Journal of Music Therapy, 62(1), 2025, thae017

https://doi.org/10.1093/jmt/thae017
© The Author(s) 2024. Published by Oxford University Press on behalf of American Music Therapy Association.
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Received December 11, 2023; revisions received May 20, 2024; accepted June 11, 2024

Integrative Review of Music and Music

Therapy Interventions on Functional
Outcomes in Children with Acquired

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Brain Injury
James Burns1,2, , Hannah Healy1,3, , Rebecca O’Connor4,
and Hilary Moss1,
1
Health Research Institute, University of Limerick, Limerick, Ireland
2
Children’s Health Ireland at Temple Street, Dublin, Ireland
3
Irish Prison Service, Ireland
4
National Rehabilitation Hospital, Dublin, Ireland

Deciding Editor: Kimberly Sena Moore

Associate Editor: Stine Lindahl Jacobsen

Abstract
Acquired brain injury (ABI) can result in a multitude of impairments to
physical, cognitive, communicative, psychological, and psychosocial
functioning. Music interventions are emerging as a valuable form of
intervention in the rehabilitation of children with ABI, stimulating brain
functions involved in movement, cognition, speech, emotions, and sen-
sory perceptions. To date, the literature detailing the impact of music and
music therapy interventions on functional outcomes in children with ABI
has not been reviewed systematically. To address this, Whittemore and
Knafl’s five-stage integrative review framework was employed, which in-
cludes (a) problem identification, (b) literature search, (c) data evaluation,
(d) data analysis and synthesis, and (e) presentation of the findings. A
total of 388 articles were retrieved, and 8 studies met the inclusion cri-
teria. Analysis and synthesis resulted in 3 overarching themes: outcomes
of using music therapy in pediatric ABI, music therapy as a motivator in
pediatric ABI rehabilitation, and collaboration. The review highlights the
pivotal role of music as a motivational catalyst that promotes adherence
to rehabilitative intervention. Nevertheless, it underscores a significant

Author Note
Conflicts of interest: None declared.
Correspondence concerning this article should be addressed to James Burns,
Irish World Academy of Music and Dance, University of Limerick, Limerick V94
DK18, Ireland. Email: [email protected]
2 Integrative Review of Music and Music Therapy Interventions

gap in empirical research within the field, emphasizing the necessity for
larger, more rigorous studies.
Keywords: music, music therapy, integrative review, pediatric, acquired
brain injury

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Background
Acquired brain injuries (ABI) are a leading cause of death and
disability worldwide (Dewan et al., 2016). In the United States, pedi-
atric ABI results in approximately 600,000 emergency department
visits and 60,000 hospitalizations annually (Lindsay et al., 2023).
These children encounter a complex sequela of chronic neuro-
psychological, behavioral, and psychosocial impacts (Beauchamp &
Anderson, 2013; Dewan et al., 2016). When ABI occurs during child-
hood, its consequences may not be immediately apparent in the
acute or post-acute phase but may only emerge as the child moves
through the developmental trajectory (DePompei & Blosser, 2019;
Schrieff-Elson et al., 2017). This gradual emergence often leads to
an underestimation of the overall long-term impact of pediatric ABI
(Hayes et al., 2017; Jenkin et al., 2022). The consequences and diffi-
culties associated with ABI are unique for each child, manifesting in
a manner that is specific to their individual growth and development.
In the initial months following the onset of an ABI, the timely
provision of early rehabilitation services by an interdisciplinary
team is paramount. These services play a crucial role in ad-
dressing the intricate and multidimensional consequences of
ABI (Knight et al., 2019; Reuter-Rice et al., 2018). Rehabilitation
strives to optimize functionality and foster active engagement
through an interdisciplinary approach to care tailored to each in-
dividual (Wade, 2020). It aims at enabling individuals to achieve
and sustain optimal levels of physical, sensory, intellectual, and
social functioning (Gordon & di Maggio, 2012). After the acute
phase, children and young people with moderate-to-severe ABIs
are often admitted to inpatient rehabilitation programs for inten-
sive therapies to regain their functional abilities with the goal of
returning to their home and community (Bedell, 2008; Gmelig
Meyling et al., 2022). Early and intensive intervention is critical
to support people who have had an ABI and is often associated
Journal of Music Therapy, 62(1), 2025, 1–32 3

with better functional outcomes (León-Carrión et al., 2013; Lind

Irgens et al., 2016).
Music has been used in rehabilitation to stimulate brain func-
tions involved in movement, cognition, speech, emotions, and sen-
sory perceptions (Magee et al., 2017). Research demonstrates that

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music promotes neuroplasticity, strengthening the brain’s ability to
reorganize itself through the formation of new neural connections
between healthy and damaged brain centers (Baker & Roth, 2004;
Magee & Baker, 2009). This process facilitates the restoration of com-
promised functionality and the cultivation of compensatory abilities.
While music-based interventions are traditionally led by a trained
music therapist, other healthcare professionals can also utilize music
to improve, restore, or maintain health, functioning, and wellbeing
(Moss, 2016). For instance, music listening has been employed by
healthcare professionals in rehabilitation settings to bolster cogni-
tive recovery and improve mood (Särkämö et al., 2008).
In comparison to broader music-based interventions, music
therapy, as defined by the American Music Therapy Association,
entails “the clinical and evidence-based use of music interven-
tions to accomplish individualized goals within a therapeutic re-
lationship by a credentialed professional who has completed an
approved music therapy program” (2005). Magee and Baker
(2009) provide an overview of the main principles underpinning
the application of music therapy in the rehabilitation of individ-
uals with ABI, underscoring the intrinsic capacity of all human
beings to appreciate and respond to music. Moreover, music pos-
sesses a motivational quality that can be utilized therapeutically
to maintain engagement with the rehabilitation process (Burns &
O’Connor, 2023; Kennelly, 2006; Tamplin, 2015). Magee (2020)
advocates for the use of music therapy within the interdiscip-
linary neurorehabilitation team, stating that music provides a fa-
miliar salient stimulus that facilitates cortical changes in the brain
to promote recovery. Despite the rapidly accumulating evidence
showcasing the positive outcomes of music therapy intervention
for adults with ABI (Magee et al., 2017), the expansion of music
therapy practices in pediatric rehabilitation is progressing at a com-
paratively slower rate (Burns & O’Connor, 2023; Kennelly, 2013).
To date, the literature detailing the impact of music and music
therapy interventions on functional outcomes in children with ABI
has not been reviewed systematically. The aim of this study was to
4 Integrative Review of Music and Music Therapy Interventions

