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

This is too fucking easy that your doctors will never implement this in their hospitals. If they haven't implemented music already with the massive amount of research already out there this is not going to change them into competent doctors.
http://journal.frontiersin.org/article/10.3389/fnhum.2016.00498/full

Preeti Raghavan^1,2*, Daniel Geller¹, Nina Guerrero², Viswanath Aluru¹, Joseph P. Eimicke^3,4, Jeanne A. Teresi^4,5, Gbenga Ogedegbe⁶, Anna Palumbo² and Alan Turry²

• ¹Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
• ²Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA
• ³Research Division, Hebrew Home at Riverdale, Bronx, NY, USA
• ⁴Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA
• ⁵Columbia University Stroud Center and New York State Psychiatric Institute, New York, NY, USA
• ⁶Department of Population Health, New York University School of Medicine, New York, NY, USA

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.

Introduction

Stroke affects one in six individuals worldwide, and is the leading cause of disability (Thrift et al., 2014). In the vast majority of survivors, the sudden and lasting physical effects of stroke lead to a catastrophic disruption in their sense of self and in relationships with the physical and social world (Ellis-Hill and Horn, 2000; Ellis-Hill et al., 2000; Secrest and Zeller, 2007; Salter et al., 2008). Depressed mood, social isolation, poor subjective well-being and mental distress contribute to increased motor impairment, disability and risk of future stroke (Ostir et al., 2001; Northcott et al., 2015). Long-term recovery is thought to be strongly influenced by coherence between the stroke survivor’s bodily perception, participation in everyday life, and sense of self (Arntzen et al., 2015). Traditional multi-disciplinary rehabilitation addresses physical limitations such as immobility and reduced functional independence, psychological limitations such as depressed mood and lack of motivation, and societal limitations such as social isolation one at a time. For example, patients may receive physical therapy for a few weeks, and subsequently or separately receive cognitive therapy or psychotherapy. Each type of therapy leads to changes in network connectivity between specific regions of the brain depending on the information that is processed during the therapy tasks (Bajaj et al., 2015a). In contrast, combination therapies can increase the connectivity between multiple brain regions that are disconnected after stroke, leading to better functional outcomes (Bajaj et al., 2015b). Since multi-disciplinary rehabilitation is not widely available—only 30% of individuals who need rehabilitation actually receive it (Go et al., 2013), and there are increasing disparities in accessibility to rehabilitation in the chronic post-stroke period (Roth et al., 2011; Winstein et al., 2016)—combination therapies may be the solution to address limitations across multiple domains simultaneously. Here we asked if a single combined intervention could be designed to address physical, psychological and social domains of rehabilitation simultaneously to facilitate long-term post-stroke upper limb recovery.

Music is one of the most powerful elicitors of spontaneous motor actions (Jäncke, 2008). It motivates people to adhere to exercise regimens (Wininger and Pargman, 2003), distracts attention from physical effort, and reduces perceived exertion (Dyrlund and Wininger, 2008). In addition, auditory-motor coupling has been shown to facilitate repetitive movements post-stroke (Roerdink et al., 2009; Rojo et al., 2011; Rodriguez-Fornells et al., 2012), and repetitive and rhythmic movement synchrony between individuals can establish and reinforce social bonds (Hove and Risen, 2009; Miles et al., 2009; Cirelli et al., 2014). Live interactive music-making engages individuals to interact spontaneously and promotes relationship building (Guerrero et al., 2014). Several studies have also shown positive effects of music listening on mood, and on cognitive and motor processing post-stroke (Särkämö et al., 2008; Malcolm et al., 2009; Särkämö and Soto, 2012). Taken together, these studies suggest that music-making activities may be used to integrate physical, psychological and social facets of rehabilitation, creating an enriched environment for post-stroke recovery. Animal studies have shown that in enriched environments the simultaneous physical and mental activity in socially interactive contexts act synergistically to promote neurogenesis, neuronal integration and recovery (Madroñal et al., 2010; Krakauer et al., 2012).

We therefore designed a novel collaborative group music-making intervention, Music Upper Limb Therapy-Integrated (MULT-I), that combined music therapy with occupational therapy to support physical effort, social participation and psychological well-being simultaneously. This study tested the hypothesis that the MULT-I intervention, provided twice a week for 6 weeks, will lead to reduced upper limb motor impairment (primary outcome); and reduced sensory impairment and activity limitation along with increased well-being and participation (secondary outcomes) post-intervention. Since the interaction among physical, psychological and social facets is thought to support long-term recovery, we further hypothesized that the improvement would persist at 1-year follow up.

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