Music interventions are used to optimize an individual’s emotional well-being, physical health, social functioning, communication abilities, and cognitive skills. This module reviews studies that incorporate music as the primary type of intervention.
Music therapy is a specific form of rehabilitation that is typically facilitated by an accredited music therapist and uses music in a variety of ways to help achieve therapeutic goals. Music therapy has been found to be helpful for people who have had a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Since music is emotionally and intellectually stimulating, this form of therapy can help to maintain or improve one’s physical and mental health, quality of life, and well-being.
Are there different kinds of music therapy?
Music therapy can be provided in different forms, depending on your needs and preferences. Various ways of conducting music therapy and its benefits include:
Active listening – develops attention, memory, and awareness to your environment.
Composing/songwriting – can be a way of sharing your feelings and being able to express yourself.
Improvising movements to music – a creative, non-verbal way of expressing feelings. Since improvisation does not require any previous musical training anyone can participate.
Rhythmic movements and dancing – improves movement, speed, balance, breathing, stamina, relaxation of muscles, and walking.
Playing instruments – increases coordination, balance, and strength. As an example, hitting a tambourine with a stick is a good exercise to improve your hand-eye coordination and develop strength in your arms and hands. This is a great activity whether or not you have previous experience playing instruments.
Singing – improves communication, speech, language skills, articulation, and breathing control. Singing is particularly useful after a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. for those who are unable to speak, because sometimes even though speech is affected, the individual is still able to sing. This happens because the speech center located in the brain is in a different location than the brain area used for singing. So, someone may have damage to the brain area responsible for speech, but no damage to the area responsible for singing.
With permission of the Music Therapy Association of British Columbia
Is music therapy offered individually or in a group?
Music therapy can be offered either way, so it is your choice. You and your music therapist can plan your music therapy sessions together. Benefits to participating in a group includes improving communication and social skills, making new friends, and the opportunity to share feelings and experiences. Playing instruments in a group can help develop cooperation and attention, as well as improve self-esteem and well-being. Composing and songwriting is another activity that works well in a group, as it allows you to communicate and work along with others. If you are not comfortable working in a group, music therapy sessions can also be offered on an individual basis. Individual sessions may lead to group sessions later on in the rehabilitation process, or the treatment plan may involve a combination of both. For people who are restricted to bed, music therapy can even be offered at their bedside with portable instruments.
Why use music therapy after a stroke?
Music therapy has the ability to help in the rehabilitation of individuals who have had a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The research on the effects of this intervention is still quite new. There is some limited evidence suggesting that music therapy can help improve the movement of the arms, walking, pain perception, mood, and behaviour after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Courtesy of the Institute for Music and Neurologic Function
Do music-based treatments work in post-stroke rehabilitation?
Researchers have studied how different music-based treatments can help patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.:
In individuals with ACUTE strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (up to 1 month after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.), studies found that:
Listening to music is MORE helpful than comparison treatment(s) in improving attention, memory, mood and affect. It is AS helpful as comparison treatment(s) in improving executive functions (cognitive processes that assist in managing oneself and one’s resources in order to achieve a goal), language, music cognition, quality of life, and the ability to identify visual and spatial relationships among objects.
Music-movement therapy is MORE helpful than comparison treatment(s) in improving mood and affect, and range of motion. It is AS helpful as comparison treatment(s) in improving functional independence in self-care activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. (e.g. dressing, feeding), and muscle strength.
Rhythmic music interventions are MORE helpful than comparison treatment(s) in improving walking ability.
In individuals with SUBACUTE strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (1 month to 6 months after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.), studies found that:
Music training is MORE helpful than a comparison treatment in improving hand and arm function.
In individuals with CHRONIC strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (more than 6 months after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.), studies found that:
Music therapy + occupational therapy is MORE helpful than comparison treatment(s) in improving functional independence in self-care activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. (e.g. dressing, feeding), quality of life, sensation, and arm function. It is AS helpful as comparison treatment(s) in improving consequences of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., and arm movement quality.
Melodic intonation therapy is AS helpful as a comparison treatment in improving language.
Rhythmic music interventions are MORE helpful than comparison treatment(s) in improving balance, behavior, walking ability, grip strength, interpersonal relationships, quality of life, legs range of movement, consequences of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., and mood and affect. They are AS helpful as comparison treatment(s) in improving cognitive functions (e.g. attention), dexterity, language, musical behavior, occupational performance, arm function, memory, and walking endurance.
In individuals with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (acute, subacute and/or chronic), studies found that:
Melodic intonation therapy is MORE helpful than a comparison treatment in improving language.
Music performance is AS helpful as comparison treatment(s) in improving dexterity and arm range of motion and function.
Rhythmic music interventions are MORE helpful than comparison treatment(s) in improving balance, and walking ability. They are AS helpful as comparison treatment(s) in improving dexterity, sensation, strength, strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. consequences, arm function and activity.
Who provides the treatment?
Many hospitals and rehabilitation centers have music therapy programs that are conducted by accredited music therapists. The music therapist will meet with you to assess your needs and discuss preferences, so that he or she can design a program specific to your needs. In some centers it may be a recreational therapist or leisure therapist who provides music therapy. Ask your health professional or family members to help you find out more about the music therapy services offered in your hospital, rehabilitation center or community.
Are there any side effects or risks?
You do not face any risks when participating in music therapy after a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., as long as activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. are practiced in a manner that fits your abilities. Consult your physician or rehabilitation healthcare professional for the best advice on how to participate safely. This is especially important if you are going to incorporate dancing or rhythmic movements into your music sessions and have some balance difficulties. *Family members/friends: it is important to help the person who has had a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. seek out new activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. such as music therapy that may be both pleasant and therapeutic.
Clinician Information
Note: When reviewing the findings, it is important to note that they are always made according to randomized clinical trial (RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.) criteria – specifically as compared to a control group. To clarify, if a treatment is “effective” it implies that it is more effective than the control treatment to which it was compared. Non-randomized studies are no longer included when there is sufficient research to indicate strong evidence (level 1a) for an outcome.
This module reviews 24 studies that use music as a primary means of rehabilitation; of these, 12 are high quality RCTs, seven are fair quality RCTs, one is a poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and four are non-randomized studies.
This module reviews the following types of music-based interventions:
Listening to music: Participants listening to music.
Music therapy + occupational therapy: Participants playing instruments (e.g. drums, bells, shakers, mallets, chimes, piano, harp) with the affected upper limb to encourage proximal and distal upper limb movements, with attention to positioning and movement quality.
Melodic intonation therapy: Participants singing phrases and tap to the rhythm of the phrases; this intervention has been shown to improve outcomes related to language/aphasia.
Music-movement therapy: Participants performing movements of lower and upper extremities while listening to music.
Music performance: Participants playing acoustic musical instruments and/or iPads with touchscreen musical instruments as part of fine/distal exercise.
Music training: Participants are taught to play a musical instrument.
Rhythmic music interventions: Participants performing matching upper and/or lower extremity movements or gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. patters to musical rhythm.
One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Sarkamo et al., 2008) investigated the effect of music interventions on attention in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to a group that listened to music for a minimum 1 hour/day, a group that listened to audio books for a minimum 1 hour/day, or a control group that received no training; all groups received conventional rehabilitation for the duration of the 2-month study. Measures of attention were taken at 3 and 6 months post-stroke, and outcomes included: (1) attention, measured by the CogniSpeed reaction time software; (2) focused attention, measured by the mental subtraction and Stroop subtests (number correct and reaction time); and (3) sustained attention, measured by the vigilance (number correct, reaction time) and simple reaction time subtests. Significant between-group differences in focused attention were found at 3 months post-stroke, favoring the music group vs. the control group. Significant between-group differences in focused attention were found at 6 months post-stroke, favoring the music group vs. the audio book group, and favoring the music group vs. the control group. There were no significant between-group differences in other measures of attention at either time point.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that listening to music is more effective than comparison interventions (listening to audio books, no training) in improving focused attention in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. However, no between-group differences were found on measures of attention or sustained attention.
