Journal of Neurology

, Volume 254, Issue 10, pp 1339–1346 | Cite as

Using musical instruments to improve motor skill recovery following a stroke

  • S. SchneiderEmail author
  • P. W. Schönle
  • E. Altenmüller
  • T. F. Münte


In previous studies, it was shown that there is a need for efficient motor rehabilitation approaches. For this purpose, we evaluated a music-supported training program designed to induce an auditory–sensorimotor co-representation of movements in 20 stroke patients (10 affected in the left and 10 in the right upper extremity). Patients without any previous musical experience participated in an intensive step by step training, first of the paretic extremity, followed by training of both extremities. Training was applied 15 times over 3 weeks in addition to conventional treatment. Fine as well as gross motor skills were addressed by using either a MIDI-piano or electronic drum pads. As a control, 20 stroke patients (10 affected left and 10 right) undergoing exclusively conventional therapies were recruited. Assignment to the training and control groups was done pseudo-randomly to achieve an equal number of left- and right-affected patients in each group. Pre- and post-treatment motor functions were monitored using a computerized movement analysis system (Zebris) and an established array of motor tests (e. g., Action Research Arm Test, Box & Block Test). Patients showed significant improvement after treatment with respect to speed, precision and smoothness of movements as shown by 3D movement analysis and clinical motor tests. Furthermore, compared to the control subjects, motor control in everyday activities improved significantly. In conclusion, this innovative therapeutic strategy is an effective approach for the motor skill neurorehabilitation of stroke patients.

