The Impact of Music-Supported Therapy on Quality of Life in patients Recovering from a Stroke: A Narrative Review

Lee Wan Zhen^1,2, Garry Kuan^3*, U.S. Mahadeva Rao⁴, Nor Farid Bin Mohd Noor⁵,

Suganya Mahadeva Rao⁶, Muhammad Hafiz Hanafi⁷, Yee Cheng Kueh⁸, Kavinthiran Murty⁹,

Pavitra Sandranggan⁹, Suchitra Solomon J Raja⁹, Vinoth Kumar Selvaraj¹⁰,

M. Bala Sundaram¹¹, Kalandar Ameer¹¹

¹Department of Wellness, Faculty of Hospitality, Tourism And Wellness (FHPK),

Universiti Malaysia Kelantan, Kampus Kota, Kelantan, Malaysia.

²Exercise and Sports Science Programme, School of Health Sciences,

Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

³Exercise and Sports Science Programme, School of Health Sciences,

Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

⁴School of Basic Medical Sciences, Faculty of Medicine,

Kampus Perubatan, UniSZA, 20400 Kuala Terengganu, Malaysia.

⁵School of Basic Medical Sciences, Faculty of Medicine,

Kampus Perubatan, UniSZA, 20400 Kuala Terengganu, MALAYSIA.

⁶PEOPLE’S College of Dental Sciences and Research Centre, PEOPLE’S University, MP, Bhopal, India.

⁷Rehabilitation Medicine Unit, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia

⁸Biostatistics and Research Methodology Unit, School of Medical Sciences,

Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia

⁹School of Physiotherapy, Faculty of Allied Health Profession, 

AIMST University, Bedong-Kedah 08100,

¹⁰School of Physiotherapy, Faculty of Allied Health Profession,

AIMST University, Bedong-Kedah 08100, Malaysia.

¹¹Unit of Biochemistry, Faculty of Medicine, AIMST University, Bedong, Kedah 08100, Malaysia.

*Corresponding Author E-mail: garry@usm.my

ABSTRACT:

Stroke, a main cause of disability around the world with it's affecting not only on physical but also cognitive and emotional health. Therefore, music therapy has become more popular traditional treatments to stroke rehabilitation due to its target multiple aspects of healing. As the review examines how Music-Supported Therapy (MST) can make stroke recovery, which by improving their motor function, mood, and overall health status. Besides, some research also shown that music therapy can help stroke survivors reactivate their motor skills, enhance cognitive function, and support their emotional recovery. For instance, it can improve their ability to walk or stand, training their hand strength, and improving overall quality of life. MST has also been found to help reduce the feelings of depression and anxiety of the survivors who are facing after a stroke. MST promotes neuroplasticity in stroke patients, improving emotional well-being, motor, and mental abilities. It boosts mood and overall wellness. Musical activities provide motivation and spirits during rehabilitation. MST is a specialized treatment for stroke recovery, stimulating neurons and activating brain networks, contributing significantly to recovery. Individual who recovering from stroke can have considerable improvements in their emotional state, physical cognitive function, and neuroplasticity with the medically proven Therapeutic Techniques (MST). This therapy is truly effective for stroke sufferers, who frequently struggle in these cases. MST's regimented nature gives them a sense of control and accomplishment, which may boost their morale and drive during their rehabilitation period. It is a promising therapeutic since its capacity to link various brain networks and stimulate neuroplasticity as well. Furthermore, incorporating MST into stroke rehabilitation programs also increase patients' happiness, quality of life, and most important is easing reintegration into society and boosting long-term recovery outcomes.

KEYWORDS: Music-supported therapy, Music therapy, Anxiety and depression, Stroke, Post stroke, Gait, Arm strength function, Quality of life.

