Neurological Music Therapy Rebuilds Structural Connectome after Traumatic Brain Injury: Secondary Analysis from a Randomized Controlled Trial

Background: Traumatic brain injury (TBI) is a common and devastating neurological condition, associated often with poor functional outcome and deficits in executive function. Due to the neuropathology of TBI, neuroimaging plays a crucial role in its assessment, and while diffusion MRI has been proposed as a sensitive biomarker, longitudinal studies evaluating treatment-related diffusion MRI changes are scarce. Recent evidence suggests that neurological music therapy can improve executive functions in patients with TBI and that these effects are underpinned by neuroplasticity changes in the brain. However, studies evaluating music therapy induced structural connectome changes in patients with TBI are lacking. Design: Single-blind crossover (AB/BA) randomized controlled trial (NCT01956136). Objective: Here, we report secondary outcomes of the trial and set out to assess the effect of neurological music therapy on structural white matter connectome changes and their association with improved execute function in patients with TBI. Methods: Using an AB/BA design, 25 patients with moderate or severe TBI were randomized to receive a 3-month neurological music therapy intervention either during the first (AB, n = 16) or second (BA, n = 9) half of a 6-month follow-up period. Neuropsychological testing and diffusion MRI scans were performed at baseline and at the 3-month and 6-month stage. Findings: Compared to the control group, the music therapy group increased quantitative anisotropy (QA) in the right dorsal pathways (arcuate fasciculus, superior longitudinal fasciculus) and in the corpus callosum and the right frontal aslant tract, thalamic radiation and corticostriatal tracts. The mean increased QA in this network of results correlated with improved executive function. Conclusions: This study shows that music therapy can induce structural white matter neuroplasticity in the post-TBI brain that underpins improved executive function

Neurological Music Therapy Rebuilds Structural Connectome after Traumatic Brain Injury: Secondary Analysis from a Randomized Controlled Trial

Background: Traumatic brain injury (TBI) is a common and devastating neurological condition, associated often with poor functional outcome and deficits in executive function. Due to the neuropathology of TBI, neuroimaging plays a crucial role in its assessment, and while diffusion MRI has been proposed as a sensitive biomarker, longitudinal studies evaluating treatment-related diffusion MRI changes are scarce. Recent evidence suggests that neurological music therapy can improve executive functions in patients with TBI and that these effects are underpinned by neuroplasticity changes in the brain. However, studies evaluating music therapy induced structural connectome changes in patients with TBI are lacking. Design: Single-blind crossover (AB/BA) randomized controlled trial (NCT01956136). Objective: Here, we report secondary outcomes of the trial and set out to assess the effect of neurological music therapy on structural white matter connectome changes and their association with improved execute function in patients with TBI. Methods: Using an AB/BA design, 25 patients with moderate or severe TBI were randomized to receive a 3-month neurological music therapy intervention either during the first (AB, n = 16) or second (BA, n = 9) half of a 6-month follow-up period. Neuropsychological testing and diffusion MRI scans were performed at baseline and at the 3-month and 6-month stage. Findings: Compared to the control group, the music therapy group increased quantitative anisotropy (QA) in the right dorsal pathways (arcuate fasciculus, superior longitudinal fasciculus) and in the corpus callosum and the right frontal aslant tract, thalamic radiation and corticostriatal tracts. The mean increased QA in this network of results correlated with improved executive function. Conclusions: This study shows that music therapy can induce structural white matter neuroplasticity in the post-TBI brain that underpins improved executive function

Neuroanatomical correlates of speech and singing production in chronic post-stroke aphasia

A classical observation in neurology is that aphasic stroke patients with impairments in speech production can nonetheless sing the same utterances. This preserved ability suggests a distinctive neural architecture for singing that could contribute to speech recovery. However, to date, these structural correlates remain unknown. Here, we combined a multivariate lesion–symptom mapping and voxel-based morphometry approach to analyse the relationship between lesion patterns and grey matter volume and production rate in speech and singing tasks. Lesion patterns for spontaneous speech and cued repetition extended into frontal, temporal and parietal areas typically reported within the speech production network. Impairment in spontaneous singing was associated with damage to the left anterior–posterior superior and middle temporal gyri. Preservation of grey matter volume in the same regions where damage led to poor speech and singing production supported better performance in these tasks. When dividing the patients into fluent and dysfluent singers based on the singing performance from demographically matched controls, we found that the preservation of the left middle temporal gyrus was related to better spontaneous singing. These findings provide insights into the structural correlates of singing in chronic aphasia and may serve as biomarkers to predict treatment response in clinical trials using singing-based interventions for speech rehabilitation.Peer reviewe

