What is Neurologic Music Therapy?
Neurologic Music Therapy
Neurologic Music Therapy (NMT) uses the nuances of music to promote and influence neuroplasticity. As a scientific-based model, it uses musical interventions to achieve goals in the cognitive, sensory, and motor domains for those experiencing a neurologic disease of the human nervous system, and it can be defined as, “The therapeutic application of music to cognitive, sensory, and motor function due to neurologic disease of the human nervous system” (Thaut, 1999). It is an evidence-based practice that employs standardized clinical techniques in areas of sensorimotor training, speech and language training, and cognitive training.
Sensorimotor Rehabilitation
These techniques are useful for individuals with motor issues related to neurological disorders, such as Parkinson’s disease, cerebral palsy, Huntington’s disease, and hemiparesis or spasticity due to stroke or a traumatic brain injury. The overall goals of sensorimotor training are to improve posture and gait, and to facilitate or enhance upper and lower extremity movement patterns. The most important feature of sensorimotor rehabilitation is the use of rhythm, or having a consistent beat available, to prime the body as needed. Rhythmic-based activities can be used to facilitate and improve an individual’s range of motion, joint mobility/agility/strength, balance, coordination, gait consistency or walking and relaxation.
Sensorimotor Rehabilitation Interventions
Rhythmic Auditory Stimulation (RAS) is an intervention to improve or normalize gait patterns by incorporating auditory stimuli within the client’s walking program. It uses rhythmic cues presented either as pure metronome beats or as strongly accentuated beats in complete musical patterns, to cue gait parameters such as step cadence, stride length, velocity, symmetry of stride length and stride duration, if the motor system in our brain is damaged, the central pattern generates can produce and coordinate movement patterns without the necessary training.
Pattern Sensory Enhancement (PSE) incorporates musical nuances to shape and guide movements accordingly. In this intervention, music is being used as a strong sensory cue that temporally structures and regulates movement patterns. The music itself, created in the moment, reflects the physical exercise that the client is required to do. For instance, if the client is to lift their leg, the music therapist can reflect this movement by going up in a scale.
Therapeutic Instrumental Music Performance (TIMP) is an intervention that involves the physical participation of playing an instrument, whether this is a drum or a piano. Therapeutically playing a musical instrument stimulates and trains functional non-musical movement patterns that are used in daily life, in an efficient and effective way. By playing a musical instrument, and having a consistent beat present ultimately creates a feedforward-feedback loop, which enables the individual to plan, anticipate, and execute the desired movement. The sound feedback from playing an instrument creates a meaningful “knowledge of result” feedback, while synchronizing to the auditory sound creates the feedforward loop. In addition, the instrument being played acts as target to hit, and can be used in functional exercises that are requires the patient to move toward or alternate between several targets.
Speech and Language Rehabilitation
Speech and language training incorporates a variety of techniques to develop and improve speech and communication skills. These techniques are useful for individuals who have lost speech due to degenerative diseases or acquired brain injuries. These techniques are also useful to improve respiratory function for those whose breathing may be compromised, strengthen oral motor structures, and develop verbal communication or symbolic communication through vocal interventions.
Speech and Language Rehabilitation Interventions
Melodic Intonation Therapy (MIT) pairs functional phrases to different melodies, such as, “May I have a coffee.” Through a repetitive process, the individual participating in MIT, will learn the melody first, pair the functional phrase to the melody, and then gradually take away the melody and the therapist’s prompting. When someone experiences an ABI, the Broca’s area of the brain can become damaged; therefore, the individual may be able to understand language, but have difficulty producing the desired words. Using music in speech and language rehabilitation is useful because music is interconnected throughout the brain so, even when the language cortex in the brain is damaged, music helps to access areas of the brain that are not damaged. By doing this, we physically moving the language cortex, for example, into the right hemisphere of the brain.
Musical Speech Stimulation (MUSTIM) incorporates musical materials, such as familiar songs, rhymes, chants, and phrases to stimulate prosodic speech gestures and trigger automatic speech. In many cases, non-propositional reflexive speech is unaffected after an ABI, and therefore overlearned musical phrases or songs can be used to stimulate spontaneous speech output. This is especially useful for aphasic clients or aphasia related to neurodegeneration, such as dementia.
Rhythmic Speech Cueing (RSC) uses auditory rhythm to control speech rate and improve temporal characteristics such as fluency, articulatory rate, pause time, and intelligibility of speaking. RSC has been shown to be effective in fluency disorder rehabilitation for stuttering and cluttering, in rate control to enhance intelligibility in dysarthric patients, and in facilitating rhythm sequencing in apraxia.