Auditory sensory memory
Not effective
1b
One high quality RCT (Sarkamo et al., 2010) investigated the effect of music interventions on auditory sensory memory in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to a group that listened to music for a minimum 1 hour/day, a group that listened to audio books for a minimum 1 hour/day, or a control group that received no training; all groups received conventional rehabilitation for the duration of the 2-month study. Auditory sensory memory was evaluated by the magnetically-measured mismatch negativity (MMNm) responses to change in sound frequency and duration from baseline to 3 and 6 months post-stroke. There were no significant differences between groups at 3 months post-stroke. At 6 months post-stroke, there were significant between-group differences in auditory sensory memory (frequency MMNm only), favoring the music group vs. the control group.
Note: Comparison of the audio book group vs. the control group revealed significant differences favoring the audio book group in frequency MMNm (left and right lesions) and duration MMNm (right lesions only) at 6 months post-stroke.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that listening to music is not more effective than comparison interventions (listening to audio books, no training) in improving auditory sensory memory among patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. in the short term.
Note: However, this high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. showed that patients who listened to music demonstrated significantly better auditory sensory memory several months following treatment than patients who received conventional rehabilitation alone.
Executive function
Not effective
1b
One high quality RCT (Sarkamo et al., 2008) investigated the effect of music interventions on executive function in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to a group that listened to music for a minimum 1 hour/day, a group that listened to audio books for a minimum 1 hour/day, or a control group that received no training; all groups received conventional rehabilitation for the duration of the 2-month study. Executive function was measured by the Frontal Assessment Battery at 3 and 6 months post-stroke. No significant between-group differences were found at either time point.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that listening to music is not more effective than comparison interventions (listening to audio books, no training) in improving executive function in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Language
Not effective
1b
One high quality RCT (Sarkamo et al., 2008) investigated the effect of music interventions on language in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to a group that listened to music for a minimum 1 hour/day, a group that listened to audio books for a minimum 1 hour/day, or a control group that received no training; all groups received conventional rehabilitation for the duration of the 2-month study. Language was measured by the Finnish version of the Boston Diagnostic AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury. An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Examination (word repetition, sentencing repetition, reading subtests), the CERAD battery (verbal fluency, naming subtests) and the Token Test at 3 and 6 months post-stroke. No significant between-group differences were found at either time point on any of the measures.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that listening to music is not more effective than comparison interventions (listening to audio books, no training) in improving language in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Memory
Effective
1b
One high quality RCT (Sarkamo et al., 2008) investigated the effect of music interventions on memory in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to a music group that listened to music for a minimum 1 hour/day, a language group that listened to audio books for a minimum 1 hour/day, or a control group that received no training; all groups received conventional rehabilitation for the duration of the 2-month study. Measures of memory were taken at 3 and 6 months post-stroke and outcomes included: (1) verbal memory, measured by the Rivermead Behavioral Memory Test (story recall subtests) and an auditory list learning task; and (2) short-term working memoryExecutive process responsible for the temporary storage and manipulation of information in both simple (e.g. recalling a series of digits such as a phone number) and complex cognitive tasks (e.g. coordinating two tasks simultaneously) (Van der Linden, 2007) , measured by the Wechsler Memory Scale – Revised (digit span subtest) and a memory interference task. Significant between-group differences in verbal memory were found at 3 months post-stroke, favoring the music group vs. the audio book group, and favoring the music group vs. the control group. Similarly, significant between-group differences in verbal memory were found at 6 months post-stroke, favoring the music group vs. the audio book group. There were no significant between-group differences in short-term working memoryExecutive process responsible for the temporary storage and manipulation of information in both simple (e.g. recalling a series of digits such as a phone number) and complex cognitive tasks (e.g. coordinating two tasks simultaneously) (Van der Linden, 2007) at either time point.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that listening to music is more effective than comparison interventions (listening to audio books, no training) in improving verbal memory in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. However, no between-group differences were found on measures of short-term working memoryExecutive process responsible for the temporary storage and manipulation of information in both simple (e.g. recalling a series of digits such as a phone number) and complex cognitive tasks (e.g. coordinating two tasks simultaneously) (Van der Linden, 2007) .
Mood
Effective
1b
One high quality RCT (Sarkamo et al., 2008) investigated the effect of music interventions on mood in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to a group that listened to music for a minimum 1 hour/day, a group that listened to audio books for a minimum 1 hour/day, or a control group that received no training; all groups received conventional rehabilitation for the duration of the 2-month study. Mood was measured by a shortened Finnish Version of the Profile of Mood States at 3 and 6 months post-stroke. Significant between-group differences in mood (depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression. score only) were found at 3 months post-stroke favoring the music group vs. the control group.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that listening to music is more effective than comparison interventions (listening to audio books, no training) in improving mood in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Music cognition
Not effective
1b
One high quality RCT (Sarkamo et al., 2008) investigated the effect of music interventions on music cognition in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to a group that listened to music for a minimum 1 hour/day, a group that listened to audio books for a minimum 1 hour/day, or a control group that received no training; all groups received conventional rehabilitation for the duration of the 2-month study. Music cognition was measured by the Montreal Battery of Evaluation of Amusia (scale and rhythm subtests) at 3 months post-stroke. No significant between-group differences were found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that listening to music is not more effective than comparison interventions (listening to audio books, no training) in improving music cognition in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Quality of life
Not effective
1b
One high quality RCT (Sarkamo et al., 2008) investigated the effect of music interventions on quality of life in patients with acute stroke. This high quality RCT randomized patients to a group that listened to music for a minimum 1 hour/day, a group that listened to audio books for a minimum 1 hour/day, or a control group that received no training; all groups received conventional rehabilitation for the duration of the 2-month study. Quality of life was measured by the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury. An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Quality of Life Scale – 39 (self-rated, proxy rated) at 3 and 6 months post-stroke. No significant between-group differences were found at either time point.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that listening to music is not more effective than comparison interventions (audio therapy, no training) in improving quality of life in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Visuospatial skills
Not effective
1b
One high quality RCT (Sarkamo et al., 2008) investigated the effect of music interventions on visuospatial skills in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to a group that listened to music for a minimum 1 hour/day, a group that listened to audio books for a minimum 1 hour/day, or a control group that received no training; all groups received conventional rehabilitation for the duration of the 2-month study. Visuospatial skills were measured by the Clock Drawing Test, Figure Copying Test, Benton Visual Retention Test (short version), and Balloons Test (subtest B) at 3 and 6 months post-stroke. No significant between-group differences were found at either time point on any of the measures.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that listening to music is not more effective than comparison interventions (listening to audio books, no training) in improving visuospatial skills in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Acute phase - Music-movement therapy
Behavioral outcomes
Effective
2b
One poor quality RCT (Jun et al., 2012) investigated the effect of music interventions on mood and affect in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive music-movement therapy or no training; both groups received standard care. Behavioral outcomes were assessed according to: 1) mood measured by the Korean version of the Profile of Mood States Brief Instrument; and 2) depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression. , measured by the Center for Epidemiologic Studies DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression. Scale at post-treatment (8 weeks). Significant between-group differences were found for mood favoring music-movement therapy vs. no training.
Conclusion: There is limited evidence (Level 2b) from one poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that music-movement therapy is more effective than no training in improving behavioral outcomes (mood) in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Functional independence
Not effective
2b
One poor quality RCT (Jun et al., 2012) investigated the effect of music interventions on functional independence in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive music-movement therapy or no training; both groups received standard care. Functional independence was measured by the Korean modified Barthel Index at post-treatment (8 weeks). No significant between-group differences were found.
Conclusion: There is limited evidence (Level 2b) from one poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that music-movement therapy is not more effective than no training in improving functional independence in patients with acute stroke.
Muscle strength
Not effective
2b
One poor quality RCT (Jun et al., 2012) investigated the effect of music interventions on muscle strength in patients with acute stroke. This poor quality RCT randomized patients to receive music-movement therapy or no training; both groups received standard care. Muscle strength of the affected upper and lower extremities was measured by the Medical Research Council Scale at post-treatment (8 weeks). No significant between-group differences were found.
Conclusion: There is limited evidence (Level 2b) from one poor quality RCT that music-movement therapy is not more effective than no training in improving muscle strength in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Range of motion
Effective
2b
One poor quality RCT (Jun et al., 2012) investigated the effect of music interventions on range of motion (ROM) in patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive music-movement therapy or no training; both groups received standard care. ROM of the affected side (shoulder/elbow/wrist flexion, hip/knee flexion) was measured by goniometer at post-treatment (8 weeks). Significant between-group differences in ROM were found (shoulder/elbow flexion, hip flexion), favoring music-movement therapy vs. no training.
