Music Therapy with a Neurologic Population
Music therapy has its beginnings as a formal therapeutic modality during World War I and II when local musicians volunteered to perform for wounded soldiers suffering from “shell shock” in field hospitals and physicians observed the notable physical and emotional responses in the patients. In 1944, the first official undergraduate degree program for music therapy was established at Michigan State University. Currently, there are over 70 colleges and universities that offer music therapy training and 30 graduate programs in the United States alone.
Music therapy is defined by the American Music Therapy Association (AMTA) as “the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.” Music therapy interventions can be designed to promote wellness, manage stress, alleviate pain, enhance memory, improve communication, and promote physical rehabilitation. Board-certified music therapists find themselves in general and psychiatric hospitals, community mental health facilities, schools, nursing homes, rehabilitation centers, and in private practice.
Music Therapy in Practice with a Neurologic Population
The story of Congresswoman Gabby Gifford’s recovery after being critically injured by a gunshot wound to the head was featured prominently in the media. Her considerable injuries required her to engage in intensive physical, cognitive, and speech therapies. One additional therapeutic modality that assisted Gifford’s during her rehabilitation was music therapy. In the following clip from ABC News, the role of music therapy is discussed in Gifford’s recovery.
Clinical research studies over the last 15 years have investigated the use of music-based interventions in the rehabilitation of speech, language, and cognitive functions. The theory of why these interventions work is that brain systems underlying music are shared with other functions and that music is a unique stimulus in that it activates brain structures bilaterally. When working with individuals with aphasia from acquired brain injury, for example, music therapists often use a specific technique called Melodic Intonation Therapy (MIT). MIT uses the musical elements of speech such as melody and rhythm to improve expressive function by engaging language-capable regions in the undamaged right hemisphere and utilizing an unaffected function (singing) with individuals with nonfluent aphasia. (1,3,4) Actively engaging in singing, which relies heavily on brain systems in the right hemisphere, can bypass injured speech centers in the left-hemisphere.
There are several other areas where music therapy has been shown to be effective in rehabilitative settings. For example, Parkinson’s patients can improve their gait length and walking speed when stepping to the beat of music. This intervention, called Rhythmic Auditory Stimulation (RAS), provides rhythmic cues for patients, allowing for more consistent, flexible movement, which additionally reduces fall risk. The rhythmic cues inherent in the music serve as an auditory trigger and assist in preventing “freezing” so commonly seen with these patients (2,5).
Video of RAS via YouTube: http://www.youtube.com/watch?v=Dr4-HGffTrk
In studies on memory, participants learning a list of words in song format demonstrate activation in temporal and frontal brain areas on both sides of the brain, as opposed to participants learning a list in spoken-word presentation, which only activated the left-hemisphere (6). Music can be used to help individuals with attention problems caused by traumatic brain injury or stroke due to music’s ability to activate the attention network on both sides of the brain (7).
Music therapy is a holistic, engaging, non-pharmacological treatment modality that can play a significant role in the long road to recovery for individuals with brain injury.
The American Music Therapy Association
Media: ABC News Clip- Gabby Giffords: Finding Words Through Music
- Hartley, M.L., Turry, A.T., & Raghavan, P. (2010). The role of music and music therapy in aphasia rehabilitation. Music and Medicine, 2, 235-242.
- Hausdorff, J.M., Lowenthal, J., Herman, T., Gruendlinger, L., Peretz, C., & Giladi, N. (2007). Rhythmic auditory stimulation modulates gait variability in Parkinson’s disease. European Journal of Neuroscience, 26, 2369-2375.
- Hommel, M., Peres, B., & Pollack, P. Memin, B., Besson, G., Gaio, J.M., & Perret, J. (1990). Effects of passive tactile and auditory stimuli on left visual neglect. Archives of Neurology, 47, 573-576.
- Schlaug, G., Marchina, S., & Norton, A. (2009). Evidence for plasticity in white-matter tracts of patients with chronic Broca’s aphasia undergoing intense intonation-based speech therapy. Annals of the New York Academy of Sciences, 1169, 385–394
- Schlaug, G., Marchina, S., & Norton, A. (2008). From singing to speaking: why singing may lead to recovery of expressive language function in patients with Broca’s aphasia. Music Perception, 25, 315-323.
- Thaut, M.H., McIntosh, G.C., Rice, R.R., Miller, R.A., Rathbun, J., & Brault, J.M. (2004). Rhythmic auditory stimulation in gain training for Parkinson’s disease patients. Movement Disorders, 11, 193-200.
- Thaut, M.H., Peterson, D.A., McIntosh, G.C. (2005). Temporal entrainment of cognitive functions: Musical mnemonics induce brain plasticity and oscillatory synchrony in neural networks underlying memory. Annals of the New York Academy of Sciences, 1060, 243-254.