Musical training as an alternative and effective method for neuro-education and neuro-rehabilitation

Reminiscent music therapy combined with robot-assisted rehabilitation for elderly stroke patients: a pilot study

BACKGROUND

Although some studies suggest that robot-assisted technology can significantly improve upper limb function in stroke patients compared to traditional rehabilitation training, it is still necessary to incorporate an auxiliary intervention to alleviate negative emotions, thereby alleviating the post-stroke fatigue and encouraging patients to actively respond to rehabilitation. However, the effect of the auxiliary intervention is unknown.

OBJECTIVE

To evaluate the effect of reminiscent music therapy combined with robot-assisted rehabilitation in elderly patients with upper limb dysfunction.

METHODS

From November 2022 to March 2023, elderly patients with upper limb dysfunction after stroke were assigned to one of three groups, with group A receiving usual rehabilitation treatment and care plus robot-assisted rehabilitation and reminiscent music therapy, group B receiving usual rehabilitation treatment and care plus robot-assisted rehabilitation, and group C receiving only usual rehabilitation treatment and care. Thirty patients completed this study, with 10 participants in each group. Activities of daily living, self-esteem, rehabilitation self-efficacy, positive emotion and upper limb function were measured before and after the intervention. One-way analysis of variance, paired-sample t-test, Kruskal-Wallis H test, Wilcoxon signed rank sum test and Chi-square test were used to analyze the data.

RESULTS

According to the intragroup comparisons, in the three groups, all outcome measurements were significantly higher than those at baseline (all P < 0.05). After the intervention, the differences in the self-management effectiveness, rehabilitation self-efficacy, and positive emotion score were statistically significant among the three groups (all P < 0.05). In accordance with the results of Bonferroni analysis, the self-management effectiveness score of group A was significantly higher than that of Group B and Group C (all P < 0.05). The rehabilitation self-efficacy score of group A was significantly higher than that of Group B and Group C (P < 0.05). The positive emotion score of group A was significantly higher than that of Group B and Group C (P < 0.05).

CONCLUSION

Reminiscent music therapy combined with robot-assisted rehabilitation is a promising approach to improve rehabilitation self-efficacy and positive emotion, which is evidence that reminiscent music therapy may be an effective auxiliary intervention to improve rehabilitation outcomes.

Audiovisual spatial ventriloquism is reduced in musicians

There is great scientific and public interest in claims that musical training improves general cognitive and perceptual abilities. While this is controversial, recent and rather convincing evidence suggests that musical training refines the temporal integration of auditory and visual stimuli at a general level. We investigated whether musical training also affects integration in the spatial domain, via an auditory localisation experiment that measured ventriloquism (where localisation is biased towards visual stimuli on audiovisual trials) and recalibration (a unimodal localisation aftereffect). While musicians (n = 22) and non-musicians (n = 22) did not have significantly different unimodal precision or accuracy, musicians were significantly less susceptible than non-musicians to ventriloquism, with large effect sizes. We replicated these results in another experiment with an independent sample of 24 musicians and 21 non-musicians. Across both experiments, spatial recalibration did not significantly differ between the groups even though musicians resisted ventriloquism. Our results suggest that the multisensory expertise afforded by musical training refines spatial integration, a process that underpins multisensory perception.

Influência da estratégia de Estimulação Auditiva Rítmica com música associada à fisioterapia sobre os sintomas depressivos no Parkinson

RESUMO A sintomatologia depressiva (SD) é comum na doença de Parkinson (DP) e considerada fator importante para má qualidade de vida e incapacidade do indivíduo. Intervenções terapêuticas baseadas em ritmo e música, a exemplo da Estimulação Auditiva Rítmica (EAR), têm sido utilizadas no tratamento da mobilidade e parecem influenciar positivamente o estado de humor do paciente. O objetivo deste estudo é avaliar o efeito da EAR com música associada à fisioterapia no estado de humor de pessoas com DP, com ênfase na SD. Trata-se de estudo quase experimental, com amostra de 18 pacientes com idades entre 40 e 80 anos e diagnóstico clínico de DP idiopática nos estágios leve a moderado. Os pacientes foram randomizados em dois grupos: grupo EAR e grupo-controle (GC). A SD foi avaliada por meio da versão em português do Inventário de Depressão de Beck (BDI). Os escores do BDI apresentaram redução em ambos os grupos. Entretanto, apenas no grupo EAR essa redução foi significativa, com diferença média no escore três vezes maior do que no GC.

