speech on music therapy

The Role of Music in Speech Therapy

For more than 50 years, music has been an integral element of routine care for children with speech impediments and hearing impairments. A great deal of research has been done that examines the role of music in an individual’s general health, as well as how music can be an effective intervention when it comes to speech and language challenges. So, it would only make sense that for both children and adults who struggle with communication issues, music should be considered an important part of their intervention and therapy plan.

Speech therapists use a wide variety of approaches, methods, and activities in their sessions, and each treatment plan is unique and focuses on the specific goals, needs, and strengths of each individual. If you think your child might benefit from speech therapy, you can learn more by scheduling your free introductory call today!

The Connection Between Music and Communication

Language and music are very closely connected at a fundamental level, as both require greater brain function and also involve cognitive skills, including attention, memory, and categorization. Music and grammar also use structures that must follow a particular order to make sense and appreciate it.

In addition, music and speech require a similar pitch. Musical sequences typically follow specific intervals, and speech also requires various frequencies when it comes to intonation, such as when a question is asked or a statement or exclamation is made. This element of speech is often referred to as ‘contour,’ and it is one that even young babies can detect.

How Does Music Therapy Help Communication Skills?

Music can have many benefits when it comes to improving communication skills. Both speech and singing require the coordination of the same mechanisms within the body. In order to speak or sing effectively, the following processes must function:

Respiration – Breathing Resonance – How airflow is shaped through the nasal and oral cavities Phonation – Initiating sound Articulation – Using the teeth and tongue to produce specific speech sounds Fluency – The ability to produce speech sounds easily and smoothly

By using a variety of interventions that involve singing as well as instrument play, music therapy can help to strengthen these processes to improve overall communication skills. If you want to learn more about the role of music in speech therapy, schedule your free introductory call today!

Can Music Facilitate Speech Recovery and Ease Pain?

The use of music in therapy is an evidence-based practice that uses music to address the cognitive, physical, emotional, and social needs of individuals of all ages. It is beneficial in various settings, such as hospitals and hospices. Music therapy has been proven to be helpful in reducing pain levels, promoting relaxation, improving communication skills, and providing comfort during challenging times.

One way music in therapy can be effective at reducing pain is through the use of rhythmical breathing exercises. These exercises involve focusing on a rhythm while taking slow, deep breaths, promoting relaxation of the body and mind. This type of approach has been shown to lower the heart rate and blood pressure, as well as decrease anxiety levels, all of which can lead to a reduction in overall pain levels.

An additional benefit of music in therapeutic settings is its ability to promote relaxation by providing a pleasant distraction from stressful feelings or thoughts.

Listening to relaxing music and creating a sense of peace and tranquility allows for more effective coping methods when dealing with challenging emotions or situations. In addition, some studies have suggested that specific types of musical interventions can have an analgesic effect because of their ability to activate the release of endorphins in the brain, which function as natural pain relievers.

How Does Music Help with Speech Therapy?

There are so many ways that music can be a beneficial part of speech therapy. The simplest way is through basic auditory stimulation. Music can expand the ability of the brain to process information. This can be beneficial in areas including behavior, skill development, sensory integration, and general coordination. Therefore, individuals who routinely listen to music can improve their speaking abilities as well as their capacity for focus. Auditory stimulation can work just as well during virtual speech therapy sessions as in-person ones.

Adults with speech problems caused by stroke or other forms of traumatic brain injury may benefit from Melodic Intonation Therapy. This is a form of therapy that is often used in situations in which the brain is damaged. This practice is rooted in the theory that using the unaffected hemisphere of the brain will help to gradually recover speech skills that have been lost in the damaged part of the brain. For instance, if an individual loses their ability to speak due to damage to the left side of the brain, MIT can be used to establish new ways to communicate. This type of therapy uses words and phrases that are supplemented by melodies, making the process of speaking closely resemble that of singing. MIT also takes advantage of the individual’s ability to sing, which in turn helps them improve their ability to speak.

For children, there are many different ways that speech therapists use music in their treatment sessions. The goal of using music in speech therapy is to help promote their language development, improve and ease their speech production, and support their overall communication skills. A recent study showed that children displayed significant improvement in their problem-solving skills, social skills, and how they interacted with others when music was a part of their speech therapy treatment plans.

Speech therapy can benefit individuals of all ages with a wide range of skills and challenges. If you would like to learn more about virtual speech therapy, get started by scheduling your free introductory call today!

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The Impact of Music on Speech Therapy

For many decades, music has been an important part of daily care for children with speech impediments and hearing-impaired children. There have been a lot of studies that examine the role of music in people’s general health as well as an effective intervention when it comes to speech and language problems. It only makes sense that for children and adults who suffer from speech issues, music should be considered as part of their intervention. 

Music, Speech, Language

Language and music are connected at a very basic level. Both require higher brain function and it also involves cognitive skills such as attention, memory, and categorization. Grammar and music also make use of structures that follow a specific order in order to make sense and appreciated it.

Also, music and speech have a similar pitch. Musical sequences follow a specific interval and speech also uses frequencies when it comes to intonation, as is the case when people ask a question, make a statement, or make an exclamation. This characteristic of speech is called contour and it is one that even infants are able to detect.

Therapeutic benefits of music

Besides language, music has a lot of therapeutic benefits. It has been proven that auditory stimulation can improve listening skills, even for people who are hard of hearing. It can also help to improve how the brain processes information which can boost skills in areas like behavior and coordination.

  A study done in 2011 explored how music impacts social skills, another aspect of communication. Half of all the participants in the study exhibited signs of improved communication and problem-solving skills, as well as their ability to work well in groups and in interacting with other people.

  There is also compelling evidence that the type of music used for therapy has an enormous impact on the outcome. In a study that was one to explore the difference in brain function between musicians and non-musicians, it stated that brain function was significantly increased when the participants listened to classical music as opposed to rock music.

Music and speech

It is also revealed that there is a close relationship between music and speech. A study was done in 2013 in which six experts who are trained professionals in music theory were asked to determine the key in a sample music score. The timescales in the samples were restricted to closely match with speech processing. It was observed that the processing used in decoding speech is also used when it comes to music.

Music for speech-language therapy

There are a lot of ways music can be used in speech therapy. One way is through simple auditory stimulation. As previously mentioned, it can expand the brain’s ability to process information which can be beneficial in areas such as behavior, skill, sensory integration, and coordination. Therefore, clients who listen to music may improve their speaking skills as well as their ability to focus. Auditory stimulation can even be done through virtual speech therapy sessions.

  For adults with speech problems due to stroke, many patients have found benefit from Melodic Intonation Therapy. This is a type of therapy that is often used in cases where the brain is damaged. The theory is rooted in the practice that using the intact hemisphere of the brain will slowly help recover speech skills that have been lost in the damaged part of the brain. For example, if a patient loses their ability to speak because the left side of the brain has been damaged, MIT can be used in order to find new ways to communicate.

  The therapy uses words and phrases supplemented by melodies to make speaking closely resemble that of speaking. This type of therapy also takes advantage of a person’s ability to sing which helps them improve their ability to speak.

  For children, there are different ways that therapists can use music in their treatment sessions with children. The goal is to help with their language development, improve their speech production, and aid in their overall communication skills. In a study done in 2011, it was concluded that children showed significant improvement in their social skills, problem-solving, and how they interact with peers when music was incorporated in their SLPs.

