Strokestra is a stroke rehabilitation program where professional musicians and clinicians use a range of musical techniques to help stroke patients recover.

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For two days in late September 2022, a steady rhythm built in Steinmetz Hall in the Dr. Phillips Center for the Performing Arts in Orlando, Florida. Some participants on the stage shook cabasas. Others played the drums or beat out rhythms on a djembe.

This was far from a typical orchestra rehearsal, though. Five stroke survivors and their families were working with musicians from London’s Royal Philharmonic Orchestra (RPO) and health experts from AdventHealth to implement music therapy into their healing.

The international medical research program, called Strokestra, was a learning exchange session between RPO members and teams at AdventHealth Rehab and Music Therapy. Preliminary data from a pilot study in the United Kingdom found that participants in the stroke rehabilitation program experienced clinically significant improvements related to mental well-being and recovery. The researchers measured improvements using the Stroke Impact Scale, which evaluates how stroke affects someone’s health and life from their own point of view.

Nearly all the participants in the pilot study reported improvements in their socialization, while 86 percent reported emotional and cognitive improvements. More than 70 percent reported improvements in physical recovery.

“My emotional well-being is through the roof because of this,” says Brandon Watson, a Strokestra participant in Orlando who is recovering from a stroke he had in July 2019. Watson said the most powerful part was feeling the energy of the other participants and knowing they felt the same way.

Music Stimulates Many Parts of the Brain

A growing number of studies in the last decade have shown that in addition to other forms of rehabilitation such as physical therapy (PT) and occupational therapy (OT), music therapy significantly improves language recovery and motor function after a stroke.

Music therapy involves playing instruments, singing, and even simply listening to tunes. According to Pablo Ripollés, PhD, an associate director of the music and audio research laboratory at New York University in New York City, music therapy creates an enriched environment that stimulates many different parts of the brain at the same time.

“It stimulates all the regions related to language and attention, but also reward and emotion,” says Dr. Ripollés.

Although researchers don’t yet fully understand how it happens, MRI studies have shown that music therapy improves brain plasticity. Brain plasticity refers to changes in the structure of the brain.

“We have found that by learning how to play piano and drums, people were less depressed, and also there were plasticity changes in the parts of the brain that control auditory and motor function,” says Ripollés.

The key is improving communication between isolated “islands” in the brain that form after a stroke, says Alex Street, PhD, a senior research fellow at the Cambridge Institute for Music Therapy Research. Brain damage kills cells in the neural pathways that connect different hemispheres of the brain, disconnecting them from one another.

“But those neural pathways are still there, and they need to be simulated. That's what music does,” Dr. Street says.

Scientists don’t believe that new neurons form, says Ripollés. Instead, existing neurons are likely reorganized in a way that allows them to connect with one another again and transmit information.

It comes down to global stimulation, says Street. By stimulating so many parts of the brain at once, music heightens a person’s awareness of their surroundings and of what their own body is doing.

“You become more able to focus your attention or divide your attention, which is very hard for stroke victims,” Street says. “Attention is the foundation of learning. If you can't attend to things, you can't learn.”

Music Therapy Helps People Relearn Language

According to the American Heart Association (AHA), about one-third of people who have a stroke experience aphasia, a language disorder that can affect speech, as well as auditory and reading comprehension and writing. Long-term language loss impacts more than 60 percent of stroke survivors a year after the event.

Indrani Acosta, MD, the stroke medical director at AdventHealth Central Florida, says music therapy — even just listening to music — can be particularly helpful for people with injuries in the part of their brain that controls language.

“It can really accelerate their rehabilitation,” she says.

A randomized control trial published in November 2021 in the European Journal of Neuroscience found that participants who listened to music with lyrics over three months had the strongest language improvement, compared with those who listened to an audiobook or instrumental music. Brain scans revealed that while both vocal and instrumental music appeared to increase brain connectivity in parts of the brain responsible for language more than listening to an audiobook, this increase in connectivity correlated with improved memory of words only among those who listened to music with lyrics.

“When people listen to music with lyrics it’s even better, because it’s another layer of stimulation,” says Ripollés.

Repetition Is Key to Improvement

Although one-time sessions can still be powerful, especially in boosting mood, to see significant changes, Street says repetition is an important factor. This is particularly true for motor skills.

“Repetition recruits more cells to the damaged neural pathways, whether that's walking or another movement such as playing an instrument,” says Street.

For example, if someone needs to work on relearning how to open a jar, a cabasa might be a good musical tool. The instrument, which is made up of metal beads wrapped around a cylinder, requires the musician to wrap their hand around the beads — in much the same way as they would a jar lid — and twist back and forth to create a sound. Drums can be a great tool to work on arm movement.

“Stroke survivors need mass practice,” says Street.

Part of increasing this repetition is finding an activity, or music, that a person enjoys or resonates with, says Ripollés. If a person likes an activity, they’re more likely to want to do it over and over again.

Music Therapy Improves Mood

Research has shown that surviving a stroke puts a person at high risk of depression and poor mental health. A study published in March 2022 in the journal Stroke included more than 86,000 people in Denmark who survived a stroke. The researchers found that people were almost 2.5 times more likely to develop a mood disorder or depression within the first year of stroke recovery than the general public.

Depression rates are even higher in those with aphasia, a common stroke side effect that impacts language and the ability to communicate. According to a study published in May 2022 in the journal Topics in Stroke Rehabilitation, people with post-stroke aphasia are more than seven times more likely to experience depression than adults without aphasia.

But even just listening to music can have a big impact on mood.

In research published in March 2020 in the journal Topics in Stroke Rehabilitation, a team of experts in the United Kingdom studied the effect of twice-weekly music therapy on nearly 200 people who had a stroke. After two years, they found that although active music therapy (playing instruments) appeared to affect hard skills like motor function and language, the biggest impact they saw when patients listened to music was a boost in their moods.

“When you do any kind of musical intervention, people’s moods always improve,” says Ripollés.

Street says since it’s short in duration, which limits repetition, the social aspect of Strokestra is likely its biggest therapeutic role.

“It's about the social and shared experience,” Street says. “Music therapy brings people together and they start to interact in new ways through music.”

Street says to ask your therapy team if the clinic or hospital where you’re receiving care has a music therapy program, or if they can connect you with one. There are also companies such as MedRhythms, based in Portland, Maine, that are conducting clinical trials and developing technology to make music therapy more accessible to everyone.

According to Street, music therapy is becoming more accepted as an important part of stroke recovery, thanks to a growing body of research that clearly demonstrates its benefits for all types of brain, language, and motor skill recovery.

“The music therapists are the glue that holds everything together,” says Street.