Influence of Rhythmic Auditory Stimulation using music associated with physical therapy on depressive symptoms in Parkinson’s

ABSTRACT Depressive symptoms are commonly found in Parkinson’s disease and are considered an important factor for an individual’s poor quality of life and disability. Therapeutic interventions based on rhythm and music, such as rhythmic auditory stimulation, have been used to treat the mobility and seem to positively influence on mood. This study aims to evaluate the effect of rhythmic auditory stimulation using music associated with physical therapy on mood in individuals with Parkinson’s, with an emphasis on depressive symptoms. This is a quasi-experimental study with a final sample of 18 patients aged 40-80 years, with a clinical diagnosis of idiopathic Parkinson’s disease, in the mild to moderate stages of the disease. Patients were randomized into two groups: Rhythmic Auditory Stimulation and Control Groups. Depressive symptoms were assessed using the Portuguese version of the Beck Depression Inventory. Both groups reduced their The Beck Depression Inventory scores. However, only in the Rhythmic Auditory Stimulation Group the reduction was significant, with a mean difference in the inventory score three times greater than the Control Group.

GuitarPD: A Randomized Pilot Study on the Impact of Nontraditional Guitar Instruction on Functional Movement and Well-Being in Parkinson's Disease

Playing musical instruments may have positive effects on motor, emotional, and cognitive deficits in patients with Parkinson's disease (PD). This pilot study examined the feasibility of a six-week nontraditional guitar instruction program for individuals with PD. Twenty-six participants with idiopathic PD (Age: 67.22 ± 8.07; 17 males) were randomly assigned to two groups (intervention first or 6 weeks of usual care control exposure) with stepwise exposure to the guitar intervention condition with cross-over at six weeks. Outcomes were assessed at baseline, 6, 12, and 18 weeks. Twenty-four participants completed the study. Combined analysis of the groups showed significant BDI-II improvement immediately after intervention completion (3.04 points, 95% CI [-5.2, -0.9], p = 0.04). PDQ-39 total quality of life scores improved from baseline to immediately postintervention 5.19 points (95% CI [-9.4, -1.0]) at trend significance (corrected p = 0.07). For Group 1 (exposed to the intervention first), MDS-UPDRS total scores improved by a mean of 8.04 points (95% CI [-12.4, -3.7], p = 0.004) and remained improved at 12 weeks by 10.37 points (95% CI [-14.7, -6.0], p < 0.001). This group also had significant improvements in mood and depression at weeks 6 and 12, remaining significant at week 18 (BDI-II: 3.75, 95% CI [-5.8, -1.7], p = 0.004; NeuroQoL-depression: 10.6, 95% CI [-4.9. -1.4], p = 0.004), and in anxiety at week 6 and week 18 (NeuroQoL; 4.42, 95% CI [-6.8, -2.1], p = 0.004; 3.58, 95% CI [-5.9, -1.2], p = 0.02, respectively). We found clinically and statistically significant improvements in mood/anxiety after 6 weeks of group guitar classes in individuals with PD. Group guitar classes can be a feasible intervention in PD and may improve mood, anxiety, and quality of life.

Effects of vibrotactile-enhanced music-based intervention on sensorimotor control capacity in the hand of an aging brain: a pilot feasibility randomized crossover trial

BACKGROUND

Music-based interventions (MBI), using music as a therapeutic medium, has been utilized as a promising strategy for motor relearning and shaping. However, currently, MBI with active performance training is restricted to being extensively applied for patients with various levels of defects in fine motor skills and cognitive functions. Therefore, the integration of vibrotactile stimulation with MBI has been adopted as a motor training strategy intended to enhance motor learning through use of vibration stimuli. The current study was designed to investigate differences in the sensorimotor performance of older adults' hands under baseline, a single session of active MBI, and vibrotactile-enriched MBI conditions.

METHODS

Thirty healthy older adults were recruited and randomized to receive either the single session of 30-min of vibrotactile-enriched MBI or 30-min of active MBI at the beginning of the experiment. After a one-week washout period, they switched their treatment programs and then were assessed to study the training effects of both approaches through measuring precision pinch performance, hand function, and sensory status.

RESULTS

The results of the Pinch-Holding-Up Activity test revealed a statistically significant difference in the FRpeak parameter (F = 14.37, p < 0.001, η2p = 0.507) under the vibrotactile-enriched MBI condition compared to the baseline and active MBI conditions. In addition, significant beneficial effects were found on the results of the barognosis (F = 19.126, p < 0.001, η2p = 0. 577) and roughness differentiation subtests (F = 15.036, p < 0.001, η2p = 0.518) in the Manual Tactile Test for the participants in the vibrotactile-enriched MBI group. In addition, the participants under both the active MBI and vibrotactile-enriched MBI conditions exhibited better performance in the three subtests of the Purdue Pegboard Test as compared to under the baseline condition (p < 0.016).

