Enhancing Attention and Processing Speed Through Home-based Music Rehabilitation Program After Stroke in Malaysia: A Feasibility Random Controlled Study
Phase: NA
Conditions: Stroke, Attention, Rehabilitation Program, Music Intervention
Sponsor: University of Malaya

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RESEARCH PROTOCOL 
 
1. 
Particulars of Researcher  
 
Full Name: DR MAZLINA BINTI MAZLAN 
 
Title: PROFESSOR  
(Please indicate title: Prof/Assoc. Prof/Dr) 
 
Present Position: HEAD OF DEPARTMENT & CONSULTANT REHABILITATION 
PHYSICIAN  
 
Department: REHABILITATION MEDICINE  
 
Office contact number: Tel: 03-7949 2972 
 
Mobile Number: 012-2069784 
 
Email: mazlinamazlan@ummc.edu.my 
 
 
 
Research expertise (List up to 5 fields of expertise):  
Traumatic brain injury, Stroke, Neuromodulation, Cognitive rehabilitation 
 
2. 
List of Co-researchers (Include all who have participated in the drafting of this proposal) 
 
1. Name: Dr. Beh Wen Fen 
Department: Faculty of Creative Arts 
Email: beh.wenfen@um.edu.my 
 
2. Name: Lim Kar Gee 
Department: Malaysian Music Therapy Association 
Email: limkargee@gmail.com 
 
3. Name: Nor Atikah binti Mustapa 
Department: Department of Rehabilitation Medicine, Universiti Malaya Medical 
Centre 
Email: atikah@ummc.edu.my 
 
 
3. 
Research Proposal 
 
TITLE OF RESEARCH PROPOSAL 
Enhancing Attention and Processing Speed Through Home-Based Music Therapy 
Rehabilitation Program After Stroke: A Feasibility Study in Malaysia 
KEY WORDS 
Music therapy; randomised controlled trial; rehabilitation; stroke; cognition; attention 

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BACKGROUND/ JUSTIFICATION 
 
Stroke is a leading cause of long-term disability worldwide, often resulting in cognitive 
impairments, particularly in attention, which can significantly affect patients' quality of life and 
daily functioning. Evidence suggests that music therapy can enhance cognitive recovery during 
neurorehabilitation by engaging multiple brain networks and promoting neuroplasticity. While 
home-based rehabilitation has demonstrated effectiveness post stroke, there is limited evidence 
regarding the feasibility and impact of music therapy delivered at home for stable stroke patients. 
Furthermore, no studies have examined the efficacy of structured music therapy as part of a 
cognitive rehabilitation program in Malaysia, despite efforts over the past decade to promote 
music for therapeutic purposes. Unlike in other countries where music therapy is an established 
neurorehabilitation modality, it has not been formally incorporated into most local 
neurorehabilitation programs. This study proposes to investigate the effects of home-based 
music therapy on cognitive functions in stroke patients in Malaysian setting. If successful, this 
approach could support the integration of music therapy into clinical neurorehabilitation home-
based settings, promoting its wider use for cognitive recovery post-stroke. 
 
OBJECTIVES/OUTCOMES 
 
Objectives:  
 
1. To determine the feasibility and acceptability of a structured home-based music therapy 
rehabilitation programme for improving attention and processing speed among stable stroke 
survivors in Malaysia, as measured by recruitment rate, adherence, retention, and participant 
satisfaction. 
 
2. To explore the preliminary effects of the home-based music therapy rehabilitation programme 
on attention and processing speed in post-stroke patients using standardized cognitive 
outcome measures. 
 
3. To assess the safety and practicality of implementing a home-based music therapy 
rehabilitation intervention, including monitoring adverse events, caregiver involvement, and 
compliance with the prescribed programme. 
 
Expected outcomes: 
 
1. Feasibility and Acceptability 
It is expected that the home-based music therapy rehabilitation programme will demonstrate 
acceptable feasibility among stable stroke survivors in Malaysia. This includes achieving 
satisfactory recruitment and retention rates, good adherence to the prescribed intervention, and 
positive participant-reported satisfaction. These outcomes will indicate that the programme is 
acceptable and practicable for implementation in a home setting within the local context. 
 
2.  Preliminary Cognitive Outcomes 
The study is expected to show trends toward improvement in attention and processing speed 
following participation in the home-based music therapy rehabilitation programme, as measured 
by standardized cognitive assessment tools. While the study is not powered to determine 
definitive efficacy, the findings will provide preliminary data on potential cognitive benefits and 
inform the selection of outcome measures and effect size estimates for future larger-scale trials. 
 
