pathway

Music Therapy and ABI

© Cheryl Jones MMT, NMT-F, MTA
Adapted from an article featured in: Pathways Ahead, December 2011.

Music therapy is an effective and rewarding intervention to use with individuals who have experienced ABI. It can be used to address both functional goals and emotional needs.

What is Music Therapy?

Music therapy uses music and its characteristics to work towards non-musical goals. Goal areas include speech and language, motor, cognition, and psychosocial.

Neurologic Music Therapy is a specialized area of music therapy and is based on research evidence of music's neural impact on the brain. With this understanding, and the knowledge that music is a multi-site stimulus, therapeutic interventions using music have been developed. These interventions use music to stimulate a response, working towards functional, non-musical goals. Music therapy can be an effective stimulus for the injured brain.

Because of music's emotional qualities, it can also be an effective tool to address psychosocial needs. Music can be used for self-expression, cathartic release, creativity, affirmation, and self-esteem. Music can be used to highlight and celebrate what an individual can do.

 A qualified music therapist has obtained a minimum of a 4 year university degree and has completed a 1000- hour internship. S/he is also accredited by the Association of Music Therapy with the professional designation MTA.

Examples of Music Therapy

Music Therapy and Speech

Music therapy uses a variety of interventions including vocal exercises, Melodic Intonation Therapy (MIT), and the use of wind instruments to support speech and language goals. These goals may include breath support, oral motor control, articulation, and word finding.

Although speech and singing share many similarities such as melody, inflection, and rhythm, they are processed differently by the brain. Therefore, singing is often used to target initial speech goals.

ABI

Music Therapy and Motor Skills

Tempo (speed), dynamic level (soft /loud) and the melodic direction of music can support and cue movement. This is especially helpful for an individual who has difficulty understanding or being aware of spatial or temporal aspects of movement and for those who may be challenged following verbal or multiple directions. For example, a client was working on range-of-motion. She did not have a sense of her movement, continuously raising her arm only a few inches when asked to lift her arm high. However, music played in the required tempo, using a steady pulse, in an ascending scale, cued her to raise her arm, how high to raise it (the length of the scale), and provided rhythmic support for control of the movement. The length of the scale directed her to continue raising her arm, achieving full range of motion. Because music is processed differently, she was able to follow the musical cues much easier than verbal directions.

Music therapy may be used to improve fine or gross motor skills by having the individual play instruments chosen specifically for the target movement.

Music Therapy and Cognition

Music therapy uses a variety of interventions to address cognition goals including attention and various types of memory (short term, sustained, divided, etc.). Procedures that need to be remembered may be put to music in the form of a song to aid in the recall of the various steps required for a specific skill.

Music Therapy and Psychosocial Needs

Because of music's emotional characteristics, it can be a powerful form of self-expression. Both music making through improvisation and song composing enable an individual to be expressive. This is especially important for individuals who are non-verbal. Being able to express your emotion through an instrument can be immensely satisfying. For example, a client who was feeling frustration, but unable to verbalize it, choose to play a large drum. After striking it several times and producing a loud sound, she felt better, having released her emotion and knowing that others now heard her level of frustration. For some, playing an instrument may be the first step in self-expression. They might not be ready to verbally express what they are feeling. Others may express themselves easier with music, not needing to worry about finding the right word.

For some, the very act of playing an instrument is empowering. A man arrived to a group improvisational activity for individuals with ABI. He promptly told the music therapist that he could not participate as he only had control of one hand, and with limited range of motion. The music therapist provided bar chimes on a stand, requiring only the slightest touch to produce a sound. He stated that it was wonderful to realize he could play an instrument. He was affirmed and valued for his contribution to the group's music. He was able to celebrate success.

A child arrived at his music therapy session feeling down and commented that no one else at school needs to wear a helmet. The music therapist offered to write a song about helmets and the child enthusiastically responded with "Yes! Make it exciting and not sad. Let's tell everyone that helmets are great!" The finished song will be recorded on a CD and played for his classmates at school, both celebrating his helmet, and improving his with self-esteem.

A young woman, who is non-verbal, was experiencing depression about her car accident. The music therapist offered to help her write a song about it, providing her the opportunity to express her feelings. Lyrics describing how she felt were signed to the music therapist and family members. The music therapist provided musical options for the young woman, who indicated one chord vs another, the melodic direction to ascend or descend, and other musical decisions with a thumbs up or thumbs down. The song was recorded to a CD. When the CD was played for the young woman, she indicated tears by running her finger down her cheek from her eye to her chin. When asked if the song sounded "like her", if it reflected what she intended to express, she signed "yes". She continued, "Now they don't only know my words, they know how I feel." By adding the musical qualities to her lyrics, the message went beyond "words", but also portrayed her heart, the emotions she wanted to express.

Conclusion

Music, with its characteristics and its neural stimulus, is an effective intervention for individuals with ABI. It can address both functional and psychosocial goal areas. Because music is a pleasant experience, it can be rewarding and motivating when used as a tool working towards rehab goals.

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Cheryl Jones MMT, NMT-F, MTA holds her Masters of Music Therapy from Wilfrid Laurier University. She has advanced training in Neurologic Music Therapy from the Bio-medical Research Centre at Colorado State University. Cheryl is a researcher for the Conrad Institute for Music Therapy Research. She is a fellow of the Robert F. Unkefer Academy of Neurologic Music Therapy, is a member of the Network of Neurologic Music Therapists, and of the International Society of Clinical Neuromusicology.
She currently resides in Ottawa where she maintains a private practice Con Brio Music Therapy.
She may be contacted at: con.brio.piano@gmail.com.