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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Mar 22, 2015; 5(1): 68-78
Published online Mar 22, 2015. doi: 10.5498/wjp.v5.i1.68
Effects of music and music therapy on mood in neurological patients
Alfredo Raglio, Lapo Attardo, Giulia Gontero, Silvia Rollino, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
Alfredo Raglio, Elisabetta Groppo, Enrico Granieri, Department of Biomedical and Specialistic Surgical Sciences, Section of Neurology, University of Ferrara, 44121 Ferrara, Italy
Author contributions: Raglio A developed the study design concept, contributed to analysis and interpretation of data and wrote the manuscript; Attardo L, Gontero G and Rollino S contributed to acquisition, analysis and interpretation of data and to draft the paper; Groppo E and Granieri E analyzed and interpreted the data and revised the manuscript; all authors approved final version of the paper.
Conflict-of-interest: The Authors have not any competing interests to declare and no funding was received for this research.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alfredo Raglio, MT, PhD, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via S. Boezio 24, 27100 Pavia, Italy. alfredo.raglio@unipv.it
Telephone: +39-0382-593797 Fax: +39-0382-593797
Received: September 26, 2014
Peer-review started: September 28, 2014
First decision: December 17, 2014
Revised: January 27, 2015
Accepted: February 9, 2015
Article in press: February 11, 2015
Published online: March 22, 2015

Abstract

Mood disorder and depressive syndromes represent a common comorbid condition in neurological disorders with a prevalence rate that ranges between 20% and 50% of patients with stroke, epilepsy, multiple sclerosis, and Parkinson’s disease. Notwithstanding, these conditions are often under-diagnosed and under-treated in the clinical practice and negatively affect the functional recovery, the adherence to treatment, the quality of life, and even the mortality risk. In addition, a bidirectional association between depression and neurological disorders may be possible being that depressive syndromes may be considered as a risk factor for certain neurological diseases. Despite the large amount of evidence regarding the effects of music therapy (MT) and other musical interventions on different aspects of neurological disorders, no updated article reviewing outcomes such as mood, emotions, depression, activity of daily living and so on is actually available; for this reason, little is known about the effectiveness of music and MT on these important outcomes in neurological patients. The aim of this article is to provide a narrative review of the current literature on musical interventions and their effects on mood and depression in patients with neurological disorders. Searching on PubMed and PsycInfo databases, 25 studies corresponding to the inclusion criteria have been selected; 11 of them assess the effects of music or MT in Dementia, 9 explore the efficacy on patients with Stroke, and 5 regard other neurological diseases like Multiple Sclerosis, Amyotrophic Lateral Sclerosis/motor neuron disease, Chronic quadriplegia, Parkinson’s Disease, and Acquired Brain dysfunctions. Selected studies are based on relational and rehabilitative music therapy approaches or concern music listening interventions. Most of the studies support the efficacy of MT and other musical interventions on mood, depressive syndromes, and quality of life on neurological patients.

Key Words: Music, Listening, Music therapy, Epilepsy, Narrative review, Stroke, Mood, Amyotrophic lateral sclerosis, Depression, Parkinson, Dementia, Multiple sclerosis, Neurological disease, Neurological disorders, Acquired brain injury

Core tip: We conducted a search on PubMed and PsychInfo databases identifying 25 Randomized Controlled Trials or Clinical Controlled Trials regarding the effects of Music Therapy and other musical interventions on mood disorders in neurological patients. Although the Jadad score evaluation revealed a generally poor methodological quality of the research protocols, we found that almost all studies supported the effectiveness of musical interventions in improving mood, depression, quality of life, functional recovery, and neuromotor performances. Therefore Music Therapy and other musical approaches seem to be effective, inexpensive and non-invasive, being that no adverse side-effects were observed.



INTRODUCTION
Neurology and psychiatry

Neurological diseases are often associated with several behavioral and psychological symptoms that are usually overlooked by neurologists because require diagnostic methods that differ from those used for classical somatic symptoms and are more suitable to the field of psychiatry. On the other hand, psychiatrists do not seem to give an adequate attention to these symptoms considering them as a consequence of a cerebral damage and more pertinent to neurologists. This clinical attitude is historically based on the obsolete and reductive distinction between “organic” and “functional” behavioral disorders introduced by the phrenologist George Combe in 19th century. According to Combe, cerebral diseases were respectively classified depending on the presence or the absence of cerebral lesions and from that time on this terminology has been used to indicate that some behavioral disorders are linked to a neurological damage while others are not. However, the reductionism of Combe’s distinction clearly emerges from the clinical observation given that a wide range of nervous system’s illnesses with different etiology shows both neurological and psychiatric symptoms. Emotional and behavioral disturbances with a polymorphic symptomatology are often connected to neurological disorders such as Multiple Sclerosis (MS)[1-3], Parkinson’s Disease (PD)[4], stroke[5], dementia[6], traumatic brain injury[7], epilepsy[8,9], Amyotrophic Lateral Sclerosis (ALS) and others Motor Neuron Diseases (MND)[10,11], pain syndromes (like headaches) and can be observed even with or without “organic” neurological diseases, thus miming in some cases an idiopathic psychiatric disorder.

Most common psychiatric disorders in neurology are depression, anxiety, maniacal states, and thought and perception disorders. Other psychiatric syndromes that can be seen in persons with neurological disorders are alexithymia, worry, and locus of control[12]. For example, mood disorders are often associated with acute or chronic cerebrovascular pathologies where the most common complications is certainly depression, usually defined post-stroke depression (PSD). The frequency of this syndrome is variable accordingly to different studies with a mean of 40% of the cases[13] and data obtained by numerous studies seem to indicate the presence of multiple etiological factors, both structural-endogenous and environmental-external, that may change depending on the early or late onset of the depressive disorder. In addition, a bidirectional association between depression and neurological disorder may be possible being that depressive syndromes may be considered as a risk factor for certain neurological disorders. As sustained by two recent meta-analysis, depressive syndromes, particularly major depressive disorder (MDD), are associated with a significantly increased risk of stroke[14,15]. On the other hand, lower rates of depression in equally impaired orthopedic patients suggest that PSD may even result from a stroke-specific neurobiological change and not only from a consequence of the psychological distress or the related impairments[16-18].

The second most common neurodegenerative disorder is represented by PD, with a prevalence of 1% of the elderly worldwide population. About 30% of PD patients show clinically significant depressive syndromes and, again, it appears to be also an increased risk for depressed patients to develop PD[19-23].

As far as regard MS, depressive syndromes are psychiatric most common disorders associated to the illness. Among individuals with MS, relative to the general population, lifetime prevalence rates are elevated for MDD (36%-54%), bipolar disorder (13%), anxiety disorders (35.7%), adjustment disorders (22%), and psychotic disorders (2%-3%). Suicide may be at least twice as common[1].

Many reports of depression and its correlation with numerous variables in clinical samples of people with MS have been published. The few population-based studies have reported a high prevalence of depression, despite using different methods of data collection. The lifetime risk of major depression in people with MS has been estimated to be as high as 50% compared to 10% to 15% in the general population[24,25].

In a recent cross-sectional, population-based study conducted in Stockholm county, the authors reported a prevalence rate of depression of 19% [Beck Depression Inventory (BDI) > 13] among patients suffering of MS. It’s interesting to note how depressive symptoms were associated with worse self-reported functioning, with poor memory function and with weak sense of coherence (SOC) (referring to ‘‘general resistance resources’’ - capacities that facilitate coping with stressors). Moreover, the authors suggested to incorporate depressive symptoms or mental health as a standard parameter for assessment and follow-up in clinical MS management[26].

