Music Therapy Protocols

Overview

The information on this page is derived from research articles, books, websites, presentations, and collaborations with music therapists. It is also derived from the personal experience of the author, Martha Summa-Chadwick. Dr. Summa-Chadwick, although not a certified music therapist, has a vast amount of experience working with children who have intellectual and developmental disabilities.

Historically, music therapy began as a vocation during World War II, when musicians volunteered at military hospitals, where they facilitated instrumental and choral ensembles and created music for the soldiers that expedited recovery from war injuries. Caregivers noticed that these soldiers felt better after hearing or performing the music, but did not know why. Demand grew for more musicians at the hospitals, and it became evident that some kind of education was needed for the musicians in order to attain the highest possible therapeutic outcome for the soldiers. Training began in several venues, and the first university undergraduate degree program for music therapy was established in 1944 at Michigan State University. The Certification Board for Music Therapists was formed in 1983 to ensure a standard of excellence in the development, implementation, and promotion of an accredited certification program for safe and competent music therapy practice. Supporting professional organizations eventually unified in 1998 to create the American Music Therapy Association (AMTA), the current professional organization for music therapy.

Music therapy, as defined by the AMTA, is classified as the clinical, evidence-based practice of music interventions to accomplish individualized nonmusical goals within a therapeutic relationship. Board-certified music therapists earn a minimum of a bachelor’s degree, which includes a six-month clinical internship. Music therapy formed as a combination of musical training and social science. With the advent of brain-imaging equipment and techniques in the 1990s, knowledge grew in neuroscience regarding brain processing and music, and this information was incorporated into the education and training of music therapists. As the music therapy profession grew over time, a knowledge base was created and secured to give music therapists many different tools to utilize and protocols to follow.

Research shows that the neural reponses to music positively affect the entire central nervous system. Rhythm is the most important factor in most music utilized in therapy. The brain oscillations tend to synchronize with the music rhythm, and the heart rate is also affected. A high percentage of music therapy protocols result in brain plasticity, when new neural growth is developed as a result of musical engagement and task repetition. Some diseases or syndromes unfortunately affect neural areas that cannot grow new cells, but functional improvements are sometimes possible with music therapy. For example, Bijan’s Grandfather Hakeem has Parkinson’s disease that has affected an area of the brain within the basal ganglia, which cannot grow new cells. Even so, Grandfather Hakeem has success with gait training that helps him attain a better quality of life.

Music for therapy is most effective when it is the style of music that the individual prefers the most. Preferences could mean that a music therapist utilizes varying genres of classical, pop, jazz, rock, hip-hop, or children’s music. Clients who cannot express a particular musical preference are more likely to respond to the music popular during their young adult years. For example, someone affected by dementia who was born in the early 1950s and who has lost the ability to initiate speech may have a favorite genre of musical influences from the mid-1960s through early 70s, such as the Beatles, Carole King, or Aretha Franklin. Different people will enjoy various genres of classical, jazz, Broadway tunes, rock, hip-hop, or children’s songs.

In many rehabilitative cases, the tempo, or speed in beats per minute (BPM) of the music, is key to therapeutic outcomes. In music therapy, goals are created for each individual based on their diagnosis or challenge. For example, a hyperactive child may come to a music therapist to calm and stabilize active behaviors in order to facilitate learning social or academic skills. The child may enter the session walking at 132 BPM. Since the heart rate will be influenced by the music, a music therapist could musically match the 132 BPM and quickly decrease the music tempo to 120 BPM or less, as the child’s behavior and movement adjust to the new tempo.

Muscles involved in activities such as gait or symmetrical body movement will entrain to the music. The muscular flow automatically follows the natural pace of the music to ensure that the movement becomes smoother and more stable. For speech disorders, disabilities could range from a nonverbal child with autism to an adult who has aphasia following a stroke. Since music is processed in both hemispheres of the brain, singing can be possible even when there are issues with speech.

Music can also help cognition challenges. Cognitive malfunctions can result in problems with executive functioning, memory loss, or inability to focus attention on a task. Such challenges can result from neurodevelopmental disorders, disease, or trauma. For example, someone who had a stroke that affected the left frontal lobe may have the same challenges as someone who had left frontal lobe damage as a result of traumatic brain injury (TBI).

