Music-based therapy in rehabilitation of people with multiple sclerosis: a systematic review of clinical trials

Abstract

Background: Multiple sclerosis (MS) is a major cause of chronic neurological disability in young adults. An increasing number of controlled studies have assessed the potential rehabilitative effects of new drug-free treatments, complementary to the standard care, including music-based therapy (MBT). Objective: To analyze the evidence for the effectiveness of MBT within the therapeutic approaches to individuals diagnosed with MS. Methods: A systematic review of clinical trials was performed with searches in the following databases: BIOSIS, CINAHL, Cochrane, EBSCO, ERIC, Google Scholar, IBECS, LILACS, LISA (ProQuest), Medline, PEDro, PsycINFO (APA), Psychological & Behavioral, PubMed, SciELO, Scopus, SPORTDiscus and Web of Science. Clinical trials comparing MBT versus conventional therapy/no intervention were included. Results: From the 282 studies identified, 10 trials were selected. Among these, the total sample consisted of 429 individuals: 253 were allocated to the experimental group (MBT) and 176 to the control group (conventional therapies or no intervention). All the studies presented high methodological quality. Modalities of MBT were clustered into four groups: (1) Rhythmic auditory; (2) Playing musical instruments; (3) Dance strategy; and (4) Neurological music therapy. Overall, the studies consistently showed that MBT was better than conventional therapy or no intervention, with regard to gait parameters (double support time and walking speed), fatigue level, fatigability, coordination, dexterity, balance, walking endurance, lower extremity functional strength, emotional status and pain. Regarding mental fatigability and memory, the data were conflicting and the evidence was unclear. Conclusion: MBT is a safe and effective approach for clinical rehabilitation of MS patients that leads to positive results regarding both motor and non-motor functions.

RESUMO

Introdução: A esclerose múltipla (EM) é a maior causa de incapacidade neurológica crônica em adultos jovens. Um crescente número de estudos controlados avalia a reabilitação por meio de tratamentos não medicamentosos, cuidados complementares incluindo a terapia baseada na música (TBM). Objetivo: Analisar a evidência de efetividade da TBM na abordagem terapêutica de indivíduos diagnosticados com EM. Métodos: Foi realizada uma revisão sistemática de ensaios clínicos com busca nas bases de dados Biosis, Cinahl, Cochrane, Ebsco, Eric, Google Scholar, Ibecs, Lilacs, Lisa (ProQuest), Medline, PEDro, PsycINFO (APA), Psychological & Behavioral, PubMed, SciELO, Scopus, Sportdiscus e Web of Science. Foram incluídos ensaios clínicos comparando TBM versus terapia convencional/sem intervenção. Resultados: Dentre os 282 estudos identificados, 10 ensaios foram selecionados. Desses, a amostra total consistia em 429 indivíduos (253 alocados no grupo experimental (TBM) e 176 no grupo controle (terapias convencionais ou sem intervenção). Todos os estudos apresentaram elevada qualidade metodológica. Modalidades da TBM foram reunidas em quatro grupos: (1) Audição rítmica; (2) Tocar instrumentos musicais; (3) Dança como estratégia; e (4) Terapia neurofuncional baseada na música. A maioria dos estudos identificou que a TBM é melhor que a terapia convencional ou nenhuma intervenção nos parâmetros da marcha (duplo apoio e velocidade), níveis de fadiga, fatigabilidade, coordenação, destreza, equilíbrio, força de membros inferiores, estado emocional e dor. Os dados sobre fatigabilidade mental e memória foram conflitantes e as evidências são incertas. Conclusão: A TBM é uma abordagem segura na reabilitação clínica de indivíduos com EM e propicia resultados positivos nas funções motoras e não motoras.

