The Effects of a Rhythm and Music-based Therapy Program and Therapeutic Riding in Late Recovery Phase Following Stroke
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      The initiative to the study is based on the fact that various forms of enriched environments
      and multimodal stimulation are found to have positive influences on motivation and
      psychosocial well-being and have been shown to facilitate multiple processes in the brain
      leading to structural regeneration and functional recovery. Since there is a lack of
      rehabilitation programs that encompass all dimensions of a stroke survivor's life researchers
      agree upon the need for a rehabilitation program that addresses both the social and physical
      needs of the patients. The aim with the project is to investigate whether it is possible to
      improve the life situation among patients with a history of stroke through a rhythm and music
      method and therapeutic riding. To get insights in the underlying mechanisms our research also
      focuses on relevant physiological, neurobiological and psychosocial mechanisms induced by the
      interventions. The hypothesis is that both treatment methods will mainly enhance
      participants' degree of participation.

      The study is a randomized controlled trial where about 123 participants (50-75 years old) who
      had their stroke incident 1 - 5 years ago will be consecutively included and randomly
      allocated to the following three groups: a) Ronnie Gardiner Rhythm Music Method (RGRM) b)
      therapeutic riding c) a control group receiving RGRM after 9 months. Treatment proceeds
      during 12 weeks and evaluation takes place pre- and post intervention, and 12 and 24 weeks
      after the treatment is finalized. The evaluation consists of a thorough neuropsychological
      assessment, a physiotherapeutic assessment, sampling of blood and questionnaires covering
      mental, psychosocial, physical and psychological well-being. Interviews are also conducted in
      order to map the participants' experiences from the two treatment programs. Specially
      designed interviews are also planned to be carried through with participants having aphasia.

      So far, there is only empirical support suggesting that RGRM has positive effects for
      individuals with a history of stroke making it significant to carry out research with the aim
      to contribute to strengthening the evidence of the method. A positive outcome would increase
      the scientific basis for this alternative treatment thus facilitating further research and
      implementation in everyday clinical practice.
    

Detailed description: 
      Background and Purpose: Treatments that improve function in late phase after stroke are
      urgently needed. We assessed whether multimodal interventions based on rhythm-and-music
      therapy or horse-riding therapy could lead to increased perceived recovery and functional
      improvement in a mixed population of individuals in late phase after stroke.

      Methods: Participants were assigned to rhythm-and-music therapy, horse-riding therapy, or
      control using concealed randomization, stratified with respect to sex and stroke laterality.
      Therapy was given twice a week for 12 weeks. The primary outcome was change in participants'
      perception of stroke recovery as assessed by the Stroke Impact Scale with an
      intention-to-treat analysis. Secondary objective outcome measures were changes in balance,
      gait, grip strength, and cognition. Blinded assessments were performed at baseline,
      postintervention, and at 3- and 6-month follow-up.

      Results: One hundred twenty-three participants were assigned to rhythm-and-music therapy
      (n=41), horse-riding therapy (n=41), or control (n=41). Post-intervention, the perception of
      stroke recovery (mean change from baseline on a scale ranging from 1 to 100) was higher among
      rhythm-and-music therapy (5.2 [95% confidence interval, 0.79-9.61]) and horse-riding therapy
      participants (9.8 [95% confidence interval, 6.00-13.66]), compared with controls (-0.5 [-3.20
      to 2.28]); P=0.001 (1-way ANOVA). The improvements were sustained in both intervention groups
      6 months later, and corresponding gains were observed for the secondary outcomes.

      Conclusions: Multimodal interventions can improve long-term perception of recovery, as well
      as balance, gait, grip strength, and working memory in a mixed population of individuals in
      late phase after stroke.
    

Intervention name(s): RGRM; Therapeutic riding; Receives no intervention
Intervention type(s): Other; Other; Other
Intervention description(s): RGRM is multi-sensory method. The group including 6-8 participants is headed by a certified therapist of the method using a unique note system. The Note system is the combined body of body symbols in red and blue, with the audio codes and movements and be assembled in countless combinations to stimulate different parts of the brain. The movements are exercised by the hands tapping on the knees and feet stamping on the floor without the need for tools other than the body. The RGRM is developed to stimulate mobility, reading and speech, rhythm-esteem, body image, balance, memory, coordination, motor skills, concentration, perseverance and social skills. The group will have two sessions per week during 12 weeks.; The horses walk provides sensory input through movement, which is variable, rhythmic, and repetitive. The many textures, sounds, sights, movement experiences of working around a horse provide an enriched sensory environment. The participants gain from the physical benefits of being on a moving horse and are socially and emotionally stimulated by interacting with a horse and the rest of the group. The intervention is headed by educated therapists (occupational therapist and physical therapist), in conjunction with experienced horse handler and specially trained therapy horses. The treatment is held in group format (4-6 participants) twice per week in 12 weeks which runs in sessions where two participants ride at the same time.; Receives no intervention and acts as a control group in the analyses but will receive rhythm and music therapy after one year, when the long-term follow-up is completed.
Other intervention name(s): The Ronnie Gardiner Rhythm Music Method (RGRM); No intervention in phase one
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment