Music Therapy

Music Therapy

Published with the kind permission of Zarihs Retoucher

Music Therapy is based on the understanding that all human beings are able to respond to music, irrespective of disability or injury. Music therapy is an evidence-based profession, designed to help people with a broad range of needs. Music is known to reduce stress, support learning and increase feelings of self-esteem. However, music therapy research has shown that it can also lead to improvements in speech disorders, physical movement, cognition and a variety of psychological issues. According to the American Music Therapy Association,

‘Research supports connections between speech and singing, rhythm and motor behaviour, memory for song and memory for academic (functional support) material, and overall ability of preferred music to enhance mood, attention, and behaviour to enable the client to maintain or optimize function.’1

Music therapists often work with speech disorders, such as aphasia and dysarthia. They have identified a range of similarities between singing and speech that include rhythm, pitch and intensity.2 Traditional music therapy has had some success in dealing with speech disorders but there now exists another branch of music therapy that deals specifically with speech disorders, called Melodic Intonation Therapy.

People have always talked about the emotional power of music. Music therapy research shows us how this translates into ways to improve mood and deal with the huge emotional adjustment that many people have to make after a serious accident or illness.3 Baker and Tamplin list some of the issues facing people who are trying to adjust to life with an acquired brain injury. These include loss of function and independence, loss of physical appearance, loss of status, and loss of their role within the family.4 A music therapist can help if communication is impaired, or when feelings are too powerful or complex to express in words. He or she might use techniques such as song writing and improvisation to help clients express their feelings in a safe environment. Doing this can offer catharsis, support and safety. For example, in 2000, researchers showed that music therapy brought about a positive change in mood in 18 patients who had been hospitalised due to acquired brain injury.5

You may also be surprised to know that music therapy can be an effective treatment for motor function disorders and that it can improve cognition. Research has shown that music and listening activities can help to activate specific neural pathways and make people more open to rehabilitation.6 In 2008, a study demonstrated that people suffering from amnesia could remember events they had experienced in the music therapy room with greater frequency than events that had happened outside the room.7 Music therapists claim that whether you are dealing with difficulties in movement or cognition,

‘…music can offer structure, stimulation and motivation for exercise routines, and can offer a purposeful and enjoyable activity for specific motor patterns through playing of instruments, which provide both auditory and physical feedback.’ 8

During a typical session, the music therapist establishes contact with the client through the shared use of musical sounds. Using a variety of instruments, the therapist provides a personal space where each person can use music to communicate feelings and work with his or her needs within safe boundaries. During a session, the client might improvise (make up) music, or use instruments with the therapist, thereby helping to communicate something about him- or herself using few or no words. The therapist also works psychodynamically, focusing on the underlying meaning of the client’s music and the use of space and silence to understand his or her internal world.

 

  • Possible benefits of Music Therapy for stroke

    Music therapy has been shown to help stroke recovery in several ways: it can enhance motor function, improve speech, reduce depression and address ‘visual neglect’, a condition that causes a person to ignore what he or she sees on either the left or the right side.

    W. Magee describes her work to improve the speech of a 30-year-old man who had both expressive and receptive aphasia.9 Over a three-month period, he progressed from no speech to being able to repeat phrases from familiar songs using musical cuing. He then went on to produce phrases outside the therapy setting. Another study, published in 2009, shows the results of a three-year long case study. Its subject was a 57-year-old man with expressive and receptive aphasia. After three years of speech therapy, he had shown no significant signs of improvement. He started music therapy three years after his cerebral haemorrhage:

    ‘After the first treatment period of 20 months, the patient showed clinically significant improvements in spontaneous speech as well as in the token test (a measure to evaluate severity of aphasia), repetition, and naming. The first follow-up study in 2005 as well as the last assessment in 2008 revealed further clinically significant improvements in speech performance. At the time of this writing, the patient is able to talk in everyday situations and to participate verbally in social life. The fact that he regained confidence and enjoyment in using speech has improved his own quality of life and that of his family and friends considerably.’10