INTRODUCTION: 

Stroke is the biggest cause of disability worldwide, with severe physical, cognitive, and emotional implications for those affected¹. A stroke can cause a variety of impairments, such as motor deficits, language difficulties, and emotional dysregulation. Its effects can vary widely based on characteristics like the location and severity of the brain lesion². Music is rapidly becoming acknowledged as a beneficial aid in the rehabilitation of stroke patients². Music intervention has the potential to access and impact change in numerous domains at the same time, making it a promising non-pharmacological strategy to meeting the holistic requirements of stroke survivors³.

Rajendran and Summa-Chadwick (2022)⁴ stated that music has long been considered as a wellness and healing medium. Its focusses on its therapeutic application and its link to stroke rebound. Besides, stroke is a devastating tragedy that may affects a person's mental, cognitive, physical, and emotional functions. Furthermore, studies also mentioned that music therapy can significantly promote stroke survivors' recovery. One key benefit of musical treatment is its ability to boost motor function. There has been an increase in the use of music-based therapies as a supplement to traditional stroke rehabilitation methods. Music is a flexible instrument that can address the needs of stroke survivors by engaging multiple brain networks involved in auditory processing, motor control, cognition, and emotion regulation.

Music-based treatments have the potential to be an affordable, engaging, and non-pharmaceutical method for stroke recovery⁵. These treatments may enhance neuroplasticity and accelerate the healing process by using the brain's natural reactions to music^1,2. Apart from that, music treatment significantly improves patients' ability to identify sound, understanding language through lyrics and singing, and the frequency and rhythm of speech^6,7. Furthermore, research shows that music-aided treatment can positively impact perceptual plasticity in chronic stroke survivors, resulting in significant improvements in motor function and brain activity⁸. This indicates that functional changes may occur in the motor cortex and that training new motor skills through music-based intervention may be an effective therapeutic strategy for stroke recovery⁹.

Research has shown that music-aided treatment increases auditory-sensorimotor connection essential for reform fine motor skills and restructuring brain networks after stroke¹⁰. The integration of auditory and motor processes is claimed to be main factor to improve physical function as well as cognitive and emotional outcomes in stroke survivors. Clements-Cortés and Haire (2019)³ found that music-aided treatments have the potential to address depression, a common comorbidity in stroke. Also, music-aided treatment enhancing mood and overall well-being by stimulating reward and emotion-associated brain regions¹¹. Listening to music, particularly motivational and soothing music, can serve as an emotionally captivating diversion that aids in diminishing unpleasant emotions, pain perception, and the associated negative emotional experience¹².

The healing effects of music-aided treatment in stroke recovery are driven by neuroplasticity, auditory-motor connection, and psychological management. Neuroplasticity is the brain's ability to grow and adapt in response to new experiences and challenges, and MST supports this possibility. Research shows that music training can cause rapid structural and functional changes in movement-related brain areas, including the supplementary motor area and primary motor cortex. Increased function in motor stroke patients who receive music-aided treatment is alleged to be the result of these plastic neurogenic changes.

Research of Rajendran and Summa-Chadwick (2022)⁴ refer that the therapeutic impact of music in stroke rehabilitation raises practical concerns. Integrating music-based therapies into recovery allows healthcare professionals to offer a personalized approach that caters to stroke survivors' diverse needs¹. In a nutshell, listening to music can improve mood and overall well-being by stimulating brain regions linked to emotions and rewards.

Music therapy benefits in stroke recovery:

In general, music therapy helps patients improve their language comprehension by improving their capacity to understand lyrics and singing, as well as improving their speech frequency and rhythm^6,7. It is primarily the distinct ways in which the two hemispheres of the brain perceive music that serves as the foundation for music therapy. The left hemisphere of the brain is responsible for comprehending lyrics and differentiating rhythms, whilst the right hemisphere is responsible for melody¹².

Furthermore, both categories that comprise the area of music therapy are engaged music therapy and passive music therapy. Active music therapy refers to when patients actively participate in singing, playing instruments, or moving to music while getting therapy. Apart from passive music treatment, also known as sensory music therapy, patients can also hear music they are already acquainted with. Passive listening to music does not require any special conditions, but it can foster an environment that makes people feel safe and comfortable¹³.