Data from the United Kingdom MS Register, those obtained directly from MS patients, confirmed a high rate of anxiety and depression: over half of the respondents (54.1%) reported anxiety and 46.9% reported a variable level of depression[27]. From this registry data were recently examined about the positive relationships between physical disability, anxiety and depression[28].

Other reports confirmed the need to recognize and treat, having widely effective treatments, several emotional disorders which may worsen functioning and quality of life, decrease treatment adherence, and increase risk of suicide[1].

The prevalence of depressive disorders is higher in MS patients than patients with other chronic disease, suggesting a possible direct effect of the illness on the pathogenesis of the depressive syndromes in addition to the reactive disorder. Some evidences suggested that depression in MS is largely biologically mediated by some of the same processes involved in the immunopathogenesis of this neurologic disease. In particular, the increase in proinflammatory cytokines, the activation of the hypothalamic-pituitary-adrenal axis, and the reduction in neurotrophic factors. Notwithstanding, depression and mood disorders still remain under-diagnosed and under-treated in neurological patients claiming for a bio-psychosocial model be used[29-32].

Music therapy

In last decades, a growing body of evidence in the use of musical intervention in clinical setting have been seen, concerning singing, music listening, musical improvisation, and other musical activities, as long as more structured music therapy (MT) treatments. Given that music engages a variety of brain areas involved in emotion, motivation, cognition, and motor functions, musical interventions have been used to increase socialization and cognitive, emotional, and neuromotor functioning[33-38]. Although the debate on what the boundaries of MT is still going on, different approaches of musical intervention are actually available referring to three principal domains: relational approaches, rehabilitative approaches and music listening.

Relational approaches refer to psychological models and involve both active and receptive techniques[39,40]. The former consist of different musical activities such as free or structured musical improvisation by means of simple musical instruments, singing, songwriting etc. that allow patient and therapist to directly interact building a musical relationship[41]. In receptive approaches music imagery and music listening are used to induce psychological beneficial effects and even to evoke and process emotions and thoughts[40].

Rehabilitative approaches, such as Neurologic Music Therapy (NMT)[42] refer to neuroscientific models and use primarily the potential of musical stimuli to activate perception and production areas in the human brain, providing a series of therapeutic applications to sensory, cognitive, and motor dysfunctions resulting from neurological disorders. Using directive approach based on a series of exercises, NMT may be used, for example, to improve gait and movements in post-stroke and PD patients[43-47] and language in persons with aphasia[48,49].

On the other hand, simple music listening interventions don’t require neither a specifically trained therapist nor a direct therapeutic relationship with the patient being that beneficial effects are induced by the content of the musical stimuli and by the activity of listening itself. For these reasons, this practice is sometimes defined with the term “Music Medicine” rather than “MT”[41,50,51]. Notwithstanding, listening interventions seem to be quite common in clinical literature, usually based on self-selected or other-selected music proposed individually[52,53] or in group, as in the case of background music[54,55].

As far as regard neurological disorders, MT may promote functional recovery and also improve social and psychological outcomes such as socialization, motivation, mood, and depression[56]. Literature in this field shows that most of the musical interventions are currently used in clinical practice, being that the majority of the interventions are based on a combination of rehabilitative and relational techniques. Also music listening seems to be a common practice in neurological rehabilitation. Due to the possible side effects of pharmacological treatment of depressive syndromes following neurological disease, music and MT may represent a valid support in reducing depressive symptoms, improving mood and adherence to treatment while contributing to the functional recovery at the same time.

RESEARCH

PubMed and PsychInfo databases were considered for articles to include in the current narrative review. The research has been conducted by three independent reviewers using the following search terms: (“Music” OR “MT”) AND (name of pathology) AND (“Mood” OR “Depression”). Names of pathologies where used alone or in combination with “OR” Boolean operator and included: “Stroke”, “Parkinson”, “Dementia”, “Epilepsy”, “ALS”, “MS”, “Cerebral palsy”, “Neurological disease”, and “Acquired brain injury”.

We included only Randomized Controlled Trials (RCTs) or Clinical Controlled Trials (CCTs) studies in English language published in peer-reviewed journals between 1st January 1997 and 31st May 2014. Importantly, we considered only trials including outcomes concerning mood or depression where experimental conditions were clearly stated and consisted only or primarily of musical activities.

Assessments of methodological quality of selected studies have been provided using Jadad score[57]. Jadad scale is based on 7 items that evaluate three main characteristics of a clinical trial: the random assignment, the double-blinding of assessments, and the flow of participants. Scoring ranges from a minimum of 0 to a maximum of 5 points where a score of 3 indicates a good quality study. Being that 2 points on 5 are scored for double-blinding and none of the included studies had double-blinding assessment, the maximum possible score was 3. Even if it doesn’t take into account allocation concealment and has been criticized for placing too much emphasis on blinding[58], Jadad scale represents a simple, easy and common way to evaluate the methodological quality of a clinical trial with good validity and reliability[59]. Due to the heterogeneity of the outcomes, no meta-analysis was carried out.

DESCRIPTION OF SELECTED STUDIES

A total of 464 records resulted from the search of which 301 from PubMed and 163 from PsychInfo. Twenty-five articles that met the inclusion criteria have been found and were included in the current review. Most of the selected studies are related to dementia (44%) and stroke (36%) while others regard MS, ALS/motor neuron disease, PD, Chronic quadriplegia, and acquired brain dysfunctions (20%). Fourteen studies (56%) employed a relational approach including both active and receptive techniques, six studies (24%) adopted a rehabilitative approach, and five (20%) concerned music listening interventions. Activities were conducted by trained music therapists in the most part of the experimental interventions. As far as regard the methodological quality of included studies, our analysis showed that only nine on twenty-five (36%) of the included studies received a Jadad score of 3 and thus can be considered of good quality. Five studies (20%) had a Jadad score of 2, three studies (12%) a score 1, and eight studies (32%) were evaluated with a score of 0. Results of the methodological assessment pointed out a general poor rigor in research protocols.

In the following subsections, results are presented through a subdivision of the selected studies by pathology (Table 1, Table 2, Table 3).

