Music - Brain Injury

Music therapy for acquired brain injury (Review)
Bradt J, Magee WL, Dileo C, Wheeler BL, McGilloway E
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2010, Issue 7
http://www.thecochranelibrary.com
Music therapy for acquired brain injury (Review)

Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
TABLE OF CONTENTS
HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
AUTHORS’ CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Analysis 1.1. Comparison 1 Music therapy versus control, Outcome 1 Gait velocity. . . . . . . . . . . . . 25
Analysis 1.2. Comparison 1 Music therapy versus control, Outcome 2 Gait stride length. . . . . . . . . . . 26
Analysis 1.3. Comparison 1 Music therapy versus control, Outcome 3 Gait cadence. . . . . . . . . . . . 26
Analysis 1.4. Comparison 1 Music therapy versus control, Outcome 4 Gait symmetry. . . . . . . . . . . . 27
APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
DIFFERENCES BETWEEN PROTOCOL AND REVIEW . . . . . . . . . . . . . . . . . . . . . 42
INDEX TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Music therapy for acquired brain injury (Review) i

[Intervention Review]
Music therapy for acquired brain injury
Joke Bradt1 , Wendy L Magee2 , Cheryl Dileo3 , Barbara L Wheeler4, Emer McGilloway5
1 The Arts and Quality of Life Research Center, Boyer College of Music and Dance, Temple University, Philadelphia, USA. 2 Institute
of Neuropalliative Rehabilitation, Royal Hospital for Neuro-disability, London, UK. 3 Department of Music Therapy and The Arts
and Quality of Life Research Center, Boyer College of Music and Dance, Temple University, Philadelphia, USA. 4 School of Music,
University of Louisville, Louisville, KY, USA. 5 Wolfson Neurorehabilitation Centre, London, UK
Contact address: Joke Bradt, The Arts and Quality of Life Research Center, Boyer College of Music and Dance, Temple University,
Presser Hall, 2001 North 13 Street, Philadelphia, USA. jbradt@temple.edu.
Editorial group: Cochrane Stroke Group.

Publication status and date: New, published in Issue 7, 2010.
Review content assessed as up-to-date: 28 March 2010.
Citation: Bradt J, Magee WL, Dileo C, Wheeler BL, McGilloway E. Music therapy for acquired brain injury. Cochrane Database of
Systematic Reviews 2010, Issue 7. Art. No.: CD006787. DOI: 10.1002/14651858.CD006787.pub2.
ABSTRACT
Background
Acquired brain injury (ABI) can result in impairments in motor function, language, cognition, sensory processing and emotional
disturbances. This may severely reduce a survivor’s quality of life. Music therapy has been used in rehabilitation to stimulate brain
functions involved in movement, cognition, speech, emotions and sensory perceptions. A systematic review is needed to gauge the
efficacy of music therapy as a rehabilitation intervention for people with ABI.
Objectives
To examine the effects of music therapy with standard care versus standard care alone or standard care combined with other therapies
on gait, upper extremity function, communication, mood and emotions, social skills, pain, behavioral outcomes, activities of daily
living and adverse events.
Search methods
We searched the Cochrane Stroke Group Trials Register (February 2010), the Cochrane Central Register of Controlled Trials (The
Cochrane Library Issue 2, 2009), MEDLINE (July 2009), EMBASE (August 2009), CINAHL (March 2010), PsycINFO (July 2009),
LILACS (August 2009), AMED (August 2009) and Science Citation Index (August 2009). We handsearched music therapy journals and
conference proceedings, searched dissertation and specialist music databases, trials and research registers, reference lists, and contacted
experts and music therapy associations. There was no language restriction.
Selection criteria
Randomized and quasi-randomized controlled trials that compared music therapy interventions and standard care with standard care
alone or combined with other therapies for people older than 16 years of age who had acquired brain damage of a non-degenerative
nature and were participating in treatment programs offered in hospital, outpatient or community settings.
Data collection and analysis
Two review authors independently assessed methodological quality and extracted data. We present results using mean differences (using
post-test scores) as all outcomes were measured with the same scale.
Music therapy for acquired brain injury (Review) 1
Main results
We included seven studies (184 participants). The results suggest that rhythmic auditory stimulation (RAS) may be beneficial for
improving gait parameters in stroke patients, including gait velocity, cadence, stride length and gait symmetry. These results were based
on two studies that received a low risk of bias score. There were insufficient data to examine the effect of music therapy on other
outcomes.
Authors’ conclusions
RAS may be beneficial for gait improvement in people with stroke. These results are encouraging, but more RCTs are needed before
recommendations can be made for clinical practice. More research is needed to examine the effects of music therapy on other outcomes
in people with ABI.
PLAIN LANGUAGE SUMMARY
Music therapy for acquired brain injury
Acquired brain injury can result in problems with movement, language, sensation, thinking or emotion. Any of these may severely
reduce a survivor’s quality of life. Many innovative therapy techniques have been developed to help recover lost functions and to prevent
depression. Music therapy involves using music to aid rehabilitation. Specific treatments may include the use of rhythmic stimulation
to aid movement and walking, singing to address speaking and voice quality, listening to music to reduce pain and the use of music
improvisations to address emotional needs and enhance a sense of wellbeing. We identified and included seven studies (involving 184
participants) in this review, all of which were carried out by a trained music therapist. The results suggest that rhythmic auditory
stimulation may be beneficial for improving measures of walking, but there was insufficient information to examine the effect of music
therapy on other outcomes. Further clinical trials are needed.
BACKGROUND tivation. Recovery of lost functions and skills after acquired brain
Acquired brain damage embraces a range of conditions involving damage is typically incomplete, putting survivors at increased risk
rapid onset of brain injury, including trauma due to head injury or for depression. Effective treatment of depression may bring sub-
postsurgical damage, vascular accident such as stroke or subarach- stantial benefits by improving medical status, enhancing quality
noid hemorrhage, cerebral anoxia, toxic or metabolic insult such of life, and reducing pain and disability (van de Port 2007; Whyte
as hypoglycemia, and infection or inflammation (RCP 2004). Ac- 2006).
quired brain injury (ABI) can result in impairments in motor func-
tion, language, cognition, sensory processing as well as emotional Acquired brain injury causes significant levels of disabilities which
disturbances. Hemiplegia and hemiparesis are common and may tend to result in long-term problems. It is estimated that in 2003
severely reduce a survivor’s quality of life. Consequently, a primary there were 135,000 people living with long-term problems follow-
concern in rehabilitation for acquired brain injury is the restora- ing brain injury in the UK and a further 300,000 people living with
tion of motor function. The improvement of ambulation and up- disabilities stemming from stroke (NA 2003). Figures from the
per extremity function directly affects the level of independence of US exceed those in the UK with an estimated 1.5 million people
the patient related to activities of daily living. The affected indi- who sustain a traumatic brain injury each year, of whom 80,000
vidual is likely to be left with communication impairments, such to 90,000 will be left with long-term disability (NCIPC 2001).
as a severely reduced ability to understand, speak, and use spoken Approximately 5.3 million Americans or 2% of the population
and written language, which can result in isolation. Furthermore, of all ages have long-term or lifelong needs for help to perform
brain damage often leads to disturbances in memory, learning, personal activities of daily living following traumatic brain injury
and awareness. Sensory disturbances and neuropathic pain may (Thurman 1999). Finally, the World Health Organization esti-
result from damage to the nervous system. Finally, there may be mated that, in 2001, there were over 20.5 million strokes world-
behavioral implications resulting in disinhibition, apathy and mo- wide. With the population ageing, even if the stroke incidence
stagnates, the number of stroke patients requiring medical and OBJECTIVES
rehabilitation care will rise dramatically over the next two decades
(WHO 2002). Further work needs to be done to identify the di- 1. To identify randomized controlled trials (RCTs) examining
rect and indirect financial costs of acquired brain injury to society the efficacy of music therapy in addressing recovery in patients
within the UK (Turner-Stokes 2003). However, within the US, with acquired brain injuries.
the costs associated with traumatic brain injury alone were esti-
2. To compare the efficacy of music therapy and standard care
mated to be around USD 60 billion for 2000 (Finkelstein 2006).
with (a) standard care alone, (b) standard care and placebo
Acquired brain injury therefore has significant effects on society
treatments, or (c) standard care and other therapies.
in terms of human and economic costs.
3. To compare the efficacy of different types of music therapy
Many innovative therapy techniques have been developed to help interventions.
the restoration of lost functions and to aid in prevention and treat-
ment of depression in acquired brain injury survivors. Music ther-
apy has been used in rehabilitation settings to stimulate brain func-
METHODS
tions involved in movement, cognition, speech, emotions, and
sensory perceptions. Interventions range from the use of rhythmic
auditory stimulation to aid in the execution of movement and
normalization of gait parameters (Thaut 1993), to music listening
Criteria for considering studies for this review
and singing to reduce pain (Kim 2005), to the use of music lis-
tening, music improvisations, composition and song discussions
to address emotional needs and enhance the sense of wellbeing Types of studies
(Nayak 2000). Music listening has also been used by non-music All prospective RCTs, parallel group designs as well as cross-over
therapists in rehabilitation settings to enhance relaxation, provide trials, of any language, published and unpublished, were eligible
distraction, and reduce pain. It is important to distinguish mu- for entry. We included controlled clinical trials (CCTs) with quasi-
sic therapy interventions from the administration of music to pa- randomized or systematic methods of treatment allocation (e.g.
tients by medical personnel. Music therapists have specific clinical alternate allocation of treatments) because only a limited number
training in assessing individual patients’ needs. Clinical practice is of RCTs were identified.
underpinned by music therapy theory. Treatment involves select-
ing from a range of music-based interventions, using both music
and the therapist-patient relationship as agents of change. In many Types of participants
countries, music therapists are board-certified, registered and/or We included patients of any gender and older than 16 years of
licensed as professionals. Therefore, interventions are classified as age who had acquired brain damage of a non-degenerative nature
music therapy if the following components are present: (1) imple- and were participating in treatment programs offered in hospital,
mentation of goal-directed music interventions by a trained music outpatient or community settings at the time that they received
therapist, and (2) the use of music experiences individualized to music therapy. This includes traumatic brain injury, stroke, anoxia,
patient need. In rehabilitation settings, these interventions may in- infection and any mixed cause. We excluded any condition of a
clude (1) listening and moving to live, improvised or pre-recorded progressive nature. We did not use the site of lesion and stage of
music as well as rhythmic auditory stimulation, (2) performing rehabilitation as inclusion or exclusion criteria.
music on an instrument, (3) improvising music spontaneously us-
ing voice or instruments or both, (4) singing or vocal activities to
Types of interventions
music, (5) music-based speech and language activities, (6) com-
posing music, and (7) music combined with other modalities (e.g. We included all studies in which standard treatment combined
imagery, art) (Dileo 2007; Magee 2006; Magee 2009). with music therapy was compared with: (1) standard care alone,
(2) standard care with placebo, or (3) standard care combined
Many research studies on the use of music in rehabilitation of ac- with other therapies. In addition, we considered studies only if (1)
quired brain injury have suffered from small sample size, making it music therapy was delivered by a formally trained music therapist
difficult to achieve statistically significant results. In addition, dif- or by trainees in a formal music therapy program, and (2) one of
ferences in factors such as study designs, methods of interventions, the following music therapy interventions was used (Magee 2006):
and intensity of treatment have led to varying results. A systematic • clinical improvisation in which participants are involved in
review is needed to more accurately gauge the efficacy of music active music making in dialogue with the therapist using musical
therapy as a rehabilitation intervention for people with acquired instruments or voice;
brain injury as well as to identify variables that may moderate its • voice and singing techniques including song-singing
effects. programs, melodic intonation therapy or modified melodic

