Rhythm-Based and Tonal-Based Music Interventions on Upper Extremity in Parkinson's Disease: A Scoping Review

Abstract

<h3>Objective(s)</h3> To compare the effects of rhythmic-based and tonal-based music interventions on upper extremity (UE) outcomes in individuals with Parkinson's Disease (PD). Rhythmic-cueing utilizes external beats to influence motor execution of rhythmic movements (e.g., walking); tonal-based interventions incorporate melody and harmony to motivate and affect movement performance. However, the majority of the PD studies exclusively focused on rhythmic cueing for gait, which is a naturally paced movement. As the upper extremity (UE) movements are more varied and may be less rhythmed (e.g., dressing, handwriting), we wonder whether different types of intervention may provide distinct benefits in UE. <h3>Data Sources</h3> Five electronic databases (Cochrane, PubMed, Medline, CINAHL, and Embase) were used, with keyword combinations of Parkinson, rhythm/music, and upper extremity. All the searches were completed in August 2021. <h3>Study Selection</h3> Two pairs of two reviewers split the potential 1560 articles from the literature search and independently reviewed the article titles and abstracts for inclusion. Forty-six English-written full-text articles were further examined by two independent reviewers from either pair, resulting in a total of 22 studies included. <h3>Data Extraction</h3> All four independent reviewers extracted the descriptive data related to the intervention, the outcome measures, and the results. <h3>Data Synthesis</h3> The four reviewers classified the studies into three groups based on the intervention type: Rhythm-Only (n=12), Music-No-Beats (n=7), and Music-With-Beats (n=4) interventions. <h3>Conclusions</h3> Regardless of the intervention types, PD participants demonstrated consistent improvements in non-functional, rhythmed tasks (e.g., finger tapping) after training. However, no studies of Rhythm-Only interventions examined UE functions (e.g., dressing). Although 4 studies of Music-No-Beats interventions assessed UE functions (e.g., eating), none showed significant improvements. Further analysis suggests that interventions using familiar melodies could be distracting and deteriorate PD patients' performance. All the Music-With-Beats studies demonstrated significant results, but only one measured and showed functional benefits (in handwriting). Overall, only limited PD studies examined UE functional outcomes. More studies are needed to understand the unique effects of each intervention type for better clinical applications in PD. <h3>Author(s) Disclosures</h3> No conflict of interest.