Let's Improvise! iPad-based music therapy with functional electrical stimulation for upper limb stroke rehabilitation
In plain language
In the western world, stroke has been identified as the leading cause of disability in adults. Impairment to the arm/hand and depressive symptoms seem to be among the most frequent resultants of stroke. This article describes a collaborative occupational therapy and music therapy intervention for post-stroke arm/hand recovery. The intervention itself combines principles of music therapy with tablet technology and functional electrical stimulation. The implementation of this novel intervention, described in this clinical case report, has implications for benefits to physical and motivational aspects of rehabilitation. Recommendations for further research of this intervention are also discussed.
Abstract
This retrospective clinical case report will examine the implementation of a novel intervention combining a Functional Electrical Stimulation (FES) protocol with an iPad application. A 74-year-old female retired pianist and Professor of Music was admitted to a rehabilitation hospital following a left pontine stroke. On assessment, she was unable to use her right upper limb functionally. Conventional occupational therapy commenced soon after admission and consisted of functional retraining, including FES to the wrist and finger extensors. At week 4, the Registered Music Therapist (RMT) and Occupational Therapist (OT) collaborated to commence a trial of forearm FES in combination with an iPad-based music making application; ThumbJam. This application was used to encourage the patient to participate in touch sensitive musical improvisation using the affected hand in an attempt to promote engagement in complex motor patterns and non-verbal expression. Within 3 weeks, the patient was able to use ThumbJam without the FES, progressed to the keyboard in 4 weeks and has since commenced independent scales on the piano at home (21 weeks), as well as successful use of the upper limb in Activities of Daily Living (ADLs). On follow up (7 months), the patient reflected on the motivating elements of the intervention that helped her to achieve a functional outcome in her upper limb. This retrospective clinical case report will review the evidence with regard to FES and music therapy, outline the treatment protocol used and make recommendations for future research of “FES+ThumbJam” in upper limb stroke rehabilitation.
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