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Wagner C, Grob C, Hediger K. Specific and Non-specific Factors of Animal-Assisted Interventions Considered in Research: A Systematic Review. Front Psychol 2022; 13:931347. [PMID: 35837630 PMCID: PMC9274084 DOI: 10.3389/fpsyg.2022.931347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/06/2022] [Indexed: 12/05/2022] Open
Abstract
Research on animal-assisted interventions (AAIs) has increased massively in the last few years. But it is still not clear how AAIs work and how important the animal is in such interventions. The aim of this systematic review was to compile the existing state of knowledge about the working mechanisms of AAIs. We searched 12 major electronic databases for previous AAI studies with active control groups. Of 2001 records identified, we included 172 studies in the systematic review. We extracted previously published hypotheses about working mechanisms and factors that have been implicitly considered specific or non-specific in AAI research by categorizing control conditions using content analysis. We analyzed the categories using descriptive statistics. We found that 84% of the included studies mentioned a hypothesis of working mechanisms, but 16% did not define specific hypotheses. By analyzing their control conditions, we found that in most controlled studies, the animal or the interaction with the animal was implicitly considered as a specific factor for the effects of the AAI. Non-specific factors such as therapeutic aspects, social interactions, or novelty have also been controlled for. We conclude that AAI research still cannot answer the question of how and why AAIs work. To address this important research gap, we suggest using component studies with innovative control conditions and results from placebo research to address both the specific and non-specific, contextual factors of AAIs to disentangle its mechanisms. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=158103, identifier: CRD42020158103.
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Affiliation(s)
- Cora Wagner
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Carmina Grob
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Karin Hediger
- Division of Clinical Psychology and Animal-Assisted Interventions, Faculty of Psychology, University of Basel, Basel, Switzerland
- REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland
- Department of Epidemiology and Public Health, Human and Animal Health Unit, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Psychology, Open University, Heerlen, Netherlands
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2
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Taylor EM, Robertson N, Lightfoot CJ, Smith AC, Jones CR. Nature-Based Interventions for Psychological Wellbeing in Long-Term Conditions: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063214. [PMID: 35328901 PMCID: PMC8954238 DOI: 10.3390/ijerph19063214] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 12/16/2022]
Abstract
Background: With the global burden of disease increasing, particularly in relation to often preventable chronic diseases, researchers and clinicians are keen to identify interventions that can mitigate ill health and enhance the psychological wellbeing of people living with long-term conditions (LTCs). It is long established that engagement with nature can support human health and wellbeing, and in recent years, nature-based interventions (NBIs) have been advanced as of potential benefit. This review thus sought to systematically appraise published evidence of the application of NBIs to address psychological wellbeing for those living with LTCs. Methods: A systematic search of three databases, PsycINFO, MEDLINE and SCOPUS, was undertaken, and the BestBETs quality assessment checklist was used to appraise methodological quality of elicited studies. Results: Of 913 studies identified, 13 studies (12 using quantitative methods, one qualitative) were used. Included papers reported use of a variety of psychological outcomes alongside more circumscribed physiological outcomes. Quality appraisal showed modest robustness, some methodological weaknesses and a dominance of application in developed countries, yet synthesis of studies suggested that reported psychological and physiological outcomes present a strong argument for NBIs having a promising and positive impact on psychological wellbeing. Conclusions: NBIs have positive psychological and physiological impacts on people with LTCs, suggesting they may be a suitable addition to current maintenance treatment. Future research should focus on minimising study bias and increasing the potential for cross-cultural applications.
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Affiliation(s)
- Eleanor M. Taylor
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7HA, UK;
- Correspondence: (E.M.T.); (C.R.J.)
| | - Noelle Robertson
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7HA, UK;
| | - Courtney J. Lightfoot
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK; (C.J.L.); (A.C.S.)
| | - Alice C. Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK; (C.J.L.); (A.C.S.)
| | - Ceri R. Jones
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7HA, UK;
- Correspondence: (E.M.T.); (C.R.J.)
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Rodríguez-Martínez MDC, De la Plana Maestre A, Armenta-Peinado JA, Barbancho MÁ, García-Casares N. Evidence of Animal-Assisted Therapy in Neurological Diseases in Adults: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12882. [PMID: 34948491 PMCID: PMC8701659 DOI: 10.3390/ijerph182412882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND In recent years, the possibility of intervening humans with animal-assisted therapy (AAT) has been growing due to numerous physical, psychological, and social benefits provided to humanity, enabling them to maintain or improve their quality of life. There exist different animals through which this therapy can be performed. The purpose of this systematic review will focus on the effects of AAT in several neurological diseases. METHODS The search of clinical trials was carried out in the PubMed, Scielo, Embase and PEDro databases. The selection of articles was made according to the different inclusion and exclusion criteria, incorporating those that approached neurological diseases to be reviewed. RESULTS Twenty-five clinical trials were identified, seventeen of which were finally included in the review. The results indicate that animal-assisted therapy (AAT) in different neurological diseases has many benefits in several areas, for example, in motor and physical ability as well as in mental and behavioural health. CONCLUSIONS This systematic review provides occupational therapy practitioners with evidence on the use of activity based on animal-assisted therapy as a novel field of intervention that can complement other therapies and obtain benefits in different populations.
