Enriched Music Therapy Benefits Stroke Patients Long Term

Daniel M. Keller, PhD

November 03, 2016

HYDERABAD, INDIA — An enriched intervention approach using music therapy encompassing movement, cognitive focus, psychological well-being, and social interaction benefits stroke patients in the long term, a study shows.

Stroke often leads to depressed mood, social isolation, and diminished feelings of well-being, the researchers point out, and mental distress can impair motor recovery and increase the risk for future stroke.

Addressing the mental, social, and physical domains at the same time, their integrative approach differs from traditional ones that provide separate, isolated occupational, physical, and speech therapies and psychological, social work, and physiatry services.

Preeti Raghavan, MD, from Rusk Rehabilitation at the New York University School of Medicine in New York City, said music is a "universal language," and this sort of enriched intervention approach is appropriate for all types of ethnic communities and may be especially beneficial in areas with limited resources.

She presented her findings here at the World Stroke Congress (WSC) 2016.

Biological Underpinnings

Animal experiments have shown that environments enhanced with sensory stimuli facilitate post-stroke recovery by promoting neurogenesis and neuronal survival, the authors note. Brain-derived neurotrophic factor can enhance learning when training is intensive, and oxytocin promotes social bonding, is neuroprotective, reduces infarct size and inflammation, and enhances neuroplasticity.

Studies in humans have shown two-way signaling between the auditory and motor cortices that underlies beat perception. Rhythms promote efficient recruitment of motor units, leading to improved motor outcomes.

For the Music Upper Limb Therapy–Integrated (MULT-I) preliminary feasibility study, Dr Raghavan recruited patients with chronic hemiparesis from a stroke that occurred at least 6 months earlier. They had to be able to open and close the hand partially on the affected side, with an upper limb score of no greater than 60 on the Fugl-Meyer Scale, meaning there was still room for improvement. Participants could not have a major disability, as indicated by a modified Rankin Scale score greater than 4.

Patients (five groups of three) participated in biweekly 45-minute sessions for 6 weeks. They did not have to have any prior musical training. One occupational therapist and two music therapists provided a 1:1 therapist-to-patient ratio.

Each session consisted of an initial 5 minutes of stretching, 35 minutes of music making, and 5 minutes of discussion. Each person chose a percussive instrument. The only requirement was that patients had to be able to hold an object with which to hit the instrument or to shake the instrument (such as maracas).

Therapists videotaped the group interactive music sessions, reviewed them, and adjusted subsequent interventions based on those observations.

Disability was reduced and well-being improved after the MULT-I program, and these improvements persisted. Modified Rankin Scale measures went from 2.4 before the program to 2.0 afterward (P = .03) and to 1.5 one year later (P = .04 vs before). World Health Organization well-being scores improved from 14 before the program to 18 afterward (P = .03) and the same one year later.

Dr Raghavan said that in the discussion period, even after just the first session, participants commented that they felt function "coming back to what I used to be doing" and "I see that the rhythm is there; it's going to my brain, telling me how to maneuver it."

The experiences in the music sessions carried over into daily life. Participants described benefits going beyond the music-making sessions, such as dancing again, taking the subway, using the affected arm in cooking, dressing, or rising from a chair.

Music Benefits Multiple Domains

Dr Raghavan explained the multiple benefits of music. In the physical domain, it promotes movement, she said, especially repetitive movements by coupling auditory and motor mechanisms. It also distracts attention from the physical efforts required. In the mental domain, music benefits mood and cognitive recovery while eliciting strong behavioral responses, and it integrates cognitive, emotional, and sensorimotor brain functions. Finally, interactive group music benefits patients' social functioning by promoting spontaneous interaction and facilitating development of relationships. Music is also a means of verbal and nonverbal communication.

She said that some of the lessons learned are that "music therapy can provide an enriched environment, it could be relatively low cost, it could be compatible with existing values in different parts of the world, it could address social isolation…and attention." The enriched environment program also has observable results in terms of reduced motor impairment and improved well-being.

Session chair Patrik Michel, MD, head of the stroke center at Lausanne University Hospital in Switzerland, commented to Medscape Medical News that Dr Raghavan presented convincing evidence "that several factors, in particular subjective well-being, were actually improved through this kind of therapy" using professionals to lead an enriched group music program.

He said that usually in rehabilitation, any different kind of enriched therapy activating previously unsolicited brain regions will usually lead to an improvement in patients' function. "This is just tapping into a domain where we have underused the brain that is going beyond traditional motor rehabilitation, traditional speech rehabilitation but just using new auditory, emotional, and musical clues to improve function," he said.

Professor Michel said it will be important to figure out the best amount of music therapy to provide and the best form of music therapy. In this study, the patients were active participants in the sessions, compared with the more traditional music therapy in which patients passively listen to music.

There was no commercial funding for the study. Dr Raghavan and Professor Michel have disclosed no relevant financial relationships.

World Stroke Congress (WSC) 2016. Presented October 28, 2016.

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