The Role of Therapeutic Instrumental Music Performance in Hemiparetic Arm Rehabilitation

ABSTRACT: This study describes the clinical application of Therapeutic Instrumental Music Performance (TIMP) on functional upper extremity movement in stroke patients. Participants for this study included 3 post-stroke outpatients showing pronounced hemiparesis in their upper extremities. Participants underwent six, 35-minute music therapy sessions in which they received training in flexion and extension exercises of their paretic arm using a Roland TD-5 Percussion Sound Module Musical Instrument Digital Interface (MIDI) drum set for TIMP exercises. Functional arm movements were assessed in the pretest and posttest using the Barthel Index, the Fugl-Meyer Test, and the Modified Ashworth Scale. MIDI data on total movement time, variability of movement time, and force were also collected during the pretest and posttest as well as at the halfway point of the treatment program. Results indicated significant improvements on the wrist and hand portion of the Fugl-Meyer Test (t = 5, p = .0377), and MIDI data showed observable improvements throughout the treatment period. These findings suggest that the addition of Neurologic Music Therapy to current rehabilitation training programs is possible and may prove beneficial in rehabilitation practices addressing functional arm movements in stroke patients. Stroke is a major leading cause of disabilities and death in the United States and it is estimated that about 700,000 new or recurrent strokes occur each year (American Heart Association, 2005; Truelsen et al., 2003; U.S. Department of Health and Human Resources, 1996). Forty-three percent of stroke patients are left with moderate to severe neurological functional impairments and 50% with hemiparesis (Hurst, 1994; Kelly-Hayes et al., 2003). About 75% of stroke patients have upper extremity weakness accompanied by muscle tone (spasticity), decreased muscle strength, decreased range of motion (ROM), and decreased ability to maintain posture and control of movements (Charness, 1995; Dewald, Sheshadri, Dawson, & Beer, 2001; Lawrence et al., 2001). A classic study by Twitchell (1951) pointed out the severity of upper extremity weakness at the onset of a stroke as an important predictor in upper extremity motor recovery following a stroke. In typical motor recovery, the upper extremity is more involved than the lower extremity at the onset and eventually this reverses. Even though most recovery takes place in the first three months, recovery may continue over a longer period of time (eMedicine, 2004). In a study conducted by Broeks, Lankhorst, Rumping, and Prevo (1999), patients showed good recovery of arm functions 16 weeks post-stroke. They also found that even patients four years post-stroke still showed good arm function recovery; therefore, continued outpatient therapy is very beneficial for recovering stroke patients. Because there are parallel neural processes in motor and auditory temporal processing which allows them to be coupled, the motor system is very responsive to the auditory system (Thaut, Kenyon, Schauer, & Mcintosh, 1999). Since temporal information of rhythms and timing information of motor movements have similar neural pathways, they also have parallel neural impulses; thus, motor responses can be entrained (synchronized) to auditory rhythms, making the movement more stable and steady (Thaut, 2003). Because the ability to respond to a rhythm and to discriminate between rhythms is innate (Cassidy & Standley, 1995; Standley, 2003; Trehub, 1 993; Trehub & Thorpe, 1989), it has been speculated that internal auditory rhythm can be a good temporal reference used to produce the complex timing and skilled movement of a motor response (Shaffer, 1982). This innate ability to entrain motor movement to an external rhythm can be effectively used for specific therapeutic goals (Thaut, 2003). Repetitive motor learning and structured training have been generally known to improve motor deficits in stroke rehabilitation (Butefisch, Hummelsheim, Denzler, & Mauritz, 1995; Platz, Bock, & Prass, 2001) through cortical rearrangement (brain plasticity). …