A tailored music therapy and real-time bio-feedback mobile ...

Click icon to add picture 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. ITS FUN!! Can we make it better? Missing feedback

Provides the receiver with a knowledge of result (KR), vital for motor learning* Missing automation and measurement. What do you we have to play with?? Wire l Sens ess ors

le Mobi y olog Techn Low acc level e per ss to so m u n al

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. 86114). New York: Wiley. GotRhythm App i.

ii. iii. iv. v. Runs on iOS mobile devices Supports multiple wireless sensors Provides real-time feedback Accesses personal iTunes 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 (M1) Controls the muscles of the body Responsible for the execution of motor plans M1 plays an important role in motor learning

Motor training induces synaptic plasticity in the primary motor cortex (M1) 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 (M1)

Classen et al. 1998 Journal of Neurophysiology Motor training induces synaptic plasticity in the primary motor cortex (M1) Classen et al. 1998 Journal of Neurophysiology Motor training induces synaptic plasticity in the primary motor cortex (M1) 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 M1 and influence M1 output TMS to measure synaptic plasticity associated with training using GotRhythm

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 GotRythm testing

Adherence to the GotRhthym 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 GotRhythm 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 GotRhythm 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), 28442854. 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, 19. Grahn, J., & Brett, M. (2007). Rhythm and Beat Perception in Motor Areas of the Brain. Journal of Cognitive Neuroscience, 19(5), 893906. 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), 23692375.

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. PLoS ONE, 7(3), e32600. 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), 124148. Thaut, M. H., & Abiru, M. (2010). Rhythmic Auditory Stimulation in Rehabilitation of Movement Disorders: A Review Of Current Research. Music Perception, 27(4), 263269. Thaut, M. H. (2005). Rhythm, Music, and the Brain: Scientific Foundations and Clinical Applications (Vol. 7). Routledge.