The effect of music therapy on rehabilitation of children with cerebral palsy: a meta-analysis

Yu-Hui Ma, Li-Na Zhang, Qian Cui, Xiao-Ming Jin, Guo-Wei Zhang, *

The effect of music therapy on rehabilitation of children with cerebral palsy: a meta-analysis

Yu-Hui Ma1, Li-Na Zhang1, Qian Cui1, Xiao-Ming Jin1, Guo-Wei Zhang1, *

1College of Chinese Medicine, Hebei University, Baoding, Hebei Province, China.

: To evaluate the clinical efficacy of music therapy in the treatment of children with cerebral palsy by systematic review and meta-analysis.: A comprehensive search of China Knowledge Network, Wan fang, VIP database and foreign databases PubMed and Cochrane Library was conducted from the setup of database to March 2019. After reading and screening them carefully, 14 qualified literates were got. Then extracted relevant data, and evaluated the quality and risk bias with Revman5.3.3 software.: There is no significant difference between music therapy in improving clinostatism and the ability of rolling over (> 0.05). However, music therapy has significant difference in improving sitting, running, and jumping movements, and it can also relieve muscle spasm, improve muscle tension and stabilize children’s emotions in the course of treatment and thevalues of which were all less than 0.05.: The music therapy has a certain effect for the treatment of pediatric cerebral palsy, especially in improving children’s gross and fine motor abilities, which has a certain clinical guiding significance for rehabilitation of children with cerebral palsy.

Pediatric cerebral palsy, Music therapy, Meta-analysis, Clinical efficacy

The music therapy has a certain effect for the treatment of pediatric cerebral palsy, especially in improving children’s gross and fine motor abilities, which has a certain clinical guiding significance for rehabilitation of children with cerebral palsy.

Introduction

Pediatric cerebral palsy, commonly known as cerebral palsy, refers to the immature stage of brain development within one month after birth, due to non-progressive brain injury syndrome [1], a common central nervous system syndrome in childhood, with lesions in the brain, involving the limbs, often accompanied by mental retardation, epilepsy, behavioral abnormalities, mental disorders, and visual, auditory, and speech disorders [2]. The incidence of cerebral palsy in children is increasing year by year [3], which brings a heavy burden to families and society. At present, there is no effective treatment, which is mainly conventional therapy consisting of a combination of medication, physical manipulation and exercise. However, due to the long process of rehabilitation therapy, the content is single and boring, children are prone to irritability, and cannot actively cooperate with treatment to reduce clinical efficacy [4-5].

Based on the theory and method of psychotherapy, music therapy uses the unique physiological and psychological effects of music to enable children to experience music through various specially designed musical behaviors [6]. As a new emerging edge science, music therapy is gradually being included in the rehabilitation training process, but it has not been widely popularized and valued. Therefore, this study collects randomized music therapy from home and abroad used to treat pediatric cerebral palsy. We use Cochrane evaluation method to carry out Meta-analysis, and explore the effect of music therapy on rehabilitation training of pediatric cerebral palsy from many aspects, in order to provide guidance and ideas for clinical rehabilitation training of children with cerebral palsy and other neurological impairment diseases.

Materials and methods

Literature collection

China Knowledge Network (CNKI), VIP database (VIP), Wan fang database and Cochrane Library, PubMed databases were searched from the setup of database to 2019. Chinese search words included “pediatric cerebral palsy" and “music therapy". English retrieval words included “pediatric cerebral palsy" and "music therapy".

Inclusion and exclusion criteria

Inclusion criteria: Randomized controlled trials (RTC); In addition to routine rehabilitation training or treatment, the experimental group received music therapy; the control group patients only received the same routine rehabilitation training or treatment as the experimental group; meet the assessment criteria for children with cerebral palsy.

Exclusion criteria

The study without controlled trials; animal experimental studies, review, and case reports; literature that did not describe the time of intervention; repeated publications and data; literature with missing or unclear data; The sample is selective (e.g., containing only female or male patients).

Data extraction and literature quality evaluation

All articles were read by two investigators who independently extracted data from the articles. The following information was sought from each article: author identification, year of publication, the number of researchers, course of treatment, sample size, and results. The quality of the study was evaluated in accordance with the RCT quality evaluation standard [7] of the Jadad scale, which include random method, assign concealment, blind method, explanation for withdrawal or loss of follow-up: (1) GMFM score; (2) FMFM score; (3) Ashworth score; (4) Comprehensive functional assessment of children with cerebral palsy; (5) Mypas, FACES ,CHEOPS and other evaluation criteria; (6) CSS score; (7) crying decibel; (8) matching rate; (9) efficiency.

