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Music therapy and acquired brain injury

Author, Neil Frost, has been working with Priory Group for over 20 years and currently works with residents at The Vines, a neurorehabilitation centre in East Sussex.

He is the director of Musik Matters, which provides music therapy, music workshops and residential entertainment throughout the South East of England. He also leads both group and individual music sessions with clients with an acquired brain injury (ABI), Huntington’s disease, learning disabilities and autistic spectrum disorders (ASDs).

The evolution of music therapy

"(Music therapy) can make the difference between withdrawal and awareness, between isolation and interaction, between chronic pain and comfort – between demoralization and dignity." - Barbara Crowe (past president of the National Association for Music Therapy)

Throughout history, human beings have used music, rhythm and melody as a tool for communication, celebration, worship, healing and mood.

This is witnessed from the drumbeat of war to the combining of voices within worship or the steady rhythmic beat of our mother’s heart in those first moments of life.

Just think about when you last put on a piece of music to bring about a change in your mood or to help you relax or motivate you for the day ahead. Like me, I’m sure many of you reading this article have had thoughts of depression and anxiety as well as those nagging questions of ‘what’s the point?’ ‘What now?’ ‘If only?’

In those moments, I find that the medium of music can resonate and pacify. Listening to the right piece of music at the right time touches your soul – your very being. It could be punk, jazz, classical, pop, maybe the tone of the vocalist, but music is often able to give us the clarity we need and the hope to find solutions and continue our journey.

Music therapy as an intervention first came into being during the time of the First and Second World Wars. Professional and amateur musicians would put on performances for the returning troops who often return with physical and emotional trauma.

It was during these performances that the doctors and hospital staff noticed that the music was having a beneficial impact on the patients’ wellbeing and helping them cope with the aftermath of war. Hospitals began to increase the use of these musicians to come in and work with their patients and music therapy, in the modern sense, was born.

The first music therapy training courses started to happen at this point, the profession grew immeasurably in the years that followed and it is now a recognised clinical intervention throughout the world.

Music therapy and ABI

One of the major advantages of music therapy is its ability to lift mood and almost instantly change the dynamic of a group. This can be used to great effect with individuals who have an ABI. In my 20 years of working with ABI, two common symptoms that I have witnessed are low self-esteem and depression. Music can help individuals to combat these negative feelings and move into a better state through a balance of relaxation and stimulation guided by the therapist.

In group sessions I will often encourage individuals to use various instruments of their choice and follow the tempo and dynamics of the music being made. Individuals are encouraged to express themselves with the instruments as well as involve themselves in song and movement if they so wish.

Reminiscence plays an important part as it can be the bedrock of memories and familiarity that allows exploration and discussion to flourish and develop. By this, I mean that some of the most important music of our lives is the music that we listened to and lived through at key stages in our own story i.e. childhood, marriage, children….divorce. The music from these events can be very powerful and used to encourage discussions and reflection as well as looking ahead to future possibilities.

Group members will talk fondly about the fashions and hairstyles associated with the music from various eras as well as world events and personal memories.

Music can also play an important role in helping individuals to improve poor motor skill control and co-ordination. This can be achieved with developing hand-eye co-ordination, using the instruments to follow rhythm and one example could be using alternate movement on a maraca to synchronise the left and right side of the body.

Sometimes the use of action songs can aid motor skills and listening skills as the individual must listen to the cues given during the song and involve themselves at the appropriate time with the appropriate action.

Sharing memories in a group can be a cathartic release and can help people to identify someone else’s feelings, allowing for compassion and understanding from the peers that they live with. This understanding can help build social relationships and patience with other individuals.

Aphasia (the inability to comprehend or formulate language) can be aided using music therapy. I have found that many patients who are unable to talk are still able to sing. In general, the left hemisphere of the brain is working hardest to process and deliver speech. When these areas are affected due to stroke, legions or brain injury, the ability to form words and communicate becomes compromised.

Music and singing uses mainly the right side of our brain and several studies have shown that the melodic structures used when singing can help compensate for the damaged left side, allowing words to be formed within melodic context. Clinical studies are ongoing to determine the benefits of music therapy in this area.

I would like to share a case study which demonstrates the progress of one patient over a 10-month period. I will refer to him as ‘A’ in order to protect confidentiality.

Case Study A (months 1 to 10)

A was referred for music therapy due to withdrawal and depression. He was not joining group activities in the home and was sleeping much of the time. There was also a recent diagnosis of dementia.

Initial sessions with A were short and terminated by A after approximately 5-10 minutes. A’s attention span was short; he would not initiate conversation and found it difficult to maintain conversation.

A continued to accept music therapy and over the following weeks began to talk about musical likes and dislikes. As the working relationship grew, A would listen to music that he liked to play on the guitar and expanded further on specific artists that had touched him during his life.

After four months, A disclosed that he used to play a guitar and learnt some of the open chords. A remembered the pinnacle of his playing was when he mastered the sequence to ‘The House of the Rising Sun’. This admission made him laugh and his eye contact through the sessions had increased, as well as his verbal communication.

A was offered a guitar to re-learn ‘The House of the Rising Sun’. He agreed and started to hold the guitar and strum along on the strings as I played.

Seven months in and A was able to hold three chord shapes and agreed to join the group session in the following weeks and accompany me.

From months eight to now, A is attending several of the group sessions and bringing a guitar with him into the group. He involves himself in group discussions although he still requires some verbal prompting and encouragement. His depression appears to have diminished and he is coming out of his room more frequently during the week for other activities.

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