement of motor effects due to immediate auditory feedback; (iii) shaping and adapting the training according to individual progress; and (iv) emotion-motivation effects due to the playfulness and emotional impact of music and the acquisition of a new skill13. Music-supported therapy may involve, for example, rhythmic auditory stimulation14, the use of a MusicGlove15 or listening to CDs16. However, the differences between these music-supported techniques have not been comprehensively considered.
Music-supported therapy has been shown to be effective in post-stroke rehabilitation of motor function in some clinical trials14,15,16,17,18,19,20,21,22,23. However, little research has focused on the potential therapeutic mechanisms by which music-supported therapy improves the motor functions of post-stroke patients. Although many researchers suggest that improvement induced by music-supported therapy is due to the combined effects of intensive repetitive practice and musical stimulation21, evidence to support these propositions has been unavailable. To explore the isolated effect of music further, we designed a systematic review on the effect of music-supported therapy on the recovery of upper-limb motor function and total motor function after stroke. No previous reviews have provided a comprehensive overview with meta-analyses.
[ARTICLE] Home-based hand rehabilitation after chronic stroke: Randomized, controlled single-blind trial comparing the MusicGlove with a conventional exercise program
Abstract — Individuals with chronic stroke have limited options for hand rehabilitation at home. Here, we sought to determine the feasibility and efficacy of home-based MusicGlove therapy. Seventeen participants with moderate hand impairment in the chronic phase of stroke were randomized to 3 wk of home-based exercise with either the MusicGlove or conventional tabletop exercises. The primary outcome measure was the change in the Box and Blocks test score from baseline to 1 mo post treatment. Both groups significantly improved their Box and Blocks test score, but no significant difference was found between groups. The MusicGlove group did exhibit significantly greater improvements than the conventional exercise group in Motor Activity Log Quality of Movement and Amount of Use scores 1 mo posttherapy (p = 0.007 and p = 0.04, respectively). Participants significantly increased their use of MusicGlove over time, completing 466 gripping movements per day on average at study end. MusicGlove therapy was not superior to conventional tabletop exercises for the primary end point but was nevertheless feasible and led to a significantly greater increase in self-reported functional use and quality of movement of the impaired hand than conventional home exercises.
Hand impairment after stroke contributes substantially to disability in the United States and around the world . Intensive movement practice can reduce hand impairment [2–6], but issues such as cost and access may limit the dose of rehabilitation exercise delivered one-on-one with a therapist. Because of these and other factors, most individuals do not perform the large number of exercise repetitions required during therapy to maximize recovery [7–8]. Home-based rehabilitation programs may be prescribed after stroke with the intent to increase the amount of rehabilitation exercise individuals perform. However, the most common approach to home-based hand therapy is following a printed handout of exercises. This approach is often not motivating and thus is associated with low compliance and high dropout rates [9–13].
To address this problem, other types of home-based rehabilitation programs for the hand have been proposed. For example, one pilot study explored a modified form of constraint-induced movement therapy performed under the supervision of a nonprofessional coach in the home and found similar benefits to the same program performed with a trained therapist in a clinic ; a larger study using this protocol found that home-based constraint-induced movement therapy led to significantly greater self-reported use of the impaired limb than conventional therapy . Another common approach is telerehabilitation, which allows a therapist to guide therapy remotely . While this approach is gaining popularity, a recent Cochrane systematic review of 10 trials with 933 total participants found limited evidence to support its use and no studies that examined its cost-effectiveness . Other approaches to home-based hand rehabilitation include functional electrical stimulation , computer gaming with custom devices [19–21], and music-based therapy . However, despite the variety of options, few home-based programs have been tested in controlled studies . Further, it is still unclear which methods are the most effective and efficient means of providing an increased dose of rehabilitation, though the use of computer games and music has been found to be highly motivating [20,24–26].
We developed the MusicGlove, an instrumented glove with sensors on each of the fingertips and the lateral aspect of the index finger. The MusicGlove requires the user to practice functional gripping movements by touching the sensor on the tip of the thumb to one of the other five sensors in time with music through a video game that displays scrolling notes on a screen (Figure 1). In previous pilot studies performed in a clinical setting, we found that the MusicGlove motivated individuals with chronic stroke to perform hundreds of functional gripping movements during a 30 min training session and that exercise with the device led to a significantly greater improvement in hand grasping ability, measured with the Box and Blocks test, than a time-matched dose of conventional tabletop therapy performed with a rehabilitation therapist [27–28]. The individuals who used the MusicGlove also reported that the exercise was more motivating than conventional therapy and expressed interest in using the device to exercise at home. An important question, therefore, was whether self-guided exercise with the MusicGlove performed at home is feasible and improves hand function compared with conventional home therapy.