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Affiliation(s)
| | | | - Juan Antonio Armenta-Peinado
- Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, C/Arquitecto Francisco Peñalosa 3, 29071 Málaga, Spain;
| | - Miguel Ángel Barbancho
- Pathological Anatomy and Physical-Sports, Education, Department of Human Physiology, Human Histology, University of Malaga, 29016 Málaga, Spain
- Centro de Investigaciones Médico Sanitarias (CIMES), University of Malaga, 29010 Málaga, Spain;
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
| | - Natalia García-Casares
- Centro de Investigaciones Médico Sanitarias (CIMES), University of Malaga, 29010 Málaga, Spain;
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
- Department of Medicine, Faculty of Medicine, University of Malaga, 29016 Málaga, Spain
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Stokowska A, Bunketorp Käll L, Blomstrand C, Simrén J, Nilsson M, Zetterberg H, Blennow K, Pekny M, Pekna M. Plasma neurofilament light chain levels predict improvement in late phase after stroke. Eur J Neurol 2021; 28:2218-2228. [PMID: 33811783 DOI: 10.1111/ene.14854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Although functional recovery is most pronounced in the first 6 months after stroke, improvement is possible also in the late phase. The value of plasma neurofilament light chain (NfL), a biomarker of axonal injury and secondary neurodegeneration, was explored for the prediction of functional improvement in the late phase after stroke. METHODS Baseline plasma NfL levels were measured in 115 participants of a trial on the efficacy of multimodal rehabilitation in the late phase after stroke. The association between NfL levels, impairment in balance, gait and cognitive domains, and improvement 3 and 9 months later was determined. RESULTS Plasma NfL levels were associated with the degree of impairment in all three domains. Individuals with meaningful improvement in balance and gait capacity had higher plasma NfL levels compared with non-improvers (p = 0.001 and p = 0.018, respectively). Higher NfL levels were associated with improvement in balance (odds ratio [OR] 2.34, 95% confidence interval [CI] 1.35-4.27, p = 0.004) and gait (OR 2.27, 95% CI 1.25-4.32, p = 0.009). Elevated plasma NfL levels showed a positive predictive value for cognitive improvement, and this effect was specific for the intervention targeting the cognitive domain. The association of NfL levels with cognitive improvement withstood correction for baseline impairment, age and total years of schooling (OR 7.54, 95% CI 1.52-45.66, p = 0.018). CONCLUSIONS In addition to its established role as a biomarker in the acute phase, elevated circulating NfL levels may predict functional improvement in the late phase after stroke. Our results should prompt further studies into the use of plasma NfL as a biomarker in the late phase after stroke.
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Affiliation(s)
- Anna Stokowska
- Laboratory of Regenerative Neuroimmunology, Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Lina Bunketorp Käll
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Center for Advanced Reconstruction of Extremities C.A.R.E, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Blomstrand
- Stroke Center West, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Joel Simrén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Michael Nilsson
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Vic, Australia.,University of Newcastle, Newcastle, NSW, Australia.,Centre for Rehab Innovations (CRI), University of Newcastle and Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia.,LKC School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Milos Pekny
- Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Vic, Australia.,University of Newcastle, Newcastle, NSW, Australia.,Laboratory of Astrocyte Biology and CNS Regeneration, Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Marcela Pekna
- Laboratory of Regenerative Neuroimmunology, Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Vic, Australia.,University of Newcastle, Newcastle, NSW, Australia
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Bunketorp-Käll L, Pekna M, Pekny M, Samuelsson H, Blomstrand C, Nilsson M. Motor Function in the Late Phase After Stroke: Stroke Survivors' Perspective. Ann Rehabil Med 2020; 44:362-369. [PMID: 32986939 PMCID: PMC7655232 DOI: 10.5535/arm.20060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/03/2020] [Indexed: 11/10/2022] Open
Abstract
Objective To examine the association between observer-assessed functional status and perceived recovery in the late phase after stroke. The study also aimed to determine whether observer-assessed functional improvements as a result of horse-riding therapy (H-RT) are related to enhanced perception of stroke recovery. Methods This is a descriptive correlational study using data derived from a three-armed randomized controlled trial in which 123 individuals were enrolled, among whom 43 received H-RT for 12 weeks. The measures included the Modified Motor Assessment Scale, Berg Balance Scale, Timed Up and Go, timed 10-m walk, and perceived recovery from stroke indicated by item #9 in the Stroke Impact Scale (version 2.0). Spearman rank order correlation (rs) was used in the analyses. Results There were moderate to strong positive or negative correlations between all four observer-assessed motor variables and participants’ ratings of perceived late-phase stroke recovery at trial entrance, ranging from rs=-0.49 to rs=0.54 (p<0.001). The results of the correlational analyses of variable changes showed that, after the end of the H-RT intervention, both self-selected and fast gait speed improvement were significantly correlated with increments in self-rated stroke recovery (rs=-0.41, p=0.01 and rs=-0.38, p=0.02, respectively). Conclusion This study provided data supporting the association between individual ratings of self-perceived recovery after stroke and observer-assessed individual motor function. The results further demonstrate that enhancement in perceived stroke recovery after completing the intervention was associated with objectively measured gains in both self-selected and fast gait speed.
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Affiliation(s)
- Lina Bunketorp-Käll
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Center for Advanced Reconstruction of Extremities (CARE), Sahlgrenska University Hospital, Mölndal, Sweden
| | - Marcela Pekna
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.,University of Newcastle, Newcastle, Australia
| | - Milos Pekny
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.,University of Newcastle, Newcastle, Australia
| | - Hans Samuelsson
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Christian Blomstrand
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Stroke Center West, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Michael Nilsson
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.,Centre for Rehab Innovations (CRI), University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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6
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Grau-Sánchez J, Münte TF, Altenmüller E, Duarte E, Rodríguez-Fornells A. Potential benefits of music playing in stroke upper limb motor rehabilitation. Neurosci Biobehav Rev 2020; 112:585-599. [PMID: 32092314 DOI: 10.1016/j.neubiorev.2020.02.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/18/2022]
Abstract
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.