3.  Safety and Practicality 

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The intervention is expected to be safe, with minimal or no adverse events related to 
participation. It is anticipated that participants and caregivers will be able to implement the 
programme with minimal difficulty, demonstrating adequate compliance with the prescribed 
activities. These findings will support the practicality of delivering a structured music therapy 
rehabilitation intervention in a home-based setting. 
 
METHODOLOGY 
 
Study design 
 
This study will adopt a prospective, single-centre, randomized controlled feasibility study design  
with two parallel groups: an intervention group receiving music therapy in addition to standard 
neurorehabilitation, and a control group receiving only standard neurorehabilitation. The primary 
focus is to evaluate the feasibility, acceptability, and safety of a structured home-based musical 
rehabilitation programme for cognitive rehabilitation after stroke. Secondary objectives include 
exploration of preliminary effects on attention and processing speed. 
 
Patients with a history of stroke who are admitted to, or attending follow-up at, University Malaya 
Medical Centre (UMMC) during the study period will be screened for eligibility. Eligible patients 
will be approached and provided with detailed information about the study and invited to 
participate. In addition, public advertisements (posters and flyers within UMMC) will be used to 
increase awareness of the study and facilitate recruitment. Patients who meet the inclusion 
criteria and agree to participate will be enrolled only after providing written informed consent.  
 
Following enrolment, all participants will be allocated to either an intervention group or a control 
group in a 1:1 ratio. To ensure that there are exactly 20 patients in both the control and 
intervention groups, block randomization will be used using a random number generator. After 
randomization, the group assignments will be kept in a password-protected file that only the study 
coordinator can access. The assessor will not have access to this information because the 
patients will be labelled with anonymous codes that do not reveal whether they are in the control 
or intervention group. The assessor will only know the code, not the group assignment, ensuring 
unbiased evaluation. 
 
A certified music therapist will prescribe the intervention and train the patients and caregivers 
before the start of the home-based music therapy. A trained assessor will evaluate the cognition 
at baseline, and also the outcome. The assessor is blinded to the patients’ allocation group and 
will evaluate the cognitive outcomes at baseline, immediately after completion of the intervention 
period at four weeks and at 3 months post intervention.  
 
Intervention group  
 
The music therapy session described follows a structured and engaging approach, aimed at 
enhancing the patient's cognitive skills. Here’s a summary of the session components: 
 
Intervention Group: Home-Based Music Therapy Rehabilitation Program  
 
1. Song Materials and Levels 
The song materials selected for this research will be sourced from copyrighted compositions 
under UM Centre of Innovation and Enterprise (UMCIE). This maximizes the utilization of readily 
available resources and serves as a platform for promoting the original works of UM lecturers. 
The songs are organised into three difficulty levels, with approximately five songs per level. 
Songs within each level have equivalent rhythmic and cognitive demands, allowing variation 
without altering task difficulty. 
 
2.  Baseline Assessment for Music Therapy 

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Participants will undergo an initial level assessment conducted at the hospital by the trained 
music therapist. If travel is not feasible, level assessment is conducted at the participant’s home. 
The songs will be presented to the participants and they will choose one song to start.  
 
To ensure the safety of the research therapist conducting home-based assessments, a multi-
layered safety protocol will be implemented for all home visits: 
a) a designated co-investigator will act as a safety contact. Before any home visit, the 
therapist will provide this contact with a full schedule, including the participant's address 
and the expected duration of the visit. 
b) the therapist will then follow a mandatory check-in procedure via text message: 
• 
Pre-departure: A message before leaving for the visit 
• 
Arrival: A message upon safely arriving at the participant's home 
• 
Departure: A message upon leaving the participant's home 
• 
Safe Return: A final message upon returning to a safe location. 
 
Escalation Protocol: 
If the safety contact does not receive the final "safe return" message within an agreed-upon time, 
they will first attempt to contact the therapist directly. If unsuccessful, they will then call the 
participant/caregiver. If contact cannot be established with either party, the safety contact will be 
authorised to contact the relevant local authorities to conduct a wellness check. 
 
Confidentiality Protocol for Unofficial Recordings by Family Members 
 
To protect participant confidentiality and the integrity of the research data, the following protocol 
will be implemented to address the possibility of family members or caregivers making personal 
recordings during home-based sessions: 
 
1. Enhanced Informed Consent: 
The Participant Information Sheet (PIS) and Consent Form will include a specific clause 
addressing this issue. During the consent process, the investigator will explicitly discuss the 
following with both the participant and the caregiver(s): 
 
Purpose of Official Recordings: A clear explanation that the researcher's video recordings are 
for official data collection and analysis purposes only and will be stored securely according to the 
university's data protection policies. 
 
