A tailored music therapy and real time biofeedback

A tailored music therapy and real -time bio-feedback mobile phone app to promote motor rehabilitation following neurotrauma

Research team A/Prof Michael Rosenberg (Health Promotion) Katherine Hankinson (health promotion, software engineer, neuroscientist and clinician) Dr Alex Shaykevich (biofeedback and Software Engineer) Music biofeedback App A/Prof Chris Etherton-Beer (Clinician - stroke rehabilitation) A/Prof Jennifer Rodger (Neuroscience – small animals) Dr Anne-Maree Vallence (Neuroscience - Humans)

It was a dark and rainy night…

Rhythmic Acoustic Stimulation Why is music particularly beneficial in physical rehabilitation? * i. Auditory-Motor Coupling ii. Priming of the Auditory-Motor Pathway iii. Cuing of the Movement Period iv. Stepwise Limit Cycle Entrainment *Thaut MH. Rhythm, Music, and the Brain: Scientific Foundations and Clinical Applications. Routledge; 2005.

IT’S FUN!!

Can we make it better? ü Missing feedback ² Provides the receiver with a knowledge of result (KR), vital for motor learning* ü Missing automation and measurement. ü What do you we have to play with? ? Wire l Sens ess ors le Mobi gy olo Techn Low acc level e per ss to so mu nal sic A New Mobile Feedback Instrument Magill, R. A. (2001). Augmented feedback in motor skill acquisition. In G. Tenenbaum & R. C. Eklund (Eds. ), Handbook of Sport Psychology (pp. 86– 114). New York: Wiley.

Got. Rhythm App i. iii. iv. v. Runs on i. OS mobile devices Supports multiple wireless sensors Provides real-time feedback Accesses personal i. Tunes music and adjusts tempo Measures motor-music synchrony (eg. foot or finger tapping to the beat) vi. Records high-resolution session data for offline analysis.

Patient Monitoring

Towards an Ecosystem Adherence Social Support $ Savings Clinical Practice Analytics Research

Music entrainment and brain plasticity The University of Western Australia

Plasticity The ability of the brain to change, structurally and functionally, with experience § Modification of synaptic strength – Long-term potentiation / long-term depression Underlies learning and memory across the lifespan Aid in recovery of function following injury

We can use transcranial magnetic stimulation (TMS) to measure plasticity in humans Motor evoked potential (MEP)

TMS to measure synaptic plasticity

TMS to measure synaptic plasticity § MEP reflects transynaptic output from pyramidal cells § A change in synaptic strength (within the cortical network activated by the stimulus) will be reflected in the MEP amplitude § Change in MEP amplitude can be used as a measure of synaptic plasticity Hallett 2007, Neuron

Motor training induces synaptic plasticity in the primary motor cortex (M 1) Controls the muscles of the body § Responsible for the execution of motor plans M 1 plays an important role in motor learning

Motor training induces synaptic plasticity in the primary motor cortex (M 1) TMS to the cortical representation of the thumb - Measure the direction of the evoked movement Classen et al. 1998 Journal of Neurophysiology

Motor training induces synaptic plasticity in the primary motor cortex (M 1) Classen et al. 1998 Journal of Neurophysiology

Rhythm in the brain A network of neural areas regularly implicated in processing of musical rhythm • • • Basal ganglia Cerebellum Parietal cortex Prefrontal cortex Premotor cortex and supplementary motor area

Rhythm in the brain A network of neural areas regularly implicated in processing of musical rhythm • Basal ganglia - motor control, action selection, and learning • Cerebellum - coordination and fine-tuning of movement by integrating sensory and motor information • Parietal cortex • Prefrontal cortex • Premotor cortex and supplementary motor area - planning, voluntary control, and execution of movement – Strongly interconnected with the basal ganglia and cerebellum All interconnected with M 1 and influence M 1 output

TMS to measure synaptic plasticity associated with training using Got. Rhythm § MEP reflects transynaptic output from pyramidal cells § A change in synaptic strength (within the cortical network activated by the stimulus) will be reflected in the MEP amplitude § Change in MEP amplitude can be used as a measure of synaptic plasticity Hallett 2007, Neuron

Got. Rythm testing

Adherence to the Got. Rhthym App will exceed 90% amongst participant drawn from a general population Acoustic feedback General adult population Acoustic feedback with music No feedback with music

Training with Got. Rhythm will induce greater and longer lasting changes in functional neuroplasticity compared to control motor training tasks Acoustic feedback with music Typical adult Control motor training Baseline 10 minutes 30 minutes

Training with Got. Rhythm will induce changes in functional neuroplasticity compared to control motor training tasks amongst neurologically impaired adults Usual treatment + Acoustic feedback with music Neurologically impaired population Usual treatment + control motor training Baseline Fugl-Meyer Assessment of Motor Recovery Post-test Fugl-Meyer Assessment of Motor Recovery

http: //www. populationhealthlinks. com/community-health. html

References • • Chen, J. L. , Penhune, V. B. , & Zatorre, R. J. (2008). Listening to Musical Rhythms Recruits Motor Regions of the Brain. Cerebral Cortex, 18(12), 2844– 2854. De Bruin, N. , Doan, J. , & Turnbull, G. (2010). Walking with Music Is a Safe and Viable Tool for Gait Training in Parkinson's Disease: The Effect of a 13 -Week Feasibility Study on Single and Dual Task Walking. Parkinson's Disease, 10, 1– 9. Grahn, J. , & Brett, M. (2007). Rhythm and Beat Perception in Motor Areas of the Brain. Journal of Cognitive Neuroscience, 19(5), 893– 906. Hausdorff, J. M. , Lowenthal, J. , Herman, T. , Gruendlinger, L. , Peretz, C. , & Giladi, N. (2007). Rhythmic Auditory Stimulation Modulates Gait Variability in Parkinson's Disease. European Journal of Neuroscience, 26(8), 2369– 2375. Hove, M. J. , Suzuki, K. , Uchitomi, H. , Orimo, S. , & Miyake, Y. (2012). Interactive Rhythmic Auditory Stimulation Reinstates Natural 1/f Timing in Gait of Parkinson's Patients. PLo. S ONE, 7(3), e 32600. Lim, H. A. , Miller, K. , & Fabian, C. (2011). The Effects of Therapeutic Instrumental Music Performance on Endurance Level, Self-Perceived Fatigue Level, and Self- Perceived Exertion of Inpatients in Physical Rehabilitation. Journal of Music Therapy, 48(2), 124– 148. Thaut, M. H. , & Abiru, M. (2010). Rhythmic Auditory Stimulation in Rehabilitation of Movement Disorders: A Review Of Current Research. Music Perception, 27(4), 263– 269. Thaut, M. H. (2005). Rhythm, Music, and the Brain: Scientific Foundations and Clinical Applications (Vol. 7). Routledge.