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Objective: Many stroke survivors still present with upper-limb paresis six months post-stroke, impacting their autonomy and quality of life (QoL). We designed an enriched Music-supported Therapy (eMST) program to reduce disability in this population. We evaluated the eMST's effectiveness in improving functional abilities and QoL in chronic stroke individuals compared to the conventional motor program Graded Repetitive Arm Supplementary Program (GRASP). Methods: We conducted a pragmatic two-arm parallel-group randomized controlled trial with a 3-month follow-up and masked assessment. The eMST involved playing instruments during individual self-administered and group music therapy sessions. The GRASP consisted of self-administered motor exercises using daily objects. Both interventions were completed at home with telemonitoring and involved four one-hour weekly sessions for 10 weeks. The primary outcome was upper-limb motor function measured with the Action Research Arm Test. Secondary outcomes included motor impairment, daily life motor performance, cognitive functions, emotional well-being, QoL, self-regulation, and self-efficacy. Intention-to-treat (ITT) and per-protocol (PP) analyses were conducted including participants who discontinued the intervention and those who completed it entirely, respectively. Results: Fifty-eight chronic stroke patients were randomized to the eMST-group (n = 26; age: 64.2 ± 12.5; 6 [23.1%] females; 2.8 ± 2.9 years post-stroke), and the control group (n = 32; age: 62.2 ± 12; 8 [25%] females; 1.8 ± 6.2 years post-stroke). The eMST-group had more participants achieving a clinically relevant improvement in motor impairment post-intervention than the control group for the ITT (55% vs 21.6%; OR = 4.5 (95% CI 1.4–14); p =.019) and PP analyses (60% vs 20%; OR = 6 (95% CI 1.5–24.7); p =.024), sustained at follow-up. The eMST-group reported greater improvements in emotion (difference = 11.1 (95% CI 0.8–21.5; p = 0.36) and participation (difference = 10.3 (95% CI 0.6–25.9); p = 0.41) subscales of QoL, and higher enjoyment during the sessions (difference = 1 (95% CI 0.3–1.5); p = 0.12). No changes were found in other outcomes. Conclusion: eMST demonstrated superiority over conventional motor rehabilitation program in enhancing upper-limb functions and QoL in chronic stroke individuals. Trial Registration: ClinicalTrials.gov (ID: NCT04507542). [ABSTRACT FROM AUTHOR]

Major advances in music neuroscience have fueled a growing interest in music‐based neurological rehabilitation among researchers and clinicians. Musical activities are excellently suited to be adapted for clinical practice because of their multisensory nature, their demands on cognitive, language, and motor functions, and music's ability to induce emotions and regulate mood. However, the overall quality of music‐based rehabilitation research remains low to moderate for most populations and outcomes. In this consensus article, expert panelists who participated in the Neuroscience and Music VII conference in June 2021 address methodological challenges relevant to music‐based rehabilitation research. The article aims to provide guidance on challenges related to treatment, outcomes, research designs, and implementation in music‐based rehabilitation research. The article addresses how to define music‐based rehabilitation, select appropriate control interventions and outcomes, incorporate technology, and consider individual differences, among other challenges. The article highlights the value of the framework for the development and evaluation of complex interventions for music‐based rehabilitation research and the need for stronger methodological rigor to allow the widespread implementation of music‐based rehabilitation into regular clinical practice. [ABSTRACT FROM AUTHOR]

After completing formal stroke rehabilitation programs, most patients do not achieve full upper limb motor function recovery. Music-supported Therapy (MST) can improve motor functionality post stroke through musical training. We designed a home-based enriched Music-supported Therapy (eMST) program to provide patients with chronic stroke the opportunity of continuing rehabilitation by themselves. We developed an app to conduct the eMST sessions at home with a MIDI-piano and percussion instruments. Here, we tested the feasibility of the eMST intervention using the novel app. This is a pilot study where five patients with chronic stroke underwent a 10-week intervention of 3 sessions per week. Patients answered feasibility questionnaires throughout the intervention to modify aspects of the rehabilitation program and the app according to their feedback. Upper limb motor functions were evaluated pre- and post-intervention as well as speed and force tapping during daily piano performance. Patients clinically improved in upper limb motor function achieving the Minimal Detectable Change (MDC) or Minimal Clinically Important Difference (MCID) in most of motor tests. The app received high usability ratings post-intervention. The eMST program is a feasible intervention for patients with chronic stroke and its efficacy should be assessed in a clinical trial. [ABSTRACT FROM AUTHOR]

