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Tamir-Ostrover H, Hassin-Baer S, Fay-Karmon T, Friedman J. Quantifying Changes in Dexterity as a Result of Piano Training in People with Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2024; 24:3318. [PMID: 38894110 PMCID: PMC11174779 DOI: 10.3390/s24113318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/01/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024]
Abstract
People with Parkinson's disease often show deficits in dexterity, which, in turn, can lead to limitations in performing activities of daily life. Previous studies have suggested that training in playing the piano may improve or prevent a decline in dexterity in this population. In this pilot study, we tested three participants on a six-week, custom, piano-based training protocol, and quantified dexterity before and after the intervention using a sensor-enabled version of the nine-hole peg test, the box and block test, a test of finger synergies using unidimensional force sensors, and the Quantitative Digitography test using a digital piano, as well as selected relevant items from the motor parts of the MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and the Parkinson's Disease Questionnaire (PDQ-39) quality of life questionnaire. The participants showed improved dexterity following the training program in several of the measures used. This pilot study proposes measures that can track changes in dexterity as a result of practice in people with Parkinson's disease and describes a potential protocol that needs to be tested in a larger cohort.
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Affiliation(s)
- Hila Tamir-Ostrover
- Department of Physical Therapy, Faculty of Medical & Health Sciences, School of Health Professions, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Sharon Hassin-Baer
- Movement Disorders Institute and Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 5262000, Israel; (S.H.-B.); (T.F.-K.)
- Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tsvia Fay-Karmon
- Movement Disorders Institute and Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 5262000, Israel; (S.H.-B.); (T.F.-K.)
- Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Jason Friedman
- Department of Physical Therapy, Faculty of Medical & Health Sciences, School of Health Professions, Tel Aviv University, Tel Aviv 6997801, Israel;
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
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Tian J, Wang H, Lu H, Yang Y, Li L, Niu J, Cheng B. Force/position-based velocity control strategy for the lower limb rehabilitation robot during active training: design and validation. Front Bioeng Biotechnol 2024; 11:1335071. [PMID: 38260744 PMCID: PMC10800786 DOI: 10.3389/fbioe.2023.1335071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Aiming at the shortcomings of most existing control strategies for lower limb rehabilitation robots that are difficult to guarantee trajectory tracking effect and active participation of the patient, this paper proposes a force/position-based velocity control (FPVC) strategy for the hybrid end-effector lower limb rehabilitation robot (HE-LRR) during active training. The configuration of HE-LRR is described and the inverse Jacobian analysis is carried out. Then, the FPVC strategy design is introduced in detail, including normal velocity planning and tangential velocity planning. The experimental platform for the HE-LRR system is presented. A series of experiments are conducted to validate the FPVC strategy's performance, including trajectory measurement experiments, force and velocity measurement experiments, and active participation experiments. Experimental studies show that the end effector possesses good following performance with the reference trajectory and the desired velocity, and the active participation of subjects can be adjusted by the control strategy parameters. The experiments have verified the rationality of the FPVC strategy, which can meet the requirements of trajectory tracking effect and active participation, indicating its good application prospects in the patient's robot-assisted active training.
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Affiliation(s)
- Junjie Tian
- Hebei Provincial Key Laboratory of Parallel Robot and Mechatronic System, Yanshan University, Qinhuangdao, China
- School of Mechanical Engineering, Yanshan University, Qinhuangdao, China
| | - Hongbo Wang
- Hebei Provincial Key Laboratory of Parallel Robot and Mechatronic System, Yanshan University, Qinhuangdao, China
- School of Mechanical Engineering, Yanshan University, Qinhuangdao, China
- Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Hao Lu
- Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Yang Yang
- Hebei Provincial Key Laboratory of Parallel Robot and Mechatronic System, Yanshan University, Qinhuangdao, China
- School of Mechanical Engineering, Yanshan University, Qinhuangdao, China
| | - Lianqing Li
- Hebei Provincial Key Laboratory of Parallel Robot and Mechatronic System, Yanshan University, Qinhuangdao, China
- School of Mechanical Engineering, Yanshan University, Qinhuangdao, China
| | - Jianye Niu
- Hebei Provincial Key Laboratory of Parallel Robot and Mechatronic System, Yanshan University, Qinhuangdao, China
- School of Mechanical Engineering, Yanshan University, Qinhuangdao, China
| | - Bo Cheng
- Qinhuangdao Hospital of Traditional Chinese Medicine, Qinhuangdao, China
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Peyre I, Roby-Brami A, Segalen M, Giron A, Caramiaux B, Marchand-Pauvert V, Pradat-Diehl P, Bevilacqua F. Effect of sonification types in upper-limb movement: a quantitative and qualitative study in hemiparetic and healthy participants. J Neuroeng Rehabil 2023; 20:136. [PMID: 37798637 PMCID: PMC10552218 DOI: 10.1186/s12984-023-01248-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 09/13/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Movement sonification, the use of real-time auditory feedback linked to movement parameters, have been proposed to support rehabilitation. Nevertheless, if promising results have been reported, the effect of the type of sound used has not been studied systematically. The aim of this study was to investigate in a single session the effect of different types of sonification both quantitatively and qualitatively on patients with acquired brain lesions and healthy participants. METHODS An experimental setup enabling arm sonification was developed using three different categories of sonification (direct sound modulation, musical interaction, and soundscape). Simple moving forward movements performed while sliding on a table with both arms were investigated with all participants. Quantitative analysis on the movement timing were performed considering various parameters (sound condition, affected arm and dominance, sonification categories). Qualitative analysis of semi-structured interviews were also conducted, as well as neuropsychological evaluation of music perception. RESULTS For both the patient and healthy groups (15 participants each), average duration for performing the arm movement is significantly longer with sonification compared to the no-sound condition (p < 0.001). Qualitative analysis of semi-structured interviews revealed different aspects of motivational and affective aspects of sonification. Most participants of both groups preferred to complete the task with sound (29 of 30 participants), and described the experience as playful (22 of 30 participants). More precisely, the soundscape (nature sounds) was the most constantly preferred (selected first by 14 of 30 participants). CONCLUSION Overall, our results confirm that the sonification has an effect on the temporal execution of the movement during a single-session. Globally, sonification is welcomed by the participants, and we found convergent and differentiated appreciations of the different sonification types.
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Affiliation(s)
- Iseline Peyre
- UMR STMS, Ircam, CNRS, Sorbonne Université, 75004, Paris, France
- ISIR, CNRS UMR 7222, Inserm U1150, Sorbonne Université, 75005, Paris, France
- Laboratoire d'Imagerie Biomédicale (LIB), Inserm, CNRS, Sorbonne Université, 75006, Paris, France
| | - Agnès Roby-Brami
- ISIR, CNRS UMR 7222, Inserm U1150, Sorbonne Université, 75005, Paris, France
| | - Maël Segalen
- UMR STMS, Ircam, CNRS, Sorbonne Université, 75004, Paris, France
- ISIR, CNRS UMR 7222, Inserm U1150, Sorbonne Université, 75005, Paris, France
| | - Alain Giron
- Laboratoire d'Imagerie Biomédicale (LIB), Inserm, CNRS, Sorbonne Université, 75006, Paris, France
| | - Baptiste Caramiaux
- ISIR, CNRS UMR 7222, Inserm U1150, Sorbonne Université, 75005, Paris, France
| | | | - Pascale Pradat-Diehl
- Laboratoire d'Imagerie Biomédicale (LIB), Inserm, CNRS, Sorbonne Université, 75006, Paris, France
- AP-HP, Hôpital Pitié-Salpêtrière, Maladies du Système Nerveux, 75013, Paris, France
- GRC HaMCRe, Sorbonne Université, 75013, Paris, France
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Barth J, Geed S, Mitchell A, Brady KP, Giannetti ML, Dromerick AW, Edwards DF. The Critical Period After Stroke Study (CPASS) Upper Extremity Treatment Protocol. Arch Rehabil Res Clin Transl 2023; 5:100282. [PMID: 37744191 PMCID: PMC10517370 DOI: 10.1016/j.arrct.2023.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Objective To present the development of a novel upper extremity (UE) treatment and assess how it was delivered in the Critical Periods After Stroke Study (CPASS), a phase II randomized controlled trial (RCT). Design Secondary analysis of data from the RCT. Setting Inpatient and outpatient settings the first year after stroke. Participants Of the 72 participants enrolled in CPASS (N=72), 53 were in the study groups eligible to receive the treatment initiated at ≤30 days (acute), 2-3 months (subacute), or ≥6 months (chronic) poststroke. Individuals were 65.1±10.5 years of age, 55% were women, and had mild to moderate UE motor capacity (Action Research Arm Test=17.2±14.3) at baseline. Intervention The additional 20 hours of treatment began using the Activity Card Sort (ACS), a standardized assessment of activities and participation after stroke, to identify UE treatment goals selected by the participants that were meaningful to them. Treatment activities were broken down into smaller components from a standardized protocol and process that operationalized the treatments essential elements. Main Outcome Measures Feasibility of performing the treatment in a variety of clinical settings in an RCT and contextual factors that influenced adherence. Results A total of 49/53 participants fully adhered to the CPASS treatment. The duration and location of the treatment sessions and the UE activities practiced during therapy are presented for the total sample (n=49) and per study group as an assessment of feasibility and the contextual factors that influenced adherence. Conclusions The CPASS treatment and therapy goals were explicitly based on the meaningful activities identified by the participants using the ACS as a treatment planning tool. This approach provided flexibility to customize UE motor therapy without sacrificing standardization or quantification of the data regardless of the location and UE impairments of participants within the first year poststroke.
