In previous studies, it was shown that there is a need for efficient motor rehabilitation approaches. For this purpose, we evaluated a music-supported training program designed to induce an auditory-sensorimotor co-representation of movements in 20 stroke patients (10 affected in the left and 10 in the right upper extremity). Patients without any previous musical experience participated in an intensive step by step training, first of the paretic extremity, followed by training of both extremities. Training was applied 15 times over 3 weeks in addition to conventional treatment. Fine as well as gross motor skills were addressed by using either a MIDI-piano or electronic drum pads. As a control, 20 stroke patients (10 affected left and 10 right) undergoing exclusively conventional therapies were recruited. Assignment to the training and control groups was done pseudo-randomly to achieve an equal number of left- and right-affected patients in each group. Pre- and post-treatment motor functions were monitored using a computerized movement analysis system (Zebris) and an established array of motor tests (e. g., Action Research Arm Test, Box & Block Test). Patients showed significant improvement after treatment with respect to speed, precision and smoothness of movements as shown by 3D movement analysis and clinical motor tests. Furthermore, compared to the control subjects, motor control in everyday activities improved significantly. In conclusion, this innovative therapeutic strategy is an effective approach for the motor skill neurorehabilitation of stroke patients.

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The present investigation demonstrates that time-varying magnetic fields induced over the skull elicit distinct types of responses in muscles supplied by the cranial nerves both on the ipsilateral and the contralateral side. When the center of the copper coil was positioned 4 cm lateral to the vertex on a line from the vertex to the external auditory meatus, bilateral responses in the masseter, orbicularis oculi, mentalis, and sternocleidomastoideus muscles with a delay of about 10 to 14 ms after the stimulus occurred. Similar to the transcranially evoked muscle responses in hand muscles, the responses in the cranial muscles can be influenced in latency and amplitude by background excitation. It is concluded that these responses are induced by excitation of the face-associated motor cortex followed by multiple I-waves in the corticonuclear tract with both ipsilateral and contralateral projections to the corresponding motoneurones. Additionally, at higher stimulation strengths "short-latency" ipsilateral responses in muscles supplied by the trigeminal, facial, and accessory nerves occurred which we suggest are induced by direct stimulation of the peripheral cranial nerves in their intracisternal course. The present study confirms the bilateral projection of corticonuclear tracts in awake unanesthetised human subjects which has been observed by electrical stimulation on the exposed cortex during surgical procedures already decades ago. The present investigation will serve as a basis for the assessment of pathophysiological mechanisms involving the corticonuclear system or the peripheral cranial nerves in their proximal parts in awake humans.

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