The Effectiveness of Piano Therapy vs. Piano Listening on Manual Dexterity in the Elderly

Study Overview
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Brief Summary
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Does active piano practice help recover hand dexterity in older adults, or does social interaction and music-listening alone affect motor performance? Researchers hypothesized improved dexterity after active piano playing, but not after passive piano listening. 15 residents of a retirement community were partnered together and completed 2 two-week piano training modules. In module 1, one partner played piano exercises and songs while the other listened. In module 2, partners switched roles. The Purdue Pegboard Test and Box and Block Test assessed fine and gross motor dexterity, before, between, and after the training modules. A repeated measures ANOVA showed a main effect of time on overall fine and gross motor function, but there was no main effect of playing versus listening. Results did not support the hypothesis, but indicate that piano-based therapy requires greater than 2 weeks to begin improving dexterity and may influenced co-occurring socialization.

Detailed Description
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The primary finding of this study is that older adults demonstrate improvements in manual dexterity after four weeks of piano training, but do not improve significantly after just two weeks. Furthermore, it does not matter whether the participants actively play for the first part and passively listen for the second part or vice versa. Of the three proposed mechanisms of Music Supported Therapy (MST) explained in the introduction, the findings of this study may be best explained by the emotion-motivation mechanism. Though dexterity scores were organized by whether the scores followed an active playing module, all participants experienced the same amount of music-listening and social interaction. Whether the participant was playing the music him/herself or observing, both groups were always hearing the same songs and scales for the same amount of time. The emotion-motivation mechanism states that this music-listening alone may increase cognitive processes like working memory and boost both mood and motivation. Therefore, these findings may mean that listening to piano music helps dexterity performance in older adults; but it does so if and only if the participants experience the music-listening module for a sufficient duration of time. Along with music-listening, social interaction was consistent between active and passive groups throughout the study. This interpersonal interaction may also have had an effect on mood and motivation, as piano instructors provided high levels of encouragement and complimented the participants' progress often. Relationship quality between patient and therapist is correlated with efficacy of therapy. This concept of increased socialization contributing to dexterity improvements is also supported by a study that identified social participation as a preventative factor of perceptual speed decline in older adults. Not finding the hypothesized effect of active versus passive condition on dexterity could be due to dexterous activities that the participants were engaged in outside of the training modules. For example, three of the 15 participants reported that they currently play piano in their free time, so it can be conjectured that those participants were engaged in active piano playing even when they were in the passive listening module. Other activities enjoyed by participants include exercise classes and painting-both of which could have been improving or maintaining their dexterity throughout the study.

Official Title
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Active Versus Passive Piano Intervention for Dexterity in Older Adults: A Randomized Controlled Trial

Conditions
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Aging, Manual Dexterity, Piano Therapy

Intervention / Treatment
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* Behavioral: Piano training (Active)
* Behavioral: Piano Training (Passive)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Able to physically and cognitively withstand 30 minute piano training sessions Exclusion Criteria: -

Ages Eligible for Study
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Minimum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: Randomized members of dyads (formed by residential treatment facility personnel) in to therapy order conditions. Two weeks piano therapy for one while the other listened followed by two week in reversed roles. Half the participants played first and listened second and the other half did the reverse.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Active-Passive<br>Active Piano training (8 sessions in two weeks) followed by listening to piano training (8 sessions in 2 weeks) (Passive condition) | Behavioral: Piano training (Active)<br>* Piano Curriculum. Participants were all trained on one of four 88-key pianos located in the assisted living facility. Piano instructors were 6 undergraduate Music Education and Music Performance majors. Each lesson of the week had a different focus: right and left hands separately, bimanually coupled, and bimanually uncoupled (Loehrer et al., 2016). Each week of the module had a different focus as well: notes played one step apart, notes played multiple steps apart (intervals), and tones played together (two-note chords) (van Vugt et al., 2016; Villeneuve et al., 2014). Each session began with skill exercises and ended with learning a simple, recognizable song. Two participants with extensive piano experience progressed to playing duets with the instructor and hymns out of a hymnal after mastery of the study curriculum. These training protocols were based on those of Schneider and colleagues' 2007 study.<br>* Other names: Piano Training (Passive);Behavioral: Piano Training (Passive)<br>* Participants listened to their research partner complete 8 active piano training sessions across 2 weeks.<br>|
| Experimental: Passive-Active<br>Passive piano training listening (8 sessions in two weeks) followed by active piano training (8 sessions in two weeks) | Behavioral: Piano training (Active)<br>* Piano Curriculum. Participants were all trained on one of four 88-key pianos located in the assisted living facility. Piano instructors were 6 undergraduate Music Education and Music Performance majors. Each lesson of the week had a different focus: right and left hands separately, bimanually coupled, and bimanually uncoupled (Loehrer et al., 2016). Each week of the module had a different focus as well: notes played one step apart, notes played multiple steps apart (intervals), and tones played together (two-note chords) (van Vugt et al., 2016; Villeneuve et al., 2014). Each session began with skill exercises and ended with learning a simple, recognizable song. Two participants with extensive piano experience progressed to playing duets with the instructor and hymns out of a hymnal after mastery of the study curriculum. These training protocols were based on those of Schneider and colleagues' 2007 study.<br>* Other names: Piano Training (Passive);Behavioral: Piano Training (Passive)<br>* Participants listened to their research partner complete 8 active piano training sessions across 2 weeks.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Purdue Pegboard | Fine Motor Manual Dexterity | 10 minutes | 
| Box and Block Test | Gross Motor Dexterity | 5 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Music Supported Therapy, plasticity, multisensory integration, bimanual coupling, auditory feedback, dexterity, piano therapy