EFFECTS OF STRUCTURED EXERCISES AND MUSIC THERAPY ON THE FUNCTIONAL INDEPENDENCE OF STROKE SURVIVORS: A RANDOMIZED CONTROLLED CLINICAL TRIAL

Abstract

Background: Stroke is a leading cause of disability worldwide. It often leaves survivors with functional impairments that significantly impact their daily lives. Improving the functional independence of stroke survivors is a critical public health concern.

Aim: This study aimed at determining if structured exercises combined with music therapy improves the functional independence of stroke survivors as compared to structured exercises alone.

Methods: The study design was a randomized controlled clinical trial (RCT) in which 86 stroke survivors who were purposively recruited from two tertiary hospitals in Rivers State (University of Port Harcourt Teaching Hospital and River State University Teaching Hospital) were randomized into two groups – experimental and control groups in a parallel ratio of 1:1. The intervention was given for a period of 6 months. All ethical procedures were followed in line with the declaration of Helsinki. Baseline values were measured and compared within groups using Paired t-test and between the groups using Independent t-test. Post-intervention value of the variables was measured and within group comparison was made using Paired t-test while Independent t-test was used for comparism between the groups.

Results: There was a statistically significant mean difference within the groups for the functional independence and its two subscales – motor and cognitive subscales (P=0.000). The mean difference between the groups for functional independence and motor subscale was not statistically significant (t= 1.39, P=0.167; t=1.82, P=0.073) while that of cognitive subscale was statistically significant (t=2.46, P=0.016).

Conclusion: Structured exercises combined with music therapy do not significantly improve the functional independence of stroke survivors as compared to structured exercises alone. Music therapy sessions should be incorporated prior to conventional treatments in order to boost cognitive functions of the stroke survivors.

Keywords:

Structured Exercises, Music Therapy, Stroke Survivors, Functional Independence, Rivers State

References

Thrift AG, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, Feigin VL, Norrving B, Donnan GA, Cadilhac DA. Global stroke statistics. International journal of stroke. 2017 Jan; 12 (1):13-32.

Diener HC, Hankey GJ. Primary and secondary prevention of ischemic stroke and cerebral hemorrhage: JACC focus seminar. Journal of the American College of Cardiology. 2020 Apr 21; 75 (15):1804-18.

Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990‐2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1545‐602.

Katan M, Luft A. Global burden of stroke. InSeminars in neurology 2018 Apr (Vol. 38, No. 02, pp. 208-211). Thieme Medical Publishers.

Yan LL, Li C, Chen J, Miranda JJ, Luo R, Bettger J, Zhu Y, Feigin V, O'Donnell M, Zhao D, Wu Y. Prevention, management, and rehabilitation of stroke in low-and middle-income countries. Eneurologicalsci. 2016 Mar 1;2:21-30.

OTI IK, BABATUNDE S. SOCIO-ECONOMIC STATUS OF STROKE SURVIVORS AND PEOPLE LIVING WITH OSTEOARTHRITIS IN PORT HARCOURT METROPOLIS, RIVERS STATE. Journal of Biomedical Investigation. 2023; 11(1):47-53.

OTI, I. K., NWAEDOZIE, O. C., AYERITE, A. B., ANYAMA, E. U., PETER, A. L., & MADUME, A. K. Prevalence and Pattern of Stroke Cases Seen at the Neurology Clinic of Physiotherapy Department, University of Port Harcourt Teaching Hospital, Port Harcourt: A Ten-Year Retrospective Study. International Journal of Medical Science and Dental Health. .2024; 10 (04), 48-60.

Adeloye D, Ezejimofor M, Auta A, Mpazanje RG, Ezeigwe N, Ngige EN, Harhay MO, Alemu W, Adewole IF. Estimating morbidity due to stroke in Nigeria: a systematic review and meta-analysis. Journal of the neurological sciences. 2019 Jul 15;402:136-44.

Akinyemi RO, Ovbiagele B, Adeniji OA, Sarfo FS, Abd-Allah F, Adoukonou T, Ogah OS, Naidoo P, Damasceno A, Walker RW, Ogunniyi A. Stroke in Africa: profile, progress, prospects and priorities. Nature Reviews Neurology. 2021 Oct;17(10):634-56.

Owolabi MO, Arulogun O, Melikam S, Adeoye AM, Akarolo-Anthony S, Akinyemi R, Arnett D, Tiwari H, Gebregziabher M, Jenkins C, Lackland D. The burden of stroke in Africa: a glance at the present and a glimpse into the future. Cardiovascular journal of Africa. 2015 Mar;26(2 H3Africa Suppl):S27.

