Neurologic music therapy in multidisciplinary acute stroke rehabilitation: Could it be feasible and helpful?

Exploring Music-Based Interventions for Executive Functioning and Emotional Well-Being in Stroke Rehabilitation: A Scoping Review

PURPOSE

Stroke is one of the leading causes of disability with life-long implications requiring assessment and treatment of several functional domains. This review identifies the results from research into music-based interventions (MBIs), including music therapy (MT), for executive functions (EFs) and emotional well-being (EWB) in adults with stroke and highlights opportunities for clinical practice and future research.

METHODS

APA PsycInfo (EBSCOhost), and CINAHL (EBSCOhost) were searched, in addition to grey literature.

RESULTS

A total of 49 studies were included and encompassed experimental, analytic, and descriptive observational studies, and case reports, involving a total of 1663 participants. In total, 32 studies included MT interventions, and 17 were MBIs. EFs were an outcome in 20.41%, and EWB in 61.22% of studies, for which active interventions were the most utilized. Overall, 73.47% of the studies reported positive results.

CONCLUSIONS

This scoping review indicates that music interventions can be beneficial for the improvement of different aspects of EFs and EWB at different stages of stroke recovery. Further research may benefit clinical practice by including standardized protocols, outcome and self-reported measures, and brain imaging data to determine the effects of interventions and support evidence-based decisions for treatment policies for stroke survivors.

To explore the application value of nursing staff involved multidisciplinary continuous nursing in stroke patients with limb dysfunction

BACKGROUND

Stroke patients often experience limb dysfunction, which can significantly impact their quality of life and daily living abilities. This study aimed to explore the effectiveness of nursing programs that incorporate multidisciplinary continuing care with the participation of nursing staff for patients with stroke and limb dysfunction.

METHODS

This was a randomized controlled trial (RCT) conducted from August 2021 to August 2023. Ninety stroke patients were randomly assigned to a control group (n = 45) and an observation group (n = 45). The control group received routine discharge care, while the observation group received multidisciplinary continuing care with the participation of nursing staff. Outcomes measured included Fugl-Meyer Assessment (FMA) scores for upper and lower limb function, quality of life, daily living ability (Barthel Index, MBI), and adverse reactions.

RESULTS

The FMA scores for upper and lower limbs were significantly higher in the observation group compared to the control group. The observation group also had significantly higher scores in all quality of life dimensions and MBI scores compared to the control group. There were 10 adverse reactions reported in the observation group and 22 in the control group.

CONCLUSIONS

Implementing multidisciplinary continuing care with the participation of nursing staff for stroke patients with limb dysfunction has a positive effect on improving limb function, quality of life, and daily living abilities, while also being relatively safe.

Development and integration of a music therapy program in the neurologic inpatient setting: a qualitative study

PURPOSE

Explore facilitators and barriers to development and integration of an inpatient music therapy (MT) program from the perspective of the patient, family member, and health care professional.

MATERIALS AND METHODS

This qualitative study recruited patients on acute neurosciences/neurorehabilitation units having participated in the hospital MT program, their family, and members of their health care team. Semi-structured individual interviews and focus groups were conducted with 35 participants (14 patients, 5 family members, 16 health care professionals). Interviews/focus groups were audio recorded and transcribed verbatim. Data were coded in duplicate and a codebook was developed through an iterative process.

RESULTS

Four dominant themes emerged from the data: (1) facilitators of program operations; (2) barriers to program establishment; (3) perceived positive impact on patient outcomes; and (4) opportunity for improvement. Facilitator sub-themes included a love for music that encouraged participation, broad appeal of MT, and support of the health care team.

CONCLUSIONS

Patients, health care professionals, and family members accepted MT as a treatment modality. While there is growing evidence for MT in neurorehabilitation, practical challenges remain in developing inpatient MT services, including funding, and optimal integration of music therapists into existing care teams.

Research on music therapy from 2013 to 2022: a bibliometric and visualized study

Background

Music therapy is a rapidly evolving multidisciplinary field. But there has been no research analyzing the latest research status and development trends in this research field from a macro perspective. We aim to identify hotspots, knowledge base, and frontiers in the field of music therapy through bibliometric analysis.

Methods

All data were retrieved from the Web of Science core database from January 1, 2013 to December 31, 2022.CiteSpace and Bibliometrix software were employed for bibliometric analysis and visualization analysis.