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Affiliation(s)
- Jennifer Grau-Sánchez
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, 08097, Spain; Escola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa (EUIT), Universitat Autònoma de Barcelona, Terrassa, Catalonia, Spain.
| | - Thomas F Münte
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Eckart Altenmüller
- Institute of Music Physiology and Musicians' Medicine, Hannover University of Music, Drama and Media, Hannover, Germany
| | - Esther Duarte
- Department of Physical Medicine and Rehabilitation, Hospitals del Mar i l'Esperança, Parc de Salut Mar, Barcelona, Spain
| | - Antoni Rodríguez-Fornells
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, 08097, Spain; Department of Cognition, Development and Educational Science, Campus Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, 08097, Spain; Catalan Institution for Research and Advanced Studies, ICREA, Barcelona, Spain.
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7
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Bunketorp-Käll L, Pekna M, Pekny M, Blomstrand C, Nilsson M. Effects of horse-riding therapy and rhythm and music-based therapy on functional mobility in late phase after stroke. NeuroRehabilitation 2019; 45:483-492. [PMID: 31868694 PMCID: PMC7029334 DOI: 10.3233/nre-192905] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Persons with stroke commonly have residual neurological deficits that seriously hamper mobility. OBJECTIVE To investigate whether horse-riding therapy (H-RT) and rhythm and music-based therapy (R-MT) affect functional mobility in late phase after stroke. METHODS This study is part of a randomized controlled trial in which H-RT and R-MT was provided twice weekly for 12 weeks. Assessment included the timed 10-meter walk test (10 mWT), the six-minute walk test (6 MWT) and Modified Motor Assessment Scale (M-MAS). RESULTS 123 participants were assigned to H-RT (n = 41), R-MT (n = 41), or control (n = 41). Post-intervention, the H-RT group completed the 10 mWT faster at both self-selected (-2.22 seconds [95% CI, -3.55 to -0.88]; p = 0.001) and fast speed (-1.19 seconds [95% CI, -2.18 to -0.18]; p = 0.003), with fewer steps (-2.17 [95% CI, -3.30 to -1.04]; p = 0.002 and -1.40 [95% CI, -2.36 to -0.44]; p = 0.020, respectively), as compared to controls. The H-RT group also showed improvements in functional task performance as measured by M-MAS UAS (1.13 [95% CI, 0.74 to 1.52]; p = 0.001). The gains were partly maintained at 6 months among H-RT participants. The R-MT did not produce any immediate gains. However, 6 months post-intervention, the R-MT group performed better with respect to time; -0.75 seconds [95% CI, -1.36 to -0.14]; p = 0.035) and number of steps -0.76 [95% CI, -1.46 to -0.05]; p = 0.015) in the 10 mWT at self-selected speed. CONCLUSIONS The present study supports the efficacy of H-RT in producing immediate gains in gait and functional task performance in the late phase after stroke, whereas the effectiveness of R-MT is less clear.
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Affiliation(s)
- Lina Bunketorp-Käll
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Center for Advanced Reconstruction of Extremities C.A.R.E. Institute of Clinical Sciences, Sahlgrenska University Hospital/Mölndal, Sweden
| | - Marcela Pekna
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Australia
| | - Milos Pekny
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Australia
- University of Newcastle, New South Wales, Australia
| | - Christian Blomstrand
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Stroke Center West, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Michael Nilsson
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Australia
- Centre for Rehab Innovations (CRI), University of Newcastle and Hunter Medical Research Institute (HMRI) Newcastle, Australia
- LKC School of Medicine, Nanyang Technological University, Singapore
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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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Pohl P, Carlsson G, Bunketorp Käll L, Nilsson M, Blomstrand C. A qualitative exploration of post-acute stroke participants' experiences of a multimodal intervention incorporating horseback riding. PLoS One 2018; 13:e0203933. [PMID: 30235246 PMCID: PMC6147507 DOI: 10.1371/journal.pone.0203933] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 08/30/2018] [Indexed: 12/29/2022] Open
Abstract
Background Multimodal rehabilitation interventions delivered in late phase of stroke recovery involve physical (motor and sensory), social, and cognitively challenging activities. Horseback riding can be incorporated within such interventions, leading to meaningful long-term improvements when applied to individuals with moderate levels of disability. There is a lack of research illuminating stroke survivors’ experiences and perceptions of horseback riding in the context of multimodal interventions. Aim To explore stroke survivors’ experiences of participation in a multimodal group-based intervention that included horseback riding. Methods An explorative interview study was conducted with individual face-to-face interviews performed on a single occasion, utilising a semi-structured interview guide. Eighteen participants were purposively selected from a larger trial (mean age 62, 12 men, 6 women) within four weeks after treatment completion. The interview duration was between 17 and 50 minutes. The data was analysed using a qualitative content analysis method. Findings Four broad themes were identified from the analysis. These themes were: transformative experiences; human–horse interaction; togetherness and belonging; and the all-in-one solution. Interacting with the horse and peers had a profound emotional impact on the participants. The participants also reported having learned new skills, increased self-efficacy and self-esteem, and improvements in balance and gait, all of which could be transferred to everyday life. The horse itself played a central role, but other components, such as the other group members, the instructors, and the challenging tasks on the horseback, were also important. Conclusion A multimodal rehabilitation intervention that includes horseback riding may provide stroke survivors in a late phase of recovery with rich pleasurable experiences that may have life-changing and profound impacts on their emotional and physical state.
