Singing the blues away : reduction of depression in dementia by recreational choir singing

Non peer reviewe

Clinical and Neural Predictors of Treatment Response to Music Listening Intervention after Stroke

Patients with post-stroke impairments present often significant variation in response to therapeutic interventions. Recent studies have shown that daily music listening can aid post-stroke recovery of language and memory, but reliable predictors of treatment response are unknown. Utilizing data from the music intervention arms of a single-blind randomized controlled trial (RCT) on stroke patients (N = 31), we built regression models to predict the treatment response of a two-month music listening intervention on language skills and verbal memory with baseline demographic, clinical and musical data as well as fMRI data from a music listening task. Clinically, greater improvement in verbal memory and language skills after the music listening intervention were predicted by the severity of the initial deficit and educational level. Neurally, greater baseline fMRI activation during vocal music listening in the left parietal cortical and medial frontal areas predicted greater treatment-induced improvement in language skills and greater baseline engagement of the auditory network during instrumental music listening predicted improvement in both verbal memory and language skills. Our results suggest that clinical, demographic, and neuroimaging data predicts music listening treatment response. This data could be used clinically to target music-based treatments.Peer reviewe

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

Traumatic brain injury (TBI) causes lifelong cognitive deficits, most often in executive function (EF). Both musical training and music-based rehabilitation have been shown to enhance EF and neuroplasticity. Thus far, however, there is little evidence for the potential rehabilitative effects of music for TBI. Here, we review the core findings from our recent cross-over randomized controlled trial in which a 10-week music-based neurological rehabilitation (MBNR) protocol was administered to 40 patients with moderate-to-severe TBI. Neuropsychological testing and structural/functional magnetic resonance imaging were collected at three time points (baseline, 3 months, and 6 months); one group received the MBNR between time points 1 and 2, while a second group received it between time points 2 and 3. We found that both general EF and set shifting improved after the intervention, and this effect was maintained long term. Morphometric analyses revealed therapy-induced gray matter volume changes most consistently in the right inferior frontal gyrus, changes that correlated with better outcomes in set shifting. Finally, we found changes in the between- and within-network functional connectivity of large-scale resting-state networks after MBNR, which also correlated with measures of EF. Taken together, the data provide evidence for concluding that MBNR improves EF in TBI; also, the data show that morphometric and resting-state functional connectivity are sensitive markers with which to monitor the neuroplasticity induced by the MBNR intervention.Peer reviewe