Results

A total of 2,397 articles were included. In the past decade, there has been a consistent increase in the number of publications. The countries and institutions with the largest production in this field are the USA and the University of London. Based on the analysis of the total number of citations, centrality, and production, the results show that the most influential journals are PLoS One and Cochrane Database Syst Rev. Keyword co-occurrence analysis and highly cited study analysis are mainly used to analyze research hotspots in the field of music therapy, while the keyword burst analysis is employed to explore frontiers and potential developmental trends. Hot keywords include "interventions", "anxiety" and "randomized controlled trial". The burst keywords include "validity", "preterm infants", and "mild cognitive impairment". In the ranking of highly cited study, the top ranked studies are "Music-based interventions in neurological rehabilitation" and "Music interventions for improving psychological and physical outcomes in cancer patients".

Conclusion

In the past decade, the research focus in music therapy was the effect of music therapy on neurological diseases and the improvement of psychological symptoms such as pain and anxiety. The neurophysiological mechanisms that bring about these therapeutic effects need to be future researched.

Effects of Music Therapy on Aphasia and Cognition of Patients with Post-stroke: A Systematic Review and Meta-analysis

PURPOSE

This investigation sought to systematically assess music therapy's impact on aphasia and cognition in patients with post-stroke.

METHODS

Comprehensive searches were performed across major databases, including PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, and Vip Chinese sci-tech periodicals (VIP), covering publications up to December 2023. After screening and extracting data from the retrieved literature, its quality was appraised, which was followed by a meta-analysis using RevMan software (version 5.4, Cochrane Collaboration, Oxford, UK).

RESULTS

Nine articles, which were published from 2008 to 2022, were covered in this investigation, comprising 309 stroke patients in total. Meta-analysis results from these variations were found to be not statistically significant in the degree of functional communication improvement between the experimental group and the control group (standardized mean difference [SMD] = 0.23, 95% confidence interval [CI] (-0.19; 0.77), P > 0.05). These variations were found to be not statistically significant in the improvement of understanding ability in the experimental group compared with that in the control group (SMD = 0.21, 95% CI [-0.66; 1.09], P > 0.05). The degree of improvement in repetitive ability of the experimental group was considerably greater than that of the control group (SMD = 0.37, 95% CI [0.01; 0.76], P < 0.05). These variations were found to be not statistically significant in the improvement of naming ability in the experimental group compared with that in the control group (SMD = 0.30, 95% CI [-0.19; 0.80], P > 0.05). The cognitive score of the experimental group was considerably greater than that of the control group (SMD = 0.75, 95% CI [0.44; 1.06], P < 0.05).

CONCLUSION

Music therapy can effectively ameliorate the repetition ability of patients with aphasia after stroke. It can also improve the cognitive ability of patients. Thus, music therapy could be further applied to treat this type of patients.

The effects of musical instrument training on fluid intelligence and executive functions in healthy older adults: A systematic review and meta-analysis

Intervention studiescombiningcognitive and motor demands have reported far-transfer cognitive benefits in healthy ageing. This systematic review and meta-analysis evaluated the effects of music and rhythm intervention on cognition in older adulthood. Inclusion criteria specified: 1) musical instrument training; 2) healthy, musically-naïve adults (≥60 years); 3) control group; 4) measure of executive function. Ovid, PubMed, Scopus and the Cochrane Library online databases were searched in August 2023. Data from thirteen studies were analysed (N = 502 participants). Study quality was assessed using the Cochrane Risk of Bias tool (RoB 2; Sterne et al., 2019). Random effects models revealed: a low effect on inhibition (d = 0.27,p = .0335); a low-moderate effect on switching (d = -0.39, p = .0021); a low-moderate effect on verbal category switching (d =0.39,p = .0166); and a moderate effect on processing speed (d = 0.47,p < .0001). No effect was found for selective visual attention, working memory, or verbal memory. With regards to overall bias, three studies were rated as "high", nine studies were rated as having "some concerns" and one was rated "low". The meta-analysis suggests that learning to play a musical instrument enhances attention inhibition, switching and processing speed in ageing.

The effects of rhythmic auditory stimulation on functional ambulation after stroke: a systematic review

BACKGROUND

Several studies have reported the effect of rhythmic auditory stimulation (RAS) on functional ambulation in stroke patients, yet no systematic overview has yet been published. This study aims to synthesize the available evidence describing changes in stroke patients after RAS intervention for functional ambulation and the use of walking assistive devices, and to find out if the effect of RAS and music-based RAS differs depending on the lesioned area.

