Summary: Musical therapy can help to improve fine motor skills in patients with Parkinson’s disease.
Source: University of Colorado
The old poem says that music soothes the savage beast, but Isabelle Buard, PhD, is conducting research to find out if music can also soothe the effects of Parkinson’s disease on fine motor skills.
Buard, an assistant research professor in the Department of Neurology in the University of Colorado School of Medicine, recently published the protocols for her study evaluating the effects on Parkinson’s patients of a specific type of music-based rehabilitative therapy called neurologic music therapy. The therapy uses specific combinations of rhythm and movement to “reprogram” certain frequencies in the brain.
“In Parkinson’s, beta frequencies are the most likely to being impaired,” Buard says. “The idea of the study is to use external rhythms that specifically target those frequencies by entraining them to a different level, modulating them to restore some kind of homeostasis in brain activity.”
Tone and tempo
In Buard’s study, which is funded by the National Institutes of Health, music therapists work with Parkinson’s patients three times a week. Sessions start with dexterity exercises and rhythmic hand and finger movements; patients then use percussion instruments called castanets and a weighted keyboard to further increase dexterity and fine motor skills. During the other four days of the week, patients do the exercises at home. Tempos increase each week of treatment.
Buard has randomized her study into four groups, one that gets no therapy at all, one that gets standard-of-care occupational therapy, one that gets neurologic music therapy in which the patient dictates the rhythm through their own movements, and one that gets neurologic music therapy in which the rhythm is dictated by a metronome, a device musicians use to keep a steady tempo.
Her hypothesis is that patients in the group using the metronome will see the most improvement, as “external rhythmic cueing” seems to have the ability to bypass certain damaged neural pathways in Parkinson’s patients and help the motor brain execute a proper movement sequence.
“The idea is that if you’re doing internally generated movements, you rely on motor neuronal loops that are impaired in Parkinson’s, so you have some problems doing movements, or they are slow and not coordinated,” she says.
“When your movement is driven by external rhythms, then the movement seems to be easier to perform. I’m looking at the networks that are mobilized during internally versus externally driven movement and trying to disentangle which different aspect is meaningful in terms of mobilization of brain networks.”
Getting creative and the road to a standardized therapy
Another component of the neurologic music therapy sessions whether or not they use externally driven movements, is a period of time where patients can improvise at the piano.
“We don’t really know why or how, but there’s a big emotional contentment component that comes with producing music. It seems to increase quality of life for some people,” she says. “A lot of people feel very uncomfortable improvising at the beginning, but by the end, they’re very much liking it.”
Buard and her team plan to collect data throughout the study, measuring finger dexterity through a “grooved pegboard test” that requires a series of 25 pegs to be rotated into certain positions to be placed correctly. They will measure quality of life and anxiety and depression levels as well.
The mechanistic data collected may inform future research leading to treatment and rehabilitative interventions for patients with Parkinson’s and other basal ganglia disorders, and possibly other neurologic diseases, Buard says — it may also further knowledge of the neural processes utilized by music.
For patients with Parkinson’s, she hopes the study eventually leads to a standardized musical intervention to help improve fine motor skills.
“Right now, if you have fine motor difficulties due to Parkinson’s, your medications are not helping with that,” Buard says. “The medications help with gait and balance, and some medications help with tremors. But fine motor skills are not really handled well by medication therapy. It’s really a symptomatic approach, so if we find that it’s effective for Parkinson’s, we will do a larger clinical trial so that music therapy can be further approved as one of the clinical therapies for fine motor skills.”
Randomized controlled trial of neurologic music therapy in Parkinson’s disease: research rehabilitation protocols for mechanistic and clinical investigations
Presently available medications and surgical treatments for Parkinson’s disease have limited effects on fine motor problems and often leave patients with significant fine motor disability. Standard of care occupational therapy (OT) yields low efficacy, potentially due to a lack of standard protocols. Neurologic music therapy (NMT) techniques, especially rhythmic auditory stimulation which relies on interaction between rhythm and movement, have shown to be effective in PD gait rehabilitation possibly through their reliance on neural pathways that are not affected by PD. Therapeutic instrumental music performance (TIMP) is one other NMT technique that holds promise but which mode of action and efficacy has not been investigated in PD yet.
One hundred PD participants will be randomly assigned to receive 15 sessions of either TIMP with rhythm or TIMP without rhythm, standard of care OT, or to be waitlisted (control) over 5 consecutive weeks. Brain oscillatory responses will be collected using magnetoencephalography during an auditory-motor task to understand the underlying mechanisms. The Grooved Pegboard, the UPDRS III finger tap, and the finger-thumb opposition will be assessed to investigate clinical changes related to fine motor function. This project will also serve to confirm or refute our pilot data findings suggesting NMT relies on compensatory brain networks utilized by the PD brain to bypass the dysfunctional basal ganglia.
This study aims to use standardized TIMP and OT research protocols for investigating the neuronal pathways utilized by each intervention and possibly study their efficacy with respect to fine motor rehabilitation via a randomized control trial in the PD population.
ClinicalTrials.gov NCT03049033. Registered on September 29, 2020