Active music therapy approach for stroke patients in the post-acute rehabilitation

Music therapy with adults in the subacute phase after stroke: A study protocol

Stroke is a highly disabling condition, for which music therapy is regularly used in rehabilitation. One possible mechanism for the effects of music therapy is the motivational aspect of music, for example regarding treatment adherence based on improved mood. In this study, changes in motivation related to Neurologic Music Therapy (NMT) techniques during rehabilitation in the subacute phase after stroke will be investigated. Using a randomised within-subjects cross-over design, the effects of two NMT techniques and related motivational indices will be investigated. Data will be collected at three timepoints: baseline (TP1), after being randomised into groups and receiving NMT or standard care (TP2), and then at a third time point after the cross-over and having received both conditions (TP3). This design allows to counteract order effects, time effects due to spontaneous and/or nonlinear recovery, as well as single-subject comparisons in a relatively heterogeneous sample. Twenty adult participants who have experienced a supratentorial ischaemic or haemorrhagic stroke and are experiencing upper-limb impairments and/or cognitive deficits will be included. Behavioural measures of motor function, cognition, and quality of life will be collected, along with self-reported indices of overall motivation. The study outcomes will have implications for the understanding of the underlying mechanisms of music therapy in stroke recovery, more specifically regarding the relevance of motivational states in neurorehabilitation.

Important findings of a technology-assisted in-home music-based intervention for individuals with stroke: a small feasibility study

PURPOSE

To examine the feasibility of stroke survivors receiving music-based rehabilitation via a mobile app.

MATERIALS AND METHODS

We recruited ten chronic stroke survivors who were community-dwelling with mild-moderate upper extremity (UE) paresis. Participants were encouraged to exercise their paretic UE with a commercial instrument training app, Yousician, with a piano keyboard at home for three weeks. The feasibility of the training was measured by: (a) the acceptance of using the app to receive in-home piano training (e.g., daily usage time, exit interview) and (b) the effects of the app functionality as a rehabilitation tool (e.g., participants' motor improvements after training).

RESULTS

Our small sample size of participants demonstrated general positive feedback and self-motivation (e.g., interest in extended training time) about using a mobile app to receive in-home, music-based UE training. Participants showed no trend of declined usage and practiced on average ∼33 min per day for 4-5 days per week during the 3-week participation. We also observed positive results in the Fugl-Meyer Assessment, Action Research Arm Test, and Nine Hole Peg Test after training.

CONCLUSIONS

This study provided insight into the feasibility of delivering music-based interventions through mobile health (mHealth) technology for stroke populations. Although this was a small sample size, participants' positive and negative comments and feedback provided useful information for future rehab app development. We suggest four ways to further improve and design a patient-oriented app to facilitate the use of a mHealth app to deliver in-home music-based interventions for stroke survivors.

Post-Stroke Neuropsychiatric Complications: Types, Pathogenesis, and Therapeutic Intervention

Almost all stroke survivors suffer physical disabilities and neuropsychiatric disturbances, which can be briefly divided into post-stroke neurological diseases and post-stroke psychiatric disorders. The former type mainly includes post-stroke pain, post-stroke epilepsy, and post-stroke dementia while the latter one includes post-stroke depression, post-stroke anxiety, post-stroke apathy and post-stroke fatigue. Multiple risk factors are related to these post-stroke neuropsychiatric complications, such as age, gender, lifestyle, stroke type, medication, lesion location, and comorbidities. Recent studies have revealed several critical mechanisms underlying these complications, namely inflammatory response, dysregulation of the hypothalamic pituitary adrenal axis, cholinergic dysfunction, reduced level of 5-hydroxytryptamine, glutamate-mediated excitotoxicity and mitochondrial dysfunction. Moreover, clinical efforts have successfully given birth to many practical pharmaceutic strategies, such as anti-inflammatory medications, acetylcholinesterase inhibitors, and selective serotonin reuptake inhibitors, as well as diverse rehabilitative modalities to help patients physically and mentally. However, the efficacy of these interventions is still under debate. Further investigations into these post-stroke neuropsychiatric complications, from both basic and clinical perspectives, are urgent for the development of effective treatment strategies.