Mahak C, Manisha N, Sandhya G, Dheeraj K, Dhandapani M, Dhandapani SS. Assessment of utilization of rehabilitation services among stroke survivors. Journal of neurosciences in rural practice. 2018 Oct;9 (4):461.

Domínguez-Téllez, P., Moral-Muñoz, J. A., Salazar, A., Casado-Fernández, E. & Lucena-Antón, D et al. Game-based virtual reality interventions to improve upper limb motor function and quality of life after stroke: systematic review and meta-analysis. Games for Health Journal, 2020; 9(1), 1-10.

Belagaje, S. R. Stroke rehabilitation. CONTINUUM: Lifelong Learning in Neurology, 2017; 23(1), 238-253.

Oti, I. K., Ojule, I. N., Chinenye, S., & Jaja, B. N. A Systematic Review of Structured Exercises and Music Therapy on the Functional Status of Stroke Survivors. International Journal of Medical Science and Dental Health, 2024; 10(06), 50-76.

Basha AK. Effect of structured home exercises on functional independence in stroke survivors. Physiotherapy-The Journal of Indian Association of Physiotherapists. 2021 Jan 1;15(1):43-9.

Jeba C, Joshi D. Influence of music therapy on spasticity, functional independence and quality of life in subjects with hemiplegia: a randomized controlled trial. International Journal of Neurorehabilitation. 2016;3(219):2376-0281.

Ghasemi E, Khademi-Kalantari K, Khalkhali-Zavieh M, Rezasoltani A, Ghasemi M, Baghban AA, Ghasemi M. The effect of functional stretching exercises on functional outcomes in spastic stroke patients: A randomized controlled clinical trial. Journal of bodywork and movement therapies. 2018 Oct 1; 22(4):1004-12.

Rasmussen, R. S., Østergaard, A., Kjær, P., Skerris, A., Skou, C., Christoffersen, J., & Overgaard, K et al. Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life: a randomised controlled trial. Clinical rehabilitation, 2016; 30(3), 225-236.

Ali, A., Tabassum, D., Baig, S. S., Moyle, B., Redgrave, J., Nichols, S., & Majid, A et al,. Effect of exercise interventions on health-related quality of life after stroke and transient ischemic attack: A systematic review and meta-analysis. Stroke, 2021; 52(7), 2445-2455.

Yoon JA, Koo BI, Shin MJ, Shin YB, Ko HY, Shin YI. Effect of constraint-induced movement therapy and mirror therapy for patients with subacute stroke. Annals of rehabilitation medicine. 2014 Aug;38(4):458.

Monticone M, Ambrosini E, Ferrante S, Colombo R. ‘Regent Suit’training improves recovery of motor and daily living activities in subjects with subacute stroke: a randomized controlled trial. Clinical rehabilitation. 2013 Sep;27(9):792-802.

Thieme H, Bayn M, Wurg M, Zange C, Pohl M, Behrens J. Mirror therapy for patients with severe arm paresis after stroke–a randomized controlled trial. Clinical rehabilitation. 2013 Apr;27(4):314-24.

Fritz SL, Peters DM, Merlo AM, Donley J. Active video-gaming effects on balance and mobility in individuals with chronic stroke: a randomized controlled trial. Topics in stroke rehabilitation. 2013 May 1;20(3):218-25.

Fujioka T, Dawson DR, Wright R, Honjo K, Chen JL, Chen JJ, Black SE, Stuss DT, Ross B. The effects of music‐supported therapy on motor, cognitive, and psychosocial functions in chronic stroke. Annals of the New York Academy of Sciences. 2018 Jul;1423(1):264-74.

Grau‐Sánchez J, Duarte E, Ramos‐Escobar N, Sierpowska J, Rueda N, Redón S, Veciana de las Heras M, Pedro J, Särkämö T, Rodríguez‐Fornells A. Music‐supported therapy in the rehabilitation of subacute stroke patients: a randomized controlled trial. Annals of the New York Academy of Sciences. 2018 Jul;1423(1):318-28.

Street AJ, Magee WL, Bateman A, Parker M, Odell-Miller H, Fachner J. Home-based neurologic music therapy for arm hemiparesis following stroke: results from a pilot, feasibility randomized controlled trial. Clinical rehabilitation. 2018 Jan;32(1):18-28.

