Ann. N.Y. Acad. Sci.

ISSN 0077-8923

A N N A L S O F T H E N E W Y O R K A C A D E M Y O F SC I E N C E S
Issue: The Neurosciences and Music IV: Learning and Memory

Making music after stroke: using musical activities to

enhance arm function
Frederike van Wijck,1 Don Knox,2 Colin Dodds,2 Gianna Cassidy,2 Gillian Alexander,3 and
Raymond MacDonald1
1
Institute for Applied Health Research and School of Health and Life Sciences, Glasgow Caledonian University, Glasgow,
United Kingdom. 2 School of Engineering and Built Environment, Glasgow Caledonian University, Glasgow, United Kingdom.
3
NHS Greater Glasgow and Clyde, Glasgow, United Kingdom

Address for correspondence: Frederike van Wijck, Institute for Applied Health Research and School of Health and Life
Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G0 4BA, UK. Frederike.vanWijck@gcu.ac.uk

A common long-term consequence of stroke is impaired arm function, which affects independence and quality
of life in a considerable proportion of stroke survivors. There is a growing need for self-management strategies
that enable stroke survivors to continue their recovery after rehabilitation has ceased. Interventions with high-
intensity, repetitive task training and feedback are most likely to improve function. Achieving the required amount
of self-practice is challenging, however. Innovative approaches are required to translate therapies into rewarding
activities that can be undertaken independently. This paper describes the key principles and development of a novel
intervention that integrates individuals’ preferred music with game technology in upper limb rehabilitation. The
“tap tempo” paradigm, which uses rhythmic auditory cueing, provides repetitive upper limb task training, which
can be tailored to individual goals and progress (e.g., in terms of movement range and complexity), while providing
sensitive quantitative feedback to promote skill acquisition and enhance self-management.

Keywords: stroke; rehabilitation; arm function; preferred music; game technology

impairments include weakness or paresis,7 abnor-

Introduction
The purpose of this paper is to describe the key
principles and the development of a prototype in-
tervention, designed to enable stroke survivors to
enhance functional recovery of their affected upper
limb through a game activity integrating evidence
from music psychology, clinical rehabilitation, neu-
roscience, movement science, and audio technology.
Stroke is defined by the World Health Organiza-
tion as “an acute neurologic dysfunction of vascular
origin with sudden (within seconds) or at least rapid
(within hours) occurrence of symptoms and signs
corresponding to the involvement of focal areas in
the brain.”1 Across the world, 15 million people suf-
fer a stroke each year, leaving five million with per-
manent disabilities.2 Up to 80% of stroke survivors
experience impaired arm function at three months
after stroke,3 which is often persistent, disabling,3–5
and affects quality of life.6 Common upper limb
mal force production,8 problems with muscle coac-
tivation9 and coordination,10 often compounded by
impaired sensation3 and proprioception11 as well as
pain. Weakness, impaired coordination, and spas-
ticity together with soft tissue stiffness (hypertonia)
may reduce range of movement and result in per-
manent deformities12 that affect the ability to un-
dertake activities of daily living.
A number of different treatments have been
shown to be effective in improving arm func-
tion after stroke.13 These comprise Constraint-
Induced Movement Therapy (CIMT), mental prac-
tice, robotics, and electromyographic biofeedback.
Repetitive task training and electrostimulation have
also demonstrated an effect, although marginal.13
Acknowledging the need for further research, the
broad conclusion of this comprehensive system-
atic review was that interventions characterized by
high-intensity, repetitive task-specific practice that

