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The Art of Healing: Music Therapy for Stroke Rehabilitation

Written by Jennifer Li ‘25

Edited by Anusha Srinivasan ‘24

Image Source: [4]


From cozy Spotify playlists to the thrill of attending live concerts, music is a colorful and omnipresent thread of our everyday lives. Today, music is easily accessible, simple to share with others, and uniquely present in a myriad of cultures. Given the potential for strong emotional and personal connections to form in conjunction with music, it’s no wonder researchers are turning towards music — specifically, music therapy — as a way of facilitating healing and rehabilitation.


According to the American Music Therapy Association, or AMTA, music therapy is defined as “an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive and social needs of individuals” [1]. Historically, music therapy has been successful as an intervention method for patients suffering from post traumatic stress disorder, children on the autism spectrum, and individuals struggling with anxiety prior to a medical procedure.


More recently, however, one of the most prominent investigations into the uses of music therapy relates to rehabilitation following traumatic brain injury.


In the case of stroke rehabilitation, for example, music therapy is an effective intervention which replies upon motor-audio coupling to recover a patients’ function.


Unsurprising, multiple clinical trials have found that music therapy positively impacts stroke patients’ recovery. Interventions fall under four separate categories: rhythmic auditory stimulation (RAS), musical motor feedback (MMF), rhythmic and music-based therapies (R-MT), and active listening [2].


Rhythmic Auditory Stimulation (RAS)

Rhythmic auditory stimulation, or RAS, involves synchronizing a repetitive movement to an external auditory cue. Depending on the patient's history, the “cue” may be a rhythm-adjusted song recording, a simple metronome beat, or live music created to align with the individual’s needs. As the music is played, the patient practices timing a target movement to the rhythm of the song, and the speed of the auditory cue may be gradually increased. As the patient learns, they are simultaneously receiving auditory feedback from the timing of the auditory cue, thus promoting “efficient coordination of a movement by synchronizing the movement to the predictable referent” [6].


Musical Motor Feedback

However, some studies found that patients were unable to keep pace with an external auditory cue. Scientists Michael Schauer of the Max-Planck-Institute of Cognitive Neuroscience and Karl-Heinz Mauritz of the Free University of Berlin believed that patients’ attempts to coordinate with an external pacemaker provided an additional burden to an already challenging task.


Schauer and Mauritz instead proposed a method of musical motor feedback, or MMF. Patients practiced walking with a device designed to detect heel contact with the ground, and instantly stretch or compress an audio segment to reflect the time between two consecutive heel-strikes [5]. In this case, musical motor feedback found a statistically significant increase in stride length, whereas cadence remained unchanged. In contrast, rhythmic auditory stimulation studies on gait generally see an increase in walking speed. Both music therapy interventions saw improved gait symmetry, and increased gait velocity (defined as the product between stride length and cadence).


Rhythm and Music Therapy

Rhythm and Music Therapy, or R-MT specifically targets sensorimotor and cognitive function. Initially developed by American jazz drummer Ronnie Gardiner, rhythm and music therapy was intended to help children with music and motor development. Rhythm and music therapy assigns target movements to symbols; participants then read the symbols and perform the corresponding movements to the rhythm of music [7]. The color of each symbol reflects whether the target movement should be performed with the left, right, or both sides, and the name of each symbol is also spoken with the movement. In essence, rhythm and music therapy successfully couples movement, speech, hearing, vision into a unique intervention program.


Active Listening

Active listening, “a technique in which patients play an instrument or compose their own music,” also leads to significant improvements in neurorehabilitation and cognitive processing [2]. For instance, patients with partial hand paralysis may be taught a simple C major scale on the keyboard. Over the course of multiple short sessions over a number of weeks, these individuals are able to improve their fine motor movements by musical means. Moreover, many patients have cited their experience as “highly enjoyable” and “a highlight of their rehabilitation process” [2].


The success of music therapy in stroke rehabilitation speaks to the interconnectivity of audio and motor pathways, as well as the personal and emotional connections to music we all share. The next time we put on our headphones, shuffle our favorite playlists, and tune out the rest of the world, we can take comfort in knowing that one of humanity’s favorite pastimes has the power to heal.

 

References

[1] American Music Therapy Association [Internet]. About Music Therapy and AMTA | American Music Therapy Association (AMTA). [cited 2022Dec11]. Available from: https://www.musictherapy.org/about/

[2] Daniel A, Koumans H, Ganti L. Impact of music therapy on gait after stroke [Internet]. Cureus. U.S. National Library of Medicine; 2021 [cited 2022Dec11]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8559977/

[3] Grau-Sánchez J, Segura E, Sanchez-Pinsach D, Raghavan P, Münte TF, Palumbo AM, et al. Enriched music-supported therapy for chronic stroke patients: A study protocol of a randomised controlled trial - BMC neurology [Internet]. BioMed Central. BioMed Central; 2021 [cited 2022Dec11]. Available from: https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-020-02019-1

[4] Music therapy: More than just entertainment [Internet]. NAMI. [cited 2022Dec11]. Available from: https://www.nami.org/Blogs/NAMI-Blog/June-2022/Music-Therapy-More-Than-Just-Entertainment

[5] Musical Motor Feedback (MMF) in walking hemiparetic ... - sage journals [Internet]. [cited 2022Dec12]. Available from: https://journals.sagepub.com/doi/10.1191/0269215503cr668oa

[6] Rhythmic Auditory Cueing in Motor Rehabilitation for Stroke Patients: Systematic Review and Meta-Analysis [Internet]. Academic.oup.com. [cited 2022Dec11]. Available from: https://academic.oup.com/jmt/article/53/2/149/2614212?login=true

[7] Ronnie Gardiner Method - musictherapy.org.nz [Internet]. [cited 2022Dec12]. Available from: https://www.musictherapy.org.nz/wp-content/uploads/2019/06/Info-RGM-NZ.pdf

[8] Treble clef treatment: Music to counter delirium in mechanically ventilated older adults in the ICU [Internet]. ScienceDaily. ScienceDaily; 2022 [cited 2022Dec11]. Available from: https://www.sciencedaily.com/releases/2022/09/220912100318.htm

[9] Wang L, Peng J-lin, Xiang W, Huang Y-jie, Chen A-lian. Effects of rhythmic auditory stimulation on motor function and balance ability in stroke: A systematic review and meta-analysis of clinical randomized controlled studies [Internet]. Frontiers. Frontiers; 2022 [cited 2022Dec11]. Available from: https://www.frontiersin.org/articles/10.3389/fnins.2022.1043575/full#B43


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