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Experiences of a group creative music-making intervention to support multidisciplinary stroke rehabilitation
... The use of music as an occupation for therapeutic purposes was addressed as early as the 1930s in the context of a mental health hospital (Thompson, 1932). The role music can play in therapeutic processes in occupational therapy has been explored in the literature in connection with music therapy (Turner & Tyas, 2012), treatment of mental health conditions (Strauss et al., 2016), neurological conditions (Nicholson & Wilson, 2018), identity and belongingness (Roberts & Farrugia, 2013), and community participation and engagement (Jacob et al., 2009;Raanaas et al., 2019). There has also been significant research into the impact of music making for specific populations, such as persons living with dementia (Cox et al., 2011(Cox et al., , 2014Tamplin et al., 2018), as well as children and youth living with disabilities (Eidevall & Leufstadius, 2014;Gee et al., 2013). ...
Music is a complex occupation, with multiple positive effects on health, occupational performance, collaboration, and socialisation. This educational discussion paper describes a 6-year collaboration between an occupational therapy program in a mid-sized Australian city and a socio-altruistic music program designed to empower all participants to engage in helping others through music. Within this transdisciplinary collaboration, singing with others is framed as both a co-occupation and a collective occupation, as participants share music and social contact through songs, voluntary movement, touch, and eye contact, for mutual well-being. The collaboration has engaged over 300 occupational therapy students in participation and facilitation of music making sessions in schools and nursing homes. Acknowledging occupational therapy’s historical connections with the arts, the paper focuses on the collective narrative of academics and graduate occupational therapy students. The paper describes how shared music outreach sessions can provide students with opportunities to experience and value the complexity of co-occupations in both personal and professional terms. As graduates who have implemented some of the music program’s approaches in subsequent employment in healthcare contexts, former students report positive interactions with clients, improvement in communication skills, doing-with-and-for-others as a key strategy in their practice, and valuing the use of the arts as a therapeutic occupation strategy.
Two major limitations of unilateral spatial neglect (USN) rehabilitation methods are actually reported: a lack of long-term efficiency and a lack of generalization to daily life. The aim of our case study was to underline how a multisensory method-music practice-could avoid these limitations. Mrs BV suffered from a chronic severe USN. She had rehabilitation sessions of music practice over 8 weeks. An improvement of her USN was found on paper-pencil tests but also in daily activities. Benefits subsisted 4 months after rehabilitation. Music practice seemed to avoid the major limitations of USN rehabilitations and could represent a promising tool.
The study assessed whether the auditory reference provided by a music scale could improve spatial exploration of a standard musical instrument keyboard in right-brain-damaged patients with left spatial neglect. As performing music scales involves the production of predictable successive pitches, the expectation of the subsequent note may facilitate patients to explore a larger extension of space in the left affected side, during the production of music scales from right to left. Eleven right-brain-damaged stroke patients with left spatial neglect, 12 patients without neglect, and 12 age-matched healthy participants played descending scales on a music keyboard. In a counterbalanced design, the participants' exploratory performance was assessed while producing scales in three feedback conditions: With congruent sound, no-sound, or random sound feedback provided by the keyboard. The number of keys played and the timing of key press were recorded. Spatial exploration by patients with left neglect was superior with congruent sound feedback, compared to both Silence and Random sound conditions. Both the congruent and incongruent sound conditions were associated with a greater deceleration in all groups. The frame provided by the music scale improves exploration of the left side of space, contralateral to the right hemisphere, damaged in patients with left neglect. Performing a scale with congruent sounds may trigger at some extent preserved auditory and spatial multisensory representations of successive sounds, thus influencing the time course of space scanning, and ultimately resulting in a more extensive spatial exploration. These findings offer new perspectives also for the rehabilitation of the disorder.
© 2015 The British Psychological Society.
Introduction
Participatory music making for older people has tended to focus on singing and performance. In a community music project undertaken by Manchester Camerata (a chamber orchestra), Blacon Community Trust and a small group of older adults, participants were given the opportunity to compose individual pieces of music interactively with professional musicians. This paper reports the findings of the research project.
Method
An arts-based research method was adopted and incorporated action research and interpretive interactionism to articulate the experiences and perceptions of participants. Participants and Manchester Camerata musicians also worked together to represent the thematic findings of the research in a group composition.
Findings
The findings demonstrate that individual and group music composition contributed to a sense of wellbeing through control over musical materials, opportunities for creativity and identity making, validation of life experience and social engagement with other participants and professional musicians.
Conclusion
The results emphasised occupation as essential to health and wellbeing in the later stages of life. The findings also highlight the particularly innovative aspects of this research: (i) the use of music composition as a viable arts-in-health occupation for older people and (ii) the arts-based research method of group composition.
Based on insights from brain research in music, neurologic music therapy (NMT) has been established as a new model for music in therapy and medicine. Standardized clinical interventions are based on clusters of research evidence and established learning principles in motor, speech/language, and cognitive training. The research support for NMT in stroke rehabilitation has been growing rapidly over the past 20 years. This paper will review research data and clinical applications for neurorehabilitation in the speech/language, cognitive and sensorimotor domains.
Playing a musical instrument demands the engagement of different neural systems. Recent studies about the musician's brain and musical training highlight that this activity requires the close interaction between motor and somatosensory systems. Moreover, neuroplastic changes have been reported in motor-related areas after short and long-term musical training. Because of its capacity to promote neuroplastic changes, music has been used in the context of stroke neurorehabilitation. The majority of patients suffering from a stroke have motor impairments, preventing them to live independently. Thus, there is an increasing demand for effective restorative interventions for neurological deficits. Music-supported Therapy (MST) has been recently developed to restore motor deficits. We report data of a selected sample of stroke patients who have been enrolled in a MST program (1 month intense music learning). Prior to and after the therapy, patients were evaluated with different behavioral motor tests. Transcranial Magnetic Stimulation (TMS) was applied to evaluate changes in the sensorimotor representations underlying the motor gains observed. Several parameters of excitability of the motor cortex were assessed as well as the cortical somatotopic representation of a muscle in the affected hand. Our results revealed that participants obtained significant motor improvements in the paretic hand and those changes were accompanied by changes in the excitability of the motor cortex. Thus, MST leads to neuroplastic changes in the motor cortex of stroke patients which may explain its efficacy.
