Age-Related Changes in Bimanual Instrument Playing with Rhythmic Cueing

Dual-Task-Based Music Therapy to Improve Executive Functioning of Elderly Patients with Early Stage Alzheimer's Disease: A Multiple Case Study

Deficits in executive functioning are a common feature of Alzheimer's disease (AD) and result from impairment in the central executive system. As a result, elderly patients with early stage AD may require interventions that are more cognitively intense than traditional interventions. To address this need, in this multiple case study, we explored a dual-task-based music therapy intervention that involved drum playing and singing designed to induce attentional and motor controls. Three octogenarians diagnosed with early stage AD participated in 12 dual-task-based music therapy sessions over 6 weeks. Measures of executive functioning and the performance of a bimanual drum tapping task were evaluated before and after the intervention. Improvements in executive functioning were observed for participants A and C. After the intervention, reduced mean synchronization errors were found for the simultaneous tapping condition for all three participants. Although there was variability in the functional changes between participants, it is noteworthy that positive improvements in the elderly patients with early stage AD were obtained following dual-task-based music therapy. The results suggest that music therapy integrated into the dual-task paradigm can be an effective way to address degenerative cognitive deficits among elderly patients with early stage AD.

Bimanual motor impairments in older adults: an updated systematic review and meta-analysis

This updated systematic review and meta-analysis further examined potential effects of aging on bimanual movements. Forty-seven qualified studies that compared bimanual motor performances between elderly and younger adults were included in this meta-analysis. Moderator variable analyses additionally determined whether altered bimanual motor performances in older adults were different based on the task types (i.e., symmetry vs. asymmetry vs. complex) or outcome measures (i.e., accuracy vs. variability vs. movement time). The random effects model meta-analysis on 80 comparisons from 47 included studies revealed significant negative overall effects indicating more bimanual movement impairments in the elderly adults than younger adults. Moderator variable analyses found that older adults showed more deficits in asymmetrical bimanual movement tasks than symmetrical and complex tasks, and the bimanual movement impairments in the elderly adults included less accurate, more variable, and greater movement execution time than younger adults. These findings suggest that rehabilitation programs for improving motor actions in older adults are necessary to focus on functional recovery of interlimb motor control including advanced motor performances as well coordination.

Case Report: Accessible Digital Musical Instrument Can Be Used for Active Music Therapy in a Person With Severe Dementia and Worsening Behavioral and Psychological Symptoms: A Case Study Over a Year and a Half

Despite the fact that accessible digital musical instruments can take into account the level of cognitive demands, previous studies have been conducted with patients with mild cognitive impairment (MCI), and it is not known whether they can be used by people with moderate to severe dementia or dementia with worsening behavioral and psychological symptoms of dementia (BPSD). The participant was an 88-year-old woman with vascular dementia (VaD) (Mini-Mental State Examination [MMSE] and Neuropsychiatric Inventory [NPI] scores: 8 and 20, respectively). Music therapy (MT) was provided twice a week for 15 min, and MT sessions spanned over 18 months. For the MT, we used the cyber musical instrument with score (Cymis), an accessible digital musical instrument; it could be played using a touch panel and switches. The cognitive function of the participant declined further, with MMSE scores of 4 after 1 year and 0 after 1.5 years. BPSD peaked with the NPI score of 54 at 1 year and declined thereafter, although only apathy remained. Despite these changes, during MT, she was able to play the accessible digital musical instrument and focus on the performance. These results suggest that even patients with severe VaD can play an accessible digital instrument and continue active music therapy even if their BPSD progress with cognitive decline.

Rhythm and Music-Based Interventions in Motor Rehabilitation: Current Evidence and Future Perspectives

Research in basic and clinical neuroscience of music conducted over the past decades has begun to uncover music’s high potential as a tool for rehabilitation. Advances in our understanding of how music engages parallel brain networks underpinning sensory and motor processes, arousal, reward, and affective regulation, have laid a sound neuroscientific foundation for the development of theory-driven music interventions that have been systematically tested in clinical settings. Of particular significance in the context of motor rehabilitation is the notion that musical rhythms can entrain movement patterns in patients with movement-related disorders, serving as a continuous time reference that can help regulate movement timing and pace. To date, a significant number of clinical and experimental studies have tested the application of rhythm- and music-based interventions to improve motor functions following central nervous injury and/or degeneration. The goal of this review is to appraise the current state of knowledge on the effectiveness of music and rhythm to modulate movement spatiotemporal patterns and restore motor function. By organizing and providing a critical appraisal of a large body of research, we hope to provide a revised framework for future research on the effectiveness of rhythm- and music-based interventions to restore and (re)train motor function.

