Posts Tagged neurologic music therapy

[ARTICLE] Musical Sonification of Arm Movements in Stroke Rehabilitation Yields Limited Benefits – Full Text

Neurologic music therapy in rehabilitation of stroke patients has been shown to be a promising supplement to the often strenuous conventional rehabilitation strategies. The aim of this study was threefold: (i) replicate results from a previous study with a sample from one clinic (henceforth called Site 1; N = 12) using an already established recording system, and (ii) conceptually replicate previous findings with a less costly hand-tracking system in Site 2 (N = 30), and (iii) compare both sub-studies’ outcomes to estimate the efficiency of neurologic music therapy. Stroke patients in both sites were randomly assigned to treatment or control groups and received daily training of guided sequential upper limb movements additional to their standard stroke rehabilitation protocol. Treatment groups received sonification (i.e., changes in musical pitch) of their movements when they moved their affected hand up and down to reproduce a sequence of the first six notes of a C major scale. Controls received the same movement protocol, however, without auditory feedback. Sensors at the upper arm and the forearm (Xsens) or an optic sensor device (Leapmotion) allowed to measure kinematics of movements and movement smoothness. Behavioral measures pre and post intervention included the Fugl-Meyer assessment (FMA) and the Stroke Impact Scale (SIS) and movement data. Bayesian regression did not show evidence supporting an additional effect of sonification on clinical mobility assessments. However, combined movement data from both sites showed slight improvements in movement smoothness for the treatment group, and an advantage for one of the two motion capturing systems. Exploratory analyses of EEG-EMG phase coherence during movement of the paretic arm in a subset of patients suggested increases in cortico-muscular phase coherence specifically in the ipsilesional hemisphere after sonification therapy, but not after standard rehabilitation therapy. Our findings show that musical sonification is a viable treatment supplement to current neurorehabilitation methods, with limited clinical benefits. However, given patients’ enthusiasm during training and the low hardware price of one of the systems it may be considered as an add-on home-based neurorehabilitation therapy.

Introduction

Stroke survivors frequently suffer from severe disabilities. Stroke may lead to impairments in motor and sensory systems, emotion regulation, language perception, and cognitive functions (Morris and Taub, 2008). Impaired arm function caused by gross-motor disability is also a common consequence of stroke immensely affecting quality of life in a considerable number of patients. In this case, regaining control over body movements is one of the crucial components in post-stroke recovery. There is an urgent need for effective motor rehabilitation approaches to improve quality of life in stroke survivors. Different therapeutic approaches such as Constraint Induced Movement Therapy (CIMT), mental practice, robot-aided therapy, electromyographic biofeedback, and repetitive task training have been applied to improve arm function after stroke (Langhorne et al., 2009). Of note, in a recent review it has been suggested that neurologic music therapy might be more effective than conventional physiotherapy (for a recent review see Sihvonen et al., 2017).

Motivational factors seem to play an important role for the beneficial effects of neurologic music therapy. From the patients’ informal descriptions of their experience with music-supported training, it appears that this is frequently highly enjoyable and a highlight of their rehabilitation process, regardless of the form of auditory stimulation, be it piano tones, or sonification of movement with other timbres [for a review see Altenmüller and Stewart (2018)]. However, effects of music supported therapy in stroke rehabilitation are not always consistent. In a recent review, seven controlled studies that evaluated the efficacy of music as an add-on therapy in stroke rehabilitation were identified (Sihvonen et al., 2017). In these studies, training of finger dexterity of the paretic hand was done using either a piano-keyboard, or, for wrist movements, drum-pads tuned to a C major scale. Superiority of the music group over fine motor training without music and over conventional physiotherapy was evident in one study after intervention comprising five 30-min sessions per week for 3 weeks (Schneider et al., 2010). The beneficial effect seen in the music group could be specifically attributed to the musical component of the training rather than the motor training per se, since patients practicing with mute instruments remained inferior to the music group. Here, the Fugl-Meyer Assessment (FMA) was applied before and after 20 sessions of either music supported therapy on a keyboard or equivalent therapy without sound. FMA scores of the motor functions of the upper limb improved by 16 in the music group and by 5 in the control group, both improvements being statistically significant although to a lesser degree in the control group (p = 0.02 vs. p = 0.04; Tong et al. (2015)).

