Therapeutic Instrumental Music Performance to Improve Upper Extremity Function in Patients with Paresis and Apraxia after Stroke

Abstract

Therapeutic Instrumental Music Performance (TIMP) has been shown to improve upper extremity (UE) functions in stroke survivors. While numerous studies have examined stroke-induced paresis, research on stroke-related comorbid disorders remains limited, with relatively little consideration being given to the consequences of stroke. Ideomotor apraxia (IMA) is one such common post-stroke consequence that may hinder the purposeful UE action and movements necessary for the performance of daily living tasks. This study investigated the therapeutic potential of TIMP intervention to improve UE functions in post-stroke patients suffering concurrently from paresis and IMA. Seven left-hemisphere stroke patients with IMA participated in 9 individual 1-hour TIMP interventions over a period of 3 weeks. During each intervention, participants engaged in gross and fine motor exercises that primarily utilized drum and keyboard playing. All outcome measures were assessed at baseline, pretest, posttest and a follow-up test 3 weeks post-intervention. Clinical measures included the UE section of the Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Box and Block Test (BBT), strength, ADL/IADL, and hand domains of the Stroke Impact Scale (SIS). The Apraxia Screen of TULIA (AST) was used to assess apraxic impairments. While therapeutic benefits varied, all UE functional levels of the participants demonstrated post-intervention improvements in gross and fine motor skills (FMA, WMFT, BBT) as well as perceived ADL skills (SIS). Moreover, such positive gains persisted for 3 weeks after the intervention. Participants continued to experience persistent IMA across the study timeline. The results of this study indicated that patients with post-stroke IMA were able to reap benefits from the TIMP intervention, as evidenced by improvement in their UE functions and perceived ADL skills despite the persistence of IMA. The findings of the study support the perception of TIMP intervention’s emerging efficacy in individuals suffering from post-stroke paresis and IMA, providing new information, implications and applications for both for researchers and clinicians. Rigorous future research is recommended to spur the development of efficacious and innovative rehabilitation interventions aimed at optimizing patient quality of care.