Keywords:

Multiple Sclerosis - Music Therapy - Rehabilitation

Palavras-chave:

Esclerose Múltipla - Musicoterapia - Reabilitação

• References

• 1 Geel FV, Asch PV, Veldkamp R, Feys P. Effects of a 10-week multimodal dance and art intervention program leading to a public performance in persons with multiple sclerosis - A controlled pilot-trial. Mult Scler Relat Disord. 2020 Jun;44:102256. https://doi.org/10.1016/j.msard.2020.102256
• 2 Impellizzeri F, Leonardi S, Latella D, Maggio MG, Cuzzola MF, Russo M, et al. An integrative cognitive rehabilitation using neurologic music therapy in multiple sclerosis. A pilot study. Medicine. 2020 Jan;99(4):e18866. https://doi.org/10.1097/MD.202003740000018866
• 3 Sihvonen AJ, Särkämö T, Leo V, Tervaniemi M, Altenmüller E, Soinila S. Music-based interventions in neurological rehabilitation. Lancet Neurol. 2017;16:648-60. https://doi.org/10.1016/S1474-4422(17)30168-0.
• 4 Longstaff MG, Heath RA. Spiral drawing performance as an indicator of fine motor function in people with multiple sclerosis. Hum Mov Sci. 2006;25:474-91. https://doi.org/10.1016/j.humov.2006.05.005
• 5 Hassan-Smith G, Douglas MR. Epidemiology and diagnosis of multiple sclerosis. Br J Hosp Med (Lond). 2011;72:M146-51. https://doi.org/10.12968/hmed.2011.72.sup10.m146
• 6 World Health Organization. Atlas: Multiple Sclerosis resources in the world. Geneva: WHO and 236 Multiple Sclerosis International Federation; 2008.
• 7 Jacobs BM, Giovannoni G, Cuzick J, Dobson R. Systematic review and meta-analysis of the association between Epstein-Barr virus, multiple sclerosis and other risk factors. Mult Scler. 2020 Mar:1352458520907901. https://doi.org/10.1177/1352458520907901
• 8 Khan F, Amatya B. Rehabilitation in Multiple Sclerosis: a Systematic Review of Systematic Reviews. Arch Phys Med Rehabil. 2017 Feb;98(2):353-67. https://doi.org/10.1016/j.apmr.2016.04.016
• 9 Khan F, McPhail T, Brand C, Turner-Stokes L, Kilpatrick T. Multiple sclerosis: disability profile and quality of life in an Australian community cohort. Int J Rehabil Res. 2006 Jun;29(2):87-96. https://doi.org/10.1097/01.mrr.0000194393.56772.62
• 10 Khan F, Pallant JF. Use of the International Classification of Functioning, Disability and Health (ICF) to identify preliminary comprehensive and brief core sets for multiple sclerosis. Disabil Rehabil. 2007 Feb;29(3):205-13. https://doi.org/10.1080/09638280600756141
• 11 Hammond SR, McLeod JG, Macaskill P, English DR. Multiple sclerosis in Australia: prognostic factors. J Clin Neurosci. 2000 Jan;7(1):16-9. https://doi.org/10.1054/jocn.1998.0107
• 12 Khan F, Amatya B, Turner-Stokes L. Symptomatic therapy and rehabilitation in primary progressive multiple sclerosis. Neurol Res Int. 2011;2011:740505. https://doi.org/10.1155/2011/740505
• 13 Comi G, Radaelli M, Sorensen SP. Evolving concepts in the treatment of relapsing remitting multiple sclerosis. Lancet. 2017 Apr;389(10076):1347-56. https://doi.org/10.1016/S0140-6736(16)32388-1
• 14 Moumdjian L, Sarkamo T, Leone C, Leman M, Feys P. Effectiveness of music- based interventions on motoricity or cognitive functioning in neurological populations: a systematic review. Eur J Phys Rehabil Med. 2017;53(3):466-82. https://doi.org/10.23736/S1973-9087.16.04429-4
• 15 Raglio A, Attardo L, Gontero G, Rollino S, Groppo E, Granieri E. Effects of music therapy on mood in neurological patients. World J Psychiatry. 2015 Mar;5(1):68-78. https://doi.org/10.5498/wjp.v5.i1.68
• 16 Ostermann T, Schmid W. Music therapy in the treatment of multiple sclerosis: a comprehensive literature review. Expert Rev Neurother. 2006 Apr;6(4):469-77. https://doi.org/10.1586/14737175.6.4.469
