A Collaborative Approach to Music Therapy Practice in Sensorimotor Rehabilitation

Abstract

A key component of clinical decision making with neurological patients is a good understanding of the most current theories of motor control in neurological rehabilitation. Current approaches recognize that movement emerges from an interaction between the individual, the task, and the environment in which the task is being carried out. It follows that movement is not the result of muscle-specific programs or stereotyped reflexes, but results from a dynamic interplay between perception, cognition and actions systems (Shumway-Cook & Woollacott, 2001). Numerous studies now support the motor learning approach or task-oriented approach to treating people affected by neurological disorders. This approach is defined as training or therapy where patients ''practice context-specific motor tasks and receive some form of feedback''(Teasell, Foley, Salter, & Jutai, 2008).Task specific training focuses on improvement of performance in functional tasks through goal directed movement and repetition. The emphasis of training is on function versus impairment. Increasing evidence also suggests that neural plastic changes are associated with task specific training (Richards, Stewart, Woodbury, Senesac, & Cauraugh, 2008), and learning is reported to be maximal for specific task related training (Goldstone, 1998).A major contributor to current theories of neurological rehabilitation is the evidence for brain plasticity, which refers to the brain's ability to reorganize itself in response to changes in behavioral demands (Rossini, Calautti, Pauri, & Baron, 2003). Both healthy and injured brains possess this capacity and therefore this ability is always active. With neuromotor interventions, neuroplastic changes and functional recovery have been demonstrated in the brain following ischemic stroke. An increasing number of researchers demonstrate changes in brain activation patterns following task-specific training (Richards et al., 2008). Evidence supports the components of task specific training which include ''real world'' or context specific activities, in a randomly ordered practice, with emphasis on repetition, and includes mass practice with the aim of reconstruction of the whole task (Hubbard, Parsons, Neilson, & Carey, 2009; Shumway-Cook & Woollacott, 2001).Clinical rehabilitation involves intensive work for patients with neurological disease or disorder. The authors have devised a collaborative approach to helping patients achieve functional real-world outcomes. Collaborations are encouraged between the physical, occupational, speech, and music therapists, each contributing unique research and clinical-based knowledge to the treatment team. For the purpose of this article, collaboration between physical and music therapies will be illustrated through three clinical vignettes.Neurologic Music TherapyThe practice of Neurologic Music Therapy (NMT) automatically incorporates the fundamental principles of motor rehabilitation. As the vignettes will clarify, NMT interventions emphasize goal-directed movement and repetition of functional tasks, while also providing immediate feedback on patient performance so that necessary adjustments can be made. By being based in motor control theories, NMT practice lends itself well to a collaborative treatment approach. Before entering into a discussion of collaborative rehabilitation techniques, a summary of the scientific foundations of Neurologic Music Therapy is in order.The principles and effectiveness of NMT techniques in the sensorimotor domain have been demonstrated by basic research. Music neuroscience researchers have found that intrinsic rhythmicity and temporality of music creates a framework for structuring learning and training to facilitate and shape neuroplasticity through synchronization and entrainment (Thaut, 2005).Entrainment is a key principle in sensorimotor rehabilitation in NMT and can be described as the magnet effect of auditory rhythm to synchronize and entrain movement patterns. …