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• W2912141994 abstract "Stroke is one of the leading causes of disabilities worldwide, and the number of affected patients per year and country is increasing due to the societies growing older. Rehabilitation of stroke patients remains a challenge, although currently several new training programs are being investigated, all aiming at an improved efficiency and sustainability of rehabilitation effects. Some traditional rehabilitation programs lack general acceptance by patients, due to high demands on the patients' cooperation, which sometimes may be perceived by patients as frustrating. Yet, even the well established standard physiotherapeutical approaches do not unambiguously provide evidence of efficacy when it comes to improvement of skilled motor behavior. Therefore there is an urgent need for innovative, patient motivating, goal directed and efficient training programs in stroke rehabilitation. Sonification stands for the usage of non-speech audio conveying otherwise not audible information. The first sonification device was the Geiger-Muller counter which detects electromagnetic radiation and communicates a decay by a click sound. In this thesis, stroke patients arm movements in a predefined three dimensional space were sonified. Sonification was then applied to develop and to incorporate musical retraining for the arm affected by the stroke. The first experimental study was conducted in order to examine and validate the effectiveness of a certain type of sonification for a later application in stroke rehabilitation. To date, no established sonification-supported rehabilitation protocol strategy exists. Therefore a computer program was developed, the “SonicPointer”, to sonify participants' computer mouse movements in real-time with complex tones. Tone characteristics were derived from a parameter mapping, invisible and unbeknown to the participants, which was overlaid on the computer screen. In each trial, a target tone was presented and subjects were instructed to indicate its “origin” with respect to the overlaid parameter mappings on the screen as quickly and accurately as possible with a mouse click. Due to the participants' ignorance of the parameter map on the screen, only implicit learning over a series of trials led to an increase in accuracy in this task. One of the aims of the study was to find out how sonification parameters should be mapped in space optimally. Twenty-six elderly healthy participants were tested with this device. Generally, subjects' localizing performance was better on the tone pitch axis as compared to the tone brightness axis. Furthermore, the learning curves were steepest and participants were fastest when pitch was mapped onto the vertical and brightness onto the horizontal axis, suggesting that this is the optimal constellation for this two-dimensional sonification. In the second experimental study presented herein we applied the previously acquired optimal sonification mapping in a newly developed musical sonification therapy designed to retrain gross-motor functions. Four stroke patients were included in this clinical pre-post feasibility study and were trained with the musical sonification therapy. Patients' upper extremity functions and their psychological states were assessed pre and post training with numerous standardized motor function tests, assessments and neuropsychological questionnaires. The four patients were subdivided into two groups. Both groups received nine days of musical sonification therapy (MG) or a sham sonification movement training (CG). The only difference between the training protocols was that in the CG no sound was played back at the patients. During the training, patients started by exploring the acoustic effects when moving their affected arm in a predefined three-dimensional space. The training proceeded with increasingly complex tone sequences leading to the patients playing simple melodies only by moving their impaired arms in the 3D space. The two MG patients improved in nearly all motor-function tests after the training. Also they reported to be less impaired by the stroke. The two CG patients did not benefit noticeably from the movement training. Since the second feasibility study yielded promising results, - although with limited statistical power,- a third clinical musical sonification therapy study was run. The setup was basically the same as in experiment two but this time 25 stroke patients were trained and tested. An advanced 3D analysis of the arm movement smoothness was developed and included into the pre post-test battery. The 15 MG patients showed significantly reduced joint pain in the Fugl Meyer Assessment as compared to the control-group after the musical sonification training. They also reported a trend to have an improved hand function on the Stroke Impact Scale. Summarizing the results of the experiments presented in this thesis it can be concluded that the mapping of sounds in space is crucial for the outcome and a musical sonification can be applied as a promising stroke rehabilitation tool. Of course the number of patients investigated is limited and further evaluation and research is necessary. Furthermore, different motor tests should be included in future research in order to prevent floor and ceiling effects" @default.
• W2912141994 created "2019-02-21" @default.
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• W2912141994 date "2015-01-01" @default.
• W2912141994 modified "2023-09-27" @default.
• W2912141994 title "Sonification of arm movements in stroke rehabilitation" @default.
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