Conclusion: There is limited evidence (Level 2b) from one poor quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that music-movement therapy is more effective than no training in improving range of motion of the proximal joints of patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Acute phase - Rhythmic music interventions
Gait parameters
Effective
2a
One fair quality RCT (Schneider et al., 2007) investigated the effect of music interventions on dexterity in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This fair quality RCT randomized patients to receive music training (drum and/or piano) + conventional rehabilitation or conventional rehabilitation alone. Dexterity was measured by the Box and Block Test and the Nine Hole Peg Test at post-treatment (3 weeks). Significant between-group differences were found on both measures of dexterity, favoring music training + conventional rehabilitation vs. conventional rehabilitation alone.
Conclusion: There is limited evidence (Level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that music training + conventional rehabilitation is more effective than conventional rehabilitation alone in improving dexterity in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Subacute phase - Music training
Dexterity
Effective
2a
One fair quality RCT (Schneider et al., 2007) investigated the effect of music interventions on dexterity in patients with subacute stroke. This fair quality RCT randomized patients to receive music training (drum and/or piano) + conventional rehabilitation or conventional rehabilitation alone. Dexterity was measured by the Box and Block Test and the Nine Hole Peg Test at post-treatment (3 weeks). Significant between-group differences were found on both measures of dexterity, favoring music training + conventional rehabilitation vs. conventional rehabilitation alone.
Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that music training + conventional rehabilitation is more effective than conventional rehabilitation alone in improving dexterity in patients with subacute stroke.
Upper extremity motor function
Effective
2a
One fair quality RCT (Schneider et al., 2007) investigated the effect of music interventions on upper extremity motor function in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive music training (drum and/or piano) + conventional rehabilitation or conventional rehabilitation alone. Upper extremity motor function was measured by the Action Research Arm Test, Arm Paresis Score, and computerized hand/fingers movement analysis (velocity and frequency profile) at post-treatment (3 weeks). Significant between-group differences were found on all measures of upper extremity motor function, favoring music training + conventional rehabilitation vs. conventional rehabilitation alone.
Conclusion: There is limited evidence (Level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that music training + conventional rehabilitation is more effective than conventional rehabilitation alone in improving upper extremity motor function in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Chronic phase - Melodic intonation therapy
Language
Not effective
1b
One high quality RCT (van Der Meulen et al., 2016), investigated the effect of music interventions on language in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality cross-over design RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive melodic intonation therapy (MIT) or no treatment. Language was measured by the Sabadel story retell task, Amsterdam-Nijmegen Everyday Language Test, Aachen AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury. An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) Test (naming, repetition, auditory comprehension), and MIT task (trained/untrained items) at post-treatment (6 weeks) and at follow-up (12 weeks). Significant between-group differences were found on only one measure of language (MIT task – trained items) at post-treatment favoring MIT vs. no treatment. These differences were not maintained at follow-up. Note: When the control group crossed-over to receive the MIT treatment, no significant between-group differences were found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that melodic intonation therapy is not more effective than no treatment in improving language in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Chronic phase - Music therapy and occupational therapy
Functional independence
Effective
2b
One quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study (Raghavan et al., 2016) investigated the effect of music interventions on functional independence in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study assigned patients to receive music therapy + occupational therapy integrated upper limb training. Functional independence was measured by the Modified Rankin Scale at baseline, post-treatment (6 weeks) and follow-up (1 year). Significant improvements were found at both time points.
Conclusion: There is limited evidence (Level 2b) from one quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study that music therapy + occupational therapy integrated upper limb training is effective in improving functional independence in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Quality of life
Effective
2b
One quasi-experimental design study (Raghavan et al., 2016) investigated the effect of music interventions on quality of life in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study assigned patients to receive music therapy + occupational therapy integrated upper limb training. Quality of life was measured by the World Health Organization Well-Being Index at baseline, post-treatment (6 weeks) and follow-up (1 year). Significant improvements were found at both time points.
Conclusion: There is limited evidence (Level 2b) from one quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study that music therapy + occupational therapy integrated upper limb training is effective in improving quality of life in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Sensation
Effective
2b
One quasi-experimental design study (Raghavan et al., 2016) investigated the effect of music interventions on sensation in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study assigned patients to receive music therapy + occupational therapy integrated upper limb training. Sensation was measured by the Two-Point Discrimination Test at baseline, post-treatment (6 weeks) and follow-up (1 year). Significant improvements were found at both time points.
Conclusion: There is limited evidence (Level 2b) from one quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study that music therapy + occupational therapy integrated upper limb training is effective in improving sensation in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Stroke outcomes
Not effective
2b
One quasi-experimental design study (Raghavan et al., 2016) investigated the effect of music interventions on strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. outcomes in patients with chronic stroke. This quasi-experimental design study assigned patients to receive music therapy + occupational therapy integrated upper limb training. StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. outcomes were measured by the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Impact Scale (SIS activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. of daily living, participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. subscales) at baseline, post-treatment (6 weeks) and follow-up (1 year). There were no significant changes in strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. outcomes from baseline to post-treatment. There was a significant improvement on one measure (SIS – activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. of daily living) from post-treatment to follow-up.
Conclusion: There is limited evidence (Level 2b) from one quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study that music therapy + occupational therapy integrated upper limb training is not effective in improving strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. outcomes in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. in the short term.
Note: However, the quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study showed significant improvements in one measure of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. outcomes (activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. of daily living) in the long term.
Upper extremity kinematics
Not effective
2b
One quasi-experimental design studies (Raghavan et al., 2016) investigated the effect of music interventions on upper extremity kinematics in patients with chronic stroke. This quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study assigned patients to receive music therapy + occupational therapy integrated upper-limb training. Kinematic analysis of wrist flexion/extension was performed at baseline and at post-treatment (6 weeks). No significant changes were found.
Conclusion: There is limited evidence (Level 2b) from one quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study that music therapy + occupational therapy integrated upper limb training is not effective in improving upper extremity kinematics in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Upper extremity motor function
Effective
2b
One quasi-experimental design studies (Raghavan et al., 2016) investigated the effect of music interventions on upper extremity motor function in patients with chronic stroke. This quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study assigned patients to receive music therapy + occupational therapy integrated upper-limb training. Upper extremity motor function was measured by the Fugl-Meyer Assessment – Upper Extremity subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). at baseline, post-treatment (6 weeks) and 1-year follow-up. Significant improvements were found at both time points.
Conclusion: There is limited evidence (Level 2b) from one quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study that music therapy + occupational therapy integrated upper limb training is effective in improving upper extremity motor function in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Chronic phase - Rhythmic music interventions
Balance
Effective
1a
Two high quality RCTs (Cha et al., 2014; Bunketorp-Kall et al., 2017) investigated the effect of music interventions on balance in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Cha et al., 2014) randomized patients to receive rhythmic auditory stimulation (RAS) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training or time-matched standard gait training. Balance was measured by the Berg Balance Scale (BBS) at post-treatment (6 weeks). Significant between-group differences were found, favoring RAS gait training vs. time-matched standard gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training.
The second high quality RCTs (Bunketorp-Kall et al., 2017) randomized patients to receive rhythm-and-music therapy (listening to music while performing rhythmic movements of the hands and feet), horse-riding therapy or no treatment. Balance was measured by the BBS and the Backstrand, Dahlberg and Liljenas Balance Scale (BDL-BS) at post-treatment (12 weeks) and follow-up (6 months). Significant between-group differences (BDL-BS only) were found at post-treatment and follow-up, favoring rhythm-and-music therapy vs. no treatment. There were no significant differences between rhythm-and-music therapy and horse-riding therapy at either time point on any of the measures. Note: There was also a significant between-group difference (BBS, BDL-BS) at post-treatment, favoring horse-riding therapy vs. no treatment. These differences did not remain significant at follow-up.
Conclusion: There is strong evidence (Level 1a) from two high quality RCTs that rhythmic music interventions are more effective than comparison interventions (time-matched standard gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training, no treatment) in improving balance in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Behavior
Effective
2b
One fair quality RCT (Raglio et al., 2016) and one quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study (Purdie et al., 1997) investigated the effect of music interventions on behavior in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Raglio et al., 2016) randomized patients to receive music therapy (using rhythmic melodic instruments and singing) + speech language therapy or speech language therapy alone. Behavior was measured by the Big Five Observer (energy/extroversion, friendship, diligence, emotional stability, open mindedness) at post-treatment (15 weeks). Neither group demonstrated significant changes in behaviour at post-treatment. Note: This study did not report between-group analyses so is not used to determine the level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) in the conclusion below.
The quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study (Purdie et al., 1997) randomized patients to receive music therapy (using percussion/synthesizers and singing) or no music therapy. Behavior was measured by the Behavior Rating Scale (BRS) at post-treatment (12 weeks). Significant between-group differences were found (BRS emotional stability, spontaneous interaction subscales), favoring music therapy vs. no music therapy.
Conclusion: There is limited evidence (Level 2b) from one quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study that rhythmic music intervention is more effective than no music therapy in improving some aspects of behavior in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Note: However, one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. reported no significant change in behavior following rhythmic music therapy + speech language therapy.
Cognitive function
Not effective
1b
One high quality RCT (Bunketorp-Kall et al., 2017) investigated the effect of music interventions on cognitive function in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive rhythm-and-music therapy (listening to music while performing rhythmic movements of the hands and feet), horse-riding therapy or no treatment. Cognitive function was measured by the Barrow Neurological Institute Screen for Higher Cerebral Functions at post-treatment (12 weeks) and follow-up (6 months). No significant between-group differences were found at either time point.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that rhythmic music intervention is not more effective than comparison interventions (horse-riding therapy, no treatment) in improving cognitive function in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Dexterity
Not effective
2b
Two quasi-experimental design studies (Hill et al., 2011; Villeneuve et al., 2014) investigated the effect of music interventions on dexterity in patients with chronic stroke.
The first quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study (Hill et al., 2011) assigned patients to receive rhythm and timing training (interactive metronome training) + occupational therapy or occupational therapy alone. Dexterity was measured by the Box and Block Test at post-treatment (10 weeks). No significant between-group differences were found
The second quasi-experimental AABA design study (Villeneuve et al., 2014) assigned patients to receive music-supported therapy (using piano training). Dexterity was measured by the Box and Block Test and the Nine Hole Peg Test at post-treatment (3 weeks) and follow-up (6 weeks). Significant improvements in both measures of dexterity were found at post-treatment. No significant changes in scores were observed from post-treatment to follow-up. Note: This study did not report between-group analyses so is not used to determine level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) in the conclusion below.
Conclusion: There is limited evidence (Level 2b) from one quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study that rhythmic music intervention is not more effective than a comparison intervention (occupational therapy alone) in improving dexterity in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Note: One quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study found improvements in dexterity immediately following music-supported therapy using piano training.
Gait parameters
Effective
1b
One high quality RCT (Cha et al., 2014) investigated the effect of music interventions on gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. parameters in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive rhythmic auditory stimulation (RAS) gait training or time-matched standard gait training. GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. parameters (gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. velocity, cadence, stride length of the affected/less-affected legs, double stance period of the affected/less-affected legs) were measured by the GAITRite system at post-treatment (6 weeks). Significant between-group differences were found for all gait parameters of the affected leg and most gait parameters of the less affected leg (excluding stride length, double stance period), favoring RAS gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training vs. time-matched standard gait training.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that rhythmic auditory stimulation gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training is more effective than a comparison intervention (time-matched standard gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training) in improving gait parameters in patients with chronic stroke.
Grip strength
Effective
1b
One high quality RCT (Bunketorp-Kall et al., 2017) investigated the effect of music interventions on grip strength in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCT randomized patients to receive rhythm-and-music therapy (listening to music while performing rhythmic movements of the hands and feet), horse-riding therapy or no treatment. Grip strength was measured by the GRIPPIT (right/left hands – max, mean and final scores) at post-treatment (12 weeks) and follow-up (6 months). Significant between-group differences were found at post-treatment (right hand max score, left hand final score), and at follow-up (left hand final score only), favoring rhythm-and-music therapy vs. no treatment. There were no significant differences between rhythm-and-music therapy and horse-riding therapy at either time point on any of the measures. Note: There were no significant differences between horse-riding therapy and no treatment at either time point on any of the measures.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that rhythm-and-music therapy is more effective than no treatment in improving grip strength in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Interpersonal relationships
Effective
2a
One fair quality RCT (Jeong et al., 2007) investigated the effect of music interventions on interpersonal relationships of patients with chronic stroke. This fair quality RCT randomized patients to receive rhythmic auditory stimulation (RAS) music-movement training (using dynamic rhythmic movement and rhythm tools) or no treatment. Perception of interpersonal relationships was measured by the Relationship Change Scale at post-treatment (8 weeks). Significant between-group differences were found, favoring RAS music-movement training vs. no treatment.
Conclusion: There is limited evidence (Level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that rhythmic music interventions are more effective than no treatment in improving interpersonal relationships in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Language
Not effective
2b
One fair quality RCT (Raglio et al., 2016) and one quasi-experimental design study (Purdie et al., 1997) investigated the effect of music interventions on language in patients with chronic stroke.
The fair quality RCT (Raglio et al., 2016) randomized patients to receive music therapy (using rhythmic melodic instruments and singing) + speech language therapy or speech language therapy alone. Language was measured by the Token Test, Boston Naming Test and Aachener Aphasie Test (picture description, spontaneous speech) at post-treatment (15 weeks). Neither group demonstrated a significant change on any measure of language at post-treatment. Note: This study did not report between-group analyses so is not used to determine level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) in the conclusion below.
The quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study (Purdie et al., 1997) randomized patients to receive music therapy training (using percussion/synthesizers and singing) or no music therapy. Language was measured by the Frenchay AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury. An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada)ScreeningTesting for disease in people without symptoms. Test at post-treatment (12 weeks). No significant between-group differences were found.
Conclusion: There is limited evidence (Level 2b) from one quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study that rhythmic music intervention is not more effective than no music therapy in improving language in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Note: Further, one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. reported no significant improvement in language following music therapy + speech language therapy.
Mood and affect
Effective
2a
Two fair quality RCTs (Jeong et al., 2007; Raglio et al., 2016) and one quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study (Purdie et al., 1997) investigated the effect of music interventions on mood and affect in patients with chronic stroke.
The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Jeong et al., 2007) randomized patients to receive rhythmic auditory stimulation (RAS) music-movement training (using dynamic rhythmic movement and rhythm tools) or no treatment. Mood and affect were measured by the Profile of Mood States at post-treatment (8 weeks). Significant between-group differences were found, favoring RAS music-movement training vs. no treatment.
The second fair quality RCT (Raglio et al., 2016) randomized patients to receive music therapy (using rhythmic melodic instruments and singing) + speech language therapy or speech language therapy alone. Mood and affect were measured by the Beck DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression. Inventory at post-treatment (15 weeks). Neither group demonstrated a significant change in mood. Note: This study did not report between-group analyses so is not used to determine level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) in the conclusion below.
The quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study (Purdie et al., 1997) randomized patients to receive music therapy (using percussion/synthesizers and singing) or no music therapy. Mood and affect were measured by the Hospital Anxiety and DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression. Scale at post-treatment (12 weeks). No significant between-group differences were found.
Conclusion: There is limited evidence (Level 2a) from one fai quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that rhythmic music intervention is more effective than no treatment for improving mood and affect in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Note: However, a quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study found that rhythmic music therapy was not more effective than no treatment for improving mood and affect; a second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. also reported no significant improvements in mood and affect following music therapy + speech language therapy. Differences in the type and duration of music interventions and outcome measures used could account for discrepancies in findings among studies.
Music behavior
Not effective
2b
One quasi-experimental design study (Purdie et al., 1997) investigated the effect of music interventions on musical behavior in patients with chronic stroke. This quasi-experimental design study randomized patients to receive music therapy (using percussion/synthesizers and singing) or no music therapy. Musical behavior was measured by the Musical Behavior Rating Scale at post-treatment (12 weeks). No significant between-group differences were found.
Conclusion: There is limited evidence (Level 2b) from one quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study that rhythmic music intervention is not more effective than no music therapy in improving musical behavior in patients with chronic stroke.
Occupational performance
Not effective
2b
One quasi-experimental design study (Hill et al., 2011) investigated the effect of music interventions on occupational performance in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study assigned patients to receive rhythm and timing training (interactive metronome training) + occupational therapy or occupational therapy alone. Occupational performance was measured by the Canadian Occupational Performance Measure (COPM – satisfaction, performance) at post-treatment (10 weeks). No significant between-group differences were found.
