This autumn, Harjula Hospital in the North Savo Wellbeing Services County piloted an innovative rehabilitation method that combines sound and movement: sonification. In physical therapy and occupational therapy sessions, individuals in rehabilitation practiced movements where they, for example, moved their arm to produce the sound of flowing water, or lifted their lower limb to trigger the call of a cuckoo.
“During recent years, there has been a growing interest in the application of sonification in neurological rehabilitation, especially in the context of subacute stroke. Already, there is promising research evidence from around the world,” says Senior Researcher and Docent Hanna Pohjola from the Department of Technical Physics at the University of Eastern Finland.
“In this collaboration, our key aim was to test sonification not only in post-stroke rehabilitation but also in other conditions, and to combine different sonification methods.”
User experiences of this innovative approach were encouraging. The new rehabilitation method improved concentration, motivation and significantly increased the number of movement repetitions. In addition, integrating sonification into physical therapy and occupational therapy stimulated individuals’ senses in diverse ways, and it was deemed creative and playful.
According to the physical therapists and occupational therapists involved in the pilot project, sonification is a particularly effective rehabilitation method because it combines physical movement with cognitive skills and memory training.
“This type of rehabilitation could be suitable, for example, for individuals with cerebrovascular disorders or spinal cord injuries,” says Occupational Therapist Amanda Kröger.
“It could also work well for people with memory disorders, amputations or various conditions relating to internal medicine. I believe this method has great potential for further expansion,” Physical Therapist Noora Puranen adds.
The pilot project conducted in Harjula Hospital tested two different sonification methods. In a camera-based approach for upper limb movement recognition, arm movements performed while sitting at a table were captured by two cameras connected to a laptop.
In the second method, motion sensors were attached to the body to transmit movement data to a computer. A sensor about the size of a matchbox was attached, for example, to the wrist, ankle or sternum, enabling movement exercises to be performed either standing up or sitting down. Movements could also be combined, allowing coordination training.
From a rehabilitation development perspective, a key element in the collaboration was the design of user-friendly software suitable for hospital-based rehabilitation, allowing physical therapists and occupational therapists to operate the equipment and guide exercises independently, without technical support.
“As regards the motion sensors, we used the same devices and software as in a previous project, the Biodatasonaatti dance piece created in collaboration with Dance Theatre Minimi,” Doctoral Researcher Aku Sinokki says.
“We adapted them further for this pilot project and also introduced the camera-based method. Before moving the equipment to Harjula Hospital, we tested both methods and adjusted the logic in our HUMEA laboratory at the Department of Technical Physics.”
The cornerstones of software design in the pilot project were enabling calm and personalized auditory feedback and selecting a wide range of suitable movement exercises. Exercises were chosen according to the physical therapists’ and occupational therapists’ preferences, and they could also suggest sounds to be generated by movements.
The sounds selected were calming nature sounds to offset the noise of the rehabilitation ward. The soundscape was partly designed to change with repeated movements. Soundscape design and implementation were handled by Audio Designers Eduard Tampu and Josu Mämmi.
“Nature sounds were familiar to individuals in rehabilitation and evoked positive associations. For example, the sound of water reminded many of swimming, canoeing, sauna bathing or splashing in a puddle. These associations motivated patients to perform more repetitions than in conventional occupational therapy,” according to Kröger.
The physical therapists and occupational therapists hope the trial will continue in the future and that the rehabilitation method will be further developed.
“In a hospital setting, physiotherapy and occupational therapy should be easily implementable in a ward.
“An individual’s condition can vary from day to day, and sometimes one cannot leave the ward. It would be wonderful to try this method with bedbound individuals in rehabilitation as well,” Puranen says.
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