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Affiliation(s)
- Petra Pohl
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Activity and Health, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- * E-mail:
| | - Gunnel Carlsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lina Bunketorp Käll
- Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital/Mölndal, Mölndal, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Michael Nilsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Christian Blomstrand
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Stroke Centre West, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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10
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Experiences from a multimodal rhythm and music-based rehabilitation program in late phase of stroke recovery - A qualitative study. PLoS One 2018; 13:e0204215. [PMID: 30226862 PMCID: PMC6143265 DOI: 10.1371/journal.pone.0204215] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/05/2018] [Indexed: 01/26/2023] Open
Abstract
Background Rehabilitative stroke interventions based on principles of multimodal stimulation have the potential to profoundly affect neuroplastic processes beyond the sub-acute phase. In order to identify important core mechanisms, there is a need to explore how interventions that combine physical, social, sensory, and cognitively challenging activities are perceived and experienced by the participants. This qualitative study, based on an interpretive interactionist perspective, explored the experiences of stroke survivors who participated in a group-based multimodal rehabilitation program based on rhythm and music. Methods and findings Within four weeks after completion of the multimodal rehabilitation program, face-to-face semi-structured interviews were conducted on a single occasion with 15 purposively selected individuals (mean age 65, 8 men, 7 women). The interview duration was between 13 and 44 minutes. Qualitative content analysis with an inductive approach was used to analyze data. Three categories were identified, each containing several sub-categories: To be intellectually challenged (energy-consuming activity and coordinating multiple input and output), Perceived therapeutic benefits (motor skills, cognitive skills, emotional and psychological responses), and Pros and cons with social integration (fellowship, competing with others, and instructor characteristics). From these categories, an overall theme was derived: The multifaceted layers of multimodal stimulation. Enjoying music, being part of a group with peers, a skilled instructor, and being able to manage the challenging movements, were related to positive experiences. In contrast, negative experiences were associated with not being able to perform the exercises, and with group members who dominated the conversational space. Conclusion This study shows that access to a multimodal rehabilitation program with rhythm and music as operating ingredients may contribute to positive experiences for many individuals in a late phase after stroke in terms of motor, cognitive, as well as emotional enhancements. Important components were the music, the social interaction, the challenging exercises, and the skilled instructor.
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Bunketorp-Käll L, Lundgren-Nilsson Å, Nilsson M, Blomstrand C. Multimodal rehabilitation in the late phase after stroke enhances the life situation of informal caregivers. Top Stroke Rehabil 2017; 25:161-167. [PMID: 29237339 DOI: 10.1080/10749357.2017.1413761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Purpose The burden of caregiving for stroke survivors is well known, but the effect of late stroke rehabilitation on the life situation of informal caregivers is unknown. Here, we assessed changes in the life situation of informal caregivers of stroke survivors enrolled in a multimodal intervention trial. Methods This controlled study was a questionnaire-based survey accompanying a three-armed randomized controlled trial of 123 stroke survivors. The care recipients of 106 caregivers who chose to participate were assigned to rhythm-and-music-based therapy (R-MT; n = 37), horse-riding therapy (H-RT; n = 37), or delayed intervention (control group, n = 32). Perceived changes in the life situation of the caregivers were evaluated with the Life Situation among Spouses after the Stroke Event (LISS) questionnaire before randomization, after the 12-week intervention, and 3 and 6 months later. Results After the intervention, the change in the median LISS score was significantly higher among intervention caregivers (1.5 [interquartile range (IQR) 8.8]) than controls (1.5 [IQR 8.8] vs. 0.0 [IQR 12.0], p = 0.036). The improvement was maintained at 3 months (1.5 [IQR 9.0] vs. 0.0 [IQR 10.5], p = 0.039) but not at 6 months (p = 0.284). Conclusion Engaging stroke survivors in multimodal interventions late after stroke appears to have potential to produce gains also in the general life situation of informal caregivers.
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Affiliation(s)
- Lina Bunketorp-Käll
- a Center for Brain Repair and Rehabilitation, Department of Clinical Neuroscience , Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
| | - Åsa Lundgren-Nilsson
- a Center for Brain Repair and Rehabilitation, Department of Clinical Neuroscience , Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.,b Stroke Center West, Department of Clinical Neuroscience , Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
| | - Michael Nilsson
- a Center for Brain Repair and Rehabilitation, Department of Clinical Neuroscience , Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.,c Hunter Medical Research Institute (HMRI) and University of Newcastle , Newcastle , Australia
| | - Christian Blomstrand
- a Center for Brain Repair and Rehabilitation, Department of Clinical Neuroscience , Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.,b Stroke Center West, Department of Clinical Neuroscience , Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
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12
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Lazarou I, Parastatidis T, Tsolaki A, Gkioka M, Karakostas A, Douka S, Tsolaki M. International Ballroom Dancing Against Neurodegeneration: A Randomized Controlled Trial in Greek Community-Dwelling Elders With Mild Cognitive impairment. Am J Alzheimers Dis Other Demen 2017; 32:489-499. [PMID: 28840742 PMCID: PMC10852896 DOI: 10.1177/1533317517725813] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
BACKGROUND Many studies have highlighted the positive effects of dance in people with neurodegenerative diseases. OBJECTIVES To explore the effects of International Ballroom Dancing on cognitive function in elders with amnestic mild cognitive impairment (aMCI). METHODS One-hundred twenty-nine elderly patients with aMCI diagnosis (mean age 66.8 ± 10.1 years) were randomly assigned into 2 groups: intervention group (IG, n = 66) and control group (CG, n = 63). The IG exercised systematically for 10 months, and both groups were submitted to extensive neuropsychological assessment prior and after the 10-month period. RESULTS According to the independent sample t test at the follow-up, significant differences between groups were found in benefit of the IG while the CG showed worse performance in the majority of neuropsychological tests. According to the Student t test, better performance is detected in IG in contrast with CG, which had worse performance almost in all scales. CONCLUSION Dance may be an important nonpharmacological approach that can benefit cognitive functions.
