Classical music in cognitive rehabilitation: Three case studies of spatial neglect

Chronic spatial neglect after right-hemisphere stroke reflects network dysfunction, with recovery influenced by structural connectivity. Music recruits coordinated bi-hemispheric activity and may promote interhemispheric communication after stroke. Following our pilot study in post-stroke aphasia, we asked whether classical music modulates connectivity and behavior in chronic neglect. Three patients completed a crossover protocol comparing two weeks of daily audiovisual classical music with an audiobook control, with neglect, mood, quality-of-life, diffusion MRI, and resting-state high-density EEG measures. All showed right superior longitudinal fasciculus II disconnection with preserved callosal pathways. In N2, line bisection shifted leftward across all five lines after music, together with increased posterior interhemispheric theta-band weighted symbolic mutual information (wSMI), then deteriorated into the pathological range after the audiobook, without mood improvement. N1 showed mixed behavioral effects, with mood and quality of life improving after music. N3 showed no significant spatial improvement and worsened mood after music. These heterogeneous responses motivate larger studies of connectional predictors. The findings support the feasibility of classical music as an adjunct to neglect rehabilitation and suggest that cognitive changes may occur independently of mood, while the audiobook cannot be considered an inert control.