doi: 10.1111/j.1749-6632.2011.06403.x
Ann. N.Y. Acad. Sci. 1252 (2011) 305–311 
c 2011 New York Academy of Sciences. 305
Music making after stroke to improve arm function
provide feedback are most likely to be effective.
Studies using neuroimaging techniques have also
shown that task-specific therapeutic activities have
the ability to forge neuroplastic changes in the
brain.14 The findings from studies that have ex-
plored the impact of CIMT on patterns of neural
activity are too diverse for any clear conclusions,
however.15 Furthermore, the principles of intensive
practice, task-specific training, and feedback have
long been recognized as cornerstones of skill acqui-
sition in healthy people.16
Taken together, converging evidence from stroke
rehabilitation, neuroscience, and motor learning re-
search indicates that activities that are functional,
practiced repeatedly, and include feedback have the
potential to drive long-term neuroplastic changes
in the brain that in turn can enhance functional
recovery after stroke. A key challenge for clinicians
working with stroke survivors is therefore to provide
the required amount of practice as well as feedback.
Health care resources are, however, under threat
in the current global recession. Contemporary
United Kingdom clinical initiatives and health poli-
cies are aimed at facilitating early supported dis-
charge after stroke and shifting the balance of care
from hospital to self-management in the commu-
nity.17 There is therefore an urgent need to improve
self-management strategies for people with stroke,
who continue to experience impaired arm function.
Exciting new opportunities for stroke rehabilita-
tion are emerging from the field of neurologic music
therapy (NMT), which aims to improve cognitive,
sensory, and motor function in people with neuro-
logical conditions through the therapeutic applica-
tion of music. Active ingredients of NMT include
auditory motor synchronization, an entrainment
function whereby the auditory rhythm is synchro-
nized with movement execution as well as motiva-
tional aspects.18 Rhythmic auditory cueing can be
effective in improving motor recovery, particularly
gait after stroke, as shown in a Cochrane system-
atic review by Bradt et al.19 This review, however,
only comprised two studies examining the effects
of music or rhythm on arm function after stroke,
including a total of 41 participants. Although both
studies showed short-term improvements, it is clear
that there is a need for further robust clinical trials.
With regards to the utility of music listening for
therapeutic purposes, a crucial issue is the nature of
the music.20 Specifically, a significant body of work
306 Ann. N.Y. Acad. Sci. 1252 (2011) 305–311 
van Wijck et al.
highlights the effects of preselected music upon a
variety of psychological variables.21 For example,
music with particular structural features (moderate
tempo and complexity) may be effective in reduc-
ing pain and anxiety in clinical contexts.22 More re-
cently, a number of studies have highlighted the im-
portance of preference in determining therapeutic
potential, demonstrating that the liking of a particu-
lar piece of music can be a key element in predicting
positive clinical outcomes. For example, Mitchell
et al. reported that participants listening to favorite
music were able to keep their hands in cold wa-
ter for longer and reported less pain than partici-
pants listening to experimenter-selected “anxiolytic
music.”23 These authors argue that listening to pre-
ferred music renders music with varying structural
features “functionally equivalent,” that is, music
with different features, such as tempo, complexity,
and key signature, can have a similar therapeutic
effect. Current work is investigating the interplay
between music structure and preference,24 which
indicates a sensitive interplay between variables that
relate to preference and key structural features of
the music. This relationship suggests that it is not
sufficient to only consider musical structure (e.g.,
tempo) but, additionally, that musical preferences
of listeners must also be taken into consideration
when evaluating the effects of music. Indeed, it is
vital to consider if participants enjoy the music that
is being listened to during experiments that examine
the effects of music.
The prototype intervention described here ad-
dresses these issues in a number of ways. In the
first instance, the intervention is designed to allow
each participant to select their preferred music to
enable them to listen to music that is familiar and
enjoyed. The hypothesis to be tested is that partic-
ipants may enjoy participating in the intervention
more than with preselected music, which may have
a positive effect on motivation and may in turn
increase the amount of time spent engaging with
the intervention. Furthermore, it will also be possi-
ble to examine the participants’ musical choices us-
ing innovative software specifically designed to ana-
lyze the relationship between key structural features
and the emotional impact of the music that may
be central when listening to music for therapeutic
purposes.24
Another emerging field of interest to neurolog-
ical rehabilitation is game play, which is receiving
c 2011 New York Academy of Sciences.
van Wijck et al.
increasing attention as a potential platform for
health promotion and self-management and ad-
dressing psychological and behavioral barriers to
optimal health care and participation.25,26 Sapos-
nik27 suggested that the parameters of effective treat-
ment, that is, repetition, task-specific training, and
challenge, are those that games scaffold intrinsi-
cally.28 From commercial “serious games” to teach
patients and clinicians,29 to tailor-made games built
as an adjunct to therapy,30 the potential of games to
innovate and enrich existing practice is emerging.
Game play can help increase patient adherence and
self-management, aid physical and psychological re-
covery, and enhance patient and clinician knowl-
edge in a range of contexts.26 In general, the litera-
ture emphasizes the potential of games to increase
patient motivation, learning through repetition and
an enriched environment, confidence through re-
inforcement and immediate feedback, and positiv-
ity through achievement and social interaction.31–38
Games may be particularly valuable in support-
ing stroke rehabilitation where effective rehabilita-
tion must be early, intensive, and repetitive.39 In a
study by Merians et al.,40 12 patients who had ex-
perienced a stroke at least six months previously
played an off-the-shelf game aimed at improving
eye–hand coordination, grip, and individual finger
movement, for two to three hours a day over eight
days. Patients also wore special robotic gloves (Cy-
berGlove) as the game controller and to assist and
measure hand movement. After eight days, patients
showed an average improvement in their standard
clinical scores of 20–22%, displaying better stabil-
ity, greater smoothness of movement, and improved
control over their fingers, in comparison to a control
group. Saposnik et al.27 reviewed 12 studies investi-
gating the effects of electronic games on upper arm
strength and mobility, concluding that patients who
played video games including Wii and Playstation