CONCLUSIONS

The findings indicated that vibrotactile-enriched MBI potentially improves the precision pinch performance of hands in healthy older adults. In addition, the add-on effect of vibrotactile stimulation to the MBI condition provides beneficial effects on the sensory functions of the upper extremities.

TRIAL REGISTRATION

NCT04802564 . Date of registration: 15/03/2021. The first posted date: 17/03/2021.

Training Effects and Intelligent Evaluated Pattern of the Holistic Music Educational Approach for Children with Developmental Delay

This study focuses on the holistic music educational approach for young children developed by music therapists and experts, which combines technology with music, integrates it into the local culture, and frameworks it for holistic education. This method includes 231 children in Taiwan's early intervention education system for children with developmental delay. The learning occurs twice a week for 40 min over 32 weeks. The results show that implementing the holistic music educational approach can significantly improve children's ability with developmental delay and that supportive training has a positive effect. In addition, the decision tree explores and develops an intelligently evaluated pattern with highly effective learning. This model has a sensitivity rate of 90.6% on the in-sample, and the comprehensive indicator F is 79.9%, so it has a high reference value. In the future, those involved in education will be able to use the data mining to use the auxiliary decision-making system as an assessment tool for young children participating in education pre- and midterm of the course, to prejudge its continued implementation and learning effectiveness, to decide whether to continue to invest in and adjust the curriculum, and to make more effective use of educational resources.

Music-based therapy in rehabilitation of people with multiple sclerosis: a systematic review of clinical trials

BACKGROUND

Multiple sclerosis (MS) is a major cause of chronic neurological disability in young adults. An increasing number of controlled studies have assessed the potential rehabilitative effects of new drug-free treatments, complementary to the standard care, including music-based therapy (MBT).

OBJECTIVE

To analyze the evidence for the effectiveness of MBT within the therapeutic approaches to individuals diagnosed with MS.

METHODS

A systematic review of clinical trials was performed with searches in the following databases: BIOSIS, CINAHL, Cochrane, EBSCO, ERIC, Google Scholar, IBECS, LILACS, LISA (ProQuest), Medline, PEDro, PsycINFO (APA), Psychological & Behavioral, PubMed, SciELO, Scopus, SPORTDiscus and Web of Science. Clinical trials comparing MBT versus conventional therapy/no intervention were included.

RESULTS

From the 282 studies identified, 10 trials were selected. Among these, the total sample consisted of 429 individuals: 253 were allocated to the experimental group (MBT) and 176 to the control group (conventional therapies or no intervention). All the studies presented high methodological quality. Modalities of MBT were clustered into four groups: (1) Rhythmic auditory; (2) Playing musical instruments; (3) Dance strategy; and (4) Neurological music therapy. Overall, the studies consistently showed that MBT was better than conventional therapy or no intervention, with regard to gait parameters (double support time and walking speed), fatigue level, fatigability, coordination, dexterity, balance, walking endurance, lower extremity functional strength, emotional status and pain. Regarding mental fatigability and memory, the data were conflicting and the evidence was unclear.

CONCLUSION

MBT is a safe and effective approach for clinical rehabilitation of MS patients that leads to positive results regarding both motor and non-motor functions.

Music Therapy Alleviates Motor Dysfunction in Rats With Focal Cerebral Ischemia-Reperfusion Injury by Regulating BDNF Expression

