Neuroplastic Effects in Patients With Traumatic Brain Injury After Music-Supported Therapy

Berit Marie Dykesteen Vik, Geir Olve Skeie, Karsten Specht, Berit Marie Dykesteen Vik, Geir Olve Skeie, Karsten Specht

Abstract

Damage to the orbitofrontal cortex (OFC) often occurs following a traumatic brain injury (TBI) and can lead to complex behavioral changes, including difficulty with attention and concentration. We investigated the effects of musical training on patients with behavioral and cognitive deficits following a mild traumatic brain injury (mTBI) and found significant functional neuro-plastic changes in the OFC's networks. The results from neuropsychological tests revealed an improved cognitive performance. Moreover, six out of seven participants in this group returned to work post intervention and reported improved well-being and social behavior. In this study, we explore the functional changes in OFC following music-supported intervention in reference to connecting networks that may be responsible for enhanced social interaction. Furthermore, we discuss the factor of dopamine release during playing as an element providing a possible impact on the results. The intervention consisted of playing piano, two sessions per week in 8 weeks, 30 min each time, with an instructor. Additional playing was required with a minimum of 15 min per day at home. Mean time playing piano in reference to participant's report was 3 h per week during the intervention period. Three groups participated, one mTBI group (n = 7), two control groups consisting of healthy participants, one with music training (n = 11), and one baseline group without music training (n = 12). Participants in the clinical group had received standardized cognitive rehabilitation treatment during hospitalization without recovering from their impairments. The intervention took place 2 years post injury. All participants were assessed with neuropsychological tests and with both task and resting-state functional magnetic resonance imaging (fMRI) pre-post intervention. The results demonstrated a significant improvement of neuropsychological tests in the clinical group, consistent with fMRI results in which there were functional changes in the orbitofrontal networks (OFC). These changes were concordantly seen both in a simple task fMRI but also in resting-state fMRI, which was analyzed with dynamic causal modeling (DCM). We hypothesized that playing piano, as designed in the training protocol, may provide a positive increase in both well-being and social interaction. We suggest that the novelty of the intervention may have clinical relevance for patients with behavioral problems following a TBI.

Keywords: dynamic causal modeling; emotional control; mTBI; music-supported therapy; neuroplasticity; orbitofrontal cortex; social interaction.

Figures

Figure 1
Figure 1
Functional magnetic resonance imaging (fMRI) task. Figure displays the results from the non-parametric analysis on the pre-post differences. The results highlighted areas where patients (P) demonstrated an increase of activity from pre- to post-examination, while control subjects (C; irrespective of music intervention) did not show an increase or even a slight decrease. The results are explored with a non-parametric p-value of p < 0.001. Bar plots show contrast estimates (with 90% confidence interval). OFC, orbitofrontal cortex; MFG, middle frontal gyrus; aIns, anterior insula; ACC, anterior cingulate cortex; SMA, supplementary motor area.
Figure 2
Figure 2
Resting-state dynamic causal modeling (DCM) analysis. Figure displays the overall connectivity of the discovered network in the shaded colors, independent of groups and repetitions. The line thickness for the shaded lines is an indicator of the averaged estimated parameter. Pre-post group differences are displayed in strong colors. Connections, where there was a difference between the patients (P) and the control group with intervention (G1) are displayed with continuous lines, and comparisons to the control group without intervention (G2) are displayed with broken lines. Line thickness inversely scales with the p-values (Note: line thicknesses of the lines in shaded and strong colors are not related and should only illustrate the relative strength of the respective effects).

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