Introduction: Purposeful activity is believed to yield better results than meaningless exercises during motor rehabilitation. The objective of this paper is to provide a narrative review of the literature regarding the influence of object affordance on motor performance, a factor that contributes to the purposefulness of a task.
Method: Thirty-five reviewed articles were selected following an online search on PubMed, Cinahl and Google Scholar and an inspection of their references. Results of reviewed studies are discussed in relation to (1) the different approaches used to increase object affordance; (2) the influence of clinical conditions on the relationship between object affordance and motor performance; and (3) the influence of object affordance on immediate motor performance vs motor learning.
Findings: The three main approaches used to increase object affordance relate to (a) the number of objects used during the task; (b) the functional information that these objects convey; and (c) the functional goals of the task. Reviewed results suggest that increasing object affordance can produce beneficial effects on immediate motor performance and motor learning, and especially support the effect of varying the number of objects. However, most evidence on object affordance has not come from high quality research.
Conclusion: Clinicians should favour the use of tasks with high object affordance during both clinical assessment and therapy in order to promote optimal motor performance. More high quality research is needed to assess the influence of object affordance during therapy and on long-term motor learning and clinical outcomes.
To investigate the therapeutic effect of neurologic music therapy (NMT) and speech language therapy (SLT) through improvement of the aphasia quotient (AQ) in post-stroke aphasic patients.
Twenty-one post-stroke, nonfluent aphasia patients who had ischemic/hemorrhagic stroke on radiologic evaluation were divided into the NMT and SLT groups. They received NMT and SLT for 1 month. Language function was assessed by Korean version-Western Aphasia Battery before and after therapy. NMT consisted of therapeutic singing and melodic intonation therapy, and SLT consisted of language-oriented therapy.
Significant improvements were revealed in AQ, repetition, and naming after therapy in the NMT group and improvements in repetition in the SLT group of chronic stroke patients (p<0.05). There were significant improvements in language ability in the NMT group of subacute stroke patients. However, there was no significant improvement in the SLT group of subacute stroke patients.
We concluded that the two therapies are effective treatments in the chronic stage of stroke and NMT is effective in subacute post-stroke aphasic patients.
This longitudinal study identified how occupational gaps were characterized in people's lived experiences of performing everyday occupations during the first year after stroke. Four participants were interviewed four times during the year after stroke. The data were collected and analyzed using the Empirical, Phenomenological, Psychological method. Five main characteristics were identified: (1) encountering occupational gaps in formerly taken-for-granted activities, (2) striving to narrow gaps in desired occupations, (3) recognizing oneself in doing, (4) searching for a new sense of self through doing, and (5) creating strategies to enable doing. The findings show the importance of being able to preserve some sense of self in everyday doings after a life course disruption caused by stroke. Important implications for clinical practice include sensitivity to clients' experiences during this process, enablement of experiences in occupations promoting recognition, and support of clients in recapturing desired occupations.
MOTOR IMPAIRMENTS ARE COMMON AFTER STROKE but efficacious therapies for these dysfunctions are scarce. Extending an earlier study on the effects of music-supported training (MST), behavioral indices of motor function were obtained before and after a series of training sessions to assess whether this new treatment leads to improved motor functions. Furthermore, music-supported training was contrasted to functional motor training according to the principles of constraint-induced therapy (CIT). In addition to conventional physiotherapy, 32 stroke patients with moderately impaired motor function and no previous musical experience received 15 sessions of MST over a period of three weeks, using a manualized, step-bystep approach. A control group consisting of 15 patients received 15 sessions of CIT in addition to conventional physiotherapy. A third group of 30 patients received exclusively conventional physiotherapy and served as a control group for the other three groups. Fine as well as gross motor skills were trained by using either a MIDI-piano or electronic drum pads programmed to emit piano tones. Motor functions were assessed by an extensive test battery. MST yielded significant improvement in fine as well as gross motor skills with respect to speed, precision, and smoothness of movements. These improvements were greater than after CIT or conventional physiotherapy. In conclusion, with equal treatment intensity, MST leads to more pronounced improvements of motor functions after stroke than CIT.
OBJECTIVE. We determined whether listening to excerpts of classical music ameliorates unilateral neglect (UN) in stroke patients.
METHOD. In this within-subject study, we recruited and separately tested 16 UN patients with a right-hemisphere stroke under three conditions within 1 wk. In each condition, participants were asked to complete three subtests of the Behavioral Inattention Test while listening to classical music, white noise, or nothing. All conditions and the presentation of the tests were counterbalanced across participants. Visual analog scales were used to provide self-reported ratings of arousal and mood.
RESULTS. Participants generally had the highest scores under the classical music condition and the lowest scores under the silence condition. In addition, most participants rated their arousal as highest after listening to classical music.
CONCLUSION. Listening to classical music may improve visual attention in stroke patients with UN. Future research with larger study populations is necessary to validate these findings.
Background
Several recently developed therapies targeting motor disabilities in stroke sufferers have shown to be more effective than standard neurorehabilitation approaches. In this context, several basic studies demonstrated that music training produces rapid neuroplastic changes in motor-related brain areas. Music-supported therapy has been recently developed as a new motor rehabilitation intervention.
Methods and Results
In order to explore the plasticity effects of music-supported therapy, this therapeutic intervention was applied to twenty chronic stroke patients. Before and after the music-supported therapy, transcranial magnetic stimulation was applied for the assessment of excitability changes in the motor cortex and a 3D movement analyzer was used for the assessment of motor performance parameters such as velocity, acceleration and smoothness in a set of diadochokinetic movement tasks. Our results suggest that the music-supported therapy produces changes in cortical plasticity leading the improvement of the subjects' motor performance.
