Music as an acoustic neuromodulation tool in physiotherapy post-stroke: a case study

Abstract

Introduction: One of the Physiotherapist objectives is the identification of neuromotor circuits that can be reactivated after the Stroke. The selection of motor and sensory modeling pathways that contribute to the recovery of impaired movements [1] depends on the acquired neuromotor learning throughout life [2]. In this approach, the stimulation of automatic gestures is paramount. In addition, rhythmic auditory stimuli, such as music, have been associated with optimized motor responses following brain injury [3,4]. Subsequently, exposing individuals to familiar and proper music can re-activate movements, which generate patterns previously learned, such as dance. Materials and methods: A 47-year-old man, native of Cape Verde, with the diagnosis of stroke, underwent a decompressive craniotomy, with 4-month. He presented hemiparesis of the right hemisphere and aphasia. During the physiotherapy sessions he underwent sensorineural stimulation to reactivate automatic motor circuits. This was accomplished through exposure to familiar music sound, in order to reactivate the standard automatic dance motor, learned before brain injury. The motion analysis was performed by direct observation and recorded through video, orthostatic position and gait phases, at the following moments: before, during and after neurosensory stimulation (music). This study follows all the principles of the Declaration of Helsinki. Results: There was an increase in gait velocity (during and after neurosensory stimulation), as well as an increase in the activation of the dorsal flexors (paretic lower limb) during the oscillating phase. In the qualitative observation, the optimization of the orthostatic position was verified, namely in the weight transfer capacity, for the paretic lower limb. Discussion and conclusions: The interaction of the automatic motor gestures reactivation with the neurosensorial stimulation, in the scope of Physiotherapy promotes a reflection on the current clinical practice. It is important to consider the possible relevance of investing and developing approaches that focus more on the specialization of stimuli applied to the recovery of the individual with stroke. The results found in this clinical case can be based on the fact that the hearing of rhythmic sounds induced by music trigger the motor centers of the basal ganglia, also theoretically associated with the neural circuits of the automatic movements. To better understand these mechanisms, and fundament as an intervention tool, it will be necessary to develop research on sensorineural stimulation in the reactivation of automatic motor circuits after stroke.