    In 2007, a research paper illustrated how music therapy could help to develop both fine and gross motor functions. It followed a music-supported training programme for 20 stroke survivors. By the end of the programme, the patients clearly demonstrated significant improvement in the areas of precision, speed and smoothness of movement. They also showed that they were better able to control their movements when performing daily activities, compared to the control group.11

    Depression often follows a stroke.12 In Scotland, researchers found that music therapy could help to reduce such depression and, as a result, other therapies became more effective. They studied 40 stroke survivors:

    ‘One group received standard care, while the other received 40 minutes of music therapy a day. After 12 weeks, the people in the music-therapy group were less depressed, less anxious, and more motivated to participate in rehabilitation.’13

    A study in 2009 focused on a different problem. Many stroke survivors lose part of their ability to see or notice objects on one side of their body. This is called ‘visual neglect’. Researchers have shown that listening to music can significantly improve overall vision:

    ‘The new study looked at three patients who had lost awareness of half of their field of vision as a result of a stroke. The patients completed tasks under three conditions: while listening to their preferred music, while listening to music they did not like and in silence. All three patients could identify coloured shapes and red lights in their depleted side of vision much more accurately while they were listening to their preferred music, compared with listening to music they did not like or silence. For example, in one task, patients were asked to press a button when they could see a red light appear. One patient could point out the light in 65% of cases while he was listening to music he liked, but could only recognise the light in 15% of cases when there was no music or music he did not like being played.’14

    Such positive results could be due to an increase in positive emotions that occur when people listen to music they like. This, in turn, might produce better signalling in the brain. MRI scans support this theory.15 Although this study only had three participants, the results are encouraging and the researchers are keen to conduct a larger trial.

    Even if music therapy is not available to you, just listening to pleasant music can have a therapeutic effect. In 2008, Finnish researchers published strong evidence that listening to music has a measurable effect on speech after a stroke. They divided 60 stroke survivors into three groups: a music group, a language group and a control group:

    ‘During the following two months, the music and language groups listened daily to self-selected music or audio books, respectively, while the control group received no listening material. In addition,all patients received standard medical care and rehabilitation.’16

    All participants were tested extensively. Results showed that the group who had listened to music improved more than either of the other groups:

    “We found that three months after the stroke, verbal memory improved from the first week post-stroke by 60 percent in music listeners, by 18 percent in audio book listeners and by 29 percent in non-listeners,” Sarkamo said. ‘Similarly, focused attention — the ability to control and perform mental operations and resolve conflicts among responses — improved by 17 percent in music listeners, but no improvement was observed in audio book listeners and non-listeners. These differences were still essentially the same six months after the stroke.’17

  • Arguments against using Music Therapy for stroke

    Some have argued that the effect of music therapy is imagined (placebo) rather than of real physical or emotional benefit.18 Also, there are times when people feel shy or inhibited about singing or learning to play an instrument.