Post Author: Eliza Brooks

Eliza  Brooks loves to write about personality development, mental and physical disabilities, and ways to overcome them effectively. She is currently working with Verboso, which offers online speech therapy for children to improve their speaking skills.

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The use of music and music-related elements in speech-language therapy interventions for adults with neurogenic communication impairments: A scoping review

Affiliation.

• 1 Institute for Applied Health Sciences, School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
• PMID: 39169848
• DOI: 10.1111/1460-6984.13104

Background: A growing body of research indicates that music-based interventions show promising results for adults with a wide range of speech, language and communication disorders.

Aims: The purpose of this scoping review is to summarize the evidence on how speech-language therapists (SLTs) use music and music-related elements in therapeutic interventions for adults with acquired neurogenic communication impairments.

Methods: This scoping review was completed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A systematic search of three databases (Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature and OVID Medline) was conducted and articles were included if they (1) incorporated adult human participants; (2) received an assessment or intervention facilitated by an SLT; (3) incorporated techniques and interventions which included music-related elements (e.g., rhythm, melody, harmony and dynamics); (4) were written in the English language; and (5) were peer-reviewed full-text articles. Data were extracted using the Rehabilitation Treatment Specification System framework.

Main contribution: A total of 25 studies met the inclusion criteria. The studies included participants with neurogenic communication impairments secondary to stroke, Parkinson's disease, dementia and traumatic brain injury. Musical interventions identified in the studies were Melodic Intonation Therapy, Modified Melodic Intonation Therapy, choral singing, singing therapy and songwriting. The majority of the studies reported interprofessional collaboration between SLTs and at least one other healthcare clinician and/or musician. Many studies also included music-based interventions lead and facilitated by musically trained SLTs.

Conclusion: The results of the studies included in this review indicate that SLTs are using music-based interventions to target therapeutic goals to improve speech, language, voice and quality of life in collaboration with other clinicians and professional musicians.

What this paper adds: What is already known on this subject A growing body of research indicates that interventions using music (i.e., choirs and songwriting) and musical elements (i.e., rhythm and dynamics) show promising results for adults with neurogenic communication impairments. Currently, however, there is no clear indication of how speech-language therapists (SLTs) are using music in their clinical practice. What this study adds This scoping review collates the current evidence on how SLTs use music and musical elements in their clinical practice. SLTs are using music and musical elements for individuals with neurogenic communication impairments in populations such as Parkinson's disease, dementia and traumatic brain injury. Common interventions described in the literature include Melodic Intonation Therapy, choral singing, singing therapy and songwriting. What are the clinical implications of this work? Many SLTs collaborate when delivering music-based interventions, particularly with music therapists (MTs). This scoping review suggests that SLTs should continue to explore music-based interventions in collaboration with MTs and professional musicians to target therapeutic goals to improve speech, language, voice and quality of life.

Keywords: music; music‐based intervention; scoping review; speech‐language pathology; speech‐language therapy.

© 2024 The Author(s). International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.

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What to Know About Music Therapy

Music can help improve your mood and overall mental health.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Verywell / Lara Antal

Effectiveness

Things to consider, how to get started.

Music therapy is a therapeutic approach that uses the naturally mood-lifting properties of music to help people improve their mental health and overall well-being.  It’s a goal-oriented intervention that may involve:

• Making music
• Writing songs
• Listening to music
• Discussing music  

This form of treatment may be helpful for people with depression and anxiety, and it may help improve the quality of life for people with physical health problems. Anyone can engage in music therapy; you don’t need a background in music to experience its beneficial effects.

Types of Music Therapy

Music therapy can be an active process, where clients play a role in creating music, or a passive one that involves listening or responding to music. Some therapists may use a combined approach that involves both active and passive interactions with music.

There are a variety of approaches established in music therapy, including:

• Analytical music therapy : Analytical music therapy encourages you to use an improvised, musical "dialogue" through singing or playing an instrument to express your unconscious thoughts, which you can reflect on and discuss with your therapist afterward.
• Benenzon music therapy : This format combines some concepts of psychoanalysis with the process of making music. Benenzon music therapy includes the search for your "musical sound identity," which describes the external sounds that most closely match your internal psychological state.
• Cognitive behavioral music therapy (CBMT) : This approach combines cognitive behavioral therapy (CBT) with music. In CBMT, music is used to reinforce some behaviors and modify others. This approach is structured, not improvisational, and may include listening to music, dancing, singing, or playing an instrument.
• Community music therapy : This format is focused on using music as a way to facilitate change on the community level. It’s done in a group setting and requires a high level of engagement from each member.
• Nordoff-Robbins music therapy : Also called creative music therapy, this method involves playing an instrument (often a cymbal or drum) while the therapist accompanies using another instrument. The improvisational process uses music as a way to help enable self-expression.
• The Bonny method of guided imagery and music (GIM) : This form of therapy uses classical music as a way to stimulate the imagination. In this method, you explain the feelings, sensations, memories, and imagery you experience while listening to the music.
• Vocal psychotherapy : In this format, you use various vocal exercises, natural sounds, and breathing techniques to connect with your emotions and impulses. This practice is meant to create a deeper sense of connection with yourself.

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Music Therapy vs. Sound Therapy

Music therapy and sound therapy (or sound healing ) are distinctive, and each approach has its own goals, protocols, tools, and settings: 

• Music therapy is a relatively new discipline, while sound therapy is based on ancient Tibetan cultural practices .
• Sound therapy uses tools to achieve specific sound frequencies, while music therapy focuses on addressing symptoms like stress and pain.  
• The training and certifications that exist for sound therapy are not as standardized as those for music therapists.
• Music therapists often work in hospitals, substance abuse treatment centers, or private practices, while sound therapists may offer their service as a component of complementary or alternative medicine.

When you begin working with a music therapist, you will start by identifying your goals. For example, if you’re experiencing depression, you may hope to use music to naturally improve your mood and increase your happiness . You may also want to try applying music therapy to other symptoms of depression like anxiety, insomnia, or trouble focusing.

During a music therapy session, you may listen to different genres of music , play a musical instrument, or even compose your own songs. You may be asked to sing or dance. Your therapist may encourage you to improvise, or they may have a set structure for you to follow.

You may be asked to tune in to your emotions as you perform these tasks or to allow your feelings to direct your actions. For example, if you are angry, you might play or sing loud, fast, and dissonant chords.

You may also use music to explore ways to change how you feel. If you express anger or stress, your music therapist might respond by having you listen to or create music with slow, soft, soothing tones.

Music therapy is often one-on-one, but you may also choose to participate in group sessions if they are available. Sessions with a music therapist take place wherever they practice, which might be a:

• Community health center
• Correctional facility
• Private office
• Physical therapy practice
• Rehabilitation facility

Wherever it happens to be, the room you work in together will be a calm environment with no outside distractions.