conduct an in-depth investigation into the current research sur-

rounding this area. This review sought to identify, evaluate, synthe-
size, and discuss the findings of existing studies and endeavored to
illuminate the diverse data sources and unrestricted study designs
in order to shed light on the current state of the field and identify

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avenues for future research.

Methods
The research team was comprised of music therapy clinician-
researchers with expertise in pediatrics, rehabilitation, and literature
review methodologies. An initial exploration of the literature revealed
a limited number of studies with various methodological designs
and philosophical approaches. This informed the choice to employ
Whittemore and Knafl’s (2005) integrative review framework. This
five-stage integrative review is distinct from other systemic review types
as it is specifically designed to accommodate for qualitative, quanti-
tative, and mixed methods research. Toronto (2020) states that an
­integrative review “enables the reviewer the ability to provide a more
holistic understanding of a specific phenomenon” (p. 4). Oermann
and Knafl (2021) and Hopia et al. (2016) echo this, stating that as
integrative reviews allow for the inclusion of multiple sources of infor-
mation, they can lead to a better understanding of complex ­concepts.
As this represents the inaugural comprehensive review of the litera-
ture concerning music and music therapy interventions targeting
functional outcomes in children with ABI, the integrative review
framework serves as an invaluable tool for capturing a diverse array
of sources. The methodological flexibility enables a thorough explor-
ation into the multifaceted nature of the subject matter.
However, the integrative review method, while promising, poses
certain complexities that warrant consideration. Its execution is
hindered by limited guidance on conducting such reviews, and
navigating the diverse methodologies involved presents inherent
challenges, particularly in terms of analysis, synthesis, and drawing
conclusions (Toronto, 2020; Whittemore & Knafl, 2005). In line
with other integrative reviews within the music and health land-
scape, transparency and reflexivity will be prioritized throughout
the review process to address these challenges, mitigating potential
biases, and ensuring the robustness of findings (Lee et al., 2022;
McCaffrey et al., 2020; Schmid et al., 2018). The five stages of
Journal of Music Therapy, 62(1), 2025, 1–32 5

Whittemore and Knafl’s (2005) framework are: (1) problem identi-

fication, (2) literature search, (3) data evaluation, (4) data analysis,
and (5) presentation of findings.

Problem Identification

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The initial stage of this integrative review involved clearly
identifying the purpose of the review and the problem that it
addressed (Whittemore & Knafl, 2005). A PEO (Population,
Exposure, Outcome(s)) framework was employed which identi-
fied the “population” as children, aged 0–18, with an ABI, the “ex-
posure” as engaging in a music or music therapy intervention, and
the “outcome” as the resulting effects of these interventions.
Studies were required to meet the following inclusion criteria: (a)
peer-reviewed, (b) written in the English language, and (c) docu-
ments the outcomes arising from the participation of children aged
0–18 with ABIs in music or music therapy interventions. Studies
were excluded if they were (a) not empirical research studies, (b)
background articles, discussion or opinion pieces, or reviews, or (c)
studies where it was not possible to extract data specific to children
with ABI. There was no restriction placed on the year of publication.

Literature Search
Three comprehensive search strategies were implemented to iden-
tify the maximum number of eligible primary sources (Conn et al.,
2003; Jadad et al., 1998; Lee et al., 2022; Whittemore & Knafl, 2005).
(1) Relevant electronic databases were identified, and a search
strategy was developed by the research team. This process
involved the rigorous testing of search terms through a
preliminary search of the literature. The search strategy
implemented in Magee et al.’s (2017) Cochrane review
on music interventions for ABI also informed the devel-
opment of the search strategy. The following electronic
databases were searched 10–11 August 2023: Cochrane
Library; EBSCOhost1; Ovid2; PubMed; Sage; Science
1
EBSCOhost is a search engine that provides access to 21 electronic data-
bases, including Academic Search Complete, AMED—The Allied and
Complementary Medicine Database, APA PsycINFO, and CINAHL Complete.
Using EBSCOhost, the 21 electronic databases were searched simultaneously.
2
Similarly to EBSCOhost, Ovid is a search engine that provides access to 11 elec-
tronic databases, including Medline/Ovid.
6 Integrative Review of Music and Music Therapy Interventions

Direct; SCOPUS; and Web of Science. The search strat-

egies are included in Supplementary Material A. The
search was limited to studies in the English language. The
references were imported to Covidence3 where they were
deduplicated and made available to the research team for

