FEATURE

Music as a Therapy to Alleviate Anxiety During Inpatient

Rehabilitation for Stroke
Maureen Le Danseur1, MSN, CNS, ACNS-BC, CRRN, CCM, April D. Crow1, RN, BSN, Sonja E. Stutzman1, PhD,
Marcos D. Villarreal2, MPH & DaiWai M. Olson1, PhD, RN, CCRN

Abstract
Purpose: The aim of the study was to determine if listening to music may reduce anxiety experienced by stroke patients during
acute rehabilitation.
Design: A prospective, nonblinded, randomized study in an inpatient rehabilitation setting.
Methods: Fifty participants were randomized into two groups: (1) 1 hour of music (intervention) or (2) no music (control). All
participants completed pretest anxiety and depression screening and 44 completed the posttest anxiety screening. Differences
between groups were determined using chi-square and t tests.
Findings: After listening to music for 1 hour, participants who completed the posttest (n = 44) reported significantly less anxiety
(p < .0001) compared to before the intervention. The control group showed no difference in their pre- and posttest anxiety scores
(p = .84). No differences were determined among age, gender, or diagnostic groups.
Conclusions: These findings demonstrate that music intervention may help lessen anxiety in rehabilitation patients poststroke.
Clinical Relevance: Offering musical intervention to stroke patients in rehabilitation may lessen symptoms of anxiety.

Keywords: Nursing; rehabilitation; stroke; music therapy.

Introduction and is defined by Endler and Kocovski (2001) as “a trait,

A stroke is a sudden and potentially life-altering event
that effects not only the person who experienced the
stroke but their loved ones as well (Dwyer Hollender,
2014). The role, relational, social, financial, and lifestyle
changes can be overwhelming. Patients admitted to the
physical medicine and rehabilitation (PM&R) unit may
experience both physical and mental stress (Rouillard,
De Weerdt, De Wit, & Jelsma, 2012). Receiving PM&R
services in an unfamiliar environment may trigger confu-
sion, fear, depression, or anxiety (Jolly, Taylor, Lip, &
Stevens, 2006). Anxiety has both physical (tachycardia,
dry mouth) and emotional (fear, worry) manifestations
Correspondence: DaiWai M. Olson, Neuroscience Nursing Research Center,
University of Texas Southwestern Medical Center, Dallas, TX, USA. E-mail:
daiwai.olson@utsouthwestern.edu
1 University of Texas Southwestern Medical Center, Dallas, TX, USA
2 University of Texas Southwestern, Dallas, TX, USA
Accepted April 25, 2017
Copyright © 2017 by the Association of Rehabilitation Nurses
Cite this article as:
Le Danseur M., Crow A. D., Stutzman S. E., Villarreal M. D., &
Olson D. M. (2017). Music as a therapy to alleviate anxiety during
inpatient rehabilitation for stroke. Rehabilitation Nursing, 00(0),
00–00. doi: 10.1097/rnj.0000000000000102
a state, a stimulus, a response, a drive, and as a motive”
(p. 232). Depression is characterized by low mood or loss
of interest in things that once one found enjoyable, both
of which affect the activities of daily living (Diagnostic
and Statistical Manual of Mental Disorders-5, 2013).
Anxiety and depression are both common following acute
stroke and may impact rehabilitation (Campbell Burton
et al., 2013; Jolly et al., 2006; Lucassen et al., 2014;
Schöttke & Giabbiconi, 2015). Symptoms of anxiety and
depression may be overlapping, and therefore, assessments
of the patient are oftentimes aimed to measure both. Pro-
viding patient and family education regarding anxiety and
depression is helpful but does not necessarily have a positive
impact on the patient’s current mood. Improving the mood
for patients recovering after stroke has the potential to im-
pact the patient and care-partner relationship following
discharge from rehabilitative services (Jones, Charlesworth,
& Hendra, 2000). Thus, interventions found to reduce stress
and anxiety in the PM&R setting could benefit patients.
The prevalence of anxiety disorders among stroke
rehabilitation patients is slightly higher (26%) than the
general adult population (20%) in the United States (Kessler,
Chiu, Demler, Merikangas, & Walters, 2005; Masskulpan,
Riewthong, Dajpratham, & Kuptniratsaikul, 2008; National
Institutes of Mental Health, 2014). Medications are available

