STROKESTRA®: Holistic Stroke Rehabilitation through ......Dementia (London). 2017 Jan 01;DOI:1471301217729237. Tsai PL, Chen MC, Huang YT, Lin KC, Chen KL, Hsu YW. Listening to classical

STROKESTRA®: Holistic Stroke Rehabilitation through Creative Music-making

@RPOonline #STROKESTRA

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14/10/2019 2Royal Philharmonic Orchestra © 2019

Overview

• Background & rationale

• STROKESTRA® development, techniques & impacts

• Challenges & lessons for working collaboratively with health services



Royal Philharmonic Orchestra -Residency Model

• 7 ‘Principal’ Residencies in culturally underserved areas of England

• Concerts underpinned by needs-based work embedded in the community

• Using the Orchestra as cultural and social resource

• All projects use creative music-making to achieve artistic, social, and personal aims

• Increasingly identifying health needs as priorities





• Studies have focused on the use of music to promote positive mood and lower depression andanxiety. (cf. Kim et al, 2011; Poćwierz-Marciniak, 2014; Särkämo, 2017)

• Listening to music has been found to improve visual awareness, visual attention and unilateral neglect. (cf. Särkämo et al, 2014; Rodriguez-Fornells et al, 2012; Tsai et al, 2013; Bernardi et al, 2017)

• Studies have concluded that music listening can improve verbal memory and attention. (cf. Särkämo et al,

2012; Särkämo et al, 2014)

Evidence Base



Evidence Base

• Cochrane reviews concluded rhythmic auditory stimulation can be beneficial for improving gait parameters. (Bradt et al, 2010; Magee et al,

2017)

• Music has been shown to support upper limb recovery incl. improved fine & gross motor movements and self-management.

(cf. Altenmüller et al, 2009, van Wijck et al, 2012; Raglio et al, 2013)

• Listening to music can also support bilateral stimulation and neuroplastic changes in stroke patients. (cf. Amengual et al, 2013; Grau-

Sánchez et al, 2013; Särkämo et al, 2014; Särkämo, 2017)

• Group therapy has also been shown to encourage additional benefits such as development of shared coping mechanisms and social support. (cf. Cowdell and Garrett, 2003; Perruzza and Kinsella, 2010; Oouchida et al.,

2013)



Research & Development



Structure• Participants referred by lead therapist who works with

patient to choose individualised goals

• Participants join either the AM or PM group

• Sessions every two weeks led alternately by RPO and clinical staff

• Each group receives 1x 2-hour session on project days

• Participants given instruments and ‘homework’ to continue work between projects

• Culminates in a public performance



Sessions



Sessions



Sessions



Sessions





Evaluation• Stroke Impact Scale v3.0 – baseline and post-project

• Specific goal related assessments (e.g. COAST, GAD-7, PHQ-9, Chedoke Upper Limb)

• Post-project semi-structured interviews with patients

• Post-project evaluation surveys with carers

• Post-project evaluation surveys with clinical staff

• Focus group with patients and carers

• Focus group with RPO team



Results – Patient Interviews

0

10

20

30

40

50

60

70

80

90

100

Symptomrelief - 86%

Social benefit -91%

Cognitivebenefit - 86%

Emotionalbenefit - 86%

Physicalbenefit - 71%

DomainStroke Impact Scale - % of patients

increasing by at least 10 points

Physical Strength 33.3

Cognition 43.8

Mood 43.8

Communication 35.3

Activities 31.3

Mobility 18.8

Hand use 56.3

Participation 62.5

Results – Stroke Impact Scale



Further Results

• 100% of family carers reported an improvement in their own wellbeing, and improved relationships with their relative.

• Participants reported a change in the traditional patient-therapist relationship.

• Clinical staff reported renewed energy, new ways of working and confidence in use of musical techniques.



Testimonials

“I found this project inspiring and energising. It has made me re-evaluate how we work with patients and the priorities we have and if we need to revisit these.” Clinician

“If you have a stroke you think your life is completely over because you can’t do what you did before. But coming here, you found out that you can do things.’ Patient

“It made me feel I wasn’t the only one in my position. Caring can be a lonely path at times and you can feel sad.” Carer



Current Work

• 3-year programme in Hull, including adapting the model for delivery in a residential unit

• Developing a programme in Stoke-on-Trent with a second health service, tailoring to local needs

• Research partnership with local universities

• Providing consultancy to other stroke services and orchestras wishing to develop similar programmes



• Finding shared language(s)

• Unpicking competing objectives/politics

• Navigating opposing timelines – funding, protocols, feasibility, research, etc.

• Ensuring balance between clinical and musical dimensions – staff must feel empowered to be experts

Key Challenges



• Top-down support to get things going; on the ground staff to make things run

• Evidence is paramount

• Programmes must be responsive – both in delivery and design

• Better music = better therapy

• Power of peer support and self-management

Key Learnings





With thanks to our partners in Hull and Staffordshire:

Acknowledgments

And our many funders:Garfield Weston Foundation, Stavros Niarchos Foundation, The Dunhill Medical Trust, The Kirby Laing Foundation, The Rayne Foundation, The Austin and Hope Pilkington Trust and Hull & East Riding Charitable Trust



References & Further ReadingAltenmüller E, Marco-Pallares J, Münte TF, Schneider S. Neural reorganization underlies improvement in stroke-induced motor dysfunction by music supported therapy. Ann NY Acad Sci. 2009 Jul;1169(1):395–405. http://doi.org/10.1111/j.1749-6632.2009.04580.x

Amengual, J. L., Rojo, N., Veciana de Las Heras, M., Marco-Pallarés, J., Grau-Sánchez, J., Schneider, S., Rodríguez-Fornells, A. Sensorimotor plasticity after music-supported therapy in chronic stroke patients revealed by TMS. PLoS ONE. 2013;8:e61883. http://doi.org/10.1371/journal.pone.0061883

Bernardi NF, Cioffi MC, Ronchi R, Maravita A, Bricolo E, Zigiotto L, Perucca L, Vallar G. Improving left spatial neglect through music scale playing. J Neuropsychol. 2017 Mar;11(1):135–158. http://doi.org/10.1111/jnp.12078

Bradt J, Magee WL, Dileo C, Wheeler BL, McGilloway E. Music therapy for acquired brain injury. Cochrane Database Syst Rev. 2010 Jul 07;(7):CD006787.