intonation therapy, vocal intonation therapy, rhythmic speech • Science Citation Index (1974 to August 2009) (Appendix
cueing, and therapeutic singing; 8);
• rhythmic auditory stimulation or rhythmic auditory cueing; • CAIRSS for Music (Computer-Assisted Information
• receptive techniques in which participants listen to music; Retrieval Service System) (August 2009) (Appendix 9);
• song-writing; • Proquest Digital Dissertations (1861 to August 2009)
• any combination of the above. (Appendix 10);
• ClinicalTrials.gov (http://www.clinicaltrials.gov/) (August
2009) (Appendix 11);
Types of outcome measures • Current Controlled Trials (http://www.controlled-
trials.com/) (August 2009) (Appendix 12);
• The National Research Register (NRR) Archive (https://
Primary outcomes portal.nihr.ac.uk/Pages/NRRArchiveSearch.aspx) (August 2009)
Rehabilitation of mobility is crucial in acquired brain injury re- (Appendix 13);
habilitation to enhance personal independence. Therefore, we se- • Rehab Trials.org (http://www.kesslerfoundation.org/)
lected the following primary outcomes for this review. (August 11 2009) (Appendix 14);
1. Improvement in gait, measured by changes in gait velocity, • Indexes to Theses in Great Britain and Ireland (http://
cadence, stride length, stride symmetry, stride timing. www.theses.com/) (August 2009) (Appendix 15);
2. Improvement in upper extremity function, measured by • Music Therapy World (www.musictherapyworld.net)
hand grasp strength, frequency and duration of identified hand (November 2007): this specialist music therapy research database
function, spatiotemporal arm control. is no longer functional, however we handsearched archives of
dissertations and conference proceedings (Appendix 16).
Secondary outcomes We handsearched the following music therapy journals and con-
1. Communication (e.g. language production, parameters of ference proceedings:
voice production, speaking fundamental frequency) • Arts in Psychotherapy (1974 to 2009; 39(4));
2. Mood and emotions (e.g. depression, anger, anxiety) • Australian Journal of Music Therapy (1990 to 2009;20);
3. Social skills and interactions (e.g. eye contact, non-verbal • Australian Music Therapy Association Bulletin (1977 to
interactions) 2005; final issue);
4. Pain • British Journal of Music Therapy (1987 to 2009;23(1));
5. Behavioral outcomes (e.g. participation in treatment, • Canadian Journal of Music Therapy (1976 to 2009;15(1));
motivation, self-esteem) • International Journal of the Arts in Medicine (1993 to 1999;
6. Activities of daily living 6(2), final issue);
7. Adverse events (e.g. death, fatigue, falls) • Journal of Music Therapy (1964 to 2009;46(2));
• Japanese Journal of Music Therapy (2005 to 2006;2; latest
issue available online);
• Musik-,Tanz-, und Kunsttherapie (Journal for Art Therapies
Search methods for identification of studies in Education, Welfare and Health Care) (1999 to 2009;20(1));
See the ’Specialized register’ section in the Cochrane Stroke Group • Musiktherapeutische Umschau (1980 to 2009;30(3));
module. • Music Therapy (1981 to 1996;14(1), final issue);
We searched the Cochrane Stroke Group Trials Register, which • Music Therapy Yearbook (1951 to 1962; final issue);
was last searched by the Managing Editor on 25 February 2010. • Music Therapy Perspectives (1982 to 2009;27(1));
In addition, we searched the following electronic bibliographic • Nordic Journal of Music Therapy (1992 to 2009;18(1));
databases and trials registers: • Music Therapy Today (online journal of music therapy)
• Cochrane Central Register of Controlled Trials (2000 to 2007;3, final issue);
(CENTRAL) (The Cochrane Library Issue 2, 2009) (Appendix 1); • New Zealand Journal of Music Therapy (1987 to 2006;20,
• MEDLINE (1950 to July 2009) (Appendix 2); latest issue with available online abstracts);
• EMBASE (1980 to August 2009) (Appendix 3); • Voices (online international journal of music therapy) (2001
• CINAHL (1982 to March 2010) (Appendix 4); to 2009;9(2));
• PsycINFO (1967 to July 2009) (Appendix 5); • Canadian Conference Proceedings (2004 to 2006);
• LILACS (Latin American and Caribbean Health Sciences • The World Music Therapy Congress Proceedings (1993 to
Literature) (1982 to August 2009) (Appendix 6); 1999);
• AMED (Allied and Complementary Medicine) (1985 to • The European Music Therapy Congress Proceedings (1992
August 2009) (Appendix 7); to 2007).

In an effort to identify further published, unpublished and ongo- Trial information
ing trials, we searched the bibliographies of relevant studies and • Study design (parallel group, cross-over)
reviews and contacted experts in the field. We consulted music • Randomization
therapy association web sites to help identify music therapy prac- • Randomization method
titioners and conference information (e.g. American Music Ther- • Allocation concealment
apy Association (http://www.musictherapy.org), the British Soci- • Allocation concealment method
ety for Music Therapy (http://www.bsmt.org/), the Association of • Level of blinding
Professional Music Therapists (APMT) (http://www.apmt.org/),
Music Therapy World (http://musictherapyworld.net)). We also
consulted a global network of professional music therapists work- Intervention information
ing in neurology (Music Therapy Neurology Network http:// • Type of intervention (e.g. clinical improvisation, voice or
www.rhn.org.uk/institute/mtnn). singing technique, rhythmic auditory stimulation or rhythmic
We did not apply any language restrictions for either searching or auditory cueing, music listening, song writing, combination)
trial inclusion. • Music selection (detailed information on music selection in
cases of music listening, beat selection in cases of rhythmic
auditory stimulation)
Data collection and analysis • Music preference (patient preferred versus researcher
selected in cases of music listening)
• Professional level of music therapist (professional or student
Selection of studies in training)
• Length of intervention
Four review authors (JB, BW, WM, and EM) conducted the
• Intensity of intervention
searches as outlined in the Search methods for identification of
• Comparison intervention
studies. One review author (JB) and a graduate research assistant
scanned titles and abstracts of each record retrieved from the search
and deleted obviously irrelevant references. When a title or abstract Participant information
could not be rejected with certainty, a graduate assistant obtained • Total sample size
the full article, which was then inspected by two review authors • Number of experimental group
(BW and WM) independently. Both review authors used an in- • Number of control group
clusion criteria form to assess the trial’s eligibility for inclusion. • Gender
One review author (JB) checked the inter-rater reliability for trial • Age
selection, and in case of disagreement or uncertainty, consulted a • Ethnicity
third review author (CD). We kept a record of both the article and • Diagnosis
the reason for exclusion for all excluded studies. • Site of lesion
• Degree of neurological damage
• Rehabilitation stage
Data extraction and management
• Setting
One author (JB) and a trained research assistant independently • Inclusion criteria
extracted data from the selected trials using a standardized coding
form. They discussed any differences in data extraction and sought
the input of a third review author (CD) when needed. We extracted Outcomes
the following data: We planned to extract statistical information for the following
outcomes (if applicable):
1. parameters of gait (e.g. velocity, cadence, stride length,
General information
stride symmetry, stride timing);
• Author 2. parameters of upper extremity function (e.g. hand grasp
• Year of publication strength, frequency and duration of identified hand function,
• Title spatiotemporal arm control);
• Journal (title, volume, pages) 3. communication outcomes (e.g. language production;
• If unpublished, source parameters of voice production, speaking fundamental
• Duplicate publications frequency);
• Country 4. mood and emotion outcomes (e.g. depression, anger,
• Language of publication anxiety);

5. social interactions outcomes (e.g. eye contact, non-verbal and this was indicated in the study, we gave the study a rating of
interactions); adequate.
6. pain; We used these four criteria to give each article an overall quality
7. behavioral outcomes (e.g. participation in treatment, rating, based on section 6.7.1 of the Cochrane Handbook for Sys-
motivation); tematic Reviews of Interventions (Higgins 2008).
8. activities of daily living; A - low risk of bias, all four criteria met.
9. adverse events (e.g. death, fatigue, falls). B - moderate risk of bias, one or more of the criteria only partly
met.
C - high risk of bias, one or more criteria not met.
Assessment of risk of bias in included studies We planned to use the overall quality assessment rating for sensi-
Two review authors (JB and CD) independently assessed all in- tivity analysis. We did not exclude studies based on a low quality
cluded trials for trial quality. We used the following four criteria score.
for quality assessment.
Dealing with missing data
1. Method of randomization We analyzed data on an endpoint basis, including only participants
for whom final data point measurement was obtained (available
• Was the trial reported as randomized? Yes/No
case analysis). We did not assume that participants who dropped
• Was the method of randomization appropriate? Yes/No/
out after randomization had a negative outcome.
Unclear
We rated randomization as appropriate if every participant had an

Assessment of heterogeneity
equal chance to be selected for either condition and if the inves-
tigator was unable to predict to which treatment the participant We investigated heterogeneity using the I2 test with I2 > 50%
would be assigned. We rated date of birth, date of admission, or indicating significant heterogeneity.
alternation as inappropriate.
Assessment of reporting biases
2. Allocation concealment We could not examine publication bias because the outcomes in-
cluded had a maximum of two trials.
We used the ratings of A - adequate, B - unclear and C - inade-
quate in accordance with section 6.3 of the Cochrane Handbook
for Systematic Reviews of Interventions (Higgins 2008). Data synthesis
A - adequate: methods to conceal allocation include (1) central
One review author (JB) entered all trials included in the system-
randomization, (2) serially numbered, opaque, sealed envelopes,
atic review into Review Manager 5 (RevMan 2008). JB conducted
or (3) other descriptions with convincing concealment.
the data analysis and this was reviewed by CD for accuracy. We
B - unclear: authors did not adequately report on method of con-
presented the main outcomes in this review as continuous vari-
cealment.
ables. We calculated standardized mean differences for outcome
C - inadequate: allocation was not adequately concealed (e.g. al-
measures using the results from different scales; we used mean
ternation methods were used).
differences for results using the same scales. We calculated pooled
estimates using the fixed-effect model unless there was substantial
heterogeneity, in which case we used the random-effects model
3. Blinding
to obtain a more conservative estimate. We determined levels of
With music therapy studies, it is not possible to blind participants heterogeneity using the I2 statistic (Higgins 2002). We calculated
and those providing the music therapy interventions. However, 95% confidence intervals (CI) for each effect size estimate. This
outcome assessors can be blinded. In this review, we marked blind- review did not include any categorical variables.
ing as ’yes’, ’no’, or ’unclear’ as it pertains to blinding of outcome We made the following treatment comparison:
assessors. • music therapy versus standard care alone.
4. Incomplete data addressed Subgroup analysis and investigation of heterogeneity

We gave a rating of adequate when numbers of dropouts and We planned the following sub-analyses a priori as described by
reasons for drop out were reported or if we were able to obtain this Deeks 2001 and as recommended in section 8.8 of the Cochrane
information from the study author. If there were no withdrawals Handbook for Systematic Reviews of Interventions (Higgins 2008),

but could not perform them because of an insufficient number of participants (Jungblut 2004; Paul 1998; Thaut 1997; Thaut 2002;
studies: Thaut 2007). Trial sample size ranged from 10 to 78 participants.
• type of music therapy intervention; Three studies used rhythmic auditory stimulation (RAS) as the
• dosage of music therapy; and music therapy intervention (Thaut 1997; Thaut 2002; Thaut
• diagnosis. 2007). RAS involves the use of rhythmic sensory cuing of the
motor system. It engages entrainment principles in which “rhyth-
mic auditory cues synchronize motor responses into stable time
Sensitivity analysis relationships. The fast-acting physiological entrainment mecha-
We planned to examine the influence of study quality using a nisms between auditory rhythm and motor response serve as cou-
sensitivity analysis where the results of including and excluding pling mechanisms to stabilize and regulate gait patterns” (Thaut
lower-quality studies are compared. However, this was not possible 2007) or reaching arm movements. Two studies (Thaut 1997;
because there were only two trials per outcome. Thaut 2007) examined the effects of RAS versus standard neu-
rodevelopmental therapy (NDT/Bobath) on improvement in gait
as measured by changes in gait velocity, cadence, stride length,
and stride symmetry. Both studies included stroke patients two to
RESULTS three weeks post-stroke. Patients were eligible if they were able to
complete five stride cycles with hand-held assistance. The training
duration of Thaut 1997 was six weeks with training held twice
Description of studies daily, 30 minutes each session, five days a week. Thaut 2007 fol-
lowed the same protocol but the training duration was only three
See: Characteristics of included studies; Characteristics of weeks. One study (Thaut 2002) examined the effects of RAS on
excluded studies; Characteristics of studies awaiting classification; spatiotemporal control of reaching movements of the paretic arm.
Characteristics of ongoing studies. In this study, patients were asked to move their affected arm back
and forth for 30 seconds as evenly timed as possible between two
touch-sensitive sensors (for details about sensor placement please
Results of the search
see Thaut 2002). Patients completed one trial with and one trial
The database searches and handsearching of conference proceed- without RAS in a randomized cross-over trial. During rhythmic
ings and journals identified 3855 citations; we retrieved 94 ref- trials, patients were asked to move their affected arm in time with
erences for possible inclusion. If necessary we contacted chief in- the metronome beat.
vestigators to obtain additional information on study details and Other music therapy interventions included electronic music mak-
data. We found many trials on the effects of rhythmic auditory ing (Paul 1998), rhythmic-melodic voice training (SIPARI®)
stimulation (RAS) on gait in people with acquired brain injury; (Jungblut 2004) and listening to pre-recorded songs (Kim 2005)
however, most of those were one group pre-test/post-test designs. or live music (Baker 2001).
In addition, several trials examined melodic intonation therapy Paul 1998 evaluated the effects of music-making activity on el-
for speech improvement, but we excluded these because the inter- bow extension in participants with hemiplegia. Electronic music
vention was not implemented by a trained music therapist or the devices were used that required active shoulder flexion and elbow
trial was not a RCT or CCT. Fourteen references to seven studies extension and that enabled easy sound manipulation by the par-
met all the inclusion criteria. ticipants. Electronic paddle drums were individually set to the
maximum range of motion of each participant. Participants in the
Included studies music therapy group participated in music-making activity for 30
minutes twice a week for 10 weeks. The control group partici-
We included seven studies with a total of 184 participants. These
pated in a physical exercise group in which they were encouraged
studies examined the effects of music therapy on gait parameters
to reach their affected extremity as far as they could in different
(Thaut 1997; Thaut 2007), speech outcomes (Jungblut 2004),
directions.
hemiparetic arm movement (Paul 1998; Thaut 2002), agitation
Only one trial (Jungblut 2004) that examined the effects of mu-
and orientation (Baker 2001) and pain during exercise (Kim 2005)
sic therapy on speech parameters met our inclusion criteria. This
in patients with an acquired brain injury. Fifty-four per cent of
study used SIPARI® with participants who suffered from chronic
the participants were male. The average age of the participants was
aphasia (Broca’s aphasia or global aphasia) due to stroke with a
59.4 years. The studies were conducted in four different countries:
mean aphasia duration of 11.5 years and who were no longer re-
USA ( Paul 1998; Thaut 1997; Thaut 2002), South Korea (Kim
ceiving speech therapy. SIPARI® is a music therapy technique
2005), Germany (Jungblut 2004), Australia (Baker 2001), and
that is based on specific use of the voice. It actively works with the
USA and Germany (Thaut 2007) by professional music therapists.
remaining speech capabilities in the right hemisphere of aphasic
Five of the seven studies did not report on the ethnicity of the