Statistical processing

Meta-analysis of the data was performed with Revman 5.3 software. The odds ratio (OR) was calculated along with its 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) was calculated for continuous outcomes. Statistical heterogeneity between studies was assessed by means of chi square and the extent of inconsistency was assessed by the I2statistic. when I2< 50%, it can be considered no heterogeneity in treatment effect between studies, the fixed effects model was appropriate. If I2> 50%, otherwise the random effect model would be more conservative. The funnel plot was drawn using RevMan 5.3 to analyze the publication bias.

Results

Basic characteristics of the included research literature

A total of 251 related articles were initially retrieved, and 19 articles were selected based on the inclusion and exclusion criteria. Further reading of the abstract and the full text removed 5 articles, and finally 14 clinical studies [8-22] were included in the meta-analysis. The basic characteristics of the included research literature are shown in Table 1.

Table 1 Basic information of the included research literature

Note: A: music therapy plus conventional therapy; B: conventional therapy

①GMFM score; ②FMFM score; ③ Ashworth score; ④ Comprehensive functional assessment of children with cerebral palsy; ⑤ Mypas, FACES ,CHEOPS and other evaluation criteria; ⑥ CSS score; ⑦Crying decibel; ⑧ matching rate; ⑨ efficiency

Table 2 Methodological quality evaluation of the included research literature

Quality evaluation of included research literature

A total of 14 RCT articles were included in the study, with 581 children in the experimental group and 579 in the control group. The quality of 14 RCTs was evaluated according to the Jadad scale evaluation criteria. The highest score was 3 points, the lowest score was 0 points, and the literature quality was low. The basic information and quality evaluation results of each document are shown in Table 2.

Meta-analysis Results

Comparison of GMFM (Gross motor function measure) scores GMFM (Gross motor function measure) was compiled and published by Russellto measure the changes of gross motor function in cerebral palsy patients, which is the most widely used gross motor function assessment scale for cerebral palsy. Four studies had reported GMFM scores, with 172 in the experimental group and 172 in the control group. Among which, 2 studies refer to the GMFM scoring standard [8, 12] and compare the effects according to five assessing items which are the decubitus position & turning, the sitting position, the crawling & the squatting, standing & walking & jumping.

For decubitus position & turning over, compared with routine care only, the combination had no significant benefit in improving decubitus position and turning over functions (WMD = 3.73, 95%CI (-0.14, 7.61),= 0.06). I2= 13%, fixed model was adopted (Figure 4). But the combination had significant benefit in improving sitting position functions (WMD = 4.66, 95% CI (3.01,6.31),< 0.001), I2= 0%, fixed model was adopted (Figure 5). The combination also had significant benefit in improving crawling and kneeling position (WMD = 4.52, 95%CI (3.20, 5.83),< 0.001), I2= 20%, fixed model was adopted (Figure 6).

The benefit of the combination on standing position (Figure 7) and walking & running & jumping functions (Figure 8) are also evaluated, which showed a great improvement in both (WMD = 3.22, 95%CI (2.01, 4.44),< 0.001, WMD = 4.40, 95% CI (2.83, 5.98),< 0.001 for both). But the researches were heterogenous, the I2were 75% and 90%, random effect models were used.

Figure 4 Meta-analysis of the Decubitus position and turning over data

Figure 5 Meta-analysis of Sitting position data

Figure 6 Meta-analysis of Crawling and Kneeling position data

Figure 7 Meta-analysis of Standing position data

Figure 8 Meta-analysis of Walking & Running &Jumping data

Two other studies [9, 21] used the total percentage value of GMFM after treatment as a measure. The heterogeneity analysis showed that there was no statistical heterogeneity (= 0.44, I2= 0%), a fixed model was used. Meta-analysis showed no significant difference in the total percentage value of GMFM between the experimental group and the control group [WMD = 6.35, 95% CI (1.05, 11.65),= 0.02], as shown in Figure 9.

Comprehensive Functional Assessment for Children with Cerebral Palsy Comprehensive Functional Assessment (CFA) is used for evaluating cognitive, speech, motor, self-care and social adaptation in children with cerebral palsy. There were 3 studies [11, 12, 14] involving CFA for Children with cerebral palsy [23]. Tang Xiumei [12] and Li Min [14] recorded the results in mean ± variance form, and in Haibo [11], the efficiency was used. Li Min and Tang Xiumei's research showed statistically heterogeneous (< 0.001, I2= 96%), a random effects model was used. The effect of the experimental group was statistically significant [WMD = 4.74, 95%CI (3.79, 5.69),< 0.001], indicating that the conventional therapy could improve the condition of children with cerebral palsy (Figure 10).