Cowdell F, Garrett D. Recreation in stroke rehabilitation part one: a review of the literature. Int J Ther Rehabil. 2003;10(9).

Grau-Sánchez J, Amengual JL, Rojo N, Veciana de las Heras M, Montero J, Rubio F, Altenmüller E, Münte TF, Rodríguez-Fornells A. Plasticity in the sensorimotor cortex induced by Music-supported therapy in stroke patients: a TMS study. Front Hum Neurosci. 2013;7:494. http://doi.org/10.3389/fnhum.2013.00494

Kim DS, Park YG, Choi JH, Im SH, Jung KJ, Cha YA, Jung CO, Yoon YH. Effects of music therapy on mood in stroke patients. Yonsei Med J. 2011;52(6):977–981. http://doi.org/10.3349/ymj.2011.52.6.977

Magee W, Clark I, Tamplin J, Bradt J. Music Interventions for Acquired Brain Injury: Findings From a Cochrane Review. Arch Phys Med Rehabil. 2017 Oct;98(10):e135. http://doi.org/10.1016/j.apmr.2017.08.441

Nicholson CM, Wilson M. Experiences of a group creative music-making intervention to support multidisciplinary stroke rehabilitation. Int J Ther Rehabil. 2018 June;25(6):292-300. http://doi.org/10.12968/ijtr.2018.25.6.292

http://doi.org/10.3349/ymj.2011.52.6.977



References & Further ReadingOouchida, Y., Suzuki, E., Aizu, N., Takeuchi, N. and Izumi, S. 2013. Applications of observational learning in neurorehabilitation. Int. J. Phys. Med. Rehabil, vol. 1, no. 5.

Perruzza N, Kinsella EA. Creative arts occupations in therapeutic practice: a review of the literature. Br J Occup Ther. 2010 Jun;73(6):261–268. http://doi.org/10.4276/030802210X12759925468943

Poćwierz-Marciniak I. Music therapy in the rehabilitation of a stroke patient. Acta Neuropsychologica. 2014;12(1):85–102.

Raglio A, Fazio P, Imbriani C, Granieri E. Neuroscientific basis and effectiveness of music and music therapy in neuromotorrehabilitation. OA Alternative Medicine. 2013 Apr;1(1):8. http://doi.org/10.13172/2052-7845-1-1-537

Rodriguez-Fornells A, Rojo N, Amengual JL, Ripollés P, Altenmüller E, Münte TF. The involvement of audio-motor coupling in the music-supported therapy applied to stroke patients. Ann N Y Acad Sci. 2012 Apr;1252(1):282–293. http://doi.org/10.1111/j.1749-6632.2011.06425.x

Särkämö T, Laitinen S, Tervaniemi M, Numminen A, Kurki M, Rantanen P. Music, emotion, and dementia: insight from neuroscientific and clinical research. Music Med. 2012 Jul 01;4(3):153–162. http://doi.org/10.1177/1943862112445323

Särkämö T, Ripollés P, Vepsäläinen H, Autti T, Silvennoinen HM, Salli E, Laitinen S, Forsblom A, Soinila S, Rodríguez-Fornells A. Structural changes induced by daily music listening in the recovering brain after middle cerebral artery stroke: a voxelbasedmorphometry study. Front Hum Neurosci. 2014 Apr 17;8:245.

Särkämö T. Music for the ageing brain: Cognitive, emotional, social, and neural benefits of musical leisure activities in stroke and dementia. Dementia (London). 2017 Jan 01;DOI:1471301217729237.

Tsai PL, Chen MC, Huang YT, Lin KC, Chen KL, Hsu YW. Listening to classical music ameliorates unilateral neglect after stroke. Am J Occup Ther. 2013 May 01;67(3):328–335. http://doi.org/10.5014/ajot.2013.006312

van Wijck F, Knox D, Dodds C, Cassidy G, Alexander G, MacDonald R. Making music after stroke: using musical activities to enhance arm function. Ann NY Acad Sci. 2012 Apr;1252(1):305–311. http://doi.org/10.1111/j.1749-6632.2011.06403.x

http://doi.org/10.1177/1943862112445323

http://doi.org/10.5014/ajot.2013.006312



To follow the progress of STROKESTRA®, visit:

www.rpo.co.uk/strokestra

Guardian Film ‘Hitting the Right Note’

Or follow us on Twitter:

@rpoonline #STROKESTRA

@CHCPHull @mpftnhs @KeeleAHP

Contact details:

Lisa Rodio

[email protected]

Thank You!

http://www.rpo.co.uk/strokestra

https://www.youtube.com/watch?v=ZIYpkD5oYec

mailto:[email protected]

Documents

STROKESTRA®: Holistic Stroke Rehabilitation through ......Dementia (London). 2017 Jan 01;DOI:1471301217729237. Tsai PL, Chen MC, Huang YT, Lin KC, Chen KL, Hsu YW. Listening to classical