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Affiliation(s)
- Jessica Barth
- Veterans Affairs Medical Center, Center of Innovation for Long-Term Supports and Services, Providence, RI
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Shashwati Geed
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Abigail Mitchell
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Kathaleen P. Brady
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Margot L. Giannetti
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Alexander W. Dromerick
- MedStar National Rehabilitation Hospital, Washington, DC
- Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Dorothy F. Edwards
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
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Unver F, Buke M. The Effect of Music on Balance Parameters. PHYSIKALISCHE MEDIZIN, REHABILITATIONSMEDIZIN, KURORTMEDIZIN 2023. [DOI: 10.1055/a-2015-3446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Abstract
Objectives This study aimed to determine the effect of music on balance
parameters in healthy individuals.
Methods Forty-two participants were included in the study, mean
age=23.3 (SD=5.31). Prokin Tecnobody balance device was used for
balance measurements. Static and dynamic balance measurements on the dominant
foot and bipedal stance were recorded while listening to high-intensity music
and without music.
Results In the study, there was a statistically significant difference in
the dominant foot static mediolateral balance in measurements taken with music
(p=0.013). But, there was no difference in other parameters
(p>0.05). When examined by gender, it was found that the mediolateral
balance scores of females on static and dynamic dominant feet were significantly
higher in high-intensity music than males (p<0.05).
Conclusion In healthy participants, music improves the mediolateral
balance on the dominant foot. Therefore, high-intensity music can be a safe and
motivating method to be used in addition to clinical applications.
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Affiliation(s)
- Fatma Unver
- Faculty of Physiotherapy and Rehabilitation, Pamukkale University,
Denizli, Turkey
| | - Meryem Buke
- Faculty of Health Sciences, Department of Physiotherapy and
Rehabilitation, Van Yuzuncu Yil University, Van, Turkey
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The Effect of Music-Based Rhythmic Auditory Stimulation on Balance and Functional Outcomes after Stroke. Healthcare (Basel) 2022; 10:healthcare10050899. [PMID: 35628037 PMCID: PMC9140539 DOI: 10.3390/healthcare10050899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 02/05/2023] Open
Abstract
Purpose: the purpose of this paper was to evaluate the effects of music-based rhythmic auditory stimulation on balance and motor function after stroke and whether there are differences depending on the affected hemisphere, lesion site and age. Materials and Methods: This study was an observational and longitudinal study. Adult stroke survivors (n = 28), starting no later than 3 weeks after a stroke, conducted 90 min sessions of music-based rhythmic auditory stimulation 3 days a week, in addition to 60 min a day of conventional physiotherapy. Balance ability was evaluated using the Mini Best Test and the Tinetti Test; motor function was evaluated using the Motor Assessment Scale. Results: All of the participants significantly improved their balance ability and motor function variables upon comparing scores at discharge and admission. Intragroup differences were observed upon comparing subgroups of patients by lesion site and by the degree of motor impairment. Age, stroke type and affected hemisphere seemed not to be directly related to the amount of improvement. Conclusions: This study suggests that the effects of music-based rhythmic auditory stimulation (RAS) on balance ability and motor function varies depending on the scale or test used for evaluation and on the variables that the tests measure. Patients with hemiparesis seemed to improve more than those with hemiplegia.
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Chea M, Pichon B, Migeot H, Bayen E. Art, as a hyphen between health professionals and individuals in rehabilitation after stroke. Ann Phys Rehabil Med 2022; 65:101658. [PMID: 35272064 DOI: 10.1016/j.rehab.2022.101658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/01/2022] [Accepted: 02/19/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Maryane Chea
- Department of Physical and Rehabilitation Medicine, Pitié-Salpêtrière hospital, APHP, Paris, France; GRC 24, Sorbonne Université, Paris, France
| | - Bertrand Pichon
- Department of Physical and Rehabilitation Medicine, Pitié-Salpêtrière hospital, APHP, Paris, France; GRC 24, Sorbonne Université, Paris, France
| | - Hélène Migeot
- Department of Physical and Rehabilitation Medicine, Pitié-Salpêtrière hospital, APHP, Paris, France; GRC 24, Sorbonne Université, Paris, France
| | - Eléonore Bayen
- Department of Physical and Rehabilitation Medicine, Pitié-Salpêtrière hospital, APHP, Paris, France; GRC 24, Sorbonne Université, Paris, France; Laboratoire d'Imagerie Biomédicale - Inserm U1146, Sorbonne Université, Paris, France; Global Brain Health Institute, Memory and Aging Center, University of California San Francisco, USA.
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Braun Janzen T, Koshimori Y, Richard NM, Thaut MH. Rhythm and Music-Based Interventions in Motor Rehabilitation: Current Evidence and Future Perspectives. Front Hum Neurosci 2022; 15:789467. [PMID: 35111007 PMCID: PMC8801707 DOI: 10.3389/fnhum.2021.789467] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/27/2021] [Indexed: 12/17/2022] Open
Abstract
Research in basic and clinical neuroscience of music conducted over the past decades has begun to uncover music’s high potential as a tool for rehabilitation. Advances in our understanding of how music engages parallel brain networks underpinning sensory and motor processes, arousal, reward, and affective regulation, have laid a sound neuroscientific foundation for the development of theory-driven music interventions that have been systematically tested in clinical settings. Of particular significance in the context of motor rehabilitation is the notion that musical rhythms can entrain movement patterns in patients with movement-related disorders, serving as a continuous time reference that can help regulate movement timing and pace. To date, a significant number of clinical and experimental studies have tested the application of rhythm- and music-based interventions to improve motor functions following central nervous injury and/or degeneration. The goal of this review is to appraise the current state of knowledge on the effectiveness of music and rhythm to modulate movement spatiotemporal patterns and restore motor function. By organizing and providing a critical appraisal of a large body of research, we hope to provide a revised framework for future research on the effectiveness of rhythm- and music-based interventions to restore and (re)train motor function.