What Music Therapy Can Help With

Music therapy may be helpful for people experiencing:

• Alzheimer’s disease
• Anxiety or stress
• Cardiac conditions
• Chronic pain
• Difficulties with verbal and nonverbal communication
• Emotional dysregulation
• Feelings of low self-esteem
• Impulsivity
• Negative mood
• Post-traumatic stress disorder (PTSD)
• Problems related to childbirth
• Rehabilitation after an injury or medical procedure
• Respiration problems
• Substance use disorders
• Surgery-related issues
• Traumatic brain injury (TBI)
• Trouble with movement or coordination

Research also suggests that it can be helpful for people with:

• Obsessive-compulsive disorder (OCD)
• Schizophrenia
• Stroke and neurological disorders

Music therapy is also often used to help children and adolescents:

• Develop their identities
• Improve their communication skills
• Learn to regulate their emotions
• Recover from trauma
• Self-reflect

Benefits of Using Music as Therapy

Music therapy can be highly personalized, making it suitable for people of any age—even very young children can benefit. It’s also versatile and offers benefits for people with a variety of musical experience levels and with different mental or physical health challenges.

Engaging with music can:

• Activate regions of the brain that influence things like memory, emotions, movement, sensory relay, some involuntary functions, decision-making, and reward
• Fulfill social needs for older adults in group settings
• Lower heart rate and blood pressure
• Relax muscle tension
• Release endorphins
• Relieve stress and encourage feelings of calm
• Strengthen motor skills and improve communication for children and young adults who have developmental and/or learning disabilities

Research has also shown that music can have a powerful effect on people with dementia and other memory-related disorders.

Overall, music therapy can increase positive feelings, like:

• Confidence and empowerment
• Emotional intimacy

The uses and benefits of music therapy have been researched for decades. Key findings from clinical studies have shown that music therapy may be helpful for people with depression and anxiety, sleep disorders, and even cancer.

Depression 

Studies have shown that music therapy can be an effective component of depression treatment. According to the research cited, the use of music therapy was most beneficial to people with depression when it was combined with the usual treatments (such as antidepressants and psychotherapy). 

When used in combination with other forms of treatment, music therapy may also help reduce obsessive thoughts , depression, and anxiety in people with OCD.

In 2016, researchers conducted a feasibility study that explored how music therapy could be combined with CBT to treat depression . While additional research is needed, the initial results were promising.

Many people find that music, or even white noise, helps them fall asleep. Research has shown that music therapy may be helpful for people with sleep disorders or insomnia as a symptom of depression.

Compared to pharmaceuticals and other commonly prescribed treatments for sleep disorders, music is less invasive, more affordable, and something a person can do on their own to self-manage their condition.

Pain Management

Music has been explored as a potential strategy for acute and chronic pain management in all age groups. Research has shown that listening to music when healing from surgery or an injury, for example, may help both kids and adults cope with physical pain.

Music therapy may help reduce pain associated with:

• Chronic conditions : Music therapy can be part of a long-term plan for managing chronic pain, and it may help people recapture and focus on positive memories from a time before they had distressing long-term pain symptoms. 
• Labor and childbirth : Music therapy-assisted childbirth appears to be a positive, accessible, non-pharmacological option for pain management and anxiety reduction for laboring people.
• Surgery : When paired with standard post-operative hospital care, music therapy is an effective way to lower pain levels, anxiety, heart rate, and blood pressure in people recovering from surgery.

Coping with a cancer diagnosis and going through cancer treatment is as much an emotional experience as a physical one. People with cancer often need different sources of support to take care of their emotional and spiritual well-being.

Music therapy has been shown to help reduce anxiety in people with cancer who are starting radiation treatments. It may also help them cope with the side effects of chemotherapy, such as nausea.

Music therapy may also offer emotional benefits for people experiencing depression after receiving their cancer diagnosis, while they’re undergoing treatment, or even after remission.

On its own, music therapy may not constitute adequate treatment for medical conditions, including mental health disorders . However, when combined with medication, psychotherapy , and other interventions, it can be a valuable component of a treatment plan.

If you have difficulty hearing, wear a hearing aid, or have a hearing implant, you should talk with your audiologist before undergoing music therapy to ensure that it’s safe for you.

Similarly, music therapy that incorporates movement or dancing may not be a good fit if you’re experiencing pain, illness, injury, or a physical condition that makes it difficult to exercise.  

You'll also want to check your health insurance benefits prior to starting music therapy. Your sessions may be covered or reimbursable under your plan, but you may need a referral from your doctor.

If you’d like to explore music therapy, talk to your doctor or therapist. They can connect you with practitioners in your community. The American Music Therapy Association (AMTA) also maintains a database of board-certified, credentialed professionals that you can use to find a practicing music therapist in your area.

Depending on your goals, a typical music therapy session lasts between 30 and 50 minutes. Much like you would plan sessions with a psychotherapist, you may choose to have a set schedule for music therapy—say, once a week—or you may choose to work with a music therapist on a more casual "as-needed" basis.  

Before your first session, you may want to talk things over with your music therapist so you know what to expect and can check in with your primary care physician if needed.

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Jasemi M, Aazami S, Zabihi RE. The effects of music therapy on anxiety and depression of cancer patients . Indian J Palliat Care . 2016;22(4):455-458. doi:10.4103/0973-1075.191823

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American Music Therapy Association (AMTA). Music therapy with specific populations: Fact sheets, resources & bibliographies .

Wang CF, Sun YL, Zang HX. Music therapy improves sleep quality in acute and chronic sleep disorders: A meta-analysis of 10 randomized studies . Int J Nurs Stud . 2014;51(1):51-62. doi:10.1016/j.ijnurstu.2013.03.008

Bidabadi SS, Mehryar A. Music therapy as an adjunct to standard treatment for obsessive compulsive disorder and co-morbid anxiety and depression: A randomized clinical trial . J Affect Disord . 2015;184:13-7. doi:10.1016/j.jad.2015.04.011

Kamioka H, Tsutani K, Yamada M, et al. Effectiveness of music therapy: A summary of systematic reviews based on randomized controlled trials of music interventions . Patient Prefer Adherence . 2014;8:727-754. doi:10.2147/PPA.S61340

Raglio A, Attardo L, Gontero G, Rollino S, Groppo E, Granieri E. Effects of music and music therapy on mood in neurological patients . World J Psychiatry . 2015;5(1):68-78. doi:10.5498/wjp.v5.i1.68

Altenmüller E, Schlaug G. Apollo’s gift: New aspects of neurologic music therapy . Prog Brain Res . 2015;217:237-252. doi:10.1016/bs.pbr.2014.11.029

Werner J, Wosch T, Gold C. Effectiveness of group music therapy versus recreational group singing for depressive symptoms of elderly nursing home residents: Pragmatic trial . Aging Ment Health . 2017;21(2):147-155. doi:10.1080/13607863.2015.1093599

Dunbar RIM, Kaskatis K, MacDonald I, Barra V. Performance of music elevates pain threshold and positive affect: Implications for the evolutionary function of music . Evol Psychol . 2012;10(4):147470491201000420. doi:10.1177/147470491201000403

Pavlicevic M, O'neil N, Powell H, Jones O, Sampathianaki E. Making music, making friends: Long-term music therapy with young adults with severe learning disabilities . J Intellect Disabil . 2014;18(1):5-19. doi:10.1177/1744629513511354

Chang YS, Chu H, Yang CY, et al. The efficacy of music therapy for people with dementia: A meta-analysis of randomised controlled trials . J Clin Nurs . 2015;24(23-24):3425-40. doi:10.1111/jocn.12976

Aalbers S, Fusar-Poli L, Freeman RE, et al. Music therapy for depression . Cochrane Database Syst Rev . 2017;11:CD004517. doi:10.1002/14651858.CD004517.pub3

Trimmer C, Tyo R, Naeem F. Cognitive behavioural therapy-based music (CBT-music) group for symptoms of anxiety and depression . Can J Commun Ment Health . 2016;35(2):83-87. doi:10.7870/cjcmh-2016-029

Jespersen KV, Koenig J, Jennum P, Vuust P. Music for insomnia in adults . Cochrane Database Syst Rev . 2015;(8):CD010459. doi:10.1002/14651858.CD010459.pub2

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Rossetti A, Chadha M, Torres BN, et al. The impact of music therapy on anxiety in cancer patients undergoing simulation for radiation therapy . Int J Radiat Oncol Biol Phys . 2017;99(1):103-110. doi:10.1016/j.ijrobp.2017.05.003

American Music Therapy Association (AMTA). Guidance for music listening programs .

