Musical Sonification of Arm Movements in Stroke Rehabilitation Yields Limited Benefits

Online reach adjustments induced by real-time movement sonification

Movement sonification can improve motor control in both healthy subjects (e.g., learning or refining a sport skill) and those with sensorimotor deficits (e.g., stroke patients and deafferented individuals). It is not known whether improved motor control and learning from movement sonification are driven by feedback-based real-time ("online") trajectory adjustments, adjustments to internal models over multiple trials, or both. We searched for evidence of online trajectory adjustments (muscle twitches) in response to movement sonification feedback by comparing the kinematics and error of reaches made with online (i.e., real-time) and terminal sonification feedback. We found that reaches made with online feedback were significantly more jerky than reaches made with terminal feedback, indicating increased muscle twitching (i.e., online trajectory adjustment). Using a between-subject design, we found that online feedback was associated with improved motor learning of a reach path and target over terminal feedback; however, using a within-subjects design, we found that switching participants who had learned with online sonification feedback to terminal feedback was associated with a decrease in error. Thus, our results suggest that, with our task and sonification, movement sonification leads to online trajectory adjustments which improve internal models over multiple trials, but which themselves are not helpful online corrections.

Moniz Game: Usability and User Experience Evaluation of a Musical Game for Motor Coordination

Purpose: The objective of this research was to develop a musical digital game for rehabilitation of upper limb and to verify its usability and user experience with professionals in the field (physical therapists). Materials and Methods: Thirty working professionals were recruited to evaluate the system. The usability was evaluated with the System Usability Scale (SUS) and the user experience was verified with the Game Flow scale. Results: The overall score of the SUS scale was 88.67 (±9.129); this score is interpreted as "Best Imaginable" (86-100). The user experience rating had most of its domains equal or higher than 4, which indicates that all the requirements for a good user experience were present in the game. Conclusions: The Moniz Game proved to be a game with good usability and can be a tool for application in clinical practice regarding motor coordination. However, further studies are needed to evaluate the effect of the Moniz Game on motor coordination in patients with neurological dysfunctions.

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

A Wearable Personalised Sonification and Biofeedback Device to Enhance Movement Awareness

Movement sonification has emerged as a promising approach for rehabilitation and motion control. Despite significant advancements in sensor technologies, challenges remain in developing cost-effective, user-friendly, and reliable systems for gait detection and sonification. This study introduces a novel wearable personalised sonification and biofeedback device to enhance movement awareness for individuals with irregular gait and posture. Through the integration of inertial measurement units (IMUs), MATLAB, and sophisticated audio feedback mechanisms, the device offers real-time, intuitive cues to facilitate gait correction and improve functional mobility. Utilising a single wearable sensor attached to the L4 vertebrae, the system captures kinematic parameters to generate auditory feedback through discrete and continuous tones corresponding to heel strike events and sagittal plane rotations. A preliminary test that involved 20 participants under various audio feedback conditions was conducted to assess the system's accuracy, reliability, and user synchronisation. The results indicate a promising improvement in movement awareness facilitated by auditory cues. This suggests a potential for enhancing gait and balance, particularly beneficial for individuals with compromised gait or those undergoing a rehabilitation process. This paper details the development process, experimental setup, and initial findings, discussing the integration challenges and future research directions. It also presents a novel approach to providing real-time feedback to participants about their balance, potentially enabling them to make immediate adjustments to their posture and movement. Future research should evaluate this method in varied real-world settings and populations, including the elderly and individuals with Parkinson's disease.

Accessibility of Motion Capture as a Tool for Sports Performance Enhancement for Beginner and Intermediate Cricket Players

Motion Capture (MoCap) has become an integral tool in fields such as sports, medicine, and the entertainment industry. The cost of deploying high-end equipment and the lack of expertise and knowledge limit the usage of MoCap from its full potential, especially at beginner and intermediate levels of sports coaching. The challenges faced while developing affordable MoCap systems for such levels have been discussed in order to initiate an easily accessible system with minimal resources.

Upper limb assessment with inertial measurement units according to the international classification of functioning in stroke: a systematic review and correlation meta-analysis

OBJECTIVE

To investigate the usefulness of inertial measurement units (IMUs) in the assessment of motor function of the upper limb (UL) in accordance with the international classification of functioning (ICF).

DATA SOURCES

PubMed; Scopus; Embase; WoS and PEDro databases were searched from inception to 1 February 2022.

METHODS

The current systematic review follows PRISMA recommendations. Articles including IMU assessment of UL in stroke individuals have been included and divided into four ICF categories (b710, b735, b760, d445). We used correlation meta-analysis to pool the Fisher Z-score of each correlation between kinematics and clinical assessment.