Background: Residual motor deficits of the upper limb in patients with chronic stroke are common and have a negative impact on autonomy, participation and quality of life. Music-Supported Therapy (MST) is an effective intervention to enhance motor and cognitive function, emotional well-being and quality of life in chronic stroke patients. We have adapted the original MST training protocol to a home-based intervention, which incorporates increased training intensity and variability, group sessions, and optimisation of learning to promote autonomy and motivation.Methods: A randomised controlled trial will be conducted to test the effectiveness of this enriched MST (eMST) protocol in improving motor functions, cognition, emotional well-being and quality of life of chronic stroke patients when compared to a program of home-based exercises utilizing the Graded Repetitive Arm Supplementary Program (GRASP). Sixty stroke patients will be recruited and randomly allocated to an eMST group (n = 30) or a control GRASP intervention group (n = 30). Patients will be evaluated before and after a 10-week intervention, as well as at 3-month follow-up. The primary outcome of the study is the functionality of the paretic upper limb measured with the Action Research Arm Test. Secondary outcomes include other motor and cognitive functions, emotional well-being and quality of life measures as well as self-regulation and self-efficacy outcomes.Discussion: We hypothesize that patients treated with eMST will show larger improvements in their motor and cognitive functions, emotional well-being and quality of life than patients treated with a home-based GRASP intervention.Trial Registration: The trial has been registered at ClinicalTrials.gov and identified as NCT04507542 on 8 August 2020. [ABSTRACT FROM AUTHOR]

• Music-based interventions integrate most of the principles of motor training and multimodal stimulation. • The use of music in rehabilitation can improve motor and cognitive functions of subacute and chronic stroke patients. • Music-based interventions lead to better mood and quality of life in stroke patients than conventional approaches. • Future studies should better address methodological aspects to improve the level of evidence of these interventions. Music-based interventions have emerged as a promising tool in stroke motor rehabilitation as they integrate most of the principles of motor training and multimodal stimulation. This paper aims to review the use of music in the rehabilitation of upper extremity motor function after stroke. First, we review the evidence supporting current music-based interventions including Music-supported Therapy, Music glove, group music therapy, Rhythm- and music-based intervention, and Musical sonification. Next, we describe the mechanisms that may be responsible for the effectiveness of these interventions, focusing on motor learning aspects, how multimodal stimulation may boost motor performance, and emotional and motivational aspects related to music. Then, we discuss methodological concerns in music therapy research related to modifications of therapy protocols, evaluation of patients and study designs. Finally, we highlight clinical considerations for the implementation of music-based interventions in clinical settings. [ABSTRACT FROM AUTHOR]

In the context of neurorehabilitation, sound is being increasingly applied for facilitating sensorimotor learning. In this study, we aimed to test the potential value of auditory stimulation for improving gait in chronic stroke patients by inducing alterations of the frequency spectra of walking sounds via a sound system that selectively amplifies and equalizes the signal in order to produce distorted auditory feedback. Twenty‐two patients with lower extremity paresis were exposed to real‐time alterations of their footstep sounds while walking. Changes in body perception, emotion, and gait were quantified. Our results suggest that by altering footsteps sounds, several gait parameters can be modified in terms of left–right foot asymmetry. We observed that augmenting low‐frequency bands or amplifying the natural walking sounds led to a reduction in the asymmetry index of stance and stride times, whereas it inverted the asymmetry pattern in heel–ground exerted force. By contrast, augmenting high‐frequency bands led to opposite results. These gait changes might be related to updating of internal forward models, signaling the need for adjustment of the motor system to reduce the perceived discrepancies between predicted–actual sensory feedbacks. Our findings may have the potential to enhance gait awareness in stroke patients and other clinical conditions, supporting gait rehabilitation. [ABSTRACT FROM AUTHOR]

Abstract: The effect of music‐supported therapy (MST) as a tool to restore hemiparesis of the upper extremity after a stroke has not been appropriately contrasted with conventional therapy. The aim of this trial was to test the effectiveness of adding MST to a standard rehabilitation program in subacute stroke patients. A randomized controlled trial was conducted in which patients were randomized to MST or conventional therapy in addition to the rehabilitation program. The intensity and duration of the interventions were equated in both groups. Before and after 4 weeks of treatment, motor and cognitive functions, mood, and quality of life (QoL) of participants were evaluated. A follow‐up at 3 months was conducted to examine the retention of motor gains. Both groups significantly improved their motor function, and no differences between groups were found. The only difference between groups was observed in the language domain for QoL. Importantly, an association was encountered between the capacity to experience pleasure from music activities and the motor improvement in the MST group. MST as an add‐on treatment showed no superiority to conventional therapies for motor recovery. Importantly, patient's intrinsic motivation to engage in musical activities was associated with better motor improvement. [ABSTRACT FROM AUTHOR]

