Music Therapy Can Support Rehabilitation and Psychosocial Goals Following a Stroke
A stroke can result in changes in several areas of a person’s life. The person may be working on rehabilitation goals in one or more areas including speech, movement, or cognition. They may also be working on psychosocial goals such as reducing depression or anxiety, increasing a sense of self-esteem, or building a new sense of identity post-stroke. Music Therapy can help support work towards all the above goal areas.
How Can Music Therapy Help?
Research investigating music cognition and music processing has provided evidence that music influences non-musical behaviour and that music can influence neural control centers for speech and movement. Music engages attentional processes, foundational for cognitive functioning.
Speech
Speech impairment, such as aphasia or apraxia, is a common outcome following a stroke. Music Therapy can support the physical aspects of speech such as respiratory strength, word retrieval and/or output, or the clarity of speech.
Because speech and singing share the same physical apparatuses, such as the lungs, lips, tongue, and facial muscles, the singers’ vocal work can be used to support the rehabilitation and strengthening of respiration or speech mechanisms.
Speaking and singing share some neural networks. Following a stroke in the left hemisphere resulting in speech impairment, a goal of music-based speech rehabilitation is to use melody combined with words to engage speech-supporting networks of the right hemisphere and to recruit unaffected areas of the left hemisphere.
Movement
Music can help to cue and organize a movement due to rhythmic entrainment. Rhythmic entrainment is a result of an external timing cue, a steady rhythm matched to the target movement parameters, that influences the motor cortex’s timing for the movement. The spontaneous matching of the motor cortex to the external timing cue helps to support the initiation, duration, and completion of a movement.
Music can also be used to sonify a movement. For example, a rising melody can reflect the target movement of an arm lift the length of the melody can demonstrate the distance of the lift, the tempo can indicate the speed of the movement, a chord change can cue a change in the movement sequence. For some individuals, after a stroke, following verbal directions can be confusing. This “musical picture” of a movement can provide a “different language” for the injured brain to receive and follow directions.
Cognition
Following a stroke, some individuals may struggle with attention or memory impairment. Components of music, such as rhythm or melody, engage attentional processes due to the brain tracking pattens and change. Music-based attention and memory tasks can be created to target specific forms of attention such as sustained attention, focused attention, and alternating attention. Music-based cognitive tasks can also address working memory and long-term memory.
Psychosocial
Music is expressive. It can convey meaning with or without words. For some individuals, creating music with the therapist can be a powerful form of self-expression and emotional release. This can be especially true for a person who has a speech impairment.
Music can provide a safe place to express anxiety or depression or to explore emotions. Improvising with the music therapist allows a person to share their feelings and to be heard and supported. Song writing can be a meaningful way to self- express or communicate with others.
Therapeutic Music Training
Therapeutic Music Training (TMT) is a music-therapy model in which learning to play the piano is designed to address cognitive goals of various forms of attention and memory. In addition to the cognitive benefits, there can be psychosocial benefits of improved sense-of-self and self-esteem. Because of the reward of learning to play music, the person is often more motivated to remain in the cognitive rehabilitation process.
Following a stroke, a person may have impaired use of one hand. TMT can be modified to learning to play one-hand songs.
Cheryl Jones
R P, PhD
Con Brio Music Therapy
Ottawa, ON
Cheryl Jones, PhD, has over 18 years experience working as a Music Therapist with a wide range of clinical populations and age groups. She is specialized in music-based rehabilitation following an acquired brain injury. She has been a guest lecture and teacher at several universities, most recently University of Miami. Her work has been published in several journals and was featured in two national CBC documentaries: Ideas and The Current. Prior to becoming an accredited music therapist, Cheryl maintained a full-time private piano studio in which she developed her own curriculum and teaching materials. She is also a registered psycho-therapist.