Effects of music production on cortical plasticity within cognitive rehabilitation of patients with mild traumatic brain injury

Figures & data

Table 1. Scores obtained in the rivermead post-concussion symptoms questionnaire (RPQ): a specific 16-item questionnaire that measures cognitive, emotional and physical symptoms. The patients symptoms during the last 24 hours are compared to before the traumatic brain injury, rating the responses of each item using a 5-point Likert scale as follows: 0 = not experienced at all; 1 = no more of a problem; 2 = a mild problem; 3 = a moderate problem; and 4 = a severe problem. Hospital anxiety (a) and depression scale (d) (had) consists of 14 items detecting states of depression (7 items) and anxiety (7 items, rated on a 4-point scale from 0 to 3:00 no symptoms, and 3 = a severe symptom or symptoms most of the time. The Glasgow Coma Scale (GCS) scores, ranging from 3 to 15, assess the level of consciousness based on eye, verbal and motor responses. Patients with a GCS score of 13–15 are classified as mild TBI, GCS score of 9–12 as moderate TBI or GCS score of 3–8 as severe TBI.

Patient	Injury date and date of examination	MRI/CT scan	Prior treatment	Intracranial injury on CT	RPQ (064)	HAD (0–42)	GCS (3–15)
42M	Commotio. 12.01.11. Examination date 10.03.11	Orbit and nose fracture	Outpatient rehab.	No	48	25 A15 D10	15
41F	Commotio. 02.12.11 Examination date 05.03.13	N	Outpatient rehab.	No	18	6 A4 D2	15
31M	Contusions. 05.06.11 Examination date 22.08.11	Small epidural haematom and contusion bleeds frontal lobe right side and both temporal lobes	1 month in TBI Unit	Yes	6	6 A5 D1	14
52F	Commotio. 11.03.12 Examination date 30.03.12	Normal (Acach.cyst)	Outpatient TBI Rehab. 4 weeks	No	21	8 A4 D4	14
55F	Subdural haematoma (concervative management). 09.07.09. Examination date 07.09.09	Orbit fracture and nose fracture	Outpatient TBI Unit	Yes	10	1 A0 D1	14
30M	1991 and 2012. 08.07.91. Examination date 01.10.12 Contusions Frontal and temporal lobes, subdural haemotoma evacuated	MR and CT micro bleeds contusions in frontal and temporal lobes bilat.	TBI unit 1 month	Yes	28	18 A9D9	Missing Probably Severe TBI. Intubated For approx.. 1 week. PTA 10 days
19M	Epidural haematoma evacuated. 09.12.11 Examination date 08.01.12	Diffuse axonal injury; Epidural haematoma contusions	TBI unit	Yes	7	16 A8 D8	15

Figure 1. Neuropsychological tests.

Figure displays the results from (a) CVLT and (b) Stroop tests. Error bars denote standard errors. Note that there is a highly significant improvement in the two training groups for the CVLT test (a), while the Stroop test (b) showed a significant improvement only for control groups, irrespective of training.

Table 2. Patient group: Scores pre-post intervention neuropsychological tests including training-time during 8 weeks intervention.

Patient	MMS Pre-interv.	MMS Post-interv.	Stroop Pre-interv.	Stroop Post-interv.	CVLT 2 Pre-interv.	CVLT2 Post-interv.	Training- time. Total 8 weeks. Hours plus minutes
42M	28	28	25	33	17	60	7 h 45 min.
41F	30	30	65	59	58	65	36 h 45min
31M	28	30	42	45	60	60	8h
52F	30	30	57	60	54	70	28 h 35 min.
55F	22	30	44	25	32	48	23 h 55 min.
30M	30	30	30	27	62	74	21 h 20 min.
19M	30	30	55	69	60	75	15 h 20 min.

Table 3. fMRI results for the two conditions as conjunction across group means. Table describes areas of activation in terms of anatomical localisation, MNI coordinates, as well as t-statistics and cluster size with related FWE corrected p-values.

