Perceptual musical functions were investigated in patients suffering from unilateral cerebrovascular cortical lesions. Using MIDI (Musical Instrument Digital Interface) technique, a standardized short test battery was established that covers local (analytical) as well as global perceptual mechanisms. These represent the principal cognitive strategies in melodic and temporal musical information processing (local, interval and rhythm; global, contour and metre). Of the participating brain-damaged patients, a total of 69% presented with post-lesional impairments in music perception. Left-hemisphere-damaged patients showed significant deficits in the discrimination of local as well as global structures in both melodic and temporal information processing. Right-hemisphere-damaged patients also revealed an overall impairment of music perception, reaching significance in the temporal conditions. Detailed analysis outlined a hierarchical organization, with an initial right-hemisphere recognition of contour and metre followed by identification of interval and rhythm via left-hemisphere subsystems. Patterns of dissociated and associated melodic and temporal deficits indicate autonomous, yet partially integrated neural subsystems underlying the processing of melodic and temporal stimuli. In conclusion, these data contradict a strong hemispheric specificity for music perception, but indicate cross-hemisphere, fragmented neural substrates underlying local and global musical information processing in the melodic and temporal dimensions. Due to the diverse profiles of neuropsychological deficits revealed in earlier investigations as well as in this study, individual aspects of musicality and musical behaviour very likely contribute to the definite formation of these widely distributed neural networks.

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Music perception deficits following acute neurological damage are thought to be rare. By a newly devised test battery of music-perception skills, however, we were able to identify among a group of 12 patients with acute hemispheric stroke six patients with music perception deficits (amusia) while six others had no such deficits. In addition we recorded event-related brain potentials (ERPs) in a passive listening task with frequent standard and infrequent pitch deviants designed to elicit the mismatch negativity (MMN). The MMN in the patients with amusia was grossly reduced, while the non-amusic patients and control subjects had MMNs of equal size. These data show that amusia is quite common in unselected stroke patients. The MMN reduction suggests that amusia is related to unspecific automatic stimulus classification deficits in these patients.

A follow-up study was performed in patients suffering from receptive amusia due to unilateral cerebrovascular cortical lesions. Perceptual musical functions had initially been assessed within the 5th and 10th day post-lesion and were re-evaluated 6-12 months after brain-damage. The standardized test battery covered local and global strategies of music perception in discrimination tasks. Retest sessions showed an overall improvement of music perception, reaching a significant group effect over all tasks. Marked improvement up to normal range was seen in four patients. These findings demonstrate the possibility of recovery from receptive amusia that can be assumed to be based on cerebral plasticity changes. Extremely mixed patterns of recovery support the hypothesis of a highly individual formation of music processing networks.

People with disabilities can benefit from engagement in musical activities. Singing and musical instrument playing may not only help to improve or restore sensory-motor control, coordination, and memory, but also contribute to social integration, emotional stability, and thus overall wellbeing. Even though many people with disabilities are highly motivated to pick up musical activities, their potential still tends to be underestimated. However, there has been an impressive development concerning adaptive equipment, ergonomics, pedagogical approaches, and music repertoire for musicians with disabilities. A number of professional musicians with physical and perceptual system disorders demonstrate that high-level musical abilities can be achieved despite severe limitations. Children and adults with disabilities should be encouraged to engage in music. They should be accompanied by an alliance of parents and family, music pedagogues, therapists, physicians, as well as musical instrument manufacturers and medical technologists. By means of individual approaches, curiosity, and willingness, musical potential can be detected and fostered. This chapter reviews the impact of various types of disabilities on musical activities in amateur and professional musicians and describes initiatives, technologies, equipment, literature, and teaching approaches that support musical instrument playing and singing in people with physical, perceptual, or mental disorders.