Key words

auditory–sensorimotor integration plasticity neurorehabilitation stroke music therapy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Langhammer B, Stanghelle JK (2000) Bobath or motor relearning programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomised controlled study. Clin Rehabil 14(4):361–369CrossRefPubMedGoogle Scholar
  2. 2.
    Lincoln N, Leadbitter D (1979) Assessment of motor function in stroke patients. Physiotherapy (England) 65(2):48–41Google Scholar
  3. 3.
    Lincoln N, Parry RH, Vass CD (1999) Randomized, controlled trial to evaluate increased intensity of physiotherapy treatment of arm function after stroke. Stroke 30:573–579PubMedGoogle Scholar
  4. 4.
    Van der Lee JH (2001) Constraint-induced therapy for stroke: more of the same or something completely different? Curr Opin Neurol (England) 14(6):741–744CrossRefGoogle Scholar
  5. 5.
    Woldag H, Hummelsheim H (2002) Evidence-based physiotherapeutic concepts for improving arm and hand function in stroke patients. J Neurol 249:518–528CrossRefPubMedGoogle Scholar
  6. 6.
    Sterr A, Elbert T, Berthold I, Kolbel S, Rockstroh B, Taub E (2002) Longer versus shorter daily contraint-induced movement therapy of chronic hemiparesis: an exploratory study. Arch Phys Med Rehabil 83(10):1374–1377CrossRefPubMedGoogle Scholar
  7. 7.
    Taub E, Elbert T, Uswatte G (2002) New treatments in neurorehabilitation founded on basic research. Nat Rev Neurosci 3(3):228–236CrossRefPubMedGoogle Scholar
  8. 8.
    Liepert J, Bauder H, Sommer M, Miltner WHR, Dettmers C, Taub E, Weiller C (1998) Motor cortex plasticity during constraint-induced movement therapy in chronic stroke patients. Neurosci Lett 250:5–10CrossRefPubMedGoogle Scholar
  9. 9.
    Liepert J, Bauder H, Miltner WHR, Taub E, Weiller C (2000) Treatment–induced cortical reorganization after stroke in humans. Stroke 31:1210–1216PubMedGoogle Scholar
  10. 10.
    Wittenberg GF, Chan R, Ishii K et al. (1999) Effect of Constraint-Induced Movement Therapy on motor function and cortical physiology in chronic stroke. Paper presented at the Second World Congress on Neurological Rehabilitation, Toronto, CanadaGoogle Scholar
  11. 11.
    Wittenberg GF, Chen R, Ishii K et al. (2000) Task related and resting regional cerebral blood flow changes after Constraint-Induced rehabilitation therapy. Paper presented at the American Academy of Neurology meeting. San Diego, CAGoogle Scholar
  12. 12.
    Buonomano DV, Merzenich MM (1998) Cortical plasticity: from synapses to maps. Annu Rev Neurosci 21:149–186CrossRefPubMedGoogle Scholar
  13. 13.
    Gerloff G, Altenmüller E, Dichgans J (1996) Disintegration and reorganization of cortical motor processing in two patients after cerebellar stroke. Electroenc Clin Neurophysiol 98:59–68CrossRefGoogle Scholar
  14. 14.
    Kujala T, Alho K, Naatanen R (2000) Cross-modal reorganization of human cortical functions. Trends Neurosci 23:115–120CrossRefPubMedGoogle Scholar
  15. 15.
    Münte TF, Kohlmetz C, Nager W, Altenmüller E (2001) Superior auditory spatial tuning in professional conductors. Nature 409:580CrossRefPubMedGoogle Scholar
  16. 16.
    Münte TF, Altenmüller E, Jäncke L (2002) Opinion: the musician's brain as a model of neuroplasticity. Nat Rev Neurosci 3(6):473–478CrossRefPubMedGoogle Scholar
  17. 17.
    Rossini PM, Pauri F (2000) Neuromagnetic integrated methods tracking human brain mechanism of sensorimotor areas “plastic-reorganization. Brain Res Rev 33:131–154CrossRefPubMedGoogle Scholar
  18. 18.
    Donoghue JP, Suner S, Sanes JN (1990) Dynamic organization of primary motor cortex output to target muscles in adult rats. II. Rapid reorganization following motor nerve lesions. Exp Brain Res 79:492–403CrossRefPubMedGoogle Scholar
  19. 19.
    Jenkins WM, Merzenich MM, Ochs MT, Allard T, Guic-Robles E (1990) Functional reorganization of primary somatosensory cortex in adult owl monkeys after behaviorally controlled tactile stimulation. J Neurophysiol 63:82–104PubMedGoogle Scholar
  20. 20.
    Nudo RJ, Milliken GW, Jenkins WM, Merzenich MM (1996) Use-dependent alterations of movement representations in primary motor cortex of adult squirrel monkeys. J Neurosci 16:785–807PubMedGoogle Scholar
  21. 21.
    Sanes JN, Suner S, Donoghue JP (1990) Dynamic organization of primary motor cortex output to target muscles in adult rats. I. Long-term patterns of reorganization following motor or mixed peripheral nerve lesions. Exp Brain Res 79:479–491CrossRefPubMedGoogle Scholar
  22. 22.
    Sanes JN, Donoghue JP (2000) Plasticity and primary motor cortex. Annu Rev Neurosci 23:393–415CrossRefPubMedGoogle Scholar
  23. 23.
    Taub E (1980) Somatosensory deafferentation research with monkeys: implications for rehabilitation medicine. In: Ince LP, (ed) Behavioral psychology in rehabilitation medicine: clinical applications. Williams & Wilkins, New York, NY 371–401Google Scholar
  24. 24.
    Bangert M, Altenmüller E (2003) Mapping perception to action in piano practice: a longitudinal DC-EEG-study. BMC Neurosci 4:26–36CrossRefPubMedGoogle Scholar