Month 2017 • Volume 00 • Number 0 www.rehabnursingjournal.com 1

Copyright © 2017 by the Association of Rehabilitation Nurses. Unauthorized reproduction of this article is prohibited.
2 Music in Stroke Rehab
to treat anxiety but have side effects that may hinder the
ability of the patient to receive the full benefit of PM&R
therapy sessions.
Music, as a therapeutic intervention, was first de-
scribed in Dunton (1946). Pacchetti et al. demonstrated
that patients with Parkinson’s disease that were involved
in music therapy also displayed increased engagement in
physical therapy (Pacchetti et al., 2000). Magee and
Davidson (2002) concluded that music therapy may be
beneficial in increasing mood states for neurologically in-
jured patients who are undergoing rehabilitation therapy.
Music improves mood and arousal through the dopami-
nergic mesolimbic system, improves memory by stimulat-
ing glutamatergic neurotransmission, alleviates stress and
anxiety by reducing cortisol levels, and increases cerebral
blood flow surrounding the ischemic or hemorrhagic le-
sion, thereby stimulating neuroplastic recovery (Peretz
& Zatorre, 2005; Särkämö & Soto, 2012; Zatorre &
McGill, 2005).
Research involving music therapy and stroke patients
has been multifaceted (Särkämö, Tervaniemi, & Huotilainen,
2013). Jun, Roh, and Kim (2013) combined music and move-
ment. It included stretching to music, followed by a ses-
sion of playing various instruments and singing, ending
with listening to music while patients shared their experi-
ences with respect to the session. The results suggested an
improved mood state and increased range of motion of
the upper extremities (Jun et al., 2013). Forsblom, Särkämö,
Laitinen, and Tervaniemi (2010) supported the premise that
music therapy could enhance recovery of the stroke patient.
Their population listened to both music and audiobooks.
They demonstrated that music directly correlated to im-
proved mood and increased relaxation (Forsblom et al.,
2010). Kim et al. (2011) focused on depressive mood
and anxiety and the effects of music with the stroke pop-
ulation in the outpatient setting. The population had ex-
perienced a stroke within the last 6 months. The results
showed a decrease in depression scores that were stati-
cally significant. However, the generalizability of the
study was limited with recommendations to repeat the
study in other settings (Kim et al., 2011).
Current research supports the use of music as an in-
tervention to benefit patients with stroke and brain injury
(Bradt, Magee, Dileo, Wheeler, & McGilloway, 2010;
Särkämö & Soto, 2012). Music has also been found to
be beneficial in acute PM&R (Thaut et al., 2009). There-
fore, the literature supports a testable assumption that
incorporating music in a PM&R setting may reduce anx-
iety. The purpose of this study was to examine the impact
of 1-hour of music listening on anxiety scores in a cohort
of inpatient PM&R patients who recently sustained
a stroke.
Copyright © 2017 by the Association of Rehabilitation Nurses. Unauthorized reproduction of this article is prohibited.
M. Le Danseur et al.
Methods
This was a prospective, nonblinded, investigator-initiated,
randomized study. All study procedures were reviewed
and approved by the institutional review board. Physical
medicine and rehabilitation patients admitted for inpatient
rehabilitation and diagnosed with an ischemic or hemor-
rhagic stroke, who were able to provide self-consent, were
considered eligible for the study. Prisoners and patients
who were deaf or very hard of hearing were excluded from
the study. Following consent, participants (N = 50) were
randomized by random number assignment to the No-
Music (control) or Music (intervention) group. A random
number generator was used based on the target sample size
of 50; then, the group assignments were placed into sealed
envelopes and were opened after participant consent. Par-
ticipants and providers were not blinded to group assign-
ment. The target sample was based on an assumption
that power is set at 0.80 and alpha is .05, with an estimated
effect size of 0.60 (24 subjects per group; Lipsey, 1990).
Measures
Demographic data were collected at baseline via chart ab-
straction. Anxiety was measured with the State–Trait
Anxiety Inventory (STAI) and the Hospital Anxiety De-
pression Score (HADS). The original STAI consists of
two sets of 20 questions to assess both state anxiety and
trait anxiety levels in adults. The STAI-State (STAI-S) ex-
amines current level anxiety: How anxious is the subject
at this moment? The STAI-Trait (STAI-T) anxiety refers
to a characteristic of personality that one endures over
time. The STAI self-evaluation tests have a 4-point scale
rated from “almost never” to “almost always.” The STAI
can be easily read by an adult with at least a sixth-grade
level of education. The STAI has been used previously
with stroke patients in rehabilitation. The results showed
that the scale had high correlation with other mental
health scales used at a .05 level of significance (Torkia,
Best, Miller, & Eng, 2016). Evidence supports using six
questions in each part of the STAI to score state anxiety
(Fioravanti-Bastos, Cheniaux, & Landeira-Fernandez, 2011).
Therefore, participants received six questions from STAI-S
and 20 questions from STAI-T to measure their levels
of anxiety.
The HADS is a validated 14-item rank scale that can be
used to score anxiety and depression (Bjelland, Dahl, Haug,
& Neckelmann, 2002; Zigmond & Snaith, 1983). Seven
items relate to anxiety and seven to depression, and HADS
scores have been found valid for poststroke screening
(Sagen et al., 2009). The HADS measure has been previ-
ously tested with patients admitted to a stroke unit, show-
ing sensitivity of 100% and specificity of 99.17% (Pedroso,
Month 2017 • Volume 00 • Number 0 www.rehabnursingjournal.com 3