Music therapy enhances executive functions and prefrontal structural neuroplasticity after traumatic brain injury : Evidence from a randomized controlled trial

Traumatic brain injury (TBI) causes lifelong cognitive deficits, particularly impairments of executive functioning (EF). Musical training and music-based rehabilitation have been shown to enhance cognitive functioning and neuroplasticity, but the potential rehabilitative effects of music in TBI are still largely unknown. The aim of the present crossover randomized controlled trial (RCT) was to determine the clinical efficacy of music therapy on cognitive functioning in TBI and to explore its neural basis. Using an AB/BA design, 40 patients with moderate or severe TBI were randomized to receive a 3-month neurological music therapy intervention either during the first (AB, n = 20) or second (BA, n = 20) half of a 6-month follow-up period. Neuropsychological and motor testing and magnetic resonance imaging (MRI) were performed at baseline and at the 3-month and 6-month stage. Thirty-nine subjects who participated in baseline measurement were included in an intention-to-treat analysis using multiple imputation. Results showed that general EF (as indicated by the Frontal Assessment Battery [FAB]) and set shifting improved more in the AB group than in the BA group over the first 3-month period and the effect on general EF was maintained in the 6-month follow-up. Voxel-based morphometry (VBM) analysis of the structural MRI data indicated that gray matter volume (GMV) in the right inferior frontal gyrus (IFG) increased significantly in both groups during the intervention versus control period, which also correlated with cognitive improvement in set shifting. These findings suggest that neurological music therapy enhances EF and induces fine-grained neuroanatomical changes in prefrontal areasPeer reviewe

Kuntoutuksen ohjaajien (AMK) työllistyminen sekä kokemukset tutkinto-ohjelmasta : kysely Jamkista vuosien 2014–2020 aikana valmistuneille kuntoutuksen ohjaajille (AMK)

