the therapeutic instrument music performance ( timp ) technique uses instruments to reinforce 
 functional motor patterns ; the instruments are usually percussive instruments , which do not 
 require any previous music skills1 . instrumental piano training entails the repetition of fine finger movements as well as 
 finger and hand coordination . furthermore , those performing the movement receive immediate 
 auditory feedback regarding performance and can therefore try to correct their own 
 performance2 . for fine motor skill 
 training , timp usually uses the keyboard as its main rehabilitative intervention instrument . 
 therapeutic keyboard music playing ( tkmp ) uses familiar melodies of famous music pieces to 
 explore a new type of timp . according to past research , tkmp not only provides pleasure from making audible music but 
 also motivates individuals to participate in rehabilitation by using their affected and 
 intact hand functions1 . although there has 
 been some research supporting the application of timp for brain injury , cerebral palsy , and 
 neuro - rehabilitation , less research supports tkmp used for physical therapy ( pt ) . actually , 
 timp , especially the tkmp method , is very suitable for patients with hand dysfunctions . rehabilitation of finger movement function during pt for patients with spinal cord injuries 
 is based on more precise controlling exercises . patients were asked to perform to the best of their ability , but the 
 patients always felt tired . however , tkmp is a new way to facilitate functional non - musical 
 outcomes by training and retraining the hand and fingers to achieve motor control and hand 
 muscle recovery . this experiment was used to observe the immediate effects of tkmp on variations in the 
 joint position error ( jpe ) test , surface electromyography ( semg ) , probe reaction time 
 ( p - rt ) , and writing time after intervention . in addition , it was also performed to explore a 
 more effective method that includes physical hand exercises and tkmp techniques to help in 
 the recovery of patients with hand dysfunction . the subjects had a mean age of 
 26.4  3.1  years , an average height of 170.0  5.6  cm , and a mean body weight of 64.5  
 7.2  kg . they were selected at random from the medical school interns who were able to 
 independently perform activities of daily living . they participated in the experimental 
 group and in the control group on different days . the same subjects were also used as the control group and performed grip 
 training , but not on the same days as when tkmp therapy was performed . all subject 
 characteristics are detailed in table 
 1table 1.subject characteristicsmean  sdn=10age ( yrs)26.4  3.1height ( cm)170.0  5.6weight ( kg)64.5  7.2 . before the experiment , all subjects were tested using the following : jpe test , semg , p - rt , 
 and writing time . after all interventions were accomplished , subjects were evaluated by 
 using the tests again to observe the intervention effects . the purpose and contents were 
 explained to the subjects before the experiment , and they gave their informed consent to 
 participate . all experimental procedures in this study were explained to them and were 
 approved by the research ethics committee of the china rehabilitation research center ( irb 
 no . the subjects sat on low chairs with their shoulders and backs straight , and they placed 
 their right hand naturally on the keyboard . in the experimental group , the subjects were 
 trained to play musical pieces for approximately 20 minutes under the guidance of the music 
 therapist . the music piece ode to joy ,  which was written by the famous german classical 
 composer beethoven , was familiar to all the experimental group participants . the melody used 
 in this experiment was only eight bars with 42 beats in c major . in the control group , the 
 subjects were trained with grip training under the guidance of the physical therapist . it is also considered the primary measure of upper limb 
 proprioception and has been widely used as an outcome measure for patients with cervical 
 spinal cord injury4 . although there are 
 few reports to support its use for measuring other joints , it has been widely used as an 
 effective evaluation of angle joints . during the jpe test , rom measurement equipment ( bioval 
 4.51 , sycomore 8.51 , rmingenierie , france ) was used . the fixed and mobile arms were the 
 vertical axis of the radius and fifth metacarpal ; the extension angles of the wrist joints 
 were recorded by the computer . the subjects were asked to close their eyes , and the examiner 
 extended the subjects wrist joints at random angles . the subjects wrist joints were put 
 back on tables , and they were asked to extend their wrists at approximately the same angles 
 as in the initial extension . each 
 measurement was performed five times , and the average value was used for analysis . semg tests the muscle function 
 through the inquiry of the electrical signal that the muscle emanates5 . it is reported that semg evaluation data are usually 
 collected by an semg system ( telemyo 2400 t ; noraxon , scottsdale , az , usa)6 . in this experiment the p - rt was tested using a digital audio player / recorder ( rio japan ) . the recorder was 
 used to play the stimulus signals to the subject and the subject s vocal response was 
 recorded through the microphone . a digital audio player / recorder was used to record the 