patients, namely singing, intonation, prosody embedded in phys- parative study of two music therapy interventions (one study), and
iologically appropriate breathing (Atmung). The SIPARI method (5) control participants did not have ABI (one study).
also employs instrumental and vocal rhythmic exercises and music Details of the excluded trials are listed in the Characteristics of
improvisations to practice communication scenarios. Participants excluded studies table.
in the experimental group (eight participants) received 20 group
music therapy sessions and 10 individual sessions over a period of
seven months. Participants in the control group (five participants) Risk of bias in included studies
did not receive any music therapy.
Listening to pre-recorded music involves methods where the pa- We included studies that used appropriate methods of random-
tient is directed to listen to audio recordings of music played on ization (e.g. computer-generated table of random numbers, draw
any media device such as compact discs, vinyl recordings, cassettes, of lots, flip of coins) (Baker 2001; Kim 2005; Thaut 1997; Thaut
or other digital technology, and is not required to be involved ac- 2002; Thaut 2007) as well as studies that used alternate group
tively in making the music him/herself. Listening to live music assignment as allocation method (Jungblut 2004; Paul 1998).
involves methods where the patient is directed to listen to vocal Four studies used allocation concealment (Kim 2005; Thaut 1997;
or instrumental music created by the therapist (or another) within Thaut 2002; Thaut 2007). In three trials, blinding of the outcome
the patient’s environment, and is not required to be involved ac- assessors was not used (Baker 2001; Kim 2005; Thaut 2002), and
tively in making the music him/herself. One trial (Baker 2001) this inevitably introduced potential for biased assessment. Blind-
examined the effects of music therapy on agitation and orientation ing of intervention allocation is not possible in music therapy in-
levels in 22 people with a severe head injury with a diagnosis of terventions, adding another layer of possible bias.The dropout rate
post-traumatic amnesia. Participants were exposed to three condi- was less than 20% for four of the trials (Baker 2001; Paul 1998;
tions (listening to live music, listening to taped music, no music), Thaut 1997; Thaut 2007). Two studies had a drop out rate be-
in random order, twice over six consecutive days. The songs in the tween 24% and 29% (Jungblut 2004; Kim 2005), and one study
live and taped music condition were identical and were suggested did not report on drop-out rate (Thaut 2002). Most studies re-
by family members as the participant’s preferred music. We found ported reasons for dropout. Detailed information on dropout rate
one RCT that investigated the effects of listening to pre-recorded is included in the Characteristics of included studies table.
music on pain in people with acquired brain injury. Kim 2005 ex- As a result, only two studies (Thaut 1997; Thaut 2007) received
posed 10 stroke patients to music (listening to songs and listening a low risk of bias rating. For all other studies there was a high risk
to karaoke instrumental music) and no music conditions during of bias. Risk of bias is detailed for each study in the risk of bias
upper extremity joint exercises over an eight-week period. tables included with the Characteristics of included studies table.
Frequency and duration of treatment sessions greatly varied among As all but two trials were rated at the same level (high risk) and
the studies. The total number of sessions ranged from three ses- because of the limited number of studies per outcome, we did not
sions to 60 sessions. Most sessions lasted 30 minutes, with the carry out sensitivity analysis on the basis of overall quality rating.
exception of one RAS trial that used 30 seconds trial intervals
for different treatment conditions (Thaut 2002). Details on fre-
quency and duration of sessions for each trial are included in the Effects of interventions
Characteristics of included studies table.
Four studies used parallel group designs (Jungblut 2004; Paul
1998; Thaut 1997; Thaut 2007), whereas the other studies used Primary outcomes
cross-over designs. Not all studies measured all outcomes identified
for this review.
Details of the studies included in the review are shown in the Gait
Characteristics of included studies table.
Two studies (Thaut 1997; Thaut 2007) with a total of 98 par-
ticipants examined the effects of RAS versus standard neurode-
velopmental therapy (NDT/Bobath) on improvement in gait as
Excluded studies measured by changes in gait velocity, cadence, stride length, and
We identified 21 additional experimental research studies that ap- stride symmetry.
peared eligible for inclusion. However, we excluded these after The pooled estimate of these two studies indicated that RAS im-
closer examination or after receiving additional information from proved gait velocity by an average of 14.32 meters per minute
the chief investigators. Reasons for exclusions were: (1) not an compared to the control group (95% CI 10.98 to 17.67, P <
RCT or CCT (16 studies), (2) insufficient data reporting (one 0.00001), and results were consistent between the two studies (I²
study), (3) could not be categorized as music therapy (as defined = 0%) (Analysis 1.1). The RAS group also showed significantly
by the authors in the background section) (two studies), (4) com- greater improvements in stride length (MD = 0.23 meters, 95%

CI 0.14 to 0.32, P < 0.00001, I² = 0%) (Analysis 1.2) and gait Test was improved significantly compared to the control group
cadence (MD = 16.71 steps/minute, 95% CI 3.40 to 30.01, P = (ES = 2.08, P = 0.003).
0.01, I2 = 69%) (Analysis 1.3) than the standard treatment group.
However, the results were inconsistent for gait cadence, with the
larger study (Thaut 2007) showing a greater cadence improvement Behavioral outcomes
(22.00 steps/minute, 95% CI 16.94 to 27.06, N = 78) than the One trial (Baker 2001) examined the effects of listening to live
smaller study (Thaut 1997) (8.00 steps/minute, 95% CI -6.47 music and listening to taped music on agitation and orientation
to 22.47, N = 20). Finally, the RAS intervention led to greater levels in 22 people with a severe head injury with a diagnosis of
improvements in gait symmetry (defined as the ratio between the post-traumatic amnesia. Listening to live music had a significant
swing time of two consecutive steps using the longer step as the effect on participant orientation levels (as measured by the West-
denominator) than standard treatment (MD = 0.12, 95% CI 0.09 mead PTA scale) compared to the no music control condition (ES
to 0.15, P < 0.00001) and these results were consistent between = 0.82, P < 0.001), and this effect was slightly larger than the effect
the two studies (I² = 0%) (Analysis 1.4). of listening to taped music compared to the control condition (ES
= 0.72, P < 0.001). Listening to live music was also effective in
reducing agitation scores (as measured by the Agitation Behavior
Upper extremity function Scale) (ES = 5.01 ABS units, P < 0.0001). Agitation also decreased
Two trials (Paul 1998; Thaut 2002) measured the effects of music after listening to taped music (6.25 ABS units, P < 0.0001).The
therapy on upper extremity function in hemispheric stroke pa- difference in effect between live and taped music was not statisti-
tients. Elbow extension angle was the only common outcome mea- cally significant (1.2 ABS units, P = 0.8).
sure in these two studies. However, because of the significant clin-
ical heterogeneity of the studies, their effect sizes were not pooled. Pain
Thaut 2002 examined the effects of RAS on spatiotemporal con-
Kim 2005 examined the effects of listening to pre-recorded music
trol of reaching movements of the paretic arm in 21 patients. Re-
on pain in people with acquired brain injury. Pain ratings on a
sults indicated that RAS increased the elbow extension angle by
zero-to-10 numeric scale indicated that there was no statistically
13.8% compared to the non-rhythmic trial, and this difference
significant difference in pain ratings between the music and the
was statistically significant (P = 0.007). Results further indicated
no-music condition (P > 0.05).
that variability of timing and reaching trajectories were reduced
We did not identify any studies that addressed the other secondary
significantly (35% and 40.5%, respectively, P < 0.05).
outcomes listed in the Secondary outcomes section, namely mood
Paul 1998 evaluated the effects of music-making activity on elbow
and emotions, social skills and interactions, activities of daily living
extension in 20 participants with hemiplegia. The elbow exten-
and adverse events.
sion (measured from 135 to 0 with negative numbers expressing
limitations) post-intervention was -29.4 (SD 29.49) for the ex-
perimental group and -39.2 (SD 38.19) for the control group.
This difference was not statistically significant. Post-test shoulder
flexion data indicated no statistically significant difference (P = DISCUSSION
0.44) between the music therapy group (85.6°, SD 26.71) and the
control group (71.8°, SD 39).
Summary of main results
The results of this review suggest that rhythmic auditory stimula-
Secondary outcomes
tion (RAS) may be beneficial for improving gait velocity, cadence,
stride length and stride symmetry in stroke patients. These results
were based on two studies that received a low risk of bias score.
Communication However, given the limited number of studies and the small total
Jungblut 2004 examined the effects of a music therapy method, sample size (98 participants), more RCTs are needed to strengthen
SIPARI®, as described in the Included studies section, on speech this evidence.
parameters in 13 participants with chronic aphasia. Post-treatment Two trials investigated the effects of music therapy on upper ex-
speech evaluation found that the use of SIPARI® was effective tremity function in hemispheric stroke patients. Because of clin-
in improving articulation and prosody (effect size (ES) = 2.12, P ical heterogeneity, these results could not be pooled. One study
= 0.024), speech repetitions (ES = 1.29, P = 0.045), and speech (Thaut 2002) found significant improvement in elbow extension,
comprehension (ES = 1.36; P = 0.037). The effect on labeling was variability of timing and reaching trajectories during rhythmic au-
not statistically significant (ES = 0.74, P = 0.22). The total speech ditory stimulation. In contrast, one study (Paul 1998) that exam-
profile of the music therapy participants on the Aachen Aphasia ined the effects of active music making on elbow extension and

shoulder flexion did not find statistically significant results. More tremity functioning. Even though functional arm movements, un-
research is needed to investigate which music therapy techniques like gait, are “discrete, biologically non-rhythmic, and volitional”
are most effective for improvement of upper extremity function. (Thaut 2002), rhythmic stimuli are successfully used to enhance
Few trials that examined the effects of music therapy on the sec- the execution of motor skills in non-rehabilitation areas such as
ondary outcomes in this review met our inclusion criteria. The music performance and sports (Thaut 2002). It is important that
results of one trial (Jungblut 2004) indicated that SIPARI®, a additional RCTs are conducted to further examine the potential
music therapy rhythmic-melodic voice training technique, signif- benefits of RAS on upper extremities functioning.
icantly improved the speech profile of people with chronic apha- The RAS trials solely included hemiparetic stroke patients. The
sia. One RCT (Baker 2001) found that music therapy is effective majority of the patients had middle cerebral artery strokes (78%).
in reducing agitation and improving orientation levels in people Patients in the gait trials (Thaut 1997; Thaut 2007) entered the
with post-traumatic amnesia following a severe head injury. In a studies within four weeks of the stroke incident and were catego-
trial evaluating the effects of music therapy on pain levels during rized as a stage four or early stage three on the Brunnstrom recov-
upper extremity exercise in stroke patients, no support was found ery scale. Patients in the upper extremity trial (Thaut 2002) were,
for the effectiveness of listening to music for pain management on average, 11.4 (SD 5.2) months post-stroke before admission
(Kim 2005). More RCTs are needed to investigate the effects of to the study and were categorized as a stage four to five on the
music therapy on these outcomes before any reliable conclusions Brunnstrom recovery scale. Site of lesion and length of post-injury
can be drawn. recovery period are important factors to consider when selecting
Other secondary outcomes listed in the Secondary outcomes sec- music interventions for adults with acquired brain injury. How-
tion of this review, namely mood and emotions, social skills and ever, because of the limited number of studies in this review and
interactions, activities of daily living and adverse events were not the heterogeneity of neurological injury, recommendations link-
addressed in any of the trials that met our inclusion criteria. ing specific interventions to specific neurological damage cannot
be made at this time.
Single controlled clinical trials have shown promising results for
Overall completeness and applicability of the effects of music therapy on speech, agitation and orientation
evidence levels in people with acquired brain injury but no conclusions can
be drawn at this time regarding the clinical applicability of this
This review included seven trials. The strength of our review is
evidence. In addition, several RCTs and CCTs which could not
that we searched all available databases and a large number of mu-
be categorized as music therapy (as defined by the authors in the
sic therapy journals, checked reference lists of all relevant trials,
background section) have reported positive effects of listening to
contacted relevant experts for identification of unpublished trials
music and music making on cognitive and motor outcomes for
and reviewed publications for eligibility without restricting lan-
ABI populations (Särkämö 2008; Schneider 2007).
guage. In spite of such a comprehensive search, it is still possible
we missed some published and unpublished trials. We requested
additional data where necessary for all trials we considered for in-
clusion. This allowed us to get accurate information on the trial
Quality of the evidence
quality and data for most trials and helped us make well-informed The quality of reporting in general was poor with only one study
trial selection decisions. detailing the method of randomization, allocation concealment
The results of two studies suggest that RAS may be effective for and level of blinding (Thaut 2007). We needed to contact the chief
improving gait velocity, cadence, stride length, and stride sym- investigators of all other studies to provide additional method-
metry in stroke patients. These findings coincide with data from ological and statistical information. As a result, only two studies
non-controlled trials about the beneficial effects of RAS on gait in (Thaut 1997; Thaut 2007) received a low risk of bias rating. Both
patients with acquired brain injury (Thaut 1993; Thaut 1997b). of these studies contributed evidence on the effects of RAS on gait
As pointed out in Thaut 1997, hemispheric stroke patients may parameters. However, because of the limited number of trials, the
benefit from RAS because auditory rhythm is processed bilaterally, results on gait parameters need to be interpreted with caution.
and no difference was observed in performance between left and It is important to consider the potential bias introduced by in-
right hemispheric patients. However, more RCTs are needed to complete outcome data. For the gait studies (Thaut 1997; Thaut
further support this evidence. 2007) there were no drop-outs in Thaut 1997 (personal com-
One trial examined the effects of RAS on hemiparetic arm move- munication with author). In Thaut 2007, participant drop-outs
ments in stroke patients. The positive results of this study are sup- were much higher in the control group. Reasons for withdrawal
ported by evidence of non-controlled trials (Malcolm 2009; Thaut were hospital transfer, early discharge, medical complications, or
1999). Given the fact that rhythmic stimulation appears to induce unspecified personal reasons. Since both studies implemented the
temporal stability and enhance motor control in walking, it could same intervention and their results were highly homogenous (I2 =
very well be that rhythmic cueing has a similar effect on upper ex- 0% for three out of four gait parameters), one could assume that

