Rhythm and Brain: Music in the Cognitive, Emotional, Motor, and Neural Rehabilitation of Traumatic Brain Injury

BACKGROUND AND AIMS: Traumatic brain injury (TBI) is one of the leading causes of serious, life-long disability. Especially the cognitive, emotional, and motors deficits caused by TBI often impair everyday psychosocial functioning, quality of life (QoL) and ability to work dramatically, thereby bringing about enormous suffering and burden to the patients and their families as well as substantial social and economic costs to the society. Early rehabilitation is highly important for restoring lost skills and functioning, but often very difficult given the severity and extent of the TBI symptoms and the high strain that the available rehabilitation methods put on the patients. Music therapy is a highly motivating, versatile, and applicable form of TBI rehabilitation, but currently there is little scientific evidence for its efficacy or mechanisms in the TBI population. The purpose of the present project was to determine the long-term effect of neurological music therapy on motor, cognitive, emotional, and social recovery after TBI and to study the neural mechanisms that underlie behavioural recovery and the efficacy of music.

METHODS: The study was a single-blind, cross-over randomized controlled trial (RCT) involving 40 patients with a moderate / severe TBI who were followed for 18 months. Using an AB/BA design, the patients received neurological music therapy intervention (20 session, 2 x week) in addition to standard care either during the first (AB group) or second (BA group) 3-month period of the study. The intervention utilized structured cognitive-motor training with drums and creative musical expression (music playing, song writing) with piano and Figure Notes. The progression of the recovery was assessed from baseline to 3-month and 6-month stages using neuropsychological and motor tests; questionnaires about mood and quality of life (QoL); and modern structural and functional magnetic resonance imaging (MRI) methods, including voxel-based morphometry (VBM), diffusion tensor imaging (DTI) and functional MRI (fMRI) measured at rest and during a rhythmic task. Questionnaires were also performed at the 18-month stage.

IMPLEMENTATION: The project was a joint collaborative effort between the Cognitive Brain Research Unit (CBRU) of University of Helsinki, Validia Rehabilitation Helsinki, the Brain Injury Outpatient Clinic of Helsinki-Uusimaa Hospital District, the Department of Music of University of Jyväskylä, and the Bellvitge Biomedical Research Institute of the University of Barcelona. The project was carried out during 2014-2018 by an experienced multidisciplinary research team comprising experts in the fields of neuropsychology, neurology, radiology, cognitive neuroscience, music therapy, and physical therapy.

RESULTS: At the moment, the results from the neuropsychological test, motor test, and VBM data are analysed and submitted for publication and the results from the questionnaire, DTI, and fMRI data are currently being analysed and are in preparation for publication. The neuropsychological results showed that general executive functioning improved more in the AB group than in the BA group over the 3-month and 6-month periods. Both groups also showed an improvement in set shifting and vigilance performance during the intervention period compared to the control period. VBM results further showed that grey matter volume (GMV) in the right inferior frontal gyrus (IFG) increased significantly in both groups during the intervention vs. control period, which also correlated with cognitive improvement in set shifting.

CONCLUSIONS: Currently, the study provides the first evidence that neurological music therapy is effective in the rehabilitation of executive functioning and in inducing fine-grained structural neuroplasticity changes in prefrontal areas. The potential benefits of the intervention on subjective well-being (mood and QoL questionnaires) and on structural and functional connectivity of brain regions (DTI and fMRI data) are currently being explored.