Home-based neurologic music therapy for upper limb rehabilitation in chronic stroke : A pilot study

Background: Upper limb hemiparesis following stroke is more common and resistant to treatment than in the lower limbs. Motivating, repetitious, task-driven interventions are needed for acute and community stage patients, with rehabilitation increasingly delivered in the home. Research has produced statistically significant gains following musical instrument playing and rhythmically cued exercises. This pilot study builds on previous research, investigating a musically synchronized, home-based exercise protocol called Therapeutic Instrumental Music Performance. The study examines three new aspects: 1) home-based, 2) facilitating music, 3) twice weekly dosage. Methods: 11 NHS stroke patients with hemiparesis who had completed their community rehabilitation were recruited within a crossover design. Participants all received treatment, randomized by the statistician via an envelope system into either treatment (n=6) or waitlist (n=5) groups. The intervention was delivered twice weekly over 6 weeks in each participant’s home and data was collected using the Action Research Arm Test at five timepoints over 18 weeks. A blind assessor conducted pre and post treatment measures. Qualitative data informed on participant compliance, motivation and tolerance. Results: 10 participants completed the study. There was no statistical significance found between early and delayed intervention. Whilst statistical significance was found between timepoint means for all participants, there was no correlation between the groups and so no statistical significance in treatment effects. Raw data for each participant indicates improvement between treatment periods and qualitative data indicates that participants clearly perceived the facilitating musical structures as helping their movement synchronization, and that the intervention was motivating. Discussion The emphasis of this pilot study was on testing the TIMP protocol, the feasibility of home delivery at this dosage, and informing on motivation and tolerance. Statistical significance was not predicted, however data analysis indicates that time since stroke may not be a factor influencing response to this protocol for patients matching this study cohort. A replicated study with a larger sample size would help to substantiate this.