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

Alexander J Street, Wendy L Magee, Helen Odell-Miller, Andrew Bateman, Jorg C Fachner, Alexander J Street, Wendy L Magee, Helen Odell-Miller, Andrew Bateman, Jorg C Fachner

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.

Keywords: ARAT; community rehabilitation; feasibility study; hemiparetic; music-supported therapy; stroke; therapeutic instrumental music performance (TIMP).

Figures

Figure 1
Figure 1
Study consort, showing the crossover design with repeated measures. BA, Blind Assessor, who will conduct ARAT and 9HPT indicated at Weeks 1 and 6 (treatment), 9 and 15 (wait list).
Figure 2
Figure 2
The action research arm test.
Figure 3
Figure 3
Chord spacing for the “Smart Piano.” Participants aim to touch the white strips at the bottom. As they move their finger up, the notes of the chord are sounded.

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