Objective: To present preliminary evidence of fine motor rehabilitation in patients with Huntington’s disease using neurologic music therapy.

Background: Huntington’s disease (HD) is an autosomal dominant neurodegenerative disease which causes progressive loss of cognitive, mood, and motor function. Reduced manual dexterity is among the myriad motor symptoms that impact patient’s quality of life (QoL)^1-3. There is no disease modifying therapy for HD, and management includes symptomatic control, however this does not fully alleviate fine motor symptoms.⁴ Neurologic music therapy (NMT) is an evidence-based clinical model consisting of standardized interventions using music for restorative training in neurorehabilitation. ⁵ NMT-associated neurophysiology suggests auditory-motor connections are mobilized during rehabilitation in patients with Parkinson’s disease. ⁶ We hypothesize that NMT holds rehabilitative potential to improve fine motor abilities in HD by mobilizing motor networks that have been spared by the disease.

Method: We investigated whether a 5-week course of NMT delivered virtually is feasible and safe in those with HD, and if there is any indication of clinical change in fine motor tasks, mood symptoms, or function in a small cohort of people with HD. Participants were evaluated in person at baseline prior to starting NMT, and again after cessation of therapy. Outcome measures included (i) Unified Huntington’s Disease Rating Scale (UHDRS) Parts I, III, IV (ii) Grooved Pegboard Test (GPT) scores (iii) Hospital Anxiety and Depression Scale (HADS), and (iv) Magnetoencephalography (MEG).

Results: 25 HD patients were contacted through the HD Center of Excellence, 3 of which enrolled in the study.  Adherence to the five-week NMT intervention was 100%, and each patient completed the pre and post clinical assessments and MEG scan.  This pilot study is not powered to detect statistical significance. There was a suggestion of improvement after the NMT intervention in the UHDRS motor scores, and GPT completion time improved in both the dominant and non-dominant hands. MEG data indicated increased evoked power in the motor cortex after NMT, possibly due to a phase reset of the oscillations.

Conclusion: We gathered preliminary evidence of NMT-based fine motor rehabilitation in HD possibly via cortical changes in oscillatory patterns. Larger studies are warranted to confirm these findings.

References: 1. Bates GP, Dorsey R, Gusella JF, Hayden MR, Kay C, Leavitt BR, Nance M, Ross CA, Scahill RI, Wetzel R, Wild EJ. Huntington disease. Nature reviews Disease primers. 2015 Apr 23;1(1):1-21.

2. Helder DI, Kaptein AA, Van Kempen GM, Van Houwelingen JC, Roos RA. Impact of Huntington’s disease on quality of life. Movement disorders: official journal of the Movement Disorder Society. 2001 Mar;16(2):325-30.

3. Ho AK, Gilbert AS, Mason SL, Goodman AO, Barker RA. Health‐related quality of life in Huntington’s disease: which factors matter most?. Movement Disorders. 2009 Mar 15;24(4):574-8.

4. Bachoud-Lévi AC, Ferreira J, Massart R, Youssov K, Rosser A, Busse M, Craufurd D, Reilmann R, De Michele G, Rae D, Squitieri F. International guidelines for the treatment of Huntington’s disease. Frontiers in neurology. 2019 Jul 3;10:710.

5. Thaut, M.H., G.C. McIntosh, and V. Hoemberg, Neurobiological foundations of neurologic music therapy: rhythmic entrainment and the motor system. Front Psychol, 2014. 5: p. 1185.

6. Thaut, M. H. a. A. M. Rhythmic auditory stimulation in rehabilitation of movement disorders: a review of the current research. Music Perception 27, 263-269 (2010).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/neurologic-music-therapy-for-fine-motor-rehabilitation-in-huntingtons-disease-a-pilot-study/