RESULTS

A total of 35 articles, involving 475 patients, met the inclusion criteria. In the included studies, IMUs have been employed to assess the mobility of joint functions (n = 6), muscle tone functions (n = 4), control of voluntary movement functions (n = 15), and hand and arm use (n = 15). A significant correlation was found in overall meta-analysis based on 10 studies, involving 213 subjects: (r = 0.69) (95% CI: 0.69/0.98; p < 0.001) as in the d445 (r = 0.71) and b760 (r = 0.64) ICF domains, with no heterogeneity across the studies.

CONCLUSION

The literature supports the integration of IMUs and conventional clinical assessment in functional evaluation of the UL after a stroke. The use of a limited number of wearable sensors can provide additional kinematic features of UL in all investigated ICF domains, especially in the ADL tasks when a strong correlation with clinical evaluation was found.

Effect of sonification types in upper-limb movement: a quantitative and qualitative study in hemiparetic and healthy participants

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.

A neuroergonomic approach to assessing motor performance in stroke patients using fNIRS and behavioral data

Stroke is characterized by high morbidity and disability, and proposing effective methods for assessing and designing rehabilitation products is an attractive topic in current research. In this study, a hand function rehabilitation aid was developed for stroke patients. Ten stroke patients and 20 healthy older people as a control group were recruited to perform a 600 s task after a 600 s resting by gripping a stick while clicking on a flashing light in an electronic insert in sequence according to a pattern. The functional near-infrared spectroscopy (fNIRS) and behavioral data were collected during their rehabilitation training. Brain function was analyzed using three indicators, namely brain area activation, functional connectivity and effective connectivity, while behavioral performance was analyzed using ten indicators, such as velocity and acceleration, and correlations were made between both. Followed by proposing a quantitative assessment method based on the fusion of multiple data sources. The results showed that the developed rehabilitation tool could effectively stimulate the patient's brain and help recover their cognitive and behavioral capacities. The scientific validity of the proposed assessment approach was further confirmed by contrasting the data results of the stroke group with those of the healthy elderly group. This study has integrated brain function and behavioral data, providing a practical quantitative evaluation method of product ergonomics and data-driven product design concepts for stroke patients.

Loudness affects motion: asymmetric volume of auditory feedback results in asymmetric gait in healthy young adults

Background

The potential of auditory feedback for motor learning in the rehabilitation of various diseases has become apparent in recent years. However, since the volume of auditory feedback has played a minor role so far and its influence has hardly been considered, we investigate the volume effect of auditory feedback on gait pattern and gait direction and its interaction with pitch.

Methods

Thirty-two healthy young participants were randomly divided into two groups: Group 1 (n = 16) received a high pitch (150-250 Hz) auditory feedback; group 2 (n = 16) received a lower pitch (95-112 Hz) auditory feedback. The feedback consisted of a real-time sonification of the right and left foot ground contact. After an initial condition (no auditory feedback and full vision), both groups realized a 30-minute habituation period followed by a 30-minute asymmetry period. At any condition, the participants were asked to walk blindfolded and with auditory feedback towards a target at 15 m distance and were stopped 5 m before the target. Three different volume conditions were applied in random order during the habituation period: loud, normal, and quiet. In the subsequent asymmetry period, the three volume conditions baseline, right quiet and left quiet were applied in random order.

Results

In the habituation phase, the step width from the loud to the quiet condition showed a significant interaction of volume*pitch with a decrease at high pitch (group 1) and an increase at lower pitch (group 2) (group 1: loud 1.02 ± 0.310, quiet 0.98 ± 0.301; group 2: loud 0.95 ± 0.229, quiet 1.11 ± 0.298). In the asymmetry period, a significantly increased ground contact time on the side with reduced volume could be found (right quiet: left foot 0.988 ± 0.033, right foot 1.003 ± 0.040, left quiet: left foot 1.004 ± 0.036, right foot 1.002 ± 0.033).

Conclusions

Our results suggest that modifying the volume of auditory feedback can be an effective way to improve gait symmetry. This could facilitate gait therapy and rehabilitation of hemiparetic and arthroplasty patients, in particular if gait improvement based on verbal corrections and conscious motor control is limited.

Where words are powerless to express: Use of music in paediatric neurology

Music is an art form that strongly affects people and can elicit many different emotions at the same time, including happiness, anxiety, sadness, and even ecstasy. What is it about music that causes such a strong reaction from each of us? Music engages many senses, which in turn can produce a multiplicity of responses and help create more extensive neuronal connections, as well as influence behaviour through structural and functional changes in the brain. Music-based interventions as a therapeutic tool in rehabilitation are becoming more common. It is said that the impact of music on the human body is positive. However, what impact does music have on the young nervous system, especially the affected one? This review presents the advantages and disadvantages of the use of music in paediatric neurology to treat dyslexia, cerebral palsy, and stroke, among others. Potential negative impacts such as musicogenic epilepsy and hallucinations will be discussed.