Conclusion
Our findings represent the first evidence of the neurophysiological changes induced by this therapy in chronic stroke patients, and their link with the amelioration of motor performance. Further studies are needed to confirm our observations.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
Objective:
To investigate whether listening to pleasant music improves visual attention to and awareness of contralesional stimuli in patients with unilateral neglect after stroke.
Methods:
A within-subject design was used with 19 participants with unilateral neglect following a right hemisphere stroke. Participants were tested in three conditions (pleasant music, unpleasant music and white noise) within 1 week. All musical pieces were chosen by the participants. In each condition, participants were asked to complete three sub-tests of the Behavioural Inattention Test (the Star Cancellation Test, the Line Bisection Test and the Picture Scanning test) and a visual exploration task with everyday scenes. Eye movements in the visual exploration task were recorded simultaneously. Mood and arousal induced by different auditory stimuli were assessed using visual analogue scales, heart rate and galvanic skin response.
Results:
Compared with unpleasant music and white noise, participants rated their moods as more positive and arousal as higher with pleasant music, but also showed significant improvement on all tasks and eye movement data, except the Line Bisection Test.
Conclusion:
The findings suggest that pleasant music can improve visual attention in patients with unilateral neglect after stroke. Additional research using randomized controlled trials is required to validate these findings.
The purpose of this study was to conduct a matrix method literature review of published research on the use of creative arts occupations in therapeutic practice. Peer-reviewed original research articles, published between the years 2000 and 2008, were included in the review. The research articles studied creative arts occupations as a therapeutic medium. Twenty-three articles, located through multiple electronic searches, were identified as meeting the criteria of the review.
Data analysis included quantitative analysis and qualitative analysis. The findings suggest that the use of creative arts occupations in therapeutic practice may have important qualitative value related to health and wellbeing. Six predominant outcomes were most frequently identified across the studies: enhanced perceived control, building a sense of self, expression, transforming the illness experience, gaining a sense of purpose and building social support.
The results suggest that qualitative research may well be the methodology of choice for the study of this topic and raise questions about the paucity of research in this area. Further research into the use of creative arts occupations as a therapeutic approach in occupational therapy and other health and social care disciplines is warranted.
Background: Acquired brain injury resulting from a stroke can result in impairments in, among other things, communication. Music therapy has been used in rehabilitation to stimulate brain functions involved in speech. The use of elements of music is well known and more often used in the treatment of aphasia and apraxia of speech.Aims: The aim of the study is to synthesise studies on the effect of music parameters in the treatment of neurological language and speech disorders. In addition, possible mechanisms that explain recovery are investigated.Methods & Procedures: Search terms were formulated based on the research question. A systematic search in databases was performed using these search terms. Then inclusion criteria were formulated and articles meeting the criteria were reviewed on patient characteristics, interventions, and methodological quality.Outcomes & Results: A total of 1250 articles have been selected from the databases, of which 15 were included in this study. The Melodic Intonation Therapy was the most studied programme. Melody and rhythm were the music interventions that have been applied the most. Measurable recovery has been reported in all those reviewed studies using music in the treatment of neurological language and speech disorders. In three studies research was also conducted into the mechanisms of explanation of the measured recovery. However, the methodological quality of the investigated studies was rated as “low”, using the ASHA level of evidence indicators for judging research.Conclusions: Although treatment outcomes were reported as positive in all of the 15 reviewed studies, caution should be used relative to conclusions about the effectiveness of treatments that incorporate components of music with neurologically impaired individuals. Methodological quality was rated as low and interpretations of mechanisms of recovery were contradictory. Suggestions for standardising and improving methodological quality drawn from the analysis are presented.A revised version of this article has been published in a Dutch journal (Stem Spraak- en Taalpathologie).
Objective: To investigate the efficacy of music therapy techniques as an aid in improving mood and social interaction after traumatic brain injury or stroke. Design: Eighteen individuals with traumatic brain injury or stroke were assigned either standard rehabilitation alone or standard rehabilitation along with music therapy (3 treatments per week for up to 10 treatments). Measures: Pretreatment and posttreatment assessments of participant self-rating of mood, family ratings of mood and social interaction, and therapist rating of mood and participation in therapy. Results: There was a significant improvement in family members' assessment of participants' social interaction in the music therapy group relative to the control group. The staff rated participants in the music therapy group as more actively involved and cooperative in therapy than those in the control group. There was a trend suggesting that self-ratings and family ratings of mood showed greater improvement in the music group than in the control group. Conclusions: Results lend preliminary support to the efficacy of music therapy as a complementary therapy for social functioning and participation in rehabilitation with a trend toward improvement in mood during acute rehabilitation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
To investigate the effects of music therapy on depressive mood and anxiety in post-stroke patients and evaluate satisfaction levels of patients and caregivers.
Eighteen post-stroke patients, within six months of onset and mini mental status examination score of over 20, participated in this study. Patients were divided into music and control groups. The experimental group participated in the music therapy program for four weeks. Psychological status was evaluated with the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) before and after music therapy. Satisfaction with music therapy was evaluated by a questionnaire.
BAI and BDI scores showed a greater decrease in the music group than the control group after music therapy, but only the decrease of BDI scores were statistically significant (p=0.048). Music therapy satisfaction in patients and caregivers was affirmative.
Music therapy has a positive effect on mood in post-stroke patients and may be beneficial for mood improvement with stroke. These results are encouraging, but further studies are needed in this field.
To investigate the meaning of acting with others, in different places over the course of 1 year post-stroke.
Qualitative interviews with 9 persons, age range 42-61 years (7 persons with cerebrovascular accident and 2 with subarachnoidal haemorrhage) over the course of a year (i.e. 3, 6, 9 and 12 months) were analysed using a grounded theory approach.
