Effects of Music Training on Cortical Plasticity: : Cognitive Rehabilitation of Patients with Traumatic Brain Injury

The aim of this thesis was to explore the neuroplastic effects of playing the piano on patients with cognitive impairment following a mild traumatic brain injury (mTBI). It was hypothesised that playing the piano would stimulate neural networks to re-route neural connections and link up cortical circuits that had been functionally inhibited due to minor disruption of brain tissue. The objective of the intervention was to restore the patients’ cognitive processing to pre-injury levels. The study was designed as a pilot study with three experimental groups: (1) 7 patients with cognitive deficits following mTBI two years post-injury (Group 1), (2) 11 healthy subjects (Group 2), and (3) 12 further healthy subjects (Group 3). A between-group design and a longitudinal (pre-post-intervention) within-subject design were applied. Groups 1 and 2 were given eight weeks of piano training. A combination of cognitive and functional neuroimaging (task-based and resting-state fMRI) in addition to neuropsychological tests were performed pre- and post-intervention for all three groups. The results concurrently demonstrated in two independent analyses and fMRI datasets that longitudinal changes in functional connectivity took place within the orbitofrontal cortex (OFC) in the mTBI patient group only, showing increased connectivity between the OFC regions post-intervention involved in executive functions (EF), social cognition and emotional regulation. This finding provides support for the contribution of the OFC as a key mechanism that potentially drives the cognitive benefit of piano training in TBI, and further suggests a network of other connected frontal regions that may be linked to this. The key findings of this study could suggest a causal relationship between musical training and a functional reorganisation of neural networks that promotes enhanced cognitive performance. These results might hold promise as regards adding a novel music-based intervention to the cognitive rehabilitation of mTBI patients