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Evidence reviews for the clinical and cost-effectiveness of music therapy for adults after a stroke

Evidence review N

NICE Guideline, No. 236

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1. Music therapy

1.1. review question.

In people after stroke, what is the clinical and cost effectiveness of music therapy to improve mood and activities of daily living?

1.1.1. Introduction

Music activates a wide range of regions within the brain including networks involved in speech, motor function and cognition. Music therapy aims to facilitate recovery mechanisms in the brain to enhance rehabilitation and overall improvements.

Usually trained music therapists deliver it with an individual or in a group. Music is used in a number of different ways; for example listening to music, actively participating in music or writing and composing music.

1.1.2. Summary of the protocol

PICO characteristics of review question.

For full details see the review protocol in Appendix A .

1.1.3. Methods and process

This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual . Methods specific to this review question are described in the review protocol in Appendix A and the methods document.

Declarations of interest were recorded according to NICE’s conflicts of interest policy .

1.1.4. Effectiveness evidence

1.1.4.1. included studies.

Twenty one randomised controlled trials (twenty three papers) were included in the review; 2 – 7 , 9 – 12 , 15 – 27 these are summarised in Table 2 below. Evidence from these studies is summarised in the clinical evidence summary below ( Table 3 ).

• Neurologic music therapy delivered by trained music therapists compared to no treatment 17 , 26
• Music therapy delivered by trained music therapists compared to no treatment 3 , 4 , 9 , 10 , 15 , 16 , 19
• Music intervention delivered by healthcare professionals compared to passive music listening 2
• Music intervention delivered by healthcare professionals compared to placebo music therapy 2
• Music intervention delivered by healthcare professionals compared to no treatment 5 – 7 , 11 , 12 , 18 , 22 – 25 , 27
• Music intervention delivered by non-healthcare professionals compared to no treatment 20 , 21
• Passive music listening
• Placebo music therapy

See also the study selection flow chart in Appendix C , study evidence tables in Appendix D , forest plots in Appendix E and GRADE tables in Appendix F .

1.1.4.1.1. Types of intervention

• Rhythmic auditory cueing 3 , 6 , 7 , 12 , 22 , 23 , 25
• Interventions where musical instruments are played (including clinical improvisation) 4 , 5 , 10 , 16 , 19
• Receptive interventions in which participants listen to music 2 , 11 , 17 , 27
• Singing a music-based voice interventions 20 , 26
• Sonofication 18
• Combinations of the above 9 , 15

Where heterogeneity was present there was an insufficient number of studies in each group representing different types of intervention, and so the heterogeneity was not resolved by subgroup analysis by these groups.

1.1.4.2. Excluded studies

One Cochrane review was identified that included relevant information for this review, Magee 2017 13 . This review was excluded as it included people with conditions other than stroke (including any acquired brain injury). While the review was excluded, the references were checked for studies relevant for this review.

A significant number of studies were excluded as they did not report outcomes relevant to the protocol, the majority of these reporting outcomes relevant to individual impairments (for example: motor function, communication). These outcomes were considered of a lower priority than functional outcomes (for example: activities of daily living) and were considered through other outcomes (for example: health-related quality of life).

See the excluded studies list in Appendix J .

1.1.5. Summary of studies included in the effectiveness evidence

1.1.5.1. neurologic music therapy delivered by trained music therapists.

Summary of studies included in the evidence review.

1.1.5.2. Music therapy delivered by trained music therapists

1.1.5.3. Music interventions delivered by healthcare professionals

1.1.5.4. Music interventions delivered by non-healthcare professionals

1.1.5.5. Summary matrix

Summary matrix of the protocol interventions compared to no treatment.

See Appendix D for full evidence tables.

1.1.6. Summary of the effectiveness evidence

1.1.6.1. neurologic music therapy delivered by trained music therapists compared to no treatment.

Clinical evidence summary: neurologic music therapy delivered by trained music therapists compared to no treatment.

1.1.6.2. Music therapy delivered by trained music therapists compared to no treatment

Clinical evidence summary: music therapy delivered by trained music therapists compared to no treatment.

1.1.6.3. Music interventions delivered by healthcare professionals compared to passive music listening

Clinical evidence summary: music intervention delivered by healthcare professionals compared to passive music listening.

1.1.6.4. Music interventions delivered by healthcare professionals compared to placebo music therapy

Clinical evidence summary: music intervention delivered by healthcare professionals compared to placebo music therapy.

1.1.6.5. Music interventions delivered by healthcare professionals compared to no treatment

Clinical evidence summary: music intervention delivered by healthcare professionals compared to no treatment.

1.1.6.6. Music interventions delivered by non-healthcare professionals compared to no treatment

Clinical evidence summary: music interventions delivered by non-healthcare professionals compared to no treatment.

See Appendix F for full GRADE tables.

1.1.7. Economic evidence

1.1.7.1. included studies.

One health economic study was included in this review. 20 This related to a music intervention delivered by non-healthcare professionals. This is summarised in the health economic evidence profile below ( Table 13 ) and the health economic evidence table in Appendix H .

No health economic studies were included that related to neurologic music therapy delivered by trained music therapists, music therapy delivered by trained music therapists or music interventions delivered by healthcare professionals.

1.1.7.2. Excluded studies

No relevant health economic studies were excluded due to assessment of limited applicability or methodological limitations.

See also the health economic study selection flow chart in Appendix G .

1.1.8. Summary of included economic evidence

Health economic evidence profile: music interventions delivered by non-healthcare professionals compared to no treatment.

1.1.9. Economic model

This area was not prioritised for new cost-effectiveness analysis.

1.1.10. Unit costs

Music therapy and music interventions require additional resource use compared to not providing such interventions related to staff time and equipment. Studies included in the clinical review reported varied resource use (see Table 1 for details) due to:

• Variation in the delivery of therapy sessions: studies based on music therapists delivering therapy reported both individual and group-based sessions, while all but one of the studies 7 that delivered therapy using health care professionals (HCPs) reported sessions on an individual basis. Group therapy will be lower cost per person.
• Significant variation in the frequency and duration of music therapy delivered, with sessions ranging from 20–90 minutes for 1–5 days per week. In the included clinical studies music therapy was generally delivered for between 5 and 10 weeks.
• Additional equipment required as part of the intervention, such as instruments (particularly keyboards, percussion/melodic instruments), metronomes, digital audio interface programs, iPod Nanos, music tapes and mindfulness audio materials.
• Clinical setting, as most studies were conducted in either an inpatient setting or as part of outpatient follow-up rehabilitation care in hospital. Jeong 2007 7 and Tarrant (2018, 21 2021 20 ) were the only two studies that were conducted in a community setting. Baylan 2020 1 provided materials for participants to carry out sessions in their own time.
• Music interventions delivered by non-healthcare professionals may be funded by the NHS.