Table 1 Characteristics of the included studies concerning effects on dementia.
RefDesign/(Jadad)SubjectsDiagnosisInterventionProfessionalsFrequencyOutcome measuresResults
Ashida[60]CCT (0)20DementiaPlaying percussion instruments and listening to live songs performed by the therapistMusic therapistFive daily session of about 40 min each in a single weekCSDDSignificant reduction of depressive symptoms (P < 0.05)
Choi et al[61]CCT (1)20DementiaSinging songs, analysis of libretto, making musical instruments, playing instruments, song drawing, and song writingMusic therapist50 min, 3 times 1 wk for 5 wk (15 sessions)MMSE, GDS, GQoL, NPI-QPositive trends for GDS and GQoL in music group. Improvements in BPDS (P = 0.004) and caregiver distress (P = 0.003)
Guètin et al[62]RCT (3)30Dementia (Alzheimer’s type)Weekly sessions of individual, self selected music listening. Control group underwent reading sessionsNot specified therapistOnce 1 wk for 18 mo for 20 minHRSD, GDSSignificant improvements in anxiety and depression (P < 0.01) in the music therapy group
Raglio et al[63]RCT (3)20DementiaActive-intersubjective approach, based on sonorous-musical improvisation. Control group took part in educational and occupational activities without musicMusic therapist2 times a week for 15 wk for 30 minECG Holter, MMSE, ADAS-Cog test, NPI, ADL, IADLSignificant improvement of depression symptoms (P = 0.02) and increase of HRV (P = 0.013)
Cooke et al[64]RCT (3)47DementiaMusician-led familiar song singing and music listening. Control group participated in reading sessionsMusicians3 mornings 1 wk for 8 wk for 40 minDQOL, GDS, MMSENot significant effects on GDS and QOL. Positive trends in music group at sub-analysis
Fischer-Terworth et al[65]CCT (0)49DementiaSinging in group with the therapist, playing elementary musical instruments and listening to biographically relevant music. Control group participated in a nonspecific occupational therapyNot specifiedOnce 1 wk for 6 mo for 45 minNPI, ICEA-D, MMST, GDSDepression decreased in both groups (P < 0.05). Improvements of NPI and ICEA-D (P < 0.01) in favor of music group No effects on mood. Improvements (P < 0.05) for MPI, MPD, attentional matrices
Ceccato et al[66]RCT (3)50DementiaCognitive and sensorial exercises associated with musical stimuliMusic therapist2 times 1 wk for 12 wk for 45 minNPI, MPD, ADL, SVAM, GMP, MMSE, CMAI, GDSNo effects on mood. Improvements (P < 0.05) for MPI, MPD, attentional matrices, ADL, SVAM, and GMP
Janata[67]RCT (3)38DementiaPreferred music listening. Control group was incidentally exposed to the music programming in the course of daily lifeMusic therapistEvery day for 12 wk from 21 to 65 minNPI, CMAI, CSDD, MMSEReduction of CSDD, NPI, and CMAI score in both groups (P < 0.0001)
Clemént et al[68]RCT (2)14Dementia (Alzheimer’s type)Listening to music and playing hand-drums over recorded music. Control group underwent cooking activities. Both groups alternated receptive and productive phasesPsychologist with no musical experience2 times 1 wk for 4 wk for 1 hBEHAVE-AD, PSMS, SIB. EFE, Discourse contents and STAI-AShort time effects of emotional indices (P < 0.05) and longer term effects of mood (P < 0.05) up to 4 wk after the end of the treatment
Narme et al[69]RCT (2)48DementiaListening to music, singing and playing percussion instruments. Control group took part in cooking activities. Both groups alternated receptive and productive phasesPsychologist with no musical experience2 times 1 wk for 4 wk for 1 hSIB, NPI, CMAI, MMST, EFE, Discourse contents and STAI-ABoth group improved in emotional state, NPI score, and professional caregiver distress at different evaluation periods (P < 0.05)
Chu et al[70]RCT (3)104DementiaSong choice, music-prompted reminiscence, singing, music listening, and instrument playingMusic therapistTwo sessions per week for 6 wk for 30 minC-CSDD, salivary cortisol, MMSEShort time effects on depression (P < 0.001) and long time effects on cognition at 1 mo follow-up (P = 0.039)
Table 2 Characteristics of the included studies concerning effects on stroke.
Ref.Design/(Jadad)Subjects(n)DiagnosisInterventionProfessionalsFrequencyOutcomes measuresResults
Purdie et al[71]RCT1 (0)40StrokePlaying familiar or improvised music with the therapist by means of percussion instruments, synthesizers, or voiceMusic therapistOnce a week for 12 sessions lasting 30-40 min eachFAST, HADS, MBRS, NRSPositive trends in communication skills, behavior and psychological state in treatment group (not significant result)
Nayak et al[72]RCT2 (0)18Stroke or TBISinging, playing instruments, composing, improvising, listeningMusic therapist2 or 3 sessions a week during the hospitalization up to a maximum of 10 sessionsFace Scale, VAS, SIP, questionnairePositive trends in mood and significant improvements in social interaction (P < 0.02) and involvement in therapy (P < 0.01) in experimental group
Jeong et al[73]RCT (2)33StrokeRhythmic motor activity with music based on Rhythmic Auditory Stimulation (RAS) theory (Neurologic Music Therapy)InstructorsOne weekly session of 2 h for 8 wkROM, POMS, SS-QOL, exit interviewImprovement in mood states and interpersonal relationship, flexibility, and range of joint motion (P < 0.05)
Särkämö et al[74]RCT (3)60StrokeTreatment group underwent preferred-music listening.A second group received self-selected audio book listening while a third control group had no listening materialMusic therapistsEvery day for 2 mo for 1 h (at minimum)RBMT, WMS-R, BDAE, CERAD, Token test, BVRT, MBEA, FAB, POMS, SAQUOL-39Improvements in depression (P = 0.024) and positive trends in confused mood with cognitive recovery (verbal memory and focused attention) in music listening group
Forsblom et al[75]RCT(3)39StrokePreferred music listening. Control group underwent audio-book listeningMusic therapistEvery day for 2 mo for 1 h (at minimum)Analysis of patient’s interviewsImproved mood, better relaxation, increased motor activity in music listening group (P < 0.0001)
Kim et al[76]CCT (0)18StrokeHello song and sharing of events in their lives (5 m), planned musical activities (30 m) and sharing feelings and goodbye song (5 m)Not specified therapistTwice a week for 4 wk for 40 minBAI, BDI, questionnaire of satisfactionImprovement in depression (P = 0.048) and positive trends for anxiety
Jun et al[77]RCT (2)40StrokeStretching exercises while listening to music, singing and/or playing songs on percussion instruments, and final verbalizationResearchers and music therapistThree times per week for 8 wk for 60 minROM, K-MBI, K-POMS-B, CES-DImprovements in mood states (P = 0.04) and increase in the degree of shoulder (P = 0.03) and elbow (P = 0.04) joint flexion
Chen et al[78]CCT (0)19StrokeSelf-selected individual listening in two different conditions: pleasant music and unpleasant music. A white noise condition acted as controlNot specified1 session for each condition, separated by no more than 1 wk3VAS, HR, GSR, SCT, LBT, PST, visual taskImprovement of mood (P = 0.03) and arousal (P < 0.001) under pleasant music condition
Van Vugt et al[79]RCT4 (1)28StrokePlay fingers exercises and children’s song on the pianoMusic therapist10 therapy sessions for 3/4 times a week for 30 min9HPT, Finger tapping measurements, POMSReduction of depression (P = 0.002) and fatigue (P = 0.02) and improvement in the synchronization tapping (P < 0.05)
Table 3 Characteristics of the included studies concerning effects on other neurological disorders.
Ref.Design/(Jadad)Subjects(n)DiagnosisInterventionProfessionalsFrequencyOutcomes measuresResults
Pacchetti et al[80]RCT (2)32Parkinson’s DiseaseRelaxing music, choral singing, breathing/voice exercises, rhythmic movements, collective improvisation, body expression to music. Control group underwent specific motor exercisesMusic therapistOnce a week for 3 mo for 2 h,HM, MS, PDQL, UPDRSImprovement in emotional (P < 0.0001) and motor (P < 0.034) functions, activities of daily living, and quality of life (P < 0.0001)
Schmid et al[81]RCT (0)20Multiple SclerosisActive role of both patient and music therapist on playing instruments or singing (Nordoff-Robbins approach)Music therapist3 blocks of individual sessions (8 to 10 sessions per block) over the course of 1 yrBDI, HADS, SESA, HAQUAMS, MSFCNot significant differences between groups but medium effect size on depression (d = 0.63), self esteem (d = 0.54), and anxiety (d = 0.63)
Thaut et al[82]CCT (0)54Acquired brain dysfunctionsGroup improvisation, singing, synchronization, attention, and memory exercises with music (Neurologic Music Therapy). Control group spent an equal amount of time restingMusic therapist4 group sessions on different days for 30 min eachWAIS-III, AVLT, TMT-B, BSI-18, MAACL, SEQImprovements on depression (P = 0.02), anxiety (P = 0.04), sensation seeking (P < 0.01), and executive functions (mental flexibility) (P < 0.01)
Horne-Thompson et al[83]CCT21ALS/Motor neuron diseaseMusic relaxation, playing/singing familiar songs, and music and imagery. A second group received a listening intervention of self-selected music while a third control group underwent activities such as reading or watching TVMusic therapist3 d per week for 30 min each conditionHADS, ESAS, HR, oxygen saturation levelsNo effect was found on depression, anxiety, heart rate, and oxygenation levels between groups
Tamplin et al[84]RCT (3)24Chronic QuadriplegiaOral motor and respiratory exercises and therapeutic singing (Neurologic Music Therapy). Control group received group music appreciation and relaxationNot specified3 times weekly for 12 wk for 1 hStandard respiratory function testing, EMG, PVP, POMS, AQoLBoth groups improved in mood (P = 0.002). The singing group showed positive effects on arousal (P = 0.006), speech intensity (P = 0.028), and maximum phonation length (P = 0.007)
Effects on dementia