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Affiliation(s)
- Thenille Braun Janzen
- Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, São Bernardo do Campo, Brazil
| | - Yuko Koshimori
- Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, ON, Canada
- Brain Health Imaging Centre, CAMH, Toronto, ON, Canada
| | - Nicole M. Richard
- Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, ON, Canada
- Faculty of Music, Belmont University, Nashville, TN, United States
| | - Michael H. Thaut
- Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- *Correspondence: Michael H. Thaut,
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Young HJ, Mehta T, Herman C, Baidwan NK, Lai B, Rimmer JH. The Effects of a Movement-to-Music (M2M) Intervention on Physical and Psychosocial Outcomes in People Poststroke: A Randomized Controlled Trial. Arch Rehabil Res Clin Transl 2021; 3:100160. [PMID: 34977542 PMCID: PMC8683867 DOI: 10.1016/j.arrct.2021.100160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the effects of a 12-week movement-to-music (M2M) intervention on physical and psychosocial outcomes in people poststroke. DESIGN Two-arm randomized controlled trial. SETTING A community-based fitness facility. PARTICIPANTS Participants (N=47) with stroke between 18 and 65 years old were randomized to M2M (n=23) or waitlist control (n=24). INTERVENTIONS Participants in M2M completed 3 60-minute exercise sessions per week for 12 weeks. Controls received biweekly educational newsletters via mail. MAIN OUTCOME MEASURES Primary outcomes included Six-Minute Walk Test (6MWT, in meters), Five Times Sit-to-Stand Test (FTSST, in seconds) and Timed Up and Go (TUG, in seconds). Secondary outcomes were self-reported measures using Patient-Reported Outcomes Measurement Information System Fatigue and Pain Interference Short Form 8a. Outcomes were collected at baseline and postintervention. Analyses involved descriptive statistics and adjusted linear mixed models. RESULTS Mixed models adjusted for the respective baseline values and demographic variables showed that M2M participants had longer 6MWT distance (least square mean difference [LSM], 14.5; 95% confidence interval [CI], -12.9 to 42.0), more FTSST time (LSM, 2.0; 95% CI, -4.5 to 8.5), and less fatigue (LSM, -3.0; 95% CI, -7.2 to 1.2) compared with controls postintervention. When controlling for baseline TUG and demographic variables, there was a larger increase in 6MWT distance (LSM, 37.9; 95% CI, -22.7 to 98.6), lower FTSST time (LSM, -6.1; 95% CI, -18.5 to 6.2), and decrease in fatigue (LSM, -6.5; 95% CI, -13.1 to 0.2) in the M2M group compared with controls. Moderate effect sizes were observed for improving 6MWT (d=0.6), FTSST (d=-0.6), and fatigue (d=-0.6). There was no group difference in change in TUG time and pain interference, with trivial effect sizes (d=-0.1). CONCLUSION M2M may be a valuable exercise form for adults with stroke. Future studies are needed to determine optimal exercise doses for improving health and function in this population.
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Key Words
- 6MWT, Six-Minute Walk Test
- AEs, adverse events
- BMI, body mass index
- CI, confidence interval
- Dance
- Exercise
- FTSST, Five Times Sit to Stand Test
- ICC, intraclass correlation coefficient
- LSM, least square means
- M2M, movement-to-music
- MCID, minimally clinically important difference
- PROMIS, Patient-Reported Outcomes Measurement Information System
- Physical performance
- Quality of life
- RPE, Rating of Perceived Exertion
- Rehabilitation
- Stroke
- TUG, Timed Up and Go
- WC, waitlist control
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Affiliation(s)
- Hui-Ju Young
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Tapan Mehta
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Cassandra Herman
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Navneet Kaur Baidwan
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Byron Lai
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Division of Pediatric and Rehabilitation Medicine, School of University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - James H. Rimmer
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Lin PC, Lay YL, Chiu HL, Chen IH, Peters K. Effectiveness of a musical fitness programme for older adults with cognitive impairment in long-term care facilities: A quasi-experimental study. J Clin Nurs 2021; 31:995-1004. [PMID: 34227165 DOI: 10.1111/jocn.15956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/12/2021] [Accepted: 06/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effectiveness of a musical fitness programme (MFP) intervention in improving neuropsychiatric symptoms, depression, upper-limb muscle strength and cognition of older adults with cognitive impairment in long-term care (LTC) facilities. BACKGROUND Because of population ageing, the number of older adults with cognitive impairment has been increasing. The effectiveness of medications in treating cognitive impairment is limited; therefore, the global trend has been for non-pharmacological treatments. However, intervention studies of MFPs on older LTC residents with cognitive impairment are scant. DESIGN This study adopted a quasi-experimental design in accordance with the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist. In total, 84 older adults with cognitive impairment were recruited from seven LTC facilities. The MFP was implemented from July-November 2019. METHODS The intervention group received the MFP, which was 50 min per session, twice a week for 12 weeks, whereas the comparison group received usual care. Neuropsychiatric inventory nursing home version, the Cornell scale for depression in dementia Chinese version, 30-s arm curl test and Mini-Mental State Examination were the outcome measures. Data were analysed using Chi-square test, t test and repeated measure analysis of variance. RESULTS After the intervention, the scores of neuropsychiatric inventory and the Cornell depression exhibited significant differences over time between two groups (F = 3.6, p = .029; F = 5.96, p = .003, respectively). Nevertheless, 30-s arm curl test and Mini-Mental State Examination demonstrated non-significant between-group differences. CONCLUSION The MFP can effectively reduce neuropsychiatric symptoms and depression in older adults with cognitive impairment in LTC facilities. To ensure a more robust evidence base, more research is warranted. RELEVANCE TO CLINICAL PRACTICE The MFP is a non-pharmacological treatment that can be implemented to promote psychological well-being among older adults with cognitive impairment in LTC facilities, and to indirectly reduce nursing staff burden. To assist nursing staff in providing this intervention, on-the-job training is needed.
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Affiliation(s)
- Pi-Chu Lin
- Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Yu-Ling Lay
- Taipei Veterans General Hospital-Yuanshan Branch, Yilan, Taiwan
| | - Huei-Ling Chiu
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - I-Hui Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Kath Peters
- School of Nursing and Midwifery, Western Sydney University, Penrith South, NSW, Australia
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Kogutek D, Holmes JD, Grahn JA, Ready E, Montero-Odasso M. Improvised active music therapy for clients with Parkinson’s disease: A feasibility study. BRITISH JOURNAL OF MUSIC THERAPY 2021. [DOI: 10.1177/13594575211029101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to test the feasibility of delivering Improvised Active Music Therapy sessions in measuring the impact of acquisition of rhythmic complexity levels on gait performance in individuals with Parkinson’s disease. In this single subject multiple baseline design, the study measured the ability of three right-handed participants with Parkinson’s disease to acquire greater density of syncopation, as a measure of rhythmic complexity levels, while playing uninterrupted improvised music on a simplified electronic drum-set. The music content of the sessions was transformed into digital music data in real-time using Musical Instrument Digital Interface. The Musical Instrument Digital Interface data were analyzed to determine the participants’ and the Music Therapist’s density of syncopation (on acoustic guitar) during baseline and treatment conditions. Results from visual analyses and Pearson’s correlations on the outcomes indicated conflicting and inconclusive outcomes about whether higher acquisition of rhythmic complexity levels improves gait performance in individuals with Parkinson’s disease. Despite this, evidence was found to support the overall value of Improvised Active Music Therapy sessions on gait performance. The study design, the intervention, and outcome measures were found to be feasible and could be scaled-up into a larger trial.
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Huang WH, Dou ZL, Jin HM, Cui Y, Li X, Zeng Q. The Effectiveness of Music Therapy on Hand Function in Patients With Stroke: A Systematic Review of Randomized Controlled Trials. Front Neurol 2021; 12:641023. [PMID: 34113305 PMCID: PMC8185294 DOI: 10.3389/fneur.2021.641023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Wen-Hao Huang
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zu-Lin Dou
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hui-Min Jin
- Shanghai Sunshine Rehabilitation Center, Shanghai, China
| | - Ying Cui
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xin Li
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qing Zeng
- Department of Rehabilitation Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China
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13
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Ghai S, Maso FD, Ogourtsova T, Porxas AX, Villeneuve M, Penhune V, Boudrias MH, Baillet S, Lamontagne A. Neurophysiological Changes Induced by Music-Supported Therapy for Recovering Upper Extremity Function after Stroke: A Case Series. Brain Sci 2021; 11:brainsci11050666. [PMID: 34065395 PMCID: PMC8161385 DOI: 10.3390/brainsci11050666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 12/30/2022] Open
Abstract
Music-supported therapy (MST) follows the best practice principles of stroke rehabilitation and has been proven to instigate meaningful enhancements in motor recovery post-stroke. The existing literature has established that the efficacy and specificity of MST relies on the reinforcement of auditory-motor functional connectivity in related brain networks. However, to date, no study has attempted to evaluate the underlying cortical network nodes that are key to the efficacy of MST post-stroke. In this case series, we evaluated changes in connectivity within the auditory-motor network and changes in upper extremity function following a 3-week intensive piano training in two stroke survivors presenting different levels of motor impairment. Connectivity was assessed pre- and post-training in the α- and the β-bands within the auditory-motor network using magnetoencephalography while participants were passively listening to a standardized melody. Changes in manual dexterity, grip strength, movement coordination, and use of the upper extremity were also documented in both stroke survivors. After training, an increase in the clinical measures was accompanied by enhancements in connectivity between the auditory and motor network nodes for both the α- and the β-bands, especially in the affected hemisphere. These neurophysiological changes associated with the positive effects of post-stroke MST on motor outcomes delineate a path for a larger scale clinical trial.
