Stroke

Preeti Kodancha

Stroke refers to the rapidly developed clinical signs of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than of vascular origin (WHO). In simpler terms, a stroke is a condition that occurs when the blood supply to the brain is interrupted, causing a lack of oxygen and glucose, resulting in the death of cells in the brain. Similar to a heart attack, a stroke is a “brain attack” – appearing suddenly.

STROKE AND DISABILITY
According to the Global Burden of Disease Study 2021 (2024), stroke is the 5th leading cause of disability in India. This means that stroke contributes significantly to long-term health problems that limit an individual’s ability to perform daily activities. Disability caused by stroke refers to long-term physical, mental, or emotional challenges that arise after the event.

These challenges can vary depending on the severity and location of the stroke in the brain, but common forms of disability include:

• Paralysis or Weakness: Weakness or complete paralysis of hand or leg or both, often on one side.
• Speech Difficulties: Problems with speaking or understanding language.
• Cognitive Impairment: Difficulties in various domains of cognition such as mental speed, memory, attention, etc.
• Emotional Changes: Depression, anxiety, or mood swings.

Due to the challenges described above, as well as other challenges, many stroke survivors struggle with basic tasks like walking, eating, dressing, and speaking. Due to these challenges, they may face other difficulties such as relationship difficulties, loss of job, and a loss of personal identity.

NEUROPSYCHOLOGICAL SEQUALAE OF STROKE
The neuropsychological sequalae of stroke include, 

• Neurocognitive Sequalae: Cognitive deficits after a stroke are common and can affect attention, memory, language, orientation, visuospatial skills, and abstract reasoning. Many stroke survivors also experience cognitive slowing. The extent of these deficits is influenced not just by the stroke's focal damage but also by reduced blood flow to areas beyond the lesion. Estimates suggest that 20% to 60% of stroke survivors experience cognitive issues, with those having strokes in cortical regions being more likely to be affected. These cognitive impairments are concerning because they significantly impact recovery and are associated with poorer functional outcomes.
• Psychological Sequalae: The mental health and emotional challenges that can arise as a result of the stroke’s impact on the brain and a person’s daily life include depression, anxiety, and grief. Post-stroke depression is a frequent outcome of stroke, in up to one-third of stroke patients. It is associated with poorer functional outcomes, prolonged hospitalization, and increased mortality. While PSD can be treated effectively, it often goes undiagnosed leading to further complications. 

MUSIC AND STROKE RECOVERY
Music therapy can be a helpful tool for stroke recovery, especially in the areas of speech, motor skills, and emotional well-being. Research has shown that music can activate various regions of the brain, promoting neuroplasticity—the brain’s ability to reorganize and form new connections after injury.

• Speech and Language Rehabilitation: Music therapy, particularly through singing, can help stroke survivors with aphasia (speech or language impairments). Singing involves different brain regions than speaking, and many patients who struggle with speech find they can sing words or phrases more easily. Techniques like melodic intonation therapy (MIT) are commonly used to improve language skills.
• ​Motor Skills and Movement: Music with a rhythm can aid motor recovery, especially for patients with impaired movement or coordination. Rhythmic auditory stimulation (RAS) helps improve walking patterns by syncing with the natural rhythm of gait, often used in physical therapy.
• Cognitive Benefits: Listening to or creating music can stimulate brain regions involved in memory, attention, and problem-solving. Several techniques like Musical Attention Control Training (MACT) and Therapeutic Instrumental Music Performance (TIMP) can be used in the cognitive rehabilitation of stroke patients. This helps improve cognitive function in stroke survivors, especially when combined with other cognitive retraining.
• Emotional and Psychological Impact: Stroke can lead to depression, anxiety, or emotional distress. Music can serve as an emotional outlet, helping patients express feelings and reduce stress. It also promotes relaxation and overall well-being, offering a sense of comfort and joy during recovery.

Music therapy, when used alongside traditional rehabilitation methods, can significantly enhance stroke recovery by engaging multiple brain regions and improving physical, cognitive, and emotional outcomes.