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review. The first and second author independently com-
pleted the initial title and abstract screening, looking for
relevance based on the inclusion and exclusion criteria es-
tablished in the problem identification stage. Any uncer-
tainties during the screening led to texts being advanced to
the next stage of full-text screening for further evaluation.
The first two authors then independently reviewed the full
texts of the included studies. A reason for exclusion was
required at this stage. A meeting with the research team
was held to mediate and resolve any disagreements, ul-
timately researching a consensus by thoroughly discussing
each point of contention. Subsequently, a final decision
was made on which studies to include in the review.
(2) A hand search of non-Institute for Scientific Information
journals relating to music therapy and/or music and
health including Approaches: An Interdisciplinary Journal
of Music Therapy, Music and Medicine, and Voices: A World
Forum for Music Therapy was conducted on 6 September
2023. Potential studies to be included in the review were
identified, shared with the research team, and reviewed at
a research meeting, where the final decision was made.
(3) An ancestry search of eligible studies was conducted.
This process involved examining the reference lists of
studies identified via search strategies one and two to un-
cover any additional relevant studies. Similarly, potential
studies for inclusion were identified, sourced, shared with
the research team, and reviewed at a research meeting,
where the final decision was made. The ancestry search
process was repeated iteratively until no new studies were
identified.

Covidence software was used for manging and streamlining the review process. It
3

facilitated easy and efficient collaboration between members of the research

team.
Journal of Music Therapy, 62(1), 2025, 1–32 7

In any instance where a potentially relevant full text could not

be located, the author was contacted. The results of the search
strategy are presented in Figure 1.

Data Evaluation

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The quality and methodological rigor of each study were critic-
ally evaluated using the Mixed Methods Appraisal Tool (MMAT)
Version 2018. Designed to serve as a checklist, the MMAT facili-
tates the concurrent appraisal and/or description of studies
­incorporated in systematic mixed studies reviews, such as an inte-
grative review. This capability stems from its capacity to accommo-
date a variety of methodological designs (Hong et al., 2018).
While the MMAT does not prescribe specific cutoff values to
differentiate between high- and low-quality studies, it enables a
structured assessment of methodological strengths and weaknesses

Studies identified
through search of Duplicates removed
electronic databases (n = 179)
(n = 388)

Studies screened by
title Studies excluded
and abstract (n = 155)
(n = 209)

Studies excluded
Studies assessed for (n = 47)
eligibility via full
text review • Wrong patient
(n = 54) population or focus
(n = 24)
• Background articles,
discussions or opinion
pieces, or reviews (n =
Included studies 9)
(n = 7) • Not empirical
research (n = 6)
Additional studies to be included • Not relevant to
from other search methods exposure (n = 5)
• Not possible to
• Hand search of related non-ISI Total included extract data specific to
journals (n = 1) studies children with ABI (n =
• Ancestry search of reference lists 2)
(n = 8)
(n = 0) • Not in English (n = 1)

Figure 1.
Search Strategy Results
8 Integrative Review of Music and Music Therapy Interventions

across various criteria (Hong et al., 2018). For the purpose of this
review, high-quality studies exhibited robust methodological ap-
proaches, including clear reporting, rigorous data analysis, and ef-
forts to minimize bias. Conversely, low-quality studies may manifest
methodological weaknesses, biases, or inadequacies in reporting

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detail.
Independent reviews of the papers were conducted by the first
and final authors, following the relevant appraisal checklists: (a)
qualitative, (b) quantitative randomized controlled trials, (c)
quantitative non-randomized, (d) quantitative descriptive, and (e)
mixed methods. In any instance of differing appraisals, a structured
consultation process was initiated involving the other members of
the research team. This collaborative effort aimed to reconcile any
discrepancies and achieve a consensus on the overall quality as-
sessment of the study under review. By engaging in dialogue and
leveraging the diverse expertise within the team, this process fos-
tered a robust and comprehensive evaluation, mitigating the po-
tential for individual biases and enhancing the reliability of the
final appraisal outcomes. Consistent with recommendations from
prior integrative reviews, no studies were excluded on the grounds
of quality appraisal (Lee et al., 2022; McCaffrey et al., 2020).
The results of the MMAT are presented in Supplementary
Material B. Overall, the qualitative, mixed methods, and quan-
titative, non-randomized, studies were perceived to be of high
quality. However, the presence of small sample sizes across dif-
ferent methodological designs posed challenges in accurately
representing the target population. Furthermore, the inclusion
of only one participant in some studies raised concerns regarding
the adherence of the quantitative component to traditional
quality standards. This underscores the significance of consid-
ering sample sizes and their implications for the validity and gen-
eralizability of findings.

Data Analysis
The studies were read several times by all members of the re-
search team to enable the identification of mutually agreed-upon
categories of information. Pertinent data was then extracted and
presented within a review matrix (Dwyer, 2020), facilitating the sys-
tematic comparison of primary data sources as recommended by
Whittemore and Knafl (2005). See Table 1.
Table 1.

Narrative Summary Overview

Authors, year Aims Research design Sample Data collection Summary of key findings

Bower et al. To explore the Mixed methods. n=1 Qualitative: Video Qualitative findings revealed four
(2014) behavioral changes Case study. recording of each distinct categories of behaviors,
of a pediatric session, including namely neutral, acceptance,
patient in post- 10 min pre- and recruitment, and rejection. The
traumatic amnesia post-session. music therapist responded with
during a music corresponding strategies, namely
therapy session holding, affirming, enticing, and
containing.

Cause of ABI: TBI Quantitative: Participant displayed brief periods

Agitated Behavior of awareness and responsiveness
Journal of Music Therapy, 62(1), 2025, 1–32

Scale (ABS) to the music, termed Islands

of Awareness, during which she
exhibited acceptance, recruitment,
or rejection behaviors.

