Abstract
Background: Impairment of upper limb function following stroke is more common than lower limb impairment and is also more resistant to treatment. Several lab-based studies with stroke patients have produced statistically significant gains in upper limb function when using musical instrument playing and techniques where rhythm acts as an external time-keeper for the priming and timing of upper limb movements.Methods: For this feasibility study a small sample size of 14 participants (3–60 months post stroke) has been determined through clinical discussion between the researcher and study host in order to test for management, feasibility and effects, before planning a larger trial determined through power analysis. A cross-over design with five repeated measures will be used, whereby participants will be randomized into either a treatment (n = 7) or wait list control (n = 7) group. Intervention will take place twice weekly over 6 weeks. The ARAT and 9HPT will be used to measure for quantitative gains in arm function and finger dexterity, pre/post treatment interviews will serve to investigate treatment compliance and tolerance. A lab based EEG case comparison study will be undertaken to explore audio-motor coupling, brain connectivity and neural reorganization with this intervention, as evidenced in similar studies.Discussion: Before evaluating the effectiveness of a home-based intervention in a larger scale study, it is important to assess whether implementation of the trial methodology is feasible. This study investigates the feasibility, efficacy and patient experience of a music therapy treatment protocol comprising a chart of 12 different instrumental exercises and variations, which aims at promoting measurable changes in upper limb function in hemiparetic stroke patients. The study proposes to examine several new aspects including home-based treatment and dosage, and will provide data on recruitment, adherence and variability of outcomes.
Highlights
Impairment of upper limb function following stroke is more common than lower limb impairment and is more resistant to treatment
Assessments for each participant will take place at the same time points after baseline measure, as illustrated in Figure 1, with the baseline and end assessments immediately before and after the 6 weeks of Therapeutic Instrumental Music Performance (TIMP) being conducted by a therapist who is blind to participant allocation
The discussion was based on defining an appropriate number of stroke patients that would represent the heterogeneity of upper limb impairment and facilitate a report on the feasibility, management and efficacy of the intervention under the stated research conditions.The sample size is considered feasible for the researcher to deliver with the available time scale and resources within the host NHS trust, including staff assisted access to patient records, identification of suitable patients and invitation to participate from NHS community stroke team therapists, and completion of data collection within a limited period of time
Summary
There are approximately 152,000 people affected by stroke in the UK every year (British Heart Foundation, 2012) causing more disability in adults than any other disease or condition. Sharing some features with this study, Music Supported Therapy (MST) is a recently researched intervention in which participants played through a series of increasingly complex musical exercises using electronic drum pads and keyboard Results from these studies have consistently shown statistically significant improvements for participants’ upper limb function, evidencing neural reorganization using EEG and fMRI technology (Schneider et al, 2007; Rojo et al, 2011; Altenmüller et al, 2009; Grau-Sánchez et al, 2013). Musical instrument playing is not widely recognized as a feasible and effective, short-term intervention for treating movement disorders resulting from stroke, a patient group within which there is a high level of heterogeneity as regards upper limb hemiparesis, cognitive, sensory and communication impairments. This biomedical research study is registered with clinical trials.gov, number NCT 02310438 and approved by the Integrated Research Application System (IRAS) and Anglia Ruskin University Ethics Boards
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