Introduction
Traumatic brain injury (TBI) is a major cause of disability across all ages. Over 50 million people experience TBI each year worldwide.1 Injury often changes the life of the patient in a very profound way, with the effects extending from physical injury and fatigue to cognitive, emotional, and behavioral impairments.2–5 Cognitive impairments vary across patients, depending on injury severity and location, but most deficits are in the domains of attention, memory, communication, and executive functioning (EF).1,6–9 EF is a broad term referring to “high-level” cognitive processes that enable individuals to regulate their thoughts and actions during goal-directed behavior.10 There is no consensus on the exact definition of the term, but various cognitive processes such as set shifting (switching from one task to another), inhibition (avoiding a dominant or prepotent response), and updating (continuously updating the contents of working memory) have been proposed as key components of EF.10 Importantly, deficits in EF are considered to be the core symptoms of TBI, affecting the everyday life and coping of patients as well as posing major challenges for rehabilitation.11,12
Given the substantial burden caused by TBI on individual survivors, their families, and the whole society, new effective rehabilitation methods are urgently needed. Considering the heterogeneous and complex nature of TBI, there is a need especially for motivating rehabilitation tools that are able to address multiple deficits simultaneously, especially targeting executive skills. Behavioral and neuroimaging studies in healthy individuals have revealed that musical training enhances EF and the recruitment of the cognitive control network, raising the question of whether music-based interventions could have similar positive effects on the executive dysfunction experienced by patients with TBI.13–22 Considering also that the ability to enjoy and engage in musical activities is typically well preserved after brain injury,23 music offers a very promising, novel approach to neurorehabilitation after TBI.
Music-based interventions have been shown to enhance verbal memory, focused attention, and visual awareness as well as to improve mood and quality of life in patients with stroke.24–27 Further, music strongly engages the brain's reward system, which can be important concerning the problems of initiation and motivation often linked to TBI.28–31 A recent randomized controlled trial (RCT) in...
