Stroke often leads to significant cognitive impairment, impacting quality of life. While existing rehabilitation options exist, there's a need for innovative, accessible, and patient-centered solutions. Research suggests music can engage multiple brain networks associated with sensory and motor processes, cognition, and affective regulation, potentially enhancing cognitive functions like attention and processing speed as well. Home-based interventions have also demonstrated positive impacts on rehabilitation adherence and outcomes. Building on this foundation, this study proposes to develop and pilot test a home-based musical rehabilitation program to improve attention and processing speed in Malaysian stroke survivors.
Diagnosed with ischemic or haemorrhagic stroke confirmed by CT scan
18 to 70 years old
Duration of stroke within the first one year
Ability to provide informed consent
Severe aphasia
Significant uncorrected hearing or visual impairments preventing engagement in music therapy.
Severe or unstable medical conditions (e.g., uncontrolled hypertension or diabetes).
Medications that significantly impair cognition or motor function (e.g., high-dose sedatives).
Parallel
Musical Home-based Rehabilitation Program
Other intervention* A certified music therapist will conduct an initial assessment (at the hospital or at your home if travel is not feasible). * You and your caregiver will receive structured training so you can carry out the programme at home independently. * You will complete home sessions of about 40 minutes per session, daily for 5 days per week, for 4 weeks. * Your caregiver will use a simple checklist after each session to record completion, duration, alertness, fatigue, and any concerns. * The therapist will make weekly phone calls to support adherence and address questions. * The therapist will conduct level checks approximately after 2 weeks (at hospital or at home) and may adjust the song tasks to match your progress.
Control group (standard care)
Other intervention* You will continue with the standard neurorehabilitation programme as prescribed by your rehabilitation team. * You will not take part in the home-based music therapy programme.
Montreal Cognitive Assessment (MoCA)
The Montreal Cognitive Assessment (MoCA) is a widely used cognitive screening tool designed to detect mild cognitive impairment. It demonstrates higher sensitivity in identifying subtle cognitive deficits compared to other screening instruments. Scale Range: 0 to 30 Interpretation: Higher scores indicate better cognitive function Cut-off Score: A score of 26 and above is generally considered normal cognitive function
Trail Making Test (TMT A and B)
Trail Making Tests are tests of speed for attention, sequencing, mental flexibility, visual search, and motor function.
Digit Span (Forward and Backward)
Forward Digit Span (FDS) assesses short-term, auditory memory, while Backward Digit Span (BDS) tests working memory and central executive processing.
Clock Drawing Test (CDT)
The Clock Drawing Test (CDT) is a quick,, widely used neurocognitive screening tool designed to detect dementia, Alzheimer's, and other cognitive impairments.
Cogniplus software for Reaction Time and Attention tests
CogniPlus is a computer-based cognitive training and assessment system developed to measure and improve attention, processing speed, and executive functions, particularly in individuals with cognitive impairments following stroke or other neurological conditions. Scale Range: Varies by subtest/module (e.g., attention, processing speed), typically reported as performance scores such as reaction time (milliseconds), accuracy (%), or standardized scores Interpretation: Higher accuracy (%) and standardized scores indicate better cognitive performance Lower reaction time (milliseconds) indicates better processing speed Outcome Metrics: Task-specific measures including reaction time, error rate, and level progression
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