Exploring Music-Based Interventions for Executive Functioning and Emotional Well-Being in Stroke Rehabilitation: A Scoping Review

 You blithering idiots need to create a protocol based on all previous music research, rather than this useless crapola review. I'd have you all fired!

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Exploring Music-Based Interventions for Executive Functioning and Emotional Well-Being in Stroke Rehabilitation: A Scoping Review 

                                 by

Camila F. Pfeiffer

^1,2,*,

Wendy L. Magee

³,

Rebecca Fülöp

³,

Travis C. Nace

³,

Candela Castro

⁴,

Agustina Iturri

⁵,

Jimena Franceschi

⁶,

Gabriela Echauri

⁷,

Liliana Gassull

⁸ and

María Julieta Russo

⁹

¹

Music Therapy Department, ArtEZ Academy of Music, ArtEZ University of the Arts, PN7511 Enschede, The Netherlands

²

Facultad de Humanidades, Ciencias Sociales y Empresariales, Universidad Maimónides, Buenos Aires C1405, Argentina

³

Music Therapy, Boyer College of Music and Dance, Temple University, Philadelphia, PA 19122, USA

⁴

Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, ON M5S 1K6, Canada

⁵

Hospital Universitario Austral, Pilar B1629, Buenos Aires, Argentina

⁶

Servicio Neurología Cognitiva, Neuropsicología y Neuropsiquiatría, Centro de Rehabilitación, CR, Departamento de Rehabilitación, Fleni, Buenos Aires C1428AQK, Argentina

⁷

Servicio de Rehabilitación y Cuidados Continuos, Centro Hirsch, Buenos Aires B1663FDC, Argentina

⁸

Independent Researcher, Buenos Aires C1428, Argentina

⁹

Instituto de Neurociencias (INEU) Fleni Consejo Nacional de Investigaciones en Científicas y Técnicas (CONICET), Buenos Aires C1060AAF, Argentina

^*

Author to whom correspondence should be addressed.

NeuroSci 2024, 5(4), 565-599; https://doi.org/10.3390/neurosci5040041

Submission received: 16 October 2024 / Revised: 8 November 2024 / Accepted: 13 November 2024 / Published: 27 November 2024

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Abstract

Purpose: 

Stroke is one of the leading causes of disability with life-long implications requiring assessment and treatment of several functional domains. This review identifies the results from research into music-based interventions (MBIs), including music therapy (MT), for executive functions (EFs) and emotional well-being (EWB) in adults with stroke and highlights opportunities for clinical practice and future research. Methods: APA PsycInfo (EBSCOhost), and CINAHL (EBSCOhost) were searched, in addition to grey literature. 

Results: 

A total of 49 studies were included and encompassed experimental, analytic, and descriptive observational studies, and case reports, involving a total of 1663 participants. In total, 32 studies included MT interventions, and 17 were MBIs. EFs were an outcome in 20.41%, and EWB in 61.22% of studies, for which active interventions were the most utilized. Overall, 73.47% of the studies reported positive results. 

Conclusions: 

This scoping review indicates that music interventions can be beneficial for the improvement of different aspects of EFs and EWB at different stages of stroke recovery. Further research may benefit clinical practice by including standardized protocols,(AND WHY THE FUCK DIDN'T YOU CREATE THESE PROTOCOLS? LAZINESS? NOT MY JOB?) outcome and self-reported measures, and brain imaging data to determine the effects of interventions and support evidence-based decisions for treatment policies for stroke survivors.

Keywords:

stroke; music therapy; music-based interventions; executive functioning; emotional well-being; cognitive rehabilitation