the incomplete data of Thaut 2007 did not bias the results. How- on upper extremity function in stroke patients combined with the
ever, since the raw data could not be accessed and no intention- positive results of non-controlled trials, calls for continued research
to-treat analyses were used, we cannot be certain of this. commitment on the efficacy of this specific music therapy inter-
The quality of evidence of the other trials was poor because of vention for hemiparetic stroke patients. Since four of the studies
high risk of bias and limited number of studies. producing significant results involved rhythm-based methods to
address upper limb and gait functioning, we recommend more
RCT investigations of rhythmic auditory stimulation across func-
tional domains.
AUTHORS’ CONCLUSIONS Future studies need to examine the relationship between the fre-
quency and duration of RAS interventions and treatment effects.
Implications for practice Thaut 2007 also recommended that future studies (1) compare
Rehabilitation of mobility is crucial in stroke rehabilitation. The RAS against other current gait-training methods besides neurode-
results of two studies included in this review suggest that rhyth- velopmental treatment/Bobath, (2) investigate the effect of RAS
mic auditory stimulation may help improve gait velocity, cadence, combined with other current gait therapy techniques, and (3)
stride length and stride symmetry in stroke patients. These results study the effect of RAS in long-term outpatient or community-
are encouraging, but more RCTs are needed before recommenda- based settings.
tions can be made for clinical practice. As most of the included More RCTs are needed to examine the effect of music therapy
studies successfully improved motor outcomes with rhythm-based interventions on speech in people with acquired brain injury. We
methods, we suggest that rhythm may be a primary factor in mu- identified several trials but could not include them in this review
sic therapy methods facilitating functional gains with this popu- because of lack of a control group, lack of randomization, or lack
lation. of pseudo-randomization. Given the many clinical reports in the
At this time, there is not sufficient evidence from RCTs or CCTs music therapy literature of beneficial effects of music on speech
to support the use of music therapy for improvement of upper in this population, research efforts need to focus on conducting
extremity function, speech, agitation and cognitive orientation. music therapy trials with high quality designs.
Other secondary outcomes listed in this review, namely mood and Future studies should consider including the following outcomes:
emotions, social skills and interactions, activities of daily living agitation, cognitive orientation, mood and emotions, social skills
and adverse events, were not addressed in any of the trials that and interactions, activities of daily living and adverse events.
met our inclusion criteria. In the absence of sufficient evidence,
recommendations for clinical practice cannot be made for these Finally, several studies in this review used a small sample size (10
outcomes. to 20 participants). Future studies need to include power analyses
so that sufficiently large samples are used.
Implications for research
This review shows encouraging results for the effects of rhythmic
auditory stimulation (RAS) on gait parameters; however, more
ACKNOWLEDGEMENTS
RCTs are needed to strengthen the current data. Several small
non-controlled trials have shown impressive results of RAS for gait The Cochrane Stroke Group Editorial Team for advice and sup-
improvement. This, combined with the results of the two RCTs port and Brenda Thomas for her assistance in the design of the
included in this review, warrants the progression to much needed search strategy. We would also like to acknowledge Patricia Gonza-
large scale studies on the effects of RAS on gait. Likewise, the re- lez and Mike Viega, graduate assistants, for their help in screening
sults of one RCT included in this review on the effects of RAS the titles and abstracts and the retrieval of articles.

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Haworth Press, 2006:51–73.
van de Port 2007
Magee 2009 van de Port IG, Kwakkel G, Bruin M, Lindeman E.
Magee WL, Baker M. The use of music therapy in neuro- Determinants of depression in chronic stroke: a prospective
rehabilitation of people with acquired brain injury. British cohort study. Disability and Rehabilitation 2007;29(5):
Journal of Neuroscience Nursing 2009;5(4):150–6. 353–8. [MEDLINE: 17364786]
Malcolm 2009 WHO 2002
Malcolm MP, Massie C, Thaut M. Rhythmic auditory- World Health Organization. The World Health Report
motor entrainment improves hemiparetic arm kinematics 2002: Reducing Risk, Promoting Health Life. World Health
during reaching movements: a pilot study. Topics in Stroke Organization, 2002.
Rehabilitation 2009;16(1):69–79. Whyte 2006
NA 2003 Whyte EM, Mulsant BH, Rovner BW, Reynolds CF.
Neurological Alliance. Neuro numbers: A Brief Review of the Preventing depression after stroke. International Review of
Numbers of People in the UK with a Neurological Condition. Psychiatry 2006;18(5):471–81. [MEDLINE: 17085365]
London: Neurological Alliance, 2003. ∗
Indicates the major publication for the study

CHARACTERISTICS OF STUDIES
Characteristics of included studies [ordered by study ID]
Baker 2001
Methods RCT
Cross-over trial
Participants 22 adults with a severe head injury with a diagnosis of post-traumatic amnesia, scoring
less than or equal to 8 on the Westmead PTA Scale on the day prior to commencement
of the experiment.
Live music therapy condition: 22 patients
Taped music condition: 22 patients
Control condition: 22 patients
Mean age: 34 years (SD 15.34)
Sex: 5 female, 17 male
Ethnicity: 72.7% Australian, 9% Croatian, 4.5% Taiwanese, 4.5% Bangladeshi, 9%
Italian
Setting: rehabilitation hospital
Country: Australia
Interventions Music conditions: listened to 10 to 12 minutes of live or taped music conditions. The
music conditions were individualized for each participant and comprised 3 music pieces
that were chosen from selections suggested by family members. All styles of music were
permitted. The same 3 pieces were played during the live music condition and the
taped music condition, and played in the same order. During both the live and taped
music conditions, the researcher was present in the room sitting opposite and facing the
participant. In the taped music condition, the music selections were played free-field on
an audio cassette player. No headphones were used because this could agitate the patient.
Control condition: the music therapist was present in the room but no music was played.
Participants were free to do whatever they wanted. Like in the music conditions, the
verbal interactions were kept to a minimum.
Number of sessions: 6 (2 of each condition)
Length of session: 10 to 12 minutes each
Outcomes Agitation (Agitation Behavior Scale): effect size reported

Level of orientation (Westmead PTA Scale): effect size reported
Notes
Risk of bias
Item Authors’ judgement Description
Adequate sequence generation? Yes Computer-generated list of random numbers
Allocation concealment? No No allocation concealment used

Baker 2001 (Continued)
Blinding? No Blinding of outcome assessors (unit nurses) was attempted but

Objective outcomes the authors reported that the nurses could still hear the music
coming from the rooms at times (personal communication)
Incomplete outcome data addressed? Yes 1 drop-out because of early resolution of PTA
All outcomes
Jungblut 2004
Methods Pseudo-randomized controlled trial (alternate group allocation)

2-arm parallel group design
Participants 13 stroke patients suffering from chronic aphasia (Broca’s aphasia and global aphasia)
who were no longer receiving speech therapy.
Mean duration of aphasia: 11.5 years
Music therapy group: 8 participants
Control group: 5 participants
Mean age: 63.8 years experimental group; 67.8 years control group
Ethnicity: not reported
Setting: outpatient services
Country: Germany
Interventions Music therapy group: rhythmic-melodic voice training (SIPARI®) sessions. SIPARI® is a
music therapy technique that is based on specific use of the voice. It actively works with the
remaining speech capabilities in the right hemisphere of aphasic patients, namely singing,
intonation, prosody embedded in physiologically appropriate breathing (Atmung). The
SIPARI method also employs instrumental and vocal rhythmic exercises and music
improvisations to practice communication scenarios.
Control group: no treatment
Number of sessions: 20 group music therapy sessions and 10 individual sessions over a
period of 7 months
Outcomes Articulation and prosody, repetitions, labeling, speech comprehension, total speech pro-
file (Aachener Aphasie Test): effect size reported
Notes
Risk of bias
Adequate sequence generation? No Alternate group allocation

Jungblut 2004 (Continued)
Blinding? Yes Independent outcome assessors were used

Objective outcomes
Incomplete outcome data addressed? Yes 1 experimental and 1 control participant

All outcomes were excluded because they could not be
clearly classified as having global aphasia or
Broca’s aphasia. In addition, 2 more con-
trol participants had to be excluded because
they became gravely ill during the research
study time frame
Kim 2005
Methods RCT
Cross-over trial
Participants 10 adult stroke patients; 8 with severe hemiplegia, 2 with mild hemiplegia
Approximately 3 years post-stroke
Music therapy conditions: 10 participants
Control condition: 10 participants
Mean age: not reported, age range: 61 to 73 years
Ethnicity: 100% South Korean
Setting: daycare center for seniors
Country: South Korea
Interventions Music therapy conditions: (1) listening to taped songs with lyrics, and (2) listening to
karaoke accompaniment (without lyrics) during upper extremities exercises
Control condition: no music during upper extremities exercises
Outcomes Pain: no post-test means or change scores were reported; only F-statistic and significance
level
Notes The author informed us that she no longer had access to the raw data; therefore, no
means or SD could be obtained
Risk of bias
Allocation concealment? Yes All participants underwent the 3 conditions in random order
Blinding? No Blinding not possible as only subjective pain report was used
Objective outcomes

Kim 2005 (Continued)
Incomplete outcome data addressed? Yes 4 patients withdrew due to health condition or frequent ab-
All outcomes sences (personal communication with author)
Paul 1998
Methods Pseudo-RCT
Participants 20 adults with unilateral cerebral hemiplegia determined to have reached their maxi-
mum capacity of physical function and subsequently discharged from occupational and
physical therapies. All participants had at least 10 degrees of limitation in active shoulder
flexion and elbow extension. Mean duration post-stroke: 93.4 days (SD 49.5).
Mean age: 61.75 years (SD 5.1)
Setting: nursing/rehabilitation facility
Country: USA
Interventions Music therapy group: participants engaged in active music improvisation sessions with
the music therapist using electronic music devices that allowed for easy sound manipu-
lation. Improvisations emphasized steady rhythmic pulses.
Control group: physical exercise group conducted by recreational therapist for the same
duration as the music therapy group
Number of sessions: 2 times per week for 10 weeks
Duration of each session: 30 minutes
Outcomes Active shoulder flexion (JAMAR goniometer): pre-test and post-test values are reported
Elbow extension (JAMAR goniometer): pre-test and post-test values are reported
Notes
Risk of bias
Adequate sequence generation? No Alternate group allocation
Blinding? Yes Occupational therapist who completed the

Objective outcomes goniometric measurements was unaware of
group assignment
Incomplete outcome data addressed? Yes There were no withdrawals

All outcomes

Thaut 1997
Methods RCT
Participants 20 adults with hemiparetic stroke

Average post-stroke:16.1 (SD 4) days for experimental group, 15.7 (SD 4) days for
control group
Mean age: 73 years (SD 7) experimental group, 72 years (SD 8) control group
Setting: hospital
Country: USA
Interventions Music therapy group: RAS

