Neurologic Music Therapy and Stroke Rehabilitation
© Cheryl Jones MMT, NMT‐F
Published in SSAO: Stroke Recovery News, Nov. 09.
The individual who has experienced a stroke will face a number of changes in their life. They may now struggle with speech, either expressive or receptive. Motor skills may be impaired. Cognition may be affected with challenges in attention, memory, and processing time. All of these become goal areas for rehabilitation. Neurologic Music Therapy (NMT) has proven to be an effective intervention to work on each of these goal areas. NMT is based on a neuroscience model of music perception and production and the influence of music on nonmusical brain behaviours. NMT uses music to work towards functional, nonmusical goals. The three main goal areas are: speech and language, motor skills, and cognition.
How Does NMT Work?
Research has proven that the brain physically responds to musical stimuli and that music stimulates multiple sites within the brain. These research studies regarding neural activity and brain responses to music have provided important information that has been used to develop music therapy interventions for rehabilitation purposes. Music can elicit a response when other forms of stimulation fail due to brain damage. In some cases, music is processed in a different, but adjacent, area to the brain damage and is able to stimulate response. In time, this adjacent area may take over some of the functioning of the damaged area, such as in speech goals. In other cases, information provided through music is cognitively easier to decode and process than verbal directions. Music is effective when working on motor skills because auditory stimulus with a regular pulse results in a motor priming response of the muscles.
Music Therapy and SpeechAn exciting area in which music therapy has proven effective is in speech goals. Depending on the location of brain damage and the resulting speech impairments, music therapy uses a variety of interventions to support goals such as oral motor control, breath support, articulation, speech rate, and word finding. Melodic Intonation Therapy has proven effective with some forms of aphasia.
Music Therapy and Motor SkillsBecause auditory stimulus with a regular pulse results in a motor priming response, music is able to stimulate and support controlled movement. Musical qualities such as tempo (speed), dynamics (loud, soft), and rhythm can provide temporal and spatial cues for movement more effectively than verbal directions. For example, an individual experiencing difficulty processing verbal or multiple directions will struggle in a rehab session requiring them to lift their leg slowly, hold, and lower slowly. A music therapist assisting in the rehab session would play a simple ascending scale, the length as required for the range of motion goal for the leg. The ascending scale would become louder to cue that more force is required (lifting against gravity). The last note would be held to demonstrate how long to maintain the leg lift. Then the music therapist would play a descending scale passage to cue the individual to lower the leg. Using music rather than verbal directions enables some individuals to more easily understand what is being required of them. In other cases, playing various musical instruments is an effective and pleasant way to target specific motor skill goals.
Music Therapy and CognitionMusic 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 to aid in the recall of the various steps required for a specific skill.
Not only is music able to support the rehabilitation of functional goal areas, it is also a wonderful expressive tool. Individuals who have lost ability to communicate can be self‐expressive nonverbally through music. This provides affirmation and validation. Playing various instruments provides the stroke survivor with a sense of empowerment and success. Sharing music with another gives a sense of belonging and can help reduce the sense of isolation stroke survivors may feel. Music, able to stimulate response for goals areas of speech and language, motor skills, and cognition, is also able to address the psychosocial needs of the individual. Thus, music therapy is able to provide a holistic response to the needs of the stroke survivor.
Cheryl Jones MMT, NMT‐F, holds her Masters of Music Therapy from Wilfrid Laurier University. She has advanced training in Neurology and Music from the Bio‐medical Research Centre at Colorado State University. 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 in Neurologic Music Therapy. She may be contacted at: firstname.lastname@example.org.