Playing Piano Can Improve Upper Extremity Function after Stroke: Case Studies

Hindawi Publishing Corporation Stroke Research and Treatment Volume 2013, Article ID 159105, 5 pages http://dx.doi.org/10.1155/2013/159105 Clinical Study Playing Piano Can Improve Upper Extremity Function after Stroke: Case Studies Myriam Villeneuve1,2 and Anouk Lamontagne1,2 1 2 School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada H3A OG4 Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Research Site of the Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Place Alton-Goldbloom, Laval, QC, Canada H7V 1R2 Correspondence should be addressed to Anouk Lamontagne; Received 5 December 2012; Accepted 23 January 2013 Academic Editor: Majaz Moonis Copyright © 2013 M. Villeneuve and A. Lamontagne. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Music-supported therapy (MST) is an innovative approach that was shown to improve manual dexterity in acute stroke survivors. The feasibility of such intervention in chronic stroke survivors and its longer-term benefits, however, remain unknown. The objective of this pilot study was to estimate the short- and long-term effects of a 3-week piano training program on upper extremity function in persons with chronic stroke. A multiple pre-post sequential design was used, with measurements taken at baseline (week0 , week3 ), prior to (week6 ) and after the intervention (week9 ), and at 3-week follow-up (week12 ). Three persons with stroke participated in the 3-week piano training program that combined structured piano lessons to home practice program. The songs, played on an electronic keyboard, involved all 5 digits of the affected hand and were displayed using a user-friendly MIDI program. After intervention, all the three participants showed improvements in their fine (nine hole peg test) and gross (box and block test) manual dexterity, as well as in the functional use of the upper extremity (Jebsen hand function test). Improvements were maintained at follow-up. These preliminary results support the feasibility of using an MST approach that combines structured lessons to home practice to improve upper extremity function in chronic stroke. 1. Introduction Persistent contralateral motor impairments are common following a stroke. It is estimated that 80% to 95% of patients experience sensorimotor upper extremity impairments as well as activity and participation limitations, which persist beyond 6 months after stroke onset [1]. This is a major concern as in order to manage daily activities, chronic stroke survivors often use nonoptimal compensation strategies that can lead to a pattern of learned disuse of the paretic arm and further exacerbate the level of disability. Existing therapies that aim at improving upper extremity function show modest to moderate improvements [2], possibly due to insufficient training intensity [3] and lack of adherence. It was also shown that well beyond the optimal recovery window that occurs within the first 6 months after a stroke, rehabilitation still has the potential to induce neurological and functional changes [4, 5]. There is a need to develop and implement interventions that will meet the patient’s interests to actively engage them during and beyond the supervised rehabilitation period so that long-term improvements in upper extremity function can be achieved. Music-supported therapy (MST) is an innovative approach that has been shown to yield larger improvements in fine and gross motor dexterity compared to conventional rehabilitation and constraint-induced movement therapy in acute stroke survivors [6]. MST was also shown to yield enhanced motor skills and neuroplastic changes of auditory-motor network in chronic stroke participants [7]. In addition to integrating key principles of motor learning and providing instantaneous auditory feedback on performance, the rapid establishment of auditory-motor coupling during music playing would underlie the efficacy of MST [7, 8]. Such coupling can be observed within 20 minutes of musical training and is largely enhanced after 5 weeks of training in nonmusicians [9]. Existing MST 2 Stroke Research and Treatment Table 1: Initial participant characteristics. Age (years) Gender (male/female) Time since stroke (months) Side of stroke (left/right) Type of stroke (ischemic/hemorrhage) CMSA arm/hand score (max = 7) Piano experience (years) Handedness ∗ Participant 1 60 Male 9 Right Ischemic 3/3 0 Right Participant 2 67 Male 10 Left Ischemic 3/3 0 Right∗ Participant 3 58 Male 16 Right Hemorrhage 4/5 0 Left∗ Affected hand is the dominant hand; CMSA: Chedoke-McMaster Stroke Assessment. programs, however, involve 5 days/week of training and may be difficult to implement in an outpatient and community rehabilitation settings. Furthermore, no previous MST program has focused on finger movement accuracy, timing, and speed, which are important determinants of finger coordination. We have developed, using a user-friendly computerized piano program, a piano training paradigm that provides feedback on note accuracy, timing and speed while allowing participants to progress through finger sequences of increasing complexity. The purpose of this study was to investigate the feasibility of an individually tailored piano training intervention that targeted finger movement coordination and combined structured piano lessons to home practice. The specific objective was to estimate the short-term and retention effects of a 3-week piano training program on manual dexterity, finger movement coordination, and functional use of upper extremity in persons with chronic stroke. 2. Methods Three male participants with a mild to moderate deficits of upper extremity motor function due to a first supratentorial chronic stroke (6 to 24 months duration) in the middle cerebral artery territory were recruited after being discharged from rehabilitation (Table 1). Participants had (1) some capacity of dissociation of upper extremity movements as reflected by scores of 3 to 6 on the arm and hand components of the Chedoke-McMaster Stroke Assessment and (2) the ability to follow simple instructions. They had corrected to normal vision and were free of visual field defects (Goldman perimetry), hemineglect (<6 omissions, Bell’s test), and cognitive deficits (scores > 23, Montreal Cognitive Assessment). None had musical experience. The study was approved by the Ethics Committee of the Centre for Interdisciplinary Research in Rehabilitation (CRIR), and informed consent was obtained from each participant. Subjects participated in a step-by-step musical training consisting of three individual 1-hour sessions per week for 3 consecutive weeks, for a total of 9 sessions. The individual sessions were complemented with a home program consisting of biweekly piano ex (...truncated)