were up to five times more likely to show improved
arm motor function in comparison to those receiv-
ing standard therapy. Further, a recent Cochrane
systematic review41 on virtual reality for stroke re-
habilitation, comprising 19 studies with 565 stroke
patients, found that playing interactive games may
improve arm function and the management of activ-
ities of daily living. Within this review, the analysis
of seven trials comparing game play with traditional
therapy indicated that virtual reality resulted in bet-
ter arm function.
Ann. N.Y. Acad. Sci. 1252 (2011) 305–311 
c 2011 New York Academy of Sciences.
Music making after stroke to improve arm function
Although these findings are promising, the rel-
ative dearth of rigorous evaluation in this body of
research, the bias toward younger and less severely
affected patients, and the limited inclusion of a range
of commercial and tailored game activities raises a
need for further robust and ecologically valid inves-
tigation. Moreover, this should comprise the entire
trajectory, from the design of game activities to the
evaluation of their impact on patient experiences
and clinical outcomes. Importantly, one pervasive
feature of game activity omitted in the current lit-
erature is music, often concurrent to game play.
In general, the power of music to benefit psycho-
logical and physical health is widely acknowledged
throughout health care literature—as explained ear-
lier. Specifically, evidence indicates that concurrent
music can have ergogenic and psychophysical ben-
efits in a range of activity contexts, including game
play.42–45
In summary, there is an urgent need to develop
innovative approaches to self-management of up-
per limb rehabilitation after stroke. Converging ev-
idence in stroke rehabilitation, neuroscience, and
motor learning indicates that interventions incor-
porating repetitive practice of functionally relevant
tasks are most likely to improve functional recov-
ery. However, for these interventions to be clinically
effective, they need to stimulate intrinsic motiva-
tion to encourage stroke survivors to undertake and
maintain the required amount of self-practice. By
using preferred music, rhythmic auditory cueing,
and game play, our aim is to design a prototype inter-
vention that enables stroke survivors to improve the
function of their affected arm through self-directed
practice. Its specifications are that the intervention
should be safe and enjoyable, relevant to the individ-
ual, clinically effective, and provide options for indi-
vidual tailoring and progression. Measures of motor
performance used for feedback purposes should be
valid, reliable, and easy for the stroke survivor to
understand, the interface should be user friendly,
and the prototype should be acceptable to stroke
survivors and therapists.
Methods and results
The prototype intervention, written in C#, is a sim-
ple graphical interface consisting of a set of concen-
tric targets, one of which is highlighted to coincide
with each bar/beat of the music currently playing.
The task for the stroke survivor is to position the
307
Music making after stroke to improve arm function
Figure 1. Screenshot of the tap tempo game. Target circles are
highlighted in synchronization with music tempo.
on-screen cursor (through movement of their af-
fected arm) above the currently highlighted circle.
Thus, the game uses a simple “tap tempo” paradigm
(Fig. 1).
Technology
The system uses inexpensive, off-the-shelf Nintendo
Wii game technology. This is a flexible and popular
system, and has been suggested as a suitable tech-
nological means for facilitating game-based stroke
rehabilitation in the home for participants with lim-
ited range of movement.46 In this implementation,
the Wii remote controls are used as sensors (using
the built-in IR cameras) and thus the accelerometers
are not required. This setup means that the stroke
survivor does not need to hold the Wii remote in
their hand. It also allows for freedom of placement of
sensors at multiple points on the arm, hand, or wrist.
Upper limb movements, which translate to actions
in the game, are tracked using small, lightweight,
wireless infrared (IR) sources (LED and battery).
These are placed on the participant’s hand or arm,
depending on the therapeutic goal. Signals from the
IR sources are picked up by two IR sensors with
a 1024 × 768 pixel resolution and an approximate
40◦ field of view. The two sensors are placed at right
angles to the participant to enable the IR sources
to be tracked in three dimensions.47 The best re-
sponse from the sensors is achieved when placed at
a distance of between 0.5 m and 3 m from the par-
ticipant.48 Up to four IR sources can be tracked at
one time, and the spatial accuracy of source tracking
308 Ann. N.Y. Acad. Sci. 1252 (2011) 305–311 
van Wijck et al.
has been shown to be acceptable.49 Sensor data are
read and translated into game input data by scripts
running on the GlovePie input emulator program
(http://glovepie.org). These scripts can be used to
tailor movement range, direction, and speed to best
match the requirements of the participant.
Integrating therapeutic goals
The game comprises a number of parameters that
enable it to be tailored to individual goals and capa-
bilities. Importantly, the activity is based on the indi-
vidual’s musical preference. Speed of movement can
be altered by setting the distance between targets on
the screen, the gain between the participant’s move-
ments and movements displayed on screen, and the
beat pulse to which participants must synchronize
their movement (e.g., bar, quarter). In addition, the
direction and range of movement can be tailored
to individual needs; for example, the activity can
be set to emphasize shoulder flexion and external
rotation together with elbow extension. Further, ac-
curacy can be tailored by altering the size of targets
(Fig. 2), while the complexity of the activity as a
whole can be adjusted by changing speed and ac-
curacy as well as the order (e.g., blocked, random)
in which targets need to be touched. The parame-
ters of speed and accuracy, range, and direction of
movement, as well as task complexity, can all be se-
lected by the therapist and stored in an individual
patient file to facilitate set-up for follow-up sessions
and independent practice.
Music selection
Music selected by the participant is preprocessed
in order to extract tempo and rhythm information.
This is achieved through use of onset detection algo-
rithms implemented in the Sonic Visualizer audio
analysis and visualization program.50 The output of
this analysis is a vector of time values, labeled with
bar/beat locations in the digital music file. The vec-
tor is stored in an output comma separated values
file that is used by the game software, along with
the digital music file. As the music plays during the
game, the game software reads the vector of time
values and synchronizes the game graphics with the
music (Fig. 3).
Feedback
Data on several aspects of the participant’s perfor-
mance are recorded during game play. These include
the music chosen by the participant, the time spent
c 2011 New York Academy of Sciences.
van Wijck et al. Music making after stroke to improve arm function

