Efficacy and Neural Basis of Music-based Neurological Rehabilitation for Traumatic Brain Injury
Condition: Traumatic Brain Injury (TBI)
MeSH terms: Brain Injuries; Brain Injuries, Traumatic; Wounds and Injuries
Study type: Interventional

Summary: 
      Traumatic brain injury (TBI) is one of the leading causes of serious, life-long disability
      among adolescents and young adults. Especially the cognitive, emotional, and motors deficits
      caused by TBI often impair everyday psychosocial functioning, quality of life and ability to
      work. The purpose of the study is to determine the long-term effect of music-based
      rehabilitation on cognitive, motor, emotional, and social recovery after TBI in adolescents
      and young adults, and to study the neural mechanisms that underlie behavioural recovery and
      the efficacy of music.
    

Detailed description: 
      Traumatic brain injury (TBI) is one of the leading causes of serious, life-long disability
      among adolescents and young adults. Especially the cognitive, emotional, and motors deficits
      caused by TBI often impair everyday psychosocial functioning, quality of life (QoL) and
      ability to work dramatically, thereby bringing about a lot of suffering and burden to the
      patients and their families as well as substantial social and economic costs to the society.
      Early rehabilitation is highly important for restoring lost skills and functioning, but often
      very difficult given the severity and extent of the TBI symptoms and the high strain that the
      available rehabilitation methods put on the patients. Music therapy is a highly motivating,
      versatile, and applicable form of TBI rehabilitation, but currently there is little
      scientific evidence for its efficacy or mechanisms in the TBI population. The purpose of the
      present project is to determine the long-term effect of Music-based Neurological
      Rehabilitation (MBNR) on cognitive, motor, emotional, and social recovery after TBI in
      adolescents and young adults, and to study the neural mechanisms that underlie behavioural
      recovery and the efficacy of music.

      The study is a single-blind, cross-over randomized controlled trial (RCT) involving 60
      adolescents and young adults with a subacute moderate / severe TBI. During an 18-month
      follow-up, the patients receive MBNR (30 session, 3 x week, 1 hour sessions) and/or Standard
      Care (SC). The MBNR intervention utilizes structured cognitive-motor training with drums and
      creative musical expression (music playing, song writing) with piano that are geared towards
      engaging and training attention, executive functions, working memory, and upper-extremity
      functions and for enhancing emotional self-expression, adjustment, and mood after TBI. The SC
      consists of other types of conventional rehabilitation (e.g., physical therapy,
      neuropsychological rehabilitation) and medical care for TBI provided in private or public
      health care. Half of the patients receive the MBNR intervention during the first 10-week
      period and half during the second 10-week period (in addition, all patients receive SC during
      the whole follow-up period).

      Outcome measures comprise neuropsychological tests (measuring executive functions, attention,
      reasoning, and working memory and learning), neurological scales (measuring neurological
      symptoms, functional outcome, adjustment, and participation), motor tests (measuring motor
      dexterity, coordination, and upper limb functioning), and structural and functional magnetic
      resonance imaging (MRI/fMRI, measuring gray and white matter structure and integrity and
      auditory-motor neural processing) performed at the start of the study (baseline), after the
      first 10-week period (3-month stage) and after the second 10-week period (6-month stage). At
      these time points as well as 12 months later (18-month stage), the patients and their
      caregivers are also given questionnaires measuring executive functions, depression symptoms,
      quality of life, and caregiver well-being and burden.
    

Intervention name(s): Music-based Neurological Rehabilitation (MBNR); Standard Care (SC)
Intervention type(s): Behavioral; Other
Intervention description(s): Music-based Neurological Rehabilitation (MBNR) will involve 10 weeks of individual training (30 sessions, 1 hour per session, 3 days per week) given by a trained music therapist. The MBNR protocol utilizes structured cognitive-motor training with drums (drum set, djembe drums) and creative musical expression (music playing, song writing) with piano that are geared towards engaging and training attention, executive functions, working memory, and upper-extremity functions and for enhancing emotional self-expression, adjustment, and mood after TBI.; Standard Care (SC) consists of other types of conventional rehabilitation (physical therapy, occupational therapy, speech therapy, and/or neuropsychological rehabilitation) and medical care for TBI that the patients receive in Finnish private or public health care.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment