Ann. N.Y. Acad. Sci. ISSN 0077-8923 ANNALS OF THE NEW YORK ACADEMY OF SCIENCES Issue: The Neurosciences and Music IV: Learning and Memory Making music after stroke: using musical activities to enhance arm function Frederike van Wijck, 1 Don Knox, 2 Colin Dodds, 2 Gianna Cassidy, 2 Gillian Alexander, 3 and Raymond MacDonald 1 1 Institute for Applied Health Research and School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom. 2 School of Engineering and Built Environment, Glasgow Caledonian University, Glasgow, United Kingdom. 3 NHS Greater Glasgow and Clyde, Glasgow, United Kingdom Address for correspondence: Frederike van Wijck, Institute for Applied Health Research and School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G0 4BA, UK. Frederike.vanWijck@gcu.ac.uk A common long-term consequence of stroke is impaired arm function, which affects independence and quality of life in a considerable proportion of stroke survivors. There is a growing need for self-management strategies that enable stroke survivors to continue their recovery after rehabilitation has ceased. Interventions with high- intensity, repetitive task training and feedback are most likely to improve function. Achieving the required amount of self-practice is challenging, however. Innovative approaches are required to translate therapies into rewarding activities that can be undertaken independently. This paper describes the key principles and development of a novel intervention that integrates individuals’ preferred music with game technology in upper limb rehabilitation. The “tap tempo” paradigm, which uses rhythmic auditory cueing, provides repetitive upper limb task training, which can be tailored to individual goals and progress (e.g., in terms of movement range and complexity), while providing sensitive quantitative feedback to promote skill acquisition and enhance self-management. Keywords: stroke; rehabilitation; arm function; preferred music; game technology Introduction The purpose of this paper is to describe the key principles and the development of a prototype in- tervention, designed to enable stroke survivors to enhance functional recovery of their affected upper limb through a game activity integrating evidence from music psychology, clinical rehabilitation, neu- roscience, movement science, and audio technology. Stroke is defined by the World Health Organiza- tion as “an acute neurologic dysfunction of vascular origin with sudden (within seconds) or at least rapid (within hours) occurrence of symptoms and signs corresponding to the involvement of focal areas in the brain.” 1 Across the world, 15 million people suf- fer a stroke each year, leaving five million with per- manent disabilities. 2 Up to 80% of stroke survivors experience impaired arm function at three months after stroke, 3 which is often persistent, disabling, 3–5 and affects quality of life. 6 Common upper limb impairments include weakness or paresis, 7 abnor- mal force production, 8 problems with muscle coac- tivation 9 and coordination, 10 often compounded by impaired sensation 3 and proprioception 11 as well as pain. Weakness, impaired coordination, and spas- ticity together with soft tissue stiffness (hypertonia) may reduce range of movement and result in per- manent deformities 12 that affect the ability to un- dertake activities of daily living. A number of different treatments have been shown to be effective in improving arm func- tion after stroke. 13 These comprise Constraint- Induced Movement Therapy (CIMT), mental prac- tice, robotics, and electromyographic biofeedback. Repetitive task training and electrostimulation have also demonstrated an effect, although marginal. 13 Acknowledging the need for further research, the broad conclusion of this comprehensive system- atic review was that interventions characterized by high-intensity, repetitive task-specific practice that doi: 10.1111/j.1749-6632.2011.06403.x Ann. N.Y. Acad. Sci. 1252 (2011) 305–311 c  2011 New York Academy of Sciences. 305