Effects of music therapy on mood, pain, and satisfaction in the neurologic inpatient setting

PURPOSE

Music therapy (MT) has been used in health care settings for a wide variety of treatment goals. Many inpatients with neurologic impairments struggle with low mood and pain for which MT may be a novel adjunct treatment. The aims of this study were to: (1) evaluate change in mood and pain following a single MT session; (2) explore the impact of an MT program on mood, pain and satisfaction from the perspective of the patient, family and staff.

MATERIALS AND METHODS

A mixed-methods study was conducted. Forty participants completed pre/post MT surveys evaluating mood, pain and satisfaction. Individual semi-structured interviews and focus groups were conducted with 14 MT program participants (inpatients), 5 family members of participants and 16 staff.

RESULTS

There was significant improvement in mood (p < 0.001) and decrease in pain (p < 0.05) from pre-to-post MT with 74% reporting being "very satisfied" with the session. "Benefits of MT" was the overarching theme of the qualitative data. Subthemes were emotional regulation, pain management, effects on self-concept, enjoyment, and social connectedness.

CONCLUSIONS

Improvements in mood and pain were reported from pre-to-post MT session and in interviews. Further evaluation of MT effectiveness against standard of care rehabilitation and cost implications is required.Implications for RehabilitationMusic therapy (MT) is delivered by accredited music therapists (MTAs) in health care settings, including rehabilitation units, as an individual, group or co-treatment therapy.MT can be used for a range of health outcomes, including the treatment of mood and pain, in addition to improving inpatient satisfaction.Early evidence using pre/post MT surveys suggests an improvement in mood and pain following a single therapy session.Qualitative data suggest overall benefit of offering MT services in addition to standard neurorehabilitation therapy, including improvements to emotional regulation, pain management, self-concept, enjoyment, and social connectedness.

Outcomes of Combined Visual and Auditive Stimulation on Functions of Hand and Grip Strengths in Patients with Hemiplegia

Background Stroke is a major ailment that results from hypoxia, ischemia, blockage, or hemorrhage. The recovery of hand functions is an essential goal in stroke patients' recovery.

Aim This study aimed to analyze the outcomes of rhythmic auditory stimulation (RAS) and mirror therapy on hand functions, as well as grip strength, in stroke patients.

Materials and Methods A quasiexperimental study has been used based on criteria of inclusion, 30 patients were enrolled. The participants were assigned to two groups, 15 patients each. Group A (control group) underwent traditional physiotherapy. Group B (experimental group) underwent RAS and mirror therapy. Both the groups received 20 minutes of treatment, 20 sessions in 1 month. The Action Research Arm Test (ARAT) and hand-held dynamometer were used to evaluate results. Paired t-test has been used to analyze the data with the SPSS software tool.

Results The paired t-test results showed that notable distinctions in ARAT mean pretest scores between two groups were not found. A notable change in ARAT results was present between the two groups with mean posttest score and difference in pretest to posttest. No notable distinctions in grip strength results were seen with mean pretest results. But a notable change was found in grip strength results among two groups with mean posttest scores.

Conclusion Combining RAS and mirror therapy programs has shown beneficial effects on hand functions, as well as grip strength of stroke patients and can be used as adjunct interventions along with conventional physiotherapy to encourage restoration of hand functions in hemiparetic patients.

EEG Hyperscanning and Qualitative Analysis of Moments of Interest in Music Therapy for Stroke Rehabilitation—A Feasibility Study

Interdisciplinary research into the underlying neural processes of music therapy (MT) and subjective experiences of patients and therapists are largely lacking. The aim of the current study was to assess the feasibility of newly developed procedures (including electroencephalography/electrocardiography hyperscanning, synchronous audio–video monitoring, and qualitative interviews) to study the personal experiences and neuronal dynamics of moments of interest during MT with stroke survivors. The feasibility of our mobile setup and procedures as well as their clinical implementation in a rehabilitation centre and an acute hospital ward were tested with four phase C patients. Protocols and interviews were used for the documentation and analysis of the feasibility. Recruiting patients for MT sessions was feasible, although data collection on three consecutive weeks was not always possible due to organisational constraints, especially in the hospital with acute ward routines. Research procedures were successfully implemented, and according to interviews, none of the patients reported any burden, tiredness, or increased stress due to the research procedures, which lasted approx. 3 h (ranging from 135 min to 209 min) for each patient. Implementing the research procedures in a rehabilitation unit with stroke patients was feasible, and only small adaptations were made for further research.