Kuntoutuksen ohjaajan tutkinto-ohjelma on sosiaali- ja terveysalan ammattikorkeakoulututkinto, jota on järjestetty Suomessa vuodesta 1997 alkaen. Vuodesta 2018 lähtien kuntoutuksen ohjaajat (AMK) ovat saaneet luvan toimia sosiaalihuollon laillistettuina ammattihenkilöinä. Jyväskylän ammattikorkeakoulu, eli Jamk, on toteuttanut kuntoutuksen ohjaajan (AMK) koulutusta tutkinnon perustamisesta lähtien. Opinnäytetyön tarkoituksena oli kartoittaa Jamkista vuosien 2014–2020 aikana valmistuneiden kuntoutuksen ohjaajien (AMK) työtilannetta sekä työllistymiseen yhteydessä olleita tekijöitä. Lisäksi selvitettiin kohderyhmän kokemuksia ja kehittämisideoita Jamkin kuntoutuksen ohjaajan (AMK) tutkinto-ohjelmaan liittyen. Jamkista valmistuneiden kuntoutuksen ohjaajien (AMK) työllistymistä oli aikaisemmin selvitetty opinnäytetöillä vuosina 2007 ja 2014. Tarkoituksena oli kerryttää aiheesta ajankohtaista tietoa. Opinnäytetyön toimeksiantajana toimi Jyväskylän ammattikorkeakoulun hyvinvointiyksikkö. Aineisto kerättiin sähköisellä kyselyllä. Kohderyhmään kuuluvia henkilöitä tavoiteltiin Jamkin rekisteristä saaduilla yhteystiedoilla, sosiaalisen median kautta sekä Jamkin omia kanavia hyödyntämällä. 60 henkilöä vastasi kyselyyn. Kartoitus toteutettiin määrällisenä tutkimuksena, mutta aineiston avointen vastausten analysoinnissa käytettiin myös laadullisen tutkimuksen menetelmiä. Kyselyn tulosten perusteella kuntoutuksen ohjaajien (AMK) työllisyystilanne oli korkea. Vastaajat työskentelivät laajasti kuntoutuksen eri osa-alueilla ja monilla eri tehtävänimikkeillä. Kuntoutuksen ohjaajan (AMK) koulutusta vastaavassa työsuhteessa olleista yli puolella oli työtehtävässä vaatimuksena sosiaalihuollon laillistetun ammattihenkilön pätevyys. Jamkin kuntoutuksen ohjaajan (AMK) tutkinto-ohjelmaan oltiin pääasiassa tyytyväisiä. Suurin osa oli saanut opintojen myötä luotujen kontaktien kautta työmahdollisuuksia. Tulokset olivat monilta osin yhtenäisiä aikaisemmin aiheesta tehtyjen selvitysten kanssa. Tuloksissa korostui erityisesti alan laajuus ja monipuolisuus. Tuloksista voidaan päätellä, että lakimuutos kuntoutuksen ohjaajien (AMK) liittämisestä sosiaalihuollon ammattihenkilöiksi on lisännyt entisestään työmahdollisuuksia. Opinnäytetyötä voidaan hyödyntää kuntoutuksen ohjaajan (AMK) tutkinto-ohjelman kehittämisessä. Lisäksi esimerkiksi alalle hakeutuvat, alan opiskelijat tai alasta muilla tavoin kiinnostuneet saavat tietoa muun muassa kuntoutuksen ohjaajien (AMK) työnkuvasta ja työllistymismahdollisuuksista.The degree programme in rehabilitation counselling is a bachelor’s degree in the field of social- and health care. The degree program was established in Finland in 1997. Since 2018 rehabilitation counsellors have been qualified to practice their profession as legal social care professionals. Jamk University of Applied Sciences (Jamk) has had a rehabilitation counsellors’ degree programme since it was established in 1997. The purpose of the thesis was to research the employment and factors contributing to the employment of Jamk rehabilitation counsellor graduates of 2014–2020. The experiences and development ideas of the target group regarding Jamk's rehabilitation counsellors’ degree programme were also studied. The employment of rehabilitation counsellors had previously been researched in Jamk with theses in 2007 and 2014. The purpose was to gather up-to-date information on the subject. The thesis was commissioned by the Welfare Unit of Jyväskylä University of Applied Sciences. An online survey was used as the research method. The target group members were reached through the contact information obtained from Jamk's register, through social media and by utilizing Jamk's own channels. 60 people responded to the survey. The survey was carried out as a quantitative study, but the methods of qualitative research were also used to analyze the open answers of the data. Based on the results, the employment situation of rehabilitation counsellors was good. The respondents worked extensively in different areas of the field and in many different job titles. More than half of those employed in the rehabilitation counsellors’ profession were required the qualification of a legal social care professional. The respondents were mainly satisfied with Jamk's degree programme in rehabilitation counselling. Most of them had gained job opportunities through contacts made during their studies. The results were in many respects consistent with previous studies on the subject. The results emphasized the scope and diversity of the field. It can be concluded from the results that the integration of rehabilitation counsellors into legal social care professionals has further increased their employment opportunities. The thesis can be utilized in the development of the rehabilitation counsellors’ degree programme. The results can also be useful to those applying or already studying to become a rehabilitation counsellor and to others interested in the subject

Resting-State Network Plasticity Induced by Music Therapy after Traumatic Brain Injury

Traumatic brain injury (TBI) is characterized by a complex pattern of abnormalities in resting-state functional connectivity (rsFC) and network dysfunction, which can potentially be ameliorated by rehabilitation. In our previous randomized controlled trial, we found that a 3-month neurological music therapy intervention enhanced executive function (EF) and increased grey matter volume in the right inferior frontal gyrus (IFG) in patients with moderate-to-severe TBI (N = 40). Extending this study, we performed longitudinal rsFC analyses of resting-state fMRI data using a ROI-to-ROI approach assessing within-network and between-network rsFC in the frontoparietal (FPN), dorsal attention (DAN), default mode (DMN), and salience (SAL) networks, which all have been associated with cognitive impairment after TBI. We also performed a seed-based connectivity analysis between the right IFG and whole-brain rsFC. The results showed that neurological music therapy increased the coupling between the FPN and DAN as well as between these networks and primary sensory networks. By contrast, the DMN was less connected with sensory networks after the intervention. Similarly, there was a shift towards a less connected state within the FPN and SAL networks, which are typically hyperconnected following TBI. Improvements in EF were correlated with rsFC within the FPN and between the DMN and sensorimotor networks. Finally, in the seed-based connectivity analysis, the right IFG showed increased rsFC with the right inferior parietal and left frontoparietal (Rolandic operculum) regions. Together, these results indicate that the rehabilitative effects of neurological music therapy after TBI are underpinned by a pattern of within- and between-network connectivity changes in cognitive networks as well as increased connectivity between frontal and parietal regions associated with music processing.Peer reviewe