title: The role of auditory feedback in music-supported stroke rehabilitation: A single-blinded randomised controlled intervention.
abstract: OBJECTIVE
  Learning to play musical instruments such as piano was previously shown to benefit post-stroke motor rehabilitation. Previous work hypothesised that the mechanism of this rehabilitation is that patients use auditory feedback to correct their movements and therefore show motor learning. We tested this hypothesis by manipulating the auditory feedback timing in a way that should disrupt such error-based learning.
  
  
  METHODS
  We contrasted a patient group undergoing music-supported therapy on a piano that emits sounds immediately (as in previous studies) with a group whose sounds are presented after a jittered delay. The delay was not noticeable to patients. Thirty-four patients in early stroke rehabilitation with moderate motor impairment and no previous musical background learned to play the piano using simple finger exercises and familiar children's songs.
  
  
  RESULTS
  Rehabilitation outcome was not impaired in the jitter group relative to the normal group. Conversely, some clinical tests suggests the jitter group outperformed the normal group.
  
  
  CONCLUSIONS
  Auditory feedback-based motor learning is not the beneficial mechanism of music-supported therapy. Immediate auditory feedback therapy may be suboptimal. Jittered delay may increase efficacy of the proposed therapy and allow patients to fully benefit from motivational factors of music training. Our study shows a novel way to test hypotheses concerning music training in a single-blinded way, which is an important improvement over existing unblinded tests of music interventions.
authors.affiliation: Institute of Music Physiology and Musicians' Medicine, University of Music, Drama and Media, Emmichplatz, Hannover, Germany.|Lyon Neuroscience Research Center, Auditory Cognition and Psychoacoustics Team, CNRS-UMR 5292, INSERM U1028, University Lyon-1, 50 av Tony Garnier, Lyon, France.
authors.forename: F T
authors.initials: FT
authors.lastname: van Vugt
authors.affiliation: Institute of Music Physiology and Musicians' Medicine, University of Music, Drama and Media, Emmichplatz, Hannover, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Kafczyk
authors.affiliation: Institute of Music Physiology and Musicians' Medicine, University of Music, Drama and Media, Emmichplatz, Hannover, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Kuhn
authors.affiliation: Institute for Neurorehabilitational Research (InFo), BDH-Clinic Teaching Hospital of Hannover Medical School (MHH), Greitstrasse 18, Hessisch Oldendorf, Germany.
authors.forename: J D
authors.initials: JD
authors.lastname: Rollnik
authors.affiliation: Lyon Neuroscience Research Center, Auditory Cognition and Psychoacoustics Team, CNRS-UMR 5292, INSERM U1028, University Lyon-1, 50 av Tony Garnier, Lyon, France.
authors.forename: B
authors.initials: B
authors.lastname: Tillmann
authors.affiliation: Institute of Music Physiology and Musicians' Medicine, University of Music, Drama and Media, Emmichplatz, Hannover, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Altenmüller
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001307:Auditory Perception / Q000502:physiology*; D056228:Feedback, Sensory / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology*; D009048:Motor Skills / Q000502:physiology*; D011569:Psychiatric Status Rating Scales; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D000071939:Stroke Rehabilitation / Q000379:methods*
keywords: Stroke rehabilitation; auditory feedback; motor learning; music intervention; sensorimotor integration; timing