Eleven studies assessed the effects of music and MT on dementia[60-70]. Eight studies employed a relational approach[60-61,63-65,68-70] based either on active or receptive techniques or a combination of both of them. Two studies concerned music listening interventions[62,67] and one study adopted a rehabilitative approach[66]. In most cases the results show a positive effect on mood, depression, and anxiety. Two studies revealed no significant effect of musical intervention[64,66] while in three studies both experimental and control group improved emotional and behavioral functioning in the same way[65,67,69]. Characteristics of the studies and main results have been summarized in Table 1.

Effects on stroke

Nine studies assessed the effects of music or MT on post-stroke patients[71-79]. Four of them were based on a relational approach[71,72,76,77], three regarded music listening interventions[74,75,78], and two used a rehabilitative approach[73,79]. All studies show a positive effect of music or MT on mood in patients with Stroke. For a synthesis of studies and results please see Table 2.

Effects on other neurological disorder

Five studies concerning other neurological disorders such as MS, ALS/motor neuron disease, PD, Chronic quadriplegia, and Acquired Brain dysfunctions, have been found[80-84]. Three studies concerned a rehabilitative approach[80,82,84] and two studies adopted a relational approach using an active technique[81] or both active and receptive techniques depending on what the therapist deemed appropriate in consultation with the patient[83]. All studies but one[83] reported positive effects of music and MT on outcomes as mood, depression, anxiety, and quality of life. Characteristics of the studies and main results have been summarized in Table 3.

DISCUSSION

In the last few decades, the development of neuroscience demonstrated that the brain isn't a static structure only influenced by genetic determinants but it is a plastic organ that continuously reorganizes synaptic connections under the influence of inner and outer factors such as genetic programs, environmental stimulation, learning and expertise[85-87].

Neurological illnesses that provoke behavioral disturbances might originate from both endogenous and external causal factors thus determining, depending on the circumstances, a more “structural” or a more “environmental” etiology. The mutual interaction between these factors occurs in the brain and gives rise to a variety of psychiatric disorders that can be distributed upon a continuum, on one end of which are behavioral disturbances clearly linked to neuroanatomic and neurochemical alterations while on the opposite those more associated to the environment.

Synaptic functions and neuroanatomic structures are proper “organic” factors that determine those alterations that are usually treated by neuropsychiatry and biological psychiatry. Behavioral disorders resulting from these factors include psychiatric syndromes that are linked to alterations of the neural transmission caused by receptor’s abnormalities and by modifications of the synaptic concentrations of one or more neurotransmitters. Given that neurotransmitters regulate the neural impulse transmission processes into neurotransmitter systems, with a widespread projection in the brain, the whole emotional, motivational, and affective state of the person will be altered[88,89].

External causal factors related to the environment may promote and characterize those behavioral disorders that are commonly counted accordingly to a bio-psychosocial model and interfere with the cognitive and emotional state of the person thus inducing an important change in the quality of the inter-individual relationships. These disorders may be considered as a reaction to the physical disability and the psycho-social difficulties produced by the disease but also as an adjustment disorder if we consider the impact of the diagnosis on patient’s life, or the weight of a chronic illness and all the other factors that may affect patient’s quality of life[90-92].

Depressive syndromes in chronic neurological illness are common and disabling. Their etiology is complex and may be multifactorial. Good history taking and detailed examination of physical and mental state (including cognitive function) will usually reveal the diagnosis and the formulation.

Providing a correct diagnosis of an emotional disorder and starting an appropriate treatment may help physicians to increases in function and quality of life of their neurological patients[93].

The current review showed how MT and musical interventions can improve mood and psychological well-being in neurological patients. These clinical results are in accordance with the literature that highlights the effects that music listening and music making have on brain structures of emotion regulation[36], on various neurochemical systems[38], and on neural plasticity[94,95]. However, the strength of this review’s findings is limited due to a generally poor methodological quality of the studies and the restricted size of samples. Moreover, the heterogeneity of the outcomes prevented any meta-analysis. Notwithstanding, the analysis of the 25 RCTs or CCTs included in this work points out a positive effect of interventions with music on psychosocial outcomes such as mood, depression, and quality of life when compared to standard care or other treatments.

CONCLUSION

Music-based activities can represent a valid and without side effects intervention for reducing psychological and behavioral disturbances related to neurological disorders and also for promoting the functional recovery. Specifically, the most significant results of the music interventions on the psychological side can be identified in the aspects more closely related to mood, especially in the reduction of the depressive and anxiety's component, and in the improvement of the emotional expression, communication and interpersonal skills, self esteem and quality of life. As revealed in advance, the efficacy of music and MT interventions could be explained by different points of view. From the neurochemistry point of view we know that music can activate limbic and paralimbic structures, such as the amygdala, the hippocampus, the nucleus accumbens, etc. that function abnormally in patients with a high depressive component. At the psychological level music can engage several social functions, can increase communication and social cohesion and can promote empathetic relationships, especially in the active MT approaches. Finally, from the rehabilitative point of view, making music can involve and influence motor areas functioning and regulation. This effect appears to be connected to the pleasure and thereby can positively affect the mood and consequently the rehabilitative process[36-38].

In conclusion, a more methodological rigor and a clearer definition of music approaches are needed to improve the quality of MT research and to focus on the specific role of music-based interventions in psychological symptoms in the field of neurology.