  25. 25.
    Bangert M, Peschel T, Schlaug G, Rotte M, Drescher D, Hinrichs H, Heinze HJ, Altenmu¨ller E (2006) Shared networks for auditory and motor processing in professional pianists: evidence from fMRI conjunction. NeuroImage 30(3):917–106CrossRefPubMedGoogle Scholar
  26. 26.
    Mahoney F, Barthel D (1965) Functional evaluation: the Barthel index. Md State Med J 14:61–65PubMedGoogle Scholar
  27. 27.
    Heller A, Wade DT, Wood VA, Sunderland A, Langton Hewer R, Ward E (1987) Arm function after stroke: measurement and recovery over the first three months. J Neurol Neurosurg Psychiatry 50:714–719CrossRefPubMedGoogle Scholar
  28. 28.
    Hermsdörfer J, Wack S, Mai N, Marquardt C (1996) Dreidimensionale Bewegungsmessung zur Analyse der Handfunktion. EKN-Report 1/1996Google Scholar
  29. 29.
    Hermsdörfer J, Marquardt C, Wack S, Mai N (1999) Comparative analysis of diadochokinetic movements. J Electromyogr Kinesiol 9:283–295CrossRefPubMedGoogle Scholar
  30. 30.
    Carroll DA (1965) A quantitative test of upper extremity function. J Chronic Dis 18:479–491CrossRefPubMedGoogle Scholar
  31. 31.
    Lyle RC (1981) A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehab Res 4:483–492CrossRefGoogle Scholar
  32. 32.
    Wade DT, Langton-Hewer R, Wood VA, Skilbeck CE, Ismail HM (1983) The hemiplegic arm after stroke : measurement and recovery. J Neurol Neurosurg Psychiatry 46:521–524CrossRefPubMedGoogle Scholar
  33. 33.
    Mathiowetz V, Volland G, Kashman N, Weber K (1985) Adult norms for the Box and Block Test of Manual Dexterity. Am J Occ Therapy 39(6):386–391Google Scholar
  34. 34.
    Parker VM, Wade DT, Langton-Hewer R (1986) Loss of arm function after stroke: measurement, frequency and recovery. Int Rehabil Med 8:69–73PubMedGoogle Scholar
  35. 35.
    Cohen J (1988) Statistical power analysis for the behavioural sciences, 2nd edn. Lawrence Earlbaum Associates, Hillsdale, NJGoogle Scholar
  36. 36.
    Elbert T, Rockstroh B, Bulach D, Meinzer M, Taub E (2003) Die Fortentwicklung der Neurorehabilitation auf verhaltensneurowissenschaftlicher Grundlage. Beispiel Constraint-induced-Therapie. Der Nervenarzt 74:334–342CrossRefPubMedGoogle Scholar
  37. 37.
    Miltner W, Bauder H, Sommer M, Dettmers C, Taub E (1999) Effects of constraint-induced movement therapy on patients with chronic motor deficits after stroke: a replication. Stroke 30(3):586–592PubMedGoogle Scholar
  38. 38.
    Van Peppen RPS (2004) The impact of physical therapy on functional outcomes after stroke: what's the evidence? Clin Rehabil 18:833–862CrossRefPubMedGoogle Scholar
  39. 39.
    Ghez C, Gordon J, Ghilardi MF (1995) Impairments of reaching movements in patients without proprioception. II. Effects of visual information on accuracy. J Neurophysiol (US) 73(1):361–372Google Scholar
  40. 40.
    Ghez C, Sainburg R (1995) Proprioceptive control of interjoint coordination. Can J Physiol Pharmacol (Canada) 73(2):273–284Google Scholar
  41. 41.
    Mercier C, Bertrand AM, Bourbonnais D (2004) Differences in the magnitude and direction of forces during a submaximal matching task in hemiparetic subjects. Exp Brain Res 157:32–42CrossRefPubMedGoogle Scholar
  42. 42.
    Dancause N, Ptito A, Levin MF (2002) Error correction strategies for motor behavior after unilateral brain damage: short-term motor learning processes. Neuropsychologia (England) 40(8):313–323Google Scholar
  43. 43.
    Parry RH (1999) Effect of severity of arm impairment on response to additional physiotherapy early after stroke. Clin Rehabil 13:187–198CrossRefPubMedGoogle Scholar
  44. 44.
    Johansen-Berg H, Dawes H, Guy C, Smith SM, Wade DT, Matthews PM (2002) Correlation between motor improvements and altered fMRI activity after rehabilitative therapy. Brain 125:2731–2742CrossRefPubMedGoogle Scholar
  45. 45.
    Levy CE, Nichols DS, Schmalbrock PM, Keller P, Chakeres DW (2001) Functional MRI evidence of cortical reorganization in upper-limb stroke hemiplegia treated with constraint-induced movement therapy. Am J Phys Med Rehabil 80(1):4–12CrossRefPubMedGoogle Scholar
  46. 46.
    Schaechter JD, Kraft E, Hilliard TS, Dijkhuizen RM, Benner T, Finklestein SP, Rosen BR, Cramer SC (2002) Motor recovery and cortical reorganization after contraint-induced movement therapy in stroke patients: a preliminary study. Neurorehabil Neural Repair 16(4):326–338CrossRefPubMedGoogle Scholar
  47. 47.
    Oldfield RC (1971) The assessment and analysis of handedness. The Edinburgh Inventory. Neuropsychologia 9:97–113CrossRefPubMedGoogle Scholar

Copyright information

© Steinkopff-Verlag 2007

Authors and Affiliations

  • S. Schneider
    • 1
    • 2
    Email author
  • P. W. Schönle
    • 3
  • E. Altenmüller
    • 2
  • T. F. Münte
    • 1
  1. 1.Dept. of NeuropsychologyOtto von Guericke UniversityMagdeburgGermany
  2. 2.Institute of Music Physiology and Musician's MedicineUniversity of Music and Drama HannoverHannoverGermany
  3. 3.Dept. of PsychologyUniversity of KonstanzKonstanzGermany

Personalised recommendations