With regard to the neurophysiological mechanisms of neurological music therapy, it was demonstrated that patients undergoing music supported therapy not only regained their motor abilities at a faster rate but also improved in timing, precision and smoothness of fine motor skills as well as showing increases in neuronal connectivity between sensorimotor and auditory cortices as assessed by means of EEG-EEG-coherence (Altenmüller et al., 2009Schneider et al., 2010).

These findings are corroborated by a case study of a patient who underwent music supported training 20 months after suffering a stroke. Along with the clinical improvement, functional magnetic resonance imaging (fMRI) demonstrated activation of motor and premotor areas, when listening to simple piano tunes, thus providing additional evidence for the establishment of an auditory-sensorimotor co-representation due to the training procedure (Rojo et al., 2011). Likewise, in a larger group of 20 chronic stroke patients, increases in motor cortex excitability following 4 weeks of music-supported therapy were demonstrated using transcranial magnetic stimulation (TMS), which were accompanied by marked improvements of fine motor skills (Amengual et al., 2013).

In addition to functional reorganization of the auditory-sensorimotor network, recent findings have reported changes in cognition and emotion after music-supported therapy in chronic stroke patients. Fujioka et al. (2018) demonstrated in a 10-week-long randomized controlled trial (RCT), including 14 patients with music supported therapy and 14 patients receiving conventional physiotherapy, that both groups only showed minor improvements. However, the music group performed significantly better in the trail making test, indicating an improvement in cognitive flexibility, and furthermore showed enhanced social and communal participation in the Stroke Impairment Scale and in PANAS (Positive and Negative Affect Schedule, Watson et al., 1988), lending support to the prosocial and motivational effects of music. In another RCT with an intervention of only 4 weeks, Grau-Sánchez et al. (2018) demonstrated no superiority in fine motor skills in the music group as compared to a control group, but instead an increase in general quality of life as assessed by the Profile of Mood states and the stroke specific quality of live questionnaire. Despite growing evidence, the neurophysiological mechanisms of neurological music therapy remain poorly understood.

Most of the existing studies on music-supported therapy have focused on rehabilitation of fine motor functions of the hand. Much less evidence exists on post-stroke rehabilitation of gross motor functions of the upper limbs. In a previous study we thus developed a movement sonification therapy in order to train upper arm and shoulder functions (Scholz et al., 2015). Gross movements of the arm were transformed into discrete sounds, providing a continuous feedback in a melodic way, tuned to a major scale (i.e., patients could use movements of their paretic arms as a musical instrument). In this way, sound perception substituted for defective proprioception. In a first pilot study in subacute stroke patients we were able to demonstrate that musical sonification therapy reduced joint pain in the Fugl-Meyer pain subscale (difference between groups: −10; d = 1.96) and improved smoothness of movements (d = 1.16) in comparison to movement therapy without sound (Scholz et al., 2016). Here, we extend these findings by comparing the effects of the established musical sonification setup (Scholz et al., 2016) with a newly developed, less expensive sonification device in a group of subacute stroke patients with upper limb motor impairments. The only apparent differences between both data acquisition methods were the improved sound quality and the loss of need to strap sensors to patient limbs. In order to further elucidate the neurophysiological underpinnings of musical sonification therapy we simultaneously recorded EEG and EMG data from a subset of patients to analyze cortico-muscular phase coherence during upper limb movements (Chen et al., 2018Pan et al., 2018). According to previous studies (Pan et al., 2018) we hypothesized that cortico-muscular phase coherence increases in the ipsilesional hemisphere after musical sonification therapy. […]

 

Continue —->  Frontiers | Musical Sonification of Arm Movements in Stroke Rehabilitation Yields Limited Benefits | Neuroscience

Figure 2. Experimental setup. (A) three-dimensional space (the Leapmotion controller at Site 2 was placed on the board at the position marked in purple), with axis labels describing qualitative sound changes when the hand was moved relative to the frame (and hence, the body). (B) Xsens sensors as used at Site 1, attached to wrist and upper arm of patient. (C) Leapmotion controller as used at Site 2, with the space axes superimposed. Panel (A) taken from Scholz et al. (2016).

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

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.