Sonification of Complex Spectral Structures

In this article, we present our work on the sonification of notated complex spectral structures. It is part of a larger research project about the design of a new notation system for representing sound-based musical structures. Complex spectral structures are notated with special symbols in the scores, which can be digitally rendered so that the user can hear key aspects of what has been notated. This hearing of the notated data is significantly different from reading the same data, and reveals the complexity hidden in its simplified notation. The digitally played score is not the music itself but can provide essential information about the music in ways that can only be obtained in sounding form. The playback needs to be designed so that the user can make relevant sonic readings of the sonified data. The sound notation system used here is an adaptation of Thoresen and Hedman's spectromorphological analysis notation. Symbols originally developed by Lasse Thoresen from Pierre Schaeffer's typo-morphology have in this system been adapted to display measurable spectral features of timbrel structure for the composition and transcription of sound-based musical structures. Spectrum category symbols are placed over a spectral grand-staff that combines indications of pitch and frequency values for the combined display of music related to pitch-based and spectral values. Spectral features of a musical structure such as spectral width and density are represented as graphical symbols and sonically rendered. In perceptual experiments we have verified that users can identify spectral notation parameters based on their sonification. This confirms the main principle of sonification that is that the data/dimensions relations in one domain, in our case notated representation of spectral features, are transformed in perceived relations in the audio domain, and back.

Effects of pitch and musical sounds on body-representations when moving with sound

The effects of music on bodily movement and feelings, such as when people are dancing or engaged in physical activity, are well-documented—people may move in response to the sound cues, feel powerful, less tired. How sounds and bodily movements relate to create such effects? Here we deconstruct the problem and investigate how different auditory features affect people’s body-representation and feelings even when paired with the same movement. In three experiments, participants executed a simple arm raise synchronised with changing pitch in simple tones (Experiment 1), rich musical sounds (Experiment 2) and within different frequency ranges (Experiment 3), while we recorded indirect and direct measures on their movement, body-representations and feelings. Changes in pitch influenced people’s general emotional state as well as the various bodily dimensions investigated—movement, proprioceptive awareness and feelings about one’s body and movement. Adding harmonic content amplified the differences between ascending and descending sounds, while shifting the absolute frequency range had a general effect on movement amplitude, bodily feelings and emotional state. These results provide new insights in the role of auditory and musical features in dance and exercise, and have implications for the design of sound-based applications supporting movement expression, physical activity, or rehabilitation.

Combined Use of EMG and EEG Techniques for Neuromotor Assessment in Rehabilitative Applications: A Systematic Review

Electroencephalography (EEG) and electromyography (EMG) are widespread and well-known quantitative techniques used for gathering biological signals at cortical and muscular levels, respectively. Indeed, they provide relevant insights for increasing knowledge in different domains, such as physical and cognitive, and research fields, including neuromotor rehabilitation. So far, EEG and EMG techniques have been independently exploited to guide or assess the outcome of the rehabilitation, preferring one technique over the other according to the aim of the investigation. More recently, the combination of EEG and EMG started to be considered as a potential breakthrough approach to improve rehabilitation effectiveness. However, since it is a relatively recent research field, we observed that no comprehensive reviews available nor standard procedures and setups for simultaneous acquisitions and processing have been identified. Consequently, this paper presents a systematic review of EEG and EMG applications specifically aimed at evaluating and assessing neuromotor performance, focusing on cortico-muscular interactions in the rehabilitation field. A total of 213 articles were identified from scientific databases, and, following rigorous scrutiny, 55 were analyzed in detail in this review. Most of the applications are focused on the study of stroke patients, and the rehabilitation target is usually on the upper or lower limbs. Regarding the methodological approaches used to acquire and process data, our results show that a simultaneous EEG and EMG acquisition is quite common in the field, but it is mostly performed with EMG as a support technique for more specific EEG approaches. Non-specific processing methods such as EEG-EMG coherence are used to provide combined EEG/EMG signal analysis, but rarely both signals are analyzed using state-of-the-art techniques that are gold-standard in each of the two domains. Future directions may be oriented toward multi-domain approaches able to exploit the full potential of combined EEG and EMG, for example targeting a wider range of pathologies and implementing more structured clinical trials to confirm the results of the current pilot studies.