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Affiliation(s)
- Shashank Ghai
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada; (T.O.); (M.-H.B.); (A.L.)
- Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital–CISSS Laval, A Research Site of the Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, QC H7V 1R2, Canada;
- Correspondence:
| | - Fabien Dal Maso
- Laboratory of Simulation and Movement Modelling, School of Kinesiology and Physical Activity, Université de Montréal, Montreal, QC H3T 1J4, Canada;
- Centre Interdisciplinaire de Recherche sur le Cerveau et l’Apprentissage, Montréal, QC H7N 0A5, Canada
| | - Tatiana Ogourtsova
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada; (T.O.); (M.-H.B.); (A.L.)
- Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital–CISSS Laval, A Research Site of the Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, QC H7V 1R2, Canada;
| | - Alba-Xifra Porxas
- Graduate Program in Biological and Biomedical Engineering, McGill University, Montreal, QC H3A 0C3, Canada;
| | - Myriam Villeneuve
- Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital–CISSS Laval, A Research Site of the Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, QC H7V 1R2, Canada;
| | - Virginia Penhune
- Department of Psychology, Concordia University, Montreal, QC H3G 1M8, Canada;
- Laboratory for Brain Music and Sound (BRAMS), Centre for Research in Brain, Language and Music, Montreal, QC H2V 2S9, Canada
| | - Marie-Hélène Boudrias
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada; (T.O.); (M.-H.B.); (A.L.)
- Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital–CISSS Laval, A Research Site of the Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, QC H7V 1R2, Canada;
| | - Sylvain Baillet
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada;
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada; (T.O.); (M.-H.B.); (A.L.)
- Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital–CISSS Laval, A Research Site of the Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, QC H7V 1R2, Canada;
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14
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Fang WH, Wang GL, Liu Q, Ding X, Wang ZY, Wang XW, Yang XW, Yang Y, Zhang DW, Wei Q, Zhang H. Effect of 'hand and foot acupuncture with twelve needles' on hemiplegia patients with 'qi deficiency and blood stasis' syndrome in the convalescent stage of Ischaemic stroke: study protocol for a randomised controlled trial. Trials 2021; 22:215. [PMID: 33736678 PMCID: PMC7977321 DOI: 10.1186/s13063-021-05128-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 02/13/2021] [Indexed: 12/14/2022] Open
Abstract
Background Hemiplegia is a common sequela after stroke, and acupuncture is one of the most common physical therapies used to treat hemiplegia during the recovery stage after ischaemic stroke. ‘Hand and foot acupuncture with twelve needles’ is an acupuncture treatment performed after stroke. The principal objective of this study is to assess the efficacy and safety of ‘hand and foot acupuncture with twelve needles’ for hemiplegia in the convalescent stage of ischaemic stroke. Methods This is the protocol for a randomised, controlled clinical trial with two groups: a ‘hand and foot acupuncture with twelve needles’ group and a routine acupuncture group. A total of 208 participants will be randomly assigned to two different groups in a 1:1 ratio and will undergo conventional rehabilitation. Limb function will be evaluated by the simplified Fugl-Meyer assessment scale, Barthel Index, modified Ashworth scale and National Institute of Health stroke scale. The participants will be evaluated at baseline (on the day of enrolment) and followed up at 2 weeks, 1 month, 2 months and 3 months after enrolment. Discussion The results of this study will provide evidence on the effectiveness of ‘hand and foot acupuncture with twelve needles’ in the treatment of limb dysfunction that can be used for future evaluations. Trial registration Chictr.org.cnChiCTR1900021774. Registered on 8 March 2019
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Affiliation(s)
- Wei-Hao Fang
- Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital, Beijing, 101300, China
| | - Gui-Ling Wang
- Beijing Hospital of Traditional Chinese Medicine, Beijing, 100010, China
| | - Qiang Liu
- World Federation of Chinese Medicine Societies, Beijing, 100101, China
| | - Xiao Ding
- Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital, Beijing, 101300, China
| | - Zhen-Yao Wang
- Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital, Beijing, 101300, China
| | - Xin-Wei Wang
- Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital, Beijing, 101300, China
| | - Xiao-Wei Yang
- Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital, Beijing, 101300, China
| | - Yang Yang
- Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital, Beijing, 101300, China
| | - Da-Wei Zhang
- Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital, Beijing, 101300, China
| | - Qing Wei
- Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital, Beijing, 101300, China
| | - Hu Zhang
- Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital, Beijing, 101300, China.
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15
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Hutchinson K, Sloutsky R, Collimore A, Adams B, Harris B, Ellis TD, Awad LN. A Music-Based Digital Therapeutic: Proof-of-Concept Automation of a Progressive and Individualized Rhythm-Based Walking Training Program After Stroke. Neurorehabil Neural Repair 2020; 34:986-996. [PMID: 33040685 DOI: 10.1177/1545968320961114] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The rhythm of music can entrain neurons in motor cortex by way of direct connections between auditory and motor brain regions. OBJECTIVE We sought to automate an individualized and progressive music-based, walking rehabilitation program using real-time sensor data in combination with decision algorithms. METHODS A music-based digital therapeutic was developed to maintain high sound quality while modulating, in real-time, the tempo (ie, beats per minute, or bpm) of music based on a user's ability to entrain to the tempo and progress to faster walking cadences in-sync with the progression of the tempo. Eleven individuals with chronic hemiparesis completed one automated 30-minute training visit. Seven returned for 2 additional visits. Safety, feasibility, and rehabilitative potential (ie, changes in walking speed relative to clinically meaningful change scores) were evaluated. RESULTS A single, fully automated training visit resulted in increased usual (∆ 0.085 ± 0.027 m/s, P = .011) and fast (∆ 0.093 ± 0.032 m/s, P = .016) walking speeds. The 7 participants who completed additional training visits increased their usual walking speed by 0.12 ± 0.03 m/s after only 3 days of training. Changes in walking speed were highly related to changes in walking cadence (R2 > 0.70). No trips or falls were noted during training, all users reported that the device helped them walk faster, and 70% indicated that they would use it most or all of the time at home. CONCLUSIONS In this proof-of-concept study, we show that a sensor-automated, progressive, and individualized rhythmic locomotor training program can be implemented safely and effectively to train walking speed after stroke. Music-based digital therapeutics have the potential to facilitate salient, community-based rehabilitation.
