Mobile-Based Music Therapy for Stroke Patients

Aung Pyae
University of Turku, Finland
Abstract Music has been used not only for entertainment but
also for therapeutic purpose in the history. Nowadays, especially
in the area of rehabilitation healthcare professionals use music as
therapeutic intervention for the patients. Music therapy is being
used in rehabilitation centers, hospices, hospitals, nursing homes,
home, and school. Basically, music therapy can benefit patients in
terms of positive emotions, motivation, attention, relaxation,
enjoyment, communication, and attention. In the area of stroke
rehabilitation, music therapy can draw attention from healthcare
professionals because of its positive impacts on the patients
social well-being, emotion, and cognition. In this study, we
proposed conceptualization and ideas of designing and
developing a mobile based music therapy (MBMT) for stroke
patients. MBMT is a mobile application that allows therapists to
configure and manage the centralized and customizable music
repository or library in which different genres of music are
stored. The therapists can create and customize the playlists that
are used as therapeutic intervention for stroke patients. The
patients can have access to the music library through mobile
devices in which mobile based music therapy application is
installed. In this way, the therapists can manage the centralized
music library and they do not need to customize for each music
device of stroke patients and stroke patients can receive musical
treatment via mobile phones. The playlists can be customized
based on the needs of individual patients to enhance their positive
emotions that lead to higher motivation in rehabilitation. In this
paper, we present the conceptualization of designing mobile
based music therapy as an interactive therapeutic music listening
tool that may have positive affects not only on the patients but on
the therapists.
Keywords- music therapy, stroke rehabilitation, mobile-based
application

I.

INTRODUCTION

Stroke can cause long term disability that affects stroke

patients physical ability, mental well-being, and their social
lifestyle. According to the World Health Organization (WHO),
every year there is 15 million people who suffer from stroke in
the world. Among them, 5 million die and another 5 million
remained with permanent disability that negatively impacts on
their post-stroke life [1]. Common problems after stroke are
cognitive problems (e.g. memory, perception, and attention),
physical problems (e.g. loss of balance, impaired upper and
lower limbs, severe pain, and spasticity), and visual problems
(e.g. central vision loss, visual field loss, and eye movement
problems). Moreover, stroke can also negatively impact on the
survivors mental health such as depression, anxieties, loss of
memories, and sudden bursts of emotion (e.g. fits of crying).
Stroke sufferers with motor disabilities experience limitations
in fine motor control, gross motor skills, endurance, strength,

and range of motion [2]. These deficits can dramatically limit

their ability to perform activities of daily living (ADL) such as
dressing, hair combing, and bathing independently.
Furthermore, these physical impairments can reduce
survivors participation in community and leisure activities.
Rehabilitation is the most important and essential part of
stroke therapy for stroke survivors to regain their physical
strength and normal life. Stroke rehabilitation helps patients
return to independent living, regain independence in doing
ADL, and reintegrate into the community. Rehabilitation
cannot reverse the effects of a stroke. However, its goals are to
build the strength, capability, independence, and confidence of
stroke sufferers so that they can continue their daily activities
and live post-stroke life positively despite the effects of stroke.
Participation in repetitive exercises can help people with
motor disabilities overcome the limitations they experience
from stroke. Often times, post-stroke patients find the
activities in rehabilitation therapy repetitively monotonous,
boring, and tiring. Therefore, some of the stroke patients are
not motivated to engage in therapy consistently. As a result,
some patients do not continue rehabilitative training and it
may lead to permanent disability in life and their social
lifestyle change dramatically such as depression, loneliness.
Thus, patients motivation has been recognized as important
for therapeutic outcome and many studies have consistently
linked motivation to better therapeutic outcomes.
II.

MUSIC THERAPY FOR STROKE REHABILITATION

Patients who suffer from stroke must have to go through a

critical rehabilitation process starting from acute
hospitalization to post-stroke rehabilitation training with the
help of medical professionals such as physical, occupational,
recreational, and speech therapists. People in the context of
rehabilitation become interested in using music as a therapeutic
and rehabilitative tool for stroke patients and their
rehabilitation. However, the role of music in facilitating and
improving rehabilitation process is unidentified. The research
area of music for therapeutic purpose is still quite new and the
findings from the previous studies were still not sufficient.
According to the literature review, many people are
emotionally influenced by music on their daily lifestyle.
Generally, people use music for different purposes in their
daily lives and activities. For instance, people listen to music
that can boost their motivation in doing exercises. They use
music to get relaxation when they are feeling tired or stressful
and they listen to music to pass time when waiting for long
queue at shopping or taking bus for long distance. Sometimes,

they use music to distract their emotions such as excitement,

nervousness, and fear. In this way, people use music in
different ways with different purposes. In the history, humans
have used music for entertainment purpose as well as
therapeutic reason. During and after World War II, physicians
used music to heal soldiers who suffered from negative
emotional experiences such as shell shock. Moreover, music
also was used for injured soldiers to distract and forget their
pain while they recovered from medical operation [3].
Nowadays, music therapy becomes a specific rehabilitation
intervention that is typically facilitated by a trained music
therapist or occupational and recreational therapist and uses
music in different ways to help achieve therapeutic goals [4].
For example, they use musical instruments to strengthen
patients muscle and movements or they use music as a source
of energy and motivation to enhance patients engagement in
rehabilitation. Music therapy has been found to be helpful for
stroke survivors and it seems to be promising therapeutic tool
that can be used for rehabilitative purpose. Since music is
emotionally and intellectually stimulating, this type of therapy
can help the stroke patients maintain and improve their
physical and mental health, emotion, cognition, quality of life,
and well-being.