On the other hand, active music therapy involves the deliberate selection of music that possesses a pronounced sense of rhythm. In contrast, passive music therapy mostly relies on the individual's own preference when choosing the music. The primary objective of active music therapy is to augment patients' sense of affiliation with their music. The choice of music and the development of treatment plans frequently vary depending on the seriousness of the illness, the patient's age, gender, and cultural heritage¹⁴. Besides, Kuan and his colleagues¹⁵ examined the psycho-physiological impacts of music engaged in mental imagery. The result shown that that unusual relaxing music (URM) was found to be the most effective in inducing a state of relaxation, while unfamiliar arousing music (UAM) was shown to be the most effective in inducing a state of arousal. They conclude that listening to relaxing songs is linked to reduced physiological signs of arousal, decreased physical and cognitive anxiety, and increased self-confidence.

The approach mentioned above makes use of music as a therapeutic tool to handle social, emotional, and cognitive needs in addition to physical ones. Music therapy can help stroke patients recover their physical abilities, regulate their emotions, and increase their cognitive function. These benefits are especially important when considering the sometimes-incapacitating symptoms of stroke, which can have a substantial impact on a person's capacity to carry out everyday tasks and to keep a good attitude on life. According to Köhler and his colleagues stated that the capacity of music therapy to improve one's mood and mental well-being is one of the most significant advantages of this form of therapy. Moreover, Perna and Harik (2020)¹⁶ mentioned that depression, anxiety, and emotional instability are common symptoms experienced by stroke patients, and these symptoms can make the overall rehabilitation process more difficult for them.

In addition, Tang (2019)¹⁷ stated that through the promotion of relaxation, the reduction of stress, and the provision of an avenue for self-expression, music therapy is able to assist in the mitigation of these unpleasant feelings. Endorphins and other neurochemicals that lead to emotions of happiness and contentment are released when one listens to music or creates music. This stimulation occurs when one experiences music¹⁸. Furthermore, the scheduled nature of musical activities can provide patients with a sense of control and accomplishment, which further boosts their morale and drive within the healthcare setting¹⁹.

People who have had a stroke additionally benefit from music therapy for mental rehabilitation. It takes a combination of cognitive functions, including executive function, memory, and attention to participate in music. Exercises utilizing music therapy can improve cognitive capacities, which can aid in the restoration of abilities that may have been affected by a stroke²⁰.

Effect of MST on QoL in Stroke Recovery:

Rehabilitation facilities for people with stroke typically take place in the initial months following the event of the stroke, which is considered to be the time when the possibility for recovery is at its highest²¹. The goal of rehabilitation is to enable the individual to attain the best possible level of functioning in order to facilitate the patient's reintegration into the life of the society²². The individual who has suffered a stroke, however, finds themselves faced with a variety of difficulties during the chronic stage after the acute recovery phase has concluded.

One third of people lives with some residual functional limits in basic tasks, fifty percent of people who have suffered a chronic stroke require assistance with instrumental activities of daily living, and sixty-five percent of people have difficulties reintegrating into community life²³. There is a negative correlation between these residual functional limits and emotional well-being and life satisfaction, particularly in relation to activities that are related to one's occupation and leisure time²⁴. There is a correlation between stroke survivors and low levels of activity, and during the chronic phase, they may even undergo functional impairment²⁵. This is despite the fact that it is recommended that stroke patients maintain an active lifestyle.

Xiong and his associates (2022)²⁶ draw attention to the fact that motor dysfunction, which is defined by weakness in the limbs and numbness. Those are a common post-stroke effects that affects normal social engagement and downgrade the quality of life. Motor function rehabilitation is an ongoing procedure which includes exercise, pharmacological treatment, and psychological counselling. Therefore, new neurorehabilitation strategies are being developed to improve motor function recovery following stroke. In addition, Kuan and his colleagues (2018)²⁷ carried out a study consisting of 12 sessions of imagery training along with music. During these sessions, participants were exposed to one of three music conditions: unknown relaxing music (URM), unfamiliar arousing music (UAM), or no music (NM). The study lasted for a duration of 4 weeks. The outcome is notably advantageous when implementing visual training in conjunction with URM to improve the execution of a fine motor function.