Four categories were identified from the analysis of the participants' experiences during the year of rehabilitation: (i) not recognized as the person I am; (ii) the burden of burden; (iii) inspiration and belonging through acting with others; (iv) reality adjustment through acting with others. From these categories a core category emerged: a process of belonging for integration.
The 4 categories identified suggest that belonging is integral to participation, which is viewed as the goal of rehabilitation.
To determine if repetitive task training after stroke improves functional activity.
Systematic review and meta-analysis of trials comparing repetitive task training with attention control or usual care.
The Cochrane Stroke Trials Register, electronic databases of published, unpublished and non-English language papers; conference proceedings, reference lists, and trial authors.
Included studies were randomized/quasi-randomized trials in adults after stroke where an active motor sequence aiming to improve functional activity was performed repetitively within a single training session. We used Cochrane Collaboration methods, resources, and software.
We included 14 trials with 17 intervention-control pairs and 659 participants. Results were statistically significant for walking distance (mean difference 54.6, 95% confidence interval (95% CI) 17.5, 91.7); walking speed (standardized mean difference (SMD) 0.29, 95% CI 0.04, 0.53); sit-to-stand (standard effect estimate 0.35, 95% CI 0.13, 0.56), and activities of daily living: SMD 0.29, 95% CI 0.07, 0.51; and of borderline statistical significance for measures of walking ability (SMD 0.25, 95% CI 0.00, 0.51), and global motor function (SMD 0.32, 95% CI -0.01, 0.66). There were no statistically significant differences for hand/arm functional activity, lower limb functional activity scales, or sitting/standing balance/reach.
Repetitive task training resulted in modest improvement across a range of lower limb outcome measures, but not upper limb outcome measures. Training may be sufficient to have a small impact on activities of daily living. Interventions involving elements of repetition and task training are diverse and difficult to classify: the results presented are specific to trials where both elements are clearly present in the intervention, without major confounding by other potential mechanisms of action.
Motor impairments are common after stroke, but efficacious therapies for these dysfunctions are scarce. By extending an earlier study on the effects of music-supported therapy, behavioral indices of motor function as well as electrophysiological measures were obtained before and after a series of therapy sessions to assess whether this new treatment leads to neural reorganization and motor recovery in patients after stroke. The study group comprised 32 stroke patients in a large rehabilitation hospital; they had moderately impaired motor function and no previous musical experience. Over a period of 3 weeks, these patients received 15 sessions of music-supported therapy using a manualized step-by-step approach. For comparison 30 additional patients received standard rehabilitation procedures. Fine as well as gross motor skills were trained by using either a MIDI-piano or electronic drum pads programmed to emit piano tones. Motor functions were assessed by an extensive test battery. In addition, we studied event-related desynchronization/synchronization and coherences from all 62 patients performing self-paced movements of the index finger (MIDI-piano) and of the whole arm (drum pads). Results showed that music-supported therapy yielded significant improvement in fine as well as gross motor skills with respect to speed, precision, and smoothness of movements. Neurophysiological data showed a more pronounced event-related desynchronization before movement onset and a more pronounced coherence in the music-supported therapy group in the post-training assessment, whereas almost no differences were observed in the control group. Thus we see that music-supported therapy leads to marked improvements of motor function after stroke and that these are accompanied by electrophysiological changes indicative of a better cortical connectivity and improved activation of the motor cortex.
Experience has shown that therapy using music for therapeutic purposes has certain effects on neuropsychiatric disorders (both functional and organic disorders). However, the mechanisms of action underlying music therapy remain unknown, and scientific clarification has not advanced. While that study disproved the Mozart effect, the effects of music on the human body and mind were not disproved. In fact, more scientific studies on music have been conducted in recent years, mainly in the field of neuroscience, and the level of interest among researchers is increasing. The results of past studies have clarified that music influences and affects cranial nerves in humans from fetus to adult. The effects of music at a cellular level have not been clarified, and the mechanisms of action for the effects of music on the brain have not been elucidated. We propose that listening to music facilitates the neurogenesis, the regeneration and repair of cerebral nerves by adjusting the secretion of steroid hormones, ultimately leading to cerebral plasticity. Music affects levels of such steroids as cortisol (C), testosterone (T) and estrogen (E), and we believe that music also affects the receptor genes related to these substances, and related proteins. In the prevention of Alzheimer's disease and dementia, hormone replacement therapy has been shown to be effective, but at the same time, side effects have been documented, and the clinical application of hormone replacement therapy is facing a serious challenge. Conversely, music is noninvasive, and its existence is universal and mundane. Thus, if music can be used in medical care, the application of such a safe and inexpensive therapeutic option is limitless.
To evaluate the impact of a community-based peer support program for individuals and their family members following traumatic brain injury (TBI).
Community-based sample of family members and individuals with traumatic brain injury.
Twenty individuals who had participated in the peer support program (11 individuals with TBI and 9 family members).
Quantitative and qualitative approaches were used: a retrospective structured interview assessing self-reported impacts of peer support on empowerment, quality of life, mood, skills and knowledge, and social supports; an in-depth qualitative interview with a subgroup of family members focused on the specific benefits/limitations of the peer support program.
Participants in the peer support program reported positive impacts of peer support on increasing their knowledge of TBI, enhancing their overall quality of life, improving their general outlook, and enhancing their ability to cope with depression post TBI. The peer support program was reported to have had a minimal impact on enhancing social support from families, friends, and the community, with varying impacts noted on levels of happiness, coping with anger and anxiety, communication with professionals, and control over one's life. Qualitative analysis suggests the merits of this type of community-based support and areas of improvement for the peer support program itself.
Preliminary data suggest that peer support is a promising approach to enhancing coping for both individuals and their family members after TBI.
