Neurologic Music Therapy in Stroke Rehabilitation

Thaut, M.H., & McIntosh, G.C. (2014). Neurologic music therapy in stroke rehabilitation. Current Physical Medicine and Rehabilitation Reports Online Journal, 2(2), 106-113.

Summary:

Neurologic Music Therapy (NMT), established as a new model for music in medicine based on scientific research findings, is proving to be effective in stroke rehabilitation in speech/language, cognitive, and sensorimotor domains. It consists of standardized clinical interventions derived from structures and patterns in music that engage the brain in ways that can be translated to nonmusical therapeutic contexts. Research suggests that music can stimulate complex sensorimotor, cognitive, and affective processes, and that these processes can be transferred to functional therapeutic applications. Thaut states that “the brain that engages in music is changed by engaging in music,” alluding to the reciprocal relationship of music and brain function, and the role of music training in facilitating the experience-driven plasticity that supports rehabilitative gains. According to Thaut, new insights generated by neuroscience research in music have contributed to a paradigm shift from a social science, interpretative model to a perceptual, neuroscientific model of music therapy.

Several studies conducted since the mid-1990s, precipitated by early evidence of the complex interactions between auditory and motor systems, have demonstrated that rhythmic entrainment of motor function is instrumental in the recovery of movement in patients following a stroke. Basic gait parameters, including velocity, step cadence, and stride symmetry improve with rhythmic cuing, leading to more efficient motor unit recruitment. By entraining to the rhythmic period, motor movement can be scaled and mapped to fit the duration of the rhythmic cue. While upper limb movement is not intrinsically rhythmic, NMT techniques have been developed that turn functional movement involving the upper body into patterns cued by auditory stimuli. Patterned Sensory Enhancement (PSE) translates temporal, spatial and force-dynamic movement components into sound patterns used to enhance motor control, while Therapeutic Instrumental Music Performance (TIMP) engages clients in practicing functional movement using musical instruments. Studies have demonstrated improvements including increased range of motion, and reduced variability of movement during forward reaching.

Music has been used in the recovery of speech function since the early 1970s, when “melodic intonation therapy” (MIT) was developed to support patients recovering from Broca’s aphasia. Though a significant amount of research has been conducted supporting its efficacy, much of it has involved small sample sizes due to difficulties in finding homogenous study samples for aphasia research. Neuroimaging has, however, provided evidence of neuroplasticity induced by MIT, rerouting speech production from the damaged left hemisphere to the homologous, language-capable region of the right hemisphere.

Music stimulation has also been used successfully to overcome visual neglect resulting from lesions in the right hemisphere following a stroke or traumatic brain injury. Musical neglect training (MNT) is a standardized NMT technique that addresses hemispatial neglect using performance on instruments spatially configured to focus attention of the unattended visual field. Chord progressions and melodic patterns (e.g., on a xylophone with tone bars reversed to ascend from right to left) move the patient’s attention and movement progressively into the neglected visual field.

NMT has been developed as a result of both basic and clinical research into music and the brain, establishing evidence-based techniques to support rehabilitation following impairment of function due to neurologic disorders such as stroke. Research evidence supports the efficacy of NMT interventions in the areas of motor, speech/language, and cognitive rehabilitation.

Reflection:

NMT is a significant new model for music therapy, drawing on the rich findings from neuroscientific research and using these findings to develop interventions to support clients undergoing rehabilitation. Other models of music therapy have successfully adopted a psychotherapeutic approach, yet with the understandings gleaned in the past twenty years with respect to music and the brain, it is important that this knowledge be incorporated in clinical settings using music therapy to support clients suffering from neurologic disorders. NMT provides evidence-based techniques which are attractive to medical personnel seeking a scientific basis for interventions, and to medical systems seeking to use research findings to justify clinical expenditures. Patients benefit when music is brought into often sterile hospital environments, not only in terms of the functional therapeutic gains that are made, but also in having access to a creative, expressive medium, which is critical for social-emotional wellbeing following a catastrophic injury.

Music therapists have a pivotal role to play in recognizing the needs of the whole person, establishing clinical goals, and implementing interventions that promote client recovery. NMT provides training and techniques that enable music therapists to use music to address functional therapeutic aims. It is for this reason that Thaut has claimed a paradigm shift from social science to neuroscience as a model for music therapy. Yet music is an important medium for providing social-emotional support as well, and the music therapist is an important facilitator in this regard. Cultural factors also need to be considered in supporting client well-being. Doidge notes the reciprocal role between culture and the brain in neuroplasticity, stating that “not only does the brain shape culture, culture shapes the brain” (2007, p. 287). The music therapist must be skilled in drawing on a variety of culturally appropriate, clinical resources that address functional and psychotherapeutic aims in accordance with client need. Thaut has made a significant contribution to the field of music therapy, particularly in the area of rehabilitation, work which will no doubt continue to evolve as new insights emerge from both research and practice. As music’s multimodal effects can be used to support the whole person, it will be important for music therapists, in the context of a holistic perspective, to continue to develop their clinical skills in the service of their clients, while at the same time remaining current with respect to new research developments.        

Reference

Doidge, N. (2007). The brain that changes itself: Stories of personal triumph from the frontiers of brain science. New York, NY: Penguin Books Ltd.