[Poster] The Efficacy of Playing Musical Instruments for Upper Limb Rehabilitation among Individuals with Stroke: A Systematic Review
To conduct a systematic review on the use of musical instruments as a form of upper limb rehabilitation in individuals post stroke and to assess its effectiveness in improving motor outcomes.
The brain has a large capacity for automatic simultaneous processing and integration of sensory information. Combining information from different sensory modalities facilitates our ability to detect, discriminate, and recognize sensory stimuli, and learning is often optimal in a multisensory environment. Currently used multisensory stimulation methods in stroke rehabilitation include motor imagery, action observation, training with a mirror or in a virtual environment, and various kinds of music therapy. Non-invasive brain stimulation has showed promising preliminary results in aphasia and neglect. Patient heterogeneity and the interaction of age, gender, genes, and environment are discussed. Randomized controlled longitudinal trials starting earlier post-stroke are needed. The advance in brain network science and neuroimaging enabling longitudinal studies of structural and functional networks are likely to have an important impact on patient selection for specific interventions in future stroke rehabilitation. It is proposed that we should pay more attention to age, gender, and laterality in clinical studies.
We live in a multisensory environment and the interaction between our genes and the environment shapes our brains. The brain has a large capacity for automatic simultaneous processing and integration of sensory information, and multisensory influences are integral to primary as well as higher order cortical operations (Ghazanfar and Schroeder, 2006). Combining information from different sensory modalities facilitates our ability to detect, discriminate, and recognize sensory stimuli (Driver and Noesselt, 2008; Shams and Seitz, 2008; Gentile et al., 2011). Non-invasive brain stimulation does not only affect the targeted local regions but also activity in remote interconnected regions. Although repetitive transcranial magnetic stimulation (rTMS) cannot directly target subcortical structures, the activity in thalamus can be modulated by stimulation of parietal cortex, an observation that open up new possibilities for studies of cortical–subcortical interactions in multisensory processing (Blankenburg et al., 2008, 2010). Multisensory enhancement of detection sensitivity for low-contrast visual stimuli by sounds reflects a brain network involving not only established multisensory and sensory-specific cortex but also visual and auditory thalamus (Noesselt et al., 2010). Diffusion tensor imaging and tractography have enhanced the opportunity to study white matter tract networks and compare structural and functional connectivity in humans (Ciccarelli et al., 2008). Combining non-invasive brain stimulation with neuroimaging offers an opportunity to study causal relations between specific brain regions and individual cognitive and perceptual functions (Driver and Noesselt, 2008; Driver et al., 2009; Bolognini and Maravita, 2011; Zamora-López et al., 2011). Non-invasive brain stimulation techniques have the advantage that they can be used both as diagnostic tools and in treatment.
[ARTICLE] Music-supported therapy (MST) in improving post-stroke patients’ upper-limb motor function
Objective: Music-supported therapy (MST) is a new approach for motor rehabilitation of stroke patients. Recently, many studies have demonstrated that MST improved the motor functions of post-stroke patients. However, the underlying mechanism for this effect is still unclear. It may result from repeated practice or repeated practice combined with musical stimulation. Currently, few studies have been designed to clarify this discrepancy. In this study, the application of “mute” musical instruments allowed for the study of music as an independent factor.
Methods: Thirty-three post-stroke patients with no substantial previous musical training were included. Participants were assigned to either audible music group (MG) or mute music group (CG), permitting observation of music’s independent effect. All subjects received the conventional rehabilitation treatments. Patients in MG (n = 15) received 20 extra sessions of audible musical instrument training over 4 weeks. Patients in CG (n = 18) received “mute” musical instrument training of the same protocol as that of MG. Wolf motor function test (WMFT) and Fugl—Meyer assessment (FMA) for upper limbs were utilised to evaluate motor functions of patients in both groups before and after the treatment. Three patients in CG dropped out.
Results: All participants in both groups showed significant improvements in motor functions of upper limbs after 4 weeks’ treatment. However, significant differences in the WMFT were found between the two groups (WMFT-quality: P = 0.025; WMFT-time: P = 0.037), but not in the FMA (P = 0.448). In short, all participants showed significant improvement after 4 weeks’ treatment, but subjects in MG demonstrated greater improvement than those in CG.
Discussion: This study supports that MST, when combined with conventional treatment, is effective for the recovery of motor skills in post-stroke patients. Additionally, it suggests that apart from the repetitive practices of MST, music may play a unique role in improving upper-limb motor function for post-stroke patients.
