OBJECTIVE: To investigate the potential benefits of 3 therapeutic instrumental music performance (TIMP)-based interventions in rehabilitation of the affected upper-extremity (UE) for adults with chronic poststroke hemiparesis. DESIGN: Randomized-controlled pilot study. Setting: University research facility. PARTICIPANTS: Community-dwelling volunteers (N = 30; 16 men, 14 women; age range 33 to 76 years; mean age 55.9 years) began and completed the protocol. All participants had sustained a unilateral stroke more than 6 months before enrollment (mean time poststroke, 66.9 months). INTERVENTION: Two baseline assessments, a minimum of 1 week apart; 9 intervention sessions (3 times/week for 3 weeks), in which rhythmically cued, functional arm movements were mapped onto musical instruments; and 1 post-test following the final intervention. Participants were block-randomized to 1 of 3 conditions: group 1 (45 minutes TIMP), group 2 (30 minutes TIMP, 15 minutes metronome-cued motor imagery (TIMP plus cMI)), and group 3 (30 minutes TIMP, 15 minutes motor imagery without cues (TIMP plus MI)). Assessors and investigators were blinded to group assignment. MAIN OUTCOME MEASURES: Fugl-Meyer Upper-Extremity (FM-UE) and Wolf Motor Function Test- Functional Ability Scale (WMFT-FAS). Secondary measures were motor activity log (MAL) - amount of use scale and trunk impairment scale. RESULTS: All groups made statistically significant gains on the FM-UE (TIMP, p = 0.005, r = 0.63; TIMP plus cMI, p = 0.007, r = 0.63; TIMP plus MI, p = 0.007, r = 0.61) and the WMFT-FAS (TIMP, p = 0.024, r = 0.53; TIMP plus cMI, p = 0.008, r = 0.60; TIMP plus MI, p = 0.008, r = 0.63). Comparing between-group percent change differences, on the FM-UE, TIMP scored significantly higher than TIMP plus cMI (p = 0.032, r = 0.57), but not TIMP plus MI. There were no differences in improvement on WMFT-FAS across conditions. On the MAL, gains were significant for TIMP (p = 0.030, r = 0.54) and TIMP plus MI (p = 0.007, r = 0.63). CONCLUSION: TIMP-based techniques, with and without MI, led to significant improvements in paretic arm control on primary outcomes. Replacing a physical training segment with imagery-based training resulted in similar improvements; however, synchronizing internal and external cues during auditory-cMI may pose additional sensorimotor integration challenges.

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