Silvia Masci
Terni, Italy

Stroke is a clinical syndrome characterized by sudden onset of neurological deficit that persists for more than 24 hours or leads to death. Based on etiology, a distinction is made between ischemic stroke (65–90%) and hemorrhagic stroke (intracerebral hemorrhages 10–25%, subarachnoid hemorrhages 0.5–5%).^1,2 According to 2019 World Stroke Organization (WSO) statistics, stroke is the third leading cause of death globally and the leading cause of disability.³ Treatment for its symptoms typically involves pharmacological interventions, but their effectiveness is often limited by side effects, poor compliance, and long response times,^4,5 prompting a shift toward non-pharmacological approaches that combine neuromotor and cognitive rehabilitation.^6-9

Several studies have demonstrated a strong correlation between residual functional limitations, which lead to significant loss of autonomy in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), depression, and cognitive deficits.^10,11 These aspects also significantly impact the costs of healthcare institutions and public spending. For this reason, many authors have emphasized the importance of addressing functional and cognitive deficits through early and effective rehabilitation.⁴

In the immediate days following an acute stroke, significant neuromotor recovery can occur,¹² and in recent years, new rehabilitation methods have gained popularity. Among these, music-based interventions have proven effective. Easily implementable and low-cost, music-based interventions improve neural connectivity, promote neural plasticity, and induce changes in frontotemporal gray and white matter.^13-15 The interventions include: rhythmic auditory stimulation techniques and music-supported therapies, used to restore coordination and balance gait and fine and gross movements; active (playing an instrument, singing) or receptive (listening to music) provided by music therapists in close collaboration with healthcare professionals, which improve emotional and cognitive aspects; and melodic intonation therapy, developed for the rehabilitation of individuals with non-fluent aphasia, as sentence production is achieved through training that transforms communication from singing to speech.^16-17

The greatest results have been observed in cognitive disorders, aphasia, and motor deficits. Cognitive (memory, attention, executive function) and emotional (depression) deficits affect approximately 30–50% of stroke patients. Some studies report that listening to music for several hours a day in the post-stroke phase facilitates memory recovery, stimulates concentration, and improves mood.¹⁸ Cognitive benefits from listening to music have also been associated with increased gray matter volume in the prefrontal and limbic areas.^13,19 Similarly, melodic intonation interventions have achieved significantly better results in people with subacute aphasia than in people treated with traditional speech therapy.¹⁷ Music-supported-therapy refers to a rehabilitation program aimed at improving motor functionality after stroke; this intervention has shown significant improvements not only in upper limb motility but also in the emotional well-being of participants. Lower levels of apathy, anger, and frustration have been recorded, as well as improvements in ADL performance.^13,20

Music-based interventions have the ability to affect motor performance, language, and cognitive function; it is plausible that the psychological effects and neurobiological mechanisms underlying this type of therapy share common neural systems for arousal, affect regulation, learning, and activity-driven brain plasticity. As such, these interventions represent promising strategies for improving the health and wellbeing of neurological patients. It is important to foster collaboration among scientists, healthcare professionals, therapists, and psychologists to develop joint research projects that can meet the health, emotional, and social needs of stroke patients while also addressing effectiveness and efficiency criteria guiding healthcare operations.

“Mens sana in corpore sano,” as Juvenal said. May music be the key to a fruitful future in clinical practice, able to reconnect the care of the body to that of the spirit.

References

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12. Guidelines ISA-AA-SPREAD, 2024.
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