Footnotes

P- Reviewer: Boehm K, Mishra J S- Editor: Ji FF L- Editor: A E- Editor: Lu YJ

References
1.  Minden SL, Feinstein A, Kalb RC, Miller D, Mohr DC, Patten SB, Bever C, Schiffer RB, Gronseth GS, Narayanaswami P. Evidence-based guideline: assessment and management of psychiatric disorders in individuals with MS: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2014;82:174-181.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 149]  [Cited by in F6Publishing: 152]  [Article Influence: 13.8]  [Reference Citation Analysis (0)]
2.  Skokou M, Soubasi E, Gourzis P. Depression in multiple sclerosis: a review of assessment and treatment approaches in adult and pediatric populations. ISRN Neurol. 2012;2012:427102.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 44]  [Cited by in F6Publishing: 47]  [Article Influence: 3.9]  [Reference Citation Analysis (0)]
3.  Koch MW, Patten S, Berzins S, Zhornitsky S, Greenfield J, Wall W, Metz LM. Depression in multiple sclerosis: A long-term longitudinal study. Mult Scler. 2014;21:76-82.  [PubMed]  [DOI]  [Cited in This Article: ]
4.  Marsh L. Depression and Parkinson’s disease: current knowledge. Curr Neurol Neurosci Rep. 2013;13:409.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 170]  [Cited by in F6Publishing: 200]  [Article Influence: 20.0]  [Reference Citation Analysis (0)]
5.  Ferro JM, Caeiro L, Santos C. Poststroke emotional and behavior impairment: a narrative review. Cerebrovasc Dis. 2009;27 Suppl 1:197-203.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 51]  [Cited by in F6Publishing: 55]  [Article Influence: 3.7]  [Reference Citation Analysis (0)]
6.  Levenson RW, Sturm VE, Haase CM. Emotional and behavioral symptoms in neurodegenerative disease: a model for studying the neural bases of psychopathology. Annu Rev Clin Psychol. 2014;10:581-606.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 97]  [Cited by in F6Publishing: 109]  [Article Influence: 10.9]  [Reference Citation Analysis (0)]
7.  Schwarzbold M, Diaz A, Martins ET, Rufino A, Amante LN, Thais ME, Quevedo J, Hohl A, Linhares MN, Walz R. Psychiatric disorders and traumatic brain injury. Neuropsychiatr Dis Treat. 2008;4:797-816.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 16]  [Cited by in F6Publishing: 56]  [Article Influence: 3.5]  [Reference Citation Analysis (0)]
8.  Kanner AM. Depression in epilepsy: a frequently neglected multifaceted disorder. Epilepsy Behav. 2003;4 Suppl 4:11-19.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 77]  [Cited by in F6Publishing: 65]  [Article Influence: 3.1]  [Reference Citation Analysis (0)]
9.  Prueter C, Norra C. Mood disorders and their treatment in patients with epilepsy. J Neuropsychiatry Clin Neurosci. 2005;17:20-28.  [PubMed]  [DOI]  [Cited in This Article: ]
10.  Taylor L, Wicks P, Leigh PN, Goldstein LH. Prevalence of depression in amyotrophic lateral sclerosis and other motor disorders. Eur J Neurol. 2010;17:1047-1053.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 40]  [Cited by in F6Publishing: 44]  [Article Influence: 3.1]  [Reference Citation Analysis (0)]
11.  Atassi N, Cook A, Pineda CM, Yerramilli-Rao P, Pulley D, Cudkowicz M. Depression in amyotrophic lateral sclerosis. Amyotroph Lateral Scler. 2011;12:109-112.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 58]  [Cited by in F6Publishing: 67]  [Article Influence: 4.8]  [Reference Citation Analysis (0)]
12.  Borkovec TD, Inz J. The nature of worry in generalized anxiety disorder: a predominance of thought activity. Behav Res Ther. 1990;28:153-158.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 408]  [Cited by in F6Publishing: 423]  [Article Influence: 12.4]  [Reference Citation Analysis (0)]
13.  Provinciali L, Coccia M. Post-stroke and vascular depression: a critical review. Neurol Sci. 2002;22:417-428.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 43]  [Cited by in F6Publishing: 48]  [Article Influence: 2.2]  [Reference Citation Analysis (0)]
14.  Dong JY, Zhang YH, Tong J, Qin LQ. Depression and risk of stroke: a meta-analysis of prospective studies. Stroke. 2012;43:32-37.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 179]  [Cited by in F6Publishing: 205]  [Article Influence: 15.8]  [Reference Citation Analysis (0)]
15.  Pan A, Sun Q, Okereke OI, Rexrode KM, Hu FB. Depression and risk of stroke morbidity and mortality: a meta-analysis and systematic review. JAMA. 2011;306:1241-1249.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 527]  [Cited by in F6Publishing: 529]  [Article Influence: 40.7]  [Reference Citation Analysis (0)]
16.  De Ryck A, Brouns R, Geurden M, Elseviers M, De Deyn PP, Engelborghs S. Risk factors for poststroke depression: identification of inconsistencies based on a systematic review. J Geriatr Psychiatry Neurol. 2014;27:147-158.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 95]  [Cited by in F6Publishing: 106]  [Article Influence: 10.6]  [Reference Citation Analysis (0)]
17.  Tang WK, Chen YK, Liang HJ, Chu WC, Mok VC, Ungvari GS, Wong KS. Location of infarcts and apathy in ischemic stroke. Cerebrovasc Dis. 2013;35:566-571.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 30]  [Cited by in F6Publishing: 32]  [Article Influence: 2.9]  [Reference Citation Analysis (0)]
18.  De Ryck A, Brouns R, Fransen E, Geurden M, Van Gestel G, Wilssens I, De Ceulaer L, Mariën P, De Deyn PP, Engelborghs S. A prospective study on the prevalence and risk factors of poststroke depression. Cerebrovasc Dis Extra. 2013;3:1-13.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 53]  [Cited by in F6Publishing: 59]  [Article Influence: 5.4]  [Reference Citation Analysis (0)]
19.  Hellmann-Regen J, Piber D, Hinkelmann K, Gold SM, Heesen C, Spitzer C, Endres M, Otte C. Depressive syndromes in neurological disorders. Eur Arch Psychiatry Clin Neurosci. 2013;263 Suppl 2:S123-S136.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 38]  [Cited by in F6Publishing: 37]  [Article Influence: 3.4]  [Reference Citation Analysis (0)]
20.  Seppi K, Weintraub D, Coelho M, Perez-Lloret S, Fox SH, Katzenschlager R, Hametner EM, Poewe W, Rascol O, Goetz CG. The Movement Disorder Society Evidence-Based Medicine Review Update: Treatments for the non-motor symptoms of Parkinson’s disease. Mov Disord. 2011;26 Suppl 3:S42-S80.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 645]  [Cited by in F6Publishing: 638]  [Article Influence: 49.1]  [Reference Citation Analysis (0)]
21.  Rocha FL, Murad MG, Stumpf BP, Hara C, Fuzikawa C. Antidepressants for depression in Parkinson’s disease: systematic review and meta-analysis. J Psychopharmacol. 2013;27:417-423.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 63]  [Cited by in F6Publishing: 63]  [Article Influence: 5.7]  [Reference Citation Analysis (0)]
22.  Sagna A, Gallo JJ, Pontone GM. Systematic review of factors associated with depression and anxiety disorders among older adults with Parkinson’s disease. Parkinsonism Relat Disord. 2014;20:708-715.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 91]  [Cited by in F6Publishing: 87]  [Article Influence: 8.7]  [Reference Citation Analysis (0)]
23.  Yang S, Sajatovic M, Walter BL. Psychosocial interventions for depression and anxiety in Parkinson’s disease. J Geriatr Psychiatry Neurol. 2012;25:113-121.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 52]  [Cited by in F6Publishing: 53]  [Article Influence: 4.4]  [Reference Citation Analysis (0)]
