Youre once, twice, three times stepping Music Therapy and - - PowerPoint PPT Presentation

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Youre once, twice, three times stepping Music Therapy and - - PowerPoint PPT Presentation

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Youre once, twice, three times stepping Music Therapy and Physiotherapy Working in Tandem for Gait Rehabilitation 11.05.2017 Taryn Holman tholman@rhn.org.uk Helen Lane hlane@rhn.org.uk 01.11.2016 Background 51 year old female

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‘You’re once, twice, three times stepping’‐ Music Therapy and Physiotherapy Working in Tandem for Gait Rehabilitation 11.05.2017

Taryn Holman tholman@rhn.org.uk Helen Lane hlane@rhn.org.uk

01.11.2016

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Background

  • 51 year old female
  • Clinical Nurse Specialist
  • Left MCA stroke May

2016

  • Admitted to The Royal

Hospital for Neuro‐ disability August 2016

01.11.2016

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01.11.2016

Activity

Assistance of 1 to wash and dress Assistance of 2 and sara steddy to transfer Independent sitting balance

Participation

Role as a clinical nurse specialist Participation in religious activities Married‐ role as a wife

Impairments (Body Structure and functioning)

Aphasia – mainly expressive Dense right hemiparesis affecting arm>leg Vision: Right hemianopia Cognitive impairments Apraxia

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Referral to Music Therapy

  • Primary focus upon speech and expression
  • Melodic Intonation Therapy:

–Expressive aphasia –Good comprehension

  • Rhythmic and melodic shaping
  • Step wise progression
  • Functional use of phrase

01.11.2016

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Linking

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Positive response to Melodic Intonation Therapy Positive response in physical rehabilitation?

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Gait Impairments

  • Lacking symmetry in gait pattern
  • Formal muscle testing‐ flickers of activity right

lower limb

  • Reduced stance phase right lower limb
  • Unable to initiate swing with right lower limb
  • Reduced step length and cadence

01.11.2016

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Neurologic Music Therapy (NMT)

  • ‘The therapeutic application of music to

cognitive, sensory and motor dysfunction due to neurologic disease of the human nervous system’

  • Techniques are directed towards functional

therapeutic goals (Thaut 1999)

06/10/2016 Helen Lane ‘Restorative Music Therapy Techniques’ 06.10.2016

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Neurologic Music Therapy

  • 19 standardised techniques (NMT)

–Sensorimotor –Speech and language –Cognition

  • Intensive training course

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The Technique

  • Sensorimotor realm
  • Patterned Sensory Enhancement

(PSE)

  • External temporal cueing through

music

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PSE Elements

  • Metronome
  • Meter and melody
  • Sung cues

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Sessions

  • Joint sessions with music therapy & physio
  • Partial body weight support (PBWS) gait training

+ FES

  • Aquatic Therapy, motormed bike, plinth based

exercises (+/‐ FES), treadmill training

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01.11.2016

Phase 1: Weight transfers

Music Therapy

Improvised 2/4 melody Dominant to tonic Simple and repetitive Sung cues

Physiotherapy

Improving stance stability + / ‐ FES glutes With and without use of partial body weight support Additional gym sessions

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01.11.2016 Video 1 forward and back.wmv

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Phase 2: Partial bodyweight supported walking

Music Therapy

Adapted familiar song introduced Metronome baseline Waltz meter (3/4)  March (2/4) Sung cues Lyrics

Physiotherapy

Improving stance stability + / ‐ FES glutes Improving swing phase right leg Reduced manual handling for therapists

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Phase 3: Walking with support of two

Music Therapy

Flexible meters Familiar song Therapist modelling

Physiotherapy

Remained challenging Various orthoses trialled to support right stance phase and ankle stability / dorsiflexion

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Outcomes & Reflections

  • Formal outcomes
  • With music versus without in sessions
  • Endurance
  • Fluidity‐ swing phase
  • Patient goal
  • Strength
  • Treadmill
  • Therapist load
  • Mood and motivation

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1 2 3 4 5 6 7 1 Eating 2 Swallowing 3 Grooming 4 Bathing 5 Dressing Upper Body 6 Dressing Lower Body 7 Toileting 8.1 Bladder ‐ Level of assistance 8.2 Bladder ‐ Frequency of accidents 9.1 Bowel ‐ Level of assistance 9.2 Bowel ‐ Frequency of accidents 10 Bed, Chair, Wheelchair transfer 11 Toilet transfer 12 Tub, Shower transfer 13 Car transfer 14.1 Locomotion ‐ Walking "w" 14.2 Locomotion ‐ Wheelchair "c" 15 Stairs 16.1 Community Mobility 17 Comprehension 18 Expression 19 Reading 20 Writing 21 Speech Intelligibility 22 Social Interaction 23 Emotional Status 24 Adjustment to Limitations 25 Leisure Activities 26 Problem Solving 27 Memory 28 Orientation 29 Concentration 30 Safety Awareness

Admission Goal Discharge CAG CAG Evaluation

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Outcomes & Reflections

  • Formal outcomes
  • With music versus without in sessions
  • Endurance
  • Fluidity‐ swing phase
  • Patient goal
  • Strength
  • Treadmill
  • Therapist load
  • Mood and motivation

01.11.2016

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References

PSE / Neurologic Music Therapy

  • Thaut, M (1999) Training Manual for Neurologic Music

Therapy Training Institute

  • Bukowska et al. Neurologic Music Therapy Training for

Mobility and Stability Rehabilitation with Parkinson’s Disease – A Pilot Study. Front Hum Neurosci. 2015; 9: 710.

  • Yoon‐Kyum Shin et al. Effect of Rhythmic Auditory Stimulation
  • n Hemiplegic Gait Patterns. Yonsei Medical Journal. 2015; 56

(6): 1703‐1713 Partial Body Weight Support

01.11.2016