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Affiliation(s)
| | | | | | | | - Brian Harris
- Sargent College, Boston University, Boston, MA, USA.,MedRhythms Inc, Portland, ME, USA
| | | | - Louis N Awad
- Sargent College, Boston University, Boston, MA, USA
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16
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Maier M, Ballester BR, Verschure PFMJ. Principles of Neurorehabilitation After Stroke Based on Motor Learning and Brain Plasticity Mechanisms. Front Syst Neurosci 2019; 13:74. [PMID: 31920570 PMCID: PMC6928101 DOI: 10.3389/fnsys.2019.00074] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 11/19/2019] [Indexed: 01/19/2023] Open
Abstract
What are the principles underlying effective neurorehabilitation? The aim of neurorehabilitation is to exploit interventions based on human and animal studies about learning and adaptation, as well as to show that the activation of experience-dependent neuronal plasticity augments functional recovery after stroke. Instead of teaching compensatory strategies that do not reduce impairment but allow the patient to return home as soon as possible, functional recovery might be more sustainable as it ensures a long-term reduction in impairment and an improvement in quality of life. At the same time, neurorehabilitation permits the scientific community to collect valuable data, which allows inferring about the principles of brain organization. Hence neuroscience sheds light on the mechanisms of learning new functions or relearning lost ones. However, current rehabilitation methods lack the exact operationalization of evidence gained from skill learning literature, leading to an urgent need to bridge motor learning theory and present clinical work in order to identify a set of ingredients and practical applications that could guide future interventions. This work aims to unify the neuroscientific literature relevant to the recovery process and rehabilitation practice in order to provide a synthesis of the principles that constitute an effective neurorehabilitation approach. Previous attempts to achieve this goal either focused on a subset of principles or did not link clinical application to the principles of motor learning and recovery. We identified 15 principles of motor learning based on existing literature: massed practice, spaced practice, dosage, task-specific practice, goal-oriented practice, variable practice, increasing difficulty, multisensory stimulation, rhythmic cueing, explicit feedback/knowledge of results, implicit feedback/knowledge of performance, modulate effector selection, action observation/embodied practice, motor imagery, and social interaction. We comment on trials that successfully implemented these principles and report evidence from experiments with healthy individuals as well as clinical work.
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Affiliation(s)
- Martina Maier
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Belén Rubio Ballester
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Paul F. M. J. Verschure
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Institucio Catalana de Recerca I Estudis Avançats, Barcelona, Spain
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17
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Chang CS, Lo YY, Chen CL, Lee HM, Chiang WC, Li PC. Alternative Motor Task-Based Pattern Training With a Digital Mirror Therapy System Enhances Sensorimotor Signal Rhythms Post-stroke. Front Neurol 2019; 10:1227. [PMID: 31824406 PMCID: PMC6882999 DOI: 10.3389/fneur.2019.01227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/04/2019] [Indexed: 12/16/2022] Open
Abstract
Mirror therapy (MT) facilitates motor learning and induces cortical reorganization and motor recovery from stroke. We applied the new digital mirror therapy (DMT) system to compare the cortical activation under the three visual feedback conditions: (1) no mirror visual feedback (NoMVF), (2) bilateral synchronized task-based mirror visual feedback training (BMVF), and (3) reciprocal task-based mirror visual feedback training (RMVF). During DMT, EEG recordings, including time-dependent event-related desynchronization (ERD) signal amplitude in both mu and beta bands, were obtained from the standard C3 (ispilesional hemisphere, IH), C4 (contralesional hemisphere, CH), and Cz scalp sites (supplementary motor area, SMA). The entire ERD curve was separated into three time-phases: P0 (-2 to 0 s), P1 (0 to 2 s), and P2 (2 to 4 s). Four-way and subsequent repeated-measures analyses of variance were used to examine the effects of group (stroke vs. control group), test condition (NoMVF, BMVF, and RMVF), time-phase (P0, P1, and P2), and brain area (IH, CH, SMA) on the ERD areas (%) in mu and beta bands. For the mu band, generally, ERD areas (%) were larger in the control than in the stroke group. The ERD areas (%) were largest under the RMVF condition, followed by BMVF and NoMVF conditions. Similar results were found in the beta bands. The main effects of group, time-phase, and test condition on the ERD areas (%) were significant for the three brain areas, except the main effect of group in the SMA (Cz) and CH (C4) brain area. The ERD areas (%) were larger in the control than in the stroke group. The ERD area (%) was significantly larger during P1 than during P0 and P2 (ps < 0.02), and during P2 than during P0 (ps < 0.01). The ERD area (%) under the RMVF condition was significantly larger than that under the BMVF condition and NoMVF condition (ps < 0.05). The present study suggests that cortical activation particularly in the SMA (Cz) of the brain increases in the RMVF condition in both healthy subjects and stroke patients. This result supports the hypothesis that stroke patients may benefit from RMVF training.
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Affiliation(s)
- Chao-Sheng Chang
- Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan.,Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Ying-Ying Lo
- Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan
| | - Chien-Liang Chen
- Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan
| | - Hsin-Min Lee
- Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan
| | - Wei-Chi Chiang
- Department of Occupational Therapy, I-Shou University, Kaohsiung, Taiwan
| | - Ping-Chia Li
- Department of Occupational Therapy, I-Shou University, Kaohsiung, Taiwan
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18
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Van Criekinge T, D'Août K, O'Brien J, Coutinho E. The Influence of Sound-Based Interventions on Motor Behavior After Stroke: A Systematic Review. Front Neurol 2019; 10:1141. [PMID: 31736857 PMCID: PMC6838207 DOI: 10.3389/fneur.2019.01141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/11/2019] [Indexed: 12/13/2022] Open
Abstract
Objective: To investigate the effects of sound-based interventions (SBIs) on biomechanical parameters in stroke patients. Methods: PubMed/Medline, Web of Science, the Physiotherapy Evidence Database (PEDro), and the Cochrane Library were searched until September 2019. Studies examining the effect of SBIs on kinematic, kinetic, and electromyographic outcome measures were included. Two independent reviewers performed the screening, and data extraction and risk-of-bias assessment were conducted with the PEDro and Newcastle–Ottawa scale. Disagreements were resolved by a third independent reviewer. Results: Of the 858 studies obtained from all databases, 12 studies and 240 participants met the inclusion and exclusion criteria. Six studies investigated the effect of SBI on upper limb motor tasks, while six examined walking. Concerning quality assessment (Newcastle–Ottawa Quality Assessment Scale and PEDro), the nine cross-sectional studies had a median score of seven, while the randomized controlled trials had a median score of five (fair to good quality). In relation to upper limb motor tasks, only one study found improvements in cortical reorganization and increased central excitability and motor control during reaching after SBI (results of the other five studies were too diverse and lacked quality to substantiate their findings). In relation to walking, results were clearer: SBI led to improvements in knee flexion and gastrocnemius muscle activity. Conclusion: Despite of the heterogeneity of the included studies, evidence was found demonstrating that SBI can induce biomechanical changes in motor behavior during walking in stroke patients. No conclusions could be formulated regarding reaching tasks. Additionally, directions for future research for understanding the underlying mechanism of the clinical improvements after SBI are: (1) using actual music pieces instead of rhythmic sound sequences and (2) examining sub-acute stroke rather than chronic stroke patients.
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Affiliation(s)
- Tamaya Van Criekinge
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium
| | - Kristiaan D'Août
- Department of Musculoskeletal Biology, University of Liverpool, Liverpool, United Kingdom
| | - Jonathon O'Brien
- School of Health Science, University of Liverpool, Liverpool, United Kingdom
| | - Eduardo Coutinho
- Applied Music Research Lab, Department of Music, University of Liverpool, Liverpool, United Kingdom
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19
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Effects of (music-based) rhythmic auditory cueing training on gait and posture post-stroke: A systematic review & dose-response meta-analysis. Sci Rep 2019; 9:2183. [PMID: 30778101 PMCID: PMC6379377 DOI: 10.1038/s41598-019-38723-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 01/09/2019] [Indexed: 01/22/2023] Open
Abstract
Gait dysfunctions are common post-stroke. Rhythmic auditory cueing has been widely used in gait rehabilitation for movement disorders. However, a consensus regarding its influence on gait and postural recovery post-stroke is still warranted. A systematic review and meta-analysis was performed to analyze the effects of auditory cueing on gait and postural stability post-stroke. Nine academic databases were searched according to PRISMA guidelines. The eligibility criteria for the studies were a) studies were randomized controlled trials or controlled clinical trials published in English, German, Hindi, Punjabi or Korean languages b) studies evaluated the effects of auditory cueing on spatiotemporal gait and/or postural stability parameters post-stroke c) studies scored ≥4 points on the PEDro scale. Out of 1,471 records, 38 studies involving 968 patients were included in this present review. The review and meta-analyses revealed beneficial effects of training with auditory cueing on gait and postural stability. A training dosage of 20–45 minutes session, for 3–5 times a week enhanced gait performance, dynamic postural stability i.e. velocity (Hedge’s g: 0.73), stride length (0.58), cadence (0.75) and timed-up and go test (−0.76). This review strongly recommends the incorporation of rhythmic auditory cueing based training in gait and postural rehabilitation, post-stroke.