Localisation		MNI coordinates			Peak		Cluster
Structure	Side	x	y	z	T-value	p(FWE)	Size(# voxel)	p(FWE)
(a) Pitch discrimination task
Supplementary Motor Area	Bilateral	−4	2	56	9.32	<0.001	663	<0.001
Operculum, Anterior Insula	Left	−48	−2	2	7.31	<0.001	138	<0.001
Cerebellum	Left	−22	−54	−28	7.05	<0.001	339	<0.001
Cerebellum	Right	24	−56	−28	6.50	0.001	59	0.001
Thalamus	Right	12	−12	0	6.47	0.001	127	<0.001
Heschl’s Gyrus, Superior Temporal Gyrus	Left	−58	−30	8	6.44	0.001	149	<0.001
Operculum, Anterior Insula	Right	50	0	0	6.31	0.001	35	0.004
Heschl’s Gyrus, Superior Temporal Gyrus	Right	60	−26	2	6.27	0.001	151	<0.001
Thalamus	Left	−10	−18	0	5.89	0.004	72	0.001
Supramarginal gyrus	Left	−46	−40	46	5.67	0.008	45	0.002
Anterior Insula	Left	−34	12	2	5.63	0.009	23	0.007
Precentral Gyrus	Right	52	2	44	5.42	0.018	9	0.017
Superior Temporal Sulcus	Right	48	−22	−10	5.39	0.020	9	0.017
Putamen	Right	24	12	0	5.29	0.026	11	0.015
(b) Tonika-Dominant-Tonika Task
Heschl’s Gyrus, Superior Temporal Gyrus	Right	58	−22	2	7.90	<0.001	591	<0.001
Heschl’s Gyrus, Superior Temporal Gyrus	Left	−44	−28	8	7.74	<0.001	434	<0.001

Figure 2. Pitch discrimination task.

Figure displays the results from a conjunction across group means, with a threshold of FWE-corrected threshold of p(FWE) <0.05.

Figure 3. Tonika-dominant-tonika task.

(a) Figure displays the results from a conjunction across group means, with a threshold of FWE-corrected threshold of p(FWE) <0.05.(b) Figure displays BOLD response and localisation of significant the group × repetition interaction effect (p(FWE) <0.05). For display purpose, the threshold is set to p < 0.001

Table

Week 1 1.1 «Sound before symbol» Listen to melody played by instructor. Introduce middle C. Kinaesthetic (motor) movement with both hands with both hands on middle C.Introduce fingering system. Introduce treble clef and bass clef.	Listen to Twinkle, twinkle little star. Play without any score on middle C with both hands alternatively. Write middle C and clefs in work book.
1.2 Repetition of previous session. Including listening to the melody (Twinkle,twinkle little star). New: Learn to play with second finger (index). Right hand and left hand.Learn the new notenames: d in treble clef and b in bass clef.	Play without score first, and then play from the book. There are 6 different pieces applying these first 3 notes. Write new learned notes in the work book
Week 2
2.1 Repetition of previous session. Reinforcement of 3 notes c-d-b. New: Introduce note values: Quarter notes, half notes. Singing,clapping/tapping. New notes: Treble clef e.	Write notes in different constellations and play. Write new note in work book.
2.2 Repetition of previous session. New: Bass clef note a.	Write new note in work book. Play pieces with new notes.From no 8 to 14. Repeat pieces 1–7.
Week 3 3.1 Reinforcement of notation and motor skill. Varying hand movements in playing the notes in different orders. New: Barlines and time signature. 2 beats in a bar.	Practise notewriting in work book.
3.2 Play all pieces from 1–14. New: Introduce 3 beats in a bar. Treble clef: f. Motor skill exercises. Introduce whole note and rests.	Write new note in work book. Play new pieces with new note f in treble clef. No 15–17
Week 4 4.1 Repetition and reinforcement. New: Bass clef g Finger-exersises of both hands playing simultaneously from middle C to treble g and bass f. New: Note value 3 beats.	Write new note in work book. Play new pieces with new note g in bass clef. No 18–21. Practise new note value together with quarter note, half note and whole note.
4.2 New:repetition sign. New note: Bass clef f. Sight read small pieces composed by the instructor in order to reinforce the notes. Individual exercises according to individual problems with sight reading	Individual work book exercises. New pieces 22–23.
Week 5 5.1 Repetition and reinforcement of previous learned material New: Applying both hands simultaneously with chords in left hand and melody in right hand.	New pieces: 24 and 25.
5.2 New: Dynamics; play piano = soft, play forte = loud.	New pieces: 26–29.
Week 6 6.1 Repetition of previous material. New note: Bass clef e, d,c Practise chords in different patterns. New:eight-notes.	New pieces: 30–34 Work book: writing new notes.
6.2 Reinforcement of pieces from no.24–34.
Week 7 7.1 Playing with all notes from bass c up to treble g. New note in treble clef: a. New handposition.	New piece: 35 and 38 Finger-exercises in right hand. New handposition including treble a.
7.2 Playing pieces no: 33–34-35 and 38	Introduce new piece for next week. Twinkle,twinkle little star. This piece is a challenge with new handposition.
Week 8 8.1 Practise new piece: Twinkle, twinkle little star.
8.2 Revision of pieces no 33.34,35. Play new piece Twinkle,twinkle little star.	39 easy progressive pieces from beginner’s tutor book is the curriculum.