Dataset Information

Music-supported motor training after stroke reveals no superiority of synchronization in group therapy.

ABSTRACT:

Background

Music-supported therapy has been shown to be an effective tool for rehabilitation of motor deficits after stroke. A unique feature of music performance is that it is inherently social: music can be played together in synchrony.

Aim

The present study explored the potential of synchronized music playing during therapy, asking whether synchronized playing could improve fine motor rehabilitation and mood.

Method

Twenty-eight patients in neurological early rehabilitation after stroke with no substantial previous musical training were included. Patients learned to play simple finger exercises and familiar children's songs on the piano for 10 sessions of half an hour. Patients first received three individual therapy sessions and then continued in pairs. The patient pairs were divided into two groups. Patients in one group played synchronously (together group) whereas the patients in the other group played one after the other (in-turn group). To assess fine motor skill recovery the patients performed standard clinical tests such as the nine-hole-pegboard test (9HPT) and index finger-tapping speed and regularity, and metronome-paced finger tapping. Patients' mood was established using the Profile of Mood States (POMS).

Results

Both groups showed improvements in fine motor control. In metronome-paced finger tapping, patients in both groups improved significantly. Mood tests revealed reductions in depression and fatigue in both groups. During therapy, patients in the in-turn group rated their partner as more sympathetic than the together-group in a visual-analog scale.

Conclusions

Our results suggest that music-supported stroke rehabilitation can improve fine motor control and mood not only individually but also in patient pairs. Patients who were playing in turn rather than simultaneously tended to reveal greater improvement in fine motor skill. We speculate that patients in the former group may benefit from the opportunity to learn from observation.

SUBMITTER: Van Vugt FT

PROVIDER: S-EPMC4033001 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Publications

Music-supported motor training after stroke reveals no superiority of synchronization in group therapy.

Van Vugt Floris T FT Ritter Juliane J Rollnik Jens D JD Altenmüller Eckart E

Frontiers in human neuroscience 20140520

<h4>Background</h4>Music-supported therapy has been shown to be an effective tool for rehabilitation of motor deficits after stroke. A unique feature of music performance is that it is inherently social: music can be played together in synchrony.<h4>Aim</h4>The present study explored the potential of synchronized music playing during therapy, asking whether synchronized playing could improve fine motor rehabilitation and mood.<h4>Method</h4>Twenty-eight patients in neurological early rehabilitat ...[more]

PMID: 24904358

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Project description:ObjectiveTo investigate the potential benefits of 3 therapeutic instrumental music performance (TIMP)-based interventions in rehabilitation of the affected upper-extremity (UE) for adults with chronic poststroke hemiparesis.DesignRandomized-controlled pilot study.SettingUniversity research facility.ParticipantsCommunity-dwelling volunteers (N=30; 16 men, 14 women; age range, 33-76 years; mean age, 55.9 years) began and completed the protocol. All participants had sustained a unilateral stroke more than 6 months before enrollment (mean time poststroke, 66.9 months).InterventionTwo baseline assessments, a minimum of 1 week apart; 9 intervention sessions (3 times/week for 3 weeks), in which rhythmically cued, functional arm movements were mapped onto musical instruments; and 1 post-test following the final intervention. Participants were block-randomized to 1 of 3 conditions: group 1 (45 minutes TIMP), group 2 (30 minutes TIMP, 15 minutes metronome-cued motor imagery [TIMP+cMI]), and group 3 (30 minutes TIMP, 15 minutes motor imagery without cues [TIMP+MI]). Assessors and investigators were blinded to group assignment.Main outcome measuresFugl-Meyer Upper-Extremity (FM-UE) and Wolf Motor Function Test- Functional Ability Scale (WMFT-FAS). Secondary measures were motor activity log (MAL)-amount of use scale and trunk impairment scale.ResultsAll groups made statistically significant gains on the FM-UE (TIMP, P=.005, r=.63; TIMP+cMI, P=.007, r=.63; TIMP+MI, P=.007, r=.61) and the WMFT-FAS (TIMP, P=.024, r=.53; TIMP+cMI, P=.008, r=.60; TIMP+MI, P=.008, r=.63). Comparing between-group percent change differences, on the FM-UE, TIMP scored significantly higher than TIMP+cMI (P=.032, r=.57), but not TIMP+MI. There were no differences in improvement on WMFT-FAS across conditions. On the MAL, gains were significant for TIMP (P=.030, r=.54) and TIMP+MI (P=.007, r=.63).ConclusionTIMP-based techniques, with and without MI, led to significant improvements in paretic arm control on primary outcomes. Replacing a physical training segment with imagery-based training resulted in similar improvements; however, synchronizing internal and external cues during auditory-cMI may pose additional sensorimotor integration challenges.