We spoke with Kyle and Lindsey Wilhelm about their innovative techniques of helping stroke survivors regain their speech and movement.
How does music therapy help stroke survivors with aphasia?
Music therapists often work in collaboration with speech-language pathologists to address speech and language skills with stroke survivors. Survivors who suffer from aphasia may have difficulty speaking, but during therapy discover that they can sing an entire song fluently.
This is because the part of the brain affected by the stroke that controls expressive language (known as Broca’s area) is localized in one area of the brain while music production (singing and playing instruments) and processing (receptive listening) activates multiple areas of the brain.
By using music, the therapist can work on skills using the non-damaged areas of the brain to help the survivor relearn how to do what the damaged area of the brain used to do.
How does music therapy help stroke survivors with their physical therapy?
Music therapists also collaborate with physical therapists to help survivors regain functioning of both their upper and lower extremities as well as fine and gross motor skills. For example, the music therapy technique Rhythmic Auditory Stimulation (RAS) uses a steady, rhythmic pulse to help the survivor with their gait (walking). The survivor will naturally match the strong rhythmic pulse providing the temporal support to regulate individual steps and motivation to keep going.
How often should a stroke survivor meet with a music therapist?
The key to learning or relearning any skill is repetition. A typical frequency is 1-2 times per week, but additional therapy will likely improve physical and motor skills.
The music therapist can show the survivor ways to incorporate music into exercises prescribed by other therapists at home. By making the exercises more enjoyable, the survivor will be more likely to do them regularly, which can positively affect rehabilitation overall.
How to find a music therapist in your local area.
2) Ask your speech therapist for a recommendation.
[REVIEW] Post-Stroke Depression | EBRSR – Evidence-Based Review of Stroke Rehabilitation – Full Text PDF
Depression is a common complication post-stroke affecting approximately one-third of patients. The presence of post-stroke depression has been associated with decreases in functional recovery, social activity and cognition. In addition, the presence of mental health disorders following stroke may be associated with increased mortality. The present review discusses the prevalence, natural history and risk factors for post-stroke depression as well as issues around its assessment and impact on rehabilitation outcomes. Strategies for the prevention and management of post-stroke depression are reviewed. Recommendations for assessment and treatment are provided based on current guidelines. A discussion of post-stroke emotionalism, its impact and treatment is also included.
[ARTICLE] Retraining and assessing hand movement after stroke using the MusicGlove: comparison with conventional hand therapy and isometric grip training – Full Text PDF
Background: It is thought that therapy should be functional, be highly repetitive, and promote afferent input to best stimulate hand motor recovery after stroke, yet patients struggle to access such therapy. We developed the MusicGlove, an instrumented glove that requires the user to practice gripping-like movements and thumb-finger opposition to play a highly engaging, music-based, video game.The purpose of this study was to 1) compare the effect of training with MusicGlove to conventional hand therapy 2) determine if MusicGlove training was more effective than a matched form of isometric hand movement training; and 3) determine if MusicGlove game scores predict clinical outcomes.
Methods: 12 chronic stroke survivors with moderate hemiparesis were randomly assigned to receive MusicGlove, isometric, and conventional hand therapy in a within-subjects design. Each subject participated in six one-hour treatment sessions three times per week for two weeks, for each training type, for a total of 18 treatment sessions. A blinded rater assessed hand impairment before and after each training type and at one-month follow-up including the Box and Blocks (B & B) test as the primary outcome measure. Subjects also completed the Intrinsic Motivation Inventory (IMI).
Results: Subjects improved hand function related to grasping small objects more after MusicGlove compared to conventional training, as measured by the B & B score (improvement of 3.21±3.82 vs. -0.29±2.27 blocks; P=0.010) and the 9 Hole Peg test (improvement of 2.14±2.98 vs. -0.85±1.29 pegs/minute; P=0.005). There was no significant difference between training types in the broader assessment batteries of hand function. Subjects benefited less from isometric therapy than MusicGlove training, but the difference was not significant (P>0.09). Subjects sustained improvements in hand function at a one month follow-up, and found the MusicGlove more motivating than the other two therapies, as measured by the IMI. MusicGlove games scores correlated strongly with the B & B score.
Conclusions: These results support the hypothesis that hand therapy that is engaging, incorporates high numbers of repetitions of gripping and thumb-finger opposition movements, and promotes afferent input is a promising approach to improving an individual’s ability to manipulate small objects. The MusicGlove provides a simple way to access such therapy.
Keywords: Stroke rehabilitation device, Hand, Music therapy, Video game therapy, Stroke assessment, Outcome measures