Music-based intervention drives paretic limb acceleration into intentional movement frequencies in chronic stroke rehabilitation

This study presented a novel kinematic assessment of paretic limb function "online" during the actual therapeutic exercisers rooted within the acceleration domain. Twenty-eight patients at chronic stroke stages participated in an auditory-motor intervention mapping reaching movements of the paretic arm unto surfaces of large digital musical instruments and sound tablets that provided rhythmic entrainment cues and augmented auditory feedback. Patients also wore a tri-axial accelerometer on the paretic limb during the nine-session intervention. The resulting acceleration profiles were extracted and quantified within the frequency domain. Measures of peak power and peak width were leveraged to estimate volitional control and temporal consistency of paretic limb movements, respectively. Clinical assessments included the Wolf Motor Function Test and Fugl-Meyer - Upper Extremity subtest. The results showed that peak power increased significantly from Session 1 to Session 9 within oscillatory frequency ranges associated with intentional movement execution (i.e., 4.5 Hz). Decreases in peak width over time provided additional evidence for improved paretic arm control from a temporal perspective. In addition, Peak width values obtained in Session 1 was significantly correlated with pre-test Fugl-Meyer - Upper Extremity scores. These results highlighted improvements in paretic limb acceleration as an underlying mechanism in stroke motor recovery and shed further light on the utility of accelerometry-based measures of paretic limb control in stroke rehabilitation. The data reported here was obtained from a larger clinical trial: https://clinicaltrials.gov/ct2/show/NCT03246217 ClinicalTrials.gov Identifier: NCT03246217.

Therapeutic Instrumental Music Training and Motor Imagery in Post-Stroke Upper-Extremity Rehabilitation: A Randomized-Controlled Pilot Study

Objective

To investigate the potential benefits of 3 therapeutic instrumental music performance (TIMP)-based interventions in rehabilitation of the affected upper-extremity (UE) for adults with chronic poststroke hemiparesis.

Design

Randomized-controlled pilot study.

Setting

University research facility.

Participants

Community-dwelling volunteers (N=30; 16 men, 14 women; age range, 33-76 years; mean age, 55.9 years) began and completed the protocol. All participants had sustained a unilateral stroke more than 6 months before enrollment (mean time poststroke, 66.9 months).

Intervention

Two baseline assessments, a minimum of 1 week apart; 9 intervention sessions (3 times/week for 3 weeks), in which rhythmically cued, functional arm movements were mapped onto musical instruments; and 1 post-test following the final intervention. Participants were block-randomized to 1 of 3 conditions: group 1 (45 minutes TIMP), group 2 (30 minutes TIMP, 15 minutes metronome-cued motor imagery [TIMP+cMI]), and group 3 (30 minutes TIMP, 15 minutes motor imagery without cues [TIMP+MI]). Assessors and investigators were blinded to group assignment.

Main Outcome Measures

Fugl-Meyer Upper-Extremity (FM-UE) and Wolf Motor Function Test- Functional Ability Scale (WMFT-FAS). Secondary measures were motor activity log (MAL)–amount of use scale and trunk impairment scale.

Results

All groups made statistically significant gains on the FM-UE (TIMP, P=.005, r=.63; TIMP+cMI, P=.007, r=.63; TIMP+MI, P=.007, r=.61) and the WMFT-FAS (TIMP, P=.024, r=.53; TIMP+cMI, P=.008, r=.60; TIMP+MI, P=.008, r=.63). Comparing between-group percent change differences, on the FM-UE, TIMP scored significantly higher than TIMP+cMI (P=.032, r=.57), but not TIMP+MI. There were no differences in improvement on WMFT-FAS across conditions. On the MAL, gains were significant for TIMP (P=.030, r=.54) and TIMP+MI (P=.007, r=.63).

Conclusion

TIMP-based techniques, with and without MI, led to significant improvements in paretic arm control on primary outcomes. Replacing a physical training segment with imagery-based training resulted in similar improvements; however, synchronizing internal and external cues during auditory-cMI may pose additional sensorimotor integration challenges.

Integrated Pedal System for Data Driven Rehabilitation

We present a system capable of providing visual feedback for ergometer training, allowing detailed analysis and gamification. The presented solution can easily upgrade any existing ergometer device. The system consists of a set of pedals with embedded sensors, readout electronics and wireless communication modules and a tablet device for interaction with the users, which can be mounted on any ergometer, transforming it into a full analytical assessment tool with interactive training capabilities. The methods to capture the forces and moments applied to the pedal, as well as the pedal's angular position, were validated using reference sensors and high-speed video capture systems. The mean-absolute error (MAE) for load is found to be 18.82 N, 25.35 N, 0.153 Nm for Fx, Fz and Mx respectively and the MAE for the pedal angle is 13.2°. A fully gamified experience of ergometer training has been demonstrated with the presented system to enhance the rehabilitation experience with audio visual feedback, based on measured cycling parameters.

