Music Therapy Helps People With Stroke Walk Better

A set protocol was used, where therapy sessions were broken into quarters. A metronome and set of tapes with predetermined rhythms that could be adjusted according to patient’s abilities. In the first quarter, a baseline walking beat matching their cadence was found. In the 2nd quarter, they increased the cueing frequency by 5% on flat ground walking. In the 3rd quarter, they practised adaptive walking patterns on slopes and steps. And the final quarter involved cue reduction for independent carryover. Why does this form of music therapy seem to work?

The authors of this article proposed that because gait is one of those tasks that is very repetitive, rhythmic and involves preplanning of steps, RAS lends itself very well for this sort of rehabilitation. RAS seems to help with reducing performance variability, and assisting in selecting optimal stepping trajectories. This may explain why it hasn’t shown to be as helpful in upper limb rehabilitation, where movement patterns tend to be less predictable, more voluntary and attentional in nature.

According to Thaut and Abiru (2009), the auditory and motor system are richly connected, across the brain and spinal cord levels (via the reticulospinal systems). The auditory system, being a precise and quick processor of timing, seems much more effective that other sensory cues. I would probably agree with this only as far as motor-based rehabilitation. This makes a lot of sense when you consider the movement patterns of a musician playing the piano with his or her eyes closed, or playing the violin with such precision and speed. Here, music IS the feedback, which unlike verbal feedback, is totally instantaneous and internally driven. I think that’s really the key in this learning mechanism, as RAS swiftly moves through the external to internal processing of learned information to maximise carryover. Since its inception, there have been a few papers that have applied RAS with treadmill facilitated gait training, and arm swing patterns in patients with stroke. A number of Japanese neurorehabilitation hospitals have also started to add RAS to their rehabilitation approach. Personally I can also see how music can be highly instrumental (excuse the pun) in therapy where I am trying to get more or less postural tone. A loud, or high pitched noise is likely to make people increase their tone whereas a softer and mellower tune is likely to reduce it. Who might music therapy work for and does lesion location matter? Thaut and Abiru (2009) suggest that in stroke, it has been most helpful for patients with lesions in their cerebellum, putamen and in the cortices. As most patients have strokes in their middle cerebral artery, I can see RAS being useful for many. They suggest that patients with full thalamic lesions tend to have more difficulties as they cannot process sensory information as well, even in the full presence of it, and hence being less effective. There is a small amount of evidence suggesting music therapy as helpful in visual neglect, due to its arousing effect in the right brain near the visual areas. (Frassinetti, Bolognini and Ladavas 2002) And of course, music therapy works wonders in people with Parkinson’s disease (putamen affected), as a cueing and focussing strategy. Thinking more broadly, other disciplines such as speech therapy, have long adopted components of music therapy to assist with aphasia, phonation and timing of speech and highlighting the features of sound. The same goes for occupational therapists for cognition, agitation, memory and behavioral management, particularly following traumatic brain injury. (Thaut, 2010)