Every year approximately 800,000 Americans have a stroke, making it one of the most common causes of death (“Stroke,” Centers, 2017, para.1). Strokes typically require invasive treatment and long term recoveries which have a significant impact on the victim as well as their family. Music therapy is more commonly being used along with other medical therapies in stroke recovery. Research shows that music therapy can help improve cognitive processing, language skills, and motor movement.
A stroke occurs when blood supply to the brain is interrupted. There are two types of strokes: ischemic and hemorrhagic. An ischemic stroke is caused when blood supply to the brain is blocked. This can happen when an artery becomes blocked, particularly in places where the artery narrows. Hemorrhagic strokes occur when a blood vessel ruptures and bleeds into the brain, an example of this would be an aneurysm that ruptures (“Stroke,” Cleveland, 2017, para 2-4). Of the two types of stroke, ischemic is much more common and makes up about 87% of all strokes that occur each year (“Stroke,” Centers, 2017, para. 1). Common symptoms of a stroke include sudden loss of speech, slurred speech, sudden vision changes, sudden weakness, dizziness or paralysis, and debilitating headache with vomiting (“Stroke,” 2018, para. 2).
Recovering from a stroke can be very difficult and often requires the patient to go through inpatient rehab. Treatment and recovery time varies from patient to patient, as the part of the brain that suffered the most damage will determine the other areas that suffer. A patient may be paralyzed or experience great weakness on one side. With this comes pain and other sensations like numbness and tingling. Patients often have to go through rigorous physical and occupational therapy to regain lost function. Patients often experience depression and may have trouble controlling their emotions through recovery as they adjust to their new normal (“Stroke,” 2018, para. 9).
Improved motor activity is a major goal for stroke patients. Gait is often affected after experiencing a stroke. A case study investigated the use of neurologic music therapy (NMT) for gait training in addition to standard practice of care in the inpatient rehabilitation setting following stroke. A 41 year old male who suffered a right middle cerebral artery stroke, rupture of aneurysm caused by an infected thrombus, and uncal herniation was the participant in the study. NMT was used during the first week of physical therapy treatment as an adjunct standard care 2-3 days a week. The participant went from a 33 on the Functional Independence Measure (FIM) and a 0/56 on the Berg Balance Scale to a 92 on the FIM and a 10/56 on the Berg Balance Scale.This means the participant’s balance increased significantly as well as their ability to function independently and complete activities of daily living. NMT was an integral part of the patient’s gait training (Spaulding & Harris, 2017, p.1). Music has a way of motivating individuals. Gait training requires the patient to be motivated to improve their motor functioning.
Entrainment is a common music therapy technique used for stroke patients. Entrainment is the synchronization of music to movement. The pulse or tempo of the rhythm is matched with the timing of specific movements. Rhythm provides predictable structure that helps the brain plan movement. Music engages both sides of the brain which may help the brain build new pathways helpful in relearning movement. Music is also a motivator and helps increase endurance. A 2013 study investigated the immediate effect of rhythm on kinematic movement patterns, especially reaching trajectories, variability of movement timing, and elbow range of motion. This study was focused on hemiparetic arm reaching movements of patients with stroke. Elbow range along with both cyclical movement timing and smoothness of reaching trajectories improved significantly (Thaut, 2013, p. 32). Research was conducted on the effect of repetitive rhythmic arm training using a Patterned Sensory Enhancement (PSE) protocol and assessed with the Wolf Motor Function Action Test (WMFT) and the self reporting Motor Activity Log (MAL). The improvements were evident throughout both assessments (Thaut, 2013, p. 32). The positive results of this study speak to the relevance of music therapy as an effective treatment. A third study was conducted using Constraint Induced Therapy (CIT). Trunk flexion and shoulder rotation were compared in a discrete arm reaching versus cyclical reaching task cued by auditory rhythm. Thaut concludes, “The rhythmic cyclical task reduced trunk flexion and increased shoulder and trunk rotation comparable to normal patterns whereas in the discrete task subjects relied mostly on extended forward flexion of the trunk to reach the targets” (2013, p.32). Music therapy uses entrainment as one way to improve motor movement of stroke patients.
When working on motor functioning, the experience can often be quite painful for patients. Music therapy can aid in managing pain perception. In a study on the effects of music therapy on pain perception of stroke patients during upper extremity joint exercises, positive effects and verbal responses were observed. Ten stroke patients participated in the study where music conditions consisted of either a song, karaoke accompaniment, or no music. Subjects repeated three conditions and rated their perceived pain on a scale immediately following each condition. The subjects played the piano, drums, and rhythm instruments and reacted positively during music therapy treatment sessions. The music therapy sessions helped reduce pain during physical exercises designed to increase the patient's hand function. (Kim & Koh, 2005, p. 1).
Music therapy is extremely beneficial for those who have suffered from a stroke. Strokes impact many people in a variety of ways so it is crucial to have treatment plans in place. Music therapy is effective in improving the quality of life for those who have experienced a stroke. Research also shows that music therapy improves speech and language skills, cognitive functioning, and motor functioning for stroke patients. It is crucial that research continues and more studies on the use of music therapy take place within the field of medical music therapy and stroke.
References
Kim, S. J., and Koh, I (2005). "The Effects of Music on Pain Perception of Stroke Patients during Upper Extremity Joint Exercises." Journal of music therapy, 42.1 (2005): 81-92. Retrieved August 12, 2019 from https://search-proquest-com.bunchproxy.idm.oclc.org/docview/1097310?accountid=8570&rfr_id=info%3Axri%2Fsid%3Aprimo
Pfeiffer, C., and Sabe, L. (2015). "Music Therapy and Cognitive Rehabilitation: Screening of Music Cognition in Adult Patients with Right Hemisphere Stroke." Psychomusicology 25.4, 392-403. Retrieved August 12, 2019 from https://search-proquest-com.bunchproxy.idm.oclc.org/docview/1783684326?accountid=8570&rfr_id=info%3Axri%2Fsid%3Aprimo
Spaulding, A., and Harris, B. (2017). “Neurologic Music Therapy for Gait Training Following Stroke: A Case Study.” Archives of Physical Medicine and Rehabilitation, vol. 98, no. 10, Retrieved August 12, 2019 from https://www.sciencedirect.com/search/advanced?docId=10.1016/j.apmr.2017.08.272
“Stroke.” (2017). Centers for Disease Control and Prevention, Centers for Disease Control and Prevention. Retrieved August 12, 2019 from www.cdc.gov/stroke/facts.htm
“Stroke.” (2017). Cleveland Clinic, The Cleveland Clinic Foundation. Retrieved August 12, 2019 from my.clevelandclinic.org/health/diseases/17519-stroke
“Stroke.” (2018). Mayo Clinic, Mayo Foundation for Medical Education and Research, Retrieved August 12, 2019 from www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113
Thaut, M. H. (2013). "Entrainment and the Motor System." Music Therapy Perspectives, 31.1, 31-34. Retrieved from https://search-proquest-com.bunchproxy.idm.oclc.org/docview/1514320468?accountid=8570&rfr_id=info%3Axri%2Fsid%3Aprimo