 

via Music Therapy Can Rewire a Broken Brain – WhoWhatWhy

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

Therapy for Brain Injuries: Facing the Music

July 31, 2018

 

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

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[WEB SITE] Taking music therapy into the mainstream – ACNR

Taking music therapy into the mainstream

Posted in on 3rd Jun 2018

Conference details: March 15th, 2018, London, UK.
Report by: Daniel Thomas, Joint Managing Director at Chroma.
Conflict of interest statement: None declared.
Published online: 3/6/18


Every 90 seconds, someone in the UK is admitted to hospital with an Acquired Brain Injury.

With over one million people in the UK currently living with the effects of a brain injury the estimated bill to the UK is £15 billion. The devastating impact radiates across families causing distress, relationship strain, financial hardship and an uncertain future. The injury has a huge physical and psychological payload.

Neurologic Music Therapy (NMT) offers an effective rehabilitation treatment that is backed by a wealth of clinical evidence and has been shown to have a profound influence on the brain. However, raising awareness of the benefits of arts therapies, including NMT, can be extremely difficult.

Chroma’s recent ABI conference entitled ‘Arts Therapies and Brain Injury: Optimising Outcomes Across Assessment, Treatment and Care’ brought together some of the leading international authorities and influencers in the arts therapies field. They delivered the latest research and scientific evidence on how arts therapies are improving outcomes for patients recovering from acquired brain injuries.

Chris Bryant, MP, and chair of the All Party Parliamentary Group on Acquired Brain Injury opened the conference by highlighting the growing problem of brain injuries and the wider impact it has on society.

Caroline Klage, Head of the Child Brain Injury Team at leading niche London law firm, Bolt Burdon Kemp, who sponsored the conference, welcomed the delegates.

She said: “As a firm, Bolt Burdon Kemp is keen to support NMT and raise awareness of its benefits. We are driven by the desire to ensure our clients receive the best quality input at the earliest point possible, with a view of enabling them to flourish and thrive post brain injury. NMT definitely has a role to play in that.”

Dr Jeanette Tamplin, of the University of Melbourne, provided an introduction to the evolving field of the creative arts therapies, specifically Neurologic Music Therapy. Dr Tamplin is pioneering the use of Virtual Reality to improve the participation and engagement of rehab patients on music therapy protocols.

“Music can bypass damaged areas, providing a scaffold to do the part of the work the brain is not doing in coordinating movement. But there is also the basic ‘use it or lose it principle’. When you exercise something, it gets stronger and the more you exercise, the better it becomes.”

The inspiring responses seen in some cases still needs to be backed up by more clinical research and Dr Tamplin added: “I want people to understand that we are an evidence-based profession and there are functional outcomes from music therapy.

“There are amazing benefits for quality of life and participating in life as well as being able to walk a bit better. Music makes us feel better and we use it in ways to help us through life but I’d like people to understand the research and evidence behind what we are doing.”

Sarah Johnson, a Neurologic Music Therapist and NMT pioneer from Colorado State University, presented a session on demonstrating the efficacy of NMT. She outlined the ‘Transformational Design Model’ a system that uses a clinical reasoning process to link assessments, goals, and learning through music.

Using case studies, video examples and clinical data, Sarah O’Doherty and Rebecca O’Connor, from the National Rehabilitation Hospital in Ireland, illustrated an innovative approach to assessing and treating children with acquired brain injuries. The approach involves a systematic observation and recording of the development of the child by a neuropsychologist during a music therapy treatment.

Practical hands-on workshops on applications in neuro-rehabilitation and articulating art therapy allowed delegates to experience, engage with and understand an arts therapy process from a client’s/patient’s point of view.

Dr Wendy Magee, a professor in the Music Therapy Department, at Temple University, Philadelphia, US showcased the MATADOC assessment for patients with prolonged disorders of consciousness (PDOC) that she and her colleagues pioneered.

According to Dr Magee, music is the auxiliary engine that has the power to reboot the brain following a catastrophic head injury, tumour or stroke. Dr Magee said: “A human being is born with the capacity to express emotions such as distress, anger and pleasure through musical parameters such as volume, dynamic range, pitch and melodic contour. So, in working with people who have lost the ability to communicate we can see that music is an innate way to communicate feelings.