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Affiliation(s)
- Ioulietta Lazarou
- 3rd Department of Neurology, Medical School, Aristotle University of Thessaloniki Greece (AUTH), Thessaloniki, Greece
| | - Themis Parastatidis
- Greek Alzheimer Association and Related Disorders (GAARD), Thessaloniki, Greece
| | - Anthoula Tsolaki
- Greek Alzheimer Association and Related Disorders (GAARD), Thessaloniki, Greece
- Medical Physics Laboratory, Medical School, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Mara Gkioka
- 3rd Department of Neurology, Medical School, Aristotle University of Thessaloniki Greece (AUTH), Thessaloniki, Greece
| | - Anastasios Karakostas
- Department of Informatics, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
- Information Technologies Institute, Center of Research and Technology Hellas (CERTH-ITI), Thermi, Greece
| | - Stella Douka
- Sports Medicine Laboratory, Department of Physical Education and Sport Sciences, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Magda Tsolaki
- 3rd Department of Neurology, Medical School, Aristotle University of Thessaloniki Greece (AUTH), Thessaloniki, Greece
- Greek Alzheimer Association and Related Disorders (GAARD), Thessaloniki, Greece
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13
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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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Abstract
BACKGROUND Acquired brain injury (ABI) can result in impairments in motor function, language, cognition, and sensory processing, and in emotional disturbances, which can severely reduce a survivor's quality of life. Music interventions have been used in rehabilitation to stimulate brain functions involved in movement, cognition, speech, emotions, and sensory perceptions. An update of the systematic review published in 2010 was needed to gauge the efficacy of music interventions in rehabilitation for people with ABI. OBJECTIVES To assess the effects of music interventions for functional outcomes in people with ABI. We expanded the criteria of our existing review to: 1) examine the efficacy of music interventions in addressing recovery in people with ABI including gait, upper extremity function, communication, mood and emotions, cognitive functioning, social skills, pain, behavioural outcomes, activities of daily living, and adverse events; 2) compare the efficacy of music interventions and standard care with a) standard care alone, b) standard care and placebo treatments, or c) standard care and other therapies; 3) compare the efficacy of different types of music interventions (music therapy delivered by trained music therapists versus music interventions delivered by other professionals). SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (January 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 6), MEDLINE (1946 to June 2015), Embase (1980 to June 2015), CINAHL (1982 to June 2015), PsycINFO (1806 to June 2015), LILACS (1982 to January 2016), and AMED (1985 to June 2015). We handsearched music therapy journals and conference proceedings, searched dissertation and specialist music databases, trials and research registers, reference lists, and contacted relevant experts and music therapy associations to identify unpublished research. We imposed no language restriction. We performed the original search in 2009. SELECTION CRITERIA We included all randomised controlled trials and controlled clinical trials that compared music interventions and standard care with standard care alone or combined with other therapies. We examined studies that included people older than 16 years of age who had ABI of a non-degenerative nature and were participating in treatment programmes offered in hospital, outpatient, or community settings. We included studies in any language, published and unpublished. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias of the included studies. We contacted trial researchers to obtain missing data or for additional information when necessary. Where possible, we presented results for continuous outcomes in meta-analyses using mean differences (MDs) and standardised mean differences (SMDs). We used post-test scores. In cases of significant baseline difference, we used change scores. We conducted a sensitivity analysis to assess the impact of the randomisation method. MAIN RESULTS We identified 22 new studies for this update. The evidence for this update is based on 29 trials involving 775 participants. A music intervention known as rhythmic auditory stimulation may be beneficial for improving the following gait parameters after stroke. We found a reported increase in gait velocity of 11.34 metres per minute (95% confidence interval (CI) 8.40 to 14.28; 9 trials; 268 participants; P < 0.00001; moderate-quality evidence). Stride length of the affected side may also benefit, with a reported average of 0.12 metres more (95% CI 0.04 to 0.20; 5 trials; 129 participants; P = 0.003; moderate-quality evidence). We found a reported average improvement for general gait of 7.67 units on the Dynamic Gait Index (95% CI 5.67 to 9.67; 2 trials; 48 participants; P < 0.00001). There may also be an improvement in gait cadence, with a reported average increase of 10.77 steps per minute (95% CI 4.36 to 17.18; 7 trials; 223 participants; P = 0.001; low-quality evidence).Music interventions may be beneficial for improving the timing of upper extremity function after stroke as scored by a reduction of 1.08 seconds on the Wolf Motor Function Test (95% CI -1.69 to -0.47; 2 trials; 122 participants; very low-quality evidence).Music interventions may be beneficial for communication outcomes in people with aphasia following stroke. Overall, communication improved by 0.75 standard deviations in the intervention group, a moderate effect (95% CI 0.11 to 1.39; 3 trials; 67 participants; P = 0.02; very low-quality evidence). Naming was reported as improving by 9.79 units on the Aachen Aphasia Test (95% CI 1.37 to 18.21; 2 trials; 35 participants; P = 0.02). Music interventions may have a beneficial effect on speech repetition, reported as an average increase of 8.90 score on the Aachen Aphasia Test (95% CI 3.25 to 14.55; 2 trials; 35 participants; P = 0.002).There may be an improvement in quality of life following stroke using rhythmic auditory stimulation, reported at 0.89 standard deviations improvement on the Stroke Specific Quality of Life Scale, which is considered to be a large effect (95% CI 0.32 to 1.46; 2 trials; 53 participants; P = 0.002; low-quality evidence). We found no strong evidence for effects on memory and attention. Data were insufficient to examine the effect of music interventions on other outcomes.The majority of studies included in this review update presented a high risk of bias, therefore the quality of the evidence is low. AUTHORS' CONCLUSIONS Music interventions may be beneficial for gait, the timing of upper extremity function, communication outcomes, and quality of life after stroke. These results are encouraging, but more high-quality randomised controlled trials are needed on all outcomes before recommendations can be made for clinical practice.