Background/Aim: Music-based therapy plays a role in central nervous system diseases. We aimed to explore the effect of different doses and durations of music therapy on motor function recovery after stroke and the underlying molecular mechanisms. Methods: Adult male Sprague-Dawley rats were subjected to middle cerebral artery occlusion (MCAO) for 1 h, which was followed by reperfusion. In experiment 1, the rats that survived 1 week after MCAO surgery were randomly allocated into four groups (n = 10 per group): MCAO group, 1 h music group (Mozart K.448 music therapy 1 h per day for 2 weeks), 12 h music group (Mozart K.448 music therapy 12 h/day for 2 weeks), and accelerated music group (reversely accelerated music therapy 12 h for 2 weeks, AM group). In experiment 2, the survived rats were randomly divied into three groups: MCAO group, 12 h music group (music therapy 12 h/day for 3 weeks), and 12 h music-R group (music therapy 12 h/day for 2 weeks and rest for 1 week). Three neuroscores were evaluated daily, starting on the first day after surgery until the end of the experiment. The rats were killed 3 weeks after MCAO surgery in experiment 1 or 4 weeks after surgery in experiment 2. Nissl staining of infart core, peri-infarct zone, and motor cortex was performed to assess neuronal survival and regeneration. Western blot and immunofluorescence were used to detect the expression and distribution of brain-derived neurotrophic factor (BDNF) and glial fibrillary acidic protein (GFAP) in ipsilateral hemispheres. Results: In the experiment of different music therapy doses, the motor function in the 12-h music group but not in the 1-h music group and AM group was significantly improved compared with that of the MCAO group. The BDNF protein level of the ipsilateral hemisphere motor cortex in the 12-h music group and the 1-h music group was higher than that of the MCAO group. The neurons and Nissl bodies were more in the 12-h music group than in the MCAO group. Immunofluorescence assay showed that a 12 h music therapy induces BDNF and GFAP accumulation at the damage boundary. In the experiment of different music therapy durations, 3 weeks music therapy (12 h music group) induced more longer cell synapses and more clearer cell-to-cell connections than 2 weeks music intervention (12 h music-R group). Moreover, the GFAP morphology in the 12-h music group was more similar to mature activated astrocytes than that in the 12-h music-R group. Conclusions: Music therapy may improve poststroke motor function and promote neuronal repair in the long term. The mechanism may be through stimulating BDNF and GFAP secretion in the injured motor cortex.

Is Phonological Awareness Related to Pitch, Rhythm, and Speech-in-Noise Discrimination in Young Children?

Purpose Phonological awareness (PA) requires the complex integration of language, speech, and auditory processing abilities. Enhanced pitch and rhythm discrimination have been shown to improve PA and speech-in-noise (SiN) discrimination. The screening of pitch and rhythm discrimination, if nonlinguistic correlates of these abilities, could contribute to screening procedures prior to diagnostic assessment. This research aimed to determine the association of PA abilities with pitch, rhythm, and SiN discrimination in children aged 5-7 years old. Method Forty-one participants' pitch, rhythm, and SiN discrimination and PA abilities were evaluated. To control for confounding factors, including biological and environmental risk exposure and gender differences, typically developing male children from high socioeconomic statuses were selected. Pearson correlation was used to identify associations between variables, and stepwise regression analysis was used to identify possible predictors of PA. Results Correlations of medium strength were identified between PA and pitch, rhythm, and SiN discrimination. Pitch and diotic digit-in-noise discrimination formed the strongest regression model (adjusted R ² = .4213, r = .649) for phoneme-grapheme correspondence. Conclusions The current study demonstrates predictive relationships between the complex auditory discrimination skills of pitch, rhythm, and diotic digit-in-noise recognition and foundational phonemic awareness and phonic skills in young males from high socioeconomic statuses. Pitch, rhythm, and digit-in-noise discrimination measures hold potential as screening measures for delays in phonemic awareness and phonic difficulties and as components of stimulation programs.

Train the brain with music (TBM): brain plasticity and cognitive benefits induced by musical training in elderly people in Germany and Switzerland, a study protocol for an RCT comparing musical instrumental practice to sensitization to music

BACKGROUND

Recent data suggest that musical practice prevents age-related cognitive decline. But experimental evidence remains sparse and no concise information on the neurophysiological bases exists, although cognitive decline represents a major impediment to healthy aging. A challenge in the field of aging is developing training regimens that stimulate neuroplasticity and delay or reverse symptoms of cognitive and cerebral decline. To be successful, these regimens should be easily integrated in daily life and intrinsically motivating. This study combines for the first-time protocolled music practice in elderly with cutting-edge neuroimaging and behavioral approaches, comparing two types of musical education.

METHODS

We conduct a two-site Hannover-Geneva randomized intervention study in altogether 155 retired healthy elderly (64-78) years, (63 in Geneva, 92 in Hannover), offering either piano instruction (experimental group) or musical listening awareness (control group). Over 12 months all participants receive weekly training for 1 hour, and exercise at home for ~ 30 min daily. Both groups study different music styles. Participants are tested at 4 time points (0, 6, and 12 months & post-training (18 months)) on cognitive and perceptual-motor aptitudes as well as via wide-ranging functional and structural neuroimaging and blood sampling.