Music engages an extensive network of auditory, cognitive, motor, and emotional processing regions in the brain. Coupled with the fact that the emotional and cognitive impact of music is often well preserved in ageing and dementia, music is a powerful tool in the care and rehabilitation of many ageing-related neurological diseases. In addition to formal music therapy, there has been a growing interest in self- or caregiver-implemented musical leisure activities or hobbies as a widely applicable means to support psychological wellbeing in ageing and in neurological rehabilitation. This article reviews the currently existing evidence on the cognitive, emotional, and neural benefits of musical leisure activities in normal ageing as well as in the rehabilitation and care of two of the most common and ageing-related neurological diseases: stroke and dementia.
Objective:
The aim of the study was to explore the impact of insomnia and sleep disturbance on the functional outcomes of mild and moderated stroke.
Design:
A multicenter-observational and correlation study was performed. Two hundred eighty patients with mild-moderate severity stroke admitted to three acute hospitals rehabilitation departments. Diagnostic Statistical Manual of Mental Disorders, Fourth Edition, criteria were used to define patients with insomnia and any sleep disturbance. Patient's initial and final functions were evaluated using the Korean version of the Berg Balance Scale, the Korean version of Modified Barthel Index, the Korean version of Mini-Mental State Examination, the Korean version of the Frontal Assessment Battery, and the Korean version of National Institute of Health Stroke Scale. Sleep disturbance and function were assessed with respect to stroke severity as defined by the Korean version of National Institute of Health Stroke Scale.
Results:
The prevalence of Diagnostic Statistical Manual of Mental Disorders, Fourth Edition insomnia and any sleep disturbance were 26.9% and 56.7%, respectively. After adjusting for age, sex, depression, anxiety, length of stay, and hypnotic usage, the improvement of Korean version of the Berg Balance Scale was significantly lower in the any sleep disturbance group. In the moderate stroke group, the Korean version of the Berg Balance Scale improvement was significantly lower in the any sleep disturbance group, whereas in the mild stroke group, the Korean version of the Berg Balance Scale improvement was not significant.
Conclusions:
Sleep disturbance after stroke was found to have negative effects on functional recovery, especially balance improvement in moderate stroke group.
Sleep-disordered breathing (SDB) and sleep-wake disorders (SWD) are frequent after stroke. Not only brain damage per se but also the consequences of stroke (immobilization, pain, hypoxia, depression etc) affect sleep wake cycle and breathing control. SDB and SWDs have a negative effect on rehabilitation outcome and quality of life after stroke. A high suspicion may lead to a diagnosis and subsequent treatment of sleep disorders after stroke and contribute to rehabilitation of these patients. This article summarizes the knowledge about the role of SDB and SWD after stroke, reviewing clinical characteristics, clinical outcome after stroke, diagnosis and treatment of various sleep disturbances.
Introduction
The human brain is exquisitely sensitive to musical stimuli. This critical review aims to include concepts of music therapy and resume studies regarding the use of music and music therapy in neuromotor rehabilitation.
Materials and methods
We analysed the main published literature about neuroscientific bases of therapy with music and controlled or randomised trials present in PubMed, PsychINFO and in the Cochrane Central Register of Controlled Trials, using key words like ‘music’, ‘music therapy’, ‘motor rehabilitation’, ‘neurorehabilitation’, ‘Parkinson’s disease’, ‘stroke’, ‘brain injury’, ‘multiple sclerosis’, ‘amyotrophic lateral sclerosis’ and ‘ataxia’. We considered the trials specifically referring to neuromotor rehabilitation treatments.
Results
Our analysis indicates significant effects of music and music therapy techniques on neuromotor rehabilitation, in particular, in the rehabilitation of stroke and Parkinson’s disease.
Conclusion
The need for a greater definition of the contents of music interventions and for a more scientific and methodological rigor, has emerged in the conduction of studies using music and music therapy in neuromotor rehabilitation.
Stroke is one of the most significant causes of morbidity and mortality in the UK. However, a review of the literature reveals a paucity of studies on stroke rehabilitation. The majority of literature is quantitative in nature, with relatively few studies seeking patients' own views.
This article reviews the studies that have investigated the concept of recreation as a part of stroke rehabilitation. It reveals that at present, no research has been undertaken specifically to investigate patients’ perceptions of the need for recreational activity while undergoing stroke rehabilitation.
Purpose:
The aim of this study was to investigate how persons with stroke experience participation in rhythm and music therapy.
Methods:
To gain knowledge of the qualitatively different ways persons with stroke experience participation in Ronnie Gardiner Rhythm and Music (RGRM) therapy, a phenomenographic approach was chosen. Interviews with 17 persons with stroke were done. Selection criteria were set to capture the variations in how the phenomenon appeared to the informants.
Results:
Two qualitatively different ways of experiencing the RGRM therapy were identified: (A) challenge leading to connection with the body and (B) being able. A feeling of being connected to the body was achieved as a result of the challenging tasks. By gaining a feeling of body awareness joy, energy and desire to do things increased. Learning new skills was promoted by having to be concentrated during therapy sessions and a sense of being able to carry out difficult tasks was achieved.
Conclusions:
Participation in RGRM seems to have helped the persons come to terms with their changed bodies, leading to feelings of being connected with their bodies. A feeling of change in competence occurred when an ability to carry out the tasks was simultaneously achieved.
Implications for rehabilitation:
Stroke may cause considerable functional limitations with needs of rehabilitation services as a consequence. Participation in rhythm and movement activities may help persons who have had a stroke come to terms with their "new" bodies. The rhythm and movement activities were considered demanding and helped return to a meaningful life.
This article examines some of the functions of music in human society, and argues for a restructuring of the current taxonomies, as driven by Martindale's psychobiological theory of aesthetic preference. The realignment proposed places the desire for pleasure generation at the highest point of a hierarchy of functions, the so called fundamental function, with other functions considered to be subsidiary. With this view, music can be defined as an auditory stimulus whose fundamental function is to produce pleasure in the listener (who may, of course, also be the performer). I refine this thesis by proposing a sub-personal, mechanistic level of explanation where neural displeasure centres are inhibited during these experiences, allowing the activation of rich and numerous memories and emotions that are experienced but not disliked (i.e. dissociation or suspension of disbelief) at the personal level. This idea of ‘dissociation’, the correlate of a mechanistic level of explanation, also provides a deeper, more significant and descriptive explanation of the function of music, describing the emotional, spiritual and ritualistic uses of music. This view has important implications for evolutionary psychologists seeking to determine the origin and distinctive functions of music compared to language.