24.  Siegert RJ, Abernethy DA. Depression in multiple sclerosis: a review. J Neurol Neurosurg Psychiatry. 2005;76:469-475.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 481]  [Cited by in F6Publishing: 425]  [Article Influence: 22.4]  [Reference Citation Analysis (0)]
25.  Arnett PA, Barwick FH, Beeney JE. Depression in multiple sclerosis: review and theoretical proposal. J Int Neuropsychol Soc. 2008;14:691-724.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 161]  [Cited by in F6Publishing: 158]  [Article Influence: 9.9]  [Reference Citation Analysis (0)]
26.  Gottberg K, Einarsson U, Fredrikson S, von Koch L, Holmqvist LW. A population-based study of depressive symptoms in multiple sclerosis in Stockholm county: association with functioning and sense of coherence. J Neurol Neurosurg Psychiatry. 2007;78:60-65.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 49]  [Cited by in F6Publishing: 48]  [Article Influence: 2.8]  [Reference Citation Analysis (0)]
27.  Jones KH, Ford DV, Jones PA, John A, Middleton RM, Lockhart-Jones H, Osborne LA, Noble JG. A large-scale study of anxiety and depression in people with Multiple Sclerosis: a survey via the web portal of the UK MS Register. PLoS One. 2012;7:e41910.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 107]  [Cited by in F6Publishing: 116]  [Article Influence: 9.7]  [Reference Citation Analysis (0)]
28.  Jones KH, Jones PA, Middleton RM, Ford DV, Tuite-Dalton K, Lockhart-Jones H, Peng J, Lyons RA, John A, Noble JG. Physical disability, anxiety and depression in people with MS: an internet-based survey via the UK MS Register. PLoS One. 2014;9:e104604.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 33]  [Cited by in F6Publishing: 36]  [Article Influence: 3.6]  [Reference Citation Analysis (0)]
29.  Kanner AM, Barry JJ. The impact of mood disorders in neurological diseases: should neurologists be concerned? Epilepsy Behav. 2003;4 Suppl 3:S3-S13.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 34]  [Cited by in F6Publishing: 35]  [Article Influence: 1.7]  [Reference Citation Analysis (0)]
30.  Pucak ML, Carroll KA, Kerr DA, Kaplin AI. Neuropsychiatric manifestations of depression in multiple sclerosis: neuroinflammatory, neuroendocrine, and neurotrophic mechanisms in the pathogenesis of immune-mediated depression. Dialogues Clin Neurosci. 2007;9:125-139.  [PubMed]  [DOI]  [Cited in This Article: ]
31.  Mellers JD. The approach to patients with “non-epileptic seizures”. Postgrad Med J. 2005;81:498-504.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 68]  [Cited by in F6Publishing: 77]  [Article Influence: 4.1]  [Reference Citation Analysis (0)]
32.  Reuber M, Mitchell AJ, Howlett SJ, Crimlisk HL, Grünewald RA. Functional symptoms in neurology: questions and answers. J Neurol Neurosurg Psychiatry. 2005;76:307-314.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 73]  [Cited by in F6Publishing: 72]  [Article Influence: 3.8]  [Reference Citation Analysis (0)]
33.  Hillecke T, Nickel A, Bolay HV. Scientific perspectives on music therapy. Ann N Y Acad Sci. 2005;1060:271-282.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 77]  [Cited by in F6Publishing: 61]  [Article Influence: 3.4]  [Reference Citation Analysis (0)]
34.  Schlaug G. Part VI introduction: listening to and making music facilitates brain recovery processes. Ann N Y Acad Sci. 2009;1169:372-373.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 16]  [Cited by in F6Publishing: 18]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
35.  Koelsch S. A neuroscientific perspective on music therapy. Ann N Y Acad Sci. 2009;1169:374-384.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 190]  [Cited by in F6Publishing: 152]  [Article Influence: 10.1]  [Reference Citation Analysis (0)]
36.  Koelsch S. Towards a neural basis of music-evoked emotions. Trends Cogn Sci. 2010;14:131-137.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 339]  [Cited by in F6Publishing: 269]  [Article Influence: 19.2]  [Reference Citation Analysis (0)]
37.  Raglio A, Fazio P, Imbriani C, Granieri E. Neuro-scientific basis and effectiveness of music and music therapy in neuromotor rehabilitation. OA Alternative Medicine. 2013;1:8-25.  [PubMed]  [DOI]  [Cited in This Article: ]
38.  Chanda ML, Levitin DJ. The neurochemistry of music. Trends Cogn Sci. 2013;17:179-193.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 400]  [Cited by in F6Publishing: 328]  [Article Influence: 29.8]  [Reference Citation Analysis (0)]
39.  Wigram T, Nygaard Pedersen I, Bonde LO.  A comprehensive guide to music therapy: Theory, clinical practice, research and training. London: Jessica Kingsley Publishers 2002; .  [PubMed]  [DOI]  [Cited in This Article: ]
40.  Grocke D, Wigram T.  Receptive methods in music therapy: Methods and techniques for music therapy clinicians, educators, and students. London: Jessica Kingsley Publishers 2006; .  [PubMed]  [DOI]  [Cited in This Article: ]
41.  Gold C, Solli HP, Krüger V, Lie SA. Dose-response relationship in music therapy for people with serious mental disorders: systematic review and meta-analysis. Clin Psychol Rev. 2009;29:193-207.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 222]  [Cited by in F6Publishing: 182]  [Article Influence: 12.1]  [Reference Citation Analysis (0)]
42.  Thaut MH Rhythm, music and the brain: Scientific foundations and clinical applications. New York and London: Taylor & Francis Group 2005; .  [PubMed]  [DOI]  [Cited in This Article: ]
43.  Suh JH, Han SJ, Jeon SY, Kim HJ, Lee JE, Yoon TS, Chong HJ. Effect of rhythmic auditory stimulation on gait and balance in hemiplegic stroke patients. NeuroRehabilitation. 2014;34:193-199.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 31]  [Cited by in F6Publishing: 37]  [Article Influence: 3.7]  [Reference Citation Analysis (0)]
44.  Nombela C, Hughes LE, Owen AM, Grahn JA. Into the groove: can rhythm influence Parkinson‘s disease? Neurosci Biobehav Rev. 2013;37:2564-2570.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 179]  [Cited by in F6Publishing: 178]  [Article Influence: 16.2]  [Reference Citation Analysis (0)]
45.  Kadivar Z, Corcos DM, Foto J, Hondzinski JM. Effect of step training and rhythmic auditory stimulation on functional performance in Parkinson patients. Neurorehabil Neural Repair. 2011;25:626-635.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 72]  [Cited by in F6Publishing: 79]  [Article Influence: 6.1]  [Reference Citation Analysis (0)]
46.  Thaut MH, Leins AK, Rice RR, Argstatter H, Kenyon GP, McIntosh GC, Bolay HV, Fetter M. Rhythmic auditory stimulation improves gait more than NDT/Bobath training in near-ambulatory patients early poststroke: a single-blind, randomized trial. Neurorehabil Neural Repair. 2007;21:455-459.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 206]  [Cited by in F6Publishing: 213]  [Article Influence: 12.5]  [Reference Citation Analysis (0)]
47.  Thaut MH, McIntosh KW, McIntosh GC, Hoemberg V. Auditory rhythmicity enhances movement and speech motor control in patients with Parkinson’s disease. Funct Neurol. 2001;16:163-172.  [PubMed]  [DOI]  [Cited in This Article: ]
48.  Bradt J, Magee WL, Dileo C, Wheeler BL, McGilloway E. Music therapy for acquired brain injury. Cochrane Database Syst Rev. 2010;16:CD006787.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 68]  [Cited by in F6Publishing: 82]  [Article Influence: 5.9]  [Reference Citation Analysis (0)]