DISCUSSION

We aim to demonstrate positive transfer effects for faculties traditionally described to decline with age, particularly in the piano group: executive functions, working memory, processing speed, abstract thinking and fine motor skills. Benefits in both groups may show for verbal memory, hearing in noise and subjective well-being. In association with these behavioral benefits we anticipate functional and structural brain plasticity in temporal (medial and lateral), prefrontal and parietal areas and the basal ganglia. We intend exhibiting for the first time that musical activities can provoke important societal impacts by diminishing cognitive and perceptual-motor decline supported by functional and structural brain plasticity.

TRIAL REGISTRATION

The Ethikkomission of the Leibniz Universität Hannover approved the protocol on 14.08.17 (no. 3604-2017), the neuroimaging part and blood sampling was approved by the Hannover Medical School on 07.03.18. The full protocol was approved by the Commission cantonale d'éthique de la recherche de Genève (no. 2016-02224) on 27.02.18 and registered at clinicaltrials.gov on 17.09.18 ( NCT03674931 , no. 81185).

Why is music therapeutic for neurological disorders? The Therapeutic Music Capacities Model

Music has cognitive, psychosocial, behavioral and motor benefits for people with neurological disorders such as dementia, stroke, Parkinson's disease (PD) and Autism Spectrum Disorder (ASD). Here we discuss seven properties or 'capacities' of music that interact with brain function and contribute to its therapeutic value. Specifically, in its various forms, music can be engaging, emotional, physical, personal, social and persuasive, and it promotes synchronization of movement. We propose the Therapeutic Music Capacities Model (TMCM), which links individual properties of music to therapeutic mechanisms, leading to cognitive, psychosocial, behavioral and motor benefits. We review evidence that these capacities have reliable benefits for people with dementia, stroke, PD and ASD when employed separately or in combination. The model accounts for the profound value that music affords human health and well-being and provides a framework for the development of non-pharmaceutical treatments for neurological disorders.

The Influence of Sound-Based Interventions on Motor Behavior After Stroke: A Systematic Review

Objective: To investigate the effects of sound-based interventions (SBIs) on biomechanical parameters in stroke patients.

Methods: PubMed/Medline, Web of Science, the Physiotherapy Evidence Database (PEDro), and the Cochrane Library were searched until September 2019. Studies examining the effect of SBIs on kinematic, kinetic, and electromyographic outcome measures were included. Two independent reviewers performed the screening, and data extraction and risk-of-bias assessment were conducted with the PEDro and Newcastle–Ottawa scale. Disagreements were resolved by a third independent reviewer.

Results: Of the 858 studies obtained from all databases, 12 studies and 240 participants met the inclusion and exclusion criteria. Six studies investigated the effect of SBI on upper limb motor tasks, while six examined walking. Concerning quality assessment (Newcastle–Ottawa Quality Assessment Scale and PEDro), the nine cross-sectional studies had a median score of seven, while the randomized controlled trials had a median score of five (fair to good quality). In relation to upper limb motor tasks, only one study found improvements in cortical reorganization and increased central excitability and motor control during reaching after SBI (results of the other five studies were too diverse and lacked quality to substantiate their findings). In relation to walking, results were clearer: SBI led to improvements in knee flexion and gastrocnemius muscle activity.

Conclusion: Despite of the heterogeneity of the included studies, evidence was found demonstrating that SBI can induce biomechanical changes in motor behavior during walking in stroke patients. No conclusions could be formulated regarding reaching tasks. Additionally, directions for future research for understanding the underlying mechanism of the clinical improvements after SBI are: (1) using actual music pieces instead of rhythmic sound sequences and (2) examining sub-acute stroke rather than chronic stroke patients.

On the Association Between Musical Training, Intelligence and Executive Functions in Adulthood

Converging evidence has demonstrated that musical training is associated with improved perceptual and cognitive skills, including executive functions and general intelligence, particularly in childhood. In contrast, in adults the relationship between cognitive performance and musicianship is less clear and seems to be modulated by a number of background factors, such as personality and socio-economic status. Aiming to shed new light on this topic, we administered the Wechsler Adult Intelligence Scale III (WAIS-III), the Wechsler Memory Scale III (WMS-III), and the Stroop Test to 101 Finnish healthy adults grouped according to their musical expertise (non-musicians, amateurs, and musicians). After being matched for socio-economic status, personality traits and other demographic variables, adult musicians exhibited higher cognitive performance than non-musicians in all the mentioned measures. Moreover, linear regression models showed significant positive relationships between executive functions (working memory and attention) and the duration of musical practice, even after controlling for intelligence and background variables, such as personality traits. Hence, our study offers further support for the association between cognitive abilities and musical training, even in adulthood.

