The Piano Prescription

At Georgia State, a cross-field team of researchers is working to rewire the injured brain in an unexpected way: with a combination of music and technology. Their work, centered around a digital app called KeyStroke, is helping patients regain movement and making the process effective and even enjoyable.

The result is a therapeutic piano app designed for stroke rehabilitation. It’s called KeyStroke, and the experience, Chen says, feels “a bit like Guitar Hero — but for recovery.” Patients are guided by on-screen notes as they play simple melodies on a piano keyboard, turning repetitive motor exercises into a kind of game.

KeyStroke’s melodies are composed by Norgaard and students in his lab using a therapeutic sequence created by Chen based on how the hand, wrist and arm relearn functional movements after injury. Norgaard’s lab also created the background music used in the app’s current version, so each exercise is like a miniature duet between the patient and the app.

“The goal isn’t really to learn to play piano,” Norgaard explains. “It’s to redevelop upper-extremity function. The songs are structured from a developmental and therapeutic perspective, not a musical one.”

Chen says that design is intentional. “If you think about traditional rehab exercises, they can be boring, repetitive and often not motivating,” she says. “With KeyStroke, people are engaged. They’re listening, moving and creating all at once.”

Assistant Professor of Communication Sciences and Disorders Rachael Harrington studies how targeted brain stimulation can aid stroke recovery, helping patients regain reading, language and motor skills through individualized neurorehabilitation.

While work continues to upgrade the app’s capabilities, Harrington is studying what’s happening in the brains of patients who use it. She’s analyzing how musical rehabilitation affects brain connectivity after therapy.

Using neuroimaging data such as functional magnetic resonance imaging (fMRI) scans, Harrington can gauge patients’ resting-state connectivity, which measures how strongly different brain regions are connected to each other, as well as their task-based activation, which measures which regions of the brain are engaged when tapping to a beat.

“So far, we’ve seen really interesting changes,” Harrington says. “We’re noticing increased connectivity between regions that handle motor control and those that process sound and rhythm. That’s a marker of neuroplasticity — the brain rewiring itself through practice.”

Harrington says music offers a unique advantage in stroke recovery because it activates both hemispheres of the brain.

“Where speech or movement are usually controlled on one side, music engages both,” she says. “So if one hemisphere is damaged, the other can help take over. That bilateral activation seems to support recovery in a way traditional therapy doesn’t always achieve.”

To analyze the patients’ progress, Harrington has access to some of the most advanced facilities in the Southeast through the collaborative Center for Advanced Brain Imaging (CABI). The facility is part of the Georgia Research Alliance’s Core Exchange, which allows university researchers to share cutting-edge scientific resources.

“CABI is such an incredible resource,” Harrington says. “It’s entirely dedicated to brain imaging and neurobiology research, with everything from a 3T MRI to advanced computing clusters for data analysis. What makes it really special is the supportive staff and the collaborative environment. They help you design experiments, interpret results and connect with other researchers across Georgia State and Georgia Tech.”

Yi-An Chen, assistant professor of occupational therapy, studies upper-extremity rehabilitation after stroke and develops music-based, home therapy apps to make recovery engaging and effective.

For Chen, who has seen patients struggle through rehabilitation after a stroke, the biggest success isn’t only in the results — it’s in the joy.

“Rehabilitation is hard,” she says. “It’s repetitive and exhausting. Most patients don’t get enough therapy after they leave the hospital because insurance only covers so much. We wanted to create something that people want to do.”

And, she says, it’s working. “One of our participants told us he used to play music with his grandchildren,” Chen says. “Now he practices using the app, and they sing along. It’s no longer a ‘rehab exercise,’ it’s something joyful they share together. That’s what we mean when we say we want rehabilitation to be part of life again.”

Another participant’s spouse told the team she was thrilled she didn’t have to “nag” her husband to practice. “He just wanted to sit down and play,” Chen says. She believes that shift is at the heart of KeyStroke’s potential.

As the researchers continue to collect and review data and refine the app, their findings are promising. They plan to publish a case study of the imaging results, sharing how individual participants respond to the intervention. They’re also seeking new funding to continue to improve the app and reach more stroke survivors.

“It’s not about ‘curing’ someone,” Chen says. “It’s about making the process more engaging — more human. Even after stroke, you can still enjoy music. You can still create something beautiful.”