Gender(s): female Quantitate data analysis on agitated

levels yielded inconclusive results.

Age(s): 10 years
9

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Table 1. Continued
10

Authors, year Aims Research design Sample Data collection Summary of key findings

Chong To evaluate the effects Quantitative. n=8 Pre- and post-MIDI- Participants demonstrated increased
et al. of keyboard playing Quasi- based test on the finger movement velocity when
(2014) using Musical experimental, pressing force of assessed through MIDI-based tests.
Instrument Digital no control. the fingers.
Interface (MIDI) on
finger movements
for adolescents with
ABI.

Cause of ABI: 3 Pre- and post-hand Participants also showed improvements

TBI, 5 non-TBI, function tests: (a) in hand function tests. Notably,
including stroke, Grip and Pinch there was a significant increase
tumor, and Strength Test (b) in grip strength, and BBT scores
infection. Box and Block Test improved.
(BBT) (c) Jebsen
Taylor Hand
Function Test

Gender(s): 6 male, 2 The study revelated a strong

female correlation between the MIDI-based
finger movement tests and BBT
results. This correlation suggested
that the improvements in finger
movement velocity were associated
with enhanced hand function.
Integrative Review of Music and Music Therapy Interventions

Age(s): 9–18 years

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Table 1. Continued

Authors, year Aims Research design Sample Data collection Summary of key findings

Cohen To explore the Quantitative. n=1 Rate of speech was Both music and functional speaking
(1988) implementation of Single-subject recorded and interventions were effective
rhythm to decrease reversal design measured using in significantly reducing the
the rate of speech in (ABACAC). metronome participant’s rate of speech
an adolescent with measurements. compared to baseline.
ABI.

Causes of ABI: Over a 3-month period without testing,

Non-TBI, the participant’s rate of speech
infection, herpes stabilized at a lower rare, indicating a
encephalitis lasting impact of the intervention.

Gender(s): female
Journal of Music Therapy, 62(1), 2025, 1–32

Age(s): 18 years

Gentle To explore the Qualitative. Case n=1 Observed behaviors The participant demonstrated
et al. preservation of study and responses. recognition and memory of
(2015) singing function previously familiar songs post ABI.
in the developing New learning and retention of
brain following unfamiliar songs was also observed.
acquired Findings suggest that the song
neurological system in childhood is a resilient and
damage. neurologically significant system able
to withstand extensive neurological
impairment.
11

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Table 1. Continued
12

Authors, year Aims Research design Sample Data collection Summary of key findings

Causes of ABI: TBI

Gender(s): female

Age(s) 5 years; 7
months

Kelly et al. To investigate if RAS Quantitative. n=4 Pre- and post- Participants walking speed and gait
(2023) would improve Non- intervention biomechanics improved with
walking speed concurrent assessments: (a) both standard physiotherapy and
and gait quality in multiple- 10m walk test (b) physiotherapy combined with RAS,
children with ABI. baseline Edinburgh Visual but individual responses varied.
single case Gait Score
experimental
design.

Causes of ABI: 1 With regards to walking speed,

TBI, 3 non- children exhibited a greater rate of
TBI, including change when undergoing standard
stroke and physiotherapy alone in comparison
hemispherectomy to standard physiotherapy plus
RAS. However, there were variations
amongst the participants, and analysis
demonstrated the effect size was
small and not statistically significant.
Integrative Review of Music and Music Therapy Interventions

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Table 1. Continued

Authors, year Aims Research design Sample Data collection Summary of key findings

Gender(s): 2 male, 2 Physiotherapy with RAS was observed

female to influence gait biomechanics,
again with variation between the
participants.

Age(s) 10–12 years

Kim et al. To examine the Quantitative. n = 12 (experimental A three-dimensional Participants who received gait training
(2016) effects of RAS on Quasi- group n = 6, Vicon 370 Motion with RAS incorporating preferred
gait function in experimental, control group Analysis system music demonstrated significant
adolescents with with control. n = 6). was employed improvements in spatiotemporal
ABI. to collect gait parameters, including
spatiotemporal increased cadence, walking velocity,
parameters and and step time.
kinematic data.
Journal of Music Therapy, 62(1), 2025, 1–32

Causes of ABI: The RAS group demonstrated

Experimental increased range of motion in hip
group: 2 TBI, and knee joints during specific
4 non-TBI, phases of the gait cycle.
including stroke
and brain tumor
Control group: 2
TBI, 4 non-TBI,
including stroke
and brain tumor
13

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Table 1. Continued
14

Authors, year Aims Research design Sample Data collection Summary of key findings

Gender(s): 8 male, 4 There was no significant difference in

female the Gait Deviation Index between
the RAS group and control group.

Age(s): Mean age of

14.5 years

Kobus et al. To examine the effects Quantitative. n = 17 Physiological data Significantly lower heart and
(2022) of live music on Quasi- was collected respiratory rates as well as higher
children’s vital experimental, 15 min before, oxygen saturation levels were
signs during with control. during, and observed during physical therapy
physical therapy 15 min after each sessions that included music
intervention. therapy session: therapy.
(a) Heart rate (b)
Respiratory
rate (c) Oxygen
saturation

Causes of ABI: TBI Findings suggest that live music

(24%), infections therapy can help stabilize and
(12%), brain improve vital signs in children
attacks due to with neurological diseases during
previous illnesses physical therapy intervention in
(29%), or birth as early rehabilitation.
preterm infant or
ill newborn (35%)
Integrative Review of Music and Music Therapy Interventions

Gender(s): 14 male,
3 female

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Table 1. Continued

Authors, year Aims Research design Sample Data collection Summary of key findings