 vocal response that the subject had in response to the stimulus signal . the sounds  yoi  and 
  pi  were pre - recorded on the rio player . yoi  gave notice that the test would begin , and 
  pi  was the stimulus signal . the results were downloaded to a pc , and the time between the auditory 
 stimulus of  pi  and the utterance of  pa  during p - rt was evaluated7 . during the writing time evaluation , the subjects were asked to write the uppercase english 
 alphabet with their left hand on a4 paper . all the subjects in the experimental group were trained with the same musical pieces and 
 the same playing method with the five fingers of their right hand . during the 20-minute 
 therapeutic sessions , the music therapist first taught them the single melody ; when the 
 subjects were accustomed to playing the melody , the music therapist began to accompany them 
 with the same harmony until they were quite skilled in playing . the musical pieces played by 
 the experimental group with their right hands are shown in fig . musical piece played by the experimental group with their right hands two - way repeated - measures analysis of variance ( anova ) was used to assess and evaluate 
 statistically significant differences in the intervention of the two groups . if any 
 significant interaction was found , then the paired t - test was used to compare the outcome 
 indicators before and after the intervention . data were analyzed with spss version 17.0 for 
 windows ( spss , chicago , il , usa ) . the data for the jpe test , semg , p - rt , and writing time for the two groups are shown in 
 table 2table 2.intervention effects of tmkpa . 1.23.6  1.63.4  1.6b < a , c , d * ave semg ( v)951.4  914.9839.2  496.61,061.4  635.2890.3  505.2max semg ( v)4,827.7  3,951.35,347.2  3,086.55,996.7  4,357.06,061.0  3,123.4p - rt ( ms)383.2  81.5323.7  53.4399 . 3 112.0426.8  155.8b < a , c , d * writing time ( s)21.9  3.418.8  4.421.7  4.021.6  3.6b < a , c , d * * p<0.05 ; p<0.01 . there were no significant differences in average and maximum muscle strength ; however , 
 there was an obvious interactive function of the jpe test and p - rt in the two groups . the 
 paired t - test results after tmkp showed that writing time , p - rt , and jpe test score all 
 significantly decreased . tkmp was used as an intervening variable to train the experimental group subjects to 
 improve their jpe test , semg , p - rt , and writing time results . grip training was used to 
 train the control group subjects so that the results could be compared to those of the 
 experimental group trained with the tkmp method . there were no significant differences in the maximum semg 
 between the two groups , which meant that grip training played the same role as tkmp training 
 for muscle strength . the experimental group subjects reported feeling joyful and interested 
 during the music training , but there was no obvious enhancement on semg . according to the data shown in table 2 , there 
 was a significant improvement in jpe test , p - rt , and writing time . this meant that the tkmp 
 intervention was more effective than grip training for reinforcing finger movement 
 functions . compared to other traditional therapy methods such as grip training or other 
 occupational therapy , the tkmp method provided tremendous advantages . in this experiment , 
 the famous music work ode to joy ,  which was very familiar to every subject , was used . it 
 was easy for the subjects to follow the melody and learn how to play . the melody , which was 
 easy for the subjects to memorize , played an active role in the session . although the active 
 psychological effects of the music were not evaluated during this experiment , they were 
 evident in the writing time and p - rt results . music , as an acoustic expression of art , has 
 unique aesthetic functions that could help improve the training efficacy . in addition , tkmp 
 combined with a familiar melody provided an interesting way to practice hand muscle function 
 and was more diverse and effective than traditional occupational therapy or pt . finally , for writing time , there was an obvious 
 enhancement in speed after keyboard playing that was not seen after grip training . therefore , tkmp is an effective and novel treatment that should be widely promoted in 
 clinics .
[ purpose ] the purpose of this study was to examine the immediate effects of therapeutic 
 keyboard music playing on the finger function of subjects hands through measurements of 
 the joint position error test , surface electromyography , probe reaction time , and writing 
 time . 
 [ subjects and methods ] ten subjects were divided randomly into experimental and 
 control groups . 
 the experimental group used therapeutic keyboard music playing and the 
 control group used grip training . 
 all subjects were assessed and evaluated by the joint 
 position error test , surface electromyography , probe reaction time , and writing time . 
 [ results ] 
 after accomplishing therapeutic keyboard music playing and grip training , 
 surface electromyography of the two groups showed no significant change , but joint 
 position error test , probe reaction time , and writing time obviously improved . 
 [ conclusion ] 
 these results suggest that therapeutic keyboard music playing is an effective 
 and novel treatment for improving joint position error test scores , probe reaction time , 
 and writing time , and it should be promoted widely in clinics .