The Feasibility and Acceptability of Neurologic Music Therapy in Subacute Neurorehabilitation and Effects on Patient Mood

Music interventions support functional outcomes, improve mood, and reduce symptoms of depression in neurorehabilitation. Neurologic music therapy (NMT) has been reported as feasible and helpful in stroke rehabilitation but is not commonly part of multidisciplinary services in acute or subacute settings. This study assessed the feasibility and acceptability of delivering NMT one-day-per-week in a subacute neurorehabilitation centre over 15 months. Data were collected on the number of referrals, who referred, sessions offered, attended, and declined, and reasons why. Staff, patients, and their relatives completed questionnaires rating the interventions. Patients completed the Visual Analog Mood Scales (VAMS) pre and post a single session. Forty-nine patients received 318 NMT sessions (83% of sessions offered). NMT was rated as helpful or very helpful as part of the multidisciplinary team (n = 36). The highest ratings were for concentration, arm and hand rehabilitation, and motivation and mood. VAMS scores (n = 24) showed a reduction in ‘confused’ (−8.6, p = 0.035, effect size 0.49) and an increase in ‘happy’ (6.5, p = 0.021, effect size = 0.12) post NMT. The data suggest that a one-day-per-week NMT post in subacute neurorehabilitation was feasible, acceptable, and helpful, supporting patient engagement in rehabilitation exercises, mood, and motivation.

Including Arts in Rehabilitation Enhances Outcomes in the Psychomotor, Cognitive, and Affective Domains: A Scoping Review

OBJECTIVE

The purpose of this scoping review was to analyze the published literature regarding the use of art in the context of rehabilitation for consideration in physical therapy.

METHODS

The CINAHL, PsycArticles, APA PsycInfo, Art Index, Music Index, Cochrane Reviews, and PubMed electronic databases were accessed. Inclusion and exclusion criteria were established and utilized to determine study eligibility. Study details were extracted from each article by researchers using a systematic format. Summation of journal type, participants, dosing and type of intervention, setting and interventionist, outcome domains, and study results were included.

RESULTS

Out of 1452 studies, 76 were included for extraction. Of these studies, most had outcome measures aligned with the psychomotor and affective domains of learning (n = 66). Very few studies had outcome measures with psychomotor and cognitive domains (n = 2) or psychomotor, affective, and cognitive outcome measures (n = 8). Regarding the arts used, music, dance, or both were used in 77 instances. Fewer studies reported using creative arts therapy, singing, theater, writing, and rhythm (n = 17). Of the 76 studies analyzed, 74 reported a within-group treatment effect.

CONCLUSION

The arts effectively enhance physical therapist practice; therefore, it is recommended that physical therapists continue to seek collaboration with art professionals and explore the use of arts in practice.

IMPACT

Findings demonstrate that combining the arts with physical therapist practice amplifies not only psychomotor but affective and cognitive outcomes as well. The arts have applicability across broad populations (eg, chronic pain, neurologic dysfunction, respiratory conditions). This study supports that physical therapist education and practice should embrace the arts as a collaborative modality to promote enhanced psychomotor, affective, and cognitive outcomes.

Effects of music intervention on physical and psychological problems in adults receiving haemodialysis treatment: A systematic review and meta-analysis

AIMS AND OBJECTIVES

To synthesise the effects of music intervention on the physical and psychological problems of adults receiving haemodialysis.

BACKGROUND

Adults receiving haemodialysis experience many physical and psychological problems. Music interventions may have beneficial effect on the management of these problems.

DESIGN

A systematic review and meta-analysis based on PRISMA 2020.

METHODS

This study followed the Cochrane 2021 guideline. Eleven electronic databases were searched from inception to July 2021. Randomised controlled trials that assessed music intervention on haemodialysis-related physical and psychological problems were included. Two authors independently assessed risk of bias with the Cochrane Collaboration tool. The Comprehensive Meta-Analysis software version 3 was used for meta-analysis.

