Soundtrack to recovery: U of T PhD candidate explores music’s role in stroke rehabilitation therapy

Anthonia Aina’s first interaction with a physiotherapist occurred during her childhood when her father was involved in a car accident. He suffered a minor vertebral shift (called spondylolisthesis) that left him bedridden for almost three months, during which he underwent of physiotherapy to help regain his ability to walk. 

“I remember the first day I saw him walking; I was so overjoyed,” says Aina, a PhD candidate in the Faculty of Kinesiology and Physical Education (KPE) at the University of Toronto. 

“Witnessing his journey from being almost bedbound to achieving recovery truly motivated me to pursue physiotherapy. I love being part of the process that helps people get better.” 

While studying physiotherapy in Nigeria, Aina noticed during her undergraduate clinical experience that individuals who had suffered a stroke engaged more effectively in therapy and had lower rates of depression when listening to their favourite music. 

At KPE, Aina is building on that observation to understand how listening to music influences movement after a stroke under the supervision of Associate Professor Joyce Chen in the Training and Enhancing Motor Performance Outcomes (TEMPO) Lab. She is particularly interested in the emotional and reward benefits of incorporating music in therapy. 

Aina’s research is supported by the Heart and Stroke Foundation’s Personnel Awards for Black Scholars, made in collaboration with the Canadian Institute of Health Research (CIHR) and Brain Canada. The program was established to increase the number of highly qualified Black trainees in heart and brain research across Canada. 

In Canada, stroke is a leading cause of adult disability. The life-altering event affects physical, cognitive and behavioral functions. Music has proven to be a valuable addition to physiotherapy because it stimulates motor, sensory, cognitive and emotional domains of the body. 

Research indicates that incorporating music into rehabilitation interventions could enhance movement quality over time and increase engagement rates.

A 2016 study published in Brain Imaging and Behavior found that individuals who had experienced a stroke and used an electronic drum set or portable digital keyboard to create music demonstrated significant improvements in the speed, precision and smoothness of movements in the affected hand. Functional magnetic resonance imaging (fMRI) conducted while they listened to music revealed activations in the affected and unaffected brain areas responsible for movement and music processing. This suggests an increase in functional brain connectivity following a stroke.

“There is a correlation between engagement and functional recovery,” Aina says. “The more you engage, the better your recovery outcome.”

To gain a deeper understanding of the benefits of music in therapy, several factors must be considered. One is the entrainment effect, which describes how our bodies synchronize to the rhythm of a song — an effect often observed in walking. Another is a concept known as the Mozart effect, which refers to heightened mood that improves performance in cognitive tasks. 

Aina says that the emotional and reward benefits of listening to music are just as important because human behaviours can be influenced by the availability of rewards. Similarly, research published in the National Library of Medicine shows that listening to pleasurable music could be rewarding because it activates similar brain regions that process other types of rewards such as money and food.  

“When we listen to music we like, its influences our mood and arousal levels, which further impacts or perception of musical reward and thus behaviour” Aina says. “Therefore, it is important to explore this potential of using music as reward to improve rehabilitation outcomes in people with stroke.”

Aina is currently in the experimental development phase of her research. She plans to first study how music influences movement kinematics in individuals who haven’t had a stroke before focusing stroke survivors and collect data in partnership with stroke communities.

Aina’s ultimate goal with understanding the benefits of music therapy is to offer an accessible way for individuals to continue to engage in rehabilitation movements after therapy sessions. This approach is particularly beneficial for people in rural areas with limited access to therapy and can enhance the convenience of virtual sessions.

“Once we understand how we can harness music in therapy, we think that it is an accessible enough approach to integrate within and outside of the clinic so people can continue to engage in the therapy,” Aina says.