Conclusion: There is limited evidence (Level 2b) from one quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study that rhythm and timing training + occupational therapy is not more effective than a comparison intervention (occupational therapy alone) in improving occupational performance in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Quality of life
Effective
1b
One high quality RCT (Cha et al., 2014) and two fair quality RCTs (Jeong et al., 2007; Raglio et al., 2016) investigated the effect of music interventions on quality of life in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
The high quality RCT (Cha et al., 2014) randomized patients to receive rhythmic auditory stimulation (RAS) gait training or time-matched standard gait training. Quality of life was measured by the Stroke Specific Quality of Life Scale (SS-QoL) at post-treatment (6 weeks). Significant between-group differences were found, favoring RAS gait training vs. time-matched standard gait training.
The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Jeong et al., 2007) randomized patients to receive RAS music-movement training (using dynamic rhythmic movement and rhythm tools) or no treatment. Quality of life was measured by the SS-QoL at post-treatment (8 weeks). No significant between-group differences were found.
The second fair quality RCT (Raglio et al., 2016) randomized patients to receive music therapy (using rhythmic melodic instruments and singing) + speech language therapy or speech language therapy alone. Quality of life was measured by the Short-Form 36 at post-treatment (15 weeks). Neither group demonstrated a significant change. Note: This study did not report between-group analyses so is not used to determine level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) in the conclusion below.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that rhythmic auditory stimulation gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training is more effective than a comparison intervention (standard gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training) in improving quality of life in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Note: However, one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found no significant difference between rhythmic auditory stimulation music-movement training and no treatment. Similarly, a second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found no significant improvement in quality of life following music therapy + speech language therapy. Differences in the type and duration of music interventions and outcome measures used could account for discrepancies in findings among studies.
Range of motion - lower extremity
Effective
2a
One fair quality RCT (Jeong et al., 2007) investigated the effect of music interventions on lower extremity range of motion (ROM) in patients with chronic stroke. This fair quality RCT randomized patients to receive rhythmic auditory stimulation (RAS) music-movement training (using dynamic rhythmic movement and rhythm tools) or no treatment. Lower extremity ROM (ankle flexion/extension) was measured by goniometer at post-treatment (8 weeks). Significant between-group differences were found (ankle extension only), favoring RAS music-movement training vs. no treatment.
Conclusion: There is limited evidence (Level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that rhythmic auditory stimulation music-movement training is more effective than no treatment in improving lower extremity range of motion (ankle extension only) in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Range of motion - upper extremity
Not effective
2b
One fair quality RCT (Jeong et al., 2007) investigated the effect of music interventions on upper extremity range of motion (ROM) in patients with chronic stroke. This fair quality RCT randomized patients to receive rhythmic auditory stimulation (RAS) music-movement training (using dynamic rhythmic movement and rhythm tools) or no treatment. Shoulder ROM (flexion) was measured by goniometer and shoulder flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008) was measured using the Back Scratch Test (upward, downward) at post-treatment (8 weeks). Significant between-group differences were found in shoulder flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008) , favoring RAS music-movement training vs. no treatment.
Conclusion: There is limited evidence (Level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that rhythmic auditory stimulation music-movement training is not more effective than no treatment in improving shoulder range of motion in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Note: However, this fair quality RCT found that RAS music-movement training is more effective than no treatment for improving shoulder flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008) .
Stroke outcomes
Effective
1b
One high quality RCT (Bunketorp-Kall et al., 2017) and one quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study (Hill et al., 2011) investigated the effect of music interventions on strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. outcomes in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Bunketorp-Kall et al., 2017) randomized patients to receive rhythm-and-music therapy (listening to music while performing rhythmic movements of the hands and feet), horse-riding therapy or no treatment. Stroke outcomes were measured by the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Impact Scale (SIS – Item 9) according to (a) the proportion of individuals reporting meaningful recovery; and (b) change scores from baseline to post-treatment (12 weeks) and follow-up (3 and 6 months). There were significant between-group differences in both measures at post-treatment and both follow-up time points, favoring rhythm-and-music therapy vs. no treatment. There were no significant differences between rhythm-and-music therapy and horse-riding therapy at any time point. Note: Significant between-group differences were also found in favour of horse-riding therapy vs. no treatment at post-treatment and both follow-up time points.
The quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study (Hill et al., 2011) assigned patients to receive rhythm and timing training (interactive metronome training) + occupational therapy or occupational therapy alone. Stroke outcomes were measured by the SIS at post-treatment (10 weeks). No significant between-group differences were found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that rhythm-and-music therapy is more effective than no treatment in improving strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. outcomes in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Note: However, the high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that rhythm-and-music therapy was not more effective than horse-riding therapy, and a quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study found that rhythm and timing training + occupational therapy was not more effective than occupational therapy alone in improving strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. outcomes in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Upper extremity coordination
Insufficient evidence
5
One quasi-experimental design study (Villeneuve et al., 2014) investigated the effect of music interventions on upper extremity coordination in patients with chronic stroke. This quasi-experimental AABA design study assigned patients to receive music-supported therapy (using piano training). Upper extremity coordination was measured by the Finger to Nose Test and the Finger Tapping Test at post-treatment (3 weeks) and follow-up (6 weeks). Significant improvements were found on both measures at post-treatment. No significant changes in scores were observed from post-treatment to follow-up. Note: This study did not report between-group analyses and is not used to determine level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) in the conclusion below.
Conclusion: There is insufficient evidence (Level 5) regarding the effectiveness of rhythmic music interventions on upper extremity coordination among patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. However, one quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study reported significant improvements in upper extremity coordination of patients with chronic stroke immediately following music-supported therapy.
Upper extremity motor function
Not effective
2b
Two quasi-experimental design studies (Hill et al., 2011; Villeneuve et al., 2014) investigated the effect of music interventions on upper extremity motor function in patients with chronic stroke.
The first quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study (Hill et al., 2011) assigned patients to receive rhythm and timing training (interactive metronome training) + occupational therapy or occupational therapy alone. Upper extremity motor function was measured by the Fugl-Meyer Assessment – Upper Extremity subtest (FMA-UE) and the Arm Motor Ability Test (AMAT) at post-treatment (10 weeks). There was a significant between-group difference on one measure of upper extremity function (AMAT), favouring occupational therapy alone vs. interactive metronome training + occupational therapy.
The second quasi-experimental AABA design study (Villeneuve et al., 2014) assigned patients to receive music-supported therapy (using piano training). Upper extremity motor function was measured by the Jebsen Hand Function Test at post-treatment (3 weeks) and follow-up (6 weeks). Significant improvements were found at post-treatment. No significant changes in scores were observed from post-treatment to follow-up. Note: This study did not report between-group analyses so is not used to determine level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) in the conclusion below.