Control group: standard neurodevelopmental treatment/Bobath
Number of sessions: twice daily for 6 weeks
Duration of session: 30 minutes
Outcomes Gait parameters: velocity, stride length, cadence, symmetry: pre-test and post-test values
EMG variability: change score
Notes
Risk of bias
Adequate sequence generation? Yes Computer-generated list of random numbers (per-

sonal communication)
Allocation concealment? Yes Recruiters did not know group conditions (per-
sonal communication)
Blinding? Yes Outcome assessors (physical therapists) were

Objective outcomes blinded to the experiment
Incomplete outcome data addressed? Yes No participant loss (personal communication)

All outcomes
Thaut 2002
Methods RCT
Cross-over trial
Participants 21 adults with left hemispheric stroke

Mean post-stroke: 11.4 (SD 5.2) months
Music therapy condition: 21 participants
Control condition: 21 participants
Mean age: 52.7 years (SD 13.7)

Thaut 2002 (Continued)
Setting: out-patient services

Country: USA
Interventions Music therapy condition: RAS

Control condition: non-cued repetitive training
Number of sessions: 1 session with RAS and 1 session without external time cueing
Length of session: 30 seconds each
Outcomes Arm timing, variability of movement timing, wrist trajectories, wrist trajectory variability,
elbow range of motion: pre-test and post-test values
Notes
Risk of bias
Adequate sequence generation? Yes Computer-generated list of random numbers (personal com-
munication)
Allocation concealment? Yes Serially numbered opaque sealed envelopes (personal commu-
nication)
Blinding? No No blinding used

Objective outcomes
Incomplete outcome data addressed? Unclear It is not clear whether there were any participant withdrawals
All outcomes
Thaut 2007
Methods RCT
Participants 78 adults with subacute hemiparetic stroke

Approximately 21 days post-stroke
Mean age: 69.2 years (SD 11.5) experimental group; 69.7 years (SD 11.2) control group
Setting: 2 research centers
Country: USA and Germany
Interventions Music therapy group: RAS

Control group: standard neurodevelopmental therapy/Bobath
Number of sessions: daily, 5 days/week for 3 weeks
Duration of session: 30 minutes

Thaut 2007 (Continued)
Outcomes Gait parameters: velocity, stride length, cadence, symmetry: post-test values
Patient satisfaction with treatment: F-statistic and P value
Notes
Risk of bias
Allocation concealment? Yes Serially-numbered opaque sealed envelopes
Blinding? Yes Outcome assessors were unaware of group assign-

Objective outcomes ment
Incomplete outcome data addressed? Yes 23% dropouts in German center, 10% in US center
All outcomes (absolute numbers are not reported)
Reasons: hospital transfer, early discharge, medical
complications, unspecified personal reasons
PTA: post-traumatic amnesia

RAS: rhythmic auditory stimulation
RCT: randomized controlled trial
SD: standard deviation
Characteristics of excluded studies [ordered by study ID]
Study Reason for exclusion
Baker 2004 Not RCT or CCT
Baker 2005 Not RCT or CCT
Cofrancesco 1985 Not RCT or CCT
Cohen 1992 Unacceptable treatment allocation method
Cohen 1995 Compared rhythmically cued speech, melodically cued speech, and verbal speech of patients who had been
receiving music therapy
No standard treatment group
Insufficient data reporting
Ford 2007 Not RCT or CCT

(Continued)
Goh 2001 Planned to be conducted as RCT, however, only 2 participants enrolled
Hitchen 2007 Insufficient data collection (personal communication)
Hurt 1998 Not RCT or CCT
Lin 2007 Not administered by music therapist
Magee 2002 Comparative study of 2 music therapy interventions
Malcolm 2009 Not RCT or CCT
Moon 2008 Not RCT or CCT (personal communication with author’s project advisor)
Nayak 2000 Not RCT or CCT

People were assigned to music therapy group individually or groups of varying sizes as this was the only way
they were available to the researchers, compromising the randomization procedures (personal communication)
Prassas 1997 Not RCT or CCT
Purdie 1997 Not RCT or CCT
Studebaker 2007 Not RCT or CCT
Särkämö 2008 Not music therapy as defined by authors of this review

Participants listened to prerecorded music without music therapist present
Thaut 1992 Control participants were normal people
Thaut 1993 Not RCT or CCT
Thaut 1997b Not RCT or CCT
Thaut 1999 Not RCT or CCT
CCT: controlled clinical trial

RCT: randomized controlled trial

Characteristics of studies awaiting assessment [ordered by study ID]
Eslinger 1997
Methods Randomized controlled trial
Participants Brain-injured patients
Interventions Music therapy group: 20 active music therapy sessions over 10 weeks
Control group: social support group sessions
Outcomes Self-perceived competency, emotional empathy, cognitive empathy, social-emotional perception, depression and
emotional expression
Notes Study results have not been published

We have requested additional study details and data from the authors
This information could not be provided at this time but will be provided for the update of this review
Characteristics of ongoing studies [ordered by study ID]
Ala-Ruona 2010
Trial name or title Examining the effects of active music therapy on post-stroke recovery: a randomised controlled cross-over
trial
Methods Randomized controlled cross-over trial; computer generated randomization
Participants 45 stroke patients
Interventions Music therapy condition: 2 (60-minute) weekly sessions of active music therapy in individual setting over a
period of 3 months
The music therapy includes a combination of structured musical exercises with different levels of difficulty,
interactive clinical improvisation, rhythmic dynamic playing with changing movement sequences, music
assisted relaxation and therapeutic discussion
Control condition: standard care according to the Finnish Current Care guidelines for stroke
Outcomes Functional disability and activities of daily living independency (BI), level of impairment (NIHSS), disability
grade (mRs), neglect (BIT) and motor function of upper extremity (ARAT)
Starting date
Contact information Professor Esa Ala-Ruona

Email: esa.ala-ruona@jyu.fi
Notes

Breitenfeld 2005
Trial name or title Is there a benefit for aphasic stroke patients treated with music therapy?
Methods Controlled clinical trial: randomization method unknown at this time
Participants Aphasic stroke patients
Interventions Music therapy
Outcomes Speech
Starting date
Contact information Dr Demarin Vida

Email: vida.demarin@zg.t-com.hr
Notes Preliminary results were presented at the 14th European Stroke Conference (30 patients)
Authors will provide data as soon as the study is completed
Magee 2006
Trial name or title Music therapy for adults with acquired brain injury
Methods Validation study of measurement tools for music therapy with adults with acquired brain injury in rehabili-
tation
Participants Adults with acquired brain injury
Interventions Music therapy
Outcomes Functional outcomes across behavioral, visual, auditory, communication and physical domains
Starting date
Contact information Email: drwmagee@rhn.org.uk
Notes Multisite project validating 2 music therapy measures
ARAT: Action Research Arm Test

BI: Barthel index
BIT: Behavioral Inattention Test
mRS: modified Rankin Scale
NIHSS: National Institutes of Health Stroke Scale

DATA AND ANALYSES
Comparison 1. Music therapy versus control
No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size
1 Gait velocity 2 98 Mean Difference (IV, Fixed, 95% CI) 14.32 [10.98, 17.67]
2 Gait stride length 2 98 Mean Difference (IV, Fixed, 95% CI) 0.23 [0.14, 0.32]
3 Gait cadence 2 98 Mean Difference (IV, Random, 95% CI) 16.71 [3.40, 30.01]
4 Gait symmetry 2 98 Mean Difference (IV, Fixed, 95% CI) 0.12 [0.09, 0.15]
Analysis 1.1. Comparison 1 Music therapy versus control, Outcome 1 Gait velocity.
Review: Music therapy for acquired brain injury
Comparison: 1 Music therapy versus control
Outcome: 1 Gait velocity
Mean Mean
Study or subgroup Experimental Control Difference Weight Difference
N Mean(SD)[meters/min]N Mean(SD)[meters/min] IV,Fixed,95% CI IV,Fixed,95% CI
Thaut 1997 10 48 (18) 10 32 (10) 6.9 % 16.00 [ 3.24, 28.76 ]
Thaut 2007 43 34.5 (9.1) 35 20.3 (6.5) 93.1 % 14.20 [ 10.73, 17.67 ]
Total (95% CI) 53 45 100.0 % 14.32 [ 10.98, 17.67 ]

Heterogeneity: Chi2 = 0.07, df = 1 (P = 0.79); I2 =0.0%
Test for overall effect: Z = 8.39 (P < 0.00001)
Test for subgroup differences: Not applicable
-20 -10 0 10 20
Favours control Favours experimental

Analysis 1.2. Comparison 1 Music therapy versus control, Outcome 2 Gait stride length.
Outcome: 2 Gait stride length
Mean Mean
N Mean(SD)[meters] N Mean(SD)[meters] IV,Fixed,95% CI IV,Fixed,95% CI
Thaut 1997 10 1 (0.3) 10 0.69 (0.19) 17.5 % 0.31 [ 0.09, 0.53 ]
Thaut 2007 43 0.88 (0.21) 35 0.67 (0.24) 82.5 % 0.21 [ 0.11, 0.31 ]
Total (95% CI) 53 45 100.0 % 0.23 [ 0.14, 0.32 ]

-2 -1 0 1 2
Analysis 1.3. Comparison 1 Music therapy versus control, Outcome 3 Gait cadence.
Outcome: 3 Gait cadence
Mean Mean
N Mean(SD)[steps/min] N Mean(SD)[steps/min] IV,Random,95% CI IV,Random,95% CI
Thaut 1997 10 98 (17) 10 90 (16) 37.8 % 8.00 [ -6.47, 22.47 ]
Thaut 2007 43 82 (12.9) 35 60 (9.9) 62.2 % 22.00 [ 16.94, 27.06 ]
Total (95% CI) 53 45 100.0 % 16.71 [ 3.40, 30.01 ]

Heterogeneity: Tau2 = 67.41; Chi2 = 3.20, df = 1 (P = 0.07); I2 =69%
Test for overall effect: Z = 2.46 (P = 0.014)
-50 -25 0 25 50

Analysis 1.4. Comparison 1 Music therapy versus control, Outcome 4 Gait symmetry.
Outcome: 4 Gait symmetry
Mean Mean
N Mean(SD) N Mean(SD) IV,Fixed,95% CI IV,Fixed,95% CI
Thaut 1997 10 0.82 (0.14) 10 0.68 (0.23) 2.7 % 0.14 [ -0.03, 0.31 ]
Thaut 2007 43 0.58 (0.05) 35 0.46 (0.07) 97.3 % 0.12 [ 0.09, 0.15 ]
Total (95% CI) 53 45 100.0 % 0.12 [ 0.09, 0.15 ]

-1 -0.5 0 0.5 1
APPENDICES
Appendix 1. CENTRAL search strategy
#1 MeSH descriptor Cerebrovascular Disorders explode all trees
#2 (stroke in All Text or poststroke in All Text or post-stroke in All Text or cerebrovasc* in All Text or (brain in All Text and
vasc* in All Text) or (cerebral in All Text and vasc* in All Text) or cva* in All Text or apoplex* in All Text or SAH in All
Text)
#3 (brain* in All Text or cerebr* in All Text or cerebell* in All Text or intracran* in All Text or intracerebral in All Text)
#4 (ischemi* in All Text or ischaemi* in All Text or infarct* in All Text or thrombo* in All Text or emboli* in All Text or
occlus* in All Text)
#5 (#3 and #4)
#6 (brain* in All Text or cerebr* in All Text or cerebell* in All Text or intracerebral in All Text or intracranial in All Text or
subarachnoid in All Text)

(Continued)
#7 (haemorrhage* in All Text or hemorrhage* in All Text or haematoma* in All Text or hematoma* in All Text or bleed* in
All Text)
#8 (#6 and #7)
#9 MeSH descriptor hemiplegia this term only
#10 MeSH descriptor paresis explode all trees
#11 (hemipleg* in All Text or hemipar* in All Text or paresis in All Text or paretic in All Text)
#12 MeSH descriptor aphasia explode all trees
#13 (aphasi* in All Text or dysphasi* in All Text)
#14 MeSH descriptor craniocerebral trauma this term only
#15 MeSH descriptor brain injuries explode all trees
#16 MeSH descriptor Head Injuries, Closed explode all trees
#17 MeSH descriptor Intracranial Hemorrhage, Traumatic explode all trees
#18 MeSH descriptor skull fractures explode all trees
#19 MeSH descriptor Brain Damage, Chronic this term only
#20 MeSH descriptor Brain Injury, Chronic this term only
#21 MeSH descriptor brain stem explode all trees with qualifiers: IN
#22 MeSH descriptor cerebellum explode all trees with qualifiers: IN
#23 (head in All Text or brain* in All Text or cerebral in All Text or cranial in All Text or craniocerebral in All Text or skull in
All Text)
#24 (injur* in All Text or trauma* in All Text or damage* in All Text)
#25 (#23 and #24)
#26 (diffuse in All Text and axonal in All Text and injur* in All Text)
#27 MeSH descriptor anoxia this term only
#28 MeSH descriptor encephalitis explode all trees
#29 MeSH descriptor meningitis explode all trees