Vieira, Brunoni, Lauterbach, & Teixeira, 2016). HADS scores paired t test to examine difference between the Music and
were included to provide concurrent validity for trait anxiety. No-Music groups.
The HADS anxiety and depression scores were calcu-
lated as standardized; eight questions were reverse-coded.
Study Procedures The odd questions addressed symptoms of anxiety, whereas
Following randomization, all participants completed three self- the even numbered questions addressed symptoms of depres-
report forms: (1) STAI-S, (2) STAI-T, and (3) HADS to provide sion. For subgroup analysis, patients were dichotomized
baseline data. The study period lasted 1 hour. Participants ran- based on the primary diagnosis of either embolic or hemor-
domized to the music intervention group listened to music of rhagic stroke. Patients with incomplete questionnaire re-
their choice (participants chose from one of five music genres: sponses were excluded from subgroup analysis for that
Christian/gospel, classical, classic rock, country western, or questionnaire. All statistics were calculated in SAS v9.3.
pop/modern) for 1 hour. Participants randomized to the con-
trol arm were asked to carry on with their daily routine for Results
1 hour (e.g., watching TV, walking, reading, eating). At the Of 50 patients enrolled in the study, two withdrew after
end of 1 hour, all participants (control and intervention) com- randomization (1 Music, 1 No-Music), and four were ex-
pleted the poststudy self-report form (STAI-S). cluded for missing data in STAI-S self-report (2 Music, 2
No-Music); therefore, 44 completed the study. Demo-
graphic data showed similar distributions between partic-
Statistical Analysis
ipants assigned to either intervention arm (Table 1). A
Baseline group characteristics were examined using a chi- difference was seen between the Music and No-Music
square test among categorical variables (gender, race) or t group in the HADS anxiety score (p = .02). A paired t
test for continuous variables (age). Participants were ex- test demonstrated a statistically significant difference in
cluded from analysis if any answers in the primary out- STAI-S scores before (pre)listening to music compared
come measures (STAI-S initial and final scores) were to after (post)listening to music (3.18, 95% CI, [2.0,
missing. The six questions from STAI-S were given nu- 4.4], p < .0001); there was no significant difference for
meric values for their four answer choices, with the most in pre- versus post-STAI scores among the No-Music
negative answer being given a 1 and the most positive an- group (−0.16, 95% CI [1.8, 1.4], p = .8374).
swer being a 4, the total STAI-S was the summation of the Multivariate modeling, displayed in Table 2, was used
six questions (minimum 6 for high-state anxiety, maxi- to examine the relationship between predictor variables
mum 24 for low-state anxiety). Initial and final total STAI and the outcome variable (anxiety). After adjusting for
scores were compared using a t test to examine differences STAI-S (pre), age, gender, primary diagnosis group, STAI-T,
among the Music and No-Music groups, followed by a HADS-A, and HADS-D, a multivariable model used to
Table 1 Demographic and primary variables of interest
No Music Music
n Mean (SD) or % n Mean (SD) or % p
Age 22 62.4 (13.5) 22 54.3 (15.3) .07
Gender .99
Female 9 40.9% 9 40.9%
Male 13 59.1% 13 59.1%
Race .22
Caucasian 7 31.8% 15 68.2%
African American 2 9.1% 1 4.5%
Asian 1 4.5% 0 0%
Unknown 12 54.5% 6 27.3%
Primary diagnosis group .61
Acute ischemic stroke 17 77.3% 19 86.4%
Hemorrhagic stroke 5 22.7% 3 13.6%
STAI-Trait 20 40.8 (11.0) 18 34.6 (10.0) .08
HADS-Depression 20 7.3 (2.5) 21 6.3 (2.4) .20
HADS-Anxiety 20 8.1 (4.8) 21 4.7 (3.6) .02
STAI-State (pre) 22 17.6 (3.9) 22 18.7 (4.8) .43
STAI-State (post) 22 17.5 (4.5) 22 21.84 (2.9) .0004

