Yale University EliScholar – A Digital Platform for Scholarly Publishing at Yale Yale School of Medicine Physician Associate Program Theses School of Medicine 5-22-2020 Efficacy of Rhythmicudit A ory Stimulation on Ataxia and Functional Dependence Post-Cerebellar Stroke Kaitlin Fitzgerald Yale Physician Associate Program, [email protected] Follow this and additional works at: https://elischolar.library.yale.edu/ysmpa_theses Recommended Citation Fitzgerald, Kaitlin, "Efficacy of Rhythmic Auditory Stimulation on Ataxia and Functional Dependence Post- Cerebellar Stroke" (2020). Yale School of Medicine Physician Associate Program Theses. 13. https://elischolar.library.yale.edu/ysmpa_theses/13 This Open Access Thesis is brought to you for free and open access by the School of Medicine at EliScholar – A Digital Platform for Scholarly Publishing at Yale. It has been accepted for inclusion in Yale School of Medicine Physician Associate Program Theses by an authorized administrator of EliScholar – A Digital Platform for Scholarly Publishing at Yale. For more information, please contact [email protected]. EFFICACY OF RHYTHMIC AUDITORY STIMULATION ON ATAXIA AND FUNCTIONAL DEPENDENCE POST-CEREBELLAR STROKE A Thesis Presented to The Faculty of the School of Medicine Yale University In Candidacy for the degree of Master of Medical Science May 2020 Kaitlin Fitzgerald, PA-SII Dr. Diana Richardson, MD Class of 2020 Assistant Clinical Professor Yale Physician Associate Program. Yale School of Medicine, Neurology i Table of Contents ABSTRACT .............................................................................................................. iv CHAPTER 1: INTRODUCTION ............................................................................. 1 1.1 Ataxia ...........................................................................................................................2 1.2 Cerebellar stroke ..........................................................................................................4 1.3 Motor recovery following stroke ...................................................................................5 1.4 Traditional stroke rehabilitation ...................................................................................5 1.5 Music therapy ..............................................................................................................7 1.6 Music therapy in stroke rehabilitation ..........................................................................8 1.7 Music therapy outside of stroke ....................................................................................9 1.8 Statement of the problem ........................................................................................... 10 1.9 Goals and objectives ................................................................................................... 11 1.10 Hypothesis ............................................................................................................... 11 1.11 Definitions ................................................................................................................ 12 1.12 References ................................................................................................................ 13 CHAPTER 2: LITERATURE REVIEW ................................................................. 24 2.1 Review of Relevant Literature .................................................................................... 25 2.1.1 The functional cerebellum ............................................................................................................ 25 2.1.2 Cerebellar dysfunction .................................................................................................................. 27 2.1.3 Functional impairment and ataxia in chronic cerebellar stroke ....................................................... 29 2.1.4 The challenge of rehabilitation in chronic stroke ........................................................................... 32 2.1.5 Music therapy in stroke rehabilitation ........................................................................................... 33 2.1.6 Music therapy in other movement disorders ................................................................................. 36 2.2 Review of relevant methods ....................................................................................... 42 2.2.1 Study design ................................................................................................................................. 42 2.2.2 Patient Selection ........................................................................................................................... 43 2.2.3 Clinical management ..................................................................................................................... 43 2.2.4 Experimental Condition................................................................................................................ 44 2.2.6 Primary outcomes ......................................................................................................................... 47 2.2.7 Secondary outcomes ..................................................................................................................... 49 2.2.8 Sample size rationale ..................................................................................................................... 49 2.2.9 Estimated recruitment sites ........................................................................................................... 51 2.2.10 Confounding .............................................................................................................................. 51 2.3 Conclusion ................................................................................................................. 51 2.4 References ................................................................................................................. 53 CHAPTER 3: METHODS ...................................................................................... 73 3.1 Study design .............................................................................................................. 74 3.2 Procedures and site selection ..................................................................................... 74 ii 3.3 Study population and sampling .................................................................................. 75 3.4 Subject confidentiality ............................................................................................... 76 3.5 Study variables and measures ..................................................................................... 76 3.6 Methodology considerations ...................................................................................... 77 3.7 Randomization procedure and assignment of intervention ......................................... 79 3.8 Blinding ..................................................................................................................... 79 3.9 Adherence .................................................................................................................. 80 3.10 Monitoring of adverse events .................................................................................... 80 3.11 Data collection ......................................................................................................... 80 3.12 Sample size calculation............................................................................................. 81 3.13 Analysis .................................................................................................................... 81 3.14 Timeline ................................................................................................................... 82 3.16 Resources & Personnel ............................................................................................. 82 3.2 References ................................................................................................................. 84 CHAPTER 4: CONCLUSIONS .............................................................................. 86 4.1 Advantages ................................................................................................................ 87 4.2 Disadvantages ........................................................................................................... 87 APPENDICES ........................................................................................................ 86 Appendix A: Single Session RAS Gait Training Protocol ................................................. 87 Appendix B: RAS Gait Training and Assessment Schedule ............................................. 86 Appendix C: Sample Size Calculation .............................................................................. 86 Appendix D: Letter to Clinical Service Lines ................................................................... 86 Appendix E: CONSORT Diagram of Participant Recruitment and Enrollment .............. 87 Appendix F: Structured Phone Call Screening Interview ................................................. 86 Appendix G: Inclusion and Exclusion Criteria ................................................................ 88 Appendix H: Informed Consent Forms ........................................................................... 86 Appendix I: Scale for the Assessment and Rating of Ataxia