Music has an important meaning in the lives of many elderly persons. Its capacity to evoke emotions and influence mood and arousal is often relatively well preserved also in dementia. Neuroscientific and clinical research has increased our understanding about the mechanisms underlying music enjoyment and its therapeutic effects. This article reviews previous studies that address the neural basis of music cognition and emotion. We also introduce the effects of varying music interventions on emotional and cognitive functioning in dementia. Findings suggest that both traditional music therapy and caregiver-implemented music activities may have the capacity to reduce emotional and behavioral disturbances in dementia, although firm conclusions about the long-term effects of music still remain elusive. The rapid growth of dementia warrants study in the rehabilitative effects of everyday musical leisure activities or hobbies, such as music listening and singing, on well-being in dementia, especially in its early stages.
Objective
To describe group therapy utilization in spinal cord injury (SCI) inpatient rehabilitation.DesignProspective observational study.SettingSix inpatient rehabilitation facilities.ParticipantsPatients (N=1376) receiving initial rehabilitation after traumatic SCI.InterventionsNot applicable.Main Outcome MeasureTime spent in group versus individual therapy for physical therapy (PT), occupational therapy (OT), therapeutic recreation (TR), and psychology (PSY) therapies.ResultsThe majority (98%) of patients participated in at least 1 group therapy session, with 83%, 81%, 80%, and 54% of patients receiving group PT, OT, TR, and PSY, respectively. On average, 24% of treatment sessions and 27% of treatment time was provided in group sessions, with TR providing the greatest percent of its time in groups. Group therapy time and time spent in specific activities varied among patient subgroups with different injury characteristics. Group therapy time also varied widely among centers (range, 1.2–6.6h/wk). Across all injury subgroups, individual and group therapy hours per week were negatively correlated for OT and positively correlated for TR. Patient characteristics, clinician experience, and treatment center predicted 32% of variance in group hours per week. PT and OT strengthening/endurance interventions and TR outings were the most common group activities overall.Conclusions
While the majority of inpatient SCI rehabilitation consists of individual sessions, most patients participate in group therapy, which contributes significantly to total therapy time. Patterns of group utilization fit with functional expectations and clinical goals. A trade-off between group and individual therapy may occur in some disciplines. Utilization of group therapy varies widely among centers, and further study is needed to identify optimal patterns of group therapy utilization.
This column is designed to underscore relationally based creative interventions used by counselors and psychotherapists in their practices. Our intention is to provide examples of novel, innovative ways of working with clients in their efforts to deepen self-awareness and their connections with others. Although the interventions within this column will be presented in a linear “how-to” manner, an essential premise of this column is that interventions submitted for publication have a contextual and relational basis. Basic to this column is the therapeutic focus of working through latent hurts and impediments to our clients' health and happiness. Client goals generally involve creating the requisite emotional space needed for genuine relational choice for connection to manifest. If you have created a useful therapy tool or if you have adapted an existing creative tool that you would like to share with readers, please follow submission guidelines in the author information packet available at http://www.creativecounselor.org/Journal.htmlDepression is one of the most common mental health issues. Although drug therapy and cognitive-behavioral therapy remain popular and effective treatments, alternative interventions such as the use of music listening and mindfulness practice as interventions during therapy have gained ground. Research on the use of music listening and mindfulness practice shows each to be effective in treating depression. The authors propose a combined intervention called Mindful Music Listening, during which clients with depression use mindfulness skills while listening to music to notice, label, discuss, and learn to manage their emotions. Possible advantages include greater client self-awareness and emotional regulation as well as a strengthened counselor–client relationship.
This study investigated the relationship between changes in mood and behavior and the number and setting (individual or group) of music therapy sessions received by people who have had a stroke or traumatic brain injury (TBI). Ten individuals who had had a stroke or TBl and some degree of depression received varying numbers of music therapy sessions in addition to standard rehabilitation. Some received group music therapy only while others were seen in both group and individual music therapy sessions. Evaluation included pre– and post–treatment assessments of participants' self–rating of mood, family ratings of mood and social interaction, and therapist ratings of mood and participation in therapy. The number of music therapy sessions seemed to influence several behavioral measures, with group sessions appearing to affect social interaction and individual sessions marginally affecting motivation for treatment. The number of group sessions was also related to family members' assessment of improvement in patients' moods in the previous 24 hours. Implications of this exploratory study for the delivery of music therapy services are discussed.
Objectifs
Cette analyse de la littérature concerne la fatigue après accident vasculaire cérébral et cherche à en évaluer la prévalence, l'impact, la physiopathologie, les facteurs associés et les traitements.
Matériel et méthode
Une recherche sur Pub Med a été réalisée jusqu'en janvier 2006 avec les mots clés : stroke, fatigue, sleep disorders, exercice, rehabilitation. Les références pertinentes des articles répertoriés ont également été analysées.
Résultats
La prévalence de la fatigue dans la population AVC est de 39 à 72 %. Quelques études montrent une répercussion fonctionnelle importante de ce symptôme ainsi qu'une augmentation de la mortalité. Il persiste de nombreuses interrogations concernant les facteurs associés à la fatigue mais son origine est clairement multifactorielle. Certaines études montrent l'existence d'un déconditionnement à l'effort, une augmentation du coût énergétique de la marche et l'existence de fréquents troubles du sommeil que l'on peut relier à une fatigue dite physique, d'autres montrent une interaction avec la dépression dans le cadre d'une fatigue psychique. L'existence d'une fatigue dite primitive, en lien direct avec l'AVC doit encore être étayée. D'autres cofacteurs sont diversement associés. Les traitements doivent faire suite à une enquête diagnostique circonstanciée. Le réentraînement à l'effort, notamment sur tapis de marche en allègement du poids du corps est une technique permettant une diminution du coût énergétique de la marche et une augmentation de la capacité à l'effort probablement utile dans le traitement de la fatigue mais des études complémentaires doivent être conduites.
