Abstract
Background: Technology-assisted home programs offer a promising approach to expanding access to rehabilitation, but may be limited by low patient compliance. Music-based therapy has been shown to enhance motivation and support holistic stroke recovery. Integrating music into technology-assisted home programs may improve adherence and amplify therapeutic benefits. To better understand how technology-assisted music-based therapy supports stroke recovery, it is important to identify features that promote high compliance and positive outcomes.
Aim: This pilot study examined the impact of accompaniment music on home rehabilitation compliance and motor performance during app-assisted music-based therapy in stroke survivors.
Methods: Six community-dwelling adults with chronic stroke completed a 2-week, within-subject study using KeyStroke, a stroke-specific music-based therapy app designed for self-directed upper extremity home exercise. Participants practiced piano-based song exercises under two alternating conditions: Music Mode (with accompaniment music) and Non-Music Mode (without accompaniment music). Two outcomes were analyzed: (1) total engagement time, measuring app usage as a proxy for home rehabilitation compliance, and (2) mean absolute delta time, assessing timing accuracy as an indicator of motor performance. Data were further categorized by the hand-use requirements of each song: more-affected hand only, less-affected hand only, and bimanual practice.
Results: Participants used the app for an average of ~30 minutes per day, 4-5 days per week over two weeks (4.51 ± 3.67 total hours), with an average total of ~14,000 keypresses. Total engagement times were higher in Music Mode than in Non-Music Mode across categories, with a particularly consistent result across participants for songs targeting the more-affected hand. Mean absolute delta times were also consistently better in Music Mode across all song categories. Notably, the training elicited a high volume of repetitions (~1,555 keypresses within 30 minutes), exceeding typical levels seen in outpatient clinics and approaching thresholds believed to promote neuroplasticity.
Conclusion: App-assisted music-based therapy with accompaniment music may support higher training compliance and improve motor performance in stroke rehabilitation. Background music may engage feedforward motor planning and enrich the rehabilitation experience. Although findings are preliminary due to the small, heterogeneous sample, they offer promising direction for future studies and app refinements targeting upper extremity recovery post-stroke.