HIGHLIGHTS

- Musicians show higher general intelligence (FSIQ), verbal intelligence (VIQ), working memory (WMI) and attention skills than non-musicians. Amateurs score in between.- Significant positive correlations between years of musical playing and cognitive abilities support the hypothesis that long-term musical practice is associated with intelligence and executive functions.

The Necessity of Ambiguity in Self-Other Processing: A Psychosocial Perspective With Implications for Mental Health

While distinguishing between the actions and physical boundaries of self and other (non-self) is usually straightforward there are contexts in which such differentiation is challenging. For example, self-other ambiguity may occur when actions of others are similar or complementary to those of the self. Even in the absence of such situational challenges, individuals experiencing hallucinations have difficulties with this distinction, often experiencing thoughts or actions of self as belonging to other agents. This paper explores the role of ambiguity in self-other differentiation, drawing from developmental, psychodynamic, and neurocognitive perspectives. A key proposal is that engagement in contexts that make distinctions between self and other challenging yet necessary allow reality-testing skills related to agency to develop. Attunement in typical caregiver-infant interactions is framed as a safe but inherently ambiguous environment that provides optimal condition for the infant to develop a coherent self-other sense. Vulnerability to psychosis may be related to limited access to such an environment in early development. However, the perceptual, cognitive, and social skills that contribution to attribution are likely to be malleable following infancy and improve though opportunities for boundary play in similarly ambiguous settings. Using music-making to illustrate, we postulate that engagement in intricate joint-actions that blurs agentic boundaries can contribute to the continued development of an adaptive sense of self and other essential to healthy social functioning. Increased insight into the self-other ambiguity may enhance our understanding of mechanisms underlying "self-disorders" such as schizophrenia and eventually extend the range of social and arts-based therapeutic possibilities.

Behavioral and electrophysiological investigation of speech perception deficits in silence, noise and envelope conditions in developmental dyslexia

The present study investigated whether children with developmental dyslexia showed specific deficits in the perception of three phonetic features (voicing, place, and manner of articulation) in optimal (silence) and degraded listening conditions (envelope-coded speech versus noise), using both standard behavioral and electrophysiological measures. Performance of children with dyslexia was compared to that of younger typically developing children who were matched in terms of reading age. Results showed no significant group differences in response accuracy except for the reception of place-of-articulation in noise. However, dyslexic children responded more slowly than typically developing children across all conditions with larger deficits in noise than in envelope than in silence. At the neural level, dyslexic children exhibited reduced N1 components in silence and the reduction of N1 amplitude was more pronounced for voicing than for the other phonetic features. In the envelope condition, the N1 was localized over the right hemisphere and it was larger for typically developing readers than for dyslexic children. Finally, in stationary noise, the N1 to place of articulation was clearly delayed in children with dyslexia, which suggests a temporal de-organization in the most adverse listening conditions. The results clearly show abnormal neural processing to speech sounds in all conditions. They are discussed in the context of recent theories on perceptual noise exclusion, neural noise and temporal sampling.

Music-supported therapy for stroke motor recovery: theoretical and practical considerations

Music may confer benefits for well-being and health. What is the state of knowledge and evidence for a role of music in supporting the rehabilitation of movements after stroke? In this brief perspective, I provide background context and information about stroke recovery in general, in order to spark reflection and discussion for how we think music may impact motor recovery, given the current clinical milieu.

Music-supported therapy in the rehabilitation of subacute stroke patients: a randomized controlled trial

The effect of music-supported therapy (MST) as a tool to restore hemiparesis of the upper extremity after a stroke has not been appropriately contrasted with conventional therapy. The aim of this trial was to test the effectiveness of adding MST to a standard rehabilitation program in subacute stroke patients. A randomized controlled trial was conducted in which patients were randomized to MST or conventional therapy in addition to the rehabilitation program. The intensity and duration of the interventions were equated in both groups. Before and after 4 weeks of treatment, motor and cognitive functions, mood, and quality of life (QoL) of participants were evaluated. A follow-up at 3 months was conducted to examine the retention of motor gains. Both groups significantly improved their motor function, and no differences between groups were found. The only difference between groups was observed in the language domain for QoL. Importantly, an association was encountered between the capacity to experience pleasure from music activities and the motor improvement in the MST group. MST as an add-on treatment showed no superiority to conventional therapies for motor recovery. Importantly, patient's intrinsic motivation to engage in musical activities was associated with better motor improvement.

