GotRhythm: A tailored music therapy and real-time biofeedback mobile phone app to promote rehabilitation following stroke

INTERVENTION: Intervention: a novel mobile software application –“GotRhythm” – uses mobiles and wireless wearable sensors to deliver music‐motor therapy to patients with real‐time feedback of movement data to the patient via the application to enhance motivation and compliance. It incorporates individualised music, wearable sensors and biofeedback to deliver a simple and inexpensive rhythmic auditory stimulation (RAS) motor training protocol to patients. As a person completes training tasks, GotRhythm collects data relating to motion and movement accuracy and provides information on motor performance (via the application) that can be correlated with any physiological response elicited by the app. GotRhythm is capable of supporting a wide array of sensors to support a variety of physical modalities including both upper and lower limb tracking as well as gross and fine motor skills. Location of intervention: The training will take place under supervision at the stroke rehabilitation clinic (either inpatient or outpatient) at the hospital at which the participant is a patient/outpatient. GotRhythm training will be tailored to the participant’s specific injury in consultation with the clinicians at the hospital at which they are a patient/outpatient (Bentley, Fiona Stanley or Fremantle Hospitals). Training will be in addition to the usual stroke rehabilitation programme recommended by their clinician throughout the study period. Usual stroke rehabilitation does not include rhythmic auditory stimulation (RAS) and these patients will not receive any GotRhythm training. The procedures, mode of delivery, materials and who does the intervention: A series of participant‐specific movement tasks focusing on different body parts will be created to match the rehabilitation goals of each patient. Movements such as grasping, knee, elbow and wrist flexion and extension, as well as walking, can all be accommodated within the GotRhythm system. Patients will wear non‐intrusive sensors on the relevant body part that link wirelessly to the app. An allied health professional in the rehabilitation clinic will control the GotRhythm training by assigning a suitable rhythm (beats per minute) for each participant, using songs chosen by the participant. Beat speed will be adjusted to suit each patient’s abilities during a session and also progressively over the 6‐week intervention period. Frequency of intervention and assessments/data collected: Participants in the intervention group will receive 6‐weeks of intervention consisting of a supervised, 20minute music entrainment session conducted three (3) times each week for six (6) weeks. There will be 2 blocks of therapy: 1. Therapy block 1 ‐ 3 x 20mins/wk x 3 weeks = total of 9 sessions 2. Therapy block 2 ‐ 3 x 20mins/wk x 3 weeks = total of 9 sessions Participants will therefore receive a total of 18 sessions (= 360mins of therapy in total). Each session is identical, and there are no differences between the sessions in Therapy Blocks 1 & 2. It is likely these sessions will be conducted on Monday/Wednesday/Friday of each week. Block 2 will follow straight on from Block 1 (following the schedule of sessions). We will look at i) compliance with the intervention ii) improvement in targeted motor task and iii) generalisation of sensory motor control. The data collected, and schedule of assessments is summarised in Figure 1 (uploaded as attachment on ANZCTR registration form) CONDITION: stroke PRIMARY OUTCOME: Compliance with the intervention: GotRhythm records the length of time each patient engages with the app. ; ; ; ; ; ; ; ; Targeted motor task: We will assess music‐motor synchrony using the in‐built measures of GotRhythm by measuring the proportion of motor task repetitions that match app metronome. Participants will be assessed at i) baseline (0 weeks), ii) mid intervention point (+3 weeks) and iii) the end of the intervention period (+6 weeks). The mid‐point assessment will be conducted after the final session of Block 1. ; We will track each participant’s progress and their adherence to their rehabilitation program by recording minutes engaged with the app for each therapy session. This will give total minutes engaged for Therapy Block 1 and Therapy Block 2 and thus a Total compliance measure ([minutes engaged Block 1+minutes engaged Block 2]/360mins) SECONDARY OUTCOME: Sensory motor control: The Fugl‐Meyer Assessment of Motor Recovery is a stroke‐specific, performance based impairment index that evaluates motor functioning, balance, sensation and joint functioning in patients following stroke. ; ; ; INCLUSION CRITERIA: neurologically impaired adults – specifically, patients who have suffered an acute stroke and are attending outpatients at the stroke clinic.