Prohibition of Unofficial Recordings: A verbal and written request that family members and 
caregivers refrain from taking any personal photos, videos, or audio recordings during the 
structured assessment and intervention sessions. 
 
Rationale: An explanation that this is to protect the participant's privacy and the integrity of the 
research data, as unofficial recordings are not covered by the study's ethical approval or data 
security protocols. 
 
The following statement will be added to the consent form, requiring a separate signature or 
initials from the participant and/or legally authorised representative: 
 
"I understand that the research team will video record the sessions for assessment and data 
analysis purposes only. I agree that I, and any family members or caregivers present, will not 
take any personal photographs, video recordings, or audio recordings during these sessions. I 
understand that any unauthorized recording would be a breach of the participant's 
confidentiality." 
 
 

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Pre-Session Reminder: 
At the beginning of each home visit, the research therapist will provide a friendly, verbal reminder 
to everyone present (participant, family members, caregiver) about the confidentiality agreement 
and the request to refrain from using personal mobile phones or other devices to record the 
session. 
 
3. Participant and Caregiver Training 
At the beginning of the intervention, both participants and caregivers will undergo a structured 
training conducted by the music therapist to ensure they can independently carry out the program 
at home. The song chosen for the training will be different than the songs they will use during the 
home-based therapy rehabilitation program.  
 
4. Caregiver Guidelines and Checklist 
Caregivers are provided with written guidelines and a structured monitoring checklist to support 
adherence, safety monitoring, and documentation throughout the intervention. 
 
5. Attentional Priming 
Each session begins with 3–5 minutes of focused listening, during which participants will be 
instructed to observe and listen attentively to the musical compositions generated by the Finale 
music software. The software's user-friendly interface will display a tempo line adorned with 
pertinent remarks and symbols, providing clear guidance for the patients to follow.  
 
An Eight-Tone Desk Bell (Figure 1) will be integrated with the Finale music software (Figure 2), 
enabling stroke patients to observe and listen to musical compositions generated.  
 
6. Rhythm–Action Training 
Participants will actively engage with the music and synchronise tapping on an Eight-Tone Desk 
Bell. The rhythmic and visual cues will be displayed on the Finale software interface, targeting 
processing speed, sustained attention, and sensorimotor integration. 
 
7. Session Dosage and Frequency 
Each session lasts 40 minutes and is conducted daily for five days per week, in accordance with 
rehabilitation literature. Session duration and frequency are recorded in the caregiver checklist. 
 
8. Progress Monitoring and Adjustment 
Progression is guided by bi-weekly level assessments by the music therapist at their homes. 
Adjustments made based on participant performance and endurance on the songs chosen 
earlier. The adjustments will include either changing the song within the same difficulty level or 
change to the songs in the next level of difficulty.  
 
9. Adherence Monitoring 
Caregivers will complete the checklist after each session, documenting completion, duration, 
participant alertness, and signs of fatigue. Weekly therapist phone call follow-ups support 
adherence and address concerns. 
 
Control Group: Standard Care 
 
Participants in the control group continue with usual standard neurorehabilitation program as 
prescribed by the rehabilitation team, without exposure to the music-based intervention. 
 
This will provide a baseline to compare outcomes with the intervention group and evaluate the 
feasibility and preliminary effects of the music therapy intervention. The usual cognitive 
rehabilitation program during the subacute stroke period focuses on restoring cognitive abilities 

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such as attention, memory, executive functions, and communication. The key components 
typically include: 
 
1. Attention Training: Exercises that improve sustained, selective, and divided attention, crucial 
for regaining concentration in daily activities. 
2. Memory Aids: Tools like mnemonic strategies, repetition tasks, and external memory aids 
(e.g., calendars, notes) help rebuild short-term and working memory. 
3. Executive Function Training: Targeting skills such as problem-solving, planning, and 
organizing tasks through structured exercises, gradually improving independent thinking. 
4. Communication and Language Therapy: Speech-language pathologists work with patients to 
improve verbal and non-verbal communication, focusing on both comprehension and 
expression. 
5. Problem-Solving Exercises: These help patients break down real-life problems into smaller, 
manageable steps, encouraging better decision-making skills. 
 