The following sections will focus on techniques that help the young protagonist Trevor with his motor skills, memorization of information, and ability to focus attention.

Link - Music Therapy definition: the American Music Therapy Association

“

"Music therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credential professional who has completed an approved music therapy program."

“

Motor

Music and gait

The first technique introduced is gait training using music. Mrs. Hopkins recognizes that Trevor’s gait is awkward and could be helped with music. His lack of coordination in walking and running has limited his participation in childhood activities. This technique works rhythmically with gait and can be utilized for persons with autism, stroke, or any disorder or trauma that adversely affects gait. Trevor adapts it into his “Skally walk,” which trains his muscles to flow rhythmically. Mrs. Hopkins selected 92 BPM for Trevor’s walking rhythm, because she knew that would be a steady beat neither too fast nor too slow for him to stabilize his muscular movement. If the goal is to encourage the muscles to move faster or slower, the technique would be adapted to fit the goal. As mentioned previously, a young child with ADHD may have a functional tempo of 132, but as the BPM is decreased in increments, the body will gradually adjust to the new tempo. The reverse would happen with someone recovering from a stroke who could at first only walk at 60 BPM; the therapist would gradually increase the tempo to encourage the patient to be able to walk at a faster rate.

Link - Auditory Rhythmic Stimulation for Gait Training

“

"Gait training in the rehabilitation of different movement disorders has had multiple treatment approahces, one of the most current and with greater evidence for its facilitating effect for functional walking is auditory rhythmic signaling, acoustic rhythmic cueing or auditory rhythmic stimulation."

“

Speech

Help for speech

Mrs. Hopkins does not use any specific speech techniques with Trevor because he is completely verbal and has no issues such as stuttering or slurring his syllables. Trevor is fascinated by the alphabet images in her studio that show how the mouth and tongue form vowels and consonants. Mrs. Hopkins has utilized speech techniques for other clients; they include spontaneous singing of syllables in familiar songs, rhythmic speech cuing to form syllables to beats of music, and also repetition of certain sung phrases to assist those with aphasia or apraxia.

Grandfather Hakeem could benefit from singing to help his Parkinson's disease. Parkinson’s choirs are effective vehicles to keep the speech flowing and stronger. As PD progresses, the voice is affected to the point where there is no projection of sound, along with some slurring of syllables. Singing can help maintain speech for a much longer time.

Link - The choir improving Parkinson’s symptoms one note at a time

“

"Research has shown that singing regualarly can improve Parkinson's symptoms and slow the progression of the disease. In Choir, we are always working on things like volume, breath support, and articulation. We even practice conveying emotion and energy to the audience."

“

Cognition

Attention control and memory

Attention control - To help Trevor focus his attention, Mrs. Hopkins uses musical exercises as games to help him focus. In the exercise, she has him follow a repetitive rhythmic lead. When she suggests that Deena become the heckler and try to distract Trevor, he learns to practice selective attention. This is a valuable skill for anyone sitting in a classroom. Picture a class of students bent over their desks in silent concentration, when the class door opens with someone carrying a message from the office. If the students are practicing selective attention with their work, they will ignore the intrusion and continue with their studies.

Memory - When the kids in the band create a song to help them memorize the parts of the circulatory system, they were utilizing music with mnemonics. creation of a musical segment or song helps to encourage “chunking” of information from short-term memory into long-term memory. An example of information being “chunked” together can be found in the childhood tune, the ABC song. Children start to learn the alphabet as toddlers and may be confused about the order of the letters. When they hear the ABC song, the individual pieces of information resolve themselves into one larger chunk. They can then recite the correct placement of the alphabet letters.

Trevor’s band creates a song to help them memorize the facts about the circulatory system. Other uses could be spelling names, learning the days of the week, or learning the order of the planets in the solar system. Trevor’s friend Tasha also used a singsong tune to help her learn her multiplication tables when she was younger.

Link - Cognitive and neural mechanisms underlying the mnemonic effect of songs after stroke

“

"Sung melody provides a mnemonic cue that can enhance the acquisition of novel verbal material in healthy subjects. Recent evidence suggest that also stroke patients, especially those with mild aphasia, can learn and recall novel narrative stories better when they are presented in sung than spoken format."

“