Music Listening Enhances Cognitive Recovery, Mood After Stroke
Music Listening Enhances Cognitive Recovery, Mood After Stroke
We know from animal studies that a stimulating and enriched environment can enhance recovery after stroke, but little is known about the effects of an enriched sound environment on recovery from neural damage in humans. In humans, music listening activates a wide-spread bilateral network of brain regions related to attention, semantic processing, memory, motor functions, and emotional processing. Music exposure also enhances emotional and cognitive functioning in healthy subjects and in various clinical patient groups. The potential role of music in neurological rehabilitation, however, has not been systematically investigated. This single-blind, randomized, and controlled trial was designed to determine whether everyday music listening can facilitate the recovery of cognitive functions and mood after stroke. In the acute recovery phase, 60 patients with a left or right hemisphere middle cerebral artery (MCA) stroke were randomly assigned to a music group, a language group, or a control group. During the following two months, the music and language groups listened daily to self-selected music or audio books, respectively, while the control group received no listening material. In addition, all patients received standard medical care and rehabilitation. All patients underwent an extensive neuropsychological assessment, which included a wide range of cognitive tests as well as mood and quality of life questionnaires, one week (baseline), 3 months, and 6 months after the stroke. Fifty-four patients completed the study. Results showed that recovery in the domains of verbal memory and focused attention improved significantly more in the music group than in the language and control groups. The music group also experienced less depressed and confused mood than the control group. These findings demonstrate for the first time that music listening during the early post-stroke stage can enhance cognitive recovery and prevent negative mood. The neural mechanisms potentially underlying these effects are discussed.
During the first weeks and months of recovery after a stroke, the brain can undergo dramatic plastic changes (Witte, 1998; Kreisel et al., 2006) that can be further enhanced by stimulation provided by the environment. Post-stroke motor and somatosensory environmental enrichment (Johansson, 2004; Nithianantharajah and Hannan, 2006), virtual environments (You et al., 2005), and electrical cortical and peripheral stimulation (Hummel and Cohen, 2005) have all been shown to improve motor recovery. Interestingly, multimodal stimulation, including auditory, visual and olfactory stimuli, combined to the enriched motor environment enhanced motor and cognitive recovery more than the enriched motor environment alone (Maegele et al., 2005). Evidence from developmental animal studies also suggests that an enriched sound environment can enhance auditory cortical functions (Engineer et al., 2004) as well as learning and memory (Chikahisa et al., 2006; Kim et al., 2006; Angelucci et al., 2007a). In humans, the effects of an enriched sound environment on recovery from neural damage have, however, not been systematically studied.
In the human brain, one of the most powerful sources of auditory stimulation is provided by music (Sacks, 2006). Listening to music is a complex process for the brain, since it triggers a sequel of cognitive and emotional components with distinct neural substrates (Peretz and Zatorre, 2005). Recent brain imaging studies have shown that neural activity associated with music listening extends well beyond the auditory cortex involving a wide-spread bilateral network of frontal, temporal, parietal and subcortical areas related to attention, semantic and music-syntactic processing, memory and motor functions (Bhattacharya et al., 2001; Janata et al., 2002; Koelsch et al., 2004; Popescu et al., 2004), as well as limbic and paralimbic regions related to emotional processing (Blood et al., 1999; Blood and Zatorre, 2001; Brown et al., 2004; Koelsch et al., 2006; Menon and Levitin, 2005). Music has a well-documented effect on alleviating anxiety, depression and pain in patients with a somatic illness (Cassileth et al., 2003; Cepeda et al., 2006; Siedliecki and Good, 2006). Recent cognitive and neuropsychological studies suggest that it may also enhance a variety of cognitive functions, such as attention, learning, communication and memory, both in healthy subjects (Wallace, 1994; Thompson et al., 2001; Thompson et al., 2005; Schellenberg et al., 2007) and in clinical conditions, such as dyslexia (Overy, 2003), autism (Gold et al., 2006), schizophrenia (Talwar et al., 2006), multiple sclerosis (Thaut et al., 2005), coronary artery disease (Emery et al., 2003) and dementia (Brotons and Koger, 2000; Foster and Valentine, 2001; Van de Winckel et al., 2004). In stroke rehabilitation, elements of music have previously been used as a part of physiotherapy (Thaut et al., 1997) and speech therapy (Belin et al., 1996) to enhance the recovery of motor and speech functions. In addition, nonverbal auditory stimuli have been shown to temporarily ameliorate left visual neglect after stroke (Hommel et al., 1990). However, the knowledge about the long-term effects of everyday music listening itself on the recovery of cognitive and emotional functions after stroke is very limited.
The purpose of this single-blind, randomized and controlled trial was to determine whether regular self-directed music listening during the first months after middle cerebral artery (MCA) stroke can enhance the recovery of cognitive functions and mood. Since the brain areas involved in music processing are mainly supplied by the MCA (Ayotte et al., 2000) we hypothesized that, in addition to engaging cognitive and emotional networks, music listening would also stimulate both the perilesional and healthy brain areas that normally show increased excitability and adaptability in this subacute recovery phase (Kreisel et al., 2006), and thereby enhance and speed up the spontaneous recovery process. As listening to real music, especially if it contains lyrics, activates the brain bilaterally, we also hypothesized that it would facilitate the recovery from unilateral stroke more than listening to purely verbal material, which activates primarily the left hemisphere (Zatorre et al., 2002; Tervaniemi and Hugdahl, 2003). Thus, we compared the effect of music listening both to the effect of listening to audio books and to normal spontaneous recovery.
