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Music may aid stroke recovery

Feb. 19, 2008
Courtesy University of Helsinki
and World Science staff

Hear­ing mu­sic in the early stages af­ter a stroke can im­prove pa­tients’ re­cov­ery, ac­cord­ing to pre­lim­i­nar­y re­search pub­lished on­line Feb. 20 in the med­i­cal jour­nal Brain.

Sci­en­tists said that if stroke pa­tients lis­tened to mu­sic for two hours a day, their ver­bal mem­o­ry and fo­cused at­ten­tion re­cov­ered bet­ter—the first time such an ef­fect has been shown in hu­mans.

A di­a­gram of prin­ci­pal blood ves­sels in and lead­ing to the brain, as would be seen from the front of the face. A stroke oc­curs when a block­age or rup­ture of a ves­sel leads to a short­age of ox­y­gen in part of the brain. (Im­age cour­te­sy Liv­er­more Nat'l Lab­o­ra­to­ry)


Mu­sic may of­fer “a val­u­a­ble ad­di­tion to the pa­tients’ care, e­spe­cially if oth­er ac­tive forms of re­ha­bilita­t­ion are not yet fea­si­ble,” said Teppo Särkämö, the stu­dy’s lead au­thor. 

Särkämö, a doc­tor­al stu­dent at the Uni­ver­s­ity of Hel­sin­ki and at the Hel­sin­ki Brain Re­search Cen­tre in Fin­land, fo­cused on pa­tients who had suf­fered a stroke of an ar­tery known as the mid­dle cer­e­bral, in the right or left side of the brain.

Särkämö and col­leagues said they started their study sub­jects on lis­tening reg­i­mens as soon as pos­si­ble af­ter their surg­eries. “The brain can un­dergo dra­mat­ic changes dur­ing the first weeks and months of re­cov­ery,” Särkämö said. “These changes can be en­hanced by stimula­t­ion from the en­vi­ron­ment.”

Most pa­tients had prob­lems with move­ment and think­ing pro­cesses such as at­ten­tion and mem­o­ry, he added. 

The re­search­ers ran­domly as­signed pa­tients to hear mu­sic, au­di­o books or noth­ing, in ad­di­tion to stand­ard re­ha­bilita­t­ion. Pa­tients in the first two groups were al­lowed to pick their own mu­sic or au­di­o books. The re­search­ers fol­lowed and as­sessed the pa­tients for up to six months; 54 pa­tients com­plet­ed the stu­dy.

“Three months af­ter the stroke, ver­bal mem­o­ry im­proved from the first week post-stroke by 60 per­cent in mu­sic lis­teners, by 18 per­cent in au­di­o book lis­teners and by 29 per­cent in non-lis­teners,” Särkämö said. “Fo­cused at­ten­tion—the abil­ity to con­trol and per­form men­tal opera­t­ions and re­solve con­flicts among responses—im­proved by 17 per­cent in mu­sic lis­teners,” but not at all among the oth­ers as a whole. These dif­fer­ences were about the same anoth­er three months lat­er, Särkämö said; the mu­sic-lis­tening pa­tients were al­so less de­pressed and con­fused on av­er­age than non-lis­teners.

The re­search­ers sug­gested mu­sic might wield the ben­e­fi­cial ef­fects by stim­u­lat­ing a brain sys­tem im­pli­cat­ed in feel­ings of pleas­ure, re­ward, arous­al, mo­tiva­t­ion and mem­o­ry, known as the dopamin­er­gic meso­cor­ti­co­lim­bic sys­tem. Mu­sic might al­so stim­u­late the brain’s abil­ity to re­pair and re­new its wir­ing more gen­er­al­ly, they added.


The study is “promis­ing but will have to be rep­li­cat­ed and stud­ied fur­ther… to bet­ter un­der­stand the un­der­ly­ing neu­ral mech­a­nisms,” Särkämö said. One lim­ita­t­ion of the study, re­search­ers added, was that the ex­pe­ri­menters knew which pa­tients were in which group. Thus it was­n’t the pre­ferred sort of stu­dy, “double-blind,” in which evaula­t­ions take place with­out pa­tients or re­search­ers know­ing any of that.

Mu­sic may not work for eve­ry pa­tient, Särkämö cau­tioned, and it should be con­sid­ered as a sup­ple­ment rath­er than a re­place­ment for oth­er ther­a­pies. Re­cov­er­ing stroke pa­tients typ­ic­ally spend about three-fourths of their daily time out­side ther­a­py, ly­ing inac­tive, he said, so this may be a good time for mu­sic.

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Hearing music in the early stages after a stroke can improve patients’ recovery, according to preliminary research published online Feb. 20 in the medical journal Brain. Scientists found that if stroke patients listened to music for two hours a day, their verbal memory and focused attention recovered better. It’s the first time such an effect has been shown in humans, the investigators said. They compared stroke patients who listened to music with patients given either nothing, or audio books to listen to. Music may offer “a valuable addition to the patients’ care—especially if other active forms of rehabilitation are not yet feasible,” said Teppo Särkämö, the study’s lead author. Särkämö, a doctoral student at the University of Helsinki, Finland, and at the Helsinki Brain Research Centre, focused on patients who had suffered a stroke of an artery known as the middle cerebral, in the right or left side of the brain. Särkämö and colleagues said they started their study subjects on listening regimens as soon as possible after their surgeries. “The brain can undergo dramatic changes during the first weeks and months of recovery,” Särkämö said. “These changes can be enhanced by stimulation from the environment.” Most patients had problems with movement and thinking processes such as attention and memory, he added. The researchers randomly assigned them to hear music, audio books or nothing, in addition to standard rehabilitation. Patients in the first two groups were allowed to pick their own music or audio books. The researchers followed and assessed the patients for up to six months; 54 patients completed the study. “Three months after the stroke, verbal memory improved from the first week post-stroke by 60 percent in music listeners, by 18 percent in audio book listeners and by 29 percent in non-listeners,” Särkämö said. “Focused attention—the ability to control and perform mental operations and resolve conflicts among responses—improved by 17 percent in music listeners,” but not at all among the others. These differences were about the same another three months later, Särkämö said; the music-listening patients were also less depressed and confused on average than non-listeners. The study is “promising but will have to be replicated and studied further… to better understand the underlying neural mechanisms,” he added. One limitation of the study was that the experimenters knew which patients were in which group. Thus it wasn’t the preferred sort of study, “double-blind,” in which evaulations take place without patients or researchers knowing any of that information. Music may not work for every patient, Särkämö cautioned, and it should be considered as a supplement rather than a replacement for other therapies. Recovering stroke patients typically spend about three-fourths of their daily time outside therapy, lying inactive, he said, so this may be a good time for music. The researchers suggested music might wield the beneficial effects by stimulating a brain system implicated in feelings of pleasure, reward, arousal, motivation and memory, known as the dopaminergic mesocorticolimbic system. Music might also stimulate the brain’s ability to repair and renew its wiring more generally, they added.