Figure 2. Changing the demand for movement accuracy by adjusting the target size.

playing the game, the number of times it was played,
and the game “score” (the number of times the cor-
rect target was hit).
In addition, the input emulator software records
the movement of the IR sources in three dimensions
for post-hoc analysis. These data can be compared
to the music beat/pulse data vector to examine the
participant’s movements in comparison to the mu-
sic and provide knowledge of results (i.e., informa-
tion about the degree to which the environmental
goal was achieved16 ) in terms of spatial and tempo-
ral accuracy. Cursor position is logged at each point
in time coinciding with the bar/beat of the music,
allowing production of scatter plots showing the ac-
curacy with which the participant moves the cursor
in time to the music (Fig. 4).
Next steps
The next step in the development of this prototype is
seeking the opinions of stroke survivors and thera-
pists in the evaluation of safety and appropriateness
of the intervention, as well as its impact on patient
motivation. Our aim is to make the interface sim-
ple to use and accessible for stroke survivors with
sensory, cognitive, and/or communication impair-
ments, since a key aim of this technology is to sup-
port its use in the home by a wide range of stroke
survivors. In addition, we will explore a range of
music game models, including creating music as
well as playing along existing music. Further work
will examine the accuracy and reliability of upper
limb movement, captured with this IR technology,
to explore its use in knowledge of performance (i.e.,

Figure 3. Music waveform with beat markers (top panel) and participant’s movements (bottom panel).