Relevant unit costs are provided below to aid consideration of cost effectiveness.

Unit costs of health care professionals who may be involved in delivering music therapy interventions.

Music therapists can complete additional specialist training to become ‘neurologically trained’ and thus provide neurologic music therapy (NMT). The committee advised that this training typically consists of a short course and people would typically still be employed at band 6 or 7. Health care professionals that delivered music interventions in the included clinical studies were either a physiotherapist or an occupational therapist. One study 10 also provided counselling by a licensed psychotherapist for both trial arms, while another had therapy materials delivered by an assistant psychologist 1 however, such staff types were not mentioned in any of the other studies.

1.1.11. Evidence statements

Effectiveness/qualitative.

One cost-utility analysis found that a singing group intervention for people with aphasia was cost-effective compared to usual care (£7,980 per QALY gained). This study was assessed as partially applicable with potentially serious limitations.

1.1.12. The committee’s discussion and interpretation of the evidence

1.1.12.1. the outcomes that matter most.

The committee included the following outcomes: person/participant and carer generic health-related quality of life, activities of daily living, psychological distress, stroke-specific Patient-Reported Outcome Measures, wellbeing scores, participation in leisure activities/social group scores and withdrawal due to adverse events. All outcomes were considered equally important for decision making and therefore have all been rated as critical. The committee noted that music therapy may have benefits in other outcomes, such as physical function, communication and cognition. The committee considered that the outcomes included (namely health-related quality of life, activities of daily living and stroke-specific Patient-Reported Outcome Measures) would also encompass any such benefits. The committee considered wellbeing scores and participation in leisure activities/social groups score as important to capture the holistic benefits that could be experienced by people participating in music interventions. The committee chose to investigate these outcomes at less than 6 months and more than and equal to 6 months, as they considered that there could be a difference in the short-term and long-term effects of the intervention.

All outcomes were reported in at least 1 study but were not given in others. The limited evidence produced an element of uncertainty, and the committee agreed that there was insufficient evidence to make a recommendation.

1.1.12.2. The quality of the evidence

• Neurologic music therapy delivered by trained music therapists compared to no treatment (2 studies)
• Music therapy delivered by trained music therapists compared to no treatment (7 studies)
• Music intervention delivered by healthcare professionals compared to passive music listening (1 study)
• Music intervention delivered by healthcare professionals compared to placebo music therapy (1 study)
• Music intervention delivered by healthcare professionals compared to no treatment (11 studies)
• Music intervention delivered by non-healthcare professionals compared to no treatment (1 study)

There was limited evidence comparing any intervention to comparators other than no treatment (including comparisons to other music interventions, passive music listening and placebo music therapy).

The evidence varied from moderate to very low quality, with the majority being of very low quality. Outcomes were commonly downgraded for risk of bias and imprecision. Risk of bias was commonly due to selection, performance, attrition and measurement bias. A significant number of studies had different baseline values for outcomes between the intervention and comparator study groups. The majority of studies had very small sample sizes, which contributed to the imprecision in the outcomes. In most cases, it was not possible to conduct a meta-analysis on outcomes as there was limited outcome data reported by the studies that was comparable enough to be meta-analysed. Where meta-analysis was possible, outcomes often had heterogenous results within studies where there was an insufficient number of studies to form valid subgroups. In these cases, outcomes were downgraded for inconsistency. Indirect evidence was uncommon, although 1 study reported a population that may have included people who did not have a stroke and so was downgraded for population indirectness.

The type of music therapy or music intervention varied between studies. This included rhythmic auditory cueing; interventions where music instruments are played (including clinical improvisation); receptive interventions in which participants listen to music; singing and music-based voice interventions; sonofication; and combinations of these interventions. the above. For the most part, these interventions were offered as a part of music therapy or as music interventions delivered by non-music therapists. However, the majority of studies reporting rhythmic auditory cueing were delivered by physiotherapists or occupational therapists rather than music therapists.

The no-treatment comparison varied. This included scenarios where no additional therapy was offered to participants who did not receive music interventions, but also included studies where usual care was offered to both study arms (which could include physiotherapy, occupational therapy, speech therapy and psychological support) and therefore the only difference in care was the music intervention.

The committee concluded that the evidence was of low quality. They acknowledged the effects that the heterogenous baseline values and small sample sizes had on the quality rating and took this into consideration while interpreting the evidence. They noted the potential bias introduced by the baseline values between intervention and control arms made it difficult to interpret the evidence. Consequentially, they found it difficult to interpret the effectiveness of music therapy and music interventions based on the evidence currently available.

1.1.12.3. Benefits and harms

1.1.12.3.1. neurologic music therapy delivered by trained music therapists.

The results showed that, when compared to no treatment, there were clinically important benefits in some subscales for person/participant generic health-related quality of life (namely SF-36 vitality and mental health) and psychological distress – depression at less than 6 months, but otherwise no clinically important difference in other subscales for health-related quality of life, psychological distress - anxiety and in stroke-specific Patient-Reported Outcome Measures at less than 6 months.

These outcomes were reported in 2 small studies with the outcomes being of low to very low quality. With this, the committee acknowledged that the evidence in this area was limited and insufficient to make a recommendation for neurologic music therapy. However, they noted the possible benefits in the intervention and made a research recommendation with the aim to gain more high-quality evidence. This should involve a large number of participants and where there were comparisons to active interventions that provide an equal intensity of therapy to those received from a music intervention, and placebo music therapy.

1.1.12.3.2. Music therapy delivered by trained music therapists

The results showed that, when compared to no treatment, there was a clinically important benefit in participation in leisure activities/social groups (based on 1 very small study with 18 participants). There were inconsistent effects seen in activities of daily living and stroke-specific Patient-Reported Outcome Measures with some outcomes showing clinically important benefits, others showing no clinically important difference and others showing clinically important harms. No clinically important difference was seen in person/participant generic health-related quality of life, psychological distress and withdrawal due to adverse events. No outcomes were reported at more than and equal to 6 months.

The evidence came from several small studies (the largest number of participants included in an outcome was 84) with the majority being of very low quality. With this, the committee acknowledged that the evidence in this area was limited. While there were more studies reporting music therapy than neurologic music therapy, the studies reported a range of different outcome measures in small trials that were probably not powered to show reliable changes in outcomes. Studies included intervention and control arms where the baseline values of outcomes were different at the start of the trial, making interpretation difficult. These trials were conducted comparing music therapy to no treatment (or usual care provided in both study arms), with no trials comparing music therapy to an intervention with equal contact with a professional to help show whether it is the music intervention that provides benefit or the interaction with the healthcare professional. These trials were less than 6 months duration with no long-term evidence being available. Based on this, the committee decided that the evidence was insufficient to make a recommendation for music therapy. However, they noted the possible benefits in the intervention and made a research recommendation with the aim to gain more high-quality research. This should involve a large number of participants and include comparisons to active interventions that provide an equal intensity of therapy to those received from a music intervention, or to placebo music therapy.

