Stroke
Conditions
Brief summary
Research has shown that music engages the brain bilaterally throughout cortical and subcortical regions, accessing extended sensorimotor, cognitive and affective networks. This research explores the hypothesis that use of these shared neural networks allows neurologic music therapy interventions targeting upper extremity motor control to promote plasticity and functional improvements in persons recovering from a cerebrovascular accident. The potential therapeutic benefits of these interventions on attentional processes and affective responding will also be examined.
Detailed description
More individuals are surviving and living with the effects of stroke, a trend that is expected to continue. Upper extremity limitations present a common, persistent challenge for stroke survivors, impacting quality of life. In addition, links have been found between physical impairment and depression, and depression and stroke-induced cognitive impairment. Music has been shown to exert multimodal effects on individuals and may be used as a mediating stimulus to promote therapeutic change. Furthermore, motor imagery may enhance the effectiveness of upper extremity interventions by engaging the same brain areas that are active in physical movement. The purpose of this study is to investigate the effects of therapeutic instrumental music performance and sensory-enhanced motor imagery on upper limb movement, affect and cognition following a stroke. Participants will be assessed at two baselines, and randomly assigned to one of three intervention groups: therapeutic instrumental music performance, therapeutic instrumental music performance and sensory-enhanced motor imagery, or therapeutic instrumental music performance and motor imagery without sensory enhancement.
Interventions
Participants will play a variety of instruments (acoustic and electronic) to facilitate retraining of everyday functional movements.
BEHAVIORALTherapeutic Performance with Sensory-Enhanced Motor Imagery
Participants will listen to a metronome set to their preferred pace for previously practised movements while engaging in motor imagery.
BEHAVIORALTherapeutic Performance with Motor Imagery
Participants will engage in motor imagery of previously practised movements.
Sponsors
University of Toronto
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
30 Years to 79 Years
Healthy volunteers
No
Inclusion criteria
* hemiparesis following a unilateral stroke (hemorrhagic or ischemic), sustained more than 6 months prior, with at least minimal volitional movement of the affected limb * permission from a physician to participate in an upper extremity rehabilitation program, including confirmation that the following disorders are not present: rheumatoid arthritis, upper extremity fracture, apraxia, neuropathy, somatosensory impairment * adequate language comprehension and neurocognitive function to understand and follow simple instructions
Exclusion criteria
* currently enrolled in an upper extremity rehabilitation program or another upper extremity study * comorbid neurological disorder (e.g. multiple sclerosis, Parkinson's disease) * evidence of perceptual or cognitive impairment; e.g., unilateral spatial neglect, significant hearing impairment, Montreal Cognitive Assessment score of 25 or less * presence of aphasia * injections for spasticity within three months of participation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Changes from baseline in Wolf Motor Function Test | Baseline 1, Baseline 2 (1 week later), Post intervention of 4 weeks | Measures upper extremity motor ability through timed and functional tasks. |
| Changes from baseline in Fugl-Meyer Assessment Upper Extremity | Baseline 1, Baseline 2 (1 week later), Post intervention of 4 weeks | Performance based measure assessing motor capacity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Multiple Affect Adjective Check List-Revised | Baseline 1, Baseline 2 (1 week later), Post intervention of 4 weeks | Measure of affective state |
| General Self-Efficacy Scale | Baseline 1, Baseline 2 (1 week later), Post intervention of 4 weeks | Assessment of perceived self-efficacy |
| Motor Activity Log | Baseline 1, Baseline 2 (1 week later), Post intervention of 4 weeks | Individuals rate quality and amount of movement during daily functional tasks. |
| Trail Making Test Part B | Baseline 1, Baseline 2 (1 week later), Post intervention of 4 weeks | Assesses mental flexibility and processing speed |
| Digit Span | Baseline 1, Baseline 2 (1 week later), Post intervention of 4 weeks | Assesses working memory and attention |
| Trunk Impairment Scale | Baseline 1, Baseline 2 (1 week later), Post intervention of 4 weeks | Assessment of upper trunk impairment using the upper trunk items of the Trunk Impairment Scale |
Countries
Canada
Outcome results
None listed