RESULTS

Sixteen randomised controlled trials were included. This meta-analysis demonstrated that music intervention had significant and large effect on physical outcomes such as breath rate, oxygen saturation, arteriovenous fistula puncture-related pain, itching, sleep quality as well as psychological outcomes such as state anxiety and stress. The study also found that music intervention had significant and medium effect on physical outcomes such as systolic and diastolic blood pressure, heart rate and pain, and psychological outcomes such as anxiety. Music intervention had no effect on physical outcomes such as body temperature and cramps, and psychological outcomes such as trait anxiety and depression. Subgroup analyses indicated that sessions of 4-6 are more effective for improving the systolic and diastolic blood pressure and heart rate than three sessions or less. It also found that music duration of 20 min or less is more effective in reducing anxiety compared to music duration of 30 min or more.

CONCLUSIONS

This study demonstrated that music intervention may partially improve haemodialysis-related physical and psychological problems.

RELEVANCE TO CLINICAL PRACTICE

This study will contribute to perform of music intervention for haemodialysis-related physical and psychological problems for health professionals, particularly nurses.

STUDY REGISTRATION

This study has been registered at PROSPERO (Registration No. CRD42021267463).

Effects of music therapy on anxiety: A meta-analysis of randomized controlled trials

This study aims to evaluate the efficacy of music therapy on anxiety from randomized controlled trials (RCTs). The following electronic databases were utilized for selecting eligible studies that were published from inception to March 2021: PubMed, Cochrane Library, PsycINFO, Medline, Web of Science, and Embase. Standard mean difference (SMD) with 95% confidence interval (CI) values were used to evaluate the efficacy of music therapy on anxiety. Thirty-two studies with 1,924 participants were included in the meta-analysis. Music therapy lasted an average of 7.5 sessions (range, 1-24 sessions), while the average follow-up duration was 7.75 weeks (range, 1-16 weeks). Music therapy significantly reduced anxiety compared to the control group at post-intervention (SMD = -0.36, 95% CI: -0.54 to -0.17, p < 0.05), but not at follow-up (SMD = -0.23, 95% CI: -0.53 to 0.08, p >0.05). Subgroup analysis found a significantly positive effect of music therapy on anxiety in < 60 and ≥ 60 age-group (SMD = -0.31, 95% CI: -0.52 to -0.09, p < 0.05; SMD = -0.45, 95% CI: -0.85 to -0. 05, p < 0.05), developed and developing country group (SMD = -0.28, 95% CI: -0.51 to -0.06, p < 0.05; SMD = -0.49, 95% CI: -0.80 to -0.17, p < 0.05), < 12 and ≥ 12 sessions group (SMD = -0.24, 95% CI: = -0.44 to -0.03, p < 0.05; SMD = -0.59, 95% CI: -0.95 to -0.22, p < 0.05), respectively. Our study indicated that music therapy can significantly improve anxiety during treatment. But given that only eight RCTs reported the effects of music therapy at follow-up and the duration of follow-up was inconsistent, further researches are needed on the lasting effects after the intervention is discontinued.

Musical interaction with children and young people with severe or profound intellectual and multiple disabilities: a scoping review

This scoping review addresses peer-reviewed research on musical interaction with children and young people with severe/profound intellectual and multiple disabilities (S/PIMD). Twenty-five articles published between the years 2000 and 2020 met the inclusion criteria. A narrative synthesis was used to summarise and evaluate different features, including participant characteristics, study design and methods, type of musical interaction, the abilities and behaviours in focus, reported benefits, promising components of musical interaction, and quality appraisal of the studies. The results revealed a variation in participant characteristics and study designs, where small-sample descriptive case studies were most common. In terms of the type of musical interaction, active music therapy was the most commonly used approach, followed by technology-mediated and multisensory musical activities. In terms of abilities and behaviours, a large majority of the studies focused on social interaction and communication, followed by engagement, attention and affect. Six categories were identified as promising components of musical interaction: the responsivity of the interaction partner, singing songs, structure and predictability in the activities, long-term interventions, technology-mediated and multisensory musical activities, and a therapeutic alliance between interaction partners. Based on this review, we discuss future research and practical implications for musical interaction and music therapy for children and young people with S/PIMD.

