Effects of neurological music therapy on behavioural and emotional recovery after traumatic brain injury: A randomized controlled cross-over trial

Abstract

Traumatic brain injury (TBI) causes deficits in executive function (EF), as well as problems in behavioural and emotional self-regulation. Neurological music therapy may aid these aspects of recovery. We performed a cross-over randomized controlled trial where 40 persons with moderate-severe TBI received a 3-month neurological music therapy intervention (2 times/week, 60 min/session), either during the first (AB, n = 20) or second (BA, n = 20) half of a 6-month follow-up period. The evidence from this RCT previously demonstrated that music therapy enhanced general EF and set shifting. In the current study, outcome was assessed with self-report and caregiver-report questionnaires performed at baseline, 3-month, 6-month, and 18-month stages. The results showed that the selfreported Behavioural Regulation Index of the Behaviour Rating Inventory of Executive Function (BRIEF-A) improved more in the AB than BA group from baseline to 3-month stage and the effect was maintained in the 6-month followup. No changes in mood or quality of life questionnaires were observed. However, a qualitative content analysis of the feedback revealed that many participants experienced ARTICLE HISTORY

Cognitive efficacy and neural mechanisms of music‐based neurological rehabilitation for traumatic brain injury

“…Regarding the effects of MBNR on behavioral adjustment, we found a positive intervention effect on everyday EF functioning measured by the self‐reported BRIEF‐A behavioral regulation index in the AB group compared to the BA group, which was maintained in the 6‐month follow‐up (Figure 2C ). 54 Contrary to our expectations, we did not find any effect of the intervention on depression or QoL of the persons with TBI. However, the qualitative analysis revealed that elevated mood and importance of having meaningful activity were the central themes in the patients’ answers.…”

“…More specifically, we analyzed FC patterns of four selected brain networks: the fronto‐parietal network (FPN), the dorsal attention network (DAN), the salience (SAL) network, and the default mode network (DMN), which were used as seeds to assess FC within them and between them and every other node in the resting‐state networks included in the CONN toolbox (for more details, see the Methods section in Ref. 55). The selection was based on brain networks whose constituent nodes have been previously found to play a functional role in the high‐level cognitive functions that are typically damaged after TBI, most frequently EF, attention, and working memory 23 .…”

“…Given the nature and limitations of the prior studies for the efficacy of music-based neurological rehabilitation (MBNR) in TBI, we sought to address some of them with the first-ever large-scale RCT in moderate-to-severe TBI. [53][54][55] In this single-blinded RCT, we used a cross-over design with n = 40 TBI patients randomly allocated to two groups, AB and BA. The randomization was stratified for lesion laterality (left/right/bilateral) using an online random number generator.…”

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part III: Executive Functions

“…This is a new recommendation based on level A evidence from 3 studies (2 RCTs; 1 meta-analysis) that focused on music therapy and executive functioning after MS-TBI. Siponkoski and colleagues28,29 conducted a repeated-measures crossover (AB/BA) RCT consisting of 2, 60-minute, sessions of rhythmical training, structured cognitive-motor training, and assisted music playing, twice a week for 10 weeks versus a usual care control condition. The AB group ( n = 20) significantly improved on measures of executive function within the first 3 months, with evidence of maintenance at 6-month follow-up 28.…”

The evolution of whole-brain turbulent dynamics during recovery from traumatic brain injury

“…In light of these findings, two interrelated questions arise: (i) would this reduced turbulence at rest (less variability in local synchronization) imply a longer and less reliable transition to a cognitive task and (ii) would cognitive tasks show a concomitant reduction in turbulence in higher-order brain regions? These are important considerations to bear in mind since a core symptom of TBI are deficits in executive function (EF) (Miyake et al, 2000) that respond to neurorehabilitation strategies (Martinez-Molina et al, 2021; Martinez-Molina et al, 2022; Siponkoski et al, 2021; Siponkoski et al, 2020) in association with enhanced structural connectivity (Sihvonen et al, 2022). The tasks for evaluating EF require the rapid communication across large-scale brain networks involving sensory, motor and higher-order regions (Bonnelle et al, 2011; Erika-Florence et al, 2014; Jilka et al, 2014; Sharp et al, 2010; Spreng & Grady, 2010).…”