成人卒中康复中的音乐干预：临床应用、拟议机制与实施的叙述性综述

文献信息

中文摘要

背景： 音乐通过治疗师实施的音乐治疗、神经音乐治疗技术、其他结构化音乐干预以及技术辅助系统应用于卒中康复。术语不一致和机制夸大使解读复杂化。
目的： 综合成人卒中康复中音乐干预的临床应用、拟议机制、局限性和实施考虑。
方法： 我们对通过PubMed/MEDLINE、CINAHL和参考文献追溯确定的同行评议英文文献进行了有针对性的叙述性综述。我们优先考虑截至2026年6月的成人卒中系统综述、对照研究、机制调查和实施研究。2010年前的开创性研究和其他神经系统人群的证据仅用于解释机制或空白，并标记为间接证据。我们未进行详尽检索、正式偏倚风险评估或定量合并。
结果： 证据最一致的是用于步态的节奏性听觉刺激和选定的音乐支持的上肢方案。旋律语调治疗可能改善非流利性失语症的训练语句和复述，但向日常交流的迁移尚不确定。聆听和歌唱方案在认知、情绪、参与度和睡眠方面显示出潜力，尽管方案异质性大。卒中后吞咽证据是初步的，血脑屏障效应仍处于临床前阶段。结局可能因卒中分期、表型、认知、听力、合并症、音乐奖赏和偏好、剂量以及提供者专业知识而异。
结论： 音乐康复包括机制知情的辅助手段，而非单一治疗。临床使用应将定义的音乐成分与功能目标联系起来，记录提供者和剂量，纳入偏好和安全筛查，并测量日常迁移。需要更大规模、务实的和机制特异性的试验，并进行预先指定的调节因素分析。

英文摘要

BACKGROUND: Music is used in stroke rehabilitation through therapist-delivered music therapy, neurologic music therapy techniques, other structured music-based interventions, and technology-assisted systems. Inconsistent terminology and overstated mechanisms complicate interpretation.
OBJECTIVES: To synthesize the clinical applications, proposed mechanisms, limitations, and implementation considerations of music-based interventions in adult stroke rehabilitation.
METHODS: We conducted a targeted narrative review of peer-reviewed English-language literature identified through PubMed/MEDLINE, CINAHL, and reference chaining. We prioritized adult stroke systematic reviews, controlled studies, mechanistic investigations, and implementation research through June 2026. Seminal pre-2010 studies and evidence from other neurological populations were used only to explain mechanisms or gaps and are labeled as indirect. We did not undertake exhaustive retrieval, formal risk-of-bias assessment, or quantitative pooling.
RESULTS: Evidence is most consistent for rhythmic auditory stimulation for gait and selected music-supported upper-limb programs. Melodic intonation therapy may improve trained utterances and repetition in nonfluent aphasia, but transfer to everyday communication is uncertain. Listening and singing programs show potential for cognition, mood, engagement, and sleep, although protocols are heterogeneous. Post-stroke swallowing evidence is preliminary, and blood-brain barrier effects remain preclinical. Outcomes may vary with stroke phase, phenotype, cognition, hearing, comorbidity, musical reward and preference, dose, and provider expertise.
CONCLUSIONS: Music-based rehabilitation comprises mechanism-informed adjuncts rather than one treatment. Clinical use should link a defined musical ingredient to a functional target, document provider and dose, incorporate preference and safety screening, and measure everyday transfer. Larger pragmatic and mechanism-specific trials with prespecified moderator analyses are needed.