Therapeutic Instrumental Music Training and Motor Imagery in Post-Stroke Upper-Extremity Rehabilitation: A Randomized-Controlled Pilot Study

Catherine M Haire; Luc Tremblay; Veronica Vuong; Kara K Patterson; Joyce L Chen; Jonathan H Burdette; Nina Schaffert; Michael H Thaut

doi:10.1016/j.arrct.2021.100162

Therapeutic Instrumental Music Training and Motor Imagery in Post-Stroke Upper-Extremity Rehabilitation: A Randomized-Controlled Pilot Study

Arch Rehabil Res Clin Transl. 2021 Oct 8;3(4):100162. doi: 10.1016/j.arrct.2021.100162. eCollection 2021 Dec.

Authors

Catherine M Haire^{1

2}, Luc Tremblay^{3

4}, Veronica Vuong^{1

2

5}, Kara K Patterson^{4

6}, Joyce L Chen^{3

4}, Jonathan H Burdette⁷, Nina Schaffert^{8

9}, Michael H Thaut^{1

2

5}

Affiliations

¹ Faculty of Music, University of Toronto, Toronto, Ontario, Canada.
² Music and Health Science Research Collaboratory, University of Toronto, Toronto, Ontario, Canada.
³ Faculty of Kinesiology, University of Toronto, Toronto, Ontario, Canada.
⁴ Toronto Rehabilitation Institute, Toronto, Ontario, Canada.
⁵ Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
⁷ Wake Forest School of Medicine, Winston-Salem, NC.
⁸ Department of Movement Science, University of Hamburg, Hamburg, Germany.
⁹ BeSB GmbH Sound Engineering Berlin, Berlin, Germany.

Abstract

Objective: To investigate the potential benefits of 3 therapeutic instrumental music performance (TIMP)-based interventions in rehabilitation of the affected upper-extremity (UE) for adults with chronic poststroke hemiparesis.

Design: Randomized-controlled pilot study.

Setting: University research facility.

Participants: Community-dwelling volunteers (N=30; 16 men, 14 women; age range, 33-76 years; mean age, 55.9 years) began and completed the protocol. All participants had sustained a unilateral stroke more than 6 months before enrollment (mean time poststroke, 66.9 months).

Intervention: Two baseline assessments, a minimum of 1 week apart; 9 intervention sessions (3 times/week for 3 weeks), in which rhythmically cued, functional arm movements were mapped onto musical instruments; and 1 post-test following the final intervention. Participants were block-randomized to 1 of 3 conditions: group 1 (45 minutes TIMP), group 2 (30 minutes TIMP, 15 minutes metronome-cued motor imagery [TIMP+cMI]), and group 3 (30 minutes TIMP, 15 minutes motor imagery without cues [TIMP+MI]). Assessors and investigators were blinded to group assignment.

Main outcome measures: Fugl-Meyer Upper-Extremity (FM-UE) and Wolf Motor Function Test- Functional Ability Scale (WMFT-FAS). Secondary measures were motor activity log (MAL)-amount of use scale and trunk impairment scale.

Results: All groups made statistically significant gains on the FM-UE (TIMP, P=.005, r=.63; TIMP+cMI, P=.007, r=.63; TIMP+MI, P=.007, r=.61) and the WMFT-FAS (TIMP, P=.024, r=.53; TIMP+cMI, P=.008, r=.60; TIMP+MI, P=.008, r=.63). Comparing between-group percent change differences, on the FM-UE, TIMP scored significantly higher than TIMP+cMI (P=.032, r=.57), but not TIMP+MI. There were no differences in improvement on WMFT-FAS across conditions. On the MAL, gains were significant for TIMP (P=.030, r=.54) and TIMP+MI (P=.007, r=.63).

Conclusion: TIMP-based techniques, with and without MI, led to significant improvements in paretic arm control on primary outcomes. Replacing a physical training segment with imagery-based training resulted in similar improvements; however, synchronizing internal and external cues during auditory-cMI may pose additional sensorimotor integration challenges.

Keywords: FM-UE, Fugl-Meyer–Upper Extremity; MAL, motor activity log; MI, motor imagery; Mdn, median; Music; Rehabilitation; Stroke; TIMP, therapeutic instrumental music performance; UE, upper extremity; Upper extremity; WMFT-FAS, Wolf Motor Function Test–Functional Ability Scale; cMI, cued motor imagery.