Neurological Music Therapy for Poststroke Depression, Activity of Daily Living and Cognitive Function: A Pilot Randomized Controlled Study

Research Objectives: To evaluate the effects of a four-week intervention involving once-weekly 60-minute MT on depression, activities of daily living and cognitive function among stroke survivors in Taiwan, in comparison to usual care.

Design: A single masked, randomized controlled study was designed and patients with subacute stroke were recruited. The patients were assigned to a MT group or a conventional therapy (CT) group. Both groups received CT including physical therapy and occupational therapy. The MT group underwent an additional hour of neurological MT per week for a total duration of four weeks. All outcome measurements were evaluated prior to the intervention period and after a total of four hours of intervention over four weeks.

Setting: The participants were recruited from the rehabilitation unit of a tertiary referral hospital in Southern Taiwan.

Participants: The recruitment and follow-up period extended from April 5th, 2017, to September 25th, 2018, concluding upon reaching our targeted number of patients (90). Inclusion criteria were as follows: (1) patients with first-ever ischemic or hemorrhagic stroke between 20~80 years old; (2) patients at subacute stage (one to six months post stroke); (3) able to follow basic instructions (verbal or gesture) and complete our 60-minute MT sessions. Individuals were excluded from the study if they were unable to engage in MT such as significant hearing loss or severe cognitive impairment (Mini-Mental State Examination, MMSE < 10), receiving ventriculoperitoneal shunting due to hydrocephalus, declined to sign the informed consent, refused further evaluation or experienced uncontrolled seizures.

Interventions: The participants in MT group received neurological MT once per week for one hour with total four hours in 4 consecutive weeks. Our main intervention consisted of therapeutic singing, melodic intonation therapy, therapeutic instrument music playing, rhythmic speech cueing, and music cognitive training.

Main Outcome Measures: The primary outcome was Beck depression inventory-II (BDI-II). Secondary outcomes were Mini-Mental State Examination (MMSE), modified rankin scale (MRS) and Barthel Index (BI).

Results: There was significant post-treatment effect among both groups, regarding Barthal Index (p < 0.001), MMSE (p < 0.001) and MRS (p < 0.001). Furthermore, the between-group effect of MRS exhibited significant difference (p=0.033).

Conclusions: This study highlights the added value of MT in improving MRS, while requiring relatively less therapeutic time. Further studies are needed to confirm the ideal therapeutic timing and frequency of MT in improving mood, cognition and ADL function.

Author(s) Disclosures: No potential conflict of interest was reported by all the authors.