Contemporary developments in psychotherapy include mindfulness-based interventions and metacognitive therapy. Both of these approaches incorporate attentional training exercises and meditative activity designed to help clients cope better with rumination, worry, and over-analytical conceptual thinking. Notably, they also use focused listening exercises within established, demonstrably effective treatment protocols. These related practices collectively highlight the promising role of listening, sonic awareness, and mindfulness of sound/music as a means to enhance psychological functioning. Moreover, the paradigm provides a cognitive-attentional framework for understanding the well established, salutary benefits of music listening and may appeal to those many professionals who work in cognitive-behavioral modalities. Examples of clinical materials based on these models are included.
Music is used to regulate mood and arousal in everyday life and to promote physical and psychological health and well-being in clinical settings. However, scientific inquiry into the neurochemical effects of music is still in its infancy. In this review, we evaluate the evidence that music improves health and well-being through the engagement of neurochemical systems for (i) reward, motivation, and pleasure; (ii) stress and arousal; (iii) immunity; and (iv) social affiliation. We discuss the limitations of these studies and outline novel approaches for integration of conceptual and technological advances from the fields of music cognition and social neuroscience into studies of the neurochemistry of music.
Following a stroke, individuals' abilities may not match the demands of their environment and occupations, resulting in compromised occupational performance. The process of adaptation can enable adjustment of the way occupations are performed to achieve occupational mastery. The purpose of this honours study was to investigate and describe older adults' lived experience of occupational adaptation following a stroke.
An interpretative phenomenological approach was used. Participants in the community were recruited through Domiciliary Care service co-ordinators. In-depth interviews were conducted with three men and two women, aged 68-78 years who had experienced a stroke up to 14 years ago. Data were analysed using the Colazzi's method to formulate themes.
Experiencing a stroke is initially a 'shock to the system' and while 'your whole life changes', there are still ways to 'get on and do your best'. The theme 'your whole life changes' had three subthemes: 'apprehension and fear', 'problem solving' and 'stretching the limitations'. Resilience, motivation and effort are the required qualities for adaptive responses after stroke. Coping strategies identified to facilitate occupational mastery include the use of humour, touch, expressing anger, using self-talk, maintaining hope, having a sense of being fortunate and supportive friends and family.
These findings support an empowering approach to therapy, facilitating clients to identify and utilise individually appropriate coping strategies to negotiate negative emotions and apprehension and enable the required personal qualities for occupational adaptation.
A common long-term consequence of stroke is impaired arm function, which affects independence and quality of life in a considerable proportion of stroke survivors. There is a growing need for self-management strategies that enable stroke survivors to continue their recovery after rehabilitation has ceased. Interventions with high-intensity, repetitive task training and feedback are most likely to improve function. Achieving the required amount of self-practice is challenging, however. Innovative approaches are required to translate therapies into rewarding activities that can be undertaken independently. This paper describes the key principles and development of a novel intervention that integrates individuals' preferred music with game technology in upper limb rehabilitation. The "tap tempo" paradigm, which uses rhythmic auditory cueing, provides repetitive upper limb task training, which can be tailored to individual goals and progress (e.g., in terms of movement range and complexity), while providing sensitive quantitative feedback to promote skill acquisition and enhance self-management.
Music is an enjoyable leisure activity that also engages many emotional, cognitive, and motor processes in the brain. Here, we will first review previous literature on the emotional and cognitive effects of music listening in healthy persons and various clinical groups. Then we will present findings about the short- and long-term effects of music listening on the recovery of cognitive function in stroke patients and the underlying neural mechanisms of these music effects. First, our results indicate that listening to pleasant music can have a short-term facilitating effect on visual awareness in patients with visual neglect, which is associated with functional coupling between emotional and attentional brain regions. Second, daily music listening can improve auditory and verbal memory, focused attention, and mood as well as induce structural gray matter changes in the early poststroke stage. The psychological and neural mechanisms potentially underlying the rehabilitating effect of music after stroke are discussed.
Music-supported therapy (MST) has been developed recently to improve the use of the affected upper extremity after stroke. MST uses musical instruments, an electronic piano and an electronic drum set emitting piano sounds, to retrain fine and gross movements of the paretic upper extremity. In this paper, we first describe the rationale underlying MST, and we review the previous studies conducted on acute and chronic stroke patients using this new neurorehabilitation approach. Second, we address the neural mechanisms involved in the motor movement improvements observed in acute and chronic stroke patients. Third, we provide some recent studies on the involvement of auditory-motor coupling in the MST in chronic stroke patients using functional neuroimaging. Finally, these ideas are discussed and focused on understanding the dynamics involved in the neural circuit underlying audio-motor coupling and how functional connectivity could help to explain the neuroplastic changes observed after therapy in stroke patients.
Abstract Caregiver burden following stroke is increasingly recognised as a significant health care concern. A growing number of studies have evaluated the patient, caregiver, and social support factors that contribute to increased caregiver burden. We conducted a systematic review of this literature to guide future research. A search of the MEDLINE, PsycINFO, CINAHL, and EMBASE databases (up to July 2008) and reference sections of published studies using a structured search strategy yielded 24 relevant articles. Studies were included if they evaluated predictors and/or correlates of caregiver burden in the setting of stroke. The prevalence of caregiver burden was 25-54% and remained elevated for an indefinite period following stroke. In studies that evaluated independent baseline predictors of subsequent caregiver burden, none of the factors reported were consistent across studies. In studies that assessed concurrent factors independently contributing to caregiver burden in the poststroke period, patient characteristics and social support factors were inconsistently reported. Several studies identified caregiver mental health and the amount of time and effort required of the caregiver as significant determinants of caregiver burden. Our findings highlight the need for more research to identify caregivers in need of support and guide the development and implementation of appropriate interventions to offset caregiver burden.