Music therapy is an innovative technique to restoring motor function of stroke survivors. It stimulates brain plasticity, brain neural network regulation, and signal transduction, resulting in enhanced motor performance. Exercise training is especially important for stroke patients with motor dysfunction. According to Douglass-Kirk and colleagues (2022)²⁸, rhythmic music can help restore motor function during treatment. Furthermore, MST is a promising innovative technique with extensive data supporting its usefulness in stroke recovery. It is believed to be beneficial due to its ability to induce calm and enhance cognitive and motor functions. Despite the fact that music therapy has been utilised in rehabilitation to stimulate brain functions involved in emotion, cognition, speech, and sensory perceptions, there are numerous research that have been conducted on the effects of music therapy on mood in patients who have suffered a stroke²⁹.

When it comes to stroke motor therapy, Gebruers and his colleagues (2010)³⁰ state that one kind of music-based intervention involves playing musical instruments with the injured upper extremity. This is done in accordance with the concepts of motor learning and multimodal stimulation. Since, vocal music engages extensive and bilateral networks within the brain, which can be observed by functional magnetic resonance imaging, vocal music has the potential to stimulate structural and functional plasticity changes in brain neural networks that are essential for emotional processing and memory. This can help improve memory recovery after a stroke. Furthermore, mindful music listening is tightly associated with relaxation and concentration and strengthened attentional control. Music listening is linked to increased activity, memory reminiscence, and positive mood³¹.

A study by Grau-Sánchez and colleagues²³ investigated the effectiveness of incorporating Music Stimulation Therapy (MST) into a conventional rehabilitation program for patients with subacute stroke. Patients were randomly assigned to either MST or conventional therapy as part of a controlled trial. It was determined that both groups received the same level of intensity and duration from the therapies. In this study, participants' motor and cognitive functioning, mood, and QoL were examined both before and after they received treatment for a period of four weeks. The retention of motor gains was investigated through a follow-up that was carried out three months later. Both groups showed a significant improvement in their motor function, and there were no discernible differences between the groups. In terms of quality of life, the only difference that was identified between the groups was in the language domain. They determined that the patient's inherent drive to participate in musical activities was linked to enhanced motor improvement. The impact on music on QoL among stroke recovery is shown in Table 1.