1.1.12.3.3. Music interventions delivered by healthcare professionals

Evidence was available comparing music interventions delivered by healthcare professionals to passive music listening, placebo music therapy and no treatment. All the outcomes comparing to passive music listening and placebo music therapy were reported in 1 study. When compared to passive music listening, there was a clinically important increase in withdrawal due to adverse events in those receiving a music intervention delivered by healthcare professionals at less than and more than and equal to 6 months (observed in one small study). This was also seen when compared to placebo music therapy. Otherwise, no clinically important difference was seen between music interventions delivered by healthcare professionals and placebo music therapy in psychological distress at less than and more than and equal to 6 months and participation in leisure activities/social group scores at less than 6 months only.

When compared to no treatment, clinically important benefits were seen in some subscales of person/participant health-related quality of life (namely SF-36 physical function, bodily pain, vitality, general health, role emotional, mental health and social function) while other measures showed no clinically important difference (McGill Quality of life) and other subscales showed clinically important harms (SF-36 role physical). Otherwise clinically important benefits were seen in activities of daily living and psychological distress (depression scores). No clinically important difference was seen in psychological distress (positive affect score), stroke-specific Patient-Reported Outcome Measures and withdrawal due to adverse events. Outcomes were only reported at less than 6 months for this comparison. The outcomes were reported in a range of different studies, with some outcomes including a larger number of participants while others had a very small number. However, the majority of evidence was of very low quality.

With this taken into account, committee acknowledged that the evidence in this area was limited. While there were more studies reporting music interventions delivered by healthcare professionals than other interventions, the studies reported a range of different outcome measures in small trials that were likely not sufficiently powered to show reliable changes in outcomes. Studies included intervention and control arms where the baseline values of outcomes were different at the start of the trial, making interpretation difficult. While there was 1 trial comparing music interventions to placebo music therapy and music listening, this was limited evidence and most comparisons studied the effect compared to no treatment (or usual care provided to both study arms). These trials were mostly performed at less than 6 months with limited long-term evidence being available. The committee noted that clinically important harms were seen in some outcomes (in particular, withdrawal due to adverse events). However, they acknowledged that due to the small sample sizes the effect on dichotomous outcomes may be overemphasised and that trials with a larger number of participants were critical for understanding this further. Based on this, the committee decided that the evidence was insufficient to make a recommendation for music interventions delivered by healthcare professionals. However, they noted the possible benefits in the intervention and made a research recommendation with the aim to gain more high-quality research. This should involve a large number of participants and include comparisons to active interventions that provide an equal intensity of therapy to those received from a music intervention, or to placebo music therapy.

1.1.12.3.4. Music interventions delivered by non-healthcare professionals

The results showed that, when compared to no treatment, there are clinically important benefits in person/participant generic health-related quality of life at more than and equal to 6 months. There were no clinically important differences in stroke-specific Patient-Reported Outcome Measures, wellbeing scores and participation in leisure activities/social group scores at less than and more than and equal to 6 months, and carer generic health-related quality of life at more than and equal to 6 months only. There were clinically important harms in person/participant health-related quality of life at less than 6 months and withdrawal due to adverse events at less than 6 months. These outcomes were reported in 1 small study (with ≤41 participants) with the majority of outcomes being very low quality. Taking this into account, the committee agreed that the evidence was limited.

On examining the effect on person/participant generic health-related quality of life, the committee thought that the small study size considered that it could be possible that people with stroke may feel apprehensive at the start of the trial and may not engage more with the singing group until later on, which may have an effect on their initial quality of life results. However, the committee acknowledged the wide confidence intervals showing very serious imprecision in the outcomes, which affected their confidence in the results. Due to the limitations in the evidence, the committee decided not to recommend music interventions delivered by non-healthcare professionals. However, they noted the possible benefits in the intervention and made a research recommendation with the aim to gain more high-quality research. This should involve a large number of participants and include comparisons to active interventions that provide an equal intensity of therapy to those received from a music intervention, or to placebo music therapy.

1.1.12.4. Cost effectiveness and resource use

No health economic studies were included that related to either music therapy (including neurologic music therapy) delivered by trained music therapists or music interventions delivered by healthcare professionals.

The review identified one health economic analysis that compared a music intervention (singing for people with aphasia (SPA)) delivered by non-healthcare professionals to no treatment. This was a within-trial cost-utility analysis of a pilot feasibility RCT which was included in the clinical review. The intervention lasted 10 weeks and involved 1.5-hour group sessions once a week which were led by a music facilitator and assisted by an individual with post-stroke aphasia. The trial was designed to assess feasibility of a trial to assess effectiveness and cost effectiveness and so had a small sample size (n=41) and was not powered to test the effectiveness of the SPA intervention.

Only intervention costs were considered. It was not stated that an NHS and PSS perspective was taken, however, the costs included are all considered relevant if the intervention is funded by the NHS. A micro-costing approach was adopted to estimate the intervention costs associated with SPA, taken from trial notes on staffing, purchases of equipment and venue costs charged by the sites. The authors then costed the staff at equivalent grades to the NHS PSSRU to show the costs that would be borne to the NHS if it were to provide these. The results found that the average cost of the intervention per participant was £399 including training costs, based on 2019-unit costs. Data on other healthcare resource use was collected but not included in cost calculations; other healthcare resource used was numerically higher with the intervention although the authors note the study was not powered to detect differences (as 1 of the objectives of the pilot study was to assess feasibility of collection).

A negative effect (-0.04) on quality of life (EQ-5D-5L) was found for participants at 3 months compared to the control group, and an improvement was found (0.10) at 6 months. Treatment effects beyond 6 months were not assessed. No change in carer quality of life (CarerQoL 7-D) was reported. Cost per QALY not reported but was estimated for this review to be £7,980 per QALY gained using 6-month EQ-5D-5L scores collected within the study and assuming no difference in mortality. This suggests that the intervention was cost-effective, however, there is uncertainty around these results as the confidence intervals for the quality-of-life follow-up estimates span across positive and negative values. As such, the committee were cautious in interpreting the results.

The study was assessed as partially applicable as mean EQ-5D-5L scores (UK tariff) at 6-months were used to calculate the cost per QALY gained for this review when the NICE reference case currently prefers EQ-5D-3L. Potentially serious limitations were noted for this study due to the small sample size and the fact that it was not powered to test the effectiveness of the music intervention or confirm differences in healthcare resource use between the groups, uncertainty around whether all relevant costs have been included, and uncertainty about long term treatment effects. Sensitivity analyses were also not performed. The committee felt that the study population (adults with post-stroke aphasia) was too specific to reflect the entire stroke population. Previous committee discussions noted that music therapy could potentially be useful to a broad range of people post-stroke but acknowledged that in practice it may be people with a higher level of disability it is used for.

