Melbourne Conservatorium of Music - Theses

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Author: Silveira, Tanya Marie × End date: 2022 × Start date: 2020 × Type: PhD thesis × Subject: music therapy ×

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    Accessible therapeutic music-making for stroke survivors with significant arm and hand weakness: A mixed-methods study
    Silveira, Tanya Marie ( 2022)
    This thesis with publication presents the results of the mixed methods study exploring a novel music therapy intervention for stroke survivors with significant weakness to their arm and hand. Using a mixed methods experimental design, with an explanatory sequential core, this randomised controlled trial sought to examine the holistic impact of a 4-week intervention protocol using functional electrical stimulation (FES) together with an iPad-based instrument (ThumbJam) on stroke survivors’ upper limb function and wellbeing outcomes. Recognising the need for more accessible approaches to music-making with this subset of stroke survivors, the intervention protocol was developed using collaborative processes drawing on knowledge from the disciplines of physiotherapy, occupational therapy and music therapy. After securing ethics clearances, recruitment commenced across five hospitals in Sydney, Australia, aiming to recruit a target sample of 40. Fourteen participants were recruited and randomised to receive usual treatment (n=8) or the daily FES+iPad-based music therapy intervention as an addition to usual treatment (n=6) for four weeks (20 sessions). Masked assessors administered the standardised measures of upper limb function and self-report wellbeing questionnaires at three time points (pre- and post- the intervention period, and at three months follow up). All participants were also interviewed at the post-intervention period regarding their perception of how their received treatment supported their overall recovery. The Motor Assessment Scale (MAS-UL) was the primary outcome for arm/hand function. The other measures of arm/hand function included the Manual Muscle Test (MMT-UL), 9-hole-peg test (9HPT) and grip dynamometry. The Depression Anxiety and Stress Scale (DASS-21), and the Stroke Self-efficacy Questionnaire (SSEQ) were used to measure wellbeing. As this study was underpowered, mean change scores, confidence intervals and effect sizes (Hedges’ g) were calculated and reported. The intervention group showed greater improvements than control on all upper limb measures, with between group differences on the MAS-UL change score of 2.08 (95% CI -2.08, 6.96; g = 0.5), 0.05 for the 9HPT (95% CI -0.13, 0.23; g = 0.32), 3.33 for the MMT-UL (95% CI -1.26, 7.93; g = 0.85), and 3.68 for grip dynamometer (95% CI -0.70, 8.07; g = 0.99). The intervention group also showed greater decreases in anxiety (between group difference: -1.83; 95% CI -7.63, 3.97; g = 0.37), but lesser reductions in depression (2.25; 95% CI -7.71, 12.21, g = 0.27). There were no notable differences between groups for stress and self-efficacy. Reflexive thematic analysis of the qualitative interview data revealed different reflections about the treatment received by each group, with intervention participant themes focusing on their perceived improvement in upper limb function and strength, as well as the motivating and relaxing aspects of musical engagement. These integrated findings suggest that FES+iPad-based music therapy has the potential to simultaneously improve post-stroke upper limb function and wellbeing. Therefore, this pilot study supports the need for future research that is adequately powered for efficacy testing.