Upper limb rehabilitation in chronic stroke using neurologic music therapy: Two contrasting case studies to inform on treatment delivery and patient suitability

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.

KEYWORDS:

• Stroke
• hemiparesis
• music therapy
• home care
• upper limb rehabilitation
• TIMP

Acknowledgments

The authors would like to thank all participants who took part in this research and the community stroke team members who facilitated it.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Alexander J. Street

Alexander J. Street, PhD, is a music therapy practitioner and researcher specializing in the design and delivery of interventions for people with acquired and traumatic brain injury. His work encorporates music technology and interdisciplinary working.

Jörg Fachner

Jörg Fachner, DMSc, is Professor for Music, Health and the Brain at Anglia Ruskin University, Cambridge; researching music and consciousness states, depression, stroke and hyperscanning in music therapy.

Wendy L. Magee

Wendy L. Magee, PhD, is Professor of Music Therapy at Temple University, Philadelphia, specializing in measurement and evidence-based practice in music therapy with people with acquired brain injury.