Table 1: The impact on music on QoL among stroke recovery

Author	Participants	Intervention Details	Length of study and Frequency per week (Duration)	Outcome Measures	Result
Wang et al., (2021) ^32	60 ischemic stroke patients, divided into two groups: control (30) and study (30) Aged range: 42-80 years old	Control group: traditional pharmacological therapy, rehabilitation training, and walking training. Study group: for four weeks (not including Sundays), music therapy in addition to the aforementioned therapies	4 weeks	Length of stride, cadence, and maximum velocity - The length of the steps on the afflicted and healthy sides differs -Scores on the Fugl Meyer Assessment (FMA) - Results on the Berg Balance Scale (BBS) -The satisfaction with stroke rehabilitation treatment	At the end of therapy and at the second week, the study group's stride length, cadence, and maximum velocity were all increased. - The study group's step length disparity between the afflicted and healthy sides was significantly reduced. - The study group showed higher FMA and BBS scores in the second and final weeks of therapy. - The study group had a higher overall satisfaction rate. The results of the study show that when music therapy is combined with conventional rehabilitation methods, patients with ischemic stroke experience significant improvements in their gait, ability to walk, lower limb motor function, balance, and level of satisfaction with their care. One of the main contributors to these improvements is the rhythmic stimulation provided by music therapy.
Huang et al., (2021) ^33	598 stroke patients (345 male, 253 female)	Music-supported therapy sessions	4–8 weeks (30 min/session, 3 times per week)	Hand strength, range of joint motion, dexterity of hands, arm function, quality of life	When compared to the control group, the intervention group showed significant increases in hand strength, range of motion, manual dexterity, and arm functionality. Overall improvement in the quality of life after therapy
Thompson et al., (2022) ^34	49 stroke patients	Neurologic Music Therapy (NMT) sessions delivered one-day-per-week	15 months	Visual Analog Mood Scales (VAMS) pre- and post-session	The results showed that after just one session, the VAMS scores showed positive changes in seven of the eight mood variables, with a statistically significant increase in "happy" and a decrease in "confusion." It was discovered that one day a week of NMT implementation in the subacute setting was feasible. Improvements in mood measures demonstrated that the intervention was helpful, especially for improving physical mobility, focus, drive, and emotional state (VAMS).
Sihvonen et al., (2020) ^35	83 stroke patients	Listening to audiobooks, instrumental music, or self-selected vocal music every day. The individuals were split up into three groups: • Vocal Music: Selecting and listening to vocal music on a daily basis. • Instrumental Music: Playing your own selections of instrumental music every day. • Audiobooks: Using audiobooks on a daily basis.	6 months	Verbal memory, language, focus, mood, and acute, three-, and six-month stages of structural and functional MRI.	The results show that vocal music, as opposed to instrumental music or audiobooks, has a stronger effect on verbal memory and language rehabilitation. It also improves functional connectivity in the default mode network and causes a rise in the amount of grey matter in the left temporal lobes. The researchers conclude that because vocal music has a positive influence on the brain's capacity for both structural and functional change and adaptation, it holds potential as a therapy for promoting early language recovery and cognitive recovery following a stroke.
Fujioka et al. (2018) ^36	28 stroke patient with unilateral arm and hand impairment	Music-Supported Therapy (MST) group (n = 14) Conventional physical training (GRASP) group (n = 14);	10 weeks 30 hours of training	Motor function: Chedoke-McMaster. Arm test for action research, Stroke Assessment hand score; Well-being: Stroke Impact Scale; Cognitive function: Switching tasks, perceiving rhythms in music	The Action Research Arm Test was completed faster by the MST group, while there was a slight increase in both groups' hand function. MST enhanced mood and social communication earlier. It also enhanced executive function and musical rhythm perception. enhanced standard of living for survivors of chronic stages.
Pandey and Singaravelan (2019) ^37	15 middle cerebral artery stroke patients (11 male, 4 female)	Music therapy	1 month (30 minutes daily)	Moss Attention Rating Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale	The current study discovered a significant improvement in the levels of depression, anxiety, and attention in patients with middle cerebral artery stroke who received music therapy in addition to conventional physiotherapy.
Lee et al., (2018) ^38	20 hemiplegic stroke patients	Patients were instructed to sing in their heads while walking through seven exercises that involved structured music therapy sessions (Mental singing while walking) The music can be listened to in a variety of ways, like while clapping your hands or pounding your feet, singing, tapping your feet, dancing and playing, or dancing while expressing yourself. Nevertheless, many evaluations such as the 10-Meter Walk Test (10MWT), Timed Up and Go Test (TUG), stride length, rhythm, and speed are not specifically stated.	No specific	10-Meter Walk Test (10MWT), Timed Up and Go test (TUG), gait velocity, cadence, stride length	Significantly improved 10MWT, TUG test, stride length, velocity, and cadence of gait. The study shows that walking while mentally singing helps improve gait in hemiplegic stroke patients, as shown by notable improvements in a number of gait measures.
Lee et al., (2018) ^38	44 participants (<6 months after stroke)	GTBR group: bilateral RAS conventional therapy combined with gait training. Control group: traditional therapy combined with RAS-free gait training .	6 weeks (30 min/day, 5 days/week)	- Step time symmetry in gait -Stance aptitude -Equanimity aptitude - Function of the lower extremities	The step time symmetry of the GTBR team's gait demonstrated notable improvements. The GTBR group's improvement in gait ability was clearly more pronounced than that of the control group. Both groups demonstrated statistically significant gains on the Timed Up and Go test (TUG), Berg Balance Scale (BBS), and Fugl–Meyer Assessment (FMA) as compared to their baseline assessments. The study's findings indicate that bidirectional rhythmic auditory stimulation (GTBR) in conjunction with gait training can enhance symmetrical gait in stroke survivors. Additionally, enhanced gait symmetry may have additional benefits if the RAS pulse frequency is consistent with the patient's trot duration.