• 17 Thaut MH, Hoemberg, V. Handbook of neurologic music therapy. UK: Oxford University Press; 2014.
• 18 Thaut MH. The discovery of human auditory-motor entrainment and its role in the development of neurologic music therapy. Prog Brain Res. 2015;217:253-66. https://doi.org/10.1016/bs.pbr.2014.11.030
• 19 Repp BH, Su YH. Sensorimotor synchronization: A review of recent research (2006-2012). Psychon Bull Rev. 2013 Jun;20(3):403-52. https://doi.org/10.3758/s13423-012-0371-2
• 20 Francois C, Grau-Sanchez J, Duarte E, Rodriguez-Fornells A. Musi¬cal training as an alternative and effective method for neuro-educa¬tion and neuro-rehabilitation. Front Psychol. 2015 Apr;6:475. https://doi.org/10.3389/fpsyg.2015.00475
• 21 Särkämö T, Soto D. Music listening after stroke: beneficial effects and potential neural mechanisms. Ann N Y Acad Sci. 2012 Apr;1252:266-81. https://doi.org/10.1111/j.1749-6632.2011.06405.x
• 22 Wan CY, Schlaug G. Music making as a tool for promoting brain plasticity across the life span. Neuroscientist. 2010 Oct;16(5):566-77. https://doi.org/10.1177/1073858410377805
• 23 Tschacher W, Schildt M, Sander K. Brain connectivity in listening to affective stimuli: A functional magnetic resonance imaging (fMRI) study and implications for psychotherapy. Psychother Res. 2010 Sep;20(5):576-88. https://doi.org/10.1080/10503307.2010.493538
• 24 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 Jul;1169:395-405. https://doi.org/10.1111/j.1749-6632.2009.04580.x
• 25 Hsu MH, Flowerdew R, Parker M, Fachner J, Odell-Miller H. Individual music therapy for managing neuropsychiatric symptoms for people with dementia and their carers: a cluster randomized controlled feasibility study. BMC Geriatr. 2015;15:84. https://doi.org/10.1186/s12877-015-0082-4
• 26 Chu H, Yang CY, Lin Y, Ou KL, Lee TY, O'Brien AP, et al. The impact of group music therapy on depression and cognition in elderly persons with dementia: a randomized controlled study. Biol Res Nurs. 2014 Apr;16(2):209-17. https://doi.org/10.1177/1099800413485410
• 27 Shin YK, Chong HJ, Kim SJ, Cho SR. Effect of rhythmic auditory stimulation on hemiplegic gait patterns. Yonsei Med J. 2015 Nov;56(6):1703-13. https://doi.org/10.3349/ymj.2015.56.6.1703
• 28 Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analyses protocols (PRISMA-P) 2015 statement. Syst Rev. 2015 Jan;4(1):1. https://doi.org/10.1186/2046-4053-4-1
• 29 Green S, Higgins JP, Alderson P, Clarke M, Mulrow COA. Introduction. In: Higgins JP GS, editor. Cochrane handbook for systematic reviews of inter-ventions. England: Willey-Blackwell; 2008. p.1.1-1.2. https://doi.org/10.1002/9780470712184.ch1
• 30 Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55(2):129-33. https://doi.org/10.1016/s0004-9514(09)70043-1
• 31 Conklyn D, Stough D, Novak E, Paczak S, Chemali K, Bethoux F. A Home-based walking program using rhythmic auditory stimulation improves gait performance in patients with multiple sclerosis: a pilot study. Neurorehabil Neural Repair. Nov-Dec 2010;24(9):835-42. https://doi.org10.1177/1545968310372139
• 32 Seebacher B, Kuisma R, Glynn A, Berger T. The effect of rhythmic-cued motor imagery on walking, fatigue and quality of life in people with multiple sclerosis: A randomised controlled trial. Mult Scler. 2017 Feb;23(2):286-96. https://doi.org/10.1177/1352458516644058
• 33 Seebacher B, Kuisma R, Glynn A, Berger T. Effects and mechanisms of differently cued and non-cued motor imagery in people with multiple sclerosis: A randomised controlled trial. Mult Scler. 2019. Oct;25(12):1593-604. https://doi.org/10.1177/1352458518795332