The effect of perceptual-motor continuity compatibility on the temporal control of continuous and discontinuous self-paced rhythmic movements

One of the questions yet to be fully understood is to what extent the properties of the sensory and the movement information interact to facilitate sensorimotor integration. In this study, we examined the relative contribution of the continuity compatibility between motor goals and their sensory outcomes in timing variability. The variability of inter-response intervals was measured in a synchronization-continuation paradigm. Participants performed two repetitive movement tasks whereby they drew circles either using continuous or discontinuous self-paced movements while receiving discrete or continuous auditory feedback. The results demonstrated that the effect of perceptual-motor continuity compatibility may be limited in self-paced auditory-motor synchronization as timing variability was not significantly influenced by the continuity of the feedback or the continuity compatibility between feedback and the movement produced. In addition, results suggested that the presence of salient perceptual events marking the completion of the time intervals elicited a common timing process in both continuous and discontinuous circle drawing, regardless of the continuity of the auditory feedback. These findings open a new line of investigation into the role of the discriminability and reliability of the event-based information in determining the nature of the timing mechanisms engaged in continuous and discontinuous self-paced rhythmic movements.

Development and evaluation of a novel music-based therapeutic device for upper extremity movement training: A pre-clinical, single-arm trial

Restoration of upper limb motor function and patient functional independence are crucial treatment targets in neurological rehabilitation. Growing evidence indicates that music-based intervention is a promising therapeutic approach for the restoration of upper extremity functional abilities in neurologic conditions such as cerebral palsy, stroke, and Parkinson's Disease. In this context, music technology may be particularly useful to increase the availability and accessibility of music-based therapy and assist therapists in the implementation and assessment of targeted therapeutic goals. In the present study, we conducted a pre-clinical, single-arm trial to evaluate a novel music-based therapeutic device (SONATA) for upper limb extremity movement training. The device consists of a graphical user interface generated by a single-board computer displayed on a 32" touchscreen with built-in speakers controlled wirelessly by a computer tablet. The system includes two operational modes that allow users to play musical melodies on a virtual keyboard or draw figures/shapes whereby every action input results in controllable sensory feedback. Four motor tasks involving hand/finger movement were performed with 21 healthy individuals (13 males, aged 26.4 ± 3.5 years) to evaluate the device's operational modes and main features. The results of the functional tests suggest that the device is a reliable system to present pre-defined sequences of audiovisual stimuli and shapes and to record response and movement data. This preliminary study also suggests that the device is feasible and adequate for use with healthy individuals. These findings open new avenues for future clinical research to further investigate the feasibility and usability of the SONATA as a tool for upper extremity motor function training in neurological rehabilitation. Directions for future clinical research are discussed.

Sound matters: The impact of auditory deprivation on movement precision in rowing

Purpose of the study was to quantify the importance of auditory feedback for movement precision in elevated rowing task difficulty with elite athletes under normal and masked hearing conditions. It was hypothesized that rowing with masked hearing would reduce the precision of movement, particularly at the non-usual/less-preferred stroke frequencies (SF). Self-reported questionnaires helped to understand the difficulty of the task. Twenty rowers completed 2 × 1000 m-distance-blocks, each separated into 4 × 250 m, with increasing SF 18, 20, 22 24 strokes/minute once with normal and once with masked hearing. Precision was determined as the deviation between the SF target and the SF actually performed (DSF). Athletes' subjective perception was requested before and after the experiment. A 2 (hearing condition) × 4 (SF 18, 20, 22, 24) repeated measures ANOVA showed systematically larger DSF during masked hearing for all SFs compared to the DSF in the normal hearing condition (p < .01). Further, the highest DSFs were found for SF 18 and 24 in both hearing conditions (no interaction effect). The athletes' perception of the relevance of natural movement sounds for their rowing performance changed when evaluated before and after the experiment. Rowing without hearing was evaluated as mentally more demanding than physically. The results confirmed our initial assumptions and showed the relevance of natural auditory information for movement precision in rowing practice, even at a high level of expertise.