Ann. N.Y. Acad. Sci. 1252 (2011) 305–311 

c 2011 New York Academy of Sciences. 309
Music making after stroke to improve arm function
Figure 4. Summary feedback on movement accuracy from sev-
eral attempts.
feedback on joint kinematics) to further facilitate
motor learning. Next, clinical trials will be con-
ducted to compare the effects and experiences of
the game activity played together with individuals’
preferred music, played with preselected music with
the same rhythm, with rhythm only, and without
any auditory stimulus. This also includes an RCT to
compare the impact of this music game interven-
tion with current conventional rehabilitation inter-
ventions in terms of clinical outcomes, motivation,
and self-efficacy. Finally, our aim is to add a social
dimension by enabling people to play together.
Conclusions
A prototype music game intervention has been de-
signed for stroke survivors with impaired arm func-
tion, based on principles of music psychology, game
technology, rehabilitation, neuroscience, movement
science, and audiotechnology. The intervention can
be tailored to individuals with a range of upper limb
impairments and activity limitations, as well as mu-
sical preferences. One of the strengths of this tech-
nology is that the therapeutic input can be quanti-
fied, while outcomes can also be measured in detail.
Several iterations of user involvement and feedback
are now underway to test and further develop the
prototype. This intervention is anticipated to open
up novel opportunities to tailor an off-the-shelf
technology to the specific preferences and rehabili-
tation needs of individuals with stroke, for use in the
home environment as a strategy for self-managed
upper limb rehabilitation.
Acknowledgments
This study was supported by a pump-priming re-
search fund from the Institute for Applied Health
310 Ann. N.Y. Acad. Sci. 1252 (2011) 305–311 
van Wijck et al.
Research, Glasgow Caledonian University, Glasgow,
UK.
Conflicts of interest
The authors declare no conflicts of interest.
References
1. World Health Organisation Task Force on Stroke and Other
Cardiovascular Disorders. 1989. Special report from the
World Health Organization. Stroke-1989. Recommenda-
tions on stroke prevention, diagnosis, and therapy. Stroke
20: 1407–1431.
2. Mackay, J. & G. Mensah. 2004. Atlas of Heart Disease and
Stroke. Geneva, Switzerland: World Health Organisation
Press.
3. Parker, V.M., D.T. Wade & R. Langton Hewer. 1986. Loss
of arm function after stroke: measurement, frequency, and
recovery. Int. Rehabil. Med. 8: 69–73.
4. Broeks, J.G., G.J. Lankhorst, K. Rumping & A.J. Prevo. 1999.
The long-term outcome of arm function after stroke: results
of a follow-up study. Disabil. Rehabil. 21: 357–364.
5. Lai, S.M., S. Studenski, P.W. Duncan & S. Perera. 2002. Per-
sisting consequences of stroke measured by the Stroke Im-
pact Scale. Stroke 33: 1840–1844.
6. Wyller, T.B., U. Sveen, K.M. Sodring, A.M. Pettersen, et al.
1997. Subjective well-being one year after stroke. Clin. Re-
habil. 11: 139–145.
7. Boissy, P., D. Bourbonnais, M.M. Carlotti, D. Gravel, et al.
1999. Maximal grip force in chronic stroke subjects and
its relationship to global upper extremity function. Clin.
Rehabil. 13: 354–362.
8. Dewald, J.P.A. & R.F. Beer. 2001. Abnormal joint torque pat-
terns in the paretic upper limb of subjects with hemiparesis.
Muscle Nerve 24: 273–283.
9. Gowland, C., H. DeBruin, J.V. Basmajian, N. Plews,
et al. 1992. Agonist and antagonist activity during volun-
tary upper-limb movement in patients with stroke. Phys.
Ther. 72: 624–633.
10. Archambault, P., P. Pigeon, A.G. Feldman & M.F. Levin.
1999. Recruitment and sequencing of different degrees of
freedom during pointing movements involving the trunk in
healthy and hemiparetic subjects. Exp. Brain Res. 126: 55–67.