Vocal Intonation Therapy (VIT) is the use of vocal exercises to train, maintain, and develop aspects of voice control due to structural, neurological, or functional abnormalities of the voice apparatus, such as in Parkinson’s disease or COPD. This includes aspects of voice control such as inflection, pitch, breath control, timbre and dynamics.
Oral Motor and Respiratory Exercises (OMREX) is a technique used to improve articulatory control, respiratory strength, and vocal output. In this intervention, the client is physically playing an instrument that requires breath support, which are applied to enhance articulatory control and strength. These techniques may be applied in developmental disorders, dysarthria, muscular dystrophy, and other disorders affecting speech motor control and respiratory function.
Therapeutic Singing (TS) refers to the more generalized use of singing activities for a variety of therapeutic processes. Therapeutic singing addresses a wide spectrum of functions and it can be implemented with individual clients or groups of patients across all ages and diagnoses. Because therapeutic singing allows direct engagement in musical creation, it can be a very success-oriented technique, thus providing important motivational input in tandem with functional enhancements.
Developmental Speech and Language Training through Music (DSLM) is a specific use of developmentally appropriate musical materials and experiences to enhance speech and language development through singing, chanting, and movement. This technique is especially useful for individuals with protracted languages skills, such as low-functioning ASD, CP, or Rett Syndrome.
Symbolic Communication training through Music (SYCOM) is a technique that utilizes musical performance exercises to stimulate and train appropriate communication behaviours and emotional expression through a non-verbal language system. These exercises can effectively be used to train structural communication behavior such as dialoguing, using questions and answers, listening, and responding, appropriate speech gestures, appropriate timing of initiation and responding, initiating and terminating communication, and other communication structures in social interaction patterns. This intervention is designed for individuals with severe loss of expressive language or developmental delays.
Cognitive Rehabilitation
These techniques are useful for individuals who may have responsive behaviours due to an ABI, developmental delays related to information processing and attention, memory issues, and/or difficulty with executive functioning/decision-making skills. It incorporates the use of music-making and instrument playing to assist in decision making, attention, memory, and behaviours.
Cognitive Rehabilitation Interventions
Musical Sensory Orientation Training (MSOT) uses live or recorded music to stimulate arousal and recovery of wake states to facilitate meaningful responsiveness and orientation to time place, and person. Active engagement in simple musical exercises increases vigilance and trains basic attention maintenance with emphasis on quantity rather than quality.
Auditory Perception Training (APT) integrates auditory, visual, tactile and kinesthetic stimuli. It requires clients to identify and discriminate between specific elements of music such as tempo, pitch, duration, or timbre, and can be organized through active musical exercises such as symbolic or graphic notation, tactile sound transmission, or movement to music.
Musical Attention Control Training (MACT) incorporates musical exercises to improve attention skills, in which musical elements cue different responses. When linked with non-musical information, music adds structure and organization to information in order to increase the probability that attention will be focused, maintained, and/or switched.
Musical Neglect Training (MNT) includes active performance exercises on musical instruments that use appropriate spatial configurations of the musical instruments to focus attention on a neglected visual field. This intervention is specifically designed for individuals with neglect syndrome and requires individuals to search in the unperceived visual field.
Musical Mnemonic Training (MMT) uses music as a mnemonic device to sequence and organize information and add meaning, pleasure, emotion, and motivation to enhance the person’s ability to learn and recall information. Music, in this case, provides immediate stimulation and structure to the brain by introducing timing, grouping, and synchronizing for better organization and by recruiting shared or parallel brain systems to assist retain the given information.
Musical Echoic Memory Training (MEMT) is particularly useful for individuals with auditory memory dysfunctions due to stroke, TBI, cochlear implants, developmental disorders and dementia. MEMT uses the training of immediate recall of musical sounds presented by singing, instrumental playing, or recorded music to promote working memory.
Associative Mood and Memory Training (AMMT) uses music to enhance memory processes in three ways – by producing a mood congruent state, by activating associative mood and memory networks, and instilling a positive mood at both encoding and recall to enhance learning and memory function.
Musical Executive Functioning Training (MEFT) is the use of improvisation and composition exercises in a group or individually to practice executive function skills such as organization, problem solving, decision making, reasoning, and comprehension, within a social context that provides important therapeutic elements such as performance, temporal structure, creative process, affective content, sensory structure, and social interaction patterns.
Musical Psychosocial Training and Counseling (MPC) is a form of psychosocial behavior training involving guided listening, and active music making. This technique fosters social interactions, appropriate emotional expression, reality orientation, impulse control, mood management, and provides incentives for behavior modification. Musical exercises can be used to facilitate the “feeling” experience of emotions, identifying such emotions, and expressing these emotions.
