Music Upper Limb Therapy—Integrated: An Enriched Collaborative Approach for Stroke Rehabilitation

Abstract

Stroke is a leading cause of disability worldwide. It leads to a sudden and overwhelming disruption in one’s physical body, and alters the stroke survivors’ sense of self. Long-term recovery requires that bodily perception, social participation and sense of self are restored; this is challenging to achieve, particularly with a single intervention. However, rhythmic synchronization of movement to external stimuli facilitates sensorimotor coupling for movement recovery, enhances emotional engagement and has positive effects on interpersonal relationships. In this proof-of-concept study, we designed a group music-making intervention, Music Upper Limb Therapy-Integrated (MULT-I), to address the physical, psychological and social domains of rehabilitation simultaneously, and investigated its effects on long-term post-stroke upper limb recovery. The study used a mixed-method pre-post design with 1-year follow up. Thirteen subjects completed the 45-min intervention twice a week for 6 weeks. The primary outcome was reduced upper limb motor impairment on the Fugl-Meyer Scale (FMS). Secondary outcomes included sensory impairment (two-point discrimination test), activity limitation (Modified Rankin Scale, MRS), well-being (WHO well-being index), and participation (Stroke Impact Scale, SIS). Repeated measures analysis of variance (ANOVA) was used to test for differences between pre- and post-intervention, and 1-year follow up scores. Significant improvement was found in upper limb motor impairment, sensory impairment, activity limitation and well-being immediately post-intervention that persisted at 1 year. Activities of daily living and social participation improved only from post-intervention to 1-year follow up. The improvement in upper limb motor impairment was more pronounced in a subset of lower functioning individuals as determined by their pre-intervention wrist range of motion. Qualitatively, subjects reported new feelings of ownership of their impaired limb, more spontaneous movement, and enhanced emotional engagement. The results suggest that the MULT-I intervention may help stroke survivors re-create their sense of self by integrating sensorimotor, emotional and interoceptive information and facilitate long-term recovery across multiple domains of disability, even in the chronic stage post-stroke. Randomized controlled trials are warranted to confirm the efficacy of this approach. Clinical Trial Registration: National Institutes of Health, clinicaltrials.gov, NCT01586221.

Long-Term Improvements After Multimodal Rehabilitation in Late Phase After Stroke

“…[5][6][7][8][9][10][11][12][13] These interventions share important core components but differ from each other with respect to their combinations of Background and Purpose-Treatments that improve function in late phase after stroke are urgently needed. We assessed whether multimodal interventions based on rhythm-and-music therapy or horse-riding therapy could lead to increased perceived recovery and functional improvement in a mixed population of individuals in late phase after stroke.…”

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

“…These techniques are designed to improve not only motor deficits but also other relevant aspects, including motivation, treatment adherence, and mood, all of which are known to contribute to the success of the rehabilitation process . For instance, music practice as a therapy for stroke patients is an enjoyable activity that includes complex and coordinated movements while placing a high demand on cognitive functions, such as attention and working memory, as well as modulating mood . Music performance facilitates auditory–motor coupling, increases the adherence to physical exercises, and promotes social bonding during group performance .…”

“…11,12 For instance, music practice as a therapy for stroke patients is an enjoyable activity that includes complex and coordinated movements while placing a high demand on cognitive functions, such as attention and working memory, as well as modulating mood. [13][14][15][16][17] Music performance facilitates auditory-motor coupling, 18 increases the adherence to physical exercises, 19 and promotes social bonding during group performance. [20][21][22] Some of these positive aspects could be partly mediated by the dopaminergic reward system, which is known to be highly responsive to music and involved in learning, memory, and the modulation of synaptic plasticity.…”

Cycling Training and Functional Electrical Stimulation for Post-Stroke Patients

“…3 In addition, lack of postural control has the greatest impact on a patients' gait and independent performance of ADLs, and such disability arises from limitations in activities and reduced participation in daily life tasks. 4 With hemiplegia contributing significantly to an inability to perform meaningful activities and participate fully in life following stroke, 5 improving motor outcomes after stroke is essential and an optimal and rapid therapeutic intervention is required. To improve outcomes after stroke, intervention focuses on improving not only the impairment level, but addressing activity limitations, such as walking and moving objects, and participation restrictions.…”