Musiikki toipuvissa aivoissa

Listening to music involves a widely distributed bilateral network of brain regions that controls many auditory perceptual, cognitive, emotional, and motor functions. Exposure to music can also temporarily improve mood, reduce stress, and enhance cognitive performance as well as promote neural plasticity. However, very little is currently known about the relationship between music perception and auditory and cognitive processes or about the potential therapeutic effects of listening to music after neural damage. This thesis explores the interplay of auditory, cognitive, and emotional factors related to music processing after a middle cerebral artery (MCA) stroke. In the acute recovery phase, 60 MCA stroke patients were randomly assigned to a music listening group, an audio book listening group, or a control group. All patients underwent neuropsychological assessments, magnetoencephalography (MEG) measurements, and magnetic resonance imaging (MRI) scans repeatedly during a six-month post-stroke period. The results revealed that amusia, a deficit of music perception, is a common and persistent deficit after a stroke, especially if the stroke affects the frontal and temporal brain areas in the right hemisphere. Amusia is clearly associated with deficits in both auditory encoding, as indicated by the magnetic mismatch negativity (MMNm) response, and domain-general cognitive processes, such as attention, working memory, and executive functions. Furthermore, both music and audio book listening increased the MMNm, whereas only music listening improved the recovery of verbal memory and focused attention as well as prevented a depressed and confused mood during the first post-stroke months. These findings indicate a close link between musical, auditory, and cognitive processes in the brain. Importantly, they also encourage the use of listening to music as a rehabilitative leisure activity after a stroke and suggest that the auditory environment can induce long-term plastic changes in the recovering brain.Musiikin kuuntelu aktivoi aivoissa laajaa, molemmille aivopuoliskoille ulottuvaa hermoverkkoa, joka säätelee useita auditiivisia, kognitiivisia, emotionaalisia sekä motorisia toimintoja. Musiikki voi hetkellisesti kohentaa mielialaa, vähentää stressiä ja tehostaa kognitiivista suoriutumista sekä myös saada aivoissa aikaan neuroplastisia muutoksia. Vielä ei kuitenkaan tiedetä, miten musiikin havaitseminen liittyy muihin auditiivisiin ja kognitiivisiin toimintoihin ja voiko musiikin kuuntelulla olla positiivisia vaikutuksia kuntoutumiseen aivovaurion jälkeen. Tässä väitöskirjassa tutkittiin auditiivisten, kognitiivisten ja emotionaalisten tekijöiden yhteyttä musiikin käsittelyyn keskimmäisen aivovaltimon (MCA) akuutin aivoinfarktin jälkeen. Tutkimukseen osallistui 60 aivoinfarktiin sairastunutta potilasta, jotka jaettiin satunnaistetusti musiikin kuunteluryhmään, äänikirjojen kuunteluryhmään ja verrokkiryhmään. Kaikille potilaille tehtiin neuropsykologiset tutkimukset sekä aivojen magnetoenkefalografiamittaukset (MEG) ja magneettikuvaukset (MRI) toistetusti kuuden kuukauden seuranta-ajan kuluessa. Tulokset osoittivat, että amusia, musiikin havaitsemisen vaikeus, on yleinen ja usein pysyvä häiriö aivoinfarktin jälkeen, erityisesti jos vaurio on oikean aivopuoliskon ohimo- tai otsalohkolla. Amusia on myös selvästi yhteydessä häiriöihin varhaisessa kuuloinformaation käsittelyssä, jota mitattiin ns. poikkeavuusvasteella (MMNm), sekä yleisissä kognitiivisissa toiminnoissa, kuten tarkkaavaisuuden säätelyssä, työmuistissa ja toiminnanohjauksessa. Sekä musiikin että äänikirjojen päivittäinen kuuntelu voimisti MMNm-vastetta, kun taas ainoastaan musiikin kuuntelu paransi kielellisen muistin ja tarkkaavaisuuden suuntaamisen toipumista sekä ehkäisi masentuneisuutta ja sekavuutta ensimmäisten aivoinfarktin jälkeisten kuukausien aikana. Tulokset viittaavat siihen, että musiikilliset, auditiiviset ja kognitiiviset toiminnot ovat aivoissa läheisesti kytköksissä toisiinsa. Mikä tärkeintä, tulokset myös kannustavat musiikin kuuntelun käyttöön kuntouttavana vapaa-ajantoimintona aivoinfarktin jälkeen sekä osoittavat, että ääniympäristön virikkeet voivat saada aikaan pitkäkestoisia plastisia muutoksia toipuvissa aivoissa

Efficacy of a multicomponent singing intervention on communication and psychosocial functioning in chronic aphasia: A randomized controlled crossover trial

The ability to produce words through singing can be preserved in severe aphasia, but the benefits of group-based singing rehabilitation in aphasia are largely unknown. Our aim was to determine the efficacy of a multicomponent singing intervention on communication and speech production, emotional-social functioning and caregiver well-being in aphasia. Fifty-four patients with acquired brain injury and chronic aphasia and their family caregivers (n = 43) were recruited. Using a crossover randomized controlled trial design, participants were randomized to two groups who received a 4-month singing intervention either during the first or second half of the study in addition to standard care. The intervention comprised weekly group-based training (including choir singing and group-level melodic intonation therapy) and tablet-assisted singing training at home. At baseline, 5- and 9-month stages, patients were assessed with tests and questionnaires on communication and speech production, mood, social functioning, and quality of life and family caregivers with questionnaires on caregiver burden. All participants who participated in the baseline measurement (n = 50) were included in linear mixed model analyses. Compared with standard care, the singing intervention improved everyday communication and responsive speech production from baseline to 5-month stage, and these changes were sustained also longitudinally (baseline to 9-month stage). Additionally, the intervention enhanced patients’ social participation and reduced caregiver burden. This study provides novel evidence that group-based multicomponent singing training can enhance communication and spoken language production in chronic aphasia as well as improve psychosocial wellbeing in patients and caregivers.Peer reviewe

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

Resting-state language network neuroplasticity in post-stroke music listening: A randomized controlled trial