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20
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Schaffert N, Janzen TB, Mattes K, Thaut MH. A Review on the Relationship Between Sound and Movement in Sports and Rehabilitation. Front Psychol 2019; 10:244. [PMID: 30809175 PMCID: PMC6379478 DOI: 10.3389/fpsyg.2019.00244] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/24/2019] [Indexed: 12/19/2022] Open
Abstract
The role of auditory information on perceptual-motor processes has gained increased interest in sports and psychology research in recent years. Numerous neurobiological and behavioral studies have demonstrated the close interaction between auditory and motor areas of the brain, and the importance of auditory information for movement execution, control, and learning. In applied research, artificially produced acoustic information and real-time auditory information have been implemented in sports and rehabilitation to improve motor performance in athletes, healthy individuals, and patients affected by neurological or movement disorders. However, this research is scattered both across time and scientific disciplines. The aim of this paper is to provide an overview about the interaction between movement and sound and review the current literature regarding the effect of natural movement sounds, movement sonification, and rhythmic auditory information in sports and motor rehabilitation. The focus here is threefold: firstly, we provide an overview of empirical studies using natural movement sounds and movement sonification in sports. Secondly, we review recent clinical and applied studies using rhythmic auditory information and sonification in rehabilitation, addressing in particular studies on Parkinson's disease and stroke. Thirdly, we summarize current evidence regarding the cognitive mechanisms and neural correlates underlying the processing of auditory information during movement execution and its mental representation. The current state of knowledge here reviewed provides evidence of the feasibility and effectiveness of the application of auditory information to improve movement execution, control, and (re)learning in sports and motor rehabilitation. Findings also corroborate the critical role of auditory information in auditory-motor coupling during motor (re)learning and performance, suggesting that this area of clinical and applied research has a large potential that is yet to be fully explored.
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Affiliation(s)
- Nina Schaffert
- Department of Movement and Training Science, Institute for Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Thenille Braun Janzen
- Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, ON, Canada
| | - Klaus Mattes
- Department of Movement and Training Science, Institute for Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Michael H. Thaut
- Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, ON, Canada
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21
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Luo D, Zhang Y, Yuan X, Pan Y, Yang L, Zhao Y, Zhuo R, Chen C, Peng L, Li W, Jin X, Zhou Y. Oleoylethanolamide inhibits glial activation via moudulating PPARα and promotes motor function recovery after brain ischemia. Pharmacol Res 2019; 141:530-540. [PMID: 30660821 DOI: 10.1016/j.phrs.2019.01.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 12/29/2018] [Accepted: 01/14/2019] [Indexed: 02/06/2023]
Abstract
Glial activation and scar formation impede the neurological function recovery after cerebral ischemia. Oleoylethanolamide (OEA), a bioactive lipid mediator, shows neuroprotection against acute brain ischemia, however, its long-term effect, especially on glial scar formation, has not been characterized. In this research, we investigate the effect of OEA on glial activation and scar formation after cerebral ischemia in vitro and in vivo experiments. Glial scar formation in vitro model was induced by transforming growth factor β1 (TGF-β1) in C6 glial cell culture, and experiment model in vivo was induced by middle cerebral artery occlusion (MCAO) in mice. The protein expressions of the markers of glial activation (S100β, GFAP, or pSmads) and glial scar (neurocan) were detected by Western blot and/or immunofluorescence staining; To evaluate the role of PPARɑ in the effect of OEA on glial activation, the PPARɑ antagonist GW6471 was used. Behavior tests were used to assay the effect of OEA on motor function recovery 14 days after brain ischemia in mice. Our results show that OEA (10-50 μM) concentration-dependently inhibited the upregulation of S100β, GFAP, pSmads and neurocan induced by TGF-β1 in C6 glial cells. At the same time, OEA promoted the protein expression and nuclear transportation of PPARɑ in glial cells. PPARα antagonist GW6471 abolished the effect of OEA on glial activation. In addition, we found that delay administration of OEA inhibited the astrocyte activation and promoted the recovery of motor function after brain ischemia in mice. These results indicate that OEA may be developed into a new candidate for attenuating astrocytic scar formation and improving motor function after ischemic stroke.
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Affiliation(s)
- Doudou Luo
- Department of Basic Medical Science, School of Medicine, Xiamen University, Xiamen, 361102, PR China; Key Laboratory of Chiral Drugs, Xiamen, 361102, PR China
| | - Yali Zhang
- Department of Basic Medical Science, School of Medicine, Xiamen University, Xiamen, 361102, PR China; Key Laboratory of Chiral Drugs, Xiamen, 361102, PR China; Medical College, Xuchang University, Xuchang, 461000, PR China
| | - Xiaoqian Yuan
- Department of Basic Medical Science, School of Medicine, Xiamen University, Xiamen, 361102, PR China; Key Laboratory of Chiral Drugs, Xiamen, 361102, PR China
| | - Yilin Pan
- Department of Basic Medical Science, School of Medicine, Xiamen University, Xiamen, 361102, PR China
| | - Lichao Yang
- Department of Basic Medical Science, School of Medicine, Xiamen University, Xiamen, 361102, PR China; Key Laboratory of Chiral Drugs, Xiamen, 361102, PR China
| | - Yun Zhao
- Department of Basic Medical Science, School of Medicine, Xiamen University, Xiamen, 361102, PR China; Key Laboratory of Chiral Drugs, Xiamen, 361102, PR China
| | - Rengong Zhuo
- Department of Basic Medical Science, School of Medicine, Xiamen University, Xiamen, 361102, PR China; Key Laboratory of Chiral Drugs, Xiamen, 361102, PR China
| | - Caixia Chen
- Department of Basic Medical Science, School of Medicine, Xiamen University, Xiamen, 361102, PR China; Key Laboratory of Chiral Drugs, Xiamen, 361102, PR China
| | - Lu Peng
- Department of Basic Medical Science, School of Medicine, Xiamen University, Xiamen, 361102, PR China; Key Laboratory of Chiral Drugs, Xiamen, 361102, PR China
| | - Wenjun Li
- Department of Basic Medical Science, School of Medicine, Xiamen University, Xiamen, 361102, PR China; Key Laboratory of Chiral Drugs, Xiamen, 361102, PR China
| | - Xin Jin
- Department of Basic Medical Science, School of Medicine, Xiamen University, Xiamen, 361102, PR China; Key Laboratory of Chiral Drugs, Xiamen, 361102, PR China.
| | - Yu Zhou
- Department of Basic Medical Science, School of Medicine, Xiamen University, Xiamen, 361102, PR China; Key Laboratory of Chiral Drugs, Xiamen, 361102, PR China.
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22
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Ghai S. Effects of Real-Time (Sonification) and Rhythmic Auditory Stimuli on Recovering Arm Function Post Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2018; 9:488. [PMID: 30057563 PMCID: PMC6053522 DOI: 10.3389/fneur.2018.00488] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/05/2018] [Indexed: 01/15/2023] Open
Abstract
Background: External auditory stimuli have been widely used for recovering arm function post-stroke. Rhythmic and real-time auditory stimuli have been reported to enhance motor recovery by facilitating perceptuomotor representation, cross-modal processing, and neural plasticity. However, a consensus as to their influence for recovering arm function post-stroke is still warranted because of high variability noted in research methods. Objective: A systematic review and meta-analysis was carried out to analyze the effects of rhythmic and real-time auditory stimuli on arm recovery post stroke. Method: Systematic identification of published literature was performed according to PRISMA guidelines, from inception until December 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale. Results: Of 1,889 records, 23 studies which involved 585 (226 females/359 males) patients met our inclusion criteria. The meta-analysis revealed beneficial effects of training with both types of auditory inputs for Fugl-Meyer assessment (Hedge's g: 0.79), Stroke impact scale (0.95), elbow range of motion (0.37), and reduction in wolf motor function time test (-0.55). Upon further comparison, a beneficial effect of real-time auditory feedback was found over rhythmic auditory cueing for Fugl-meyer assessment (1.3 as compared to 0.6). Moreover, the findings suggest a training dosage of 30 min to 1 h for at least 3-5 sessions per week with either of the auditory stimuli. Conclusion: This review suggests the application of external auditory stimuli for recovering arm functioning post-stroke.