Keeping brains young with making music

Music-making is a widespread leisure and professional activity that has garnered interest over the years due to its effect on brain and cognitive development and its potential as a rehabilitative and restorative therapy of brain dysfunctions. We investigated whether music-making has a potential age-protecting effect on the brain. For this, we studied anatomical magnetic resonance images obtained from three matched groups of subjects who differed in their lifetime dose of music-making activities (i.e., professional musicians, amateur musicians, and non-musicians). For each subject, we calculated a so-called BrainAGE score which corresponds to the discrepancy (in years) between chronological age and the "age of the brain", with negative values reflecting an age-decelerating brain and positive values an age-accelerating brain, respectively. The index of "brain age" was estimated using a machine-learning algorithm that was trained in a large independent sample to identify anatomical correlates of brain-aging. Compared to non-musicians, musicians overall had lower BrainAGE scores, with amateur musicians having the lowest scores suggesting that music-making has an age-decelerating effect on the brain. Unlike the amateur musicians, the professional musicians showed a positive correlation between their BrainAGE scores and years of music-making, possibly indicating that engaging more intensely in just one otherwise enriching activity might not be as beneficial than if the activity is one of several that an amateur musician engages in. Intense music-making activities at a professional level could also lead to stress-related interferences and a less enriched environment than that of amateur musicians, possibly somewhat diminishing the otherwise positive effect of music-making.

Aerobic Exercises for Cognition Rehabilitation following Stroke: A Systematic Review

BACKGROUND

Cognitive impairments are highly prevalent in stroke survivors and can substantially affect their physical rehabilitation and quality of life. The management of these impairments currently remains limited, but increasing studies reported the effect of aerobic exercise on cognitive performance in patients suffering from stroke. The purpose of this review was to assess the effects of aerobic exercise on cognitive function following stroke.

METHODS

Seven electronic databases (China National Knowledge Infrastructure [CNKI], Chinese Science and Technology Periodical Database [VIP], Wanfang, China Biology Medicine disc [CBM], Science Citation Index [SCI], EMBASE, and PubMed) were searched from their inception to May 31, 2015, for the effects of aerobic exercise on cognitive ability compared to usual physical activity in stroke survivors. RevMan V5.3 (The Nordic Cochrane Centre) was used to analyze the data and to evaluate the methodological quality of the included studies.

RESULTS

Ten eligible studies including 394 participants were identified. Six studies showed that aerobic exercise significantly improved global cognitive ability in stroke survivors. Four studies reported aerobic exercise to be beneficial in improving memory, but only one showed statistical significance. Two studies investigated the effects of aerobic exercise on attention, and one showed a significant improvement. One study reported a significant benefit of aerobic exercise on visuospatial ability in stroke survivors. No adverse events were reported in the included studies.

CONCLUSIONS

Aerobic exercise may have a positive effect on improving global cognitive ability and a potential benefit on memory, attention, and the visuospatial domain of cognition in stroke survivors. However, further large, rigorously designed trials are needed to confirm these findings.

Context-Dependent Neural Activation: Internally and Externally Guided Rhythmic Lower Limb Movement in Individuals With and Without Neurodegenerative Disease

Parkinson’s disease is a neurodegenerative disorder that has received considerable attention in allopathic medicine over the past decades. However, it is clear that, to date, pharmacological and surgical interventions do not fully address symptoms of PD and patients’ quality of life. As both an alternative therapy and as an adjuvant to conventional approaches, several types of rhythmic movement (e.g., movement strategies, dance, tandem biking, and Tai Chi) have shown improvements to motor symptoms, lower limb control, and postural stability in people with PD (1–6). However, while these programs are increasing in number, still little is known about the neural mechanisms underlying motor improvements attained with such interventions. Studying limb motor control under task-specific contexts can help determine the mechanisms of rehabilitation effectiveness. Both internally guided (IG) and externally guided (EG) movement strategies have evidence to support their use in rehabilitative programs. However, there appears to be a degree of differentiation in the neural substrates involved in IG vs. EG designs. Because of the potential task-specific benefits of rhythmic training within a rehabilitative context, this report will consider the use of IG and EG movement strategies, and observations produced by functional magnetic resonance imaging and other imaging techniques. This review will present findings from lower limb imaging studies, under IG and EG conditions for populations with and without movement disorders. We will discuss how these studies might inform movement disorders rehabilitation (in the form of rhythmic, music-based movement training) and highlight research gaps. We believe better understanding of lower limb neural activity with respect to PD impairment during rhythmic IG and EG movement will facilitate the development of novel and effective therapeutic approaches to mobility limitations and postural instability.