  • Case histories
    1. This article explains how music therapy helped Harvey Alter, now 62, to speak again after a stroke:
      ‘Music Therapy Helps Stroke Patients Recover‘. redOrbit.com: News/Health section. Source: International Herald Tribune
    2. This abstract outlines a study that shows how ‘motor control in everyday activities improved significantly’ as a result of music therapy:
      Schneider S, Schönle PW, Altenmüller E, Münte TF (October 2007). ‘Using musical instruments to improve motor skill recovery following a stroke’. In J. Neurol. 254 (10): 1339–46
  • Notes and references
    1. ‘Habilitation: Music Therapy Research and Evidence-Based Practice Support’ by American Music Therapy Association
    2. Patel A.D. et. Al. 1998 ‘Processing prosodic and musical patterns: A neuropsychological investigation’. InBrain and Language 61 123-144
    3. Simon Gilbertson and David Aldridge, Music therapy and traumatic brain injury: A light on a dark night.London: Jessica Kingsley (2008)
    4. Baker F. and Tamplin J., Music therapy methods in neurorehabilitation: A clinician’s manual. London: Jessica Kingsley (2006)
    5. Nayak S. et al (2000) ‘Effect of music therapy on mood and social interaction among individuals with acute traumatic brain injury and stroke.’ In Rehabilitation Psychology 45(3), 274-283
    6. Knox R. and Jutai J. (1996) ‘Music-based rehabilitation of attention following brain injury’. In Canadian Journal of Rehabilitation 9(2) 169-181
    7. Simon Gilbertson and David Aldridge, Music therapy and traumatic brain injury: A light on a dark night.London: Jessica Kingsley (2008)
    8. Kennelly, J., Brien-Elliott, K. (2001). The role of music therapy in paediatric Rehabilitation. In Paediatric Rehabilitation, 2001, Vol. 4
    9. Magee, W. (1999) ‘Music therapy within brain injury rehabilitation: To what extent is our clinical practice influenced by the search for outcomes?’ In Music Therapy Perspectives, 17(1), 20-26.
    10. M. Jungblut, M. Suchanek, and H. Gerhard, ‘Long-Term Recovery From Chronic Global Aphasia: A Case Report’. In Music and Medicine, July 1, 2009; 1(1): 61 – 6
    11. Schneider S, Schönle PW, Altenmüller E, Münte TF (October 2007). ‘Using musical instruments to improve motor skill recovery following a stroke‘. In J. Neurol. 254 (10): 1339–46
    12. Another study looked at 18 survivors of traumatic brain injury and stroke. Researchers asked whether music therapy could improve the participants’ mood and if that would have an impact on their recovery. After about 10 treatments, they found:

      ‘There was a significant improvement in family members’ assessment of participants’ social interaction in the music therapy group relative to the control group. The staff rated participants in the music therapygroup as more actively involved and cooperative in therapy than those in the control group. There was a trend suggesting that self-ratings and family ratings of mood showed greater improvement in the musicgroup than in the control group.’ (‘Effect of music therapy on mood and social interaction among individuals with acute traumatic brain injury and stroke’ by Nayak, S., Wheeler, B. L., Shiflett, S. C., & Agostinelli, S. In Rehabilitation Psychology, 45(3), 274–283 2000)

    13. Music/Sound Therapy for Stroke. holisticonline.com: Stroke/Alternative and Complementary Medicine for Stroke section
    14. Listening To Pleasant Music Could Help Restore Vision In Stroke Patients, Suggests Study’. InScienceDaily (Mar. 25, 2009). Original source: ‘Pleasant music overcomes the loss of awareness in patients with visual neglect’ by David Soto, María J. Funes, Azucena Guzmán-García, Tracy Warbrick, Pia Rotshtein, and Glyn W. Humphreys. In Proceedings of the National Academy of Sciences, 2009
    15. ‘Listening To Pleasant Music Could Help Restore Vision In Stroke Patients, Suggests Study’. InScienceDaily (Mar. 25, 2009). Original source: ‘Pleasant music overcomes the loss of awareness in patients with visual neglect’ by David Soto, María J. Funes, Azucena Guzmán-García, Tracy Warbrick, Pia Rotshtein, and Glyn W. Humphreys. In Proceedings of the National Academy of Sciences, 2009
    16. ‘Music listening enhances cognitive recovery and mood after middle cerebral artery stroke’ by Sarkamo T, Tervaniemi M, Laitinen S, et al. In Brain. 2008;131:866-876
    17. ‘Music Therapy Improves Stroke Outcomes source’. In Washington Post. Original source: ‘Music listening enhances cognitive recovery and mood after middle cerebral artery stroke’ by Sarkamo T, Tervaniemi M, Laitinen S, et al. In Brain. 2008;131:866-876
    18. Music Therapy. ayushveda.com: Alternative Therapies/Music Therapy section

Aviva Cohen is the author and CEO of Neuro Hero