The Journal of Alternative and Complementary Medicine Vol. 25, No. 10 pp. 993-1004
Effects of Five-Element Music on Language Recovery in Patients with Poststroke Aphasia: A Systematic Review and Meta-Analysis
Yang Yang (1), Yueh-Yen Fang (2), Jing Gao (1), and Gui-Ling Geng (2)
1School of Nursing, Nantong University, Nantong, China.
2 School of Nursing, Fooyin University, Kaohsiung, Taiwan.
Abstract
Objectives: Five-element music constitutes a complementary therapy in stroke and other acquired brain injuries. Aphasia represents a great problem faced by individuals with stroke. Five-element music, a new type of therapy, may benefit people with poststroke aphasia (PSA). The present study summarized evidences describing the effects of five-element music in language treatment in patients with PSA.
Methods: A total of 20 databases and websites were searched from inception to May 2018, including published or unpublished gray literature. Both randomized controlled trials (RCTs) and controlled clinical trials were included in the literature review. Two reviewers independently screened and assessed relevant publications; data extraction was carried out with specific forms. The above reviewers also assessed the quality of each trial by using the Cochrane Handbook for Systematic Reviews of Interventions. After evaluating heterogeneity among studies, quantitative synthesis was applied, where appropriate. Review Manager (Rev Man) 5.3 was employed to examine the pooled effect of five-element music for PSA compared with control therapy.
Results: Six RCTs met the eligibility criteria and included 516 patients and were assessed by meta-analysis and quality analysis. Five-element music more significantly increased language scores than Western music therapy or routine care controls in repetition (standardized mean difference [SMD]=1.96; 95% confidence interval [CI] 0.55–3.37), spontaneous speech (SMD=1.29; 95% CI 0.53–2.04), and naming (SMD=1.11; 95% CI 0.80–1.43) (all p<0.05). No adverse events were reported.
Conclusions: Five-element music might moderately improve language rehabilitation in individuals with PSA; however, higher quality RCTs with consistent interventions are required to confirm these findings.
https://www.liebertpub.com/doi/10.1089/acm.2018.0479Excerpts:
"In recent years, with advances in neuro-musical therapy techniques, music therapy has been gradually applied to the rehabilitation of stroke patients.19 In the past decade, the increased number of related controlled studies demonstrated that music interventions have potential rehabilitation effects in neurological diseases.20 Studies have indicated that there are similar structures between music and language,21 and musical interventions have been widely used for rehabilitation in patients with acquired brain injuries to stimulate brain function involving motor, cognition, speech, psychological, and sensory perception activities.22
"Music therapy is an alternative treatment for patients with aphasia in a noninvasive manner23–25 and commonly involves melodic intonation therapy (MIT). MIT is a language production therapy for severe aphasic patients as a method of inducing verbally phrases using intonation (rising and falling of speech) or rhythm (beat or speed), which is a type of reorganization language rehabilitation with stimulation functions of the nondominant hemisphere."
"Five-element music therapy with the traditional pentatonic theory of Chinese medicine uses five different music tunes such as angle, sign, palace, business, and feather to cure ailments. It aims to equilibrate yin and yang, regulate qi and blood, maintain dynamic homeostasis, and keep individual health.
:The history of five-element music can date back to thousands of years ago, and it is a part of traditional Chinese folk music. As a special therapy, five-element music plays an important role in improving negative emotions and partial physical symptoms. The designation of “five-element music” is defined as the scale name, which is equivalent to the '12356' of numbered musical notation, whereas Western music consists of heptachord of '1234567.' In the treatment, there are five different music styles. According to modern music theory, what kind of melody is which main scale.
"The sign and palace of five-element music with style of bright color, relaxation, and vivacity give people the effect of being full of energy and tonifying the spleen and nourishing the heart. The tune of business in five-element music is between sign and palace, which makes people feel gratified and plays a role in clearing the lung heat such as coughing, wheezing, shortness of breath, and chest tightness. The type of angle and feather is muted color, keeping people warm and inner peace, which favor of tonifying the kidney, soothing the liver, and relieving depression."
“'Huangdi Neijing' is one of the earliest medical classics in China, which reflects the medical achievements of ancient China...The five-element music in 'Huangdi Neijing' can be described as the root of five-element music in Chinese medicine. 'Huangdi Neijing' described that angle in five melodies is as wood in five elements as liver in five internal organs, sign as fire as heart, palace as terra as spleen, business as golden as lung, and feather as water as kidney. The five sounds of music, the five organs of the human body, and the five elements of heaven and earth correspond to each other.27
"Five-element music intervention uses the five melodies of angle, sign, palace, business, and feather, and the corresponding relations of five elements and five viscera to determine the treatment principle according to the law of the five elements and to provide a treatment tool of clinical music selection.28 It was reported that five-element music therapy for the rehabilitation of PSA is important in language function29; however, no reliable evidence is available to support this notion owing to variations in the quality of the literature. Currently, there are no conclusive data regarding the effects and safety features of five-element music therapy in PSA."
"Of 920 potentially relevant citations reviewed, only 6 studies (0.65%) matching the inclusion criteria were found. This intriguingly low amount of articles in the literature highlights the need for further investigation of five-element music for language improvement in PSA."
"The majority of trials revealed five-element music as a promising nonpharmacological tool improving language rehabilitation. The pooled effects of five-element music on language function were statistically relevant in comparison with those of Western music treatment or routine care. In this review including six trials, four RCTs adopted the sign of five-element music for the experimental group, one adopted the music of symptomatic music, and the last one chose the music based on individual preferences of patients."
"However, due to the diversity of interventions in this meta-analysis, a definite conclusion regarding the effectiveness of a given five-element music cannot be drawn. In addition, intervention times and frequencies greatly varied among trials, as well as the types of five-element music. This review found that there was no statistical difference among the music of symptomatic music,44 the music selected based on individual preferences of patients,45 and other four interventional methods using a sign of five-element music. Therefore, identifying the most effective intervention feature (type, duration, intensity, or format) in this study is challenging."
"The results showed that the music of five elements was superior to the Western counterpart in terms of repetition, spontaneous speech, speak aloud, and reading, while there was no significant difference in auditory comprehension."
"An RCT demonstrated that Western music significantly improves spontaneous speech in PSA.26 Compared with Western music therapy, the results of five-element music interventions were obvious statistical advantages. However, the clinical differences are not significant, which means that they seemed more to be equivalent.
"Moreover, participants of the two RCTs included in this review were Chinese, and five-element music is deeply loved by the Chinese, especially in the elderly. Most of the aphasic patients in this meta-analysis were seniors, which may be because they are more accepting and affectionate of five-element music that is rich in national style, showing better intervention compliance compared with Western music, so the rehabilitation effect is relatively better."