DISCUSSION:

This review discusses the benefits of integrating music into stroke recovery treatment, highlighting its efficacy in improving gait and fine motor skills as well as overall functional recovery. Wang et al. (2021)³² stated that music therapy has been found to have a positive impact on mood and cognitive performance. Study of Huang et al. (2021)³³ showed enhancements in emotional aspects after Neurologic Music Therapy (NMT) sessions. These findings suggest that music therapy not only contributes to the physical recovery process but also addresses the psychosocial and cognitive aspects of stroke recovery.

However, the diversity of influencing details, such as frequency, length, and type of music therapy, highlights the need for standardization of clinical practice. Thompson et al. (2022) reflected that discrepancy in intervention regimens may affect the comparability of study results. Hence, future research should focus on identifying the most effective treatment parameters to improve treatment results (Pandey and Singaravelan, 2019).

Many forms of music treatment have been assessed and found to have significant impacts on stroke recovery. Lee et al. (2018)³⁸ found that mental singing while walking enhanced gait characteristics, while Huang et al. (2021)³³ focused on music aided treatments to improve hand function and overall condition of patient. The wide range of treatment methods have shown that customized music therapy strategies tailored to a patient's specific needs and recovery goals can produce better outcomes than standardized strategies.

This study shows that integrating music aided treatment into a stroke rehabilitation program can improve functional outcomes and patient pleasure. It improves realism and overall body function and allows for a more comprehensive approach to stroke recovery that considers physical and psychological needs, according to Wang et al. (2021) and Lee et al. (2018)^32,38.

Future research must emphasise on improving music therapy methods and analysing their long-term effects. Studies by Lee and colleagues (2018) and Wang and colleagues (2021)^32,38 demonstrate the benefits of comprehensive treatments such as rhythmic auditory stimulation and gait training. The goal should be to provide consistent advice for music therapy, including frequency, duration, and music genre.

Studying the relationship between music therapy and other forms of rehabilitation could help develop customized treatment plans for stroke patients. This highlights the major impact of music therapy on stroke recovery and suggests further research to improve its effectiveness.

CONCLUSION:

Music therapy (MST) is a promising approach to address the modern challenges of stroke, enhancing emotional well-being, cognitive performance, and motor function. Research shows that MST can reduce mental problems associated with stroke recovery and enhance physical rehabilitation outcomes such as gait and hand function.

Nonetheless, research suggests that consistent recommendations are needed due to variations in interference methods, such as music therapy style, frequency, and duration. Consistency of treatment regimens is critical to promote comparability and maximize outcomes. Future research should focus on the best identified characteristics, such as duration and frequency, to optimize the effectiveness of music therapy in stroke patients.

Music therapy is a promising adjunctive intervention in stroke rehabilitation that addresses both physical and psychological aspects. Further study is required to build evidence-based guides and improve music therapy procedures. By enhancing our understanding of how music therapy influences stroke recovery, we can improve rehabilitation strategies and ultimately contribute to better outcomes and QoL for stroke survivors.

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Received on 11.01.2025      Revised on 15.03.2025

Accepted on 24.05.2025   Published on 12.06.2025

Available online from June 14, 2025

Research J. Pharmacy and Technology. 2025;18(6):2930-2937.

DOI: 10.52711/0974-360X.2025.00420

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