(Continued)
#30 MeSH descriptor brain neoplasms explode all trees
#31 (anoxi* in All Text or hypoxi* in All Text or encephalit* in All Text or meningit* in All Text)
#32 (brain in All Text or cereb* in All Text)
#33 (neoplasm* in All Text or lesion* in All Text or tumor* in All Text or tumour* in All Text)
#34 (#32 and #33)
#35 MeSH descriptor music this term only
#36 MeSH descriptor music therapy this term only
#37 MeSH descriptor acoustic stimulation this term only
#38 (music* in All Text or rhythmic* in All Text or melod* in All Text)
#39 (auditory in All Text or acoustic in All Text)
#40 (stimulat* in All Text or cue* in All Text)
#41 (#39 and #40)
#42 (sing in All Text or sings in All Text or singing in All Text or song* in All Text or compose in All Text or composing in All
Text or improvis* in All Text)
#43 (#35 or #36 or #37 or #38 or #41 or #42)
#44 (#1 or #2 or #5 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20 or #21 or
#22 or #25 or #26 or #27 or #28 or #29 or #30 or #31 or #34)
#45 (#43 and #44)
Appendix 2. MEDLINE search strategy

MEDLINE (Ovid)
1. cerebrovascular disorders/ or exp basal ganglia cerebrovascular disease/ or exp brain ischemia/ or exp carotid artery diseases/ or
cerebrovascular accident/ or exp brain infarction/ or exp cerebrovascular trauma/ or exp hypoxia-ischemia, brain/ or exp intracranial
arterial diseases/ or intracranial arteriovenous malformations/ or exp “Intracranial Embolism and Thrombosis”/ or exp intracranial
hemorrhages/ or vasospasm, intracranial/ or vertebral artery dissection/
2. (stroke or poststroke or post-stroke or cerebrovasc$ or brain vasc$ or cerebral vasc$ or cva$ or apoplex$ or SAH).tw.
3. ((brain$ or cerebr$ or cerebell$ or intracran$ or intracerebral) adj5 (isch?emi$ or infarct$ or thrombo$ or emboli$ or occlus$)).tw.
4. ((brain$ or cerebr$ or cerebell$ or intracerebral or intracranial or subarachnoid) adj5 (haemorrhage$ or hemorrhage$ or haematoma$
or hematoma$ or bleed$)).tw.
5. hemiplegia/ or exp paresis/
6. (hemipleg$ or hemipar$ or paresis or paretic).tw.
7. exp aphasia/
8. (aphasi$ or dysphasi$).tw.
9. craniocerebral trauma/ or exp brain injuries/ or exp head injuries, closed/ or exp intracranial hemorrhage, traumatic/ or exp skull
fractures/
10. brain damage, chronic/ or brain injury, chronic/
11. exp brain stem/in or exp cerebellum/in
12. ((head or brain$ or cerebral or cranial or craniocerebral or skull) adj5 (injur$ or trauma$ or damage$)).tw.
13. diffuse axonal injur$.tw.
14. anoxia/ or exp encephalitis/ or exp meningitis/ or exp brain neoplasms/
15. (anoxi$ or hypoxi$ or encephalit$ or meningit$).tw.
16. ((brain or cereb$) and (neoplasm$ or lesion$ or tumor$ or tumour$)).tw.
17. or/1-16
18. music/ or music therapy/ or acoustic stimulation/
19. (music$ or rhythmic$ or melod$).tw.
20. ((auditory or acoustic) adj5 (stimulat$ or cue$)).tw.
21. (sing or sings or singing or song$ or compose or composing or improvis$).tw.
22. or/18-21
23. Randomized Controlled Trials/
24. random allocation/
25. Controlled Clinical Trials/
26. control groups/
27. clinical trials/
28. double-blind method/
29. single-blind method/
30. Placebos/
31. placebo effect/
32. cross-over studies/
33. Multicenter Studies/
34. Therapies, Investigational/
35. Research Design/
36. Program Evaluation/
37. evaluation studies/
38. randomized controlled trial.pt.
39. controlled clinical trial.pt.
40. clinical trial.pt.
41. multicenter study.pt.
42. evaluation studies.pt.
43. random$.tw.
44. (controlled adj5 (trial$ or stud$)).tw.
45. (clinical$ adj5 trial$).tw.
46. ((control or treatment or experiment$ or intervention) adj5 (group$ or subject$ or patient$)).tw.
47. (quasi-random$ or quasi random$ or pseudo-random$ or pseudo random$).tw.
48. ((multicenter or multicentre or therapeutic) adj5 (trial$ or stud$)).tw.
49. ((control or experiment$ or conservative) adj5 (treatment or therapy or procedure or manage$)).tw.
50. ((singl$ or doubl$ or tripl$ or trebl$) adj5 (blind$ or mask$)).tw.
51. (coin adj5 (flip or flipped or toss$)).tw.
52. latin square.tw.
53. versus.tw.
54. (cross-over or cross over or crossover).tw.
55. placebo$.tw.
56. sham.tw.
57. (assign$ or alternate or allocat$ or counterbalance$ or multiple baseline).tw.
58. controls.tw.
59. (treatment$ adj6 order).tw.
60. journal of music therapy.jn.
61. or/23-60
62. 17 and 22 and 61
63. limit 62 to humans
Appendix 3. Embase search strategy

1 CEREBROVASCULAR-DISEASE#.DE. 127204
2 BASAL-GANGLION#.DE. 7146
3 BRAIN-ISCHEMIA#.DE. 27862
4 CAROTID-ARTERY-DISEASE#.DE. 13288
5 CEREBROVASCULAR-ACCIDENT#.DE. 15445
6 BRAIN-HYPOXIA#.DE. 3930
7 BRAIN-ARTERIOVENOUS-MALFORMATION#.DE. 1883
8 BRAIN-EMBOLISM#.DE. 2186
9 THROMBOSIS#.W..DE. 60661
10 8 AND 9 262
11 BRAIN-HEMORRHAGE#.DE. 23280
12 BRAIN-VASOSPASM#.DE. 1756
13 ARTERY-DISSECTION#.DE. 2636
14 BRAIN#.W.DE. 265092
15 13 AND 14 334
16 VERTEBRAL-ARTERY#.DE. 2779
17 ARTERY-DISSECTION#.DE. 2636
18 16 AND 17 419
19 1 OR 2 OR 3 OR 4 OR 5 OR 6 OR 7 OR 10 OR 11 OR 12 OR 15 OR 18 135371
20 (STROKE OR POSTSTROKE OR POST-STROKE).TI,AB. 55444
21 (CEREBROVASC$5 OR BRAIN ADJ VASC$5 OR CEREBRAL ADJ VASC$5 OR CVA$1 OR APOPLEX$2 OR SAH).TI,AB.
18086
22 20 OR 21 69383
23 BRAIN$1 OR CEREB$3 OR CEREBELL$2 OR INTRACRAN$3 OR INTRACERE BRAL 461900
24 23.TI,AB. 311588
25 (ISCH$5 OR CMA OR INFARCT$3 OR THROMBO$3 OR EMBOLIS$1 OR OCCLUS$3).TI,AB. 216016
26 24 NEAR 25 27603
27 (BRAIN$1 OR CEREBR$3 OR CEREBELL$3 OR INTRACEREBRAL OR INTRACRANIAL OR SUBARACH-
NOID).TI,AB. 314775
28 (HAEMORRHAGE$1 OR HEMORRHAGE$1 OR HAEMATOMA$1 OR HEMATOMA$1 OR BLEED$3).TI,AB. 90167
29 27 NEAR 28 15381
30 HEMIPLEGIA#.W..DE. 3127
31 PARESIS#.W..DE. 1597
32 30 OR 31 4672
33 (HEMIPLEG$2 OR HEMIPAR$4 OR PARESIS OR PARETIC).TI,AB. 8703
34 APHASIA#.W..DE. 5128
35 (APHASI$1 OR DYSPHASI$1).TI,AB. 4272
36 HEAD-INJURY#.DE. 58268
37 BRAIN-INJURY#.DE. 35070
38 BRAIN-HEMORRHAGE#.DE. 23280
39 SKULL-FRACTURE#.DE. OR TRAUMATIC-BRAIN-INJURY#.DE. 5646
40 36 OR 37 OR 38 OR 39 78916
41 BRAIN ADJ DAMAGE ADJ CHRONIC 7
42 BRAIN ADJ STEM 16877
43 BRAIN-STEM#.DE. 43572
44 CEREBELLUM 24297
45 CEREBELLUM#.W..DE. 19781
46 (IN ADJ 43 OR 45).TI,AB. 0
47 (BRAINSTEM OR CEREBELLUM).TI,AB. 26391
48 (43 OR 44 OR 47).TI,AB. 26391
49 (HEAD OR BRAIN$1 OR CEREBRAL OR CRANIAL OR CRAIOCEREBRAL OR SKULL).TI,AB. 364290
50 (INJUR$3 OR TRAUMA$1 OR DAMAGE$1).TI,AB. 317818
51 49 OR 50 625696
52 (DIFFUSE ADJ AXONAL ADJ INJUR$3).TI,AB. 370
53 ANOXIA 2563
54 ANOXIA#.W..DE. 1718
55 ENCEPHALITIS 11397
56 ENCEPHALITIS#.W..DE. 18509
57 MENINGITIS 16834
58 MENINGITIS#.W..DE. 17163
59 BRAIN ADJ NEOPLASMS 157
60 BRAIN-TUMOR#.DE. 29864
61 54 OR 56 OR 58 OR 60 63435
62 (ANOXI$2 OR HYPOX$2 OR ENCEPHALIT$2 OR MENINGIT$2).TI,AB. 50200
63 (BRAIN OR CEREB$5).TI,AB. 296238
64 (NEOPLASM$1 OR LESION$1 OR TUMOR$1 OR TUMOUR$1).TI,AB. 554036
65 63.TI,AB. AND 64.TI,AB. 46422
66 49 NEAR 50 36758
67 19 OR 22 OR 26 OR 29 OR 32 OR 33 OR 34 OR 35 OR 40 OR 48 OR 66 OR 52 OR 61 OR 62 OR 65 336986
68 MUSIC ADJ THERAPY OR MUSIC 3983
69 MUSIC-THERAPY#.DE. OR MUSIC#.W..DE. 3039
70 (MUSIC$2 OR RHYTHMIC$2 OR MELOD$2 OR ACOUSTIC ADJ STIMULATION).TI,AB. 8686
71 (AUDITORY OR ACOUSTIC).TI,AB. 36263
73 (STIMULAT$3 OR CUE$1).TI,AB. 318466
74 71 NEAR 73 2253
75 (SING OR SINGS OR SINGING OR SONG$1 OR COMPOSE OR COMPOSING OR IMPROVIS$3).TI,AB. 4084
76 69 OR 70 OR 74 OR 75 15281
79 RANDOMIZED-CONTROLLED-TRIAL#.DE. 140800
80 RANDOM ADJ ALLOCATION 382
81 RANDOMIZED ADJ ALLOCATION 89
82 CLINICAL-TRIAL#.DE. 432115
83 CONTROL ADJ GROUPS 105179
84 CLINICAL-TRIAL#.DE. 432115
86 (DOUBLE ADJ BLIND ADJ METHOD).TI,AB. 94
90 (RANDOM ADJ ALLOCATION).TI,AB. 382
91 (CONTROL ADJ GROUPS).TI,AB. 104560
92 (DOUBLE ADJ BLIND).TI,AB. 48103
93 (SINGLE ADJ BLIND).TI,AB. 3864
95 PLACEBOS 105823
96 PLACEBO 105823
97 PLACEBO#.W..DE. 75282
98 (PLACEBO ADJ EFFECT).TI,AB. 1233
99 95 OR 96 OR 97 OR 98 105823
100 83 OR 84 OR 90 OR 91 OR 92 OR 93 522209
101 (CROSS ADJ OVER ADJ STUDIES).TI,AB. 2307
103 (MULTICENTER ADJ STUDIES OR MULTICENTER ADJ STUDY).TI,AB. 9887
104 THERAPIES ADJ INVESTIGATIONAL 15
105 (THERAPIES ADJ INVESTIGATIONAL).TI,AB. 15
106 (INVESTIGATIONAL ADJ THERAPIES).TI,AB. 106
107 INVESTIGATIONAL ADJ THERAPY 106
108 (INVESTIGATION ADJ THERAPY).TI,AB. 134
111 (RESEARCH ADJ DESIGN).TI,AB. 6513
114 (PROGRAM ADJ EVALUATION).TI,AB. 848
115 (EVALUATION ADJ STUDIES OR EVALUATION ADJ STUDY).TI,AB. 1440
116 (MULTICENTRE ADJ STUDY).TI,AB. 9887
117 RANDOM$4.TI,AB. 272854
118 (CONTROLLED NEAR TRAIL$1 OR STUD$3).TI,AB. 2227101
119 (CLINICAL NEAR TRIAL$1 OR STUD$3).TI,AB 2264572
120 (CLINICAL NEAR TRIAL$1).TI,AB. 88793
121 (CONTROL OR TREATMENT OR EXPERIMENT$5 OR INTERVENTION).TI,AB 1911277
122 (GROUP$1 OR SUBJECT$1 OR PATIENT$1).TI,AB. 2143855
123 (121 NEAR 122).TI,AB. 452104
124 (QUASI-RANDOM$4 OR QUASI ADJ RAMDOM$4 OR PSEUDO-RANDOM$4 OR PSEUDO ADJ RAN-
DOM$4).TI,AB. 203
125 (MUTICENTER OR MULTICENTRE OR THERAPEUTIC).TI,AB. 252037
126 (TRIAL$1 OR STUD$3).TI,AB. 2321790
127 (MULTICENTER OR MULTICENTRE OR THERAPEUTIC).TI,AB. 252031
128 (127 NEAR 126).TI,AB. 41906
129 (CONTROL OR EXPERIMENT$3 OR CONSERVATIVE).TI,AB. 1033345
130 (TREATMENT OR THERAPY OR PROCEDURE OR MANAGE$4).TI,AB. 1542337
131 (129 NEAR 130).TI,AB. 65544
132 (SINGL$1 OR DOUBL$1 OR TRIPL$1 OR TREBL$1).TI,AB. 465484
133 (BLIND$2 OR MASK$2).TI,AB. 94835
134 (132 NEAR 133).TI,AB. 57683
135 (FLIP OR FLIPPED OR TOSS$2).TI,AB. 2874
136 COIN.TI,AB. 807
137 (136 NEAR 135).TI,AB. 42
138 (LATIN ADJ SQUARE).TI,AB. 536
139 VERSUS.TI,AB. 155325
140 (CROSS-OVER OR CROSS ADJ OVER OR CROSSOVER).TI,AB. 23436
141 PLACEBO$1.TI,AB. 70826
142 SHAM.TI,AB. 21506
143 (ASSIGN$2 OR ALTERNATE OR ALLOCAT$3 OR COUNTERBALANCE$1 OR MULTIPLE ADJ BASELINE).TI,AB.
93768
144 CONTROLS.TI,AB. 702865
145 (TREATMENT$1 NEAR ORDER).TI,AB. 5973
146 (JOURNAL ADJ OF ADJ MUSIC ADJ THERAPY).SO. 0
147 138 OR 139 OR 140 OR 141 OR 142 250805
148 (138 OR 139 OR 140 OR 141 OR 142).TI,AB. 250805
149 (144 OR 146 OR 146).TI,AB. 702865
150 99 OR 100 OR 101 OR 103 OR 108 OR 114 OR 115 OR 116 OR 118 OR 123 OR 128 OR 131 OR 143 OR 137 OR 148
OR 149 2844110
151 150.TI,AB. 2704175
152 67 AND 76 AND 151 990
153 152 AND HUMAN=YES 635