We performed two parallel interview studies of stroke patients (n= 20) and professional nurses (n= 5) to gain more insight into the therapeutic role of music listening in stroke rehabilitation. Results suggest that music listening can be used to relax, improve mood, and provide both physical and mental activation during the early stages of recovery from stroke. Thus, music listening could provide a useful clinical tool in stroke rehabilitation.
This study examined the immediate effects of neurologic music therapy (NMT) on cognitive functioning and emotional adjustment with brain-injured persons. Four treatment sessions were held, during which participants were given a pre-test, participated in 30 min of NMT that focused on one aspect of rehabilitation (attention, memory, executive function, or emotional adjustment), which was followed by post-testing. Control participants engaged in a pre-test, 30 min of rest, and then a post-test. Treatment participants showed improvement in executive function and overall emotional adjustment, and lessening of depression, sensation seeking, and anxiety. Control participants improved in emotional adjustment and lessening of hostility, but showed decreases in measures of memory, positive affect, and sensation seeking.
In this article, we aim to develop the understanding of what helps or hinders resumption of valued activities up to 12-months post-stroke.
As part of a longitudinal study, semi-structured interviews were conducted with 19 people with stroke and eight informal carers 12-months post-stroke. Interviews covered ongoing effects of stroke, experience of trying to resume activities highlighted as important pre-stroke and factors that influenced progress. Interviews were transcribed, coded and analysed in depth to explore this aspect of the experience of living with stroke.
Valued activities discussed related to employment; domestic and social roles including driving; hobbies, sports and socialising. Outcomes for individuals were influenced by: aspects of physical or cognitive disability; environmental factors; the adaptability of the individual; support from others and professional help. Inability to resume activities impacted on people's sense of self and quality of life, but some tolerated change and presented themselves as adaptable.
This study indicates a long-term role for rehabilitation services such as: identifying the significance of different types of activities; providing access to support and treatment for debilitating symptoms such as fatigue and dizziness; addressing patients' emotional and behavioural responses to their condition; working with patients' wider social networks and where appropriate, supporting adaptation to a changed way of life.
A previous study (carried out in 2003-2004) had included 34 patients with traumatic brain injury in order to study the feasibility and usefulness of music therapy in patients with this type of injury.
To evaluate the effect of music therapy on mood, anxiety and depression in institutionalised patients with traumatic brain injury. STUDY METHODOLOGY: A prospective, observational study.
Thirteen patients with traumatic brain injury were included in the present study and took part in individual, weekly, 1-hour music therapy sessions over a period of 20 weeks. Each session was divided into two 30-minute periods - one devoted to listening to music (receptive music therapy) and the other to playing an instrument (active music therapy). The assessment criteria (measured at weeks 1, 5, 10, 15 and 20) were mood (on the face scale) and anxiety-depression (on the Hospital Anxiety and Depression [HAD] Scale). Mood was assessed immediately before and after the first music therapy session and every fifth session.
Music therapy enabled a significant improvement in mood, from the first session onwards. This short-term effect was confirmed by the immediate changes in the scores after music therapy sessions (from 4.6+/-3.2 to 2.6+/-2; p<0.01). Music therapy also led to a significant reduction in anxiety-depression (p<0.05) from week 10 onwards and up until the end of the study (week 20).
These results confirm the usefulness of music therapy in the treatment of anxiety-depression and mood in patients with traumatic brain injury. Music therapy could usefully form an integral part of the management programme for these patients.
To explore the long-term experience of mood changes in community-dwelling stroke survivors at 1, 3, and 5 years after stroke.
A qualitative study using a modified grounded theory approach. The primary data collection method was semi-structured interviewing.
Community-dwelling stroke survivors in metropolitan Newcastle, NSW, Australia.
Twelve community-dwelling stroke survivors (6 men, 6 women; age range 43-92y; 4 participants from each cohort) discharged from a tertiary referral hospital.
Not applicable.
Qualitative outcomes were participants' perceptions using in-depth, semi-structured interviews with participants from 3 community-based cohorts of stroke survivors at 1, 3, and 5 years poststroke.
Four main categories of mood change were described by participants including feelings of frustration, reduced self-efficacy, dependency, and loss. Factors that modulated these mood changes included the presence or absence of insight, hope for the future, faith, and support. A modified grounded theory approach was used for data analysis using a process of constant comparison.
Mood changes continued well beyond discharge and in some cases commenced after discharge in this sample of stroke survivors. Use of qualitative methodology extends our understanding of the extent and nature of low mood after stroke. There is a need for enhanced services to monitor and address low mood.
One way that stroke units may improve outcome is by reducing complications of immobility through early mobilization; however, this intervention needs testing. The purpose of this study was to determine the physical activity patterns of stroke patients managed within acute stroke units as a first step in developing an early mobilization protocol.
We recruited 64 patients within 14 days after stroke from 5 metropolitan stroke units and observed them for 2 consecutive days at 10-minute intervals between the hours of 8 am and 5 pm. At each observation, we ascertained physical activity, location, and other person(s) present. Therapists recorded therapy details.
The 58 patients who completed the study had a mean age of 71.3 years. Stroke severity ranged from mild (National Institutes of Health Stroke Scale score, 1) to severe (score, 27), and mean time after stroke at observation was 5.6 days (range, 0 to 13 days). Only 9 patients were restricted to bed. During the therapeutic day, patients spent >50% resting in bed, 28% sitting out of bed, and only 13% engaged in activities with the potential to prevent complications and improve recovery of mobility. Patients were alone >60% of the time.
This is the first multicenter study of physical activity early after stroke. We believe the next step is to conduct a randomized controlled trial to evaluate the effect of increased levels of physical activity early after stroke compared with current standards of care.