We know from animal studies that a stimulating and enriched environment can enhance recovery after stroke, but little is known about the effects of an enriched sound environment on recovery from neural damage in humans. In humans, music listening activates a wide-spread bilateral network of brain regions related to attention, semantic processing, memory, motor functions, and emotional processing. Music exposure also enhances emotional and cognitive functioning in healthy subjects and in various clinical patient groups. The potential role of music in neurological rehabilitation, however, has not been systematically investigated. This single-blind, randomized, and controlled trial was designed to determine whether everyday music listening can facilitate the recovery of cognitive functions and mood after stroke. In the acute recovery phase, 60 patients with a left or right hemisphere middle cerebral artery (MCA) stroke were randomly assigned to a music group, a language group, or a control group. During the following two months, the music and language groups listened daily to self-selected music or audio books, respectively, while the control group received no listening material. In addition, all patients received standard medical care and rehabilitation. All patients underwent an extensive neuropsychological assessment, which included a wide range of cognitive tests as well as mood and quality of life questionnaires, one week (baseline), 3 months, and 6 months after the stroke. Fifty-four patients completed the study. Results showed that recovery in the domains of verbal memory and focused attention improved significantly more in the music group than in the language and control groups. The music group also experienced less depressed and confused mood than the control group. These findings demonstrate for the first time that music listening during the early post-stroke stage can enhance cognitive recovery and prevent negative mood. The neural mechanisms potentially underlying these effects are discussed.
During the first weeks and months of recovery after a stroke, the brain can undergo dramatic plastic changes (Witte, 1998; Kreisel et al., 2006) that can be further enhanced by stimulation provided by the environment. Post-stroke motor and somatosensory environmental enrichment (Johansson, 2004; Nithianantharajah and Hannan, 2006), virtual environments (You et al., 2005), and electrical cortical and peripheral stimulation (Hummel and Cohen, 2005) have all been shown to improve motor recovery. Interestingly, multimodal stimulation, including auditory, visual and olfactory stimuli, combined to the enriched motor environment enhanced motor and cognitive recovery more than the enriched motor environment alone (Maegele et al., 2005). Evidence from developmental animal studies also suggests that an enriched sound environment can enhance auditory cortical functions (Engineer et al., 2004) as well as learning and memory (Chikahisa et al., 2006; Kim et al., 2006; Angelucci et al., 2007a). In humans, the effects of an enriched sound environment on recovery from neural damage have, however, not been systematically studied.
In the human brain, one of the most powerful sources of auditory stimulation is provided by music (Sacks, 2006). Listening to music is a complex process for the brain, since it triggers a sequel of cognitive and emotional components with distinct neural substrates (Peretz and Zatorre, 2005). Recent brain imaging studies have shown that neural activity associated with music listening extends well beyond the auditory cortex involving a wide-spread bilateral network of frontal, temporal, parietal and subcortical areas related to attention, semantic and music-syntactic processing, memory and motor functions (Bhattacharya et al., 2001; Janata et al., 2002; Koelsch et al., 2004; Popescu et al., 2004), as well as limbic and paralimbic regions related to emotional processing (Blood et al., 1999; Blood and Zatorre, 2001; Brown et al., 2004; Koelsch et al., 2006; Menon and Levitin, 2005). Music has a well-documented effect on alleviating anxiety, depression and pain in patients with a somatic illness (Cassileth et al., 2003; Cepeda et al., 2006; Siedliecki and Good, 2006). Recent cognitive and neuropsychological studies suggest that it may also enhance a variety of cognitive functions, such as attention, learning, communication and memory, both in healthy subjects (Wallace, 1994; Thompson et al., 2001; Thompson et al., 2005; Schellenberg et al., 2007) and in clinical conditions, such as dyslexia (Overy, 2003), autism (Gold et al., 2006), schizophrenia (Talwar et al., 2006), multiple sclerosis (Thaut et al., 2005), coronary artery disease (Emery et al., 2003) and dementia (Brotons and Koger, 2000; Foster and Valentine, 2001; Van de Winckel et al., 2004). In stroke rehabilitation, elements of music have previously been used as a part of physiotherapy (Thaut et al., 1997) and speech therapy (Belin et al., 1996) to enhance the recovery of motor and speech functions. In addition, nonverbal auditory stimuli have been shown to temporarily ameliorate left visual neglect after stroke (Hommel et al., 1990). However, the knowledge about the long-term effects of everyday music listening itself on the recovery of cognitive and emotional functions after stroke is very limited.
The purpose of this single-blind, randomized and controlled trial was to determine whether regular self-directed music listening during the first months after middle cerebral artery (MCA) stroke can enhance the recovery of cognitive functions and mood. Since the brain areas involved in music processing are mainly supplied by the MCA (Ayotte et al., 2000) we hypothesized that, in addition to engaging cognitive and emotional networks, music listening would also stimulate both the perilesional and healthy brain areas that normally show increased excitability and adaptability in this subacute recovery phase (Kreisel et al., 2006), and thereby enhance and speed up the spontaneous recovery process. As listening to real music, especially if it contains lyrics, activates the brain bilaterally, we also hypothesized that it would facilitate the recovery from unilateral stroke more than listening to purely verbal material, which activates primarily the left hemisphere (Zatorre et al., 2002; Tervaniemi and Hugdahl, 2003). Thus, we compared the effect of music listening both to the effect of listening to audio books and to normal spontaneous recovery.