Conclusion: There is limited evidence (Level 2b) from one quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints. that rhythmic music intervention is not more effective than a comparison intervention (occupational therapy alone) in improving upper extremity motor function in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. In fact, occupational therapy alone was found to be more effective than metronome training + occupational therapy. Note: However, a second quasi-experimental designA study in which subjects typically receive differing treatments and outcomes are then compared. No randomization is done in the assignment of treatment groups. study reported significant improvements in upper extremity motor function following music-supported training in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Walking endurance
Not effective
1b
One high quality RCT (Bunketorp-Kall et al., 2017) investigated the effect of music interventions on walking endurance in patients with chronic stroke. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive rhythm-and-music therapy (listening to music while performing rhythmic movements of the hands and feet), horse-riding therapy or no treatment. Walking endurance was measured by the Timed Up and Go Test at post-treatment (12 weeks) and follow-up (6 months). There were no significant differences between rhythm-and-music therapy vs. horse-riding therapy, nor between rhythm-and-music therapy vs. no treatment at either time point. Note: There were significant between-group differences in favour of horse-riding therapy vs. no treatment at post-treatment and at follow-up.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that rhythmic music intervention is not more effective than comparison interventions (horse-riding therapy, no treatment) in improving walking endurance in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Working memory
Not effective
1b
One high quality RCT (Bunketorp-Kall et al., 2017) investigated the effect of music interventions on working memoryExecutive process responsible for the temporary storage and manipulation of information in both simple (e.g. recalling a series of digits such as a phone number) and complex cognitive tasks (e.g. coordinating two tasks simultaneously) (Van der Linden, 2007) in patients with chronic stroke. This high quality RCT randomized patients to receive rhythm-and-music therapy (listening to music while performing rhythmic movements of the hands and feet), horse-riding therapy or no treatment. Working memoryExecutive process responsible for the temporary storage and manipulation of information in both simple (e.g. recalling a series of digits such as a phone number) and complex cognitive tasks (e.g. coordinating two tasks simultaneously) (Van der Linden, 2007) was measured by the Letter-Number Sequencing“The coordination and proper ordering of the steps that comprise the task, requiring a proper allotment of attention to each step” (Lezak, 1989; as cited in (Baum, Morrison, Hahn & Edwards, 2007)) Test at post-treatment (12 weeks) and follow-up (6 months). Significant between-group differences were found at follow-up only, favoring rhythm-and-music therapy vs. no treatment. No other significant between-group differences were found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that rhythmic music intervention is not more effective, in the short term, than no treatment, and, in the short and the long term, than horse-riding therapy, in improving working memoryExecutive process responsible for the temporary storage and manipulation of information in both simple (e.g. recalling a series of digits such as a phone number) and complex cognitive tasks (e.g. coordinating two tasks simultaneously) (Van der Linden, 2007) in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Note: However, a significant between-group difference was found, in the long term, favoring rhythmic music intervention vs. no treatment.
Phase not specific to one period - Melodic intonation therapy
Language
Effective
2a
One fair quality RCT (Conklyn et al., 2012) investigated the effect of music interventions on language in patients with stroke. This high quality RCT randomized patients with acute/subacute stroke and Broca’s aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury. An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) to receive 3 sessions of modified melodic intonation therapy (MMIT) or education. Language were measured by a non-standardized modified version of the Western Aphasia Battery (mWAS – repetition, responsivenessThe ability of an instrument to detect clinically important change over time. , total score) at baseline and at the end of each session. Significant between-group differences were found after session 1 (mWAS – repetition, responsivenessThe ability of an instrument to detect clinically important change over time. , total score), and after session 2 (mWAS – responsivenessThe ability of an instrument to detect clinically important change over time. ), favoring MMIT vs. education. No results were provided following session 3.
Conclusion: There is limited evidence (Level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that one session of modified melodic intonation therapy is more effective than a comparison intervention (education) in improving language in patients with stroke and Broca’s aphasia.
Phase not specific to one period - Music performance
Dexterity
Not effective
1b
One high quality RCT (Street et al., 2017) investigated the effect of music interventions on dexterity in patients with stroke. This high quality cross-over design RCT randomized patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive music performance therapy (therapeutic instrumental music performance) or no treatment. Dexterity was measured by the Nine Hole Peg Test at post-treatment (6 weeks). No significant between-group differences were found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that music performance therapy is not more effective than no treatment in improving dexterity in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Range of motion
Not effective
2a
One fair quality RCT (Paul & Ramsey, 1998) investigated the effect of music interventions on range of motion (ROM) in patients with stroke. This fair quality RCT randomized patients with subacute/chronic stroke to receive music performance therapy (group-based electronic music-making training) or recreation therapy. ROM (shoulder flexion/elbow extension) was measured by JAMAR goniometer at post-treatment (10 weeks). No significant between-group differences were found.
Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that group-based music performance therapy is not more effective than a comparison intervention (recreation therapy) in improving upper extremity range of motion in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Upper extremity motor function
Not effective
1b
One high quality RCT (Street et al., 2017) investigated the effect of music interventions on upper extremity (UE) motor function in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality cross-over design RCT randomized patients with subacute/chronic stroke to receive music performance therapy (therapeutic instrumental music performance) or no treatment. UE motor function was measured by the Action Research Arm Test at post-treatment (6 weeks). No significant between-group differences were found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that music performance therapy is not more effective than no treatment in improving upper extremity motor function in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Phase not specific to one period - Rhythmic music interventions
Balance
Effective
1a
Two high quality RCTs (Chouhan & Kumar, 2012; Suh et al., 2014) and one fair quality RCT (Kim et al., 2012) investigated the effect of music interventions on balance in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
The first high quality RCT (Chouhan & Kumar, 2012) randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive rhythmic auditory stimulation (RAS) gait/fine/gross motor training, visual cueing gait/fine/gross motor training or no additional training. Balance was measured by the Dynamic GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. Index during treatment (1 and 2 weeks), post-treatment (3 weeks) and follow-up (4 weeks). Significant between-group differences were found at 2, 3 and 4 weeks, favoring RAS training vs. no training. Significant between-group differences were found at all time points, favoring RAS training vs. visual cueing training. Note: Significant between-group differences in balance were found at all time points, favoring visual cueing training vs. no training.
The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Suh et al., 2014) randomized patients with acute/subacute/chronic stroke to receive RAS gait training + neurodevelopmental therapy (NDT) or NDT alone. Balance was measured using the Biosway® computerized dynamic posturography system (overall stability index, anteroposterior index and mediolateral index) at post-treatment (3 weeks). Significant between-group differences in all measures of balance were found, favoring RAS gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training + NDT vs. NDT alone.
The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Kim et al., 2012) randomized patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive RAS gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training + conventional physical therapy or conventional physical therapy alone. Balance was measured by the Four-Square Step Test, Up/Down Stairs (sec), Timed Up and Go Test (TUG); and balance confidence was measured by the ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. Specific Balance Confidence Scale (ABC Scale) at post-treatment (5 weeks). Significant between-group differences were found on the TUG and ABC Scale, favoring RAS gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training + conventional physical therapy vs. conventional physical therapy alone.
Conclusion: There is strong evidence (Level 1a) from two high quality RCTs and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that rhythmic music interventions are more effective than comparison interventions (visual cueing training, no training, NDT alone, conventional physical therapy alone) in improving balance and balance confidence in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Dexterity
Not effective
1b
One high quality RCT (van Delden et al., 2013) investigated the effect of music interventions on dexterity in patients with stroke. This high quality RCT randomized patients with acute/subacute stroke to receive modified bilateral arm training with rhythmic auditory cueing (mBATRAC), modified constraint induced movement therapy (mCIMT) or conventional rehabilitation. Dexterity was measured by the Nine Hole Peg Test at post-treatment (6 weeks) and follow-up (12 weeks). No significant between-group differences were found at either time point.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that modified bilateral arm training with rhythmic auditory cueing is not more effective than comparison interventions (modified constraint induced movement therapy, conventional rehabilitation) in improving dexterity in patients with stroke.
Gait ability
Effective
2a
One fair quality RCT (Kim et al., 2012) investigated the effect of music interventions on gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. ability in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This fair quality RCT randomized patients with subacute/chronic stroke to receive rhythmic auditory stimulation (RAS) gait training + conventional physical therapy or conventional physical therapy alone. GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. ability was measured by the Functional AmbulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second. Category (FAC) test and the Dynamic Gait Index (DGI) at post-treatment (5 weeks). There was a significant between-group difference on one measure of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. ability (DGI) at post-treatment, favoring RAS gait training + conventional physical therapy vs. conventional physical therapy alone.
Conclusion: There is limited evidence (Level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that rhythmic auditory gait training is more effective than a comparison intervention (conventional physical therapy alone) in improving gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. ability in patients with stroke.
The first high quality RCT (Thaut et al., 2007) randomized patients with acute/subacute stroke to receive rhythmic auditory stimulation (RAS) gait training or neurodevelopmental therapy (NDT) training. GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. parameters (velocity, stride length, cadence, symmetry) were measured by computerized foot sensors at post-treatment (3 week). Significant between-group differences were found in all gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. parameters, favoring RAS gait training vs. NDT gait training.
The second high quality RCT (Suh et al., 2014) randomized patients with acute / subacute / chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive RAS gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training + neurodevelopmental therapy (NDT) or NDT alone. GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. parameters (cadence, velocity, stride length) were measured at baseline and post-treatment (3 weeks). There were no significant differences in gait parameter scores at post-treatment. Note: However, there was a significant between-group difference in change scores from baseline to post-treatment for one gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. parameter only (velocity), favoring RAS gait training + NDT vs. NDT alone.
