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김세민, 여명선, 김수지 (2020). 척수손상환자의 보행기능 향상을 위한 음악 동조화 자극 적용 사례. 재활복지, 24(4), 235-256.

본 연구는 다양한 음악요소를 활용한 통합적 음악 동조화 자극을 적용한 중재가 척수손상환자의 보행기능에 미치는 영향에 대해 알아보고자 시행되었다. 중재는 총 4명의 척수손상환자를 대상으로 하여 주 3회, 회기 당 30분씩 총 8-10회기에 걸쳐 진행되었으며, 중재 전후로 동작보행검사를 시행하 였다. 중재에 사용된 음악 동조화 자극은 기존 메트로놈 중재와 차별화되도록 선율 및 화성 요소를 반영하여 구성되었다. 중재 결과, 대상자들의 분속 수, 보장시간, 활보장시간 및 시상 면에서의 족관절 운동범위에 개선이 나타났고, 중재 후 대상자들의 분속 수가 제공된 음악자극의 템포와 유사하게 변 화하여 척수손상환자를 대상으로도 동조화 원리가 적용됨을 알 수 있었다. 이러한 결과를 통해 음악 동조화 자극을 적용한 보행훈련이 척수손상환자의 보행기능 개선에 활용될 수 있는 치료적 중재임을 확인하였고, 음악의 리듬 요소 외에 선율 및 화성 요소 역시 동조화 촉진에 중요한 역할을 하고 있음 을 알 수 있었다.

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Kim, S. J., & Yoo, G. E. (2019). Instrument playing as a cognitive intervention task for older adults: A systematic review and meta-analysis. Frontiers in Psychology, 10, 151. doi: 10.3389/fpsyg.2019.00151

The aim of this meta-analysis was to review studies that applied musical instrument playing as an intervention to improve cognitive functioning of older adults with and without cognitive impairment. English-language articles published between 1990 and 2018 were searched using electronic databases. Music therapy journals were also hand searched for relevant research. Inclusion criteria for participants were older adults, ages 60 years and older, and any clinical diagnosis of cognitive impairment had to be due to aging. Searches used combinations of the following keywords: older adults, instrument playing, and cognitive outcomes measures. A total of 10 studies that met the inclusion criteria were included in the final analysis: five studies with healthy older adults, two with older adults with mild cognitive impairment (MCI), two studies with older adults with dementia, and one study with both healthy older adults and older adults with MCI. The results of this meta-analysis demonstrated that different types of cognitive involvement were demanded from instrument playing. Furthermore, depending on the type of involvement, a target cognitive domain was found to be differentially impacted by the instrument playing intervention. This study supports using different types of instrument playing for interventions targeting specific cognitive domains of older adults with varying levels of cognitive aging.

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여명선, 김수지. (2018). 연하장애환자의 후두기능 및 연하관련 삶의 질 향상을 위한 치료적 노래부르기 중심 음악중재사례. 재활복지, 22, 169-194.

The aim of this study is to examine changes in swallowing function and quality of life with therapeutic singing-based music therapy for patients with dysphagia. The music therapy program was based on the previous study (Kim, 2010), and designed to improve breathing, phonation, and swallowing functions focusing on laryngeal elevation. Three patients with dysphagia participated in this study and each participant received a total of 11 or 12 individual music therapy sessions and each session was conducted for 30 minutes. In this study, three kinds of measurements were used. First, the measures of maximum phonation time (MPT), fundamental frequency, average intensity, jitter, shimmer, noise to harmonics ratio (NHR) by Praat test, second, laryngeal-diadochokinesis (L-DDK) to investigate laryngeal elevation, and last, the Swallowing-Quality of Life (SWAL-QOL) was measured. These cases have shown improved breathing, phonation, swallowing function, and the scores of SWAL-QOL in all of the patients. It suggests that this music therapy intervention was effective on laryngeal elevation, and the music intervention with therapeutic singing can be effectively implemented in further research for patients with dysphagia.

