Post-Stroke Music Assist: What’s Happening in the Brain?

There have been several studies that have looked at the use of “music supported” therapy in the treatment of adults who have had a stroke (see Altenmüller et al. 2009 and Schneider et al. 2007). A recent study investigated cortical changes with music supported therapy. 

Rojo et al. (2011) completed a case study of an individual who underwent music supported therapy (MST) 5xs a week for four weeks. MST included playing note sequences and children’s songs on a MIDI piano (for fine motor movements) and a electronic drum kit (for gross motor movements).

Significant improvements were seen in movement quality, as measured by 3D motion analysis. fMRI showed a decrease in extra cortical activations after MST. Lastly, TMS showed changes in neuronal excitability. These results demonstrate that cortical changes can occur after 5 weeks of MST.

There are some limitations in this study. First, there was only one participant. Since the location and severity of a stroke varies from persons to person, there is no way to generalize these results. Furthermore, there was no control group – similar changes may be possible after another motor therapy protocol.

Also, the authors refer to the use of music supported therapy as “recently-developed”. Since music has been used in rehabilitation for quite some time, a more accurate statement would be “recently studied using neuroimaging techniques”. The authors never use the exact term “music therapy”, so they could be speaking specifically about their “MST” program.

There are a few things that might be considered in future research including an external rhythmic cue for entrainment and/or use of age-approprite preferred music. What seems evident (in Altenmüller et al. 2009; Schneider et al. 2007; and Rojo et al. 2011) is that playing an instrument can lead to motor changes. It would be interesting to see if using live music to facilitate instrument playing would yield different results.

References:

Altenmüller, E., Marco-Pallares, J., Münte, T.F., & Schneider, S. (2009). Neural reorganization underlies improvement in stroke-induced motor dysfunction by music-supported therapy. Ann N Y Acad Sci., 1169, 395-405. PMID: 19673814

Rojo, N., Amengual, J., Juncadella, M., Rubio, F., Camara, E., . . . Rodriguez-Fornells, A. (2011). Music-supported therapy induces plasticity in the sensorimotor cortex in chronic stroke: a single-case study using multimodal imaging (fMRI-TMS). Brain Inj., 25(7-8), 787-93. PMID: 21561296

Schneider, S., Schönle, P.W., Altenmüller, E., & Münte, T.F. (2007). Using musical instruments to improve motor skill recovery following a stroke. J Neurol., 254(10), 1339-46. PMID: 17260171