1. Introduction

Stroke is a major health concern with a high incidence worldwide, affecting millions of people annually [1]. Stroke is clinically defined as a vascular injury of the central nervous system that can be caused by a wide range of risk factors and disease processes. It can impact any brain region to different extents and its sequelae will depend, among other factors, on the size and location of the vascular lesion [2]. As one of the leading causes of death and disability around the world, it commonly causes cognitive, motor, sensory, and mood dysfunctions that can be either transient or permanent [2,3]. Current evidence suggests that cognitive impairments are prevalent after stroke and often remain present over time [4,5]. Specifically, executive functions (EFs) play an important role in functional recovery as they encompass a set of interrelated cognitive processes of learning and applying knowledge to behavior, which involve attention control, planning, working memory, cognitive flexibility, problem-solving, decision-making, and goal-oriented behavior. These processes often work interdependently with one another to accomplish goal-driven tasks, concentrate, or solve unexpected challenges [6,7,8]. Behaviors characterized as “dysexecutive” are common to stroke and can entail diminished mental flexibility, speed of processing, attention control, and a lack of inhibition control that can potentially lead to risky decisions in harmful situations [4,9]. Early treatment is necessary to prevent these behaviors from becoming chronic [3,10]. Together with post-stroke depression, executive functioning is a strong predictor of a person’s functional status after rehabilitation [11] and can seriously compromise their return to independent work and social life. As executive and emotional disorders frequently co-occur in stroke survivors [12,13], there are some indications that cognitive functioning is influenced by the person’s emotional state [14].

Emotional well-being (EWB) encompasses a variety of components and is broader than the relative absence of negative emotional states such as depressive or anxious feelings. EWB entails the perception of positive functioning, life satisfaction, positive social relationships, a feeling of life balance, and a sense of purpose [15]. According to the working definition developed by the National Institute of Health (NIH), EWB is a multidimensional construct that describes “how positive an individual feels generally and about life overall. It includes both experiential features (emotional quality …) and reflective features (judgments about life satisfaction, sense of meaning, and ability to pursue goals …). These features occur in the context of culture, life circumstances, resources, and life course” [16], p. 16. EWB is also linked to psychopathology and health outcomes with a consensus that they are on a continuum; a positive perception of EWB has been shown to reduce the risk of death by nearly 20% [17]. Stroke survivors commonly face some type of emotional and mood disorders (e.g., fatigue, depression, lack of initiative, emotional incontinence, anxiety, feelings of loneliness, apathy) and experience a diminished quality of life [18,19,20,21,22,23]. This implies that after a stroke, people may have limited opportunities for experiencing EWB. Consequently, rehabilitation treatment continues seeking effective and meaningful interventions that contribute to functional and emotional recovery.

Music has long been applied in different forms to treat stroke sequelae, for instance, through music listening, group singing, exercising with pre-recorded music, or longer music therapeutic processes [24,25,26]. Overall, music holds a high potential for promoting health [27,28]. MT utilizes evidence-based interventions that aim to accomplish personalized goals and are carried out by credentialed music therapy professionals [29]. MT is usually a process that includes assessment, treatment, and evaluation of the client’s progress over time [30]. Other MBIs are protocols that study the therapeutic effects of music, which can be delivered by other caregivers, do not take place in a therapeutic relationship typical for MT, and may be prescribed or delivered in a single contact without evaluation or follow-up [30,31]. Accordingly, this review utilized the term music therapy for studies in which music therapists were involved in the delivery of the intervention, and music-based interventions for those in which no music therapists were involved. The latest Cochrane review on MBIs for persons with acquired brain injuries found that music interventions are beneficial to motor recovery, communication, and quality of life in stroke survivors. However, no strong evidence could be found on the benefits of music on cognitive and emotional outcomes and further research was recommended [27]. A growing body of studies investigated the effects of music interventions on cognitive and emotional rehabilitation after stroke and reported positive results specifically on mood, depressive syndromes, and quality of life [26,32].

Despite the rapid advances in the field, there remain, however, some limitations in the literature that this scoping review seeks to address. Our objective is to synthesize comprehensive knowledge of the current literature available on MBIs, including MT, in stroke rehabilitation targeting EF and EWB. The review seeks to identify the types of interventions used to address these domains, the outcome measures utilized, and how gained data can be translated into opportunities that will guide clinical practice and future research. Given the specificity of the topic, a limited number of sources was expected; therefore, a broader scope on the two main outcomes was taken by considering factors that influence EWB and EFs, such as mood disorders, quality of life, and cognitive functions interdependent with EFs, such as attention and memory. A scoping review was considered the most accurate approach to obtaining a comprehensive understanding of the applications of music-based and music therapy interventions in stroke rehabilitation [33,34].

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