Music and Adherence in an Upper Extremity Home Program for People With Stroke and Aphasia

PURPOSE: Upper extremity (UE) hemiparesis is persistent in 50% of people in the chronic phase of stroke recovery and has been found to substantially affect quality of life (Mozaffarian et al., 2015). One potential reason for the persistence of this impairment is limited access to and duration of therapeutic services. Home programs are often designed to bridge this gap; however, adherence to these programs is low (Miller et al., 2016). Novel ways to augment adherence to home programs should be explored to support patient recovery and intervention effectiveness. The purpose of this study was to measure adherence to a UE home program with and without music designed for people with stroke who also have aphasia.

METHOD: The study used a single-subject ABAB design with pre- and posttest measures. To be included in the study, participants had to be in the chronic phase of stroke recovery and to have mild to moderate hemiparesis and aphasia. Participants with UE Fugl-Meyer Assessment (FMA) scores between 21 and 50 were included in the study. Western Aphasia Battery–Revised Aphasia Quotient scores confirmed the diagnosis of aphasia, and the sequential commands subtests ensured participants’ understanding of one-step directions. Seven participants were recruited through a local clinic and support groups.

Before home program implementation began, we evaluated UE function with the Motor Activity Log (MAL–14), the Canadian Occupational Performance Measure (COPM), and the Chedoke Arm and Hand Activity Inventory (CAHAI–9). For the COPM and MAL–14, we used added photographs and modified presentation of rating scales to accommodate participants’ language impairments. The FMA, CAHAI–9, and COPM were used to gather information about level of motor function and participant goals for individualization of each home program

Home program materials were modified to support the participants’ aphasia by using step-by-step photographs combined with simplified wording for instructions and logbooks. During designated weeks, participants practiced the home program with a personalized music playlist compiled by a music therapist. Adherence was measured against the recommended amount of practice and was analyzed through visual inspection and use of the C statistic to measure change in trends across phases. Pretest–posttest measures were analyzed through comparison of observed changes to established values of clinical significance.

RESULTS: Preliminary results from five participants indicate that the average adherence to the number of repetitions was at or above the number requested in >75% of phases for four of the five participants. Data from practice logs suggest variable practice performance across phases, participants, and tasks. C statistical analyses indicated that some of the changes were significant. Three of the five participants reported perceived changes in UE use, and four of the five showed clinically significant increases in satisfaction on the COPM. All participants reported clinically significant increases in either amount of use or quality of UE function in at least three activities on the MAL–14. The researchers will use CAHAI–9 results to compare perceived changes to UE motor function.

Although the effect of music on measures of adherence was inconsistent, adherence in the preliminary analysis was at or above recommended levels of practice. This study can contribute to future occupational therapy practice by providing insight into components that may increase home program adherence for people with aphasia, including client-centered activities and adaptations for recalling and recording practice. Future research will determine the value of each of these components

References

Miller, K. K., Porter, R. E., DeBaun-Sprague, E., Van Puymbroeck, M., & Schmid, A. A. (2016). Exercise after stroke: Patient adherence and beliefs after discharge from rehabilitation. Topics in Stroke Rehabilitation, 24, 142–148. https://doi.org/10.1080/10749357.2016.1200292

Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., . . . Turner, M. B. (2015). Heart disease and stroke statistics—2016 update. .Circulation, 133, e38–e360. https://doi.org/10.1161/CIR.0000000000000350