Copyright © 2017 by the Association of Rehabilitation Nurses. Unauthorized reproduction of this article is prohibited.
4 Music in Stroke Rehab M. Le Danseur et al.

Table 2 Multivariable model for STAI-State (pre and post) outcome

STAI-State (Pre) Outcome STAI-State (Post) Outcome
Variable Parameter Estimate Standard Error t Pr > |t| Parameter Estimate Standard Error t Pr > |t|
Intercept 2.041 3.202 0.64 0.529 1.195 3.135 0.38 0.706
STAI-State (pre) * * * * 0.288 0.161 1.79 0.084
Age 0.064 0.037 1.72 0.096 −0.004 0.034 −0.11 0.910
Gender −0.498 1.076 −0.46 0.647 0.749 0.900 0.84 0.410
Primary diagnosis group 0.100 1.506 0.07 0.948 1.626 1.354 1.20 0.240
STAI-Trait 0.223 0.070 3.19 0.003 0.095 0.068 1.40 0.172
HADS-Anxiety 0.371 0.159 2.34 0.026 0.318 0.160 1.98 0.058
HADS-Depression −0.641 0.272 −2.36 0.025 −0.126 0.247 −0.51 0.614
Music group * * * * −2.217 1.024 −2.17 0.039

predict post STAI-S scores demonstrated a decrease of 2.2
points in anxiety scores for the Music group (p = .039). To
confirm this difference was not originally present in the two
groups, a multivariable model to predict pre-STAI-S
scores was constructed. The values that significantly pre-
dicted pre STAI-S scores were as follows: STAI-T (p = .003),
HADS-A (p = .026), and HADS-D (p = .025). Race was not
included as variable in the final model because of the large
number of missing values (41% of the study sample), which
would not yield a useful sensitivity analysis in this small,
single site study for confounding.
Discussion
The difference in pre- versus post-STAI scores for the Mu-
sic group, where no such differences were found in the
No-Music group, supports the hypothesis that the inter-
vention was associated with a significant decrease in anx-
iety (measured by STAI). Music has been employed as an
ambient or adjunct tool during medical procedures and
for chronic pain management (Supnet, Crow, Stutzman,
& Olson, 2016). However, there is no consensus in the
literature regarding protocols for listening to music, its ef-
ficacy in certain procedures, and which type of music is
most effective. Our results showed that a 1-hour music in-
tervention had a significant effect on the anxiety levels of
participants. The group that listened to 1 hour of music,
regardless of the genre, reported significantly lower levels
of anxiety than the group that did not listen to music.
There were several novel aspects of this study that
presented new information on the direct impact of music
on anxiety in poststroke patients in inpatient rehabilita-
tion. One unique aspect of this study was that the partic-
ipants in the music intervention group were allowed to
pick between five different music genres, increasing the
chances that the patient would enjoy the experience of
the music. Within a clinical setting, using the type of mu-
sic that the patient prefers to listen to may provide less-
ened anxiety. Furthermore, the statistical analyses
confirmed that the benefits of the music intervention were
not affected by age, gender, and type of stroke (ischemic
vs. hemorrhagic), demonstrating that music intervention
may be helpful for men and women of all ages undergo-
ing inpatient stroke rehabilitation. Interventions aimed
at decreasing anxiety may improve overall mood and en-
hance the environment for better rehabilitation.
Rehabilitation professionals have all felt the pull to
improve and individualize patient care. Alleviation of
poststroke anxiety during rehabilitation is an elusive but
important goal (Campbell Burton et al., 2013). Beyond
pharmacotherapy, several alternative interventions such
as relaxation techniques, cognitive therapy, art therapy,
and massage have recently been explored to reduce post-
stroke anxiety during rehabilitation (Ali, Gammidge, &
Waller, 2014; Bowen, Hazelton, Pollock, & Lincoln, 2013;
Kneebone, Walker-Samuel, Swanston, & Otto, 2014;
Thanakiatpinyo et al., 2014). This study helps build a plat-
form to add an intervention (music) for patients experiencing
anxiety. This may represent a viable nonpharmacologic
option for anxiety reduction, depression reduction, and
mood enhancement.
Limitations
The first limitation of the study was that all participants
were recruited from one university hospital setting and
data were not recorded for the number of days since they
first experienced a stroke; therefore, the data may not be
generalizable to all stroke patients in rehabilitation. Sec-
ond, the study allowed participants to choose their own
music because adequate research identifying the most ef-
fective types of music to decrease anxiety was lacking.
Music was used, in this study, only as a one-time interven-
tion, and additional research is required to determine if
the impact of this intervention is sustained, amplified,
or reduced if the intervention is delivered more often or
for longer sessions. The time of the intervention was
based on convenience and patient preference, and the
timing of therapy sessions was not recorded. Thus, asso-
ciations between pre- and posttherapy anxiety, as well