Tong Y, Forreider B, Sun X, Geng X, Zhang W, Du H, Zhang T, Ding Y. Music-supported therapy (MST) in improving post-stroke patients' upper-limb motor function: a randomised controlled pilot study. Neurological research. 2015 May 20;37(5):434-40.

Van Vugt FT, Ritter J, Rollnik JD, Altenmüller E. Music-supported motor training after stroke reveals no superiority of synchronization in group therapy. Frontiers in human neuroscience. 2014 May 20; 8:315

Friedman N, Chan V, Reinkensmeyer AN, Beroukhim A, Zambrano GJ, Bachman M, Reinkensmeyer DJ. Retraining and assessing hand movement after stroke using the MusicGlove: comparison with conventional hand therapy and isometric grip training. Journal of neuroengineering and rehabilitation. 2014 Dec; 11:1-4.

Grau-Sánchez J, Münte TF, Altenmüller E, Duarte E, Rodríguez-Fornells A. Potential benefits of music playing in stroke upper limb motor rehabilitation. Neuroscience & Biobehavioral Reviews. 2020 May 1; 112:585-99.

Särkämö T, Tervaniemi M, Laitinen S, Numminen A, Kurki M, Johnson JK, Rantanen P. Cognitive, emotional, and social benefits of regular musical activities in early dementia: randomized controlled study. The Gerontologist. 2014 Aug 1;54(4):634-50.

Sihvonen AJ, Särkämö T, Leo V, Tervaniemi M, Altenmüller E, Soinila S. Music-based interventions in neurological rehabilitation. The Lancet Neurology. 2017 Aug 1;16(8):648-60.

Winstein, C. J., Stein, J., Arena, R., Bates, B., Cherney, L. R., Cramer, S. C. & Zorowitz, R. D. et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2016; 47(6), e98-e169.

Teasell, R., Salbach, N. M., Foley, N., Mountain, A., Cameron, J. I., Jong, A. D., & Lindsay, M. P et al. Canadian stroke best practice recommendations: rehabilitation, recovery, and community participation following stroke. Part one: rehabilitation and recovery following stroke; update 2019. International Journal of Stroke, 2020; 15(7), 763-788.

Kish L (2005). Statistical design for research. John Wiley & Sons; Feb 25

Prodinger, B., O'Connor, R. J., Stucki, G., & Tennant, A. Establishing score equivalence of the Functional Independence Measure motor scale and the Barthel Index, utilising the International Classification of Functioning, Disability and Health and Rasch measurement theory. Journal of rehabilitation medicine.2017; 49(5), 416-422.

Parry, S. M., Granger, C. L., Berney, S., Jones, J., Beach, L., El-Ansary, D., ... & Denehy, L.. Assessment of impairment and activity limitations in the critically ill: a systematic review of measurement instruments and their clinimetric properties. Intensive care medicine. 2015; 41, 744-762.

Ottenbacher KJ, Yungwen HY, Granger CV, Fiedler RC. The reliability of the functional independence measure: A quantitative review. Arch Physical Medicine and Rehabilitation.1996; 77: 1226-1232.

Onwuchekwa, A. C., Tobin-West, C., & Babatunde, S. (2014). Prevalence and risk factors for stroke in an adult population in a rural community in the Niger Delta, south-south Nigeria. Journal of Stroke and Cerebrovascular Diseases. 23(3), 505-510.

Jun, E. M., Roh, Y. H., & Kim, M. J. The effect of music‐movement therapy on physical and psychological states of stroke patients. Journal of clinical nursing. 2013; 22(1-2), 22-31.

Yoon JA, Koo BI, Shin MJ, Shin YB, Ko HY, Shin YI. Effect of constraint-induced movement therapy and mirror therapy for patients with subacute stroke. Annals of rehabilitation medicine. 2014 Aug;38(4):458.

Scholz DS, Rohde S, Nikmaram N, Brückner HP, Großbach M, Rollnik JD, Altenmüller EO. Sonification of arm movements in stroke rehabilitation–a novel approach in neurologic music therapy. Frontiers in neurology. 2016 Jun 30; 7:106.

Raglio A, Zaliani A, Baiardi P, Bossi D, Sguazzin C, Capodaglio E, Imbriani C, Gontero G, Imbriani M. Active music therapy approach for stroke patients in the post-acute rehabilitation. Neurological Sciences. 2017 May; 38:893-7.