Recent evidence suggests that post-stroke vocal music listening can aid language recovery, but the network-level functional neuroplasticity mechanisms of this effect are unknown. Here, we sought to determine if improved language recovery observed after post-stroke listening to vocal music is driven by changes in longitudinal resting-state functional connectivity within the language network. Using data from a single-blind randomized controlled trial on stroke patients (N = 38), we compared the effects of daily listening to self-selected vocal music, instrumental music and audio books on changes of the resting-state functional connectivity within the language network and their correlation to improved language skills and verbal memory during the first 3 months post-stroke. From acute to 3-month stage, the vocal music and instrumental music groups increased functional connectivity between a cluster comprising the left inferior parietal areas and the language network more than the audio book group. However, the functional connectivity increase correlated with improved verbal memory only in the vocal music group cluster. This study shows that listening to vocal music post-stroke promotes recovery of verbal memory by inducing changes in longitudinal functional connectivity in the language network. Our results conform to the variable neurodisplacement theory underpinning aphasia recovery.Peer reviewe

Time course of motor gains induced by Music-Supported Therapy after stroke : An exploratory case study

OBJECTIVE: Previous studies have shown that Music-Supported Therapy (MST) can improve the motor function and promote functional neuroplastic changes in motor areas; however, the time course of motor gains across MST sessions and treatment periods remain unknown. The aim of this study was to explore the progression of the rehabilitation of motor deficits in a chronic stroke patient for a period of 7 months. METHOD: A reversal design (ABAB) was implemented in a chronic stroke patient where no treatment was provided in the A periods and MST was applied in the B periods. Each period comprised of 4 weeks and an extensive evaluation of the motor function using clinical motor tests and 3D movement analysis was performed weekly. During the MST periods, a keyboard task was recorded daily. A follow-up evaluation was performed 3 months after the second MST treatment. RESULTS: Improvements were observed during the first sessions in the keyboard task but clinical gains were noticeable only at the end of the first treatment and during the second treatment period. These gains were maintained in the follow-up evaluation. CONCLUSIONS: This is the first study examining the pattern of motor recovery progression in MST, evidencing that gradual and continuous motor improvements are possible with the repeated application of MST training. Fast-acquisition in specific motor abilities was observed at the beginning of the MST training but generalization of these improvements to other motor tasks took place at the end or when another treatment period was provided.Peer reviewe

Neural basis of acquired amusia and its recovery after stroke

Although acquired amusia is a relatively common disorder after stroke, its precise neuroanatomical basis is still unknown. To evaluate which brain regions form the neural substrate for acquired amusia and its recovery, we performed a voxel-based lesion-symptom mapping (VLSM) and morphometry (VBM) study with 77 human stroke subjects. Structural MRIs were acquired at acute and 6 month poststroke stages. Amusia and aphasia were behaviorally assessed at acute and 3 month poststroke stages using the Scale and Rhythm subtests of the Montreal Battery of Evaluation of Amusia (MBEA) and language tests. VLSM analyses indicated that amusia was associated with a lesion area comprising the superior temporal gyrus, Heschl's gyrus, insula, and striatum in the right hemisphere, clearly different from the lesion pattern associated with aphasia. Parametric analyses of MBEA Pitch and Rhythm scores showed extensive lesion overlap in the right striatum, as well as in the right Heschl's gyrus and superior temporal gyrus. Lesions associated with Rhythm scores extended more superiorly and posterolaterally. VBM analysis of volume changes from the acute to the 6 month stage showed a clear decrease in gray matter volume in the right superior and middle temporal gyri in nonrecovered amusic patients compared with nonamusic patients. This increased atrophy was more evident in anterior temporal areas in rhythm amusia and in posterior temporal and temporoparietal areas in pitch amusia. Overall, the results implicate right temporal and subcortical regions as the crucial neural substrate for acquired amusia and highlight the importance of different temporal lobe regions for the recovery of amusia after stroke

Musical training predicts cerebello-hippocampal coupling during music listening.

Cerebello-hippocampal interactions occur during accurate spatiotemporal prediction of movements. In the context of music listening, differences in cerebello-hippocampal functional connectivity may result from differences in predictive listening accuracy. Using functional MRI, we studied differences in this network between 18 musicians and 18 nonmusicians while they listened to music. Musicians possess a predictive listening advantage over nonmusicians, facilitated by strengthened coupling between produced and heard sounds through lifelong musical experience. Thus, we hypothesized that musicians would exhibit greater functional connectivity than nonmusicians as a marker of accurate online predictions during music listening. To this end, we estimated the functional connectivity between cerebellum and hippocampus as modulated by a perceptual measure of the predictability of the music. Results revealed increased predictability-driven functional connectivity in this network in musicians compared with nonmusicians, which was positively correlated with the length of musical training. Findings may be explained by musicians’ improved predictive listening accuracy. Our findings advance the understanding of cerebellar integrative function.Peer reviewe