Music Has Powers to Ease the Stroke-Injured Brain

Medical News: Strokes

Music Has Powers to Ease the Stroke-Injured Brain
By Judith Groch, Senior Writer, MedPage Today
Published: February 19, 2008
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine. Earn CME/CE credit
for reading medical news


HELSINKI, Finland, Feb. 19 -- Listening to music enhanced cognitive recovery and improved mood after a middle cerebral artery stroke, researchers reported.
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Action Points

Explain to interested patients that listening to music right after a stroke appears to be an inexpensive and possibly valuable addition to other forms of rehabilitation.


Note that these findings for improved cognition and mood came from a single study at one hospital and that music therapy may not work for all patients.
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Recovery of verbal memory and focused attention was better in patients who listened to music of their choice soon after a stroke than in patients who did not listen to anything or in those who listened to audio books, Teppo Sarkamo, M.A., of the University of Helsinki, and colleagues reported online in Brain.

Patients who listened to music also had a more positive mood, the researchers said.

Research has shown that during the first weeks and months after a stroke, patients typically spend most of their time in non-therapeutic activities, mostly inactive in their rooms, even though this time window is ideal for rehabilitation, the researchers said.

It's also been shown, they noted, that "an enriched sound environment" can enhance various brain function, including learning and memory. But, they said, its effects on recovery from neural damage have not been systematically studied.

So the researchers recruited 60 patients, ages 75 or younger, in the acute recovery phase from a left or right hemisphere middle cerebral artery stroke.

Patients entered a single-blind, randomized, controlled trial from March 2004 to May 2006, with therapy starting as soon as possible after admission to the Helsinki University Central Hospital.

They were randomly assigned to a music group, a language group, or a control group receiving only standard care.

During the following two months, the music and language groups listened daily for at least an hour to self-selected music (pop, classical, jazz, or folk) or audio books. The control group received no special auditory stimulation.

All patients received standard medical care and rehabilitation.

At one week (baseline), three months, and six months after the stroke, they also underwent an extensive neuropsychological assessment, which included a wide range of cognitive tests as well as mood and quality-of-life questionnaires.

Fifty-four patients completed the study.

Tests at three months showed that verbal memory was significantly better in the music group than in the control group (P=0.012) or in the language group (P=0.006).

Focused attention recovery was also significantly better in the music group than in the control group (P=0.049) and marginally better in the music group than in the language group (P=0.058).

At six months, the findings were similar, the researchers said.

In addition, the researchers found that the music group experienced less depression and confusion. At three months, there was a significant difference in depression (P=0.031) and confusion (P=0.045).

Post hoc tests found that the depression score was significantly lower in the music group then in the control group (P=0.024) but only marginally different between the music and the language group.

The confusion score was marginally lower in the music group than in the control group (P=0.061).

At six months, the differences between the music and control groups were still marginally different for depression and confusion.

It is possible, the researchers suggested, that music in itself may help patients cope with the emotional stress caused by a sudden severe neurological illness.

Some aphasic patients in the language group, the investigators suggested, had difficulty listening to the audio books and thus did not find the intervention as enjoyable as patients in the music group.

In reviewing the possible neural mechanisms involved in the music-stroke connection, the researchers suggested that enhanced alertness, attention, memory, emotion, and motivation may be mediated by the dopaminergic mesocorticolimbic system.

Also, music may stimulate the recovery of damaged areas of the brain, they said.

In addition to the effect on cognition and mood, the investigators hypothesized that music may also have general effects on brain plasticity after a stroke.

Listening to music, they said, may stimulate both the peri-infarct regions in the damaged hemisphere but also regions in the other healthy hemisphere, thereby speeding up recovery.

It is possible, they suggested, that listening to music, especially if it contains lyrics, which activate the brain bilaterally, would facilitate recovery from unilateral stroke more than listening to purely spoken material, which activates the left hemisphere primarily.

However, the researchers said, this suggestion is tentative, and further research is needed to explain the potential effects of a musically enriched recovery environment on brain plasticity after a stroke.

They concluded that listening to music every day during early stroke recovery "offers a valuable addition to the patient's care … by providing an individually targeted, easy-to-conduct, and inexpensive means to facilitate cognitive and emotional recovery."

The study was supported by the Academy of Finland, Jenny and Antti Wihuri Foundation (Helsinki, Finland), and the National Graduate School of Psychology and Neurology Foundation (Helsinki, Finland). Funding to pay the Open 100 Access publication charges for this article was provided by the Cognitive Brain Research Unit, Department of Psychology, University of Helsinki, Finland.

No financial conflicts were reported.

Primary source: Brain
Source reference:
Särkämö T, et al "Music listening enhances cognitive recovery and mood after middle cerebral artery stroke" Brain 2008: DOI: 10.1093/brain/awn013.

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