Impact of Music Therapy on Gait After Stroke

Music therapy or music-supported therapy is a therapeutic modality sometimes used during the rehabilitation phase after an acute ischemic or hemorrhagic stroke. The intervention suggests that the resulting audio-motor coupling can enhance motor function. Multiple clinical studies have reported various improvements-including cognitive, mood, and limb function. Gait impairment after stroke confers significant morbidity. The authors present a systematic review of randomized controlled trials that have examined the impact of music therapy on patient recovery, specifically on gait and ambulation.

Music-based techniques and related devices in neurorehabilitation: a scoping review

Introduction:The music as a powerful, and versatile stimulus for the brain, is at the date sometimes used in neurorehabilitation and proposed as a promising complementary strategy provided in combination with other therapy in individuals with neurological disorders. Different techniques and devices have been developed in the field of the music-based neurorehabilitation.Areas covered:This scoping review analyzes the current scientific literature concerning the different techniques and devices used in the music-supported neurorehabilitation, also focusing on the devices used in music-based therapies in patients with neurological disorders: 46 studies met the inclusion criteria and were included.Expert opinion:Included studies, highlight the potentiality and the versatility of the music-based therapy in the rehabilitation of neurological disorders. The variety of existing techniques allow to applied the music-based therapy in different situations and conditions. Moreover, the wide range of used devices that ranging from the simple musical instruments to the more advanced technologies, allows to develop customized exercises based on the needs of the patient. This review may be considered as a starting point to better design future RCTs that would investigate the effectiveness of music therapy on neurological disorders.

Improvement of freezing of gait in patients with Parkinson's disease by music exercise therapy: a study protocol for a randomized controlled trial

Background

Progression of freezing of gait, a common pathological gait in Parkinson’s disease, is an important risk factor for diagnosing the disease and has been shown to predispose patients to easy falls, loss of independent living ability, and reduced quality of life. Treating Parkinson’s disease with freezing of gait is very difficult, while the use of medicine and operation has been ineffective. Music exercise therapy, which entails listening to music as you exercise, has been proposed as a treatment technology that can change patients’ behavior, emotions, and physiological activity. In recent years, music exercise therapy has been widely used in treatment of motor disorders and neurological diseases and achieved remarkable results. Results from our earlier pilot study revealed that music exercise therapy can improve the freezing of gait of Parkinson’s patients and improve their quality of life. Therefore, we aim to validate clinical efficacy of this therapy on freezing of gait of Parkinson’s patients using a larger sample size.

Methods/design

This three-arm randomized controlled trial will evaluate clinical efficacy of music exercise therapy in improving the freezing of gait in Parkinson’s patients. We will recruit a total of 81 inpatients with Parkinson’s disease, who meet the trial criteria. The patients will randomly receive music exercise with and without music as well as routine rehabilitation therapies, followed by analysis of changes in their gait and limb motor function after 4 weeks of intervention. We will first use a three-dimensional gait analysis system to evaluate changes in patients’ gait, followed by assessment of their limb function, activity of daily living and fall risk.

Discussion

The findings of this trial are expected to affirm the clinical application of this therapy for future management of the disease.

Trial registration

Chinese Clinical Trial Registry ChiCTR1900026063. Registered on September 20, 2019

Hand rehabilitation with sonification techniques in the subacute stage of stroke

After a stroke event, most survivors suffer from arm paresis, poor motor control and other disabilities that make activities of daily living difficult, severely affecting quality of life and personal independence. This randomized controlled trial aimed at evaluating the efficacy of a music-based sonification approach on upper limbs motor functions, quality of life and pain perceived during rehabilitation. The study involved 65 subacute stroke individuals during inpatient rehabilitation allocated into 2 groups which underwent usual care dayweek) respectively of standard upper extremity motor rehabilitation or upper extremity treatment with sonification techniques. The Fugl-Meyer Upper Extremity Scale, Box and Block Test and the Modified Ashworth Scale were used to perform motor assessment and the McGill Quality of Life-it and the Numerical Pain Rating Scale to assess quality of life and pain. The assessment was performed at baseline, after 2 weeks, at the end of treatment and at follow-up (1 month after the end of treatment). Total scores of the Fugl-Meyer Upper Extremity Scale (primary outcome measure) and hand and wrist sub scores, manual dexterity scores of the affected and unaffected limb in the Box and Block Test, pain scores of the Numerical Pain Rating Scale (secondary outcomes measures) significantly improved in the sonification group compared to the standard of care group (time*group interaction < 0.05). Our findings suggest that music-based sonification sessions can be considered an effective standardized intervention for the upper limb in subacute stroke rehabilitation.

Potential benefits of music playing in stroke upper limb motor rehabilitation

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