When a music therapist first came to Karima Collins’ stroke ward, her NHS- issue sceptic alert fired up.

“We’re trained to be quite critical and to focus on the evidence,” she says.

“When someone makes grand claims about what the therapy can do, like improving attention, communication and reducing neglect, I was sceptical. How on earth could it do all these things?”

Then she saw the video evidence – and heard more about how neurologic music therapy (NMT) can transform outcomes in stroke patients.

Karima is clinical lead at London’s Charing Cross Hospital’s acute stroke ward, and a speech and language therapist.

The music therapy consultant was Daniel Thomas, from specialist therapy provider Chroma.

A five-week trial of NMT on the ward spiralled into a nine-month project funded by the Imperial Health Charity, which supports Charing Cross as part of Imperial Stroke Services.

The initiative, the first programme of its kind in an acute stroke unit setting in the UK, has won widespread acclaim, and the support of bodies including the UK Acquired Brain Injury Forum.

The idea was to embed a neurologic music therapist on the ward, delivering NMT in conjunction with other rehabilitation therapies to accelerate recovery.

Would the results match the impressive video evidence that swayed Karima at the outset?

Music therapy in long-term residential care environments is well-established and publicised.

YouTube is home to an abundance of clips showing people with dementia and other neurodegenerative diseases being lit-up by music therapy interventions. But the obvious difference when attempting any kind

of comparison is that this is a local stroke unit in a busy public-funded hospital, where stroke survivors from across North London come after their three days of immediate medical attention and stabilisation in the hyper acute unit.

“People can still be quite acutely unwell,” says Karima.

“Their levels of how awake and alert they are can be quite low, and they can be very fatigued.

“We weren’t sure it would work with these very sick, very early stage stroke patients, because we knew it was a very different setting to the traditional neuro- rehabilitation unit.

“The average length of their stay is only around 19 days, which is very short compared to the type of neuro-rehab unit you might associate with NMT, where people stay for eight to 12 weeks.

“We were also mindful of the fact that we didn’t want to reduce the amount of existing therapies patients were getting.”

While it may not initially appear the ideal setting for such a project, the results speak volumes in terms of NMT’s effectiveness.

An impressive 100 per cent of patients receiving NMT for aphasia achieved their target language in one session, with the project scoring the same level of success among patients who received NMT for dysarthria – increasing their decibel output by an average of 72 per cent.

Furthermore, 88.2 per cent receiving NMT for cognitive impairments were able to achieve one of their MDT goals in under two NMT sessions, and 85.7 per cent of patients with gait irregularities improved on average by over 40 per cent in a single session.

Patient stories themselves help to articulate those statistics even more powerfully.

Karima remembers one patient who had not spoken during her time on the ward, did not want to interact with staff or patients and engaged reluctantly with the NMT project.

“She eventually agreed to sit at the keyboard. We found out from a relative of hers, as we conduct a music history questionnaire with the patient and their relatives, that she had in the past played piano and was very musical.

“So she sat and actually put her hands on the keyboard and played the notes from something she remembered, and then started speaking.

“That was the first time she came out of herself and initiated any kind of communication with anyone. It was amazing.

“Another patient was finding it difficult to stick to one thing, even in communication she was very distracted, going off topic and looking around, losing track of herself.

“But when she sat at the drums and played a rhythm, even while being distracted by other rhythms that were added in, she was really focused, absolutely 100 per cent focused on that activity.

“It was only beating a drum, but she really concentrated on that task and it really helped her.”

Through a combination of individual and group sessions, adapted to the needs of the individuals involved, and under the careful guidance of music therapist Charlie Flint, the project helped to uncover new ways of inspiring patients.

It motivated them through a love of music, helping the medical team to find new ways of joint working on the ward.

Charlie was regarded as ‘one of the team’ on the ward through delivering NMT two days a week.

“One of the benefits we found came as a result of Charlie being able to conduct the team.

He could say, ‘if we are working towards these functional goals, like the patient making a cup of tea or a sandwich in order to be able to go home, then how can we use music to integrate the same goals? Can we get them into the kitchen, standing up and reaching to get their cup from the cupboard?’

“Even though we strive to devise realistic goal settings, often it’s easier to goal set within disciplines. So, for example, if the physios were working on walking, they would just focus on that, and their goal would be to just get a patient up and walking.

“Then the speech therapist looks at the stuff around language or speech. There isn’t always very much crossover.

“NMT had an interesting effect on how people thought about goals, with music at the centre of everything. Also, attention is so core for any physio, occupational or speech and language session the patient needs to be able to attend.

“We found that having music therapists there enabled us to speed up the process of getting the patient paying attention.

“So we could use music to improve attention faster because patients were very engaged with the music and the types of activity it offered.

“That would then speed up the process of opening them up to the next stage of their therapy.

“For example focus might start at ‘music for attention’, then ‘music for the finding words you need to say’.

“It meant there was an extra tool in our toolkit for addressing the difficulties a patient has.

“It’s very difficult to sit and make an interesting session around finding a word for something, whereas actually attending to produce something based around music is much more motivational.”

Karima and the team’s hope is that funding can be accessed so that the NMT project can not only continue in the stroke unit, but also to enable it to be extended to the neuro-rehab unit onsite at Charing Cross.

“We know it will work very well in the neuro-rehab environment, albeit with a slightly different model, because the patients stay there for longer.

“This means you can plan and predict how many sessions they might engage in.”

Like many therapy types within neuro-rehab, proving cost effectiveness of NMT is vital.

“Ideally we would have set a trial up with some patients receiving NMT and some who weren’t. That would have provided a control group where we could have compared and contrasted, but that takes a lot of time and we really just wanted the patients to have the benefits of NMT as soon as possible.

“The data we’ve gathered certainly suggests that it is cost effective and has a very strong influence on patient outcome and motivation.

“Also, patients and families tell us they love it. Staff feel that patients respond differently to it than traditional, slightly more boring therapy.

“We’re also hoping to be able to bring in some volunteers – perhaps music therapists who want to specialise in NMT. That might be a great way of extending the impact.”

Chroma has secured funding to continue its work at Charing Cross for three days a week throughout 2020.

For more on NMT see: www.wearechroma.com.