Age(s): 1–134
months

Twyford To investigate the Mixed methods. n=6 Qualitative The joint program positively impacted
and effectiveness of a Quasi- measures: (a) the participants’ self-regulation
Watters joint music therapy experimental, Goal Attainment skills, social interaction, and
(2016) and occupational no control. Scaling (b) learning.
therapy group in Individualized
promoting the Music Therapy
development of Assessment
self-regulation skills Profile (c)
in children with an School Function
Journal of Music Therapy, 62(1), 2025, 1–32

ABI. Assessment (d)

Canadian
Occupational
Performance
Measure (e)
Likert-type self-
evaluation scale
15

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Table 1. Continued
16

Authors, year Aims Research design Sample Data collection Summary of key findings

Causes of ABI: Mixed measures: Parents of the children involved felt

Unspecified (a) Parent supported and empowered to
variety of TBI and questionnaire (b) implement a range of strategies for
non-TBI Staff survey their child’s rehabilitation.

Gender(s): not Music therapy was found to be a

reported motivating and effective tool for
promoting skills, complementing
occupational therapy.

Age(s) 5–10 years

Integrative Review of Music and Music Therapy Interventions

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Journal of Music Therapy, 62(1), 2025, 1–32 17

To analyze the collected data, Braun and Clarke’s (2006, 2019)

six-phase cyclical process of thematic analysis was adopted. Initially
developed for qualitative data analysis, this approach extends to
the identification and organization of salient recurring, or pivotal,
themes and concepts found across a multitude of literary sources

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(Dwyer, 2020; Popay et al., 2006). This process involved (a) famil-
iarizing yourself with your data, (b) generating initial codes, (c)
searching for themes, (d) reviewing themes, (e) defining and
naming themes; and (f) producing the report (Braun & Clarke,
2006, 2019). The first and second authors independently reviewed
and analyzed the data, identifying commonalities, patterns, and
connections across the dataset. An inductive approach was utilized
to allow for a comprehensive exploration, ensuring that the de-
rived themes were data-driven rather than being influenced by pre-
conceived theories and researcher bias (Kiger & Varpio, 2020). To
enhance the reliability and objectivity of the analysis, the final two
authors served as mediators, reviewing themes and resolving any
interpretational discrepancies. As neutral parties, they facilitated
discussions to reconcile differing perspectives and maintain the in-
tegrity of the analysis process. The iterative nature of thematic ana-
lysis involved continually reviewing and refining emerging themes
until a final set of themes was achieved, ensuring that the identified
themes accurately reflected the nuances and complexities present
within the dataset.

Results
Descriptive Results
A total of eight studies met the inclusion criteria for this review,
all of which comprised of journal articles. These studies originated
from Australia (n = 3), South Korea (n = 2), Germany (n = 1), the
United States (n = 1), and an international collaboration between
Australia and the United Kingdom (n = 1). The date range of the
studies spans 1988–2023. Of the studies included, one was pub-
lished prior to 1990 (12.5%), five from 2010 to 2020 (62.5%), and
two published between 2021 and 2023 (25%).
The studies had diverse methodological designs. One study was
qualitative using observation as the data collection method (Gentle
et al., 2015). Five studies employed a quasi-experimental design, all
of which used quantitative measures to measure change across the
18 Integrative Review of Music and Music Therapy Interventions

domains of functioning (Chong et al., 2014; Cohen, 1988; Kelly et

al., 2023; Kim et al., 2016; Kobus et al., 2022). The final two studies
used other mixed methods designs (Bower et al., 2014; Twyford &
Watters, 2016).
A total of 50 children with ABIs participated in the studies, which

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reported a range of etiologies including traumatic brain injury
(TBI) and non-TBI conditions such as stroke, brain tumors, and
viral infections. The smallest sample size was n = 1 (Bower et al.,
2014; Cohen, 1988; Gentle et al., 2015) and the largest was n = 17
(Kobus et al., 2022). Gender was reported in seven studies. Among
the children with ABI, 30 were male (60%), 14 were female (28%),
and gender was not indicated for the remaining 6 participants
(12%). Age was reported in all studies. The youngest participant
reported was 1 month old (Kobus et al., 2022) and the oldest was
18 years old (Chong et al., 2014; Cohen, 1988). None of the studies
disclosed information regarding the ethnicity of the participants.
All studies reported the use of music therapy interventions for
enhancing functional outcomes, with none reporting the application
of general music-based interventions. The described music therapy
interventions targeted various domains of functioning, including
motor skills (n = 3), speech, language, and communication skills
(n = 2), psychosocial care (n = 1), physiological outcomes (n = 1), and
behavioral and cognitive skills (n = 1). The interventions employed
comprised of song singing (n = 2), rhythmic auditory stimulation
(RAS) (n = 2), and other methods (n = 4). An overview of the music
therapy interventions is presented in Table 2. These interventions
were administered in diverse healthcare settings, with the ­majority
occurring in hospitals (62.5%) across five studies. Additionally, one
study took place in a post-acute neurorehabilitation center (12.5%),
another in a rehabilitation hospital (12.5%), and one in an unspeci-
fied setting (12.5%).

Theme 1: Outcomes of Using Music Therapy in Pediatric ABI

Augmented Motor Skills
Three studies found that participating in music therapy inter-
vention enhanced motor skills in children with ABI (Chong et al.,
2014; Kelly et al., 2023; Kim et al., 2016). Chong et al. (2014) inves-
tigated keyboard-based rehabilitation and demonstrated improve-
ments in finger dexterity and hand function. Kelly et al. (2023)
Table 2.

