Upper Limb Rehabilitation in Chronic Stroke Using Neurologic Music Therapy: Two Contrasting Case Studies to Inform on Treatment Delivery and Patient Suitability

Journal

Nordic Journal of Music Therapy

Year

2019

Abstract

Introduction: Therapeutic Instrumental Music Performance (TIMP) is well suited for upper limb rehabilitation following stroke. Published protocols serve to inform clinicians on intervention design and delivery. However, few case studies are available that address patient suitability, protocol modifications to support treatment adherence and suitability of home environment.Methods: Two case studies from a small randomized controlled trial illustrate TIMP protocol modifications and considerations required for home delivery. Qualitative, quantitative and observational data report on participants' outcomes and engagement with six weeks of bi-weekly exercises. TIMP adaptations to enhance audio-motor synchronization are described.Results: Outcomes for the less impaired participant with fewer complex health needs were significantly better after six weeks, particularly pinch grip (1 peg in 20 seconds to 15/120). The second participant improved on the water pouring task: 44 seconds to 13.16.Discussion: Severity of stroke and impairment are major factors influencing treatment outcomes. Flexibility in the TIMP protocols, such as emphasizing the underlying pulse and building the dynamic contour, aids treatment adherence and movement synchrony. It is essential to assess homes for access, sound containment and space. Outcome measures for detecting compensatory movement, smoothness and velocity of movement are needed to better inform treatment effects.

Music and Health Institute Terms

Functional Status; Music Therapy; Rehabilitation Exercises; Stroke

Indexed Terms

hemiparesis; home care; Rehabilitation; Stroke; TIMP; upper limb rehabilitation

Study Type

Randomized Controlled; Trial; Quantitative Methods

Document Type

Article

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