Home-based neurologic music therapy for upper limb rehabilitation with stroke patients at community rehabilitation stage—a feasibility study protocol

Abstract

Background: Impairment of upper limb function following stroke is more common than lower limb impairment and is also more resistant to treatment. Several lab-based studies with stroke patients have produced statistically significant gains in upper limb function when using musical instrument playing and techniques where rhythm acts as an external time-keeper for the priming and timing of upper limb movements.Methods: For this feasibility study a small sample size of 14 participants (3–60 months post stroke) has been determined through clinical discussion between the researcher and study host in order to test for management, feasibility and effects, before planning a larger trial determined through power analysis. A cross-over design with five repeated measures will be used, whereby participants will be randomized into either a treatment (n = 7) or wait list control (n = 7) group. Intervention will take place twice weekly over 6 weeks. The ARAT and 9HPT will be used to measure for quantitative gains in arm function and finger dexterity, pre/post treatment interviews will serve to investigate treatment compliance and tolerance. A lab based EEG case comparison study will be undertaken to explore audio-motor coupling, brain connectivity and neural reorganization with this intervention, as evidenced in similar studies.Discussion: Before evaluating the effectiveness of a home-based intervention in a larger scale study, it is important to assess whether implementation of the trial methodology is feasible. This study investigates the feasibility, efficacy and patient experience of a music therapy treatment protocol comprising a chart of 12 different instrumental exercises and variations, which aims at promoting measurable changes in upper limb function in hemiparetic stroke patients. The study proposes to examine several new aspects including home-based treatment and dosage, and will provide data on recruitment, adherence and variability of outcomes.

Music‐supported therapy in the rehabilitation of subacute stroke patients: a randomized controlled trial

“…MST can also be adapted in order to be applied at home or in groups to incorporate more social aspects. 69,70 In this study, MST in addition to the rehabilitation program did not show superiority over conventional therapies. Importantly, the patient's intrinsic motivation to engage in music activities should be taken into account, since we observed an association between motivation and motor improvement.…”

“…The MST program could be modified by introducing new components, such as the self‐selection of songs or musical styles, improvization, music sonification, and other types of feedback that are in line with the most advanced motor learning paradigms. MST can also be adapted in order to be applied at home or in groups to incorporate more social aspects …”

Assessing a cognitive music training for older participants: a randomised controlled trial

“…The exercises were designed according to the following two categories: Imitation, creation and execution of rhythms: a set of body percussion and instrument percussion exercises were designed for stimulating sustained, divided, selective and alternate attention; concentration and short‐term and long‐term memory. These exercises, based on playing musical instruments and rhythms, stimulated the cognitive skills involved in movement, encouraged intentional programming sequences of movements, and planning of intentional praxis movements (Street et al, ). The processes involved in these activities were anticipation, emotive communication and feedback.…”

Home-based neurologic music therapy for arm hemiparesis following stroke: results from a pilot, feasibility randomized controlled trial

“…Arm movements were synchronized with accompanying, strongly pulsed musical patterns played live by the researcher on an acoustic guitar. 9 Equipment set-up time was 15 minutes.…”

“… 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.…”