Playing Piano to Improve Hand Function Early After Stroke

Official title

A Piano Training Program to Improve Manual Dexterity and Upper Extremity Function in Subacute Stroke Survivors

Overview

The goal of this clinical trial is to study the feasibility of a 6-week piano playing training intervention in a subacute stroke population. More specifically, the investigators aim to (1) implement and test the feasibility of the intervention in the subacute stroke rehabilitation program; and (2) explore the acceptability of the supervised training sessions and home practice sessions. Researchers will also (3) estimate and contrast the effects of the piano training intervention as compared to conventional therapy on manual dexterity, coordination, functional use of the upper extremity, attention and mood. Therapy specifically provided as part of this project will be delivered above and beyond usual therapy time in both intervention groups. Participants of the piano group will: * Engage in a step-by-step musical training consisting of two supervised, individual 45-min sessions per week for 6 consecutive weeks, for a total of 12 sessions. * The supervised session will also be complemented with a biweekly home program (15 minutes) consisting of piano exercises. Participants in the conventional group will: * Engage in two individual 45-min sessions per week for 6 consecutive weeks consisting in conventional occupational therapy treatment. * They will also receive a biweekly home program consisting in occupational therapy exercises (15 minutes).

Detailed description

Piano Training: Musical pieces are designed to involve all 5 digits of the paretic hand. Whether played with the right or left hand, they involve the same number of finger repetitions as well as similar finger sequences and melodic patterns. A Musical Instrument Digital Interface (MIDI) piano program called Synthesia will be used to display musical pieces on a computer screen that is adapted for people with no music reading abilities. Participants will be cued to press a sequence of key presses required to produce a melody by a visual display showing a blue dot falling from the upper part of the screen down to indicate the correct key on a virtual keyboard. After each cue, the program will pause until the participant pressed the correct key before moving on. During the supervised training sessions, participants will play on a touch sensitive piano keyboard. A computer will record the responses from the piano keyboard and provided a final score indicating the number of errors and total duration for each musical piece. A professional therapist will be present during these supervised sessions and will provide verbal feedback on the quality of movement and discouraged compensatory strategies. Nine musical pieces will be introduced to the participants in an order of increasing difficulty: level 1 involving movements of consecutive fingers (e.g.,1-2-3-4-5); level 2 involving third, fourth, and fifth intervals or movements of non-consecutive fingers (e.g., 1-3-5-1-4); and level 3 involving chords, that is 2 fingers played at the same time. Within each level, 3 musical pieces involving an increasing number of key presses and changes in melodic direction will be introduced. The speed of execution or tempo will also increase within each musical piece.

Conventional Intervention: Conventional sessions will consist of usual occupational therapy treatment (e.g., mobility, ADL, IALD, information session), excluding treatments focusing specifically on arm and hand motor recovery. The nature therapy provided as part of the conventional intervention will be carefully documents in the chart.

Home Practice: All participants in the piano group will receive an unsupervised home program consisting of piano sequence exercises comprising short excerpts of the same musical pieces practiced during the supervised sessions and they will receive a roll-up flexible piano. Participants in the conventional group will receive assignments related to occupational therapy exercises and/or IALD/ADLs. All participants will report on their practice duration and content in a logbook after each practice session.

Interventions

• Other Music intervention
  Participants will engage in a step-by-step piano training consisting in playing piano pieces designed to involve all 5 digits of the paretic hand and increasing in complexity. They will be using a Musical Instrument Digital Interface (MIDI) piano program called Synthesia to display musical pieces on a computer screen that is adapted for people with no music reading abilities and will be playing on a touch sensitive piano keyboard. The supervised session will also be complemented with a unsupervi
• Other Occupational Therapy
  Participants will receive conventional occupational therapy treatment (e.g., mobility, ADL, IALD, information session), excluding treatments focusing specifically on arm and hand motor recovery.The supervised session will also be complemented with an unsupervised home program consisting of assignments related to occupational therapy exercises and/or IALD/ADLs.

Primary outcome measures

• Feasibility: Characteristics of stroke participants [Time frame: Pre-intervention (week0)]
• Feasibility: Number of eligible vs. referred participants [Time frame: Post-intervention (week6)]
• Feasibility: adherence to intervention - number of completed sessions [Time frame: Post-intervention (week6)]
• Feasibility: adherence to intervention - number of piano pieces completed (piano group) vs occupational therapy exercises completed (conventional group) [Time frame: Post-intervention (week6)]
• Feasibility: adherence to intervention - number of home practice sessions [Time frame: Post-intervention (week6)]
• Feasibility: adherence to intervention - time of home practice sessions [Time frame: Post-intervention (week6)]
• Feasibility: presence of adverse or undesirable effects during the intervention [Time frame: Post-Intervention (week6)]
• Acceptability of the intervention [Time frame: Post-intervention (week6)]
• Acceptability: Overall experience [Time frame: Post-intervention (week6)]

Secondary outcome measures (8)

• Change from Baseline in the Box and Block test at Post-intervention [Time frame: Post-intervention (week6) and Follow-up (week12)]
• Change from Baseline in the Nine Hole Peg Test (NHPT) at Post-intervention [Time frame: Post-intervention (week6) and Follow-up (week12)]
• Change from Baseline in the Finger to Nose test at Post-intervention [Time frame: Post-Intervention (week6) and Follow-up (week12)]
• Change from Baseline in the Finger Tapping test at Post-intervention [Time frame: Post-intervention (week6) and Follow-up (week12)]
• Change from Baseline in the 6-items Jebsen Hand Function test at Post-intervention [Time frame: Post-intervention (week6) and Follow-up (week12)]
• Change from Baseline in the Digit Span Test - Forward at Post-intervention [Time frame: Post-intervention (week6) and Follow-up (week12)]
• Change from Baseline in the Digit Span Test - Backward at Post-intervention [Time frame: Post-intervention (week6) and Follow-up (week12)]
• Change from Baseline in the Hospital Anxiety and Depression Scale at Post-intervention [Time frame: Post-intervention (week6) and Follow-up (week12)]

Eligibility criteria

Inclusion criteria

• Have normal/corrected visual and auditory acuity
• Present a first-ever supratentorial unilateral stroke (1-24 weeks post-stroke)
• Present some capacity of dissociation of arm and finger movements, as reflected by scores of 3 to 6 on the arm and hand components of the Chedoke McMaster Stroke Assessment
• Have the capacity to follow simple instructions
• Have no professional piano experience (only for the piano group)

Exclusion criteria

• Presence of visual field defect, hemineglect as well as dementia or moderate-to-severe cognitive deficits (score less than 18 on the Montreal Cognitive Assessment).

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Canada · 1 center

• Jewish Rehabilitation Hospital — Laval

Identifiers

NCT: NCT06621771 · MP-50-2024-2096

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