stroke patients improve in emotion, mood, attention, memory,

and motivation. However, the actual benefits of applying music
in therapeutic and rehabilitative training are still under
research. Therefore, it would be interesting to study how music
therapy and listening to music may be helpful and effective
intervention in clinical setting for stroke rehabilitation.

Generally, music therapy includes active listening,

rhythmic dancing and movements, singing musical notes, and
playing musical instruments. Music listening in rehabilitation
can develop attention, memory, and awareness whereas
rhythmic movements and dancing can improve movements,
speeds, balance, and walking. Singing in music therapy can
improve communication, speech, and language skills.
Listening, walking, moving, and singing to music all have
some positive effects on post-stroke pateints [5] and music
therapy can be combined with other forms of therapies such as
physical, occupational, and speech therapy or it can be used as
a separate therapy or rehabilitative tool for stroke patients.

In this study, we would like to propose conceptualization

and ideas of designing a mobile-based music therapy (MBMT)
for stroke patients. Basically, mobile-based music therapy is a
mobile application that can help the stroke patients listen to
their preferred and favorite music through mobile in
therapeutic way. However, the difference between the normal
mobile music application and the mobile-based music therapy
application is that MBMT is not randomized playlist but based
on the therapeutic intervention facilitated and recommended by
the music therapist or recreational therapist for the stroke
patients. The list of songs and the genres of music can be
configured and created by the music therapist to meet the
individual needs in stroke rehabilitation and recreation. In
addition to this, the music therapist can customize the playlist
according to the needs and desires of individual patient. For
example, the music therapist can create a new playlist (e.g.
upload the patients preferred songs and songs that can enhance
the therapeutic benefits of the individual patient), set the
number of repetition of a particular song or the whole playlist,
set the time for listening to the whole playlist, and manage the
different playlists. Further, the application itself can keep track
the patients music listening history and activity records in the
system. In this way, the music therapist or the caregiver can
retrieve the patients record for further therapeutic music
listening activities. The main objectives of MBMT are as
follows:

Music therapy may have positive effects on the physical,

cognitive, and psychological components of the post stroke
rehabilitation process. Applying music into a rehabilitative
training may have positive neurological and cognitive effects in
reaching not only functional but personal and social goals. The
combination of a dynamic rhythmic music with repetitive
dance movements of stroke patients leads to the regaining
motor function [6]. Music therapy can be applied to various
therapy groups such as physical disability, cognition and
emotion, recreation, and art. Music therapy can be divided into
two main categories, receptive music therapy (e.g. music
listening based intervention) and active music therapy (e.g.
music making, playing musical instruments). A recent study
reported that listening to the preferred music daily for a three
months time period improved the patients with acute stroke in
cognitive areas such as in verbal memory and focused attention
[7]. Music listening activities can help patients to activate
specific neural pathways to brain and make them more
motivated and engaged in rehabilitation. When people listen to
music that they prefer and enjoy, they may have positive
affections that might produce better signaling in the brain.
Generally, listening to pleasant and preferred music can have a
therapeutic effect on individual patient although he or she is
not going through music therapy. Music therapy may help the

III.

MOBILE-BASED MUSIC THERAPY

Music therapy has been found to be helpful for stroke

survivors. Since music therapy is used as a form of stimulating
tool, this type of therapy can help the stroke patients maintain
or improve physical and mental health, quality of life, lifesatisfaction, and well-being. In addition to this, music therapy
can enhance the social connection and communication of
stroke patients as it can be done by small group or by larger
group. For instance, stroke patients and musicians can
participate in a particular music therapy session such as singing
along, playing traditional drums, and dancing with rhythms and
they can socially interact and emotionally connect each other.
Therefore, music therapy seems to be a promising therapeutic
tool that can physically and emotionally impact on the stroke
patients physical improvements, cognition, and motivation.

To design and develop patient-centered mobile based

music listening therapy application for stroke patients

To design and develop centralized and customizable

music library that can be easily configured and
managed by the music therapists for different patients
and their individual needs

To enhance the music listening experiences of stroke

patients by using smart mobile devices

To enhance the patients positive affection through

music listening

Patients
Listen

IV.

