Music Upper Limb Therapy—Integrated: An Enriched Collaborative Approach for Stroke Rehabilitation

NYU Langone Medical Center’s Rusk Rehabilitation Center and Steinhardt School of Culture, Education and Human Development’s Nordoff-Robbins Center for Music Therapy have just published an article on their groundbreaking research on integrating Occupational Therapy and Nordoff-Robbins Music Therapy in stroke rehabilitation to enhance upper limb recovery.

This research has been supported by funds from the American Music Therapy Association's Arthur Flagler Fultz Research Award, Steinhardt's Community Collaborative Award, and the Grammy Foundation Grant. Congratulations to Preeti Raghavan, Daniel Geller, Nina Guererro, Viswanath Aluru, Joseph P. Eimicke, Jeanne A. Teresi, Gbenga Ogedegbe, Anna Palumbo, and Alan Turry.

Abstract

Stroke is a leading cause of disability worldwide. It leads to a sudden and overwhelming disruption in one’s physical body, and alters the stroke survivors’ sense of self. Long-term recovery requires that bodily perception, social participation and sense of self are restored; this is challenging to achieve, particularly with a single intervention. However, rhythmic synchronization of movement to external stimuli facilitates sensorimotor coupling for movement recovery, enhances emotional engagement and has positive effects on interpersonal relationships. In this proof-of-concept study, we designed a group music-making intervention, Music Upper Limb Therapy-Integrated (MULT-I), to address the physical, psychological and social domains of rehabilitation simultaneously, and investigated its effects on long-term post-stroke upper limb recovery. The study used a mixed-method pre-post design with 1-year follow up. Thirteen subjects completed the 45-min intervention twice a week for 6 weeks. The primary outcome was reduced upper limb motor impairment on the Fugl-Meyer Scale (FMS). Secondary outcomes included sensory impairment (two-point discrimination test), activity limitation (Modified Rankin Scale, MRS), well-being (WHO well-being index), and participation (Stroke Impact Scale, SIS). Repeated measures analysis of variance (ANOVA) was used to test for differences between pre- and post-intervention, and 1-year follow up scores. Significant improvement was found in upper limb motor impairment, sensory impairment, activity limitation and well-being immediately post-intervention that persisted at 1 year. Activities of daily living and social participation improved only from post-intervention to 1-year follow up. The improvement in upper limb motor impairment was more pronounced in a subset of lower functioning individuals as determined by their pre-intervention wrist range of motion. Qualitatively, subjects reported new feelings of ownership of their impaired limb, more spontaneous movement, and enhanced emotional engagement. The results suggest that the MULT-I intervention may help stroke survivors re-create their sense of self by integrating sensorimotor, emotional and interoceptive information and facilitate long-term recovery across multiple domains of disability, even in the chronic stage post-stroke. Randomized controlled trials are warranted to confirm the efficacy of this approach.

Link to full article