Effective score Three studies [14-16] reported effective scores, with 127 in the experimental group and 127 in the control group. there was no heterogeneity between the studies (= 0.27, I2= 23%), and meta-analysis was performed using a fixed effect model. The results showed that the scores in experimental group was better than that of the control group, and the difference was statistically significant [OR = 2.72, 95% CI (1.35, 5.50),= 0.005], as shown in Figure 11, indicating that music therapy-assisted conventional therapy can effectively improve the ability of children with cerebral palsy.

Figure 9 Meta-analysis of the total percentage value of GMFM

Figure 10 Comprehensive Functional Assessment for Children with Cerebral Palsy

Figure 11 Meta-analysis of efficiency score data

Discussion

Cerebral palsy is a common central nervous system syndrome in the clinic [24]. The main pathological mechanism is hypoxia in the brain, which leads to some complications. The children mainly have language disorders, mental retardation, dyskinesia, and music. Music has physiological functions such as regulating breathing, circulation,and also shows therapeutic effects on mental diseases, vascular diseases, brain function improvement, chronic diseases,[25]. For the functions of regulating and improving the brain, muscles and emotions, music therapy was used in the rehabilitation training of children with cerebral palsy, as it is beneficial to improve the curative effect and improve the dysfunction of all aspects of children.

In this study, meta-analysis with 14 randomized controlled trials was used to evaluate its effectiveness from multiple perspectives. Musical therapy could effectively improve the gross motor function and other obstacles in children, as music therapy has a significant effect on improving the gross and fine motor functions of children with cerebral palsy, such as crawling, kneeling, standing and walking. Music therapy can also effectively alleviate the tendon of the child and improve the muscle tension of the child. In addition, the music therapy has a certain calming effects on the child's mood, which helps the child to better cooperate with the rehabilitation training.

In foreign studies, researchers found that with the input of music information, the structure of motor nerve, emotion and memory in the brain will change accordingly. In addition, scientific music training has a certain positive impact on heart rate, blood pressure, respiratory frequency and other aspects of the human body, and the impact is mainly manifested in emotion [26]. Some scholars think that owing to the characteristics of music experience and music structure, the people who feels music may produce an expectation, and the way and degree of expectation and expectation will affect the emotional response, which may be activated by music from the brain stem to the amygdala, or from the medial geniculate nucleus of the thalamus to the auditory synaptic cortex and then back to the amygdala. Cognitive theory holds that people do not necessarily need to experience music emotions through personal experience; emotional theory holds that the induction of music makes people feel the emotions in it; and aesthetic Trinity holds that people's musical experience is the result of individual immersion in music and the integration of music [27].

This study also has certain limitations. The number of documents included in the literature is mostly Chinese literature, and the quality is generally low. There is no specific detailed explanation on the allocation of hidden and blind methods. The above factors have the representativeness of the literature research and the intensity of the evidence. Certain influences need to be further improved. We look forward to extensive research in music therapy in the future, so that it can be widely used in clinical practice, bringing good news to patients with social, cerebral palsy and other disorders with neurological and motor functions.

1. Wang MJ, Zhou B, Yang DM. Therapeutic effect of scalp acupuncture combined with body acupuncture and acupoint injection on 128 children with cerebral palsy. Liaoning J Tradit Chin Med 2007, 34: 1144-1145.

2. Tina L. Samuelsa A, Justin YN, Pawjai Khampanga,. Association of microRNA 146 with middle ear hyperplasia in pediatric otitis media. International J Pediatric Otorhinolaryngology 2016, 88: 104-108.

3. Wang F, Wang MJ, Ye XF,. Clinical study on the improvement of intelligence in children with cerebral palsy by two-point and five-needle method. Guangming Chin Med 2017, 32: 1012-1013.

4. Yao ML, Zhao YS, Zhu XM,. Analysis of the effect of digital auditory integration training on children's psychological behavior problems. Chin Maternal Child Health Care 2006: 2964-2965.

5. Wu CH, Zou WY, Wu H,Effect of sensory integration training combined with music therapy on rehabilitation of cerebral palsy in children. Nursing Rehabilitation 2012, 11: 771-772.

6. Dong XL, Sun WM, Yuan YF,Receptive music therapy to improve the depression of the elderly in the community. Chin J Gerontology 2017, 37: 1752-1753.

7. Chen L, Lan LP, Chen H,. Effects of music therapy on cognitive function in patients with Alzheimer's disease. Sichuan Mental Health 2012, 25: 234-235.

