Project Summary This is a feasibility trial testing music listening as an intervention for mental health recovery after stroke. Stroke disproportionally affects older individuals and is the second largest cause of death and the third leading cause of disability world-wide, with 75% of survivors suffering from motor impairments and more than 30% suffering from mental health problems (Lawrence et al., 2001; Hacket and Pickels, 2014). While worse mental health after stroke is related with higher risk of long-term disability and higher mortality rate (Jorgensen et al., 2016; Medeiros et al., 2020; Blöchl et al. 2019; Shi et al., 2017), there is a lack of affordable, easy to deliver, and accessible interventions with minimal side effects that improve mental health in the chronic stage of stroke (Allida et al., 2020). Intentional music listening (IML) refers to the active practice of listening to music (i.e., paying attention to the music without engaging in other activities). IML is one of the most popular leisure activities that people use to upregulate their mood (Dingle et al., 2021; Linnemann et al., 2015). In stroke, preliminary studies show that IML has the potential to reduce depression and anxiety at the acute stage of stroke (Särkämö et al., 2008, 2014; Le Danseur et al., 2019; Baylan et al., 2016). However, these preliminary studies suffer from multiple limitations, including small sample sizes and the lack of an objective measure of treatment dose (e.g., time engaged in IML, acoustic properties of the music listened to). Therefore, research has yet to provide a neuromechanistic account of whether and how IML improves mental health outcomes in stroke. Moreover, there are no studies assessing the effects of IML at the chronic stage of stroke, when long-term mental health ailments keep increasing the risk of disability and mortality (Jorgensen et al., 2016). Here we propose a feasibility trial testing a remote IML intervention in chronic stroke that is guided by the NIH Music-based Intervention Toolkit and that includes an objective measure of treatment dose. Our neuromechanistic framework builds connections between clinical and basic research and borrows the notion of “enriched environment” from animal models of stroke rehabilitation: increased motor, sensory, cognitive, and social contexts promote brain plasticity and recovery after brain injury (Matsumori et al., 2006; Söderström et al., 2009; Johansson and Belichenko, 2002). This feasibility trial will pave the way for future large-scale clinical trials testing whether and how IML provides an optimal enriched environment for mental health recovery in chronic stroke. Across two aims, we develop and test the feasibility of the proposed IML intervention for chronic stroke. The studies will help to validate the NIH Music-based Intervention Toolkit’s guiding principles and will generate pilot data to design future large-scale clinical trials that use IML as an intervention for brain disorders of aging.

Project Narrative The proposed research is relevant to public health because it capitalizes on intentional music listening to test the feasibility of a clinical trial aimed at improving mental health and wellness in chronic stroke. Findings will have direct, translational implications enabling clinicians to design large-scale clinical trials that allow for the optimization of music-based interventions for mental health recovery in stroke. Thus, the proposed research is relevant to the part of the NIH mission that pertains to reducing illness and disability.