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Affiliation(s)
- Wendy L Magee
- Temple UniversityBoyer College of Music and Dance2001 North 13th StreetPhiladelphiaUSAPA 19122
| | - Imogen Clark
- University of MelbourneMusic Therapy, Faculty of VCA and MCM151 Barry StreetMelbourneVICAustralia3010
| | - Jeanette Tamplin
- University of MelbourneMusic Therapy, Faculty of VCA and MCM151 Barry StreetMelbourneVICAustralia3010
| | - Joke Bradt
- College of Nursing and Health Professions, Drexel UniversityDepartment of Creative Arts Therapies1601 Cherry Street, room 7112PhiladelphiaPAUSA19102
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15
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Zhang Y, Cai J, Zhang Y, Ren T, Zhao M, Zhao Q. Improvement in Stroke-induced Motor Dysfunction by Music-supported Therapy: A Systematic Review and Meta-analysis. Sci Rep 2016; 6:38521. [PMID: 27917945 PMCID: PMC5137001 DOI: 10.1038/srep38521] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 11/08/2016] [Indexed: 12/27/2022] Open
Abstract
To conduct a meta-analysis of clinical trials that examined the effect of music-supported therapy on stroke-induced motor dysfunction, comprehensive literature searches of PubMed, Embase and the Cochrane Library from their inception to April 2016 were performed. A total of 10 studies (13 analyses, 358 subjects) were included; all had acceptable quality according to PEDro scale score. The baseline differences between the two groups were confirmed to be comparable. Compared with the control group, the standardized mean difference of 9-Hole Peg Test was 0.28 (-0.01, 0.57), 0.64 (0.31, 0.97) in Box and Block Test, 0.47 (0.08, 0.87) in Arm Paresis Score and 0.35 (-0.04, 0.75) in Action Research Arm Test for upper-limb motor function, 0.11 (-0.24, 0.46) in Berg Balance Scale score, 0.09 (-0.36, 0.54) in Fugl-Meyer Assessment score, 0.30 (-0.15, 0.74) in Wolf Motor Function Test, 0.30 (-0.15, 0.74) in Wolf Motor Function time, 0.65 (0.14, 1.16) in Stride length and 0.62 (0.01, 1.24) in Gait Velocity for total motor function, and 1.75 (0.94, 2.56) in Frontal Assessment Battery score for executive function. There was evidence of a positive effect of music-supported therapy, supporting its use for the treatment of stroke-induced motor dysfunction. This study was registered at PRESPERO (CRD42016037106).
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Affiliation(s)
- Yingshi Zhang
- School of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, 110016, P.R. China.,Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang, 110840, P.R. China
| | - Jiayi Cai
- School of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, 110016, P.R. China.,Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang, 110840, P.R. China
| | - Yaqiong Zhang
- School of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, 110016, P.R. China.,Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang, 110840, P.R. China
| | - Tianshu Ren
- Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang, 110840, P.R. China
| | - Mingyi Zhao
- School of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, 110016, P.R. China
| | - Qingchun Zhao
- School of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, 110016, P.R. China.,Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang, 110840, P.R. China
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Street AJ, Magee WL, Odell-Miller H, Bateman A, Fachner JC. Home-based neurologic music therapy for upper limb rehabilitation with stroke patients at community rehabilitation stage-a feasibility study protocol. Front Hum Neurosci 2015; 9:480. [PMID: 26441586 PMCID: PMC4585041 DOI: 10.3389/fnhum.2015.00480] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/17/2015] [Indexed: 11/13/2022] Open
Abstract
Background: Impairment of upper limb function following stroke is more common than lower limb impairment and is also more resistant to treatment. Several lab-based studies with stroke patients have produced statistically significant gains in upper limb function when using musical instrument playing and techniques where rhythm acts as an external time-keeper for the priming and timing of upper limb movements. Methods: For this feasibility study a small sample size of 14 participants (3–60 months post stroke) has been determined through clinical discussion between the researcher and study host in order to test for management, feasibility and effects, before planning a larger trial determined through power analysis. A cross-over design with five repeated measures will be used, whereby participants will be randomized into either a treatment (n = 7) or wait list control (n = 7) group. Intervention will take place twice weekly over 6 weeks. The ARAT and 9HPT will be used to measure for quantitative gains in arm function and finger dexterity, pre/post treatment interviews will serve to investigate treatment compliance and tolerance. A lab based EEG case comparison study will be undertaken to explore audio-motor coupling, brain connectivity and neural reorganization with this intervention, as evidenced in similar studies. Discussion: Before evaluating the effectiveness of a home-based intervention in a larger scale study, it is important to assess whether implementation of the trial methodology is feasible. This study investigates the feasibility, efficacy and patient experience of a music therapy treatment protocol comprising a chart of 12 different instrumental exercises and variations, which aims at promoting measurable changes in upper limb function in hemiparetic stroke patients. The study proposes to examine several new aspects including home-based treatment and dosage, and will provide data on recruitment, adherence and variability of outcomes.