Copyright © 2017 by the Association of Rehabilitation Nurses. Unauthorized reproduction of this article is prohibited.
Month 2017 • Volume 00 • Number 0
Key Practice Points
• Medications to treat anxiety have side effects that may
hinder the stroke patient’s ability to participate in
rehabilitation.
• Music as an intervention has been shown to decrease
anxiety levels.
•
The patient’s ability to choose the music genre may
maximize this benefit.
• The data suggest that this noninvasive holistic approach
to decreasing anxiety should become part of our practice.
as long-term outcomes of decreasing anxiety, could not
be examined.
The control group was able to choose the noise level
and activity during the 1 hour of no music intervention,
which may have included listening to music. This was
not controlled for as the study design intended to align
as closely as possible with a clinical setting and daily clin-
ical activities. However, subjects who were aware that
they were randomized into the no music group could
have been less inclined to listen to music than they nor-
mally would because of the name of their intervention
arm; therefore, we could see a larger effect size than what
actually exists. Currently, there is no report of an optimal
amount of time of listening to music to decrease anxiety
levels in patients. In this study, we chose to incorporate
music for 1 hour, but there is no scientific evidence favor-
ing a 1 hour period over any other time period. As a re-
sult, the STAI-S posttest was given only 1 hour after the
pretest, and no studies to our knowledge have given suc-
cessive STAI tests in that short of a time frame. Data were
not recorded on patients who withdrew from the study; it
is unknown if there are characteristic differences that
would influence the outcome.
Conclusion
Although this was a small, single-site study, we discov-
ered significant indications that music may lessen anxiety
symptoms in PM&R stroke patients. We found that
symptoms were lessened in the period of time immedi-
ately following the intervention by allowing patients to
listen to the music selection of their choice for 1 hour.
The results of this study have clinical implications for
nurses and clinicians, as playing music is a noninvasive
holistic approach to improve the well-being of patients.
Future studies are needed with a larger patient sample at
multiple hospital locations and multiple postassessment
times throughout the entire period of rehabilitation in or-
der to generalize the preliminary study results. Future
studies of poststroke patients in acute rehabilitation may
Copyright © 2017 by the Association of Rehabilitation Nurses. Unauthorized reproduction of this article is prohibited.
www.rehabnursingjournal.com 5
benefit from examining different music genres and the op-
timal dose (sessions per day and time for each session) for
music used as a therapeutic intervention. Additional re-
search will be required to determine if the benefits of music
as a therapeutic intervention are sustained over time.
Acknowledgments
The University of Texas Southwestern Medical Center Hospi-
tal and the Department of Neurology and Neurotherapeutics
provided financial support. The authors declare no conflict
of interest.
References
Ali, K., Gammidge, T., & Waller, D. (2014). Fight like a ferret:
A novel approach of using art therapy to reduce anxiety in
stroke patients undergoing hospital rehabilitation. Medical
Humanities, 40(1), 56–60. doi:10.1136/medhum-2013-010448.
Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002).
The validity of the Hospital Anxiety and Depression Scale. An
updated literature review. Journal of Psychosomatic Research,
52(2), 69–77.
