NMT for Parkinson's Disease

Parkinson's Disease (PD) is defined by characteristic motor symptoms including slow
movements, small movements, difficulty with movement initiation and disruptions in timing.
Besides gross motor symptoms, fine motor impairments in PD cause difficulties with everyday
tasks such as writing, self-care, and fine object manipulation. These activity limitations
can lead to disability, social isolation, and a reduced quality of life. In a series of
breakthrough studies Michael Thaut and colleagues developed Neurologic Music Therapy (NMT)
and found it can address many gross motor impairments and improve gait and balance. Other
music therapies such as Music-supported Therapy (MST) have proven motor benefits in stroke
patients through movement exercises with musical instruments. However, the pathological basal
ganglia (BG) in PD brains leads to a reduced supply of those internally generated movements.
In contrast, externally cued movements (eg. via a beat or a rhythm) during NMT sessions are
instantaneously entrained to the period of a rhythmic stimulus possibly without involvement
of the BG. The underlying idea is that rhythm is the essential component relating music
specifically to motor behavior. The mechanism of action is called "rhythmic entrainment"
where one system's motion or signal frequency entrains the frequency of another system. The
effect of NMT on fine motor function has not been investigated yet. Music activities are
important in the lives of many older adults. Notably, the use of music has been associated
with increased well-being for older adults, as it fosters social connection and mood
regulation. Furthermore, many musical activities have limited physical demands, making them
attainable for individuals who are living with mobility impairments or other physical
restrictions. Based on the literature and the investigators preliminary studies, the
investigators propose to test the efficacy of Neurologic Music Therapy in comparison to Music
Supported Therapy and Occupational Therapy (OT) as standard of care on adults in the
Parkinson's spectrum. The investigators have defined a working plan using different musical
instruments and growing tempo to specifically improve fine motor movements.