Effects of Auditory Rhythm and Music on Gait Disturbances in Parkinson's Disease

Gait abnormalities, such as shuffling steps, start hesitation, and freezing, are common and often incapacitating symptoms of Parkinson’s disease (PD) and other parkinsonian disorders. Pharmacological and surgical approaches have only limited efficacy in treating these gait disorders. Rhythmic auditory stimulation (RAS), such as playing marching music and dance therapy, has been shown to be a safe, inexpensive, and an effective method in improving gait in PD patients. However, RAS that adapts to patients’ movements may be more effective than rigid, fixed-tempo RAS used in most studies. In addition to auditory cueing, immersive virtual reality technologies that utilize interactive computer-generated systems through wearable devices are increasingly used for improving brain–body interaction and sensory–motor integration. Using multisensory cues, these therapies may be particularly suitable for the treatment of parkinsonian freezing and other gait disorders. In this review, we examine the affected neurological circuits underlying gait and temporal processing in PD patients and summarize the current studies demonstrating the effects of RAS on improving these gait deficits.

Experience Changes How Emotion in Music Is Judged: Evidence from Children Listening with Bilateral Cochlear Implants, Bimodal Devices, and Normal Hearing

Children using unilateral cochlear implants abnormally rely on tempo rather than mode cues to distinguish whether a musical piece is happy or sad. This led us to question how this judgment is affected by the type of experience in early auditory development. We hypothesized that judgments of the emotional content of music would vary by the type and duration of access to sound in early life due to deafness, altered perception of musical cues through new ways of using auditory prostheses bilaterally, and formal music training during childhood. Seventy-five participants completed the Montreal Emotion Identification Test. Thirty-three had normal hearing (aged 6.6 to 40.0 years) and 42 children had hearing loss and used bilateral auditory prostheses (31 bilaterally implanted and 11 unilaterally implanted with contralateral hearing aid use). Reaction time and accuracy were measured. Accurate judgment of emotion in music was achieved across ages and musical experience. Musical training accentuated the reliance on mode cues which developed with age in the normal hearing group. Degrading pitch cues through cochlear implant-mediated hearing induced greater reliance on tempo cues, but mode cues grew in salience when at least partial acoustic information was available through some residual hearing in the contralateral ear. Finally, when pitch cues were experimentally distorted to represent cochlear implant hearing, individuals with normal hearing (including those with musical training) switched to an abnormal dependence on tempo cues. The data indicate that, in a western culture, access to acoustic hearing in early life promotes a preference for mode rather than tempo cues which is enhanced by musical training. The challenge to these preferred strategies during cochlear implant hearing (simulated and real), regardless of musical training, suggests that access to pitch cues for children with hearing loss must be improved by preservation of residual hearing and improvements in cochlear implant technology.

A groundwork for allostatic neuro-education

We propose to enliven educational practice by marrying a conception of education as guided human development, to an advanced scientific understanding of the brain known as allostasis (stability through change). The result is a groundwork for allostatic neuro-education (GANE). Education as development encompasses practices including the organic (homeschooling and related traditions), cognitive acquisition (emphasis on standards and testing), and the constructivist (aimed to support adaptive creativity for both learner and society). Allostasis views change to be the norm in biology, defines success in contexts of complex natural environments rather than controlled settings, and identifies the brain as the organ of central command. Allostatic neuro-education contrasts with education focused dominantly on testing, or neuroscience based on homeostasis (stability through constancy). The GANE perspective is to view learners in terms of their neurodevelopmental trajectories; its objective is to support authentic freedom, mediated by competent, integrated, and expansive executive functionality (concordant with the philosophy of freedom of Rudolf Steiner); and its strategy is to be attuned to rhythms in various forms (including those of autonomic arousal described in polyvagal theory) so as to enable experiential excitement for learning. The GANE presents a variety of testable hypotheses, and studies that explore prevention or mitigation of the effects of early life adversity or toxic stress on learning and development may be of particular importance. Case studies are presented illustrating use of allostatic neurotechnology by an adolescent male carrying diagnoses of Asperger’s syndrome and attention-deficit hyperactivity disorder, and a grade school girl with reading difficulties. The GANE is intended as a re-visioning of education that may serve both learners and society to be better prepared for the accelerating changes of the 21st century.