Aging and Bimanual Effects on Finger Center of Pressure during Precision Grip: Different Strategies for Spatial Stability

The purpose of this study was to examine aging and bimanual effects on finger spatial stability during precision grip. Twenty-one older and 21 younger adults performed precision grip tasks consisting of a single task (grip and lift an object with the thumb and index finger) and a dual task (the grip-lifting task with one hand and a peg board task with the other hand). The center of pressure (COP) trajectory and the grip force were evaluated using a pressure sensor with a high spatial resolution. In the COP trajectory, the main effects of age for the thumb (F_1,140 = 46.17, p < 0.01) and index finger (F_1,140 = 22.14, p < 0.01) and task difficulty for the thumb (F_1,140 = 6.47, p = 0.01) were significant based on ANCOVA. The COP trajectory was statistically decreased in the older adults. The COP trajectory was also decreased in the dual task, regardless of age. The results suggest the existence of a safety strategy to prioritize the spatial stability in the elderly group and in the dual task. This study provides new insights into the interpretation of the COP trajectory.

Dual-Task-Based Drum Playing with Rhythmic Cueing on Motor and Attention Control in Patients with Parkinson's Disease: A Preliminary Randomized Study

Although there have been increasing reports regarding the effectiveness of dual-task interventions in rehabilitation, the scope of this research is limited to gross motor movement, such as gait among patients with Parkinson's disease (PD). To expand the dual-task paradigm to upper extremity motor and attention control in PD, drum playing with modulation of musical elements was attempted. The objective of this study was to evaluate the effects of a drum playing intervention with rhythmic cueing on upper extremity motor control and attention control in patients with PD. Twelve participants were randomly assigned to the drum playing intervention with rhythmic cueing group or the control group. The results showed that the drum playing with rhythmic cueing (DPRC) group significantly increased their sustained time of entrainment (45 BPM) and their latency time until entrainment from pretest to posttest. For the DPRC group, the latency time until entrainment was significantly improved, and improvements in cognitive measures were also found. This study shows that DPRC has great potential to improve upper extremity motor control and attention control and supports the development of new interventions that include this technique for rehabilitation in patients with PD.

Rhythm-Motor Dual Task Intervention for Fall Prevention in Healthy Older Adults

This study aimed to investigate the effects of a rhythm-motor dual task intervention on cognitive and gait control for older adults in relation to fall prevention. Ten healthy older adults participated in a rhythm-motor dual task intervention and 10 participated in the control group. The intervention group received 16 30-min intervention sessions for 8 weeks. During the intervention sessions, participants engaged in walking or bimanual tapping as a primary motor task with concurrent rhythm tasks including playing instruments and rhythmic chanting or singing. At pretest and post-test, measures of cognition, balance/mobility, and gait were administered. A significant difference between groups was found for part B of the Trail Making Test (TMT-B) measure that involved executive control of attention. Also, changes in the gait ratio in the dual task condition of walking while playing an instrument were significantly different between groups. The findings in this study support the use of the rhythm-motor dual task intervention for increasing available cognitive resources and improving gait control, which are critical factors in fall prevention.

The Effects of Bimanual Coordination in Music Interventions on Executive Functions in Aging Adults

Music training programs have been shown to enhance executive functions in aging adults; however, little is known regarding the extent to which different types of bimanual coordination (i.e., fine and gross motor) in music instruction contribute to these outcomes. The aim of this study was to examine the effects of bimanual coordination in music interventions on cognitive performance in healthy older adults (60-80 years). Participants (N = 135) completed motor measures and battery of standardized cognitive measures, before and after a 16-week music training program with a 3 h practice requirement. All participants were matched by age, education, and estimate of intelligence to one of three training programs: piano training (fine motor); percussion instruction (gross motor), and music listening instruction (MLI) (no motor control condition). Results of a Repeated Measures ANOVA revealed significant enhancements in bimanual synchronization and visual scanning/working memory abilities for fine and gross motor training groups as compared to MLI. Pairwise comparisons revealed that piano training significantly improved motor synchronization skills as compared to percussion instruction or music listening. Results suggest that active music performance may benefit working memory, the extent of these benefits may depend upon coordination demands.