49.  Zumbansen A, Peretz I, Hébert S. Melodic intonation therapy: back to basics for future research. Front Neurol. 2014;5:7.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 61]  [Cited by in F6Publishing: 57]  [Article Influence: 5.7]  [Reference Citation Analysis (0)]
50.  Haas R, Brandes V.  Music that Works: Contributions of biology, neurophysiology, psychology, sociology, medicine and musicology. Vienna and New York: Springer-Verlag 2009; .  [PubMed]  [DOI]  [Cited in This Article: ]
51.  MacDonald RA. Music, health, and well-being: a review. Int J Qual Stud Health Well-being. 2013;8:20635.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 80]  [Cited by in F6Publishing: 57]  [Article Influence: 5.2]  [Reference Citation Analysis (0)]
52.  Gerdner LA. Effects of individualized versus classical “relaxation” music on the frequency of agitation in elderly persons with Alzheimer’s disease and related disorders. Int Psychogeriatr. 2000;12:49-65.  [PubMed]  [DOI]  [Cited in This Article: ]
53.  Gerdner LA. Individualized music for dementia: Evolution and application of evidence-based protocol. World J Psychiatry. 2012;2:26-32.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in CrossRef: 46]  [Cited by in F6Publishing: 41]  [Article Influence: 3.4]  [Reference Citation Analysis (1)]
54.  Dunn KS, Riley-Doucet CK. Comparative analysis of two musical genres within a multisensory environmental intervention. J Holist Nurs. 2013;31:62-70.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 9]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
55.  Götell E, Brown S, Ekman SL. Caregiver singing and background music in dementia care. West J Nurs Res. 2002;24:195-216.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 29]  [Cited by in F6Publishing: 34]  [Article Influence: 1.5]  [Reference Citation Analysis (0)]
56.  Maratos AS, Gold C, Wang X, Crawford MJ. Music therapy for depression. Cochrane Database Syst Rev. 2008;1:CD004517.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3035]  [Cited by in F6Publishing: 2412]  [Article Influence: 141.9]  [Reference Citation Analysis (0)]
57.  Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1-12.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12275]  [Cited by in F6Publishing: 12405]  [Article Influence: 443.0]  [Reference Citation Analysis (0)]
58.  Clark HD, Wells GA, Huët C, McAlister FA, Salmi LR, Fergusson D, Laupacis A. Assessing the quality of randomized trials: reliability of the Jadad scale. Control Clin Trials. 1999;20:448-452.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 417]  [Cited by in F6Publishing: 442]  [Article Influence: 17.7]  [Reference Citation Analysis (0)]
59.  Olivo SA, Macedo LG, Gadotti IC, Fuentes J, Stanton T, Magee DJ. Scales to assess the quality of randomized controlled trials: a systematic review. Phys Ther. 2008;88:156-175.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 536]  [Cited by in F6Publishing: 563]  [Article Influence: 35.2]  [Reference Citation Analysis (0)]
60.  Ashida S. The effect of reminiscence music therapy sessions on changes in depressive symptoms in elderly persons with dementia. J Music Ther. 2000;37:170-182.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 113]  [Cited by in F6Publishing: 115]  [Article Influence: 5.0]  [Reference Citation Analysis (0)]
61.  Choi AN, Lee MS, Cheong KJ, Lee JS. Effects of group music intervention on behavioral and psychological symptoms in patients with dementia: a pilot-controlled trial. Int J Neurosci. 2009;119:471-481.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 60]  [Cited by in F6Publishing: 55]  [Article Influence: 3.7]  [Reference Citation Analysis (0)]
62.  Guétin S, Portet F, Picot MC, Pommié C, Messaoudi M, Djabelkir L, Olsen AL, Cano MM, Lecourt E, Touchon J. Effect of music therapy on anxiety and depression in patients with Alzheimer’s type dementia: randomised, controlled study. Dement Geriatr Cogn Disord. 2009;28:36-46.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 218]  [Cited by in F6Publishing: 189]  [Article Influence: 12.6]  [Reference Citation Analysis (1)]
63.  Raglio A, Oasi O, Gianotti M, Manzoni V, Bolis S, Ubezio MC, Gentile S, Villani D, Stramba-Badiale M. Effects of music therapy on psychological symptoms and heart rate variability in patients with dementia. A pilot study. Curr Aging Sci. 2010;3:242-246.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 35]  [Cited by in F6Publishing: 40]  [Article Influence: 3.1]  [Reference Citation Analysis (0)]
64.  Cooke M, Moyle W, Shum D, Harrison S, Murfield J. A randomized controlled trial exploring the effect of music on quality of life and depression in older people with dementia. J Health Psychol. 2010;15:765-776.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 88]  [Cited by in F6Publishing: 92]  [Article Influence: 6.6]  [Reference Citation Analysis (1)]
65.  Fischer-Terworth C, Probst P. Evaluation of a TEACCH- and music therapy-based psychological intervention in mild to moderate dementia. Gero Psych. 2011;24:93-101.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 11]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
66.  Ceccato E, Vigato G, Bonetto C, Bevilacqua A, Pizziolo P, Crociani S, Zanfretta E, Pollini L, Caneva PA, Baldin L. STAM protocol in dementia: a multicenter, single-blind, randomized, and controlled trial. Am J Alzheimers Dis Other Demen. 2012;27:301-310.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 39]  [Cited by in F6Publishing: 42]  [Article Influence: 3.5]  [Reference Citation Analysis (0)]
67.  Janata P. Effects of widespread and frequent personalized music programming on agitation and depression in assisted living facility residents with Alzheimer-type dementia. MMD. 2012;4:8-15.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 39]  [Cited by in F6Publishing: 41]  [Article Influence: 3.2]  [Reference Citation Analysis (0)]
68.  Clemént S, Tonini A, Khatir F, Schiaratura L, Samson S. Short and longer term effects of musical intervention in severe Alzheimer’s disease. Music Percept. 2012;29:533-541.  [PubMed]  [DOI]  [Cited in This Article: ]
69.  Narme P, Clément S, Ehrlé N, Schiaratura L, Vachez S, Courtaigne B, Munsch F, Samson S. Efficacy of musical interventions in dementia: evidence from a randomized controlled trial. J Alzheimers Dis. 2014;38:359-369.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 60]  [Cited by in F6Publishing: 69]  [Article Influence: 6.9]  [Reference Citation Analysis (1)]
70.  Chu H, Yang CY, Lin Y, Ou KL, Lee TY, O’Brien AP, Chou KR. The impact of group music therapy on depression and cognition in elderly persons with dementia: a randomized controlled study. Biol Res Nurs. 2014;16:209-217.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 118]  [Cited by in F6Publishing: 125]  [Article Influence: 11.4]  [Reference Citation Analysis (0)]
71.  Purdie H, Hamilton S, Baldwin S. Music therapy: facilitating behavioural and psychological change in people with stroke--a pilot study. Int J Rehabil Res. 1997;20:325-327.  [PubMed]  [DOI]  [Cited in This Article: ]
72.  Nayak S, Wheeler BL, Shiflett SC, Agostinelli S. Effect of music therapy on mood and social interaction among individuals with traumatic brain injury and stroke. Rehabil Psychol. 2000;3:274-283.  [PubMed]  [DOI]  [Cited in This Article: ]