METHODS

The PubMed, PEDro, Cochrane Central Register of Controlled Trials, Web of Science, Scopus and CINAHL electronic databases were searched for reports evaluating the effect of RAS on walking in stroke patients, applying the PICOS criteria for the inclusion of studies.

RESULTS

Twenty one articles were included (948 stroke survivors). Most studies were of good methodological quality according to the PEDro scale, but they had a high risk of bias. The most consistent finding was that RAS improves walking and balance parameters in stroke patients in all phases compared to baseline and versus control groups with conventional treatment. Functional ambulation and the use of walking assistive devices were inconsistently reported. Several studies also suggest that RAS may be as good as other complementary therapies (horse-riding and visual cueing).

CONCLUSIONS

Despite the beneficial effects of RAS, the question remains as to whether it is better than other complementary therapies. Given the heterogeneity of the interventions, the interventions in control groups, the varied durations, and the different outcome measures, we suggest that care should be taken in interpreting and generalizing findings.

PROSPERO REGISTRATION

CRD42021277940.

Effects of music therapy on mood, pain, and satisfaction in the neurologic inpatient setting

PURPOSE

Music therapy (MT) has been used in health care settings for a wide variety of treatment goals. Many inpatients with neurologic impairments struggle with low mood and pain for which MT may be a novel adjunct treatment. The aims of this study were to: (1) evaluate change in mood and pain following a single MT session; (2) explore the impact of an MT program on mood, pain and satisfaction from the perspective of the patient, family and staff.

MATERIALS AND METHODS

A mixed-methods study was conducted. Forty participants completed pre/post MT surveys evaluating mood, pain and satisfaction. Individual semi-structured interviews and focus groups were conducted with 14 MT program participants (inpatients), 5 family members of participants and 16 staff.

RESULTS

There was significant improvement in mood (p < 0.001) and decrease in pain (p < 0.05) from pre-to-post MT with 74% reporting being "very satisfied" with the session. "Benefits of MT" was the overarching theme of the qualitative data. Subthemes were emotional regulation, pain management, effects on self-concept, enjoyment, and social connectedness.

CONCLUSIONS

Improvements in mood and pain were reported from pre-to-post MT session and in interviews. Further evaluation of MT effectiveness against standard of care rehabilitation and cost implications is required.Implications for RehabilitationMusic therapy (MT) is delivered by accredited music therapists (MTAs) in health care settings, including rehabilitation units, as an individual, group or co-treatment therapy.MT can be used for a range of health outcomes, including the treatment of mood and pain, in addition to improving inpatient satisfaction.Early evidence using pre/post MT surveys suggests an improvement in mood and pain following a single therapy session.Qualitative data suggest overall benefit of offering MT services in addition to standard neurorehabilitation therapy, including improvements to emotional regulation, pain management, self-concept, enjoyment, and social connectedness.

Neuroplastic Changes in Addiction Memory-How Music Therapy and Music-Based Intervention May Reduce Craving: A Narrative Review

Recent findings indicate that Music Therapy (MT) and Music-Based Interventions (MBIs) may reduce craving symptoms in people with Substance Use Disorders (SUD). However, MT/MBIs can lead SUD clients to recall memories associated with their drug history and the corresponding strong emotions (addiction memories). Craving is a central component of SUD, possibly linked to relapse and triggered by several factors such as the recall of memories associated with the drug experience. Therefore, to address the topic of what elements can account for an improvement in craving symptoms after MT/MBIs, we conducted a narrative review that (1) describes the brain correlates of emotionally salient autobiographical memories evoked by music, (2) outlines neuroimaging and neurophysiological studies suggesting how the experience of craving may encompass the recall of emotionally filled moments, and (3) points out the role of perineuronal nets (PNNs) in addiction memory neuroplasticity. We highlight how autobiographical memory retrieval, music-evoked autobiographical memories, and craving share similar neural activations with PNNs which represent a causal element in the processing of addiction memory. We finally conclude by considering how the neuroplastic characteristics of addiction memory might represent the ground to update and/or recalibrate, within the therapy, the emotional content related to the recall.

