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Improvement of motor rehabilitation after stroke with piano training
Submitted by: Prof. Dr. Eckart Altenmüller, University of Music, Drama and Media, Hannover, Germany
Other researcher involved in project: Floris van Vugt, MSc, University of Music, Drama and Media, Hannover, Germany
Stroke rehabilitation, piano training, fine-motor abilities, brain plasticity
In previous studies we could demonstrate that music supported training (MST) in stroke patients facilitates rehabilitation of fine motor skills of the paretic hand. About 6 weeks after the stroke, patients were asked to replay simple tunes on a keyboard or on an electronic set of drumpads and were trained to systematically increase their sensory-motor skills during a 3 weeks training period. The recovery of motor skills was more pronounced than in a control group undergoing constraint-induced therapy (CIT) (Altenmüller et al. 2009, Schneider et al. 2010). Extending this study, we now aim to reproduce these effects in patients suffering from chronic stroke (more than 6 months after the stroke) and we aim to elucidate the underlying neurobiological mechanisms of brain plasticity.
A longitudinal 2-year clinical trial will be conducted comparing two neuro-rehabilitation techniques, MT and CIT, in chronic patients (N = 30, for each group) with mild to moderate chronic motor deficit after stroke (minimum 6 months after stroke). The MT-group will receive intensive training of the paretic upper extremity (30 minutes each day, 12-week treatment period), and application of a number of other techniques designed to produce transfer to the life situation. This group will be compared to a CIT group, which will receive a full CIT program involving movement restriction of the unaffected arm, massed practice and shaping. Treatment effects will be evaluated at the end of the therapy course as well as six and twelve months thereafter in order to evaluate the stability of the effects. Motor function will be evaluated using 3-D movement analysis and conventional motor tests. Sensorimotor reorganization and brain connectivity will be evaluated using EEG, fMRI, and TMS.
We expect to observe significant clinical improvement of the functional use of the affected limb in both, MT and CIT groups. We also expect a transfer to daily activities and persisting improvements after treatment. Finally, EEG, fMRI and TMS-derived measures will provide evidence as regards the neural mechanisms underlying the improvements seen after the therapeutic interventions.
Submitted: March 25, 2011
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