Targeting Cognition and Behavior Post-Stroke: Combined Emotional Music Stimulation and Virtual Attention Training in a Quasi-Randomized Study

Rosaria De Luca ¹, Federica Impellizzeri ¹, Francesco Corallo ¹

⁰IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.

Brain Sciences +

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November 27, 2025

View abstract on PubMed

Summary

Adding personalized emotional music stimulation (EMS) to virtual reality rehabilitation systems (VRRS) significantly improved cognitive function, mood, and motivation in chronic stroke survivors compared to VRRS alone.

Area Of Science

Neurorehabilitation
Psychology
Cardiology

Background

Emotionally salient music may enhance attention-based rehabilitation.
Concurrent music and virtual reality (VR) programs for chronic stroke are understudied.
Personalized emotional music stimulation (EMS) combined with VR rehabilitation system (VRRS) was evaluated.

Purpose Of The Study

To assess if EMS layered onto VRRS augments cognitive, affective, physiological, and functional outcomes in chronic stroke survivors.
To compare outcomes between VRRS alone and VRRS+EMS interventions.
To investigate correlations between physiological changes and psychological improvements.

Main Methods

A quasi-randomized outpatient trial involving 20 adults post-ischemic stroke.
Intervention groups: VRRS alone (control, n=10) and VRRS+EMS (experimental, n=10).
Both groups underwent 8 weeks of 3x/week VRRS cognitive training; EMS group had additional music sessions. Primary outcomes: cognition and global function; secondary: motivation, depression, anxiety, heart rate.

Main Results

The VRRS+EMS group showed significant improvements across all measured domains: cognition, motivation, depression, anxiety, heart rate, and disability, with large effect sizes.
The control group (VRRS alone) exhibited modest gains in cognition and motivation, and a slight heart rate reduction, but no significant mood or disability changes.
Post-treatment, the music group outperformed controls in cognition, motivation, and disability. Change-score analyses favored the music intervention for all endpoints.

Conclusions

Integrating personalized emotional music into VR attention training yields substantial and clinically meaningful improvements in stroke survivors.
The combined VRRS+EMS approach enhances cognition, mood, motivation, autonomic regulation, and functional independence.
This study demonstrates the synergistic effect of combining auditory emotional stimuli with immersive virtual reality for neurorehabilitation.

Keywords:

attention processes autonomic regulation chronic stroke intrinsic motivation mood symptoms music stimulation neurorehabilitation virtual reality training