Listening to classical music influences brain connectivity in post-stroke aphasia: a pilot study

Abstract

Stroke-induced aphasia is a leading cause of cognitive disability. The healthy right hemisphere may play a role in aphasia compensation. Music-based therapy, known to enhance cognitive functions after stroke, offers a potential intervention due to its impact on brain connectivity, engaging both hemispheres. In this proof-of-concept study, we aimed to assess the feasibility and effectiveness of music-assisted therapy for language disorders following left hemisphere strokes. We also sought preliminary insights into the impact of music on post-stroke brain connectivity. We enrolled four right-handed patients (one female and three males, mean age 57.75 years, SD 7.63) who experienced their first left-hemisphere stroke inducing chronic aphasia symptoms three months post-stroke. Patients were randomly assigned to receive either two weeks of music therapy, involving daily 2-hour sessions of listening to instrumental music by Haydn, Mozart, and Beethoven, in addition to standard rehabilitation, or two weeks of standard care, using a crossover design. Patients underwent cognitive and neuroimaging assessments at baseline, crossover, and study end, with preliminary evaluation one week before the study to confirm stable deficits. All patients listened to the same curated playlist, accompanied by narrations situating the music in its with historical context. Cognitive assessments included the Core Assessment of Language Processing (CALAP) and a French aphasia battery (Bilan Informatise dAphasie, BIA). EEG and MRI data were analyzed, focusing on functional connectivity metrics (weighted symbolic mutual information, permutation entropy) and white matter tractography. Preliminary findings indicate that music therapy may be a feasible and promising approach to aphasia rehabilitation, with improvements observed in language tests and brain connectivity metrics. Despite limitations such as a small sample size and patient heterogeneity, these preliminary results suggest that intensive classical music listening may enhance language abilities in post-stroke aphasia patients. Additionally, using EEG connectivity metrics originally designed for non-communicative patients provides a novel avenue for monitoring brain plasticity during rehabilitation.