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Affiliation(s)
- Alexander J Street
- Music and Performing Arts, Music for Health Research Centre, Anglia Ruskin University Cambridge, UK
| | - Wendy L Magee
- Music Therapy Program, Boyer College of Music and Dance, Temple University Philadelphia, PA, USA
| | - Helen Odell-Miller
- Music and Performing Arts, Music for Health Research Centre, Anglia Ruskin University Cambridge, UK
| | - Andrew Bateman
- Department of Psychiatry, University of Cambridge Cambridge, UK ; National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care, Cambridgeshire and Peterborough NHS Trust Cambridge, UK ; Oliver Zangwill Centre for Neuropsychological Rehabilitation Ely, UK ; Cambridgeshire Community Services NHS Trust St Ives, UK
| | - Jorg C Fachner
- Music and Performing Arts, Music for Health Research Centre, Anglia Ruskin University Cambridge, UK
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Morone G, Pisotta I, Pichiorri F, Kleih S, Paolucci S, Molinari M, Cincotti F, Kübler A, Mattia D. Proof of principle of a brain-computer interface approach to support poststroke arm rehabilitation in hospitalized patients: design, acceptability, and usability. Arch Phys Med Rehabil 2015; 96:S71-8. [PMID: 25721550 DOI: 10.1016/j.apmr.2014.05.026] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 04/30/2014] [Accepted: 05/02/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the feasibility of brain-computer interface (BCI)-assisted motor imagery training to support hand/arm motor rehabilitation after stroke during hospitalization. DESIGN Proof-of-principle study. SETTING Neurorehabilitation hospital. PARTICIPANTS Convenience sample of patients (N=8) with new-onset arm plegia or paresis caused by unilateral stroke. INTERVENTIONS The BCI-based intervention was administered as an "add-on" to usual care and lasted 4 weeks. Under the supervision of a therapist, patients were asked to practice motor imagery of their affected hand and received as a discrete feedback the movements of a "virtual" hand superimposed on their own. Such a BCI-based device was installed in a rehabilitation hospital ward. MAIN OUTCOME MEASURES Following a user-centered design, we assessed system usability in terms of motivation, satisfaction (by means of visual analog scales), and workload (National Aeronautics and Space Administration-Task Load Index). The usability of the BCI-based system was also evaluated by 15 therapists who participated in a focus group. RESULTS All patients successfully accomplished the BCI training. Significant positive correlations were found between satisfaction and motivation (P=.001, r=.393). BCI performance correlated with interest (P=.027, r=.257) and motivation (P=.012, r=.289). During the focus group, professionals positively acknowledged the opportunity offered by BCI-assisted training to measure patients' adherence to rehabilitation. CONCLUSIONS An ecological BCI-based device to assist motor imagery practice was found to be feasible as an add-on intervention and tolerable by patients who were exposed to the system in the rehabilitation environment.
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Affiliation(s)
- Giovanni Morone
- Neuroelectrical Imaging and BCI Laboratory, Santa Lucia Foundation IRCCS, Rome, Italy; Clinical Laboratory of Experimental Neurorehabilitation, Santa Lucia Foundation IRCCS, Rome, Italy.
| | - Iolanda Pisotta
- Experimental Neurorehabilitation Laboratory, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Floriana Pichiorri
- Neuroelectrical Imaging and BCI Laboratory, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Sonja Kleih
- Institute of Psychology, University of Würzburg, Würzburg, Germany
| | - Stefano Paolucci
- Clinical Laboratory of Experimental Neurorehabilitation, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Marco Molinari
- Experimental Neurorehabilitation Laboratory, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Febo Cincotti
- Neuroelectrical Imaging and BCI Laboratory, Santa Lucia Foundation IRCCS, Rome, Italy; Department of Computer, Control, and Management Engineering, Sapienza University of Rome, Italy
| | - Andrea Kübler
- Institute of Psychology, University of Würzburg, Würzburg, Germany
| | - Donatella Mattia
- Neuroelectrical Imaging and BCI Laboratory, Santa Lucia Foundation IRCCS, Rome, Italy
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Mayo NE, Anderson S, Barclay R, Cameron JI, Desrosiers J, Eng JJ, Huijbregts M, Kagan A, MacKay-Lyons M, Moriello C, Richards CL, Salbach NM, Scott SC, Teasell R, Bayley M. Getting on with the rest of your life following stroke: a randomized trial of a complex intervention aimed at enhancing life participation post stroke. Clin Rehabil 2015; 29:1198-211. [DOI: 10.1177/0269215514565396] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 12/01/2014] [Indexed: 11/15/2022]
Abstract
Objective: To enhance participation post stroke through a structured, community-based program. Design: A controlled trial with random allocation to immediate or four-month delayed entry. Setting: Eleven community sites in seven Canadian cities. Subjects: Community dwelling persons within five years of stroke onset, cognitively intact, able to toilet independently. Interventions: Evidence-based program delivered in three 12-week sessions including exercise and project-based activities, done as individuals and in groups. Main measures: Hours spent per week in meaningful activities outside of the home and Reintegration to Normal Living Index; Stroke-Specific Geriatric Depression Scale, Apathy Scale, gait speed, EuroQuol EQ-5D, and Preference-Based Stroke Index. All measures were transformed to a scale from 0 to 100. Assessments prior to randomization, after the first session at three months, six months, 12 months, and 15 months. Results: A total of 186 persons were randomized. The between-group analysis showed no disadvantage to waiting and so groups were combined and a within-person analysis was carried out at three time points. There were statistically significant increases in all study outcomes on average over all persons. Over 45% of people met or exceeded the pre-specified target of a three hour per week increase in meaningful activity and this most often took a full year of intervention to achieve. Greatest gains were in satisfaction with community integration (mean 4.78; 95% CI: 2.01 to 7.55) and stroke-specific health-related quality of life (mean 4.14; 95% CI: 2.31 to 5.97). Conclusions: Community-based programs targeting participation are feasible and effective, but stroke survivors require time to achieve meaningful gains.