Music Therapy Alleviates Motor Dysfunction in Rats With Focal Cerebral Ischemia-Reperfusion Injury by Regulating BDNF Expression

Background/Aim: Music-based therapy plays a role in central nervous system diseases. We aimed to explore the effect of different doses and durations of music therapy on motor function recovery after stroke and the underlying molecular mechanisms. Methods: Adult male Sprague-Dawley rats were subjected to middle cerebral artery occlusion (MCAO) for 1 h, which was followed by reperfusion. In experiment 1, the rats that survived 1 week after MCAO surgery were randomly allocated into four groups (n = 10 per group): MCAO group, 1 h music group (Mozart K.448 music therapy 1 h per day for 2 weeks), 12 h music group (Mozart K.448 music therapy 12 h/day for 2 weeks), and accelerated music group (reversely accelerated music therapy 12 h for 2 weeks, AM group). In experiment 2, the survived rats were randomly divied into three groups: MCAO group, 12 h music group (music therapy 12 h/day for 3 weeks), and 12 h music-R group (music therapy 12 h/day for 2 weeks and rest for 1 week). Three neuroscores were evaluated daily, starting on the first day after surgery until the end of the experiment. The rats were killed 3 weeks after MCAO surgery in experiment 1 or 4 weeks after surgery in experiment 2. Nissl staining of infart core, peri-infarct zone, and motor cortex was performed to assess neuronal survival and regeneration. Western blot and immunofluorescence were used to detect the expression and distribution of brain-derived neurotrophic factor (BDNF) and glial fibrillary acidic protein (GFAP) in ipsilateral hemispheres. Results: In the experiment of different music therapy doses, the motor function in the 12-h music group but not in the 1-h music group and AM group was significantly improved compared with that of the MCAO group. The BDNF protein level of the ipsilateral hemisphere motor cortex in the 12-h music group and the 1-h music group was higher than that of the MCAO group. The neurons and Nissl bodies were more in the 12-h music group than in the MCAO group. Immunofluorescence assay showed that a 12 h music therapy induces BDNF and GFAP accumulation at the damage boundary. In the experiment of different music therapy durations, 3 weeks music therapy (12 h music group) induced more longer cell synapses and more clearer cell-to-cell connections than 2 weeks music intervention (12 h music-R group). Moreover, the GFAP morphology in the 12-h music group was more similar to mature activated astrocytes than that in the 12-h music-R group. Conclusions: Music therapy may improve poststroke motor function and promote neuronal repair in the long term. The mechanism may be through stimulating BDNF and GFAP secretion in the injured motor cortex.

The Effectiveness of Music Therapy on Hand Function in Patients With Stroke: A Systematic Review of Randomized Controlled Trials

Objective: This study aims to evaluate the efficacy of music-supported therapy for stroke patients' hand function. Methods: The databases used included Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PubMed, Embase, Music Index, and Google Scholar. Studies published between January 2010 and August 2020 were included. The searching key terms included "music-supported therapy," "music therapy," "hand function," "hand dysfunction," "stroke," "ischemic," and "hemorrhagic." Randomized controlled trials or controlled trials involving adults who have hand function problems caused by stroke are included in this study. The methodological quality and risk of bias of the included studies were rated by two independent assessors under the guidance of Cochrane collaboration's risk of bias tool. Results: Twelve studies that met the inclusion criteria were included in this study. Totally, the data included 598 stroke patients (345 male, 253 female) with recruited time from 1.7 months to 3 years, and the mean age of the participants were 61.09 years old. Based on the Cochrane risk of bias tool, study quality ranged from three to seven out of seven points. Compared with the control group, outcomes including hand strength, range of joint motion, dexterity of hands, arm function, and quality of life were significantly superior with music-supported therapy. Five studies reported improved dexterity of hands, and one study reported the improvement of range of motion and strength of patients' hands, which supported the therapy has positive effects on patients' hand function and improving their quality of life after the therapy. The therapy ranged over a period of 4-8 weeks, with an average duration of 30 min/session and an average of three times per week. Conclusion: Based on the results, music-supported therapy could be a useful treatment for improving hand function and activities of daily living in patients with stroke, especially for patients within 6 months after stroke. However, the low certainty of evidence downgrades our confidence to practice in hospital. More and more randomized controlled trials and larger sample sizes are required for a deeper review.