11. Carey, L.M., L.E. Oke & T.A. Matyas. 1996. Impaired limb
position sense after stroke: a quantitative test for clinical use.
Arch. Phys. Med. Rehabil. 77: 1271–1278.
12. Edwards, S. 2002. Abnormal tone and movement as a result
of neurological impairment: considerations for treatment.
In Neurological Physiotherapy: A Problem-Solving Approach.
S. Edwards, Ed.: 89–120. Churchill Livingstone. Edinburgh.
13. Langhorne, P., F. Coupar & A. Pollock. 2009. Motor recovery
after stroke: a systematic review. Lancet Neurol. 8: 741–754.
14. Hubbard, I.J., M.W. Parsons, C. Neilson & L.M. Carey. 2009.
Task-specific training: evidence for and translation to clinical
practice. Occup. Ther. Int. 16: 175–189.
15. Huang, W.C., Y.J. Chen, C.L. Chien, H. Kashima & K.C. Li.
2011. Constraint-induced movement therapy as a paradigm
of translational research in neurorehabilitation: reviews and
prospects. Am. J. Transl. Res. 3: 48–60.
c 2011 New York Academy of Sciences.
van Wijck et al.
16. Schmidt, R.A. & C.A. Wrisberg. 2008. Motor Learning and
Performance: A Situation-Based Learning Approach. 4th ed.
Human Kinetics. Champaign, IL.
17. Scottish Government. 2009. Improving the health and
wellbeing of people with long term conditions in Scotland:
A national action plan [online]. Available at: http://
www.scotland.gov.uk/Publications/2009/12/03112054/11
(Accessed 24 September, 2011).
18. Thaut, M.H. 2008. Rhythm, Music, and the Brain: Scientific
Foundations and Clinical Applications. Routledge. New York.
19. Bradt, J., W.L. Magee, C. Dileo, et al. 2010. Music ther-
apy for acquired brain injury. Cochrane Database Syst. Rev.:
CD006787, doi:10.1002/14651858.CD006787.pub2.
20. Pothoulaki, M., R.A.R. MacDonald & P. Flowers. 2008. An
investigation of the effects of music on anxiety and pain
perception in patients undergoing haemodialysis treatment.
J. Health Psych. 13: 912–920.
21. Bernatzky, G., S. Strickner, M. Presch, et al. (in press). Mu-
sic as non-pharmacological pain management in clinics. In
Music Health and Being. R.A.R. MacDonald, G. Kreutz & L.
Mitchell, Eds. Oxford University Press. Oxford.
22. Spintge, R. (in press). Clinical use of music in operating
theatres. In Music Health and Being. R.A.R. MacDonald, G.
Kreutz & L. Mitchell, Eds. Oxford University Press. Oxford.
23. Mitchell, L.A., R.A.R. MacDonald & C. Knussen. 2008. An
investigation of the effects of music and art on pain percep-
tion. Psych. Aesth. Creat. Arts. 2: 162–170.
24. Knox, D., S. Beveridge, L.A. Mitchell & R.A. MacDonald.
2011. Acoustic analysis and mood classification of pain-
relieving music. J. Acoust. Soc. Am. 130: 1673–1682.
25. Kato, P. 2010. Video games in health care: closing the gap.
Am. Psych. Ass. 14: 113–121.
26. Kato, P.M., S.W. Cole, A.S. Bradlyn & B. Pollock. 2008. A
video game improves behavioral outcomes in adolescents
and young adults with cancer: a randomized trial. Pediatrics
122: 305–317.
27. Saposnik, G., R. Teasell, M. Mamdani, et al. 2010. Effective-
ness of virtual reality using Wii gaming technology in stroke
rehabilitation: a pilot randomized clinical trial and proof of
principle. Stroke 41: 1477–1484.
28. Gee, J.P. 2003. What Video Games have to Teach Us About
Learning and Literacy. Palgrave Macmillan. New York.
29. Annetta, L. 2010. The “I’s” have it: A framework for serious
educational game design. Rev. Gen. Psych. 14: 105–112.
30. Hoffman, H.G., D.R. Patterson, E. Seibel, et al. 2008. Virtual
reality pain control during burn wound debridement in the
hydrotank. Clin. J. Pain 24: 299–304.
31. Fitzgerald, S. & R. Cooper. 2004. The GAME(Cycle) exercise
system: comparison with standard ergometry. J. Spin. Cord
Med. 27: 453–459.
32. Graves, L., G. Stratton, N. Ridgers & N. Cable. 2008. Energy
expenditure in adolescents playing new generation computer
games. Br. J. Sports Med. 42: 592–594.
