Faculty of Music, Music and Health Science Research Collaboratory, University of Toronto, Toronto, Canada.
Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.
NeuroRehabilitation. 2021;48(2):195-208. doi: 10.3233/NRE-208014.
The burden of post-stroke cognitive impairment, as well as affective disorders, remains persistently high. With improved stroke survival rates and increasing life expectancy, there is a need for effective interventions to facilitate remediation of neurocognitive impairments and post-stroke mood disorders.
To investigate the effects of Therapeutic Instrumental Music Performance (TIMP) training with and without Motor Imagery on cognitive functioning and affective responding in chronic post-stroke individuals.
Thirty chronic post-stroke, community-dwelling participants were randomized to one of three experimental arms: (1) 45 minutes of active TIMP, (2) 30 minutes of active TIMP followed by 15 minutes of metronome-cued motor imagery (TIMP+cMI), (3) 30 minutes of active TIMP followed by 15 minutes of motor imagery without cues (TIMP+MI). Training took place three times a week for three weeks, using a selection of acoustic and electronic instruments. Assessments, administered at two baselines and post-training, included the Trail Making Test (TMT) - Part B to assess mental flexibility, the Digit Span Test (DST) to determine short-term memory capacity, the Multiple Affect Adjective Checklist - Revised (MAACL-R) to ascertain current affective state, and the General Self-Efficacy Scale (GSE) to assess perceived self-efficacy. The Self-Assessment Maniqin (SAM) was also administered prior to and following each training session.
Thirty participants completed the protocol, ten per arm [14 women; mean age = 55.9; mean time post-stroke = 66.9 months]. There were no statistically significant differences between pooled group baseline measures. The TIMP+MI group showed a statistically significant decrease in time from pre-test 2 to post-test on the TMT. The TIMP group showed a significant increase on MAACL sensation seeking scores, as well as on the Valence and Dominance portions of the SAM; TIMP+cMI showed respective increases and decreases in positive and negative affect on the MAACL, and increases on the Valence, Dominance, and Arousal portions of the SAM. No statistically significant association between cognitive and affective measures was obtained.
The mental flexibility aspect of executive functioning appears to be enhanced by therapeutic instrumental music training in conjunction with motor imagery, possibly due to multisensory integration and consolidation of representations through motor imagery rehearsal following active practice. Active training using musical instruments appears to have a positive impact on affective responding; however, these changes occurred independently of improvements to cognition.
脑卒中后认知障碍和情感障碍的负担仍然很高。随着脑卒中患者生存率的提高和预期寿命的延长，需要有效的干预措施来促进神经认知障碍和脑卒中后情绪障碍的康复。
研究治疗性乐器演奏（TIMP）训练结合和不结合运动想象对慢性脑卒中患者认知功能和情感反应的影响。
30 名慢性脑卒中、社区居住的参与者被随机分配到三个实验组之一：（1）45 分钟主动 TIMP，（2）30 分钟主动 TIMP 后 15 分钟节拍器引导的运动想象（TIMP+cMI），（3）30 分钟主动 TIMP 后 15 分钟无提示的运动想象（TIMP+MI）。训练每周进行三次，为期三周，使用一系列声学和电子乐器。在两次基线和训练后进行评估，包括连线测试 B（TMT-B）评估思维灵活性、数字跨度测试（DST）评估短期记忆容量、多情感形容词检查表修订版（MAACL-R）评估当前情感状态以及一般自我效能感量表（GSE）评估自我效能感。在每次训练前后还进行了自我评估曼尼（SAM）测试。
30 名参与者完成了方案，每组 10 名[14 名女性；平均年龄 55.9 岁；平均脑卒中后时间 66.9 个月]。 pooled group baseline measures 之间没有统计学上的显著差异。TIMP+MI 组在 TMT 预测试 2 到 post-test 的时间上有统计学上的显著减少。TIMP 组在 MAACL 感觉寻求评分上以及 SAM 的 Valence 和 Dominance 部分上有显著增加；TIMP+cMI 在 MAACL 上分别表现出积极和消极影响的增加和减少，以及 SAM 的 Valence、Dominance 和 Arousal 部分的增加。没有获得认知和情感测量之间的统计学上显著关联。
治疗性乐器演奏训练结合运动想象似乎增强了执行功能的思维灵活性，这可能是由于多感觉整合和通过主动练习后的运动想象排练巩固了代表。使用乐器进行主动训练似乎对情感反应有积极影响；然而，这些变化与认知的改善无关。