Purpose. This study is aimed at evaluating the effectiveness of multisensory stimulation intervention (MSS) on mood, behaviour, quality of life, and physiological parameters in people with major neurocognitive disorder who live in a nursing home. Methods. We conducted a pilot study with a quasiexperimental design. A total of 17 individuals diagnosed with moderate to severe major neurocognitive disorder received eight 30‐minute sessions of MSS. Sessions were adapted based on individuals' cognitive level (GDS 6‐7) and sensory preferences. Outcomes regarding mood, behaviour, and physiological parameters were collected before and after each session. Outcomes related to quality of life and neuropsychiatric symptoms were assessed pre and postintervention. Results. Participants presented significant improvements in mood and behaviour. They were happier, more attentive to their environment, active/alert, and relaxed/content after sessions. In addition, immediately after their sessions, they were less tearful/sad, fearful/anxious, confused, and wandering/aggressive, as well as less bored/inactive. In terms of physiological parameters, a significant increase in the median heart rate of participants was detected after the sessions, but no differences were found in oxygen saturation. Moreover, a substantial improvement in the participants' quality of life, measured with the quality of life in Alzheimer's disease (p =.03) and in neuropsychiatric symptoms (neuropsychiatric inventory‐questionnaire, p =.04), was observed postintervention. Conclusion. MSS appears to be effective on mood and behaviour immediately after sessions and also appears to improve quality of life and reduce neuropsychiatric symptoms postintervention, when these are person‐centred through one‐to‐one interventions that have been adapted to the participants' sensory preferences. [ABSTRACT FROM AUTHOR]

Stroke induces a loss of neural function, but it triggers a complex amount of mechanisms to compensate the associated functional impairment. The present study aims to increase our understanding of the functional reshape of the motor system observed in chronic stroke patients during the preparation and the execution of movements. A cohort of 14 chronic stroke patients with a mild-to-moderate hemiparesis and 14 matched healthy controls were included in this study. Participants were asked to perform a bimanual reaction time task synchronizing alternated responses to the presentation of a visual cue. We used Laplacian-transformed EEG activity (LT-EEG) recorded at the locations Cz and C3/C4 to study the response-locked components associated with the motor system activity during the performance of this task. Behaviorally, patients showed larger variable errors than controls in synchronizing the frequency of execution of responses to the interstimulus interval, as well as slower responses compared with controls. LT-EEG analysis showed that whereas control participants increased their supplementary motor area (SMA) activity during the preparation of all responses, patients only showed an increment of activity over this area during their first response of the sequence. More interestingly, patients showed a clear increment of the LT-EEG activity associated with SMA shortly after motor responses as compared to the control participants. Finally, patients showed a hand-dependent inhibitory activity over motor areas ipsilateral to the response hand. Overall, our findings reveal drastic differences in the temporal dynamics of the LT-EEG components associated with the activity over motor and premotor cortices in chronic stroke patients compared with matched control participants during alternated hand responses. [ABSTRACT FROM AUTHOR]

Background: Several recently developed therapies targeting motor disabilities in stroke sufferers have shown to be more effective than standard neurorehabilitation approaches. In this context, several basic studies demonstrated that music training produces rapid neuroplastic changes in motor-related brain areas. Music-supported therapy has been recently developed as a new motor rehabilitation intervention. Methods and Results: In order to explore the plasticity effects of music-supported therapy, this therapeutic intervention was applied to twenty chronic stroke patients. Before and after the music-supported therapy, transcranial magnetic stimulation was applied for the assessment of excitability changes in the motor cortex and a 3D movement analyzer was used for the assessment of motor performance parameters such as velocity, acceleration and smoothness in a set of diadochokinetic movement tasks. Our results suggest that the music-supported therapy produces changes in cortical plasticity leading the improvement of the subjects' motor performance. Conclusion: Our findings represent the first evidence of the neurophysiological changes induced by this therapy in chronic stroke patients, and their link with the amelioration of motor performance. Further studies are needed to confirm our observations. [ABSTRACT FROM AUTHOR]