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Affiliation(s)
- Nancy E Mayo
- Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada
| | - Sharon Anderson
- Department of Human Ecology, University of Alberta, Alberta, Canada
| | - Ruth Barclay
- Department of Physical Therapy, University of Manitoba, Manitoba, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Johanne Desrosiers
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Maria Huijbregts
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Aura Kagan
- Education and Applied Research, Aphasia Institute – The Pat Arato Aphasia Centre, Toronto, ON, Canada
| | | | - Carolina Moriello
- McGill University Health Center (MUHC), MUHC Research Institute, Montreal, QC, Canada
| | - Carol L Richards
- Department of Rehabilitation and Center for Interdisciplinary Research in Rehabilitation and Social Integration, Laval University, Quebec, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Susan C Scott
- Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada
| | - Robert Teasell
- Department of Physical Medicine and Rehabilitation, Western University, London, UK
| | - Mark Bayley
- Brain and Spinal Cord Rehab Program, UHN-Toronto Rehabilitation Institute, Toronto, ON, Canada
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Berg EL, Causey A. The life-changing power of the horse: Equine-assisted activities and therapies in the U.S. Anim Front 2014. [DOI: 10.2527/af.2014-0025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Erika L. Berg
- Department of Animal Sciences, North Dakota State University, Fargo
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20
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Van Vugt FT, Ritter J, Rollnik JD, Altenmüller E. Music-supported motor training after stroke reveals no superiority of synchronization in group therapy. Front Hum Neurosci 2014; 8:315. [PMID: 24904358 PMCID: PMC4033001 DOI: 10.3389/fnhum.2014.00315] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 04/28/2014] [Indexed: 12/19/2022] Open
Abstract
Background: Music-supported therapy has been shown to be an effective tool for rehabilitation of motor deficits after stroke. A unique feature of music performance is that it is inherently social: music can be played together in synchrony. Aim: The present study explored the potential of synchronized music playing during therapy, asking whether synchronized playing could improve fine motor rehabilitation and mood. Method: Twenty-eight patients in neurological early rehabilitation after stroke with no substantial previous musical training were included. Patients learned to play simple finger exercises and familiar children's songs on the piano for 10 sessions of half an hour. Patients first received three individual therapy sessions and then continued in pairs. The patient pairs were divided into two groups. Patients in one group played synchronously (together group) whereas the patients in the other group played one after the other (in-turn group). To assess fine motor skill recovery the patients performed standard clinical tests such as the nine-hole-pegboard test (9HPT) and index finger-tapping speed and regularity, and metronome-paced finger tapping. Patients' mood was established using the Profile of Mood States (POMS). Results: Both groups showed improvements in fine motor control. In metronome-paced finger tapping, patients in both groups improved significantly. Mood tests revealed reductions in depression and fatigue in both groups. During therapy, patients in the in-turn group rated their partner as more sympathetic than the together-group in a visual-analog scale. Conclusions: Our results suggest that music-supported stroke rehabilitation can improve fine motor control and mood not only individually but also in patient pairs. Patients who were playing in turn rather than simultaneously tended to reveal greater improvement in fine motor skill. We speculate that patients in the former group may benefit from the opportunity to learn from observation.
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Affiliation(s)
- Floris T Van Vugt
- Institute of Music Physiology and Musicians' Medicine, University of Music, Drama, and Media Hanover Hanover, Germany ; Lyon Neuroscience Research Center, CNRS-UMR 5292, INSERM U1028, University Claude Bernard Lyon-1 Lyon, France
| | - Juliane Ritter
- Institute of Music Physiology and Musicians' Medicine, University of Music, Drama, and Media Hanover Hanover, Germany
| | - Jens D Rollnik
- BDH-Klinik, Institute for Neurorehabilitational Research (InFo), Teaching Hospital of Hanover Medical School Hessisch Oldendorf, Germany
| | - Eckart Altenmüller
- Institute of Music Physiology and Musicians' Medicine, University of Music, Drama, and Media Hanover Hanover, Germany
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Abstract
BACKGROUND Many survivors of stroke complain about attentional impairments, such as diminished concentration and mental slowness. However, the effectiveness of cognitive rehabilitation for improving these impairments is uncertain. OBJECTIVES To determine whether (1) people receiving attentional treatment show better outcomes in their attentional functions than those given no treatment or treatment as usual, and (2) people receiving attentional treatment techniques have a better functional recovery, in terms of independence in activities of daily living, mood and quality of life, than those given no treatment or treatment as usual. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (October 2012), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library October 2012), MEDLINE (1948 to October 2012), EMBASE (1947 to October 2012), CINAHL (1981 to October 2012), PsycINFO (1806 to October 2012), PsycBITE and REHABDATA (searched October 2012) and ongoing trials registers. We screened reference lists and tracked citations using Scopus. SELECTION CRITERIA We included randomised controlled trials (RCTs) of cognitive rehabilitation for impairments of attention for people with stroke. The primary outcome was measures of global attentional functions, and secondary outcomes were measures of attention domains, functional abilities, mood and quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data and assessed trial quality. MAIN RESULTS We included six RCTs with 223 participants. All six RCTs compared cognitive rehabilitation with a usual care control. Meta-analyses demonstrated no statistically significant effect of cognitive rehabilitation for persisting effects on global measures of attention (two studies, 99 participants; standardised mean difference (SMD) 0.16, 95% confidence interval (CI) -0.23 to 0.56; P value = 0.41), standardised attention assessments (two studies, 99 participants; P value ≥ 0.08) or functional outcomes (two studies, 99 participants; P value ≥ 0.15). In contrast, a statistically significant effect was found in favour of cognitive rehabilitation when compared with control for immediate effects on measures of divided attention (four studies, 165 participants; SMD 0.67, 95% CI 0.35 to 0.98; P value < 0.0001) but no significant effects on global attention (two studies, 53 participants; P value = 0.06), other attentional domains (six studies, 223 participants; P value ≥ 0.16) or functional outcomes (three studies, 109 participants; P value ≥ 0.21).Thus there was limited evidence that cognitive rehabilitation may improve some aspects of attention in the short term, but there was insufficient evidence to support or refute the persisting effects of cognitive rehabilitation on attention, or on functional outcomes in either the short or long term. AUTHORS' CONCLUSIONS The effectiveness of cognitive rehabilitation remains unconfirmed. The results suggest there may be a short-term effect on attentional abilities, but future studies need to assess the persisting effects and measure attentional skills in daily life. Trials also need to have higher methodological quality and better reporting.
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