Music Upper Limb Therapy–Integrated Provides a Feasible Enriched Environment and Reduces Post-stroke Depression: A Pilot Randomized Controlled Trial
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Objective: This study’s aims were to refine Music Upper Limb Therapy–Integrated (MULT-I) to create a feasible enriched environment for stroke rehabilitation and compare its biologic and behavioral effects with that of a home exercise program (HEP). Design: This was a randomized mixed-methods study of 30 adults with post-stroke hemiparesis. Serum brain-derived neurotrophic factor and oxytocin levels measured biologic effects, and upper limb function, disability, quality of life, and emotional well-being were assessed as behavioral outcomes. Participant experiences were explored using semistructured interviews. Results: MULT-I participants showed reduced depression from preintervention to postintervention as compared with HEP participants. Brain-derived neurotrophic factor levels significantly increased for MULT-I participants but decreased for HEP participants, with a significant difference between groups after excluding those with post-stroke depression. MULT-I participants additionally improved quality of life and self-perceived physical strength, mobility, activity, participation, and recovery from preintervention to postintervention. HEP participants improved upper limb function. Qualitatively, MULT-I provided psychosocial support and enjoyment, whereas HEP supported self-management of rehabilitation. Conclusions: Implementation of a music-enriched environment is feasible, reduces post-stroke depression, and may enhance the neural environment for recovery via increases in brain-derived neurotrophic factor levels. Self-management of rehabilitation through an HEP may further improve upper limb function.
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Post-stroke patients showed improvements in depression and motor functions after 6 weeks of interactive improvised group music-making therapy.
“after participating in interactive improvised group music-making therapy for 6 weeks, post-stroke patients showed improvements in depression and motor functions without significant OXT changes Palumbo et al., (2022).”
From Music's context-dependent influence on oxytocin, social bonding, and emotion regulation: a systematic review (2026) · cites this paper as Palumbo et al., (2022)
Methods (Study Design and Intervention; page not provided) describes six weeks of interactive group music therapy. The Discussion reports reduced depression and improved self-perceived physical strength, mobility, and activity in the MULT-I group, but no significant improvement in upper-limb motor impairment on the Fugl-Meyer Scale. Results (Within-group differences) reports no significant oxytocin change, so the citing sentence is supported except that its broad reference to improved motor function obscures the distinction between self-reported function and measured motor impairment. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn children with ASD and post-stroke patients, no significant changes in peripheral OXT levels were observed after long-term group music therapy.
“However, in children with ASD Corbett et al., (2011) and post-stroke patients Palumbo et al., (2022), no significant changes in peripheral OXT levels were observed after long-term group music therapy.”
From Music's context-dependent influence on oxytocin, social bonding, and emotion regulation: a systematic review (2026) · cites this paper as Palumbo et al., (2022)
Empirical studies on music-induced peripheral OXT changes have yielded inconsistent findings: some reported increases, others no significant change or decreases.
“Although empirical studies have suggested that music can lead to peripheral OXT changes, the findings are inconsistent. Some studies reported OXT increases after musical activities (Grape et al., 2003; Nilsson, 2009), while others observed no significant change (Palumbo et al., 2022) or even decreases (Eerola et al., 2021; Fancourt et al., 2016; Schladt et al., 2017).”
From Music's context-dependent influence on oxytocin, social bonding, and emotion regulation: a systematic review (2026) · cites this paper as Palumbo et al., 2022
Post-stroke patients showed no significant OXT changes after 6 weeks of interactive improvised group music-making therapy.
“without significant OXT changes Palumbo et al., (2022).”
From Music's context-dependent influence on oxytocin, social bonding, and emotion regulation: a systematic review (2026) · cites this paper as Palumbo et al., (2022)
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Self-citationA Unified Model for Stroke Recovery and Rehabilitation
Raghavan, P. (2023) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000002141 · Cited by 4 · see citing works
Self-citationSukumar, M., Thanneeru, S. K., Sutar, R. F., Sahu, A. K., & Agrawal, A. (2024) · Indian Journal of Palliative Care · doi:10.25259/ijpc_23_2024 · Cited by 3 · see citing works
Parambath, S. K., Krishna, N., & Krishnamurthy, R. G. (2025) · Biogerontology · doi:10.1007/s10522-025-10232-z · Cited by 3 · see citing works
Busse, P. K., Neugebauer, L., Kaschubowski, G., Anheyer, D., & Ostermann, T. (2025) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2024.1504229 · Cited by 3 · see citing works
Pan, Q., We, W., & Tang, C. (2025) · Noise and Health · doi:10.4103/nah.nah_101_25 · Cited by 3 · see citing works
Navarro, L., Mallah, N. E. Z., Pardo-Seco, J., Gómez‐Carballa, A., Pischedda, S., Nowak, W., Segura, E., Rodríguez‐Fornells, A., Martinón‐Torres, F., & Salas, A. (2025) · medRxiv · doi:10.1101/2025.07.29.25332404 · Cited by 2 · see citing works
Palumbo, A., Balagula, C., Turry, A., Aluru, V., & Raghavan, P. (2024) · Disability and Rehabilitation · doi:10.1080/09638288.2024.2346240 · Cited by 1 · see citing works
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Music for Stroke Rehabilitation
Palumbo, A., Kim, S. J., & Raghavan, P. (2023) · Current clinical neurology · doi:10.1007/978-3-031-47092-9_3
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Application of Optogenetic Neuromodulation in Regulating Depression
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Self-citationThe role of oxytocin in music interventions: A systematic review
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Current Progress of Mechanisms Underlying Post-Stroke Depression and Music Therapy
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Environmental enrichment in post-stroke rehabilitation: a scoping review of clinical applications
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- Authors
- Palumbo, A., Aluru, V., Battaglia, J., Geller, D., Turry, A., Ross, M., Cristian, A., Balagula, C., Ogedegbe, G., Khatri, L., Chao, M. V., Froemke, R. C., Urbanek, J. K., & Raghavan, P.
- Affiliations
- Columbia University Irving Medical Center (US)
- Kingsbrook Jewish Medical Center (US)
- New York University (US)
- Baptist Health South Florida (US)
- NYU Langone Health (US)
- Johns Hopkins University (US)
- Corresponding author
- Raghavan, Preeti
- Venue
- American Journal of Physical Medicine & Rehabilitation
- Published
- 2021-12-06
- Volume
- 101
- Issue
- 10
- Pages
- 937-946
- ISSN
- 0894-9115 (ISSN-L)
- 1537-7385
- PMC
- PMC9163211
- OpenAlex
- W4200184823
- Cited by
- 46
- References
- 59
- Citations by year
- 2026: 13 · 2025: 11 · 2024: 14 · 2023: 6 · 2022: 2
- FWCI
- 2.89
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Physical Medicine & Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR000038, UL1TR001445)
- National Heart, Lung, and Blood Institute (R25HL105444)
- National Institute of Neurological Disorders and Stroke (U54NS081765)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Social Sciences › Psychology › Social Psychology › Music Therapy and Health
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Keywords
- music therapy, stroke rehabilitation, post-stroke depression, hemiparesis, environmental enrichment, brain-derived neurotrophic factor, oxytocin, home exercise program, upper limb function, quality of life, psychosocial support
- MeSH terms
- Stroke Rehabilitation, Adult, Biological Products, Depression, Exercise Therapy, Humans, Music Therapy, Pilot Projects, Quality of Life, Treatment Outcome, Brain-Derived Neurotrophic Factor, Recovery of Function, Stroke, Upper Extremity
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