The first fair quality RCT (Schauer & Mauritz, 2003) randomized patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training with musical motor feedback or conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training. GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. parameters (walking speed, stride length, cadence, symmetry deviation, rollover path length) were measured by computerized foot sensors at post-treatment (3 weeks). Significant within-treatment group improvements were noted for most measures. Note: This study did not report between-group analyses so is not used to determine level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) in the conclusion below.
The second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Kim et al., 2012) randomized patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive RAS gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training + conventional physical therapy or conventional physical therapy alone. GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. parameters (velocity, cadence, stride length, cycle time) were measured by the GAITRite system at post-treatment (5 weeks). There were significant between-group differences in two gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. parameters (velocity, cadence), favoring RAS gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training + conventional physical therapy vs. conventional physical therapy alone.
Conclusion: There is conflicting evidence (Level 4) from two high quality RCTs regarding the effectiveness of rhythmic auditory stimulation (RAS) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training in improving gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. parameters in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. While one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that RAS gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training was more effective than a comparison intervention (NDT gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training), a second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. reported that RAS gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training + NDT was not more effective than a comparison intervention (NDT alone) in improving gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. parameters in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Further, a fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. reported significant differences in 2 of 4 gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. parameters following RAS gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training vs. conventional physical therapy alone. Another fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. reported improved gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. parameters following gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training with music motor feedback.
Sensation
Not effective
1b
One high quality RCT (van Delden et al., 2013) investigated the effect of music interventions on sensation in patients with stroke. This high quality RCT randomized patients with acute/subacute stroke to receive modified bilateral arm training with rhythmic auditory cueing, modified constraint induced movement therapy or conventional rehabilitation. Sensation was measured by the Eramus modification of the Nottingham Sensory Assessment at post-treatment (6 weeks) and follow-up (12 weeks). No significant between-group differences were found at either time point.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that modified bilateral arm training with rhythmic auditory cueing is not more effective than comparison interventions (modified constraint induced movement therapy, conventional rehabilitation) in improving sensation in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Strength
Not effective
1b
One high quality RCT (van Delden et al., 2013) investigated the effect of music interventions on strength in patients with stroke. This high quality RCT randomized patients with acute/subacute stroke to receive modified bilateral arm training with rhythmic auditory cueing, modified constraint induced movement therapy or conventional rehabilitation. Strength was measured by the Motricity Index at post-treatment (6 weeks) and follow-up (12 weeks). No significant between-group differences were found at either time point.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that modified bilateral arm training with rhythmic auditory cueing is not more effective than comparison interventions (modified constraint induced movement therapy, conventional rehabilitation) in improving strength in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Stroke outcomes
Not effective
1b
One high quality RCT (van Delden et al., 2013) investigated the effect of music interventions on stroke outcomes in patients with stroke. This high quality RCT randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive modified bilateral arm training with rhythmic auditory cueing (mBATRAC), modified constraint induced movement therapy (mCIMT) or conventional rehabilitation. StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. outcomes were measured by the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Impact Scale (SIS – strength, memory, emotion, communication, ADL, mobility, hand function, social participation subtests) at post-treatment (6 weeks) and follow-up (12 weeks). No significant between-group differences were found at post-treatment. Significant between-group differences were found at follow-up (SIS strength, emotion), favoring conventional rehabilitation vs. mBATRAC.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that modified bilateral arm training with rhythmic auditory cueing is not more effective than comparison interventions (modified constraint induced movement therapy, conventional rehabilitation) in improving strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. outcomes in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. In fact, modified bilateral arm training with rhythmic auditory cueing was found to be less effective than conventional rehabilitation in improving some strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. outcomes in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Upper extremity motor activity
Not effective
1b
One high quality RCT (van Delden et al., 2013) investigated the effect of music interventions on upper extremity motor activity in patients with stroke. This high quality RCT randomized patients with acute/subacute stroke to receive modified bilateral arm training with rhythmic auditory cueing, modified constraint induced movement therapy or conventional rehabilitation. Upper extremity motor activity was measured by the Motor Activity Log (amount of use, quality of movement) at post-treatment (6 weeks) and follow-up (12 weeks). No significant between-group differences were found at either time point.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that modified bilateral arm training with rhythmic auditory cueing is not more effective than comparison interventions (modified constraint induced movement therapy, conventional rehabilitation) in improving upper extremity motor activity in patients with stroke.
The first high quality RCT (Chouhan & Kumar, 2012) randomized patients with acute/subacute stroke to receive gait/fine/gross motor rhythmic auditory stimulation (RAS) training, gait/fine/gross motor visual cueing training, or no training; all groups received conventional rehabilitation. Upper extremity motor function was measured by the Fugl-Meyer Assessment – Upper Extremity subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). (FMA-UE) during treatment (1 and 2 weeks), post-treatment (3 weeks) and follow-up (4 weeks). Significant between-group differences were found at 3 and 4 weeks, favoring RAS training vs. no training. However, significant between-group differences were found at 2, 3 and 4 weeks, favoring visual cueing training vs. RAS training. Note: There were also significant between-group differences at 2, 3, and 4 weeks, favouring visual cueing training vs. no training.
The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (van Delden et al., 2013) randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive modified bilateral arm training with rhythmic auditory cueing, modified constraint induced movement therapy or conventional rehabilitation. Upper extremity motor function was measured by the FMA-UE and the Action Research Arm Test at post-treatment (6 weeks) and follow-up (12 weeks). No significant between-group differences were found at either time point on any of the measures.
The fair quality RCT (Tong et al., 2015) randomized patients with acute/subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive music-supported therapy (musical instrument rhythmic training using wooden percussion instruments) or muted music-supported therapy. Upper extremity motor function was measured by the FMA-UE and the Wolf Motor Function Test (WMFT quality, time) at post-treatment (4 weeks). Significant between-group differences were found (WMFT quality, time), favoring music-supported training vs. muted music-supported training.
Conclusion: There is conflicting evidence (Level 4) from two high quality RCTs regarding the effectiveness of rhythmic music interventions in improving upper extremity motor function in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Results from two high quality RCTs indicate that rhythmic auditory stimulation training is more effective than no training; not more effective than (i.e. comparable to) modified constraint induced movement therapy or conventional rehabilitation; and less effective than visual cueing training. Further, a fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that musical instrument rhythmic training is more effective than the comparison intervention (muted music-supported therapy) in improving upper extremity motor function in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
References
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Jun, E. M., Roh, Y. H., & Kim, M. J. (2013). The effect of music‐movement therapy on physical and psychological states of strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients. Journal of Clinical Nursing, 22(1-2), 22-31. https://www.ncbi.nlm.nih.gov/pubmed/22978325