Potential Benefits of Music Therapy on Stroke Rehabilitation

Stroke is associated with a high rate of disability and mortality, and survivors are usually accompanied with dysphagia, aphasia, motor dysfunction, cognitive impairment, depression, and other complications. In the past decades, many studies have been conducted to reveal the pathogenesis and pathological mechanisms of stroke. Furthermore, treatment methods have been developed that contribute to the elevated survival rate of stroke patients. Early rehabilitation poststroke is starting to be recognized as important and has been receiving increasing attention in order to further improve the quality of life of the patients. As an emerging method of poststroke rehabilitation, music therapy can help attenuate dysphagia and aphasia, improve cognition and motor function, alleviate negative moods, and accelerate neurological recovery in stroke patients. This review helps summarize the recent progress that has been made using music therapy in stroke rehabilitation and is aimed at providing clinical evidence for the treatment of stroke patients.

Age-related Changes in Brain Functional Networks under Multisensory-Guided Hand Movements Assessed by the Functional Near - Infrared Spectroscopy

OBJECTIVES

This study aims to explore the age-related effects of hand rehabilitation training under multisensory stimulation interaction on brain functional networks.

METHODS

A multisensory stimulation training glove (MSTG) was designed to realize 3 sensory guidance modes, namely audio-visual guidance (AVG), visual guidance (VG) and no guidance (NG). This study recruited 20 older subjects as the experimental group and 22 young people as the control group. Functional near-infrared spectroscopy (fNIRS) was used to monitor haemoglobin concentration in the motor cortex (MC), prefrontal cortex (PFC), temporary lo be (TL) and occipital lobe (OL) under three different guidance stages, and further analysed the cortical activation and functional connectivity (FC).

RESULTS

Multisensory guidance stage showed more activation and higher FC in all subjects. The activated brain regions of the older subjects showed bilateral activation, which is consistent with the Hemispheric Asymmetry Reduction in Older Adults (HAROLD) model. In terms of brain region coordination, older people have a more balanced and denser functional network in the left and right hemispheres compared to younger people. Meanwhile, multisensory stimulation produced a positive training effect on the number of training and reaction time.

CONCLUSION

Audio-visual combined stimulation had a significant gain effect on hand training at different ages. However, older adults induce a wider range of cortical activations. At the same time, young and older people have different intercortical coordination networks. All these results provide theoretically and applied references for multisensory stimulation in the prevention and rehabilitation of ageing and brain neurological disorders.

The Feasibility and Acceptability of Neurologic Music Therapy in Subacute Neurorehabilitation and Effects on Patient Mood

Music interventions support functional outcomes, improve mood, and reduce symptoms of depression in neurorehabilitation. Neurologic music therapy (NMT) has been reported as feasible and helpful in stroke rehabilitation but is not commonly part of multidisciplinary services in acute or subacute settings. This study assessed the feasibility and acceptability of delivering NMT one-day-per-week in a subacute neurorehabilitation centre over 15 months. Data were collected on the number of referrals, who referred, sessions offered, attended, and declined, and reasons why. Staff, patients, and their relatives completed questionnaires rating the interventions. Patients completed the Visual Analog Mood Scales (VAMS) pre and post a single session. Forty-nine patients received 318 NMT sessions (83% of sessions offered). NMT was rated as helpful or very helpful as part of the multidisciplinary team (n = 36). The highest ratings were for concentration, arm and hand rehabilitation, and motivation and mood. VAMS scores (n = 24) showed a reduction in ‘confused’ (−8.6, p = 0.035, effect size 0.49) and an increase in ‘happy’ (6.5, p = 0.021, effect size = 0.12) post NMT. The data suggest that a one-day-per-week NMT post in subacute neurorehabilitation was feasible, acceptable, and helpful, supporting patient engagement in rehabilitation exercises, mood, and motivation.

Rhythm and Music-Based Interventions in Motor Rehabilitation: Current Evidence and Future Perspectives

Research in basic and clinical neuroscience of music conducted over the past decades has begun to uncover music’s high potential as a tool for rehabilitation. Advances in our understanding of how music engages parallel brain networks underpinning sensory and motor processes, arousal, reward, and affective regulation, have laid a sound neuroscientific foundation for the development of theory-driven music interventions that have been systematically tested in clinical settings. Of particular significance in the context of motor rehabilitation is the notion that musical rhythms can entrain movement patterns in patients with movement-related disorders, serving as a continuous time reference that can help regulate movement timing and pace. To date, a significant number of clinical and experimental studies have tested the application of rhythm- and music-based interventions to improve motor functions following central nervous injury and/or degeneration. The goal of this review is to appraise the current state of knowledge on the effectiveness of music and rhythm to modulate movement spatiotemporal patterns and restore motor function. By organizing and providing a critical appraisal of a large body of research, we hope to provide a revised framework for future research on the effectiveness of rhythm- and music-based interventions to restore and (re)train motor function.