Music therapy for stress reduction: a systematic review and meta-analysis

Music therapy is increasingly being used as an intervention for stress reduction in both medical and mental healthcare settings. Music therapy is characterized by personally tailored music interventions initiated by a trained and qualified music therapist, which distinguishes music therapy from other music interventions, such as 'music medicine', which concerns mainly music listening interventions offered by healthcare professionals. To summarize the growing body of empirical research on music therapy, a multilevel meta-analysis, containing 47 studies, 76 effect sizes and 2.747 participants, was performed to assess the strength of the effects of music therapy on both physiological and psychological stress-related outcomes, and to test potential moderators of the intervention effects. Results showed that music therapy showed an overall medium-to-large effect on stress-related outcomes (d = .723, [.51-.94]). Larger effects were found for clinical controlled trials (CCT) compared to randomized controlled trials (RCT), waiting list controls instead of care as usual (CAU) or other stress-reducing interventions, and for studies conducted in Non-Western countries compared to Western countries. Implications for both music therapy and future research are discussed.

The use of music as an arts-based method in migrant health research: a scoping review protocol

There is increasing recognition that people’s lived experience needs to be incorporated into health decision-making. This has led to rising imperatives for involving the public in health processes, including research. While there have been significant advances in the field, patterns of exclusion still exist in some areas, including migrant participation in health research. Migration and mobility create challenges around social inclusion and this extends to social and cultural practices used in research. There is an emerging body of literature about improving meaningful, participatory spaces for migrants’ involvement in health research using creative tools and techniques that are attuned to cultural diversity. These include the use of arts-based research methods. There is strong evidence for the use of music, particularly singing, as an effective arts-based participatory tool . The goal of this scoping review is to investigate the evidence for the use of music as an arts-based method in migrant health research. Developed by an interdisciplinary team specialising in public and patient involvement; nursing and midwifery; primary health care; and the performing arts, it aims to analyse existing evidence across disciplines that are not usually studied together, identify gaps in current knowledge and use these as a foundation to build effective strategies towards increasing access to and knowledge of participatory, arts-based methods using music in migrant health research.

Methods: The protocol for this scoping review follows the guidelines and stages set out in the JBI Reviewer’s Manual ( Peters et al., 2017), and by Levac et al, (2010), which build on the methodological framework of Arksey and O’Malley (2005). This incorporates six stages: 1) Identifying the research question; 2) Identifying relevant studies; 3) Study selection; 4) Charting the data; 5) Collating, summarising, and reporting results; and 6) Consultation.

"Music Makes My Old Heart Beat": A Randomised Controlled Study on the Benefits of the Use of Music in Comprehensive Care for Institutionalised Older Adults

BACKGROUND

Research on the therapeutic use of music is growing, but the lack of experimental rigour and outcomes diversity has impeded researchers from obtaining clear evidence of the multiple benefits of music interventions in older adults. We explored the outcomes of a music-complemented intervention integrated into the therapeutic activities of institutionalised elderly people.

METHODS

A randomised controlled study with baseline, post-intervention, and 2-week follow-up measures was carried out with 50 residents in a caring institution. Several indicators of physical health, cognitive functioning, emotional well-being, pain, and happiness were assessed at all phases.

RESULTS

Mixed factorial ANOVAs showed a positive impact of the music intervention on the outcomes in the intervention group (effect sizes up to .78) compared to the stability in the control (waiting list) group. Notably, the benefits seemed to be temporary, as they decreased progressively after the discontinuation of the intervention.

CONCLUSIONS

This study demonstrates the effects of a planned music-based intervention on several health- and well-being-related outcomes and has important applications regarding the use of music as a complement in therapeutic interventions with elderly people. The implementation of music therapy within the comprehensive care of institutionalised people must be maintained over time for the effects to be durable.

Return to Work and Quality of Life after Stroke in Italy: A Study on the Efficacy of Technologically Assisted Neurorehabilitation

Cerebrovascular diseases, including stroke, are historically considered diseases of old adults so only in a few studies has “return to work” (RTW) been considered as an index of rehabilitative outcome. At the moment, data on RTW in patients with stroke are highly variable: four different reviews reported the following ranges: 11–85%, 19–73%, 22–53%, and 40–45%. The absence of re-integration to work after a stroke is shown to be associated with an increase of cardiac disorders and depression, with a higher level of mortality, with social isolation and with insufficient adaptive skills. The aim of this study was to verify the effectiveness of technological treatment, performed with optic (SonicHand) and wearable (Riablo™) systems providing auditory and visual biofeedback, on RTW in patients with stroke. RTW was found to be associated with a higher independence in the activities of daily living (assessed by the Modified Barthel Index). No significant differences were found between technological versus conventional rehabilitation in terms of RTW, despite the former showing a higher odds ratio than the latter (OR = 9 vs. 6). Assistive devices were mainly used in patients who had not returned to work. Finally, quality of life was found higher in those patients who returned to work with the same conditions (work duties and time) as before stroke.