THE CONCEPT OF MOBILE-BASED MUSIC THERAPY

In designing mobile based music therapy, there will have a

centralized music library that can be managed and used by the
music therapists to provide the different music listening
interventions to different stroke patients to meet their
individual needs. For instance, the music therapist can create a
particular playlist that includes different genres of music and
songs for individual patients to receive music listening therapy
for their rehabilitation in cognition, memory, attention,
motivation, and emotion. The music therapist can manage the
different playlists for different patients on the centralized
music library application that can be accessed by individuals
music device, smart phone, desktop application, or web-based
application. In this way, the music therapist does not need to
configure and manage the playlists and songs for every
patients music player or device. The songs that are stored in
the centralized music library can be shared among the stroke
patients so that the resources for music can be reduced. The
duration for music therapy listening for a particular session
can be set by the music therapist and the songs for the stroke
patients to listen, can be customized for different sessions to
meet the different needs for different therapeutic sessions.
Moreover, the concept of MBMT can be achieved at homebased music listening therapy for the stroke patients. The
music therapist can remotely control and manage the
centralized music library for the individual stroke patients and
set the music intervention for them. Moreover, the system can
alert the patients to listen to the playlist that includes musical
intervention regularly. In addition to this, mobile based
patients affective response to a particular song or playlist can
be done remotely. The potential benefits of MBMT are as
follows:
The music therapist can save time and resources to
support music listening therapy for many stroke patients
at the same time
The centralized music library can share different genres
of songs for individual needs of stroke patients and their
musical intervention
The mobile based music therapy seems to be interactive,
portable, accessible, and low-cost for many therapeutic
sessions
The centralized music library can keep track the history
of activities of different stroke patients so that these can
be used for music therapists for further investigation of
health improvements or analysis of data
Fig 1 shows the conceptual diagram of MBMT.

Personalized Music App

Configur
e

Listen
Music Library Application

Figure 1. Mobiles-Based Music Therapy Conceptual Diagram

V.

CONCLUSION

Music therapy becomes an interesting and promising area

for both healthcare professionals and researchers from different
areas (e.g. Interaction Designer, Psychologist). Not only music
therapists but other therapists such as occupational therapist,
recreational therapists, use music as a tool for rehabilitation for
the stroke patients to benefit their attention, communication,
cognition, and emotion. It would be useful and effective for the
therapists to use mobile based music therapy in the
occupational, recreational, and musical therapies so that they
can manage and support the intervention to many patients at
the same time. In addition to this, this technology supported
music therapy may potentially help the patients and therapists
save time, reduce the cost for rehabilitation and solve the
problems of needs of human resources in the context of
rehabilitation. However, further in-depth research of how
music can be effectively used in the area of mobile healthcare
information system is important. In conclusion, it would be
worthwhile to integrate the latest technologies in the area of
traditional music therapy.
REFERENCES
[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

J. W. Burke, M. D. J. McNeill, D. K. Charles, P. J. Morrow, J. H.

Crosbie, S. M. McDonough, Desinging Engaging, Playable Games for
Rehabilitation, International Conference Series On Disability, Virtual
Reality And Associated Technologies (ICDVRAT), 2010
M. Balaam, S.R. Egglestone. et al. Rehabiliation Centred Design, Proc
28th int conf extended abstracts on Human factors in computing systems
(Atlanta, Georgia, USA, 2010), 4583-4586, 2010
Y. J. Chang, S. F. Cheng, and J. D. Huang. "A kinect-based system for
physical rehabilitation: A pilot study for young adults with motor
disabilities, Research in Developmental Disabilities, 32, 2566-2570,
2011
N. Maclean, P. Pound, C. Wolfe, and A. Rudd. The concept of patient
motivation: A qualitative analysis of stroke professionals attitudes,
Stroke, 33, pp. 444-448, 2002
J. Halton. "Virtual rehabilitation with video games: A new frontier for
occupational therapy," Occupational Therapy Now, vol. 9(6), pp. 12-14,
2008
F. Anderson, M. Annett, and W.F. Bischof. "Lean on Wii: Physical
rehabilitation with virtual reality and wii peripherals," Annual Review of
CyberTherapy and Telemedicine, vol. 8, pp. 181-184, 2010
J.Y. Mao, K. Vredenburg, P. W. Smith, and T. Carey. "User-centered
design methods in practice: a survey of the state of the art," in Proc.
Centre for Advanced Studies on Collaborative research, p.12, 2001
T. Keinonen. User-centered design and fundamental need. In: Proc. of
the 5th Nordic Conference on Human-Computer interaction: Building
Bridges. NordiCHI 2008, vol. 358, pp. 211219. ACM, New York ,
2008

[9]

V. Kantola, S. Titta, K. Mehto, and T. Kankainen. Using dramaturgical

methods to gain more dynamic user understanding in user-centered
design, In Proc. Of C&C 07. ACM, New York, NY, 173-182, 2007
[10] A. Cooper. The inmates are running the asylum, Sams., 1999
[11] R. Sinha. Persona development for information-rich domains., in
CHI03 extended abstracts, ACM Press, 830-831, 2003

[12] J. Pruitt and T. Adlin. The persona lifecycle : keeping people in mind
throughout product design, Morgan Kaufman, 2006
[13] J. McGinn and N. Kotamraju. Data-driven persona development, In
Proceeding of the Twenty-Sixth Annual SIGCHI Conference on Human
Factors in Computing Systems (Florence, Italy, April 05 - 10, 2008).
CHI '08. ACM, New York, NY, 1521-1524, 2008.