Bowen, A., Hazelton, C., Pollock, A., & Lincoln, N. B. (2013).
Cognitive rehabilitation for spatial neglect following stroke.
The Cochrane Database of Systematic Reviews, (7), cd003586. doi:
10.1002/14651858.CD003586.pub3
Bradt, J., Magee, W. L., Dileo, C., Wheeler, B. L., & McGilloway, E.
(2010). Music therapy for acquired brain injury. The Cochrane
Database of Systematic Reviews, 7, CD006787. doi:10.1002/
14651858.CD006787.pub2.
Campbell Burton, C. A., Murray, J., Holmes, J., Astin, F.,
Greenwood, D., & Knapp, P. (2013). Frequency of anxiety after
stroke: A systematic review and meta-analysis of observational
studies. International Journal of Stroke, 8(7), 545–559. doi:10.
1111/j.1747-4949.2012.00906.x.
Diagnostic and Statistical Manual of Mental Disorders-5. (2013).
American Psychiatric Association; Arlington, VA.
Dunton, W. R. Jr. (1946). Recreation and music therapy. Occupational
Therapy and Rehabilitation, 25(6), 247–252.
Dwyer Hollender, K. (2014). Screening, diagnosis, and treatment of
post-stroke depression. The Journal of Neuroscience Nursing,
46(3), 135–141. doi:10.1097/jnn.0000000000000047.
Endler, N. S., & Kocovski, N. L. (2001). State and trait anxiety
revisited. Journal of Anxiety Disorders, 15(3), 231–245.
Fioravanti-Bastos, A. C. M., Cheniaux, E., & Landeira-Fernandez, J.
(2011). Development and validation of a short-form version of
the Brazilian state-trait anxiety inventory. Psicologia: Reflexão
e Crítica, 24(3), 485–494.
Forsblom, A., Särkämö, T., Laitinen, S., & Tervaniemi, M. (2010).
The effect of music and audiobook listening on people recovering
from stroke: The patient’s point of view. Music and Medicine,
4(2), 226–228.
Jolly, K., Taylor, R. S., Lip, G. Y., & Stevens, A. (2006). Home-based
cardiac rehabilitation compared with centre-based rehabilitation and
usual care: A systematic review and meta-analysis. International
Journal of Cardiology, 111(3), 343–351. doi:10.1016/j.ijcard.2005.
11.002.
Jun, E. M., Roh, Y. H., & Kim, M. J. (2013). The effect of music-
movement therapy on physical and psychological states of
stroke patients. Journal of Clinical Nursing, 22(1–2), 22–31.
doi:10.1111/j.1365-2702.2012.04243.x.
Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., &
Walters, E. E. (2005). Prevalence, severity, and comorbidity of
12-month DSM-IV disorders in the National Comorbidity
6 Music in Stroke Rehab
Survey Replication. Archives of General Psychiatry, 62(6), 617–627.
doi:10.1001/archpsyc.62.6.617.
Kim, D. S., Park, Y. G., Choi, J. H., Im, S. H., Jung, K. J., Cha, Y. A.,
… Yoon, Y. H. (2011). Effects of music therapy on mood in
stroke patients. Yonsei Medical Journal, 52(6), 977–981. doi:10.
3349/ymj.2011.52.6.977
Kneebone, I., Walker-Samuel, N., Swanston, J., & Otto, E. (2014).
Relaxation training after stroke: Potential to reduce anxiety.
Disability and Rehabilitation, 36(9), 771–774. doi:10.3109/
09638288.2013.808275.
Jones, A. L., Charlesworth, J. F., & Hendra, T. J. (2000). Patient
mood and carer strain during stroke rehabilitation in the
community following early hospital discharge. Disability and
Rehabilitation, 22(11), 490–494. doi:10.1080/096382800413970.
Lipsey, M. W. (1990). Design sensitivity: Statistical power for
experimental research. Newbury Park, CA: Sage Publications.
Lucassen, P. J., Pruessner, J., Sousa, N., Almeida, O. F., Van Dam, A. M.,
Rajkowska, G., … Czéh, B. (2014). Neuropathology of stress. Acta
Neuropathologica, 127(1), 109–135. doi:10.1007/s00401-013-1223-5
Magee, W. L., & Davidson, J. W. (2002). The effect of music
therapy on mood states in neurological patients: A pilot study.
Journal of Music Therapy, 39(1), 20–29.
Masskulpan, P., Riewthong, K., Dajpratham, P., & Kuptniratsaikul,