Potential benefits of music playing in stroke upper limb motor rehabilitation

Music-based interventions have emerged as a promising tool in stroke motor rehabilitation as they integrate most of the principles of motor training and multimodal stimulation. This paper aims to review the use of music in the rehabilitation of upper extremity motor function after stroke. First, we review the evidence supporting current music-based interventions including Music-supported Therapy, Music glove, group music therapy, Rhythm- and music-based intervention, and Musical sonification. Next, we describe the mechanisms that may be responsible for the effectiveness of these interventions, focusing on motor learning aspects, how multimodal stimulation may boost motor performance, and emotional and motivational aspects related to music. Then, we discuss methodological concerns in music therapy research related to modifications of therapy protocols, evaluation of patients and study designs. Finally, we highlight clinical considerations for the implementation of music-based interventions in clinical settings.

Development of Adapted Guitar to Improve Motor Function After Stroke: Feasibility Study in Young Adults

Recent research indicates that music-supported therapies may offer unique benefits for rehabilitation of motor function after stroke. We designed an adapted guitar and training task aimed to improve coordination between rhythmic and discrete movements because individuals recovering from stroke have greater difficulty performing discrete vs. rhythmic movements. In this paper, we report a feasibility study on training to play this adapted guitar in healthy young adults. Subjects (N = 10) practiced two rhythmic strumming patterns over three consecutive days using their non-dominant hand guided by an audiovisual metronome (60 bpm). They were also instructed to press a foot pedal while maintaining the strumming movement. Elbow and wrist kinematics were estimated using wireless inertial measurement units. Results showed positive mean asynchrony between strum onsets and metronome onsets, and a decrease in the standard deviation of mean asynchrony over practice. In early practice, participants slowed the strumming movement when they pressed the foot pedal, but this interference decreased on days two and three. Smoothness of the elbow movement during the strum phase, which includes the contact with the strings, increased over practice, while smoothness of the return phase did not change over practice. The predominant joint coordination pattern used for the strum phase consisted of elbow extension coupled with elbow pronation, wrist extension, and ulnar deviation. We discuss how these results fit into current music-based rehabilitation literature and outline directions for future applications of this music-supported intervention.

Non-pharmacological interventions for the improvement of post-stroke activities of daily living and disability amongst older stroke survivors: A systematic review

Globally, stroke remains a leading cause of death and disability, with older adults disproportionately affected. Numerous non-pharmacological stroke rehabilitation approaches are in use to address impairments, but their efficacy in older persons is largely unknown. This systematic review examined the evidence for such interventions as part of the Optimal Evidence-Based Non-Drug Therapies in Older Persons (ONTOP) project conducted under an European Union funded project called the Software Engine for the Assessment and Optimisation of Drug and Non-Drug Therapies in Older Persons (SENATOR) [http://www.senator-project.eu]. A Delphi panel of European geriatric experts agreed activities of daily living and disability to be of critical importance as stroke rehabilitation outcomes. A comprehensive search strategy was developed and five databases (Pubmed, CINAHL, Embase, PsycInfo and Cochrane Database of Systematic Reviews) searched for eligible systematic reviews. Primary studies meeting our criteria (non-pharmacologic interventions, involving stroke survivors aged ≥65 years, assessing activities of daily living and/or disability as outcome) were then identified from these reviews. Eligible papers were double reviewed, and due to heterogeneity, narrative analysis performed. Cochrane risk of bias and GRADE assessment tools were used to assess bias and quality of evidence, allowing us to make recommendations regarding specific non-pharmacologic rehabilitation in older stroke survivors. In total, 72 primary articles were reviewed spanning 14 types of non-pharmacological intervention. Non-pharmacological interventions based on physiotherapy and occupational therapy techniques improved activities of daily living amongst older stroke survivors. However, no evidence was found to support use of any non-pharmacological approach to benefit older stroke survivors' disability. Evidence was limited by poor study quality and the small number of studies targeting older stroke survivors. We recommend future studies explore such interventions exclusively in older adult populations and improve methodological and outcome reporting.