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Affiliation(s)
- Shashank Ghai
- Institute for Sports Science, Leibniz University Hannover, Hannover, Germany
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23
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Chen JL. Music-supported therapy for stroke motor recovery: theoretical and practical considerations. Ann N Y Acad Sci 2018; 1423:57-65. [PMID: 29740833 DOI: 10.1111/nyas.13726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/09/2018] [Accepted: 03/20/2018] [Indexed: 11/30/2022]
Abstract
Music may confer benefits for well-being and health. What is the state of knowledge and evidence for a role of music in supporting the rehabilitation of movements after stroke? In this brief perspective, I provide background context and information about stroke recovery in general, in order to spark reflection and discussion for how we think music may impact motor recovery, given the current clinical milieu.
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Affiliation(s)
- Joyce L Chen
- Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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24
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Ghai S, Ghai I, Effenberg AO. Effect of rhythmic auditory cueing on gait in cerebral palsy: a systematic review and meta-analysis. Neuropsychiatr Dis Treat 2018; 14:43-59. [PMID: 29339922 PMCID: PMC5746070 DOI: 10.2147/ndt.s148053] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Auditory entrainment can influence gait performance in movement disorders. The entrainment can incite neurophysiological and musculoskeletal changes to enhance motor execution. However, a consensus as to its effects based on gait in people with cerebral palsy is still warranted. A systematic review and meta-analysis were carried out to analyze the effects of rhythmic auditory cueing on spatiotemporal and kinematic parameters of gait in people with cerebral palsy. Systematic identification of published literature was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and American Academy for Cerebral Palsy and Developmental Medicine guidelines, from inception until July 2017, on online databases: Web of Science, PEDro, EBSCO, Medline, Cochrane, Embase and ProQuest. Kinematic and spatiotemporal gait parameters were evaluated in a meta-analysis across studies. Of 547 records, nine studies involving 227 participants (108 children/119 adults) met our inclusion criteria. The qualitative review suggested beneficial effects of rhythmic auditory cueing on gait performance among all included studies. The meta-analysis revealed beneficial effects of rhythmic auditory cueing on gait dynamic index (Hedge's g=0.9), gait velocity (1.1), cadence (0.3), and stride length (0.5). This review for the first time suggests a converging evidence toward application of rhythmic auditory cueing to enhance gait performance and stability in people with cerebral palsy. This article details underlying neurophysiological mechanisms and use of cueing as an efficient home-based intervention. It bridges gaps in the literature, and suggests translational approaches on how rhythmic auditory cueing can be incorporated in rehabilitation approaches to enhance gait performance in people with cerebral palsy.
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Affiliation(s)
- Shashank Ghai
- Institute for Sports Science, Leibniz University Hannover, Hannover, Germany
| | - Ishan Ghai
- School of Life Sciences, Jacobs University, Bremen, Germany
| | - Alfred O Effenberg
- Institute for Sports Science, Leibniz University Hannover, Hannover, Germany
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25
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Feng F, Zhang Y, Hou J, Cai J, Jiang Q, Li X, Zhao Q, Li BA. Can music improve sleep quality in adults with primary insomnia? A systematic review and network meta-analysis. Int J Nurs Stud 2017; 77:189-196. [PMID: 29100201 DOI: 10.1016/j.ijnurstu.2017.10.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 10/14/2017] [Accepted: 10/20/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Primary insomnia is one of the most common issues for adults. However, whether to use music intervention as a non-pharmacological method of treatment, as well as which treatment should be preferred, is still a matter of controversy. Therefore, we aimed to compare and rank music interventions and no-music controls for primary insomnia patients. METHODS A network meta-analysis was used to identify evidence from relevant clinical trials. We searched PubMed, Embase, the Cochrane Library, and the China National Knowledge Infrastructure Library for publications up to May 2017, pertaining to music intervention for primary insomnia patients. The prespecified primary outcome was sleep quality (scored by the PSQI and overall), and the secondary outcomes were sleep onset latency and sleep efficiency. We did pairwise meta-analyses using the random-effects model, later completing the random-effects network meta-analyses. The study was registered with PROSPERO, number CRD42017064750. RESULTS We deemed 20 trials to be eligible, involving 1339 patients and 12 intervention arms. For PSQI scores, all intervention arms were statistically more effective than the usual care, with patients ranking listening to music as the best means of intervention (SMD: -0.61, 95%CrI: -1.01 to -0.20). For overall sleep quality, only music-associated relaxation was statistically more effective than the patients' usual care (-0.28, -0.48 to -0.08). In terms of sleep onset latency, music-associated relaxation and listening to music had significant advantages (-0.26, -0.64 to -0.09, and -0.28, -0.53 to -0.02); listening to music and music with exercise displayed a tendency to improve sleep efficiency. CONCLUSIONS When considering the efficacy, music intervention seemed to offer clear advantages for adults with primary insomnia. Listening to music and music-associated relaxation are probably the best options to consider in the application of music intervention.
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Affiliation(s)
- Fan Feng
- Center for Clinical Laboratory, The 302nd Hospital of Chinese PLA, Beijing 100039, PR China; Research Center for Clinical and Transitional Medicine, The 302nd Hospital of Chinese PLA, Beijing 100039, PR China.
| | - Yingshi Zhang
- Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang 110840, PR China; Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China.
| | - Jun Hou
- Research Center for Clinical and Transitional Medicine, The 302nd Hospital of Chinese PLA, Beijing 100039, PR China.
| | - Jiayi Cai
- College of Pharmaceutical Science, China Medical University, Shenyang 110013, PR China.
| | - Qiyu Jiang
- Research Center for Clinical and Transitional Medicine, The 302nd Hospital of Chinese PLA, Beijing 100039, PR China.
| | - Xiaojuan Li
- Research Center for Clinical and Transitional Medicine, The 302nd Hospital of Chinese PLA, Beijing 100039, PR China.
| | - Qingchun Zhao
- Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang 110840, PR China; Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China.
| | - Bo-An Li
- Center for Clinical Laboratory, The 302nd Hospital of Chinese PLA, Beijing 100039, PR China.
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26
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Bunketorp-Käll L, Lundgren-Nilsson Å, Samuelsson H, Pekny T, Blomvé K, Pekna M, Pekny M, Blomstrand C, Nilsson M. Long-Term Improvements After Multimodal Rehabilitation in Late Phase After Stroke: A Randomized Controlled Trial. Stroke 2017; 48:1916-1924. [PMID: 28619985 DOI: 10.1161/strokeaha.116.016433] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/26/2017] [Accepted: 04/28/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Treatments that improve function in late phase after stroke are urgently needed. We assessed whether multimodal interventions based on rhythm-and-music therapy or horse-riding therapy could lead to increased perceived recovery and functional improvement in a mixed population of individuals in late phase after stroke. METHODS Participants were assigned to rhythm-and-music therapy, horse-riding therapy, or control using concealed randomization, stratified with respect to sex and stroke laterality. Therapy was given twice a week for 12 weeks. The primary outcome was change in participants' perception of stroke recovery as assessed by the Stroke Impact Scale with an intention-to-treat analysis. Secondary objective outcome measures were changes in balance, gait, grip strength, and cognition. Blinded assessments were performed at baseline, postintervention, and at 3- and 6-month follow-up. RESULTS One hundred twenty-three participants were assigned to rhythm-and-music therapy (n=41), horse-riding therapy (n=41), or control (n=41). Post-intervention, the perception of stroke recovery (mean change from baseline on a scale ranging from 1 to 100) was higher among rhythm-and-music therapy (5.2 [95% confidence interval, 0.79-9.61]) and horse-riding therapy participants (9.8 [95% confidence interval, 6.00-13.66]), compared with controls (-0.5 [-3.20 to 2.28]); P=0.001 (1-way ANOVA). The improvements were sustained in both intervention groups 6 months later, and corresponding gains were observed for the secondary outcomes. CONCLUSIONS Multimodal interventions can improve long-term perception of recovery, as well as balance, gait, grip strength, and working memory in a mixed population of individuals in late phase after stroke. CLINICAL TRIAL REGISTRATION URL: http//www.ClinicalTrials.gov. Unique identifier: NCT01372059.