8. Zu J, Shi CX. Observation on the application effect of music therapy combined with rehabilitation training in promoting functional rehabilitation of children with cerebral palsy. Zhongkangkang Med 2018, 30: 96-97.

9. Yi X. On the effect of music therapy on rehabilitation training of children with cerebral palsy. Health frontier 2018, 27: 8.

10. Xi Jing. Clinical application of traditional Chinese medicine five-line somatosensory music therapy for children with cerebral palsy. Shenzhen J Integr Tradit Chin Western Med 2018, 28: 42-44.

11. Yu HB, Liu YF, Wu LX. Clinical observation of 30 cases of cerebral palsy treated with acupuncture combined with music therapy. J Tradit Chin Med 2008, 49: 1093-1095, 1111.

12. Tang XM, Zhong T. Observation on the effect of sensory integration training combined with music therapy on rehabilitation of cerebral palsy in children. Modern Diagnosis Treatment 2013, 24: 2385, 2389.

13. Li SZ, Yu HB, Liu YF. Effects of music therapy on anxiety and pain in acupuncture treatment of children with cerebral palsy. International J Nursing 2008, 27: 1147-1150.

14. Li Min. Effects of music therapy on behavior and mood of children with cerebral palsy. China Health Nutrition 2018, 28: 127.

15. Huang QJ. Evaluation of the efficacy of traditional Chinese medicine five elements of music therapy in improving the sputum of children with cerebral palsy. Pediatric Professional Committee of China Association of Integrative Medicine. Compilation of the 20th National Conference of Pediatric Integrative Medicine. Pediatric Professional Committee of Western Medicine Association: China Association of Integrative Medicine 2016: 1.

16. Zhang JL, Cheng LH, Yan YJ,Observation on the therapeutic effect of head and body acupuncture plus moxibustion on limb function of children with cerebral palsy. Practical Clinical J Integr Tradit Chin Western Med 2013, 13: 41-42.

17. Deng Y, Zhang Y, Zeng L. Effects of music therapy on anxiety and pain in acupuncture treatment of children with cerebral palsy. Chin Foreign Health Digest 2010, 07: 16-18.

18. Bai QY, Zhang H. Application of music in fumigation treatment of children with spastic cerebral palsy. Guangming Chin Med 2016, 31: 2148-2149.

19. Zhang Y, Yang HJ, Wu LJ,The role of music therapy in the rehabilitation of children with cerebral palsy. Shaanxi Med J 2013, 42: 1517-1919.

20. Li YX, Jin BX, Yan XT,. Observation of nervous therapy in relieving moxibustion treatment in children with cerebral palsy. J Pediatrics Tradit Chin Med 2013, 9: 34-36.

21. Wu J, Yan YY, Wang HY,Clinical observation of interactive scalp combined with music therapy for children with cerebral palsy. World Chin Med 2016: 1755-1756.

22. Fang SP. Therapeutic effect of music therapy on children with spastic cerebral palsy. Primary Med Forum 2017, 21: 1069-1070.

23. Wang Hui. Research on present situation and future of the cerebral palsy child. Chin J Special Education 2004, 44: 86-91.

24. Hui WK. Cardiopulmonary training programmed for adolescents with cerebral palsy: a pilot study. Hong Kong Physiotherapy J 2015, 65: 33.

25. Wang W, Jiang YD, Jiang Y,. Progress in the treatment of migraine by Chinese medicine non-drug therapy. Guangming Chin Med 2018, 33: 2936-2938.

26. Lisa Summer. Considering the future of music therapy. Arts Psychotherapy 1997, 56: 24.

27. Agell I. Musical management of Parkinson's disease. Hospital Med 2002, 63: 54.

28. Yang YX, Quan YW, Yang YF. Philosoghical thinking on chinese five elements of music therapy. China J Tradit Chin Med Pharmacy 2015, 30: 2759-2762.

29. Sarkamo T. Music for the ageing brain: cognitive, emotional, social, and neural benefits of musical leisure activities in stroke and dementia. Dementia 2017, 17:670-685.

30. Ganlinska E. Music therapy in neurological rehabilitation settings. Psychiatr 2015, 49: 835-846.

25 March 2019,

16 July 2019.

Guo-Wei Zhang, College of Chinese Medicine, Hebei University, Baoding, Hebei Province, 071000, China. Email: xxzgw@126.com

The authors declare that there is no conflict of interests regarding the publication of this paper.

10.12032/TMRIM201903014

Mu YH, Zhang LN, Cui Q,The effect of music therapy on rehabilitation of children with cerebral palsy: a meta-analysis. TMR Integrative Medicine 2019, 3: e19014.

Chang Liu