Project description:BackgroundVirtual reality-based training has found increasing use in neurorehabilitation to improve upper limb training and facilitate motor recovery.ObjectiveThe aim of this study was to directly compare virtual reality-based training with conventional therapy.MethodsIn a multi-center, parallel-group randomized controlled trial, patients at least 6 months after stroke onset were allocated either to an experimental group (virtual reality-based training) or a control group receiving conventional therapy (16x45 minutes within 4 weeks). The virtual reality-based training system replicated patients´ upper limb movements in real-time to manipulate virtual objects. Blinded assessors tested patients twice before, once during, and twice after the intervention up to 2-month follow-up for dexterity (primary outcome: Box and Block Test), bimanual upper limb function (Chedoke-McMaster Arm and Hand Activity Inventory), and subjective perceived changes (Stroke Impact Scale).Results54 eligible patients (70 screened) participated (15 females, mean age 61.3 years, range 20-81 years, time since stroke 3.0±SD 3 years). 22 patients were allocated to the experimental group and 32 to the control group (3 drop-outs). Patients in the experimental and control group improved: Box and Block Test mean 21.5±SD 16 baseline to mean 24.1±SD 17 follow-up; Chedoke-McMaster Arm and Hand Activity Inventory mean 66.0±SD 21 baseline to mean 70.2±SD 19 follow-up. An intention-to-treat analysis found no between-group differences.ConclusionsPatients in the experimental and control group showed similar effects, with most improvements occurring in the first two weeks and persisting until the end of the two-month follow-up period. The study population had moderate to severely impaired motor function at entry (Box and Block Test mean 21.5±SD 16). Patients, who were less impaired (Box and Block Test range 18 to 72) showed higher improvements in favor of the experimental group. This result could suggest that virtual reality-based training might be more applicable for such patients than for more severely impaired patients.Trial registrationClinicalTrials.gov NCT01774669.

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Project description:Given emerging evidence that learning to play a musical instrument may lead to a number of cognitive benefits for older adults, it is important to clarify how these training programs can be delivered optimally and meaningfully. The effective acquisition of musical and domain-general skills by later-life learners may be influenced by social, cultural and individual factors within the learning environment. The current study examines the effects of a 10-week piano training program on healthy older adult novices' cognitive and motor skills, in comparison to an inactive waitlisted control group. Fifteen participants completed piano training led by a music facilitator in small groups (max n = 4 per lesson class; two experimental, two waitlisted control groups). Data was collected using an explanatory sequential design: quantitative data from a battery of cognitive and motor tests was collected pre/post-test on all participants, with further post-test data from the waitlisted control group (n = 7). Qualitative data included weekly facilitator observations, participant practice diaries, and an individual, semi-structured, post-experiment interview. Bayesian modelling demonstrated moderate evidence of a strong positive impact of training on part A of the Trail Making test (TMT), indicating improved visuo-motor skills. Moderate evidence for negative impacts of training on part B of the Trail Making Test (and difference score delta) was also found, suggesting no benefit of cognitive switching. Qualitative results revealed that the group learning environment motivated participants to play in musical ensembles and to socialize. Motivation was optimal when all participants were happy with the chosen repertoire (participants reported they were motivated by learning to play familiar music) and when the facilitator observed that groups had formed cohesive bonds. Informed by these factors, exploratory analyses demonstrated strong evidence that a participant's lesson class had an impact on post-test scores (TMT part A). These results not only demonstrate the extent of cognitive benefits of a short-term piano training intervention for older adults, but also the importance of considering the group dynamics in the learning environment.

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Dataset Information

Music-supported motor training after stroke reveals no superiority of synchronization in group therapy.

Background

Aim

Method

Results

Conclusions

Publications

Music-supported motor training after stroke reveals no superiority of synchronization in group therapy.

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