Let's talk about music and post-stroke rehabilitation

Let's talk about music and post-stroke rehabilitation

Stroke is the leading cause of disability among adults in my country, with high morbidity, high recurrence rate, and high economic burden. Among them, 70% to 80% of survivors have varying degrees of motor, speech, cognitive and other functional disorders, which seriously affect the quality of life of patients and bring heavy economic burdens to their families and society. Therefore, medical researchers have been exploring effective rehabilitation measures.

Thousands of years ago, the ancients proposed that "gong, shang, jiao, wei, yu" corresponded to the five internal organs "spleen, lung, liver, heart, and kidney" respectively. Ancient doctors applied the matching of the five tones and internal organs to clinical practice, regulating the five internal organs, adjusting the body and mind, and promoting physical and mental recovery through the five tones, thereby achieving the purpose of preventing and treating diseases. Although music therapy has a long history, it is an emerging rehabilitation therapy technology in modern medicine. It exerts a therapeutic effect by stimulating brain functions involving movement, cognition, speech, emotion, and senses. In recent years, more and more studies have found that music has a good effect in improving cognitive disorders, language disorders, depression or anxiety disorders, etc. Music therapy, as a post-stroke rehabilitation method, is very worthy of promotion and popularization.

1. Indications for music therapy

1.1 Post-stroke aphasia

Post-stroke aphasia is caused by damage to the language and related areas of the brain after a stroke, resulting in the impairment or loss of previously acquired language functions. Music is a special form of language expression. The two share some neural pathways, and music therapy can enhance the connection of the neural network responsible for language in the brain. Studies have confirmed that music therapy is indeed effective for non-fluent aphasia after a stroke, and the efficacy is correlated with rhythm and pitch.

1.2 Post-stroke depression

Patients with post-stroke depression show symptoms of apathy, pessimism, and sleep disorders. Commonly used drugs in clinical practice can improve depressive symptoms, but may also cause adverse reactions such as gastrointestinal disorders, dizziness, allergies, and nausea. Music therapy can adjust emotions through different modes and melodies. It is low-cost, easy to operate, and has no adverse reactions. It is an ideal method for treating post-stroke depression. Music achieves the purpose of adjusting emotions by stimulating physiological changes such as the reticular structure of the brain, the limbic system of the brain, and the endocrine system. It can also increase the content of dopamine, a happy neurotransmitter in the body, making people feel happy.

1.3 Post-stroke cognitive impairment

Post-stroke cognitive impairment usually refers to impairment of one of the cognitive domains of executive function, attention, memory, language ability, and visual-spatial ability. Music therapy can activate a variety of high-level cognitive areas and link sound with brain activity, thereby improving limb function and promoting the recovery of perception, motor perception, and emotions. Clinical studies at home and abroad have confirmed that music therapy can increase the expression of serum brain-derived neurotrophic factor in stroke patients, promote nerve repair, and thus improve cognitive function.

2. Implementation methods of music therapy

Music therapy comes in many forms and can be divided into active participation (playing an instrument/singing) or passive participation (listening). These treatments can be carried out at home or in a nursing home or rehabilitation facility; they can be one-on-one or in a group. Considering the different ways each patient grasps music and the severity of the disease, music therapists divide music therapy into three categories to help patients better integrate music.

2.1 Receptive Music Therapy

Receptive music therapy is generally described as listening to music. This is also the easiest way to carry out music therapy. Let the patient listen to specific music, such as the "Falling Wild Goose on the Plain Sand" with a vast and tranquil artistic conception and full of interest, and the "Guangling San" with a generous and passionate melody. By listening to the melody and rhythm of the music, the patient's nervous system is affected, thereby achieving the purpose of treatment. The therapist can choose different music according to different patients. By listening to music suitable for the patient, the central nervous system is relaxed, the patient's subconsciousness is mobilized, and under the guidance of the therapist, the patient re-understands himself through association or imagination.

2.2 Re-creative music therapy

Re-creative music therapy means that patients should not only listen, but also participate in various music activities in person. There is no requirement for the patient's musical foundation, and the main emphasis is on the patient's participation. Patients can use musical instruments/any objects to play music, and can choose to sing solo or with others. In addition, in the process of playing music with others, it can increase the patient's communication, cultivate a sense of belonging and collective consciousness, and thus alleviate the occurrence of psychological diseases such as depression.

2.3 Improvisational Music Therapy

Improvisational music therapy refers to the creation of music on the spot, and the form of the music is not fixed (such as singing, instrumental music, or even the sound of small objects in life being hit, etc.). We can create lyrics, melodies, song accompaniments in an instant, or use objects around us to create rhythms, syllables, tones, etc. The simplest form is to use percussion, pick up a pen or a cup, and hit the object with your hand to generate rhythm. A relatively more advanced method is that patients can compose their own music under the guidance of a music therapist. Improvisational music therapy has higher requirements on the music therapist's musical skills and professional level, but this method can quickly establish a therapeutic relationship with the patient and obtain the patient's cooperation.

In addition, music therapy can be flexible and varied according to the type of music, the patient's cultural background, and treatment needs. It is not limited to one type of music therapy and can be combined with multiple forms of music. In addition to single music intervention for patients, music can also be combined with other intervention therapies, such as music therapy combined with exercise therapy, transcranial magnetic therapy, acupuncture therapy, etc., to develop individualized treatment plans for patients.

3. Application prospects of music therapy

Globally, my country has the highest lifetime risk of stroke and the heaviest disease burden, so post-stroke rehabilitation is particularly important. Music therapy, as a non-drug auxiliary rehabilitation treatment method, conforms to the requirements of the times and the general environment. It is time-saving, labor-saving, non-invasive and has no adverse reactions, and is easily accepted by patients. With the continuous in-depth research of scholars from various countries on music therapy, music therapy will surely become more and more standardized and bring more blessings to patients.

This article has been published in the 11th issue of Public Health in 2023

Author: Chen Songmei, Gong Zheng; Illustration: Zhang Xiaolin

Shanghai Third Rehabilitation Hospital