Music Upper Limb Therapy-Integrated: An Enriched Collaborative Approach for Stroke Rehabilitation

Abstract

Stroke is a leading cause of disability worldwide. It leads to a sudden and overwhelming disruption in one's physical body, and alters the stroke survivors' sense of self. Long-term recovery requires that bodily perception, social participation and sense of self are restored; this is challenging to achieve, particularly with a single intervention. However, rhythmic synchronization of movement to external stimuli facilitates sensorimotor coupling for movement recovery, enhances emotional engagement and has positive effects on interpersonal relationships. In this proof-of-concept study, we designed a group music-making intervention, Music Upper Limb Therapy-Integrated (MULT-I), to address the physical, psychological and social domains of rehabilitation simultaneously, and investigated its effects on long-term post-stroke upper limb recovery. The study used a mixed-method pre-post design with 1-year follow up. Thirteen subjects completed the 45-min intervention twice a week for 6 weeks. The primary outcome was reduced upper limb motor impairment on the Fugl-Meyer Scale (FMS). Secondary outcomes included sensory impairment (two-point discrimination test), activity limitation (Modified Rankin Scale, MRS), well-being (WHO well-being index), and participation (Stroke Impact Scale, SIS). Repeated measures analysis of variance (ANOVA) was used to test for differences between pre- and post-intervention, and 1-year follow up scores. Significant improvement was found in upper limb motor impairment, sensory impairment, activity limitation and well-being immediately post-intervention that persisted at 1 year. Activities of daily living and social participation improved only from post-intervention to 1-year follow up. The improvement in upper limb motor impairment was more pronounced in a subset of lower functioning individuals as determined by their pre-intervention wrist range of motion. Qualitatively, subjects reported new feelings of ownership of their impaired limb, more spontaneous movement, and enhanced emotional engagement. The results suggest that the MULT-I intervention may help stroke survivors re-create their sense of self by integrating sensorimotor, emotional and interoceptive information and facilitate long-term recovery across multiple domains of disability, even in the chronic stage post-stroke. Randomized controlled trials are warranted to confirm the efficacy of this approach.

Clinical trial registration: National Institutes of Health, clinicaltrials.gov, NCT01586221.

Keywords: bodily perception; enriched environment; functional recovery; music therapy; psycho-social adjustment; rehabilitation; sense of self; social participation.

Figure 1

Mean scores (±SE) on the (A) Fugl-Meyer Scale (FMS; n = 10), (B) Two-point Discrimination test (n = 7), (C) Modified Rankin Scale (MRS; n = 10), (D) the WHO Well-being scale (n = 9), (E) the activities of daily living subscale of the Stroke Impact Scale (SIS; n = 10) and (F) the participation subscale of the SIS (n = 10) at pre-intervention, immediate post-intervention and 1-year follow up assessments.

Figure 2

(A) Mean (±SE) Fugl-Meyer scores in low-functioning subjects (n = 5) showed greater improvement compared with high-functioning subjects (n = 8). (B) The low-functioning subjects (active wrist range-of-motion <15°) showed better bimanual-to-unimanual learning across trials with the affected hand post-intervention than the high-functioning subjects (active wrist range-of-motion >30°).