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Affiliation(s)
- Lina Bunketorp-Käll
- From the Center for Brain Repair and Rehabilitation, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (L.B.-K., A.L.-N., H.S., T.P., M. Pekna, M. Pekny, C.B., M.N.); Center for Advanced Reconstruction of Extremities, Institute of Clinical Sciences, Sahlgrenska University Hospital, Mölndal, Sweden (L.B.-K.); Stroke Center West, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (A.L.-N., C.B.); Department of Psychology, University of Gothenburg, Sweden (H.S.); Occupational Health Care Unit (Hälsan och Arbetslivet), Region Västra Götaland, Gothenburg, Sweden (K.B.); Florey Institute of Neuroscience and and Mental Health, Parkville, Melbourne, Australia (M. Pekna, M. Pekny, M.N.); and Hunter Medical Research Institute and University of Newcastle, Australia (M. Pekna, M. Pekny, M.N.)
| | - Åsa Lundgren-Nilsson
- From the Center for Brain Repair and Rehabilitation, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (L.B.-K., A.L.-N., H.S., T.P., M. Pekna, M. Pekny, C.B., M.N.); Center for Advanced Reconstruction of Extremities, Institute of Clinical Sciences, Sahlgrenska University Hospital, Mölndal, Sweden (L.B.-K.); Stroke Center West, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (A.L.-N., C.B.); Department of Psychology, University of Gothenburg, Sweden (H.S.); Occupational Health Care Unit (Hälsan och Arbetslivet), Region Västra Götaland, Gothenburg, Sweden (K.B.); Florey Institute of Neuroscience and and Mental Health, Parkville, Melbourne, Australia (M. Pekna, M. Pekny, M.N.); and Hunter Medical Research Institute and University of Newcastle, Australia (M. Pekna, M. Pekny, M.N.)
| | - Hans Samuelsson
- From the Center for Brain Repair and Rehabilitation, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (L.B.-K., A.L.-N., H.S., T.P., M. Pekna, M. Pekny, C.B., M.N.); Center for Advanced Reconstruction of Extremities, Institute of Clinical Sciences, Sahlgrenska University Hospital, Mölndal, Sweden (L.B.-K.); Stroke Center West, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (A.L.-N., C.B.); Department of Psychology, University of Gothenburg, Sweden (H.S.); Occupational Health Care Unit (Hälsan och Arbetslivet), Region Västra Götaland, Gothenburg, Sweden (K.B.); Florey Institute of Neuroscience and and Mental Health, Parkville, Melbourne, Australia (M. Pekna, M. Pekny, M.N.); and Hunter Medical Research Institute and University of Newcastle, Australia (M. Pekna, M. Pekny, M.N.)
| | - Tulen Pekny
- From the Center for Brain Repair and Rehabilitation, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (L.B.-K., A.L.-N., H.S., T.P., M. Pekna, M. Pekny, C.B., M.N.); Center for Advanced Reconstruction of Extremities, Institute of Clinical Sciences, Sahlgrenska University Hospital, Mölndal, Sweden (L.B.-K.); Stroke Center West, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (A.L.-N., C.B.); Department of Psychology, University of Gothenburg, Sweden (H.S.); Occupational Health Care Unit (Hälsan och Arbetslivet), Region Västra Götaland, Gothenburg, Sweden (K.B.); Florey Institute of Neuroscience and and Mental Health, Parkville, Melbourne, Australia (M. Pekna, M. Pekny, M.N.); and Hunter Medical Research Institute and University of Newcastle, Australia (M. Pekna, M. Pekny, M.N.)
| | - Karin Blomvé
- From the Center for Brain Repair and Rehabilitation, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (L.B.-K., A.L.-N., H.S., T.P., M. Pekna, M. Pekny, C.B., M.N.); Center for Advanced Reconstruction of Extremities, Institute of Clinical Sciences, Sahlgrenska University Hospital, Mölndal, Sweden (L.B.-K.); Stroke Center West, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (A.L.-N., C.B.); Department of Psychology, University of Gothenburg, Sweden (H.S.); Occupational Health Care Unit (Hälsan och Arbetslivet), Region Västra Götaland, Gothenburg, Sweden (K.B.); Florey Institute of Neuroscience and and Mental Health, Parkville, Melbourne, Australia (M. Pekna, M. Pekny, M.N.); and Hunter Medical Research Institute and University of Newcastle, Australia (M. Pekna, M. Pekny, M.N.)
| | - Marcela Pekna
- From the Center for Brain Repair and Rehabilitation, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (L.B.-K., A.L.-N., H.S., T.P., M. Pekna, M. Pekny, C.B., M.N.); Center for Advanced Reconstruction of Extremities, Institute of Clinical Sciences, Sahlgrenska University Hospital, Mölndal, Sweden (L.B.-K.); Stroke Center West, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (A.L.-N., C.B.); Department of Psychology, University of Gothenburg, Sweden (H.S.); Occupational Health Care Unit (Hälsan och Arbetslivet), Region Västra Götaland, Gothenburg, Sweden (K.B.); Florey Institute of Neuroscience and and Mental Health, Parkville, Melbourne, Australia (M. Pekna, M. Pekny, M.N.); and Hunter Medical Research Institute and University of Newcastle, Australia (M. Pekna, M. Pekny, M.N.)
| | - Milos Pekny
- From the Center for Brain Repair and Rehabilitation, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (L.B.-K., A.L.-N., H.S., T.P., M. Pekna, M. Pekny, C.B., M.N.); Center for Advanced Reconstruction of Extremities, Institute of Clinical Sciences, Sahlgrenska University Hospital, Mölndal, Sweden (L.B.-K.); Stroke Center West, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (A.L.-N., C.B.); Department of Psychology, University of Gothenburg, Sweden (H.S.); Occupational Health Care Unit (Hälsan och Arbetslivet), Region Västra Götaland, Gothenburg, Sweden (K.B.); Florey Institute of Neuroscience and and Mental Health, Parkville, Melbourne, Australia (M. Pekna, M. Pekny, M.N.); and Hunter Medical Research Institute and University of Newcastle, Australia (M. Pekna, M. Pekny, M.N.)
| | - Christian Blomstrand
- From the Center for Brain Repair and Rehabilitation, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (L.B.-K., A.L.-N., H.S., T.P., M. Pekna, M. Pekny, C.B., M.N.); Center for Advanced Reconstruction of Extremities, Institute of Clinical Sciences, Sahlgrenska University Hospital, Mölndal, Sweden (L.B.-K.); Stroke Center West, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (A.L.-N., C.B.); Department of Psychology, University of Gothenburg, Sweden (H.S.); Occupational Health Care Unit (Hälsan och Arbetslivet), Region Västra Götaland, Gothenburg, Sweden (K.B.); Florey Institute of Neuroscience and and Mental Health, Parkville, Melbourne, Australia (M. Pekna, M. Pekny, M.N.); and Hunter Medical Research Institute and University of Newcastle, Australia (M. Pekna, M. Pekny, M.N.)
| | - Michael Nilsson
- From the Center for Brain Repair and Rehabilitation, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (L.B.-K., A.L.-N., H.S., T.P., M. Pekna, M. Pekny, C.B., M.N.); Center for Advanced Reconstruction of Extremities, Institute of Clinical Sciences, Sahlgrenska University Hospital, Mölndal, Sweden (L.B.-K.); Stroke Center West, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden (A.L.-N., C.B.); Department of Psychology, University of Gothenburg, Sweden (H.S.); Occupational Health Care Unit (Hälsan och Arbetslivet), Region Västra Götaland, Gothenburg, Sweden (K.B.); Florey Institute of Neuroscience and and Mental Health, Parkville, Melbourne, Australia (M. Pekna, M. Pekny, M.N.); and Hunter Medical Research Institute and University of Newcastle, Australia (M. Pekna, M. Pekny, M.N.).
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