Therapeutic Instrumental Music Training and Sensory-enhanced Motor Imagery in Chronic Post-stroke Upper-extremity Rehabilitation: A Randomized Controlled Trial

Objectives: To investigate the effectiveness of Therapeutic Instrumental Music Performance (TIMP) training, with or without motor imagery, in upper-extremity rehabilitation for individuals with chronic, post-stroke hemiparesis. Secondary objectives investigate effects of interventions on cognition and affect. Methods: Two baseline assessments, a minimum of one week apart; one final assessment. Nine interventions (3x/wk for 3 wks), facilitated by a qualified Neurologic Music Therapist. Thirty participants were randomized to one of three groups: 45 minutes of active TIMP; 30 minutes of TIMP followed by 15 minutes of metronome-cued motor imagery (TIMP+cMI); 30 minutes of TIMP followed by 15 minutes of motor imagery without cues (TIMP+MI). A selection of acoustic and electronic instruments was used. Results: Thirty participants completed the protocol, ten per arm [14 women; mean age= 55.9; mean time post-stroke= 66.9 months]. Pooled group baseline measures did not significantly differ. There were significant improvements from pre-test 2 to post-test for all groups on the Fugl-Meyer-Upper Extremity (FM-UE) and the Wolf Motor Function Test-Functional Ability Scale (WMFT-FAS), and for TIMP and TIMP+MI on the Motor Activity Log (MAL)-Amount of Use Scale. Comparing percent change differences between groups, TIMP (mean rank = 21.05) scored significantly higher than TIMP+cMI (mean rank = 11.00, p = .032) on the FM-UE. There were no significant percentage change differences between TIMP and TIMP+MI. The TIMP+MI group showed a significant change on the Trail Making Test (TMT)–Part B. The TIMP group showed a significant increase on the Multiple Affect Adjective Checklist (MAACL) Sensation Seeking scale and the Valence and Dominance portions of the Self-Assessment Manikin (SAM); TIMP+cMI showed respective increases and decreases in positive and negative affect on the MAACL, as well as an increase in Valence, Dominance, and Arousal portions of the SAM. There was no statistically significant association between cognitive and affective measures. Conclusions: Implementation of TIMP-based techniques led to significant improvements in paretic arm control. TIMP and TIMP+MI showed greater benefits than TIMP+cMI, suggesting that synchronizing internal and external cues during cMI may pose additional sensory integration challenges. TIMP+MI appeared to increase mental flexibility, while active TIMP interventions appeared to enhance positive affect. Trial Registration: ClinicalTrials NCT03246217

Department dc:contributor.department

Music

Year dc:date.issued

2021

Author dc:creator

• Haire, Catherine Margaret

Advisor dc:contributor.advisor

• Thaut, Michael H

• affective responding
• cognition
• motor imagery
• music
• stroke
• upper extremity rehabilitation

Handle dc:identifier.uri

http://hdl.handle.net/1807/106537

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/106537