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Kim, S. J., Cho, S. R., & Yoo, G. E. (2017). The applicability of rhythm-motor tasks to a new dual task paradigm for older adults. Frontiers in Neurology, 8(671), 1.

Given the interplay between cognitive and motor functions during walking, cognitive demands required during gait have been investigated with regard to dual task performance. Along with the needs to understand how the type of concurrent task while walking affects gait performance, there are calls for diversified dual tasks that can be applied to older adults with varying levels of cognitive decline. Therefore, this study aimed to examine how rhythm-motor tasks affect dual task performance and gait control, compared to a traditional cognitive-motor task. Also, it examined whether rhythm-motor tasks are correlated with traditional cognitive-motor task performance and cognitive measures. Eighteen older adults without cognitive impairment participated in this study. Each participant was instructed to walk at self-paced tempo without performing a concurrent task (single walking task) and walk while separately performing two types of concurrent tasks: rhythm-motor and cognitive-motor tasks. Rhythm-motor tasks included instrument playing (WalkIP), matching to rhythmic cueing (WalkRC), and instrument playing while matching to rhythmic cueing (WalkIP+RC). The cognitive-motor task involved counting forward by 3s (WalkCount.f3). In each condition, dual task costs (DTC), a measure for how dual tasks affect gait parameters, were measured in terms of walking speed and stride length. The ratio of stride length to walking speed, a measure for dynamic control of gait, was also examined. The results of this study demonstrated that the task type was found to significantly influence these measures. Rhythm-motor tasks were found to interfere with gait parameters to a lesser extent than the cognitive-motor task (WalkCount.f3). In terms of ratio measures, stride length remained at a similar level, walking speed greatly decreased in the WalkCount.f3 condition. Significant correlations between dual task-related measures during rhythm-motor and cognitive-motor tasks support the potential of applying rhythm-motor tasks to dual task methodology. This study presents how rhythm-motor tasks demand cognitive control at different levels than those engaged by cognitive-motor tasks. It also indicates how these new dual tasks can effectively mediate dual task performance indicative of fall risks, while requiring increased cognitive resources but facilitating gait control as a compensatory strategy to maintain gait stability.

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Kim, S. J., Cho, S. R., & Yoo, G. E. (2017). Age-related changes in bimanual instrument playing with rhythmic cueing. Frontiers in Psychology, 8, 1569.

Deficits in bimanual coordination of older adults have been demonstrated to significantly limit their functioning in daily life. As a bimanual sensorimotor task, instrument playing has great potential for motor and cognitive training in advanced age. While the process of matching a person’s repetitive movements to auditory rhythmic cueing during instrument playing was documented to involve motor and attentional control, investigation into whether the level of cognitive functioning influences the ability to rhythmically coordinate movement to an external beat in older populations is relatively limited. Therefore, the current study aimed to examine how timing accuracy during bimanual instrument playing with rhythmic cueing differed depending on the degree of participants’ cognitive aging. Twenty one young adults, 20 healthy older adults, and 17 older adults with mild dementia participated in this study. Each participant tapped an electronic drum in time to the rhythmic cueing provided using both hands simultaneously and in alternation. During bimanual instrument playing with rhythmic cueing, mean and variability of synchronization errors were measured and compared across the groups and the tempo of cueing during each type of tapping task. Correlations of such timing parameters with cognitive measures were also analyzed. The results showed that the group factor resulted in significant differences in the synchronization errors-related parameters. During bimanual tapping tasks, cognitive decline resulted in differences in synchronization errors between younger adults and older adults with mild dimentia. Also, in terms of variability of synchronization errors, younger adults showed significant differences in maintaining timing performance from older adults with and without mild dementia, which may be attributed to decreased processing time for bimanual coordination due to aging. Significant correlations were observed between variability of synchronization errors and performance of cognitive tasks involving executive control and cognitive flexibility when asked for bimanual coordination in response to external timing cues at adjusted tempi. Also, significant correlations with cognitive measures were more prevalent in variability of synchronization errors during alternative tapping compared to simultaneous tapping. The current study supports that bimanual tapping may be predictive of cognitive processing of older adults. Also, tempo and type of movement required for instrument playing both involve cognitive and motor loads at different levels, and such variables could be important factors for determining the complexity of the task and the involved task requirements for interventions using instrument playing.