Music-based techniques and related devices in neurorehabilitation: a scoping review

Introduction:The music as a powerful, and versatile stimulus for the brain, is at the date sometimes used in neurorehabilitation and proposed as a promising complementary strategy provided in combination with other therapy in individuals with neurological disorders. Different techniques and devices have been developed in the field of the music-based neurorehabilitation.Areas covered:This scoping review analyzes the current scientific literature concerning the different techniques and devices used in the music-supported neurorehabilitation, also focusing on the devices used in music-based therapies in patients with neurological disorders: 46 studies met the inclusion criteria and were included.Expert opinion:Included studies, highlight the potentiality and the versatility of the music-based therapy in the rehabilitation of neurological disorders. The variety of existing techniques allow to applied the music-based therapy in different situations and conditions. Moreover, the wide range of used devices that ranging from the simple musical instruments to the more advanced technologies, allows to develop customized exercises based on the needs of the patient. This review may be considered as a starting point to better design future RCTs that would investigate the effectiveness of music therapy on neurological disorders.

Developing and implementing an exercise-based group for stroke survivors and their carers: the Carers Count group

PURPOSE

Guidelines recommend that carers of stroke survivors should be engaged early in rehabilitation. There has been limited research implementing exercise programs that include carers. The aims of this study were to develop, facilitate, and evaluate an intervention, the Carers Count group, an exercise-based group for stroke survivors and their carers.

METHODS

Over a 5-month period, a staged approach was used to design the intervention and implementation strategies which would maximise the chances of embedding the intervention within an inpatient stroke ward. Implementation strategies included planning, educating, restructuring, financing, and managing quality. Following development and facilitation of the intervention, outcomes were evaluated through collecting data about therapy time, surveys (n = 30) and interviews (n = 18) with participants, and a focus group with staff.

RESULTS

Thirty stroke survivors and their carers participated in the Carers Count group. Analysis of time spent in therapy showed that participation led to increased dose of physiotherapy time (service outcome). Survey and interview data suggested that participation in the group was a rewarding and engaging experience for participants (client outcomes).

CONCLUSION

Using multifaceted strategies, a group designed to include carers was implemented on a stroke rehabilitation ward. The intervention provided positive outcomes in terms of increased therapy dose and satisfaction according to participant feedback.

CLINICAL TRIALS REGISTRATION NUMBER

ANZCTR12620000708954Implications for rehabilitationIt is possible to develop modes of delivery in rehabilitation that include the carers of stroke survivors and these interventions are considered enjoyable and beneficial.Health professionals should consider interventions that are engaging and fun for stroke survivors and their carers.Health professionals should carefully plan and utilise appropriate implementation strategies when aiming to introduce a new intervention into an established health service.Health professionals should ensure stroke survivors and their carers have an understanding of recovery following stroke and how to maximise outcomes through increasing amount of practice.

Development and evaluation of a novel music-based therapeutic device for upper extremity movement training: A pre-clinical, single-arm trial

Restoration of upper limb motor function and patient functional independence are crucial treatment targets in neurological rehabilitation. Growing evidence indicates that music-based intervention is a promising therapeutic approach for the restoration of upper extremity functional abilities in neurologic conditions such as cerebral palsy, stroke, and Parkinson's Disease. In this context, music technology may be particularly useful to increase the availability and accessibility of music-based therapy and assist therapists in the implementation and assessment of targeted therapeutic goals. In the present study, we conducted a pre-clinical, single-arm trial to evaluate a novel music-based therapeutic device (SONATA) for upper limb extremity movement training. The device consists of a graphical user interface generated by a single-board computer displayed on a 32" touchscreen with built-in speakers controlled wirelessly by a computer tablet. The system includes two operational modes that allow users to play musical melodies on a virtual keyboard or draw figures/shapes whereby every action input results in controllable sensory feedback. Four motor tasks involving hand/finger movement were performed with 21 healthy individuals (13 males, aged 26.4 ± 3.5 years) to evaluate the device's operational modes and main features. The results of the functional tests suggest that the device is a reliable system to present pre-defined sequences of audiovisual stimuli and shapes and to record response and movement data. This preliminary study also suggests that the device is feasible and adequate for use with healthy individuals. These findings open new avenues for future clinical research to further investigate the feasibility and usability of the SONATA as a tool for upper extremity motor function training in neurological rehabilitation. Directions for future clinical research are discussed.