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

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

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? 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?? 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. Mobile Technology Wireless Sensors Low level access to personal music A New Mobile Feedback Instrument A New Mobile Feedback Instrument

GotRhythm App i.Runs on iOS mobile devices ii.Supports multiple wireless sensors iii.Provides real-time feedback iv.Accesses personal iTunes music and adjusts tempo v.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 Social Support Analytics Research Clinical Practice Clinical Practice $ Savings

The University of Western Australia Music entrainment and brain 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 Plasticity

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

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 TMS to measure synaptic plasticity

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

TMS to the cortical representation of the thumb -Measure the direction of the evoked movement Classen et al Journal of Neurophysiology Motor training induces synaptic plasticity in the primary motor cortex (M1)

Classen et al Journal of Neurophysiology Motor training induces synaptic plasticity in the primary motor cortex (M1)

Classen et al Journal of Neurophysiology Motor training induces synaptic plasticity in the primary motor cortex (M1)

Classen et al Journal of Neurophysiology Motor training induces synaptic plasticity in the primary motor cortex (M1)

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 Rhythm in the brain

 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 TMS to measure synaptic plasticity associated with training using GotRhythm

GotRythm testing

Adherence to the GotRhthym App will exceed 90% amongst participant drawn from a general population General adult population Acoustic feedback 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 Typical adult Acoustic feedback with music Control motor training Baseline 30 minutes 10 minutes

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

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. PLoS ONE, 7(3), e 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.