• 34 Gatti R, Tettamanti A, Lambiase S, Rossi P, Comola M. Improving hand functional use in subjects with multiple sclerosis using a musical keyboard: a randomized controlled trial. Physiother Res Int. 2015 Jun;20(2):100-7. https://doi.org/10.1002/pri.1600
• 35 Young H-J, Mehta TS, Herman C, Wang F, Rimmer JH. The effects of M2M and adapted yoga on physical and psychosocial outcomes in people with multiple sclerosis. Arch Phys Med Rehabil. 2019 Mar;100(3):391-400. https://doi.org/10.1016/j.apmr.2018.06.032
• 36 Moore KS, Peterson DA, O'Shea G, Mclntosh GC, Thaut MH. The Effectiveness of music as a mnemonic device on recognition memory for people with multiple sclerosis. J Music Ther. 2008 Fall;45(3):307-29. https://doi.org/10.1093/jmt/45.3.307
• 37 Aldridge D, Schmid W, Kaeder M, Schmidt C, Ostermann T. Functionality or aesthetics? A pilot study of music therapy in the treatment of multiple sclerosis patients. Complement Ther Med. 2005 Mar;13(1):25-33. https://doi.org/10.1016/j.ctim.2005.01.004
• 38 Thaut M. Music therapy, affect modification, and therapeutic change: towards an integrative model. Music Ther Perspect. 1989;7(1):55-62. https://doi.org/10.1093/mtp/7.1.55
• 39 Davis WB, Gfeller KE, Thaut MH. An introduction to music therapy: Theory and practice. 3. ed. Silver Spring, MD: American Music Therapy Association; 2008.
• 40 Moreira SV, Miotto EC, Alcântara-Silva TR, Oliveira PN, Silva DJ, Moreira M. Musicoterapia como estratégia de reabilitação de pacientes com esclerose múltipla: uma revisão sistemática. LAMSJ. 2012;1(3):139-144 [accessed on 2020 Jun 11]. Available at: https://www.researchgate.net/publication/256498573
• 41 Särkämö T, Ripollés P, Vepsäläinen H, Autti T, Silvennoinen HM, Salli E, et al. Structural changes induced by daily music listening in the recovering brain after middle by daily music listening in the recovering brain after middle cerebral artery stroke: a voxel based morphometry study. Front Hum Neurosci. 2014;8:245. https://doi.org/10.3389/fnhum.2014.00245
• 42 Vinciguerra C, De Stefano N, Federico A. Exploring the role of music therapy in multiple sclerosis: brief updates from research to clinical practice. Neurol Sci. 2019 Nov;40(11):2277-2285. https://doi.org/10.1007/s10072-019-04007-x
• 43 Molinari M, Leggio MG, De Martin M, Cerasa A, Thaut M. Neurobiology of rhythmic motor entrainment. Ann N Y Acad Sci. 2003 Nov;999:313-21. https://doi.org/10.1196/annals.1284.042
• 44 Scholz DS, Rohde S, Nikmaram N, Brückner HP, Großbach M, Rollnik JD, Altenmüller EO. Sonification of arm movements in stroke rehabilitation-a novel approach in neurologic music therapy. Front Neurol. 2016 Jun;7:106. https://doi.org/10.3389/fneur.2016.00106
• 45 Chiaravalloti ND, DeLuca J. Cognitive impairment in multiple sclerosis. Lancet Neurol. 2008 Dec;7(12):1139-51. https://doi.org/10.1016/S1474-4422(08)70259-X
• 46 Salimpoor VN, Benovoy M, Larcher K, Dagher A, Zatorre RJ. Anatomically distinct dopamine release during anticipation and experience of peak emotion to music. Nat Neurosci. 2011 Feb;14(2):257-62. https://doi.org/10.1038/nn.2726
• 47 Okada K, Kurita A, Takase B, Otsuka T, Kodani E, Kusama Y, et al. Effects of music therapy on autonomic nervous system activity, incidence of heart failure events, and plasma cytokine and catecholamine levels in elderly patient with cerebrovascular diseases and dementia. Int Heart J. 2009 Jan;50(1):95-110. https://doi.org/10.1536/ihj.50.95