Functional electrical stimulation+iPad-based music therapy for upper limb recovery after stroke: Study protocol for a mixed methods randomised controlled trial

ABSTRACT

Introduction

Music therapy offers an effective avenue for simultaneously addressing goals of upper limb function and wellbeing post stroke. However, there are currently no trials of therapeutic music-making interventions for stroke survivors with a very weak upper limb (Grade 0–3 level of strength). This randomised controlled trial will examine the effect of Functional Electrical Stimulation (FES) with iPad-based music therapy on upper limb recovery and wellbeing outcomes for stroke survivors.

Method

This convergent mixed methods study will take place at seven participating hospitals in Sydney, Australia. Forty participants will be randomly allocated to usual care only or usual care plus daily FES+iPad-based music therapy for four weeks (20 sessions). Standardised assessments of the paretic upper limb and self-report wellbeing measures will be administered at three time points (pre- and post- intervention, and at three months follow up) by a blinded assessor. All participants will be interviewed about their perceptions of the way the treatment they received (usual care only or usual care plus daily FES+iPad-based music therapy) supported their recovery.

Results

Ethics approval has been granted and data collection has commenced.

Discussion

This treatment approach has the potential to improve upper limb function and wellbeing for stroke survivors. The intervention is novel in its capacity to engage stroke survivors with a very weak upper limb in therapeutic music-making.

KEYWORDS:

• Music therapy
• upper limb
• stroke
• iPad
• FES

Disclosure statement

Grace Thompson is Associate Editor of the Nordic Journal of Music Therapy. To avoid conflict of interest, Grace Thompson was fully masked to the editorial process including peer review and editorial decisions and had no access to records of this manuscript.

Notes

¹ Stroke survivors that have a level of strength greater than level 3 do not require electrical stimulation.

² Intervention period is four weeks.

³ Patients with a cardiac pacemaker, hypersensitivity to electrical stimulation, severe skin conditions and epilepsy are not recommended to receive electrical stimulation (Roy, n.d.).

Additional information

Funding

No funding was received for this study. TS created the basis of the protocol based on clinical work and drafted the manuscript. JT, SD and GT provided insight and advice to shape and clarify the protocol in the context of the research project and contributed to the development of the manuscript.

Notes on contributors

Tanya Marie Silveira

Tanya Marie Silveira is a Registered Music Therapist, Neurologic Music Therapist and PhD Graduate Researcher based in Sydney, Australia. Tanya’s PhD research examines how accessible music-making can impact the hand function and wellbeing of stroke survivors. In 2019, Tanya was invited to speak about her PhD research at the inaugural TEDxNewtown event. Over the years, Tanya has presented internationally and nationally on her research and clinical work. She has also established multiple ongoing music therapy programs in Australia and India. Drawing upon a holistic approach, Tanya combines motivational, interactional, physical and communicative aspects of music therapy when working in a strengths-based model. Tanya has collaborated closely with doctors, physiotherapists, occupational therapists, speech pathologists, psychologists and creative arts therapists. Tanya is extremely passionate about engaging in the profession and advocating for the place of music therapy.

Simone Dorsch

Simone Dorsch works part-time as a lecturer in Neurological Physiotherapy at ACU and part-time as a Clinical Specialist in Rehabilitation at Bankstown-Lidcombe Hospital. She has a Masters of Health Science (Neurological Physiotherapy) and a PhD from the University of Sydney. Her PhD “Increasing Strength after Stroke”, included a systematic review of interventions with the potential to increase strength after stroke, descriptive studies investigating the extent of loss of strength after stroke and the relationships between leg strength and walking speed and a clinical trial investigating the effectiveness of EMG-triggered electrical stimulation at increasing strength after stroke. She is currently involved in research projects investigating; the use of technology to increase practice and improve outcomes in rehabilitation, the relationships between walking ability and physical activity after stroke and the relationships between changes in impairments and activity after stroke. She regularly teaches workshops on Stroke Rehabilitation nationally and internationally.

Grace Thompson

Grace Thompson is a music therapist and senior lecturer at the University of Melbourne. Grace has worked with children, young people and families for over 20 years within the early childhood intervention and special education sector. In her clinical work, Grace developed a collaborative approach to music therapy practice with families guided by ecological theories and family-centred philosophy. Her research continues to explore the ways music therapists can foster relationships and social connection through participating in engaging and accessible music making. Grace is past president of the Australian Music Therapy Association and co-editor of the book “Music Therapy with Families: Therapeutic Approaches and Theoretical Perspectives”. She is currently an Associate Editor with the Nordic Journal of Music Therapy.

Jeanette Tamplin

Jeanette Tamplin is a Senior Lecturer in Music Therapy at The University of Melbourne and music therapist at the Royal Talbot Rehabilitation Centre - Austin Health. Jeanette specialises in neurorehabilitation and her research in this area focuses on the therapeutic effects of singing, speech and language rehabilitation, therapeutic songwriting, and coping and adjustment following neurological injury or illness. She coordinates and collaborates with several different research teams, and has generated over AUD$2.5 million in grant funding. She held an NHMRC-ARC Dementia Research Fellowship from 2016-2019 and co-edited a book on “Music and Dementia: From Cognition to Therapy (Oxford University Press). Jeanette is regularly invited to present at national and international fora. She publishes regularly in international and interdisciplinary refereed journals, has contributed chapters to several edited books on music therapy and co-authored a book: “Music Therapy Methods in Neurorehabilitation: A Clinician’s Manual” (Jessica Kingsley Publishers).