V. (2008). Anxiety and depressive symptoms after stroke in 9
rehabilitation centers. Journal of the Medical Association of
Thailand = Chotmaihet thangphaet, 91(10), 1595–1602.
National Institutes of Mental Health. (2014). Anxiety disorders.
Retrieved from http://www.nimh.nih.gov/health/topics/anxiety-
disorders/index.shtml
Pacchetti, C., Mancini, F., Aglieri, R., Fundarò, C., Martignoni, E.,
& Nappi, G. (2000). Active music therapy in Parkinson's disease:
An integrative method for motor and emotional rehabilitation.
Psychosomatic Medicine, 62(3), 386–393.
Pedroso, V. S., Vieira, É. L., Brunoni, A. R., Lauterbach, E. C., &
Teixeira, A. L. (2016). Psychopathological evaluation and use
of the Hospital Anxiety and Depression Scale in a sample of
Brazilian patients with post-stroke depression. Archives of Clinical
Psychiatry (São Paulo), 43(6), 147–150.
Peretz, I., & Zatorre, R. J. (2005). Brain organization for music
processing. Annual Review of Psychology, 56, 89–114. doi:10.
1146/annurev.psych.56.091103.070225.
Rouillard, S., De Weerdt, W., De Wit, L., & Jelsma, J. (2012).
Functioning at 6 months post stroke following discharge from
Copyright © 2017 by the Association of Rehabilitation Nurses. Unauthorized reproduction of this article is prohibited.
M. Le Danseur et al.
inpatient rehabilitation. South African Medical Journal = Suid-
Afrikaanse tydskrif vir geneeskunde, 102(6), 545–548.
Sagen, U., Vik, T. G., Moum, T., Mørland, T., Finset, A., &
Dammen, T. (2009). Screening for anxiety and depression after
stroke: Comparison of the hospital anxiety and depression
scale and the Montgomery and Asberg depression rating scale.
Journal of Psychosomatic Research, 67(4), 325–332. doi:10.1016/
j.jpsychores.2009.03.007.
Särkämö, T., & Soto, D. (2012). Music listening after stroke:
Beneficial effects and potential neural mechanisms. Annals of
the New York Academy of Sciences, 1252, 266–281. doi:10.1111/
j.1749-6632.2011.06405.x.
Särkämö, T., Tervaniemi, M., & Huotilainen, M. (2013). Music per-
ception and cognition: Development, neural basis, and rehabilitative
use of music. Wiley Interdisciplinary Reviews. Cognitive Science, 4(4),
441–451. doi:10.1002/wcs.1237.
Schöttke, H., & Giabbiconi, C. M. (2015). Post-stroke depression and
post-stroke anxiety: Prevalence and predictors. International
Psychogeriatrics, 27(11), 1805–1812. doi:10.1017/s1041610215000988.
Supnet, C., Crow, A., Stutzman, S., & Olson, D. (2016). Music as
medicine: The therapeutic potential of music for acute stroke
patients. Critical Care Nurse, 36(2), e1–e7. doi:10.4037/ccn2016413.
Thanakiatpinyo, T., Suwannatrai, S., Suwannatrai, U., Khumkaew,
P., Wiwattamongkol, D., Vannabhum, M., … Kuptniratsaikul,
V. (2014). The efficacy of traditional Thai massage in decreasing
spasticity in elderly stroke patients. Clinical Interventions in
Aging, 9, 1311–1319. doi:10.2147/cia.s66416
Thaut, M. H., Gardiner, J. C., Holmberg, D., Horwitz, J., Kent, L.,
Andrews, G., … McIntosh, G. R. (2009). Neurologic music
therapy improves executive function and emotional adjustment
in traumatic brain injury rehabilitation. Annals of the New York
Academy of Sciences, 1169, 406–416. doi:10.1111/j.1749-
6632.2009.04585.x
Torkia, C., Best, K. L., Miller, W. C., & Eng, J. J. (2016). Balance
confidence: A predictor of perceived physical function, perceived
mobility, and perceived recovery 1 year after inpatient stroke
rehabilitation. Archives of Physical Medicine and Rehabilitation,
97(7), 1064–1071.
Zatorre, R., & McGill, J. (2005). Music, the food of neuroscience?
Nature, 434(7031), 312–315. doi:10.1038/434312a.
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and
depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370.