Music-4-MS to Improve Cognition in People Living With Multiple Sclerosis: a Feasibility Study

Multiple sclerosis (MS) affects more than 2.8 million people worldwide; its prevalencehas increased in every region and nearly doubled in the U.S. since 2013. In manycountries, MS is the main cause of nontraumatic disability in young adults. The course ofMS is unpredictable, and common symptoms in persons with MS include impaired day‐to‐dayactivities such as walking, cognitive impairment, vision problems, paresthesia in theextremities, trouble sleeping, and chronic pain. Physical difficulties associated with MScontribute to secondary symptoms of depression, anxiety, and fatigue.Cognitive impairment affects up to 70% of people with MS, and the incidence ofearly‐onset dementia is 7 times higher than it is in adults without MS. Impairments likeslowed processing, poor memory, and learning difficulties impact quality of life, social,and occupational functioning. Working memory deficits are associated with reducedconnectivity between brain regions, especially the frontal and parietal lobes, duringmemory encoding, maintenance, and recall. Cognitive‐based rehabilitation, however, canimprove memory and learning as well as symptoms of depression and anxiety, which mayreinforce cognition. Traditional approaches to cognitive rehabilitation use restorative(drill‐and‐practice) and compensatory (management) strategies. Yet most cognitiveinterventions for persons with MS are predominantly visual or speech‐focused, whicheliminates the possibility of stimulating multiple senses.Music consists of complex, multidomain stimuli that engage a large bilateral network oftemporal, frontal, parietal, cerebellar, limbic, and paralimbic brain areas associatedwith multiple parallel cognitive, verbal, motor, and emotional processes. Playing amusical instrument involves intricate coordination and communication between multiplesensory systems (visual, auditory, tactile) and motor functions. As individuals read andtranslate musical notes into physical actions, they simultaneously receive feedback fromtheir auditory system. The ability to engage these systems and coordinate multipledomains may induce new cortical pathways fostering neuroplasticity. This rewiring in thebrain created by repeated musical practice can create alternate pathways and structuresto help those with MS compensate for deficits caused by demyelinating disease. Musicinterventions for other neurodegenerative conditions have been studied, but very few havebeen implemented for those with MS. A recent systematic review evaluated the impact ofactive (singing, dancing, instrument playing) and passive (listening) music interventionson psychosocial and neurological outcomes in individuals with MS. Of the 15 studiesreviewed, none examined a music learning intervention and the impact on cognitiveimpairment‐a critical gap to be addressed.Our multi‐disciplinary team has conducted a proof‐of‐concept study to evaluate aninnovative ukulele training intervention, Music‐4‐MS, to address the gap in cognitiverehabilitation for persons with MS. Based on the feedback from participants in thatstudy, our team of experts in human and music learning, music therapy, neuroscience,nursing, and cognitive rehabilitation optimized Music‐4‐MS. The primary goal of thepresent study is to evaluate the feasibility of the optimized Music‐4‐MS as a manualizedeHealth intervention. Guided by the therapeutic music capacities model, Music‐4‐MS willsupport cognitive, psychosocial, and functional well‐being. In a prospective, randomized(1:1) trial with 64 individuals with MS recruited nationwide, the Music‐4‐MS group willbe compared with an active control group. This will be a step toward a larger clinicaltrial to test the intervention's efficacy in improving MS health outcomes. The specificaims are as follows:Aim 1: To determine the feasibility and acceptability of delivering the optimizedMusic‐4‐MS eHealth intervention to individuals with MS over 12 weeks.Aim 2: To evaluate the preliminary effect of the optimized Music‐4‐MS on cognitive(objective performance, subjective function), psychosocial (anxiety, depression, socialfunction), and functional (physical function, fatigue, hand dexterity) well‐being overtime in the Music‐4‐MS versus the active control group.Aim 3: To explore participants' perceptions of the motivation, engagement, connection,and usefulness of Music‐4‐MS in their daily lives.