Both the intervention and control groups will continue receiving the standard care   
 
 
 
 
 
 
 
Figure 1. Eight-Tone Desk Bell 
 

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Figure 2: Finale Music Software User Interface 
 
 
Inclusion Criteria: 
1. Diagnosed with ischemic or haemorrhagic stroke confirmed by CT scan  
2. Duration of stroke within the first one year 
3. Age 18 – 70 years old 
4. Ability to provide informed consent  
5. Understands Bahasa Melayu or English with basic communication abilities to follow 
instructions during therapy sessions 
6. Mild to moderate cognitive impairments with MoCA score of 10-25, with incomplete score for 
the attention sections    
7. Availability of caregiver (formal or informal) who can assist in the music therapy, monitor and 
give feedback during the music therapy sessions at home  
8. Have one normal functioning hand to perform the movements during the music therapy 
rehabilitation program 
9. Have good balance and able to sit upright  
 
Exclusion Criteria: 
1. Severe aphasia  
2. Significant uncorrected hearing or visual impairments preventing engagement in music 
therapy. 
3. Severe or unstable medical conditions (e.g., uncontrolled hypertension or diabetes). 
4. Medications that significantly impair cognition or motor function (e.g., high-dose sedatives). 
5. History of neurological diseases other than stroke (eg, Parkinson’s disease). 
 
Outcome measures  
This will be assessed at baseline, after completion of 4-week sessions and also at 3 months after 
completion.  Primary outcome measures are Montreal Cognitive Assessment (MoCA), Trail 
Making Test (TMT A and B), Digit Span (Forward and Backward) and Clock Drawing Test (CDT). 
The secondary outcome measure is computer-based Cogniplus software for Reaction Time and 
Attention tests 
 
 

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Sample size calculation:  
 
A sample of 40 subacute stroke patients (18 control and 18 intervention) within the first one year 
post-stroke, will be recruited from UMMC. This number is chosen based on practical 
considerations to evaluate feasibility metrics and exploratory analysis as in the objectives. For 
these purposes, a sample size of 36 is typically adequate to gather enough information about 
the practical aspects of the trial. This number could also ensure that the feasibility objectives are 
met even with at least 20% dropouts. This total number of 36 will be sufficient within the study 
period and the grant duration.  
 
Statistical Analysis:  
 
Descriptive Statistics and Exploratory Inferential Statistics will be used in this study. 
 
The means, standard deviations, and 95% confidence intervals (CIs) for cognitive outcome 
measures (e.g., memory, attention, executive function scores) at baseline, post-intervention, and 
follow-up will be used. This will provide a preliminary understanding of the data distribution and 
effect sizes. 
 
For the exploratory Inferential Statistics, independent t-test (or Mann-Whitney U Test) will be 
used to compare the mean changes in cognitive scores between the intervention and control 
groups. The independent t-test if the data are normally distributed. If not, we will use the Mann-
Whitney U test as a non-parametric alternative. 
 
Within each group, we will compare the baseline and post-intervention scores using the paired 
t-test for normally distributed data or the Wilcoxon signed-rank test for non-parametric data. 
Cohen’s d will be used for independent t-tests (between groups) or r for non-parametric tests.  
 
A repeated measures ANOVA (if the data is normally distributed) or a mixed-effects model will 
be used to explore changes over time (baseline, post-intervention, and follow-up). Given the 
small sample size, these analyses will likely be underpowered but can provide estimates of 
variability and preliminary trends. 
 
 
RESEARCH DATA 
 
Where will the data be kept?  
The demographic data of the patients, and data on cognitive performance and other relevant 
data will be kept in a dedicated research file and hard drive. The files are in the laptop will be 
secured with password and the notes will be kept in a locker in the Department of 
Rehabilitation Medicine, Faculty of Medicine with one of the co-researchers.  
 
Anonymity of data 
All patients will be identified with a code number and not real names in the research files. The 
data entry into the excel sheet and into the research thumb drive will follow the similar process.  
 