“There is strong neurological evidence that music activates many different areas across the brain. The motor system is very sensitive to picking up cues from the auditory system so when we hear music, particularly pulse or rhythm, it kicks straight into the motor system going around the brain.”

Summing up the conference, Daniel Thomas, managing director of Chroma, who organised the event, said: “As a neurologic music therapist and parent, I am deeply aware of the need for arts therapies to be provided in line with the rehabilitation code at the earliest possible point in someone’s recovery.

“As a profession, we regularly punch above our weight and this conference has demonstrated our ability to make a significant difference to the lives of people with brain injuries, their families and the professional teams around them.

“It has also given a glimpse into the future developments of arts therapies and shown how it can be an absolutely essential rehabilitation treatment in mainstream health services.”

via Taking music therapy into the mainstream | ACNR | Online Neurology Journal

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[ARTICLE] Neurologic Music Therapy to Facilitate Recovery from Complications of Neurologic Diseases – Full Text 

Abstract

Neurologic music therapy (NMT) has fostered recovery from complications in patients suffering from a wide variety of neurologic diseases. Combining music and virtual reality with standard rehabilitation therapies can improve patient compliance and make therapy more enjoyable. Listening to music can reduce epileptiform discharges and enhances brain plasticity. Music produces variations in brain anatomy between musicians and non-musicians. Music therapy is an inexpensive intervention to help post-stroke patients to recover faster and more efficiently if applied soon after the event. There is evidence that incorporating music into a rehabilitation program fosters recovery of hand function, dexterity, spatial movement, cognitive function, mood, coordination, stride length and memory. Learning words as lyrics, melodic intonation therapy and singing can help the aphasic patient to recover faster. NMT therapists are valuable members of the rehabilitation team. NMT has been approved by the World Rehabilitation Federation as an effective evidence based method of treatment.

Introduction

Incorporating music into routine rehabilitation programs not only fosters initial recovery but also contributes to improvement and enduring benefit after stopping the treatment. Disabilities stem from different neurologic disorders, work-related injuries and trauma such as motor vehicle accidents and sport injuries. Disabilities can have devastating physical, emotional and financial effects on the lives of patients and their families. It is important to identify and incorporate strategies that supplement traditional rehabilitation therapy in order to optimize the recovery of function and quality of life. NMT, by facilitating the patients’ recovery, contributes to positive patient outcomes. The following reviews the evidence base highlighting the importance of adding music to more standard forms of rehabilitation therapy. It references the neurobiological foundation of NMT, its history and applications. Evidence in support of its use to facilitate recovery from a wide range of complications related to specific neurological diagnoses will be discussed.[…]

Continue —>  Neurologic Music Therapy to Facilitate Recovery from Complications of Neurologic Diseases | Insight Medical Publishing

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[ARTICLE] Music therapy in neurological rehabilitation settings – Full Text PDF

Summary

The neurologic music therapy is a new scope of music therapy. Its techniques deal with dysfunctions resulting from diseases of the human nervous system. Music can be used as an alternative modality to access functions unavailable through non-musical stimulus. Processes in the brain activated by the influence of music can be generalized and transferred to non-musical functions.

Therefore, in clinical practice, the translation of non-musical therapeutic exercises into analogous, isomorphic musical exercises is performed. They make use of the executive peculiarity of musical instruments and musical structures to prime, cue and coordinate movements. Among musical components, a repetitive rhythm plays a significant role. It regulates physiologic and behavioural functions through the mechanism of entrainment (synchronization of biological rhythms with musical rhythm based on acoustic resonance). It is especially relevant for patients with a deficient internal timing system in the brain.

Additionally, regular rhythmic patterns facilitate memory encoding and decoding of non-musical information hence music is an efficient mnemonic tool. The music as a hierarchical, compound language of time, with its unique ability to access affective/motivational systems in the brain, provides time structures enhancing perception processes, mainly in the range of cognition, language and motor learning. It allows for emotional expression and improvement of the motivation for rehabilitation activities.

The new technologies of rhythmic sensory stimulation (i.e. Binaural Beat Stimulation) or rhythmic music in combination with rhythmic light therapy appear. This multimodal forms of stimulation are used in the treatment of stroke, brain injury, dementia and other cognitive deficits.

Clinical outcome studies provide evidence of the significant superiority of rehabilitation with music over the one without music.

Full Text PDF

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