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Kim, S. J., Shin, Y. K., Yoo, G. E., Chong, H. J., & Cho, S. R. (2016). Changes in gait patterns induced by rhythmic auditory stimulation for adolescents with acquired brain injury. Annals of the New York Academy of Sciences, 1385(1), 53-62.

The effects of rhythmic auditory stimulation (RAS) on gait in adolescents with acquired brain injury (ABI) were investigated. A total of 14 adolescents with ABI were initially recruited, and 12 were included in the final analysis (n = 6 each). They were randomly assigned to the experimental (RAS) or the control (conventional gait training) groups. The experimental group received gait training with RAS three times a week for 4 weeks. For both groups, spatiotemporal parameters and kinematic data, such as dynamic motions of joints on three‐dimensional planes during a gait cycle and the range of motion in each joint, were collected. Significant group differences in pre–post changes were observed in cadence, walking velocity, and step time, indicating that there were greater improvements in those parameters in the RAS group compared with the control group. Significant increases in hip and knee motions in the sagittal plane were also observed in the RAS group. The changes in kinematic data significantly differed between groups, particularly from terminal stance to mid‐swing phase. An increase of both spatiotemporal parameters and corresponding kinematic changes of hip and knee joints after RAS protocol indicates that the use of rhythmic cueing may change gait patterns in adolescents with ABI.

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Yoo, G. E., & Kim, S. J. (2016). Rhythmic auditory cueing in motor rehabilitation for stroke patients: Systematic review and meta-analysis. Journal of Music Therapy, 53(2), 149-177.

Abstract
Background:
Given the increasing evidence demonstrating the effects of rhythmic auditory cueing for motor rehabilitation of stroke patients, this synthesized analysis is needed in order to improve rehabilitative practice and maximize clinical effectiveness.

Objective:
This study aimed to systematically analyze the literature on rhythmic auditory cueing for motor rehabilitation of stroke patients by highlighting the outcome variables, type of cueing, and stage of stroke.

Methods:
A systematic review with meta-analysis of randomized controlled or clinically controlled trials was conducted. Electronic databases and music therapy journals were searched for studies including stroke, the use of rhythmic auditory cueing, and motor outcomes, such as gait and upper-extremity function.

Results:
A total of 10 studies (RCT or CCT) with 356 individuals were included for meta-analysis. There were large effect sizes (Hedges’s g = 0.984 for walking velocity; Hedges’s g = 0.840 for cadence; Hedges’s g = 0.760 for stride length; and Hedges’s g = 0.456 for Fugl-Meyer test scores) in the use of rhythmic auditory cueing. Additional subgroup analysis demonstrated that although the type of rhythmic cueing and stage of stroke did not lead to statistically substantial group differences, the effect sizes and heterogeneity values in each subgroup implied possible differences in treatment effect.

Conclusions:
This study corroborates the beneficial effects of rhythmic auditory cueing, supporting its expanded application to broadened areas of rehabilitation for stroke patients. Also, it suggests the future investigation of the differential outcomes depending on how rhythmic auditory cueing is provided in terms of type and intensity implemented.

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Chung, Y. K., Chong, H. J., & Kim, S. J. (2016). Perception of complexity, interest level, and preference for harmonic progression of music for adults with schizophrenia. The Arts in Psychotherapy, 48, 1-7.

