New trial to investigate if music therapy helps patients recover from brain injury

The trial at the National Hospital for Neurology and Neurosurgery (NHNN) will involve patients recovering in hospital following conditions such as stroke and aphasia.

There is already some evidence that music therapy can be beneficial for these groups of patients, and improve memory and mood.

However, the trial at UCLH is the first time the therapy will be tested in a randomised control trial involving patients with severe brain injury who are undergoing a specialist rehabilitation programme.

NICE recommended investigating the therapy in this way in their latest stroke rehabilitation guideline, published in October 2023.

The therapy will be an intensive programme lasting three to four months and will involve inpatients who have already been referred for rehab at UCLH. It will form part of the patients’ rehabilitation in the hospital ward.

The team will look at a variety of measures before, during and after the therapy, including independence in daily activities, mobility, communication with loved ones, mood, and other measures of wellbeing.

In music therapy sessions, patients will be invited to actively participate in the music making and could get involved in playing instruments, singing familiar songs, making up music from scratch, or a combination.

Patients may also prefer to listen to and discuss music or work towards a specific musical goal. It is fluid and will be responsive to each patient.

Trial lead, Dr Sara Ajina (UCL Queen Square Institute of Neurology, and Rehabilitation Medicine at UCLH), said: “A patient’s recovery from severe brain injury can take time and can be challenging. We already know that music can activate multiple brain regions – and we hope to be able to provide robust evidence that inclusion of music therapy in a patient’s programme of rehabilitation is helpful to patients.

“If we can do this, we will build on indications which already suggest that the therapy can help with things like communication, mood and anxiety levels. And we will help ensure more patients have access to the therapy in future.”

In a control arm of the trial, participants will receive a different recreation-based intervention. If they are still in hospital, they will be offered music therapy when they finish the control intervention.

The trial is led by UCL and UCLH, working with the music therapy charity Nordoff and Robbins who will deliver the music therapy sessions. The trial is funded by UCLH Charity with additional funding from The National Brain Appeal.

Rebecca Burns, music therapist at Nordoff and Robbins who will deliver the one-to-one therapy sessions, said: “Music can involve the whole person, physically, mentally, emotionally, and spiritually, making it an especially versatile tool in the context of neurorehabilitation.

“We know from research and from our own experiences that music has a range of positive effects: it can improve mood, stimulate positive memories, bring people together and help people to express themselves even if they struggle with verbal communication.

“I’ve worked with many patients who have struggled with speech but have been able to sing and make music with fluency due to the different brain regions and processes involved. Music can also make us want to move, and I often see how this supports patients in their functional tasks on the unit. For these reasons and more, we think music therapy will help patients recover from brain injury and improve their quality of life in hospital and beyond.”

The trial was set up by Nicola Perkins – a speech and language therapist within the UCLH neurorehabilitation unit. Ms Perkins helped to ensure the trial was inclusive for those with severe thinking and/or communication difficulties who are not normally invited to take part in research. This means that all patients currently in hospital at UCLH in recovery from severe brain injury will be able to take part.

The trial is being delivered following a successful feasibility study done in 2019 by Rebecca Burns. In that study, 100% of patients who had the therapy strongly agreed that it can be helpful.

For example, patients felt that the therapy improved their self-esteem, social interaction and anxiety (92%), cognitive skills (88%), and communications skills and speech (84%). Meanwhile, 76% felt the therapy had an impact beyond sessions.

Links

• Stroke rehabilitation in adults. NICE guideline [NG236] Published: 18 October 2023
• Dr Sara Ajina's academic profile

Image

• Credit: kzenon on iStock