STROKESTRA

Nick Rutter

STROKESTRA is a pioneering collaboration between the Royal Philharmonic Orchestra (RPO) and the Humber NHS Trust’s Hull Integrated Community Stroke Service (HICSS) which uses group creative music-making alongside professional musicians to drive patient-led recovery in stroke survivors and their carers.

The programme began in December 2014 with an intensive research and development phase which brought together professional musicians and stroke therapists to devise appropriate musical techniques to address a wide range of stroke rehabilitation needs, including improved sensation, mobility, strength, cognitive function, socialisation, communication, wellbeing and more. The team designed a programme model for engaging patients and carers in group creative music-making, which aims to:

  • Develop a sustainable, cost-effective model of group creative music therapy that supports the holistic rehabilitation of stroke survivors and aids the achievement of stroke related goals.
  • Empower patients to take ownership of, and begin to self-manage, recovery.
  • Improve relationships between patients, carers and clinical staff.
  • Provide a period of respite for carers where they are able to take a break from their carer role, and/or allow them to participate in a fun and creative activity alongside their family member.
  • Train HICSS staff in creative and musical leadership skills enabling them to utilise techniques in interim projects and in their wider professional work.
  • Produce meaningful pieces of music depicting the lives of Hull stroke survivors, improving participants’ instrumental, rhythmic and creative abilities.

Description of the arts activity

Between May and October 2015, a pilot programme trialled the techniques and structure designed during the research and development phase. The programme consisted of a series of fortnightly intensive projects, alternately led by the RPO and HICSS teams. RPO-led projects ran over two days and featured an artistic team including a workshop leader, three trained musicians and a project manager, supported by HICSS therapists and associate practitioners. These sessions alternated with 1-day interim projects led by HICSS staff who had been specially trained in musical leadership by the RPO workshop leader. See the attached schedule for a full list of project activity and dates.
A total of 50 patients and carers were referred by HICSS therapists and consented to take part in the project. All patients worked with their referring therapist to create a list of individualised goals to work towards during the project, ranging from social and communication goals to improved mobility and wellbeing. Participants were assigned to a morning or afternoon group, and attended two-hour sessions on each project day.
Sessions were designed to provide opportunities for social integration, including group discussions and tea breaks, as well as more concrete rehabilitation work through musical techniques such as:

  • Conducting – RPO musicians improvise while following specifically designed cues from participant conductors. This exercise supports work around: fine and gross upper limb movement as participants move arms up and down to indicate higher or lower notes and open and close hands to signify dynamics; abstract thinking to understand the relationship between their movements and the resulting music; and attention to the group process in order to pass the conducting role on to other participants, or conducting simultaneously.
  • Drum patterns – Participants copy drum patterns demonstrated by the workshop leader. This exercise requires patients to understand spoken and visual cues, as well as successfully involve fine and gross upper limb movement, coordination, timing, motor planning, initiating, inhibiting and sequencing of movement. This technique also supports the development of a feeling of belonging, as participants contribute to a group sound while receiving immediate auditory feedback about the accuracy of their movements.
  • Musical ‘postcards’ – Participants, staff and musicians work in small groups to create short musical sections representing a chosen theme or image. This technique requires verbal and musical communication, abstract thinking, holding and playing of instruments and creativity, as well as supports socialisation through sharing ideas and creating something new with others.
  • Specific instruments were identified and adapted for their potential rehabilitative uses and patients wishing to work on relevant goals were supported to access appropriate instruments throughout all activities.
  • The pilot culminated in a public performance at Hull City Hall ahead of an RPO concert, thus providing an ultimate goal for the programme. This final project involved three days of standard workshops as compared to the normal two, followed by a fourth day which brought both participant groups together for a two-hour dress rehearsal before performing in front of family, friends and the general public.

Evaluation methods and findings

A service evaluation of the pilot project was approved by the Humber NHS Trust Research and Development Department. HICCS is a multi-disciplinary service which provides goal-focused holistic stroke rehabilitation. The evaluation therefore focused on the achievement of individual goals as the outcome, and utilised baseline and post-project Stroke Impact Scale scores, post-project evaluation surveys, semi-structured interviews, focus groups, case studies and clinical measures specific to individual goals.
Patients, carers and staff reported marked improvements in a number of areas:

  • 86% of patients felt the sessions relieved disability symptoms citing improved sleeping, reduced anxiety, fewer dizzy spells and reduced epilepsy symptoms.
  • 91% of patients reported social benefits, including improved relationships and communication skills.
  • 86% of patients indicated that the project provided cognitive benefits, including reports of increased concentration, focus and memory.
  • 86% of patients felt the project provided emotional benefits, citing increases in confidence, morale and a renewed sense of self.
  • 71% of patients achieved physical improvements, including improved walking, standing, upper arm strength and increased stamina.
  • 100% of carers reported improvements in wellbeing, including respite from their role as a carer and improved relationships with their relative.

A full programme report including results, methodologies and learnings is available by contacting the RPO on details below or visitng www.rpo.co.uk/strokestra.

FUNDING
The pilot project was funded with a £48,000 grant from Hull Public Health which covered all research & development, delivery, evaluation, dissemination and extension project expenditure. HICSS staff time was given In Kind and integrated into their normal working hours. Participation was completely free to participants, with transportation to and from sessions provided.

Supported using public funding by the Arts Council England