73.  Jeong S, Kim MT. Effects of a theory-driven music and movement program for stroke survivors in a community setting. Appl Nurs Res. 2007;20:125-131.  [PubMed]  [DOI]  [Cited in This Article: ]
74.  Särkämö T, Tervaniemi M, Laitinen S, Forsblom A, Soinila S, Mikkonen M, Autti T, Silvennoinen HM, Erkkilä J, Laine M. Music listening enhances cognitive recovery and mood after middle cerebral artery stroke. Brain. 2008;131:866-876.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 422]  [Cited by in F6Publishing: 374]  [Article Influence: 23.4]  [Reference Citation Analysis (0)]
75.  Forsblom A, Särkämo T, Laitinen S, Tervaniemi M. The effect of music and audiobook listening on people recovering from stroke: The patient’s point of view. MMD. 2010;2:229-233.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 12]  [Cited by in F6Publishing: 13]  [Article Influence: 0.9]  [Reference Citation Analysis (0)]
76.  Kim DS, Park YG, Choi JH, Im SH, Jung KJ, Cha YA, Jung CO, Yoon YH. Effects of music therapy on mood in stroke patients. Yonsei Med J. 2011;52:977-981.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 50]  [Cited by in F6Publishing: 51]  [Article Influence: 3.9]  [Reference Citation Analysis (0)]
77.  Jun EM, Roh YH, Kim MJ. The effect of music-movement therapy on physical and psychological states of stroke patients. J Clin Nurs. 2013;22:22-31.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 30]  [Cited by in F6Publishing: 31]  [Article Influence: 2.6]  [Reference Citation Analysis (0)]
78.  Chen MC, Tsai PL, Huang YT, Lin KC. Pleasant music improves visual attention in patients with unilateral neglect after stroke. Brain Inj. 2013;27:75-82.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 32]  [Cited by in F6Publishing: 34]  [Article Influence: 3.1]  [Reference Citation Analysis (0)]
79.  Van Vugt FT, Ritter J, Rollnik JD, Altenmüller E. Music-supported motor training after stroke reveals no superiority of synchronization in group therapy. Front Hum Neurosci. 2014;8:315.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 13]  [Cited by in F6Publishing: 16]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
80.  Pacchetti C, Mancini F, Aglieri R, Fundarò C, Martignoni E, Nappi G. Active music therapy in Parkinson’s disease: an integrative method for motor and emotional rehabilitation. Psychosom Med. 2004;62:386-393.  [PubMed]  [DOI]  [Cited in This Article: ]
81.  Schmid W, Aldridge D. Active music therapy in the treatment of multiple sclerosis patients: a matched control study. J Music Ther. 2004;41:225-240.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 26]  [Cited by in F6Publishing: 26]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
82.  Thaut MH, Gardiner JC, Holmberg D, Horwitz J, Kent L, Andrews G, Donelan B, McIntosh GR. Neurologic music therapy improves executive function and emotional adjustment in traumatic brain injury rehabilitation. Ann N Y Acad Sci. 2009;1169:406-416.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 113]  [Cited by in F6Publishing: 93]  [Article Influence: 6.2]  [Reference Citation Analysis (0)]
83.  Horne-Thompson A, Bolger K. An investigation comparing the effectiveness of a live music therapy session and recorded music in reducing anxiety for patients with amyotrophic lateral sclerosis/motor neurone disease. AJMT. 2010;21:23-38.  [PubMed]  [DOI]  [Cited in This Article: ]
84.  Tamplin J, Baker FA, Grocke D, Brazzale DJ, Pretto JJ, Ruehland WR, Buttifant M, Brown DJ, Berlowitz DJ. Effect of singing on respiratory function, voice, and mood after quadriplegia: a randomized controlled trial. Arch Phys Med Rehabil. 2013;94:426-434.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 46]  [Cited by in F6Publishing: 48]  [Article Influence: 4.0]  [Reference Citation Analysis (0)]
85.  Cooke SF, Bliss TV. Plasticity in the human central nervous system. Brain. 2006;129:1659-1673.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 737]  [Cited by in F6Publishing: 687]  [Article Influence: 38.2]  [Reference Citation Analysis (0)]
86.  Ziemann U, Paulus W, Nitsche MA, Pascual-Leone A, Byblow WD, Berardelli A, Siebner HR, Classen J, Cohen LG, Rothwell JC. Consensus: Motor cortex plasticity protocols. Brain Stimul. 2008;1:164-182.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 434]  [Cited by in F6Publishing: 428]  [Article Influence: 26.8]  [Reference Citation Analysis (0)]
87.  Berlucchi G, Buchtel HA. Neuronal plasticity: historical roots and evolution of meaning. Exp Brain Res. 2009;192:307-319.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 102]  [Cited by in F6Publishing: 73]  [Article Influence: 4.6]  [Reference Citation Analysis (0)]
88.  Willner P, Scheel-Krüger J, Belzung C. The neurobiology of depression and antidepressant action. Neurosci Biobehav Rev. 2013;37:2331-2371.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 295]  [Cited by in F6Publishing: 311]  [Article Influence: 25.9]  [Reference Citation Analysis (0)]
89.  Price JL, Drevets WC. Neural circuits underlying the pathophysiology of mood disorders. Trends Cogn Sci. 2012;16:61-71.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 563]  [Cited by in F6Publishing: 559]  [Article Influence: 43.0]  [Reference Citation Analysis (0)]
90.  Haghgoo HA, Pazuki ES, Hosseini AS, Rassafiani M. Depression, activities of daily living and quality of life in patients with stroke. J Neurol Sci. 2013;328:87-91.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 69]  [Cited by in F6Publishing: 75]  [Article Influence: 6.8]  [Reference Citation Analysis (0)]
91.  Michalski D, Liebig S, Thomae E, Hinz A, Bergh FT. Pain in patients with multiple sclerosis: a complex assessment including quantitative and qualitative measurements provides for a disease-related biopsychosocial pain model. J Pain Res. 2011;4:219-225.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 20]  [Cited by in F6Publishing: 24]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
92.  Marchetti RL, Kurcgant D, Neto JG, von Bismark MA, Marchetti LB, Fiore LA. Psychiatric diagnoses of patients with psychogenic non-epileptic seizures. Seizure. 2008;17:247-253.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 42]  [Cited by in F6Publishing: 33]  [Article Influence: 1.9]  [Reference Citation Analysis (0)]
93.  Rickards H. Depression in neurological disorders: Parkinson’s disease, multiple sclerosis, and stroke. J Neurol Neurosurg Psychiatry. 2005;76 Suppl 1:i48-i52.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 119]  [Cited by in F6Publishing: 121]  [Article Influence: 6.4]  [Reference Citation Analysis (0)]
94.  Wan CY, Schlaug G. Music making as a tool for promoting brain plasticity across the life span. Neuroscientist. 2010;16:566-577.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 252]  [Cited by in F6Publishing: 239]  [Article Influence: 18.4]  [Reference Citation Analysis (0)]
95.  Altenmüller E, Marco-Pallares J, Münte TF, Schneider S. Neural reorganization underlies improvement in stroke-induced motor dysfunction by music-supported therapy. Ann N Y Acad Sci. 2009;1169:395-405.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 149]  [Cited by in F6Publishing: 163]  [Article Influence: 10.9]  [Reference Citation Analysis (0)]