Appendix 4. CINAHL search strategy
Database: CINAHL - Cumulative Index to Nursing & Allied Health Literature, 1982 to March 2010; EBSCO
S38 .S28 and S37
S37 .S29 or S30 or S31 or S32 or S35 or S36
S36 .TI ( sing or sings or singing or song* or compose or composing or improvis* ) or AB ( sing or sings or singing or song* or compose
or composing or improvis* )
S35 .S33 and S34
S34 .TI ( stimulat* or cue* ) or AB ( stimulat* or cue* )
S33 .TI ( auditory or acoustic ) or AB ( auditory or acoustic )
S32 .TI ( music* or rhythmic* or melod* ) or AB ( music* or rhythmic* or melod* )
S31 .(MH “Singing”)
S30 .(MH “Acoustic Stimulation”)
S29 .(MH “Music”) or (MH “Music Therapy”) or (MH “Music Therapy (IowaNIC)”) or (MH “Performing Artists”) or (MH
“Performing Arts”)
S28 .S1 or S2 or S5 or S8 or S9 or S10 or S11 or S12 or S13 or S14 or S15 or S18 or S19 or S20 or S21 or S22 or S23 or S24 or S27
S27 .S25 and S26
S26 .TI ( neoplasm* or lesion* or tumor* or tumour* ) or AB ( neoplasm* or lesion* or tumor* or tumour* )
S25 .TI ( brain or cereb* ) or AB ( brain or cereb* )
S24 .TI ( anoxi* or hypoxi* or encephalit* or meningit* ) or AB ( anoxi* or hypoxi* or encephalit* or meningit* )
S23 .(MH “Brain Neoplasms+”)
S22 .(MH “Meningitis+”)
S21 .(MH “Encephalitis+”)
S20 .(MH “Anoxia”)
S19 .TI diffuse axonal injur* or AB diffuse axonal injur*
S18 .S16 and S17
S17 .TI ( injur* or trauma* or damage* ) or AB ( injur* or trauma* or damage* )
S16 .TI ( head or brain* or cerebral or cranial or craniocerebral or skull ) or AB ( head or brain* or cerebral or cranial or craniocerebral
or skull )
S15 .(MH “Brain Stem/IN”) or (MH “Cerebellum/IN”)
S14 .(MH “Brain Damage, Chronic”)
S13 .(MH “Head Injuries+”)
S12 .TI ( aphasi* or dysphasi* ) or AB ( aphasi* or dysphasi* )
S11 .(MH “Aphasia+”)
S10 .TI ( hemipleg* or hemipar* or paresis or paretic ) or AB ( hemipleg* or hemipar* or paresis or paretic )
S9 .(MH “Hemiplegia”)
S8 .S6 and S7
S7 .TI ( haemorrhage* or hemorrhage* or haematoma* or hematoma* or bleed* ) or AB ( haemorrhage* or hemorrhage* or haematoma*
or hematoma* or bleed* )
S6 .TI ( brain* or cerebr* or cerebell* or intracerebral or intracranial or subarachnoid ) or AB ( brain* or cerebr* or cerebell* or
intracerebral or intracranial or subarachnoid )
S5 .S3 and S4
S4 .TI ( ischemi* or ischaemi* or infarct* or thrombo* or emboli* or occlus* ) or AB ( ischemi* or ischaemi* or infarct* or thrombo*
or emboli* or occlus* )
S3 .TI ( brain* or cerebr* or cerebell* or intracran* or intracerebral ) or AB ( brain* or cerebr* or cerebell* or intracran* or intracerebral
)
S2 .TI ( stroke or poststroke or post-stroke or cerebrovasc* or brain vasc* or cerebral vasc or cva or apoplex or SAH ) or AB ( stroke or
poststroke or post-stroke or cerebrovasc* or brain vasc* or cerebral vasc or cva or apoplex or SAH )
S1 .(MH “Cerebrovascular Disorders+”) or (MH “stroke patients”) or (MH “stroke units”)

Appendix 5. PsycInfo search strategy
Database: PsycINFO; 1806 to July Week 4 2009
1 Music/ (7866)
2 Music Therapy/ (2235)
3 exp Auditory Stimulation/ or acoustic stimulation.mp. (19648)
4 (music$ or rhythmic$ or melod$).tw. (25383)
5 ((auditory or acoustic) adj5 (stimulat$ or cue$)).tw. (4605)
6 (sing or sings or singing or song$ or compose or composing or improvis$).tw. (9531)
7 or/1-6 (52839)
8 cerebrovascular disorders/ or exp cerebral ischemia/ or exp carotid arteries/ or cerebrovascular accident/ or exp brain damage/ or
exp embolisms/ or exp cerebral hemorrhage/ or aneurysms/ (29149)
9 (stroke or poststroke or post-stroke or cerebrovasc$ or brain vasc$ or cerebral vasc$ or cva$ or apoplex$ or SAH).tw. (12629)
10 ((brain$ or cerebr$ or cerebell$ or intracran$ or intracerebral) adj5 (isch?emi$ or infarct$ or thrombo$ or emboli$ or occlus$)).tw.
(2795)
11 ((brain$ or cerebr$ or cerebell$ or intracerebral or intracranial or subarachnoid) adj5 (haemorrhage$ or hemorrhage$ or
haematoma$ or hematoma$ or bleed$)).tw. (1149)
12 hemiplegia/ (592)
13 exp paresis/ (126)
14 (hemipleg$ or hemipar$ or paresis or paretic).tw. (2942)
15 exp aphasia/ (12045)
16 (aphasi$ or dysphasi$).tw. (9512)
17 exp head injuries/ (3939)
18 exp Brain Damage/ (20526)
19 ((head or brain$ or cerebral or cranial or craniocerebral or skull) adj5 (injur$ or trauma$ or damage$)).tw. (25819)
20 diffuse axonal injur$.tw. (99)
21 exp ANOXIA/ (1219)
22 exp encephalitis/ (1000)
23 exp meningitis/ (252)
24 exp brain neoplasms/ (899)
25 (anoxi$ or hypoxi$ or encephalit$ or meningit$).tw. (5125)
26 ((brain or cereb$) and (neoplasm$ or lesion$ or tumor$ or tumour$)).tw. (16302)
27 or/8-26 (72335)
28 empirical study.md. (1177004)
29 followup study.md. (31660)
30 longitudinal study.md. (57905)
31 prospective study.md. (9953)
32 quantitative study.md. (396174)
33 “2000”.md. ( Treatment Outcome/Randomized Clinical Trial ) (14862)
34 treatment effectiveness evaluation/ (10973)
35 exp hypothesis testing/ (1992)
36 repeated measures/ (449)
37 exp experimental design/ (40424)
38 placebo$.ti,ab. (22661)
39 random$.ti,ab. (82864)
40 (clin$ adj25 trial$).ti,ab. (14727)
41 ((singl$ or doubl$ or trebl$ or tripl$) adj (blind$ or mask$)).ti,ab. (13966)
42 or/28-41 (1225715)
43 7 and 27 and 42 (874)
44 limit 43 to human (798)
45 (infant$ or neonat$ or child$).tw. (455254)
46 44 not 45 (635)

Appendix 6. LILACS search strategy
((([MH] (music$)) or (((music and therapy))) or (([MH]“MUSIC THERAPY”) ) or ((((rhythmic and auditory and stimulation))) or
(([MH] (“auditory stimulation”)) AND or (((singing or song$))) AND Group=Humans (313)
Appendix 7. AMED search strategy

Database: AMED (Allied and Complementary Medicine) 1985 to August 2009
1 music/ or music therapy/ or acoustic stimulation/ (540)
2 (music$ or rhythmic$ or melod$).tw. (1145)
3 ((auditory or acoustic) adj5 (stimulat$ or cue$)).tw. (86)
4 (sing or sings or singing or song$ or compose or composing or improvis$).tw. (205)
5 4 or 1 or 3 or 2 (1354)
6 exp Cerebral ischemia/ (102)
7 exp Cerebrovascular disorders/ (5456)
8 carotid artery diseases.mp. (2)
9 exp Cerebrovascular accident/ (1505)
10 brain infarction.mp. (12)
11 exp Brain injuries/ (3171)
12 (stroke or poststroke or post-stroke or cerebrovasc$ or brain vasc$ or cerebral vasc$ or cva$ or apoplex$ or SAH).tw. (6235)
13 ((brain$ or cerebr$ or cerebell$ or intracran$ or intracerebral) adj5 (isch?emi$ or infarct$ or thrombo$ or emboli$ or occlus$)).tw.
(447)
14 ((brain$ or cerebr$ or cerebell$ or intracerebral or intracranial or subarachnoid) adj5 (haemorrhage$ or hemorrhage$ or
haematoma$ or hematoma$ or bleed$)).tw. (188)
15 hemiplegia/ or exp paresis/ (956)
16 (hemipleg$ or hemipar$ or paresis or paretic).tw. (1925)
17 (aphasi$ or dysphasi$).tw. (587)
18 exp aphasia/ (408)
19 brain damage.mp. (220)
20 ((head or brain$ or cerebral or cranial or craniocerebral or skull) adj5 (injur$ or trauma$ or damage$)).tw. (4671)
21 diffuse axonal injur$.tw. (21)
22 exp Anoxia/ (109)
23 exp Encephalitis/ (22)
24 exp Meningitis/ (27)
25 exp Brain neoplasms/ (118)
26 (anoxi$ or hypoxi$ or encephalit$ or meningit$).tw. (374)
27 ((brain or cereb$) and (neoplasm$ or lesion$ or tumor$ or tumour$)).tw. (786)
28 or/6-27 (12769)
29 Randomized controlled trials/ (1357)
30 random allocation/ (288)
31 clinical trials/ (1625)
32 Double blind method/ (389)
33 single-blind method/ (1)
34 Placebos/ (504)
35 Research Design/ (1640)
36 Program Evaluation/ (1766)
37 randomized controlled trial.pt. (1384)
38 controlled clinical trial.pt. (69)
39 clinical trial.pt. (1103)
40 multicenter study.pt. (233)
41 evaluation studies.pt. (103)
42 random$.tw. (10474)
43 (controlled adj5 (trial$ or stud$)).tw. (5636)
44 (clinical$ adj5 trial$).tw. (3992)
45 ((control or treatment or experiment$ or intervention) adj5 (group$ or subject$ or patient$)).tw. (16898)
46 (quasi-random$ or quasi random$ or pseudo-random$ or pseudo random$).tw. (42)
47 ((multicenter or multicentre or therapeutic) adj5 (trial$ or stud$)).tw. (1096)
48 ((control or experiment$ or conservative) adj5 (treatment or therapy or procedure or manage$)).tw. (2948)
49 ((singl$ or doubl$ or tripl$ or trebl$) adj5 (blind$ or mask$)).tw. (1870)
50 (coin adj5 (flip or flipped or toss$)).tw. (3)
51 latin square.tw. (24)
52 versus.tw. (3434)
53 (cross-over or cross over or crossover).tw. (674)
54 placebo$.tw. (2228)
55 sham.tw. (564)
56 (assign$ or alternate or allocat$ or counterbalance$ or multiple baseline).tw. (4709)
57 controls.tw. (3690)
58 (treatment$ adj6 order).tw. (305)
59 or/29-58 (36291)
60 59 and 28 and 5 (26)
Appendix 8. Science Citation Index search strategy
# 59 94 #58 AND #45 AND #11
# 58 >100,000 #57 OR #56 OR #55 OR #54 OR #53 OR #52 OR #51 OR #50 OR #49 OR #48 OR #47 OR #46
# 57 >100,000 TS=((control* or prospectiv* or volunteer*))
# 56 2,536 TS=((prospective stud*))
# 55 6,024 TS=((follow up stud*))
# 54 9,689 TS=((evaluation stud*))
# 53 41,459 TS=((comparative study))
# 52 78,169 TS=((random*))
# 51 15,695 TS=((placebo*))
# 50 25,464 TS=((Clinical trial*))
# 49 548 TS=((single blind method*))
# 48 4,496 TS=((double blind method*))
# 47 16,727 TS=((Randomized controlled trial*))
# 45 24,620 #44 OR #43 OR #42 OR #41 OR #40 OR #39 OR #38 OR #37 OR #36 OR #35 OR #34 OR #33 OR #32
OR #31 OR #30 OR #29 OR #28 OR #27 OR #26 OR #25 OR #24 OR #23 OR #22 OR #21 OR #20 OR