Who will have access to the research data? 
All the co-researchers & research assistant  
 
How long will the data be kept?   
7 years 
 

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BUDGET / FINANCIAL SUPPORT (IF APPLICABLE):  
 
Grant: BKP-ECRG of RM50,000 
 
 
GANTT CHART  
 
 
Feb – 
April 
2026 
April –
August 
2026 
Sept 
2026 
Oct – Feb  
2026/27 
March 
–June 
2027 
July –
Oct 
2027 
1. Development of the 
project and trial 
registry 
 
 
 
 
 
 
2. Recruitment and 
randomisation phase  
 
 
 
 
 
 
3. Data entry & analysis 
 
 
 
 
 
 
4. Manuscript writing 
 
 
 
 
 
 
5. Submission for 
publication  
 
 
 
 
 
 
6. Promote research 
outcomes 
 
 
 
 
 
 
 
REFERENCES (up to 10 references) 
 
1. Thaut, M. H., Gardiner, J. C., Holmberg, D., Horwitz, J., Kent, L., Andrews, G., Donelan, B., & 
McIntosh, G. R. (2009). Neurologic Music Therapy improves executive function and emotional 
adjustment in traumatic brain injury rehabilitation. Annals of New York Academy Sciences, 1169, 406-
416. 
2. Thaut, M. H. (2010). Neurologic Music Therapy in cognitive rehabilitation. Music Perception, 27(4), 
281-285. 
3. Yoo, G. E., & Kim, S. J. (2016). Rhythmic auditory cueing in motor rehabilitation for stroke patients: 
Systematic review and meta-analysis. Journal of Music Therapy, 53(2), 149-177 
4. Alluri, V., Toiviainen, P., Jääskeläinen, I. P., Glerean, E., Sams, M., & Brattico, E. (2012). Large-scale 
brain networks emerge from dynamic processing of musical timbre, key and rhythm. NeuroImage, 
59(4), 3677-3689. 
5. Antić, S., Morović, S., Kes, V. B., Zavoreo, I., Jurašić, M. J., & Demarin, V. (2012). Enhancement of 
stroke recovery by music. Periodicum Biologorum, 114(3), 397-401. 
6. Cha, Y., Kim, Y., & Chung, Y. (2014). Immediate effects of rhythmic auditory stimulation with tempo 
changes on gait in stroke patients. Journal of Physical Therapy Science, 26(4), 479-482.  
7. Magee, W. L., Clark, I. N., Tamplin, J., & Bradt, J. (2017). Music interventions for acquired brain injury: 
Reviews. 
Cochrane 
Database 
of 
Systematic 
Reviews, 
2017(1), 
1-130, 
doi: 
10.1002/14651858.CD006787.pub3. 
8. Stegemöller, E. L. (2014). Exploring a neuroplasticity model of music therapy. Journal of Music 
Therapy, 51(3), 211-227. 
9. Magee WL, Clark I, Tamplin J, Bradt J. Music interventions for acquired brain injury. Cochrane 
Database 
of 
Systematic 
Reviews 
2017, 
Issue 
1. 
Art. 
No.: 
CD006787. 
DOI: 
10.1002/14651858.CD006787.pub3.  

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VERSION DATE:  11.02.2026 
10. Laver KE, Adey‐Wakeling Z, Crotty M, Lannin NA, George S, Sherrington C. Telerehabilitation 
services for stroke. Cochrane Database of Systematic Reviews 2020, Issue 1. Art. No.: CD010255. 
DOI: 10.1002/14651858.CD010255.pub3. 
11. Ke Wu, Chenxi Li and Sike Zhu et al. Application of Music Therapy in Stroke Rehabilitation: A 
Research Review. BIOI. 2025. Vol. 6(1). DOI: 10.15212/bioi-2025-0074 
 
 
POTENTIAL IMPACT 
 
This study could provide evidence supporting the integration of music therapy into 
neurorehabilitation programs for cognitive recovery post-stroke. It also has the potential to inform 
the development of accessible, low-cost, and culturally appropriate cognitive rehabilitation 
strategies for stroke survivors in Malaysia. By evaluating the feasibility and safety of a home-
based musical rehabilitation programme, the findings may support wider adoption of community-
based cognitive interventions that complement existing rehabilitation services. Preliminary 
evidence generated from this study will guide future larger-scale clinical trials and contribute to 
the integration of music-based therapies into neurorehabilitation practice. Ultimately, this 
approach may improve cognitive outcomes, promote patient engagement, and reduce long-term 
disability following stroke.  
 
 
 
 
4. 
Please state whether you have submitted this research proposal for funding, now or before 
• 
Yes, a brief research proposal was submitted to the grant funder (BKP-ECRG) with 
the grant PI from the Faculty of Arts. The proposed study was approved and grant has 
been offered.  
 
This proposal will be kept strictly private and confidential. It will not be shared with anyone 
without your prior approval. 
 
Name of Researcher (CAPITAL): PROFESSOR DR MAZLINA BINTI MAZLAN 
 
Signature of Researcher:      
 
                                                       
Date: 11-2-2026