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

The effect of music-supported therapy (MST) as a tool to restore hemiparesis of the upper extremity after a stroke has not been appropriately contrasted with conventional therapy. The aim of this trial was to test the effectiveness of adding MST to a standard rehabilitation program in subacute stroke patients. A randomized controlled trial was conducted in which patients were randomized to MST or conventional therapy in addition to the rehabilitation program. The intensity and duration of the interventions were equated in both groups. Before and after 4 weeks of treatment, motor and cognitive functions, mood, and quality of life (QoL) of participants were evaluated. A follow-up at 3 months was conducted to examine the retention of motor gains. Both groups significantly improved their motor function, and no differences between groups were found. The only difference between groups was observed in the language domain for QoL. Importantly, an association was encountered between the capacity to experience pleasure from music activities and the motor improvement in the MST group. MST as an add-on treatment showed no superiority to conventional therapies for motor recovery. Importantly, patient's intrinsic motivation to engage in musical activities was associated with better motor improvement.

Systematic Review on Acupuncture for Treatment of Dysphagia after Stroke

OBJECTIVE

To assess the therapeutic efficacy of acupuncture for dysphagia after stroke.

METHODS

Seven electronic databases were searched from their inception until 31 September 2016. All randomized controlled trials (RCTs) incorporating acupuncture or acupuncture combined with other interventions for treatment of dysphagia after stroke were enrolled. Then they were extracted and assessed by two independent evaluators. Direct comparisons were conducted in RevMan 5.3.0 software.

RESULTS

6010 patients of 71 papers were included. The pooled analysis of efficacy rate of 58 studies indicated that acupuncture group was superior to the control group with moderate heterogeneity (RR = 1.17, 95% CI: 1.13 1.21, Z = 9.08, and P < 0.00001); meta-analysis of the studies using blind method showed that the efficacy rate of acupuncture group was 3.01 times that of control group with no heterogeneity (RR = 3.01, 95% CI: 1.95 4.65, Z = 4.97, and P < 0.00001). Only 13 studies mentioned the safety evaluation.

CONCLUSION

The result showed that the acupuncture group was better than control group in terms of efficacy rate of dysphagia after stroke. And the combining result of those researches using blind method was more strong in proof. Strict evaluation standard and high-quality RCT design are necessary for further exploration.

A systematic review of rehabilitation interventions to prevent and treat depression in post-stroke aphasia

PURPOSE

Stepped psychological care is the delivery of routine assessment and interventions for psychological problems, including depression. The aim of this systematic review was to analyze and synthesize the evidence of rehabilitation interventions to prevent and treat depression in post-stroke aphasia and adapt the best evidence within a stepped psychological care framework.

METHOD

Four databases were systematically searched up to March 2017: Medline, CINAHL, PsycINFO and The Cochrane Library.

RESULTS

Forty-five studies met inclusion and exclusion criteria. Level of evidence, methodological quality and results were assessed. People with aphasia with mild depression may benefit from psychosocial-type treatments (based on 3 level ii studies with small to medium effect sizes). For those without depression, mood may be enhanced through participation in a range of interventions (based on 4 level ii studies; 1 level iii-3 study and 6 level iv studies). It is not clear which interventions may prevent depression in post-stroke aphasia. No evidence was found for the treatment of moderate to severe depression in post-stroke aphasia.

CONCLUSIONS

This study found some interventions that may improve depression outcomes for those with mild depression or without depression in post-stroke aphasia. Future research is needed to address methodological limitations and evaluate and support the translation of stepped psychological care across the continuum. Implications for Rehabilitation Stepped psychological care after stroke is a framework with levels 1 to 4 which can be used to prevent and treat depression for people with aphasia. A range of rehabilitation interventions may be beneficial to mood at level 1 for people without clinically significant depression (e.g., goal setting and achievement, psychosocial support, communication partner training and narrative therapy). People with mild symptoms of depression may benefit from interventions at level 2 (e.g., behavioral therapy, psychosocial support and problem solving). People with moderate to severe symptoms of depression require specialist mental health/behavioral services in collaboration with stroke care at levels 3 and 4 of stepped psychological care.