Overview of Music Therapy Interventions

Type of music therapy Length of music therapy

Authors, year intervention Facilitator(s) intervention Brief description of musical content

Bower Singing of familiar Music Therapist 10 weekdays (14 The intervention compromised of live singing of
et al. songs consecutive days), familiar songs, either unaccompanied or with
(2014) 5–22 min per guitar accompaniment. The music therapist
session. matched tempo, volume, vocal timbre, and
accompaniment to the characteristics of the
patient’s presentation.
Chong Keyboard playing Unspecified 4–6 weeks, 25-min The exercises involved playing simple melodic
et al. exercises Therapist per session, twice patterns and sequences on the keyboard. The
(2014) weekly. therapist offered harmonic accompaniment.
Journal of Music Therapy, 62(1), 2025, 1–32

Cohen Song singing Not Specified Music intervention The participant was asked to sing along to “Hey
(1988) (Treatment B) Jude” by The Beatles at a tempo of m.m. = 80.
lasted for 4 weeks, The participant was instructed to tap the beat of
20 min per session. the music on her legs while singing along.
Gentle Neurologic music Music Therapist 20 + sessions up to 60 Familiar songs were used to stimulate arousal,
et al. therapy: Musical min awareness, and orientation and facilitate
(2015) Neglect Training meaningful responses. The therapist offered
(MNT), Music simple guitar accompaniment. Small hand held
Attention and percussion instruments gradually introduced.
Control Training
(MACT), and Musical
Sensory Orientation
Training (MSOT)
19

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Table 2. Continued
20

Type of music therapy Length of music therapy

Authors, year intervention Facilitator(s) intervention Brief description of musical content

Kelly et al. RAS Music Therapist 4 weeks, approx. Music therapist played guitar. During RAS, the
(2023) and 60 min per session, tempo was set to match the child’s natural
Physiotherapist twice weekly. walking speed. The tempo was adjusted by
5–10% (faster and slower) to challenge the child
to walk at different speeds.
Kim et al. RAS Music Therapist 4 weeks, 30 min per RAS utilized participant preferred music with
(2016) session, thrice a focus on creating a rhythmic and melodic
weekly. framework that could be effectively used as a
cue for gait training. RAS was provided live on
keyboard.
Kobus Music listening Music Therapist Twice weekly. The music therapist played the sansula, reflecting
et al. and Physical The mean duration the children’s breathing and responses. The
(2022) Therapist of each therapy tempo was adjusted according to breathing and
session was 44 min heart rates.
(21–71 min).
Twyford Group music therapy Music Therapist 7 weeks, 60 min per Each sessions begin and finished with the same
and and occupational and session. song/activity. Sessions were non-linear to
Watters therapy Occupational respond to group dynamics and perceived needs,
(2016) Therapist incorporating improvization, song singing, and
verbal processing.
Integrative Review of Music and Music Therapy Interventions

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Journal of Music Therapy, 62(1), 2025, 1–32 21

and Kim et al. (2016) explored gait rehabilitation of children and

adolescents, respectively. Kelly et al. (2023) noted varying improve-
ments in walking speed and gait biomechanics when combining
RAS with standard physiotherapy. Kim et al. (2016) similarly re-
ported significant enhancements in gait parameters, including

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walking cadence, velocity, and joint mobility among adolescents
when exposed to RAS.

Enhanced Communication Abilities

Two studies centered on the application of music therapy inter-
vention to address speech, language, and communication skills.
Cohen (1988) explored the effects of music therapy on the rate of
speech, while Gentle et al. (2015) examined the recovery of mu-
sical and linguistic abilities following ABI. Both studies leveraged
song-based methods as a central component to their interventions.
Cohen (1988) used synchronized tapping with a song as a pacing
method to modify speech rate. Gentle et al. (2015) employed pre-
morbidly familiar songs and nursery rhymes to stimulate ­awareness,
orientation, and meaningful responses to foster increased respon-
siveness, basic attention, and encourage active participation in
singing familiar songs, in turn supporting language rehabilitation.

Theme 2: Music Therapy as a Motivator in Pediatric ABI

Rehabilitation
Adherence to Therapeutic Intervention
Music therapy has emerged as a compelling and multifaceted mo-
tivating factor in pediatric ABI rehabilitation. Despite the absence
of specific measures used to assess participants’ motivation, several
studies have documented its pervasive influence (Chong et al., 2014;
Kim et al., 2016; Kobus et al., 2022; Twyford & Watters, 2016). Chong
et al. (2014) believed that the role of music, particularly in keyboard
playing, was to facilitate motivation through immediate auditory
feedback, creating intrinsic motivation for endurance in the execu-
tion of simple repetitive movements. Similarly, Twyford and Watters
(2016) suggested that music therapy may furnish focus, potentially
facilitating increased engagement, which could enhance children’s
commitment to rehabilitation. Furthermore, Kim et al. (2016) ac-
knowledged that using participants’ preferred music during inter-
vention has the potential to maximize motivation, thereby enhancing
22 Integrative Review of Music and Music Therapy Interventions

adherence to rehabilitation. Kobus et al. (2022) echoed these senti-

ments, stating that music activates brain regions involved in reward,
motivation, emotion, and arousal, thus highlighting the promising
role of music in promoting sustained engagement.

