Therapeutic Instrumental Music Performance With Sensory-Enhanced Motor Imagery in Chronic Post-Stroke Rehabilitation

Not Applicable

Completed

• Conditions: Stroke
• Interventions: Behavioral: Therapeutic Instrumental Music Performance; Behavioral: Therapeutic Performance with Motor Imagery; Behavioral: Therapeutic Performance with Sensory-Enhanced Motor Imagery

• Registration Number: NCT03246217
• Lead Sponsor: University of Toronto

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.

Study Timeline

• Study Start: 2017-07-20
• Study First Submitted: 2017-08-07
• Study First Submitted QC: 2017-08-09
• Study First Posted: 2017-08-11
• Status Verified: 2019-09
• Primary Completion: 2019-09-05
• Study Completion: 2019-09-05
• Last Update Submitted: 2019-09-11
• Last Update Posted: 2019-09-16

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 30

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

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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

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Therapeutic Performance with Motor Imagery	Therapeutic Instrumental Music Performance	Participants will receive nine individual sessions, three times per week: thirty minutes of Therapeutic Instrumental Music Performance, followed by fifteen minutes of motor imagery. Motor imagery will involve mental practice of previous movement exercises.
Therapeutic Performance with Motor Imagery	Therapeutic Performance with Motor Imagery	Participants will receive nine individual sessions, three times per week: thirty minutes of Therapeutic Instrumental Music Performance, followed by fifteen minutes of motor imagery. Motor imagery will involve mental practice of previous movement exercises.
Therapeutic Instrumental Music Performance	Therapeutic Instrumental Music Performance	Therapeutic Instrumental Music Performance is a Neurologic Music Therapy technique in which selection of instruments, spatial configurations and sequences for playing are designed to facilitate retraining of movement patterns used in everyday life. Participants will receive nine individual forty-five minute sessions of Therapeutic Instrumental Music Performance, three sessions per week.
Therapeutic Performance with Sensory-Enhanced Motor Imagery	Therapeutic Instrumental Music Performance	Participants will receive nine individual sessions, three times per week: thirty minutes of Therapeutic Instrumental Music Performance, followed by fifteen minutes of sensory-enhanced motor imagery. During sensory-enhanced motor imagery, participants will listen to a metronome set to their preferred pace for previously practised movements while engaging in motor imagery.
Therapeutic Performance with Sensory-Enhanced Motor Imagery	Therapeutic Performance with Sensory-Enhanced Motor Imagery	Participants will receive nine individual sessions, three times per week: thirty minutes of Therapeutic Instrumental Music Performance, followed by fifteen minutes of sensory-enhanced motor imagery. During sensory-enhanced motor imagery, participants will listen to a metronome set to their preferred pace for previously practised movements while engaging in motor imagery.

Primary Outcome Measures

Name	Time	Method
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 Outcome Measures

Name	Time	Method
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.
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
Multiple Affect Adjective Check List-Revised	Baseline 1, Baseline 2 (1 week later), Post intervention of 4 weeks	Measure of affective state
Digit Span	Baseline 1, Baseline 2 (1 week later), Post intervention of 4 weeks	Assesses working memory and attention
Trail Making Test Part B	Baseline 1, Baseline 2 (1 week later), Post intervention of 4 weeks	Assesses mental flexibility and processing speed

Trial Locations

Locations (1)

Faculty of Music, University of Toronto; 🇨🇦 Toronto, Ontario, Canada