33. Kato, P.M. & I.L. Beale. 2006. Factors affecting acceptability
to young cancer patients of a psychoeducational video game
about cancer. J. Pediatr. Onc. Nurs. 23: 269–275.
34. Krichevets, A., E. Sirotkina, I. Yevsevecheva & L. Zeldin.
1994. Computer games as a means of movement rehabilita-
tion. Disabil. Rehabil. 17: 100–105.
35. Lanningham-Foster, L., T. Jensen, R. Foster, et al. 2006.
Energy expenditure of sedentary screen time compared
Ann. N.Y. Acad. Sci. 1252 (2011) 305–311 
c 2011 New York Academy of Sciences.
Music making after stroke to improve arm function
with active screen time for children. Pediatrics 118: 1831–
1835.
36. Lieberman, D.A. 1997. Interactive video games for health
promotion: effects on knowledge, self-efficacy, social sup-
port, and health. In Health Promotion and Inter-active Tech-
nology: Theoretical Applications and Future Directions. R.L.
Street, W.R. Gold & T. Manning, Eds.: 103–120. Erlbaum.
Mahwah, N.J.
37. Rosas, R., M. Nussbaum, P. Cumsille, et al. 2003. Beyond
Nintendo: design and assessment of educational video games
for first and second grade students. Comput. Educ. 40: 71–94.
38. Sharar, S., G. Carrougher, D. Nakamura, et al. 2007. Factors
influencing the efficacy of virtual reality distraction analgesia
during postburn physical therapy: preliminary results from
3 ongoing studies. Arch. Phys. Med. Rehabil. 88: 43–49.
39. Burke, J.W., M.D. McNeill, D.K. Charles, et al. 2009. Op-
timising engagement for stroke rehabilitation using serious
games. Vis. Comput. 25: 1085–1099.
40. Merians, A.S., G.G. Fluet, Q. Qiu, et al. 2011. Robotically
facilitated virtual rehabilitation of arm transport integrated
with finger movement in persons with hemiparesis. J. Neu-
roeng. Rehabil. 8: 27.
41. Laver, K.E., S. George, S. Thomas, et al. 2011. Virtual re-
ality for stroke rehabilitation. Cochrane Database Syst. Rev.:
CD008349, doi:10.1002/14651858.CD008349.pub2.
42. Cassidy, G. & R.A. MacDonald. 2008. The role of music in
videogames: the effects of self-selected and experimenter-
selected music on driving game performance and expe-
rience. In Proceedings of the 10th International Conference
on Music Perception and Cognition, 25–29 August, Sapporo,
Japan.
43. Cassidy, G.G. & R.A.R. MacDonald. 2009. The effects of mu-
sic choice on task performance: A study of the impact of self-
selected and experimenter-selected music on driving game
performance and experience (ESCOM Young Researcher of
the Year Award).
44. Cassidy, G.G. & R.A. MacDonald. 2010. The effects of music
on time perception and performance of a driving game.
Scand. J. Psyc. 51: 455–464.
45. Knox, D., G. Cassidy, S. Beveridge & R. MacDonald. 2008.
Music emotion classification by audio signal analysis: anal-
ysis of self-selected music during game play. In Proceedings
of the 10th International Conference on Music Perception and
Cognition, 25–29 August 2008, Sapporo, Japan.
46. Alankus, G., A. Lazar, M. May & C. Kelleher. 2010. Towards
customizable games for stroke rehabilitation. In CHI 2010:
Therapy and Rehabilitation. Atlanta, GA, USA.
47. Murgia, A., R. Wolff, P.M. Sharkey & B. Clark. 2008. Low-cost
optical tracking for immersive collaboration in the CAVE
using the Wii Remote. In Proceedings of the 7th ICDVRAT
with ArtAbilitation, Maia, Portugal.
48. Schou, T. & H.J. Gardner. 2007. A Wii remote, a game engine,
five sensor bars and a virtual reality theatre. In Proceedings
of OzCHI 2007, Adelaide, Australia.
49. Vannoni, M. & S. Straulino. 2007. Low-cost accelerometers
for physics experiments. Eur. J. Phys. 28: 781–787.
50. Cannam, C., C. Landone & M. Sandler. 2010. Sonic Visu-
aliser: an open source application for viewing, analysing,
and annotating music audio files. In Proceedings of the ACM
Multimedia 2010 International Conference, MM’10, Firenze,
Italy.
311