Enjoyment

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Music therapy is described as a fun and non-threatening me-
dium for therapeutic intervention. Twyford and Watters (2016)
utilized a Children’s Enjoyment and Self-Observation Survey to
gauge participants’ satisfaction levels, revealing a consistently high
level of enjoyment among participants. Additionally, parental
feedback indicated that the children enjoyed attending the group
sessions, emphasizing music therapy as a source of enjoyment that
provided opportunities for children to express themselves through
creative activities. Although Kelly et al. (2023) did not collect spe-
cific data on participants’ enjoyment levels, they affirmed that all
participating children found the music therapy intervention enjoy-
able, alluding to how the inherent enjoyment of music results in
full engagement from children during rehabilitative intervention.

Theme 3: Collaboration
Three studies highlighted the collaborative efforts between music
therapy and other allied health professions in pediatric rehabilita-
tion. A joint music therapy and occupational therapy intervention
was identified as a cohesive strategy in supporting children with
ABI to achieve shared therapeutic goals. This approach was noted
to facilitate the acquisition of self-regulation and interpersonal skills
(Twyford & Watters, 2016). The integration of music therapy and
physiotherapy, incorporating RAS, resulted in enhanced walking
speed and gait biomechanics (Kelly et al., 2023). Furthermore, the
inclusion of music therapy in physical therapy sessions during neuro-
logical early rehabilitation led to decreased heart and respiratory
rates and increased oxygen saturation (Kobus et al., 2022). These
studies contribute to the growing recognition of the advantages of
collaborative approaches in pediatric rehabilitation.

Discussion
This integrative review of eight papers explored the use of
music and music therapy interventions on functional outcomes in
Journal of Music Therapy, 62(1), 2025, 1–32 23

children with ABI. Although the initial scope encompassed both

music-based and music therapy interventions, it is noteworthy that
the findings exclusively focus on music therapy, as no music-based
studies met the inclusion criteria. The absence of music-based
interventions begs further examination and prompts reflection on

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the underlying reasons within the context of pediatric ABI. It is
plausible to consider whether the interactive nature inherent in
music therapy renders it more suitable for this population com-
pared to music-based interventions, which might be perceived
as less engaging or accessible to children. Additionally, it raises
a question of whether other health care professionals lack confi-
dence or training in implementing music interventions, thereby
contributing to the dearth of these studies with this population.
Given the intricacy of pediatric ABI, it raises questions about the
feasibility, appropriateness, and perhaps even the underestimation
of potential benefits associated with music-based approaches. This
may suggest a gap in research exploration rather than an inherent
lack of applicability. The absence of published research does not
necessarily imply the absence of practice, as music-based interven-
tions might be occurring informally or anecdotally in clinical set-
tings. Understanding the underlying reasons could pave the way
for future research directions and the development of innovative
interventions tailored to the needs of children with ABI. The pre-
dominance of music therapy studies underscores the recognized
potential and relevance of the profession in pediatric ABI. It sug-
gests a growing acknowledgment of the therapeutic potential of
music within these clinical settings. However, the exclusive focus
on music therapy warrants consideration of whether alternative
music-based interventions are being overlooked or underexplored
in the context of ABI.

A Heterogeneous Landscape
The complexity of music therapy in pediatric ABI is accentuated
by the heterogeneity discernible within the presented results. The
geographical diversity of the studies highlights the global interest
and applicability of music therapy in pediatric ABI rehabilitation.
However, the variation in cultural contexts, health care settings,
and established methodological designs may be rooted in this
nascent stage of research development. The expansive spectrum
of music therapy interventions, targeting motor skills, speech,
24 Integrative Review of Music and Music Therapy Interventions

language, and communication skills, psychosocial care, physio-

logical outcomes, and behavioral and cognitive skills, contrib-
utes to the observed heterogeneity. The choice of intervention
methods, such as song singing or rhythmic auditory stimulation,
reflects the adaptability and versatility of music therapy in fostering

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the recovery and enhancement of diverse functional capacities in
children with ABI. Nevertheless, this flexibility proves disadvanta-
geous when endeavoring to establish meaningful comparisons of
interventions. Magee et al. (2017) echo a similar sentiment in their
Cochrane review of music interventions on functional outcomes
in adults with ABI. As the field of music therapy for children with
ABI progresses, increased and enhanced research rigor will likely
unveil apparent trends and guide future investigations. This evo-
lution holds promise for refining interventions and establishing
clearer pathways for advancing pediatric ABI rehabilitation.

Music Therapy in Pediatric ABI

Despite the existing heterogeneity across the various studies,
there was a consensus amongst the papers that the use of music
within a therapeutic context serves as a motivational catalyst,
elevating engagement and participation in children with ABI
(Chong et al., 2014; Kim et al., 2016; Kobus et al., 2022; Twyford
& Watters, 2016). Similar observations have been documented
in the broader landscape of pediatric ABI (Burns & O’Connor,
2023; Kennelly, 2006) and in the context of adult ABI (Magee
et al., 2017; Tamplin, 2015). Neurologically, music is intrinsically
rewarding, activating brain regions associated with reward, mo-
tivation, emotion, and arousal, thus contributing to maximizing
motivation and fostering sustained engagement (Kobus et al.,
2022). Furthermore, music therapy inherently involves inter-
actions among the therapist, the child, and the music, fostering a
therapeutic relationship that may further enhance treatment out-
comes. Kennelly (2013) highlights the significance of these rela-
tionships, noting that hospitalization for an ABI and subsequent
rehabilitation can be lengthy, leading to prolonged isolation from
peers. Consequently, building supportive relationships with chil-
dren becomes an important psychosocial aspect of their recovery
journey. While the specific impact of this therapeutic relationship
is not explored in the included empirical studies, it is reasonable
Journal of Music Therapy, 62(1), 2025, 1–32 25

to speculate that the quality of these relationships contributed

to the success of the interventions. Within a musical therapeutic
milieu enriched with enjoyable and preferred activities, there is
a cultivation of intrinsic motivation that addresses challenges re-
lated to adherence to therapy. Moreover, music therapy in a collab-

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orative capacity further supports its potential to foster a cohesive
and synergistic approach (Burns & O’Connor, 2023), amplifying
its impact on motivation and adherence within a multidisciplinary
rehabilitation context. Finally, it is important to acknowledge the
scarcity of empirical research in music therapy for pediatric ABI.
Practitioners, researchers, and students alike must exercise caution
against overstating claims without robust evidence to substantiate
them, emphasizing the need for further research to validate and
expand upon preliminary findings.