Kim J., Park, S., Lim, H., Park, G., Kim, M., & Lee, B. (2012). Effects of the combination of rhythmic auditory stimulation and task-oriented training on functional recovery of subacute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients. Journal of Physical Therapy Science, 24(12), 1307-1313. http://ci.nii.ac.jp/naid/10031148292/
Paul, S., & Ramsey, D. (1998). The effects of electronic music‐making as a therapeutic activity for improving upper extremity active range of motion. Occupational Therapy International, 5(3), 223-237. http://onlinelibrary.wiley.com/doi/10.1002/oti.77/full
Raghavan, P., Geller, D., Guerrero, N., Aluru, V., Eimicke, J. P., Teresi, J. A., Ogedegbe, G., Palumbo, A. & Turry, A. (2016). Music Upper Limb Therapy—Integrated: An Enriched Collaborative Approach for StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Rehabilitation. Frontiers in Human Neuroscience, 10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5053999/
Raglio, A., Oasi, O., Gianotti, M., Rossi, A., Goulene, K., & Stramba-Badiale, M. (2016). Improvement of spontaneous language in strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients with chronic aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury. An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) treated with music therapy: a randomized controlled trial. International Journal of Neuroscience, 126(3), 235-242. http://www.tandfonline.com/doi/abs/10.3109/00207454.2015.1010647
Särkämö, T., Pihko, E., Laitinen, S., Forsblom, A., Soinila, S., Mikkonen, M., Autti, T., Silvennoinen, H.M., Erkkilä, J., Laine, M., & Peretz, I. (2010). Music and speech listening enhance the recovery of early sensory processing after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Journal of Cognitive Neuroscience, 22(12), 2716-2727. http://www.mitpressjournals.org/doi/abs/10.1162/jocn.2009.21376#.WPTkq9Lytzo
Särkämö, T., Tervaniemi, M., Laitinen, S., Forsblom, A., Soinila, S., Mikkonen, M., Autti, T., Silvennoinen, H.M., Erkkilä, J., Laine, M., Peretz, I., & HIetanen, M. (2008). Music listening enhances cognitive recovery and mood after middle cerebral artery strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Brain, 131(3), 866-876. https://academic.oup.com/brain/article/131/3/866/318687/Music-listening-enhances-cognitive-recovery-and
Schauer, M., & Mauritz, K. H. (2003). Musical motor feedback (MMF) in walking hemiparetic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients: randomized trials of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. improvement. Clinical Rehabilitation, 17(7), 713-722. http://journals.sagepub.com/doi/abs/10.1191/0269215503cr668oa
Schneider, S., Schönle, P. W., Altenmüller, E., & Münte, T. F. (2007). Using musical instruments to improve motor skill recovery following a strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Journal of Neurology, 254(10), 1339-1346. https://link.springer.com/article/10.1007%2Fs00415-006-0523-2?LI=true
Street, A. J., Magee, W. L., Bateman, A., Parker, M., Odell-Miller, H., & Fachner, J. (2017). Home-based neurologic music therapy for arm hemiparesis following strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.: results from a pilot, feasibility randomized controlled trial. Clinical Rehabilitation, 0269215517717060. http://journals.sagepub.com/doi/abs/10.1177/0269215517717060
Suh, J. H., Han, S. J., Jeon, S. Y., Kim, H. J., Lee, J. E., Yoon, T. S., & Chong, H. J. (2014). Effect of rhythmic auditory stimulation on gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. and balance in hemiplegic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients. NeuroRehabilitation, 34(1), 193-199. http://content.iospress.com/articles/neurorehabilitation/nre1008
Thaut, M. H., McIntosh, G. C., & Rice, R. R. (1997). Rhythmic facilitation of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. training in hemiparetic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. rehabilitation. Journal of the Neurological Sciences, 151(2), 207-212. http://www.jns-journal.com/article/S0022-510X(97)00146-9/abstract
Thaut, M. H., Leins, A. K., Rice, R. R., Argstatter, H., Kenyon, G. P., McIntosh, G. C., Bolay, H.V. & Fetter, M. (2007). Rhythmic auditor y stimulation improves gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. more than NDT/Bobath training in near-ambulatory patients early poststroke: a single-blind, randomized trial. Neurorehabilitation and Neural Repair, 21(5), 455-459. http://journals.sagepub.com/doi/abs/10.1177/1545968307300523
Tong, Y., Forreider, B., Sun, X., Geng, X., Zhang, W., Du, H., Zhang, T. & Ding, Y. (2015). Music-supported therapy (MST) in improving post-stroke patients’ upper-limb motor function: a randomised controlled pilot study. Neurological research, 37(5), 434-440. http://www.tandfonline.com/doi/abs/10.1179/1743132815Y.0000000034
van Delden, A. L. E., Peper, C. L. E., Nienhuys, K. N., Zijp, N. I., Beek, P. J., & Kwakkel, G. (2013). Unilateral versus bilateral upper limb training after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., STROKEAHA-113. http://stroke.ahajournals.org/content/strokeaha/early/2013/07/18/STROKEAHA.113.001969.full.pdf
Van Der Meulen, I., Van De Sandt-Koenderman, M. W., Heijenbrok, M. H., Visch-Brink, E., & Ribbers, G. M. (2016). Melodic intonation therapy in Chronic AphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person's ability to communicate. It is most often the result of stroke or head injury. An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person's intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada): Evidence from a pilot randomized controlled trial. Frontiers in human neuroscience, 10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088197/
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Excluded Studies
Cha, Y., Kim, Y., & Chung, Y. (2014). Immediate effects of rhythmic auditory stimulation with tempo changes on gait in stroke patients. Journal of Physical Therapy Science, 26(4), 479-482. Reason for exclusion: Cross-sectional observational study, not an intervention RCT.
Chouhan, S., & Kumar, S. (2012). Comparing the effects of rhythmic auditory cueing and visual cueing in acute hemiparetic stroke. International Journal of Therapy and Rehabilitation, 19(6), 344-351. Reason for exclusion: Same as Chouhan & Kumar 2012 publication that is already included (manuscript published twice, see references section for details).
Cofrancesco, Elaine M. (1985). The Effect of Music Therapy on Hand Grasp Strength and Functional Task Performance in Stroke Patients. Journal of Music Therapy, 22 (3), 129-145. Reason for exclusion: Not RCT.
Cross P., McLellan M., Vomberg E., Monga M., & Monga, T.N. (1984). Observations on the use of music in rehabilitation of stroke patients. Physiotherapy Canada, 36(4), 197-201. Reason for exclusion: Not RCT.
Dogan, S. K., Tur, B. S., Dilek, L., & Kucukdeveci, A. (2011). Single music therapy session reduces anxiety in patients with stroke/Tek seans muzik terapisi inmeli hastalarda anksiyeteyi azaltir. Turkish Journal of Physical Medicine and Rehabilitation, 12-16. Reason for exclusion: Not RCT.
Friedman, N., Chan, V., Zondervan, D., Bachman, M., & Reinkensmeyer, D. J. (2011, August). MusicGlove: Motivating and quantifying hand movement rehabilitation by using functional grips to play music. In Engineering in Medicine and Biology Society, EMBC, 2011 Annual International Conference of the IEEE (pp. 2359-2363). IEEE. Reason for exclusion: Not RCT.
Kim, S. J. (2010). Music therapy protocol development to enhance swallowing training for stroke patients with dysphagia. Journal of Music Therapy, 47(2), 102-119. Reason for exclusion: Protocol, not RCT.
Kim S.J. & Koh, I. (2005). The Effects of Music on Pain Perception of Stroke Patients during Upper Extremities Joint Exercises. Journal of Music Therapy, 42(1), 81-92. Reason for exclusion: Not RCT.
Kim, D.S., Park, Y. G., Choi, J.H., Im, S.H., Jung, K.J., Cha, Y.A., Jung, C.O., & Yoon, Y.H. (2011). Effects of music therapy on mood in stroke patients. Yonsei Medical Journal, 52(6), 977-81. Reason for exclusion: Not RCT; quasi-experimental study design with outcomes available in RCTs.
Magee W.L., & Davinson, J.W (2002). The effects of Music Therapy on Mood States in Neurological Patients: A Pilot Study. Journal of Music Therapy, 39(1), 20-29. Reason for exclusion: Not RCT.
Prassas S., Thaut M., McIntosh G., & Rice, R. (1997). Effect of auditory rhythmic cueing on gait kinematic parameters of stroke patients. Gait and Posture, 6, 218-223. Reason for exclusion: Not RCT.
Ribeiro, A. S. F., Ramos, A., Bermejo, E., Casero, M., Corrales, J. M., & Grantham, S. (2014). Effects of different musical stimuli in vital signs and facial expressions in patients with cerebral damage: a pilot study. Journal of Neuroscience Nursing, 46(2), 117-124. Reason for exclusion: Stroke population less than 50% of the sample.
Trobia, J., Gaggioli, A., & Antonietti, A. (2011). Combined use of music and virtual reality to support mental practice in stroke rehabilitation. Journal of CyberTherapy and Rehabilitation, 4(1), 57-61. Reason for exclusion: Not RCT.
van Vugt, F. T., Kafczyk, T., Kuhn, W., Rollnik, J. D., Tillmann, B., & Altenmüller, E. (2016). The role of auditory feedback in music-supported stroke rehabilitation: a single-blinded randomised controlled intervention. Restorative Neurology and Neuroscience, 34(2), 297-311. Reason for exclusion: Both groups received a type of music therapy; the feedback was variable between groups.
Van Vugt, F. T., Ritter, J., Rollnik, J. D., & Altenmüller, E. (2014). Music-supported motor training after stroke reveals no superiority of synchronization in group therapy. Frontiers in human neuroscience, 8, 315. Reason for exclusion: Both groups received a form of music therapy.
van Wijck, F., Knox, D., Dodds, C., Cassidy, G., Alexander, G., & MacDonald, R. (2012). Making music after stroke: using musical activities to enhance arm function. Annals of the New York Academy of Sciences, 1252(1), 305-311. Reason for exclusion: Review.
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