Abstract
This study compared how adults with a diagnosis of schizophrenia and those without schizophrenia perceived the harmonic progression of music. Thirty adults diagnosed with schizophrenia (SP) and 37 healthy adults without schizophrenia (NSP) listened to musical excerpts with five different harmonic progressions. After listening to each excerpt, the participants reported their perception of the complexity of the musical excerpt, their personal interest in the excerpt, and their personal preference for the musical excerpt on an 11-point scale. The results showed that the SP group tended to be less sensitive to increased harmonic complexity, and this difference reached statistical significance (p = 0.040). No significant differences were found between the groups in terms of their interest in or preference for harmonic progression in music. However, among harmonic progression, interest level (p = 0.014), and personal preference (p = 0.000), there were significant interaction effects. Overall, and in line with previous studies the findings indicate that adults with SP are less sensitive to harmonic progressions and harmonic changes in music. Findings from this study provide essential information for music selection when working with clients with schizophrenia in mental health settings.

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Shin, Y. K., Chong, H. J., Kim, S. J., & Cho, S. R. (2015). Effect of rhythmic auditory stimulation on hemiplegic gait patterns. Yonsei Medical Journal, 56(6), 1703-1713.

Abstract

Purpose
The purpose of our study was to investigate the effect of gait training with rhythmic auditory stimulation (RAS) on both kinematic and temporospatial gait patterns in patients with hemiplegia.

Materials and Methods
Eighteen hemiplegic patients diagnosed with either cerebral palsy or stroke participated in this study. All participants underwent the 4-week gait training with RAS. The treatment was performed for 30 minutes per each session, three sessions per week. RAS was provided with rhythmic beats using a chord progression on a keyboard. Kinematic and temporospatial data were collected and analyzed using a three-dimensional motion analysis system.

Results
Gait training with RAS significantly improved both proximal and distal joint kinematic patterns in hip adduction, knee flexion, and ankle plantar flexion, enhancing the gait deviation index (GDI) as well as ameliorating temporal asymmetry of the stance and swing phases in patients with hemiplegia. Stroke patients with previous walking experience demonstrated significant kinematic improvement in knee flexion in mid-swing and ankle dorsiflexion in terminal stance. Among stroke patients, subacute patients showed a significantly increased GDI score compared with chronic patients. In addition, household ambulators showed a significant effect on reducing anterior tilt of the pelvis with an enhanced GDI score, while community ambulators significantly increased knee flexion in mid-swing phase and ankle dorsiflexion in terminal stance phase.

Conclusion
Gait training with RAS has beneficial effects on both kinematic and temporospatial patterns in patients with hemiplegia, providing not only clinical implications of locomotor rehabilitation with goal-oriented external feedback using RAS but also differential effects according to ambulatory function.

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Chong, H. J., Kim, S. J., Lee, E. K., & Yoo, G. E. (2015). Analysis of surface EMG activation in hand percussion playing depending on the grasping type the tempo. Journal of Exercise Rehabilitation, 11(4), 228-235. doi: 10.12965/jer.150216

Abstract

Although instrument playing-based training has been repeatedly reported to improve functional hand movements including grasping, the attempts to present quantitative information on physiological mechanism of grasping have been relatively insufficient to determine the type and the intensity of the exercises involved. This study aimed to examine the muscle activation during hand percussion playing depending on the grasping type and the playing tempo. A total of twelve healthy older adults with a mean age of 71.5 years participated in this study. Surface electrodes were placed on three grasping-related muscles: Flexor digitorum superficialis, extensor digitorum, and flexor pollicis brevis. Participants were instructed to play with the egg shaker, paddle drum mallet and clave involving different types of grasp at three different tempi (i.e., 80, 100, and 120 bpm) and sEMG data were collected during each playing. Significantly greater muscle activation was generated with the small sphere type of egg shaker, compared to the handle type of paddle drum mallet and the small cylinder type of clave. Playing at faster tempo also elicited significantly greater muscle activation than at slower tempo. With regard to the rise time of muscle activation, while tempo significantly affected the rise time, the time to peak muscle did not significantly change depending on the grasping type. This study confirmed that grasping pattern and the tempo of movement significantly influence the muscular activation of grasping involved in instrument playing. Based on these results, clinical implication for instrument selection and structured instrument playing would be suggested.

Keywords: Electromyography, Grasping, Muscular contraction, Instrument playing