In addition to this study, relevant unit costs were presented to the committee to aid consideration of cost effectiveness of neurologic or standard music therapy delivered by trained music therapists and music interventions delivered by healthcare professionals. Music therapy and interventions require additional resource use related to staff time and equipment. Studies included in the clinical review reported varied resource use, owing to a few factors such as the delivery of therapy sessions (either individual and group-based); the frequency and duration of music therapy delivered (with sessions ranging from 20 to 90 minutes for 1 to 5 days per week for between 5 and 10 weeks); additional equipment (for example, instruments) required as part of the intervention; clinical setting (most reported an inpatient setting or hospital-based outpatient follow-up) and interventions delivered by non-healthcare professionals. The heterogeneity of the interventions reported in the clinical evidence made it challenging for the committee to confidently assess the resource impact of providing these interventions nationwide. Staff costs, however, were found to be similar for healthcare professionals who may be involved in delivering music therapy or interventions. Although neurologic music therapists complete additional specialist training to become ‘neurologically trained’, the committee advised that this training typically consists of a short course and people would typically still be employed at band 6 or 7. Healthcare professionals who delivered music interventions in the included clinical studies were either a physiotherapist or an occupational therapist also be employed at band 6 or 7. One study (Kim, 2011) also provided counselling by a licensed psychotherapist for both trial arms, while another had therapy materials delivered by an assistant psychologist (Baylan, 2020), however, such staff roles were not mentioned in any other studies. The committee noted that music interventions delivered by the rehabilitation team and non-music therapists are used in current practice, but that music therapy delivered by music therapists and neurologic music therapy are not widely available in the NHS.

The committee discussed the clinical and economic evidence and, based on the limitations described in the clinical evidence section and the uncertainty in the economic evidence, were not able to make recommendations about which music interventions may be appropriate for people following a stroke. A research recommendation has been made.

1.1.12.5. Other factors the committee took into account

The committee acknowledged that benefits may be seen in outcomes specific to impairments that were not included in the protocol (for example: physical function, communication, cognition). A Cochrane review 13 investigating music therapy for people with acquired brain injury had identified additional evidence showing benefit for these outcomes. When designing the protocol, the committee prioritised functional outcomes over impairment-based outcomes which meant that those were not identified. The committee considered that there could be additional benefits during their deliberation.

The committee highlighted that additional therapies may be present that incorporate sound and could therefore be beneficial for people after stroke (for example: sound therapy). While this was not investigated during this guideline update, this was highlighted as a potential area that could be beneficial for people to consider.

Members of the committee also spoke about their own personal experiences of music therapy, stating it significantly improved both their quality of life and that of their family members. They highlighted this as an important area that required consideration in the future. The committee believe that future studies which are larger and more rigorous than those currently available, should be conducted in this area so that a complete understanding of the intervention can be obtained.

It was noted that music therapy interventions may be delivered outside of NHS services by third sector organisations, such as charities (either as outsourcing of services by the NHS or outside of formal care). The involvement of third sector organisations was emphasised by the committee as important for the delivery of interventions in this area.

1.1.13. Recommendations supported by this evidence review

This evidence review supports the research recommendation on music therapy in Appendix K . No recommendations were made for this review.

1.1.14. References

Appendix a. review protocols.

Review protocol for the clinical and cost-effectiveness of music therapy after a stroke (PDF, 299K)

Appendix B. Literature search strategies

B.1. clinical search literature search strategy.

Searches were constructed using a PICO framework where population (P) terms were combined with Intervention (I) and in some cases Comparison (C) terms. Outcomes (O) are rarely used in search strategies as these concepts may not be indexed or described in the title or abstract and are therefore difficult to retrieve. Search filters were applied to the search where appropriate.

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B.2. Health Economics literature search strategy

Health economic evidence was identified by conducting searches using terms for a broad Stroke Rehabilitation population. The following databases were searched: NHS Economic Evaluation Database (NHS EED - this ceased to be updated after 31 st March 2015), Health Technology Assessment database (HTA - this ceased to be updated from 31 st March 2018) and The International Network of Agencies for Health Technology Assessment (INAHTA). Searches for recent evidence were run on Medline and Embase from 2014 onwards for health economics, and all years for quality-of-life studies. Additional searches were run in CINAHL and PsycInfo looking for health economic evidence.

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Appendix C. Effectiveness evidence study selection

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Appendix D. Effectiveness evidence

Baylan, 2020 (PDF, 285K)

Cha, 2014 (PDF, 246K)

Fujioka, 2018 (PDF, 256K)

Grau-Sanchez, 2018 (PDF, 322K)

Hill, 2011 (PDF, 231K)

Jeong, 2007 (PDF, 234K)

Jun, 2013 (PDF, 241K)

Kim, 2011 (PDF, 241K)

Lin, 2017 (PDF, 230K)

Luft, 2004 (PDF, 231K)

Nayak, 2000 (PDF, 272K)

Palumbo, 2022 (PDF, 313K)

Pocwierz-Marciniak, 2017 (PDF, 293K)

Raglio, 2021 (PDF, 237K)

Raglio, 2017 (PDF, 249K)

Tarrant, 2018 (PDF, 196K)

Tarrant, 2021 (PDF, 325K)

Tian, 2020 (PDF, 293K)

van Delden, 2009 (PDF, 203K)

van Delden, 2013 (PDF, 263K)

Whitall, 2011 (PDF, 244K)

Zhang, 2021 (PDF, 282K)

Zhao, 2022 (PDF, 267K)

Appendix E. Forest plots

E.1. neurologic music therapy delivered by trained music therapists compared to no treatment.

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E.2. Music therapy delivered by trained music therapists compared to no treatment

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E.3. Music intervention delivered by healthcare professionals compared to passive music listening

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E.4. Music intervention delivered by healthcare professionals compared to placebo music therapy

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E.5. Music intervention delivered by healthcare professionals compared to no treatment

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E.6. Music intervention delivered by non-healthcare professionals compared to no treatment

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Appendix F. GRADE tables

F.1. neurologic music therapy delivered by trained music therapists compared to no treatment.

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F.2. Music therapy delivered by trained music therapists compared to no treatment

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F.3. Music interventions delivered by healthcare professionals compared to passive music

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F.4. Music interventions delivered by healthcare professionals compared to placebo music therapy

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F.5. Music interventions delivered by healthcare professionals compared to no treatment

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F.6. Music interventions delivered by non-healthcare professionals compared to no treatment

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Appendix G. Economic evidence study selection

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Appendix H. Economic evidence tables

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Appendix I. Health economic model

New cost-effectiveness analysis was not conducted in this area.

Appendix J. Excluded studies

Clinical studies, table 24 studies excluded from the clinical review.

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Health Economic studies

Published health economic studies that met the inclusion criteria (relevant population, comparators, economic study design, published 2006 or later and not from non-OECD country or USA) but that were excluded following appraisal of applicability and methodological quality are listed below. See the health economic protocol for more details.

Table 25 Studies excluded from the health economic review

Appendix k. research recommendations – full details, k.1. research recommendation.

What is the clinical and cost-effectiveness of music therapy for people after a first stroke or recurrent strokes?

K.1.1. Why this is important

Music therapy is an evidence based clinical intervention, delivered by trained music therapists with the aim to help people achieve their therapeutic goals. It is becoming increasingly used to help people after a stroke to support people’s emotional, cognitive, physical and communication needs. This review identified studies that in general reported positive outcomes of music interventions. However, the majority of the evidence was for music interventions not delivered by trained music therapists. Furthermore, the evidence base was limited due to small sample sizes and a lack of cost effectiveness data. Therefore, it was not possible to make a recommendation for use in the NHS at this time. High quality randomised controlled trials, with a larger number of participants that include cost effectiveness data and compare music therapy with a time matched appropriate comparator are needed. Research should also include outcomes important to people who have had a stroke such as stroke-specific Patient-reported Outcome Measures and activities of daily living to fully explore the possible benefits of this therapy. The committee highlighted that additional therapies may be present that incorporate sound and could therefore be beneficial for people after stroke (for example: sound therapy). While this was not investigated during this guideline update, this was highlighted as a potential area that could benefit from further investigation.

