Abstract
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.
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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):361–369
Lincoln N, Leadbitter D (1979) Assessment of motor function in stroke patients. Physiotherapy (England) 65(2):48–41
Lincoln N, Parry RH, Vass CD (1999) Randomized, controlled trial to evaluate increased intensity of physiotherapy treatment of arm function after stroke. Stroke 30:573–579
Van der Lee JH (2001) Constraint-induced therapy for stroke: more of the same or something completely different? Curr Opin Neurol (England) 14(6):741–744
Woldag H, Hummelsheim H (2002) Evidence-based physiotherapeutic concepts for improving arm and hand function in stroke patients. J Neurol 249:518–528
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):1374–1377
Taub E, Elbert T, Uswatte G (2002) New treatments in neurorehabilitation founded on basic research. Nat Rev Neurosci 3(3):228–236
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 250:5–10
Liepert J, Bauder H, Miltner WHR, Taub E, Weiller C (2000) Treatment–induced cortical reorganization after stroke in humans. Stroke 31:1210–1216
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, Canada
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, CA
Buonomano DV, Merzenich MM (1998) Cortical plasticity: from synapses to maps. Annu Rev Neurosci 21:149–186
Gerloff G, Altenmüller E, Dichgans J (1996) Disintegration and reorganization of cortical motor processing in two patients after cerebellar stroke. Electroenc Clin Neurophysiol 98:59–68
Kujala T, Alho K, Naatanen R (2000) Cross-modal reorganization of human cortical functions. Trends Neurosci 23:115–120
Münte TF, Kohlmetz C, Nager W, Altenmüller E (2001) Superior auditory spatial tuning in professional conductors. Nature 409:580
Münte TF, Altenmüller E, Jäncke L (2002) Opinion: the musician's brain as a model of neuroplasticity. Nat Rev Neurosci 3(6):473–478
Rossini PM, Pauri F (2000) Neuromagnetic integrated methods tracking human brain mechanism of sensorimotor areas “plastic-reorganization. Brain Res Rev 33:131–154
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 79:492–403
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 63:82–104
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 16:785–807
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 79:479–491
Sanes JN, Donoghue JP (2000) Plasticity and primary motor cortex. Annu Rev Neurosci 23:393–415
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 371–401
Bangert M, Altenmüller E (2003) Mapping perception to action in piano practice: a longitudinal DC-EEG-study. BMC Neurosci 4:26–36
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):917–106
Mahoney F, Barthel D (1965) Functional evaluation: the Barthel index. Md State Med J 14:61–65
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 50:714–719
Hermsdörfer J, Wack S, Mai N, Marquardt C (1996) Dreidimensionale Bewegungsmessung zur Analyse der Handfunktion. EKN-Report 1/1996
Hermsdörfer J, Marquardt C, Wack S, Mai N (1999) Comparative analysis of diadochokinetic movements. J Electromyogr Kinesiol 9:283–295
Carroll DA (1965) A quantitative test of upper extremity function. J Chronic Dis 18:479–491
Lyle RC (1981) A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehab Res 4:483–492
Wade DT, Langton-Hewer R, Wood VA, Skilbeck CE, Ismail HM (1983) The hemiplegic arm after stroke : measurement and recovery. J Neurol Neurosurg Psychiatry 46:521–524
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):386–391
Parker VM, Wade DT, Langton-Hewer R (1986) Loss of arm function after stroke: measurement, frequency and recovery. Int Rehabil Med 8:69–73
Cohen J (1988) Statistical power analysis for the behavioural sciences, 2nd edn. Lawrence Earlbaum Associates, Hillsdale, NJ
Elbert T, Rockstroh B, Bulach D, Meinzer M, Taub E (2003) Die Fortentwicklung der Neurorehabilitation auf verhaltensneurowissenschaftlicher Grundlage. Beispiel Constraint-induced-Therapie. Der Nervenarzt 74:334–342
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):586–592
Van Peppen RPS (2004) The impact of physical therapy on functional outcomes after stroke: what's the evidence? Clin Rehabil 18:833–862
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):361–372
Ghez C, Sainburg R (1995) Proprioceptive control of interjoint coordination. Can J Physiol Pharmacol (Canada) 73(2):273–284
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 157:32–42
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):313–323
Parry RH (1999) Effect of severity of arm impairment on response to additional physiotherapy early after stroke. Clin Rehabil 13:187–198
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 125:2731–2742
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):4–12
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):326–338
Oldfield RC (1971) The assessment and analysis of handedness. The Edinburgh Inventory. Neuropsychologia 9:97–113
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Schneider, S., Schönle, P.W., Altenmüller, E. et al. Using musical instruments to improve motor skill recovery following a stroke. J Neurol 254, 1339–1346 (2007). https://doi.org/10.1007/s00415-006-0523-2
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DOI: https://doi.org/10.1007/s00415-006-0523-2