(Continued)
#19 OR #18 OR #17 OR #16 OR #15 OR #14 OR #13 OR #12
# 44 2,467 TS=((anoxi* or hypoxi* or encephalit* or meningit*))
# 43 1,407 TS=((anoxia or encephalitis or meningitis or brain neoplasm*))
# 42 99 TS=((diffuse axonal injur*))
# 41 466 TS=((chronic brain injury))
# 40 332 TS=((chronic brain damage))
# 39 81 TS=((skull fractures))
# 38 7 TS=((traumatic intracranial haemorrhage))
# 37 19 TS=((traumatic intracranial hemorrhage))
# 36 1,607 TS=((closed head injur*))
# 35 1,337 TS=((brain injuries))
# 34 45 TS=((craniocerebral trauma))
# 33 6,984 TS=((aphasi* or dysphasi*))
# 32 5,368 TS=(Aphasia)
# 31 240 TS=((hemiplegi*or hemipar* or paresis or paretic))
# 30 27 TS=((intracranial haemorrhage))
# 29 12,095 TS=((stroke or poststroke or post-stroke or cerebrovasc* or brain vasc* or cerebral vasc* or cva* or apoplex* or
SAH))
# 28 1 TS=((intracranial artery dissection))
# 27 2 TS=((vertebral artery dissection))
# 26 8 TS=((intracranial vasospasm*))
# 25 150 TS=((intracranial hemorrhage*))
# 24 10 TS=((Intracranial Thrombosis*))
# 23 5 TS=((Intracranial Embolism*))

(Continued)
# 22 9 TS=((intracranial arteriovenous malformation*))
# 21 10 TS=((intracranial arterial disease*))
# 20 19 TS=((hypoxia-ischemia))
# 19 27 TS=((cerebrovascular trauma))
# 18 407 TS=((brain infarction))
# 17 373 TS=((cerebrovascular accident))
# 16 211 TS=((carotid artery disease*))
# 15 234 TS=((brain ischemia))
# 14 18 TS=((basal ganglia cerebrovascular disease))
# 13 585 TS=((cerebrovascular disorder*))
# 12 63 TS=((cerebral vascular accident))
# 11 24,182 #10 OR #9 OR #8 OR #7 OR #6 OR #5 OR #4 OR #3 OR #2 OR #1
# 10 26 TS=((melodic intonation therapy))
#9 3,865 TS=((sing OR singing OR song OR sings OR improvis*))
#8 657 TS=((acoustic cue*))
#7 1,316 TS=((auditory cue*))
#6 1,415 TS=((auditory stimulat*))
#5 490 TS=((acoustic stimulat*))
#4 463 TS=((acoustic stimulation))
#3 17,736 TS=((rhythmic* OR melod* OR music*))
#2 12,135 TS=(music)
#1 1,089 TS=((music therapy))

Appendix 9. CAIRSS search strategy
1. Brain injur? [as a phrase] OR head injur? [as a phrase] OR skull fracture [as a phrase] (10)
2. Brain damage [as a phrase] OR cerebral trauma [as a phrase] OR brain neoplasm? [as a phrase] (61)
3. Brain tumor? [as a phrase] OR cereb? tumor? [as a phrase] OR brain infarction [as a phrase] (2)
4. cerebrovascular disorder? [as a phrase] OR brain ischemia [as a phrase] OR cerebrovascular accident [as a phrase] (3)
5. intracranial hemorrhage? [as a phrase] OR stroke OR poststroke (17)
6. post-stroke [as a phrase] OR cva OR cereb? Thrombosis [as a phrase] (15)
7. brain thrombosis [as a phrase] OR brain embolism [as a phrase] (0)
8 hemiplegi? OR paresis OR paretic (1)
9. Aphasi? OR dysphasi? (61)
Appendix 10. Proquest Digital Dissertations search strategy

(music) OR ((music therapy)) OR ((rhythmic auditory stimulation)) OR ((acoustic stimulation)) OR ((rhythmic auditory cueing))
OR ((auditory stimulation)) AND (stroke OR head OR brain OR intracranial OR cerebrovascular) (543)
Appendix 11. ClinicalTrials.gov search strategy

music OR (music therapy) OR singing OR song OR songs OR (rhythmic auditory stimulation) OR (rhythmic auditory cueing) OR
(acoustic stimulation) OR (acoustic cueing) OR melody OR melodic (247)
Appendix 12. Current Controlled Trials search strategy

music OR (music therapy) (26)
Appendix 13. National Research Register search strategy

(music OR (music therapy) OR (rhythmic auditory stimulation) OR (rhythmic auditory cueing) OR (acoustic stimulation) OR
(acoustic cueing) OR melodic) AND (stroke OR poststroke OR cerebrovascular OR (brain ischemia) or (brain infarction) OR (brain
injur$) OR intracranial OR aphasi$ OR dysphasi$ OR hemiplegi$ OR paretic OR paresis OR (head injur$) OR (brain trauma) OR
(brain damage) OR encephalitis OR meningitis OR (brain tumor) OR (brain neoplasm) OR (brain tumour)) (145)
Appendix 14. Rehab Trials.org

music (0)
music therapy (0)
rhythmic (0)
Auditory stimulation (0)
Acoustic stimulation (0)
Melodic (0)

Appendix 15. Indexes to Theses
(acoustic cueing) OR melodic) AND (stroke OR poststroke OR cerebrovascular OR (brain ischemia) or (brain infarction) OR (brain
injur$) OR intracranial OR aphasi$ OR dysphasi$ OR hemiplegi$ OR paretic OR paresis OR (head injur$) OR (brain trauma) OR
(brain damage) OR encephalitis OR meningitis OR (brain tumor) OR (brain neoplasm) OR (brain tumour)) (1)
(acoustic cueing) OR melodic)AND (stroke OR brain OR head OP cerebrovascular OR intracranial) (14)
Appendix 16. The Specialist Music Therapy Research Database

The database is no longer functional. However, archives of dissertations and conference proceedings were handsearched
HISTORY
Protocol first published: Issue 4, 2007
Review first published: Issue 7, 2010
Date Event Description
10 July 2008 Amended Converted to new review format.
CONTRIBUTIONS OF AUTHORS
Protocol
• Background, objectives, criteria for considering studies: Bradt, Magee, Dileo, Wheeler (approved by McGilloway)
• Search strategies, methods: Bradt (reviewed and approved by Magee, Dileo, Wheeler, McGilloway).
Review
• Searches: Bradt, Wheeler, Magee, McGilloway
• Trials selection: Wheeler, Magee, Bradt (Dileo, in case of disagreement)
• Interrater reliability (trial selection): Bradt
• Development of coding form: Bradt
• Data extraction: Bradt and trained research assistant
• Quality assessment of trials: Bradt and Dileo
• Data entry: Bradt
• Data analysis: Bradt and Dileo

DECLARATIONS OF INTEREST
Four of the review authors (JB, CD, WM, BW) are music therapists. Wendy Magee is involved in the design, conduct and publication
of studies, of which one (Magee 2006) it is currently in the Ongoing studies section. Barbara Wheeler was involved in one study that
was considered for this review (Nayak 2000), but it was subsequently excluded.
SOURCES OF SUPPORT
Internal sources
• No sources of support supplied
External sources
• State of Pennsylvania Formula Fund, USA.
DIFFERENCES BETWEEN PROTOCOL AND REVIEW

The following journal was added for the handsearching: Japanese Journal of Music Therapy.
INDEX TERMS
Medical Subject Headings (MeSH)

Acoustic Stimulation [methods]; Aphasia [rehabilitation]; Brain Damage, Chronic [∗ rehabilitation]; Brain Injuries [complications;
∗ rehabilitation];
Gait Disorders, Neurologic [etiology; ∗ rehabilitation]; Music Therapy [∗ methods]; Randomized Controlled Trials as
Topic
MeSH check words

Adult; Female; Humans; Male


Music - Brain Injury

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Music therapy for acquired brain injury (Review)

Bradt J, Magee WL, Dileo C, Wheeler BL, McGilloway E

Music therapy for acquired brain injury (Review)

Music therapy for acquired brain injury (Review) i

Music therapy for acquired brain injury

Editorial group: Cochrane Stroke Group.

PLAIN LANGUAGE SUMMARY

Music therapy for acquired brain injury

Music therapy for acquired brain injury (Review) 3

Music therapy for acquired brain injury (Review) 4

Music therapy for acquired brain injury (Review) 5

We rated randomization as appropriate if every participant had an

4. Incomplete data addressed Subgroup analysis and investigation of heterogeneity

Music therapy for acquired brain injury (Review) 6

Music therapy for acquired brain injury (Review) 7

Music therapy for acquired brain injury (Review) 8

Music therapy for acquired brain injury (Review) 9

Music therapy for acquired brain injury (Review) 10

Music therapy for acquired brain injury (Review) 11

Music therapy for acquired brain injury (Review) 14

Characteristics of included studies [ordered by study ID]

Outcomes Agitation (Agitation Behavior Scale): effect size reported

Item Authors’ judgement Description

Adequate sequence generation? Yes Computer-generated list of random numbers

Allocation concealment? No No allocation concealment used

Music therapy for acquired brain injury (Review) 15

Blinding? No Blinding of outcome assessors (unit nurses) was attempted but

Methods Pseudo-randomized controlled trial (alternate group allocation)

Item Authors’ judgement Description

Adequate sequence generation? No Alternate group allocation

Allocation concealment? No No allocation concealment used

Music therapy for acquired brain injury (Review) 16

Blinding? Yes Independent outcome assessors were used

Incomplete outcome data addressed? Yes 1 experimental and 1 control participant

Item Authors’ judgement Description

Adequate sequence generation? Yes Computer-generated list of random numbers

Music therapy for acquired brain injury (Review) 17

Item Authors’ judgement Description

Adequate sequence generation? No Alternate group allocation

Allocation concealment? No No allocation concealment used

Blinding? Yes Occupational therapist who completed the

Incomplete outcome data addressed? Yes There were no withdrawals

Music therapy for acquired brain injury (Review) 18

Participants 20 adults with hemiparetic stroke

Interventions Music therapy group: RAS

Item Authors’ judgement Description

Adequate sequence generation? Yes Computer-generated list of random numbers (per-

Blinding? Yes Outcome assessors (physical therapists) were

Incomplete outcome data addressed? Yes No participant loss (personal communication)

Participants 21 adults with left hemispheric stroke

Music therapy for acquired brain injury (Review) 19

Setting: out-patient services

Interventions Music therapy condition: RAS

Item Authors’ judgement Description

Blinding? No No blinding used

Participants 78 adults with subacute hemiparetic stroke

Interventions Music therapy group: RAS

Music therapy for acquired brain injury (Review) 20

Item Authors’ judgement Description

Adequate sequence generation? Yes Computer-generated list of random numbers