K.1.2. Rationale for research recommendation

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K.1.3. Modified PICO table

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Final version

Evidence reviews underpinning recommendations for research in the NICE guideline

These evidence reviews were developed by NICE

Disclaimer : The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government , Scottish Government , and Northern Ireland Executive . All NICE guidance is subject to regular review and may be updated or withdrawn.

• Cite this Page Evidence reviews for the clinical and cost-effectiveness of music therapy for adults after a stroke: Stroke rehabilitation in adults (update): Evidence review N. London: National Institute for Health and Care Excellence (NICE); 2023 Oct. (NICE Guideline, No. 236.)
• PDF version of this title (2.9M)

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• Music therapy

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• NICE Evidence Reviews Collection

Related NICE publication

• Stroke rehabilitation in adults

Supplemental NICE documents

• Economic model: Cost-utility analysis: intensity of physiotherapy rehabilitation (PDF)
• Economic model: Cost-utility analysis of botulinum toxin A to reduce spasticity (PDF)
• Methods (PDF)

Related information

• PMC PubMed Central citations
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Similar articles in PubMed

• Music listening enhances cognitive recovery and mood after middle cerebral artery stroke. [Brain. 2008] Music listening enhances cognitive recovery and mood after middle cerebral artery stroke. Särkämö T, Tervaniemi M, Laitinen S, Forsblom A, Soinila S, Mikkonen M, Autti T, Silvennoinen HM, Erkkilä J, Laine M, et al. Brain. 2008 Mar; 131(Pt 3):866-76.
• Music and speech listening enhance the recovery of early sensory processing after stroke. [J Cogn Neurosci. 2010] Music and speech listening enhance the recovery of early sensory processing after stroke. Särkämö T, Pihko E, Laitinen S, Forsblom A, Soinila S, Mikkonen M, Autti T, Silvennoinen HM, Erkkilä J, Laine M, et al. J Cogn Neurosci. 2010 Dec; 22(12):2716-27.
• Measuring the effects of listening for leisure on outcome after stroke (MELLO): A pilot randomized controlled trial of mindful music listening. [Int J Stroke. 2020] Measuring the effects of listening for leisure on outcome after stroke (MELLO): A pilot randomized controlled trial of mindful music listening. Baylan S, Haig C, MacDonald M, Stiles C, Easto J, Thomson M, Cullen B, Quinn TJ, Stott D, Mercer SW, et al. Int J Stroke. 2020 Feb; 15(2):149-158. Epub 2019 Apr 2.
• Review Music listening after stroke: beneficial effects and potential neural mechanisms. [Ann N Y Acad Sci. 2012] Review Music listening after stroke: beneficial effects and potential neural mechanisms. Särkämö T, Soto D. Ann N Y Acad Sci. 2012 Apr; 1252:266-81.
• Review The effects of music listening interventions on cognition and mood post-stroke: a systematic review. [Expert Rev Neurother. 2016] Review The effects of music listening interventions on cognition and mood post-stroke: a systematic review. Baylan S, Swann-Price R, Peryer G, Quinn T. Expert Rev Neurother. 2016 Nov; 16(11):1241-1249. Epub 2016 Aug 29.

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Music Therapy

Reviewed by Psychology Today Staff

Music therapy is a form of treatment that uses music within the therapeutic relationship to help accomplish the patient’s individualized goals . This evidence-based approach involves techniques such as listening to, reflecting on, and creating music under the guidance of a trained music therapist.

It’s not necessary to have a musical background to benefit from music therapy. People of all ages, from children to adults, may find it is a good fit for their therapeutic needs.

• When It's Used
• How It Works
• What to Expect
• What to Look for in a Music Therapist

Music therapy is often practiced one-on-one, but it can also be used in group settings, such as a hospital, correctional facility, or nursing home. It is generally most effective when used in combination with other therapies and or medications.

Music therapy can help people manage physical pain and has proven effective in treating a variety of health conditions, including cardiac complications, cancer, diabetes, and dementia . It can help:

• Lower heart rate and blood pressure
• Reduce stress
• Improve sleep
• Boost memory and cognitive function

Music can also have powerful effects on a person’s psychological health. It can influence anyone’s mood, causing a range of effects from providing comfort to soothing physical pain to boosting energy. Studies have shown that music therapy can be particularly helpful for people who have an autism spectrum disorder or depression .

Other psychological benefits of music therapy include:

• Lifting one’s mood
• Increasing joy and awe
• Reducing anxiety
• Alleviating depression
• Regulating emotions, particularly difficult ones
• Facilitating self-reflection
• Assisting in the processing of trauma

Humans have long appreciated the healing and cathartic power of music. Music taps into a primal sense of rhythm that we all possess. But modern music therapy began after World War II, according to the American Music Therapy Association. When community musicians visited hospitals to perform for veterans, the soldiers seemed to improve both physically and emotionally, eventually prompting the institutions to hire professionals for the job.

Music therapy continues to be practiced in hospitals, adding a therapeutic layer for patients hospitalized by illness or injury. It can help patients cope with emotional trauma and physical pain or feel more confident, joyful, and connected. Outside of a clinical setting, people can still enjoy these benefits, as music can stir emotion , prompt discussion, facilitate expression, and lower stress .

That power still holds when dementia or brain damage strikes. Music is processed and produced through a different pathway than verbal speech; bypassing that pathway allows patients to express themselves, communicate with loved ones, and experience the world more vibrantly.

After an initial assessment, a therapist will tailor techniques to fit a client's musical ability, interests, and specific needs. One approach is to create music—humming a nostalgic tune from one’s childhood , singing as part of a choir, or improvising on instruments such as the drums, piano, guitar, or chimes.

If the client is able to discuss the experience, a therapist might ask what memories the sounds provoke or what they’re feeling. The pair might listen to a song together and discuss the emotions and memories the song elicits. Or the client might write a song, which can illuminate a character or conflict in their lives or provide a cathartic release. The therapist could engage the client in breathing exercises, with or without music, to release tension and calm anxiety.

All of these exercises allow the therapist and client to explore the psychological, familial, social, cultural, and spiritual components of the person’s inner world. And clients don’t need to have any musical training or talent; the practice doesn’t focus on technical skills but employs music as a tool for reflection and communication.

While music therapy may not be a helpful approach for everyone, many people have found it beneficial. Start by looking for a board-certified music therapist. In the U.S., the certification process requires therapists to complete an undergraduate or master’s degree in music therapy at an approved institution, along with clinical training and a supervised internship. Therapists then must complete a board certification test. The Certification Board for Music Therapists grants practitioners the credential MT-BC (Music Therapist-Board Certified).

Seeking out a therapist with whom the client feels a connection is also valuable. Creating a strong foundation of trust and appreciation can help an individual embrace the process and find success in therapy.

You may want to ask the music therapist a few questions before getting started:

• How would they help with your particular concerns?
• Have they dealt with this type of problem before?
• What is their process?
• What is their timeline for treatment?
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