A Review on the Relationship Between Sound and Movement in Sports and Rehabilitation

The role of auditory information on perceptual-motor processes has gained increased interest in sports and psychology research in recent years. Numerous neurobiological and behavioral studies have demonstrated the close interaction between auditory and motor areas of the brain, and the importance of auditory information for movement execution, control, and learning. In applied research, artificially produced acoustic information and real-time auditory information have been implemented in sports and rehabilitation to improve motor performance in athletes, healthy individuals, and patients affected by neurological or movement disorders. However, this research is scattered both across time and scientific disciplines. The aim of this paper is to provide an overview about the interaction between movement and sound and review the current literature regarding the effect of natural movement sounds, movement sonification, and rhythmic auditory information in sports and motor rehabilitation. The focus here is threefold: firstly, we provide an overview of empirical studies using natural movement sounds and movement sonification in sports. Secondly, we review recent clinical and applied studies using rhythmic auditory information and sonification in rehabilitation, addressing in particular studies on Parkinson's disease and stroke. Thirdly, we summarize current evidence regarding the cognitive mechanisms and neural correlates underlying the processing of auditory information during movement execution and its mental representation. The current state of knowledge here reviewed provides evidence of the feasibility and effectiveness of the application of auditory information to improve movement execution, control, and (re)learning in sports and motor rehabilitation. Findings also corroborate the critical role of auditory information in auditory-motor coupling during motor (re)learning and performance, suggesting that this area of clinical and applied research has a large potential that is yet to be fully explored.

Authors' response to the letter to the editor: "Effects of acoustic feedback training in elite-standard Para-Rowing" by Schaffert and Mattes (2015)

Our article in the Journal of Sports Sciences was designed to examine effects of auditory feedback on mean boat speed during on-water training of visually impaired athletes in elite-standard Para-Rowing. This aim is stated explicitly in the title, abstract, introduction and discussion section. The effects were analysed on the basis of a conservative approach to using inferential statistics by emphasising measures that communicate meaningful differences and effect sizes to help interpret the data's practical importance for sport competition. Biomechanical measurements have been combined with standardised questionnaires to assess the athletes' perceived experience during rowing with acoustic feedback. An application for high-performance rowing has already been used to successfully investigate the effects of acoustic feedback on the time structure of the rowing cycle during the recovery phase. In this response, we provide our comments to the concerns presented in the 'Letter to the Editor' along with a brief description of the issues that relate to research in high-performance sport.

Effects of acoustic feedback training in elite-standard Para-Rowing

Assessment and feedback devices have been regularly used in technique training in high-performance sports. Biomechanical analysis is mainly visually based and so can exclude athletes with visual impairments. The aim of this study was to examine the effects of auditory feedback on mean boat speed during on-water training of visually impaired athletes. The German National Para-Rowing team (six athletes, mean ± s, age 34.8 ± 10.6 years, body mass 76.5 ± 13.5 kg, stature 179.3 ± 8.6 cm) participated in the study. Kinematics included boat acceleration and distance travelled, collected with Sofirow at two intensities of training. The boat acceleration-time traces were converted online into acoustic feedback and presented via speakers during rowing (sections with and without alternately). Repeated-measures within-participant factorial ANOVA showed greater boat speed with acoustic feedback than baseline (0.08 ± 0.01 m·s(-1)). The time structure of rowing cycles was improved (extended time of positive acceleration). Questioning of athletes showed acoustic feedback to be a supportive training aid as it provided important functional information about the boat motion independent of vision. It gave access for visually impaired athletes to biomechanical analysis via auditory information. The concept for adaptive athletes has been successfully integrated into the preparation for the Para-Rowing World Championships and Paralympics.

RNAi knockdown of hPrp31 leads to an accumulation of U4/U6 di-snRNPs in Cajal bodies

Cajal bodies (CBs) are subnuclear organelles of animal and plant cells. A role of CBs in the assembly and maturation of small nuclear ribonucleoproteins (snRNP) has been proposed but is poorly understood. Here we have addressed the question where U4/U6.U5 tri-snRNP assembly occurs in the nucleus. The U4/U6.U5 tri-snRNP is a central unit of the spliceosome and must be re-formed from its components after each round of splicing. By combining RNAi and biochemical methods, we demonstrate that, after knockdown of the U4/U6-specific hPrp31 (61 K) or the U5-specific hPrp6 (102 K) protein in HeLa cells, tri-snRNP formation is inhibited and stable U5 mono-snRNPs and U4/U6 di-snRNPs containing U4/U6 proteins and the U4/U6 recycling factor p110 accumulate. Thus, hPrp31 and hPrp6 form an essential connection between the U4/U6 and U5 snRNPs in vivo. Using fluorescence microscopy, we show that, in the absence of either hPrp31 or hPrp6, U4/U6 di-snRNPs as well as p110 accumulate in Cajal bodies. In contrast, U5 snRNPs largely remain in nucleoplasmic speckles. Our data support the idea that CBs may play a role in tri-snRNP recycling.