Exclusion of Non-Empirical Studies

Six studies were excluded from the final review due to their
non-empirical nature, as they primarily presented case vignettes
elucidating the role of music therapy within pediatric ABI. Although
not meeting the criteria for empirical research, these studies con-
tribute valuable insights, reinforcing the efficacy of music therapy
within this context. Kennelly and Brien-Elliott (2001) provide a com-
pilation of vignettes delineating the applications of music therapy
in four main goal areas: motor skills, behavioral and cognitive skills,
psychosocial care, and speech, language, and communication skills.
Robb (1996) illustrates the use of songwriting as a means to foster
emotional wellbeing in adolescents with ABI. Furthermore, Magee
et al. (2011) offer two case vignettes that illustrate the application
of music therapy with children with neurobehavioral disorders in-
curred by ABI. Kennelly et al. (2001) and Bower and Shoemark
(2009) contribute vignettes that underscore the synergistic effect
of collaborative music therapy and speech and language therapy
supporting language rehabilitation, communication, and interper-
sonal relationships. Similarly, O’Doherty and O’Connor (2015)
provide an account of joint working between music therapy and
neuropsychology to improve rehabilitation outcomes. As the field
of music therapy within pediatric ABI continues its expansion, fu-
ture literature reviews should consider incorporating non-empirical
research studies. This inclusive approach ensures a comprehensive
26 Integrative Review of Music and Music Therapy Interventions

examination of the burgeoning body of research recognizing the

intrinsic value of studies that may not conform to traditional em-
pirical methodologies.

Limitations and Recommendations

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A constraint of this review is that it only included studies written
in English. Consequently, the results may have excluded valuable
accounts of music and music therapy interventions used to support
children with ABI from other geographical regions. Additionally,
the heterogenous findings limit generalizability and restrict the
formation of meaningful comparisons. It is also crucial to reflect
on the validity and limitations inherent in the methodological ap-
proach. Despite best efforts to adhere to established frameworks
and guidelines, the interpretation of study findings and the syn-
thesis of themes inevitably involve subjective judgements. The it-
erative nature of this review process allowed for ongoing r­ eflection
and discussion among members of the research team, which helped
mitigate potential biases. However, the fallibility of human judge-
ment and possibility of overlooking alternative interpretations or
excluding relevant literature despite the rigorous search strategy
is recognized.
The findings highlight the need for larger, more rigorous studies
in this area to begin addressing the existing gaps and provide a
more robust foundation for evidence-based practices. Within this
examination, significant recommendations emerge to guide future
research and inquiry for music and music therapy interventions
and pediatric ABI:
• Undertake a comprehensive review that incorporates both
empirical and non-empirical research. Recognizing the
value of case vignettes and theoretical discussions will pro-
vide a more holistic understanding of the varied applications
of music and music therapy interventions and their impact
on children with ABI, which is necessary during this founda-
tional phase of exploration.
• Establish a special interest group focused on music therapy in
pediatric ABI. This network can serve as a collaborative plat-
form for researchers, clinicians, and stakeholders to direct
and coordinate future investigations. The group can facilitate
Journal of Music Therapy, 62(1), 2025, 1–32 27

the design and implementation of multisite studies, enabling

access to larger and more diverse sample sizes, ensuring the
generation of more robust and generalizable findings.
• Enhance the description of music and music therapy
­interventions and delivery methods. Although the inherent

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flexibility of music ensures the uniqueness of each inter-
action, offering detailed descriptions would facilitate the
replication of studies in the future, thereby fostering com-
parability across research endeavors.

Conclusion
The findings of this integrative review affirm that music therapy
intervention holds a diverse role in the rehabilitation of children
with ABI. Music therapy possesses the capacity to enhance motiv-
ation and engagement during rehabilitative interventions across
various functional domains. However, it is crucial to note the ab-
sence of general music-based intervention studies within the scope
of this review. This discrepancy prompts reflection on potential
overlooked avenues within music-based approaches for pediatric
ABI. Nevertheless, further research with children and adolescents
recovering from ABI is required in order to develop techniques and
interventions that are developmentally appropriate and grounded
in evidence-based practices.

Supplementary Material
Supplementary material is available online at Journal of Music
Therapy.

Author Contributions
James Burns (Conceptualization [Lead], Data curation [Lead],
Formal analysis [Lead], Investigation [Lead], Project administra-
tion [Lead], Writing—original draft [Lead], Writing—review &
editing [Lead]), Hannah Healy (Data curation [Supporting], Formal
analysis [Supporting], Investigation [Supporting], Methodology
[Supporting]), Rebecca O’Connor (Data curation [Supporting],
Formal analysis [Supporting], Investigation [Supporting],
28 Integrative Review of Music and Music Therapy Interventions

Methodology [Supporting], Writing—review & editing [Supporting]),

and Hilary Moss (Conceptualization [Supporting], Data cur-
ation [Supporting], Formal analysis [Supporting], Investigation
[Supporting], Methodology [Supporting], Writing—review & editing
[Supporting])

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