Editor’s note: The use of music in therapy for the brain has evolved rapidly as brain-imaging techniques have revealed the brain’s plasticity—its ability to change—and have identified networks that music activates. Armed with this growing knowledge, doctors and researchers are employing music to retrain the injured brain. Studies by the authors and other researchers have revealed that because music and motor control share circuits, music can improve movement in patients who have suffered a stroke or who have Parkinson’s disease. Research has shown that neurologic music therapy can also help patients with language or cognitive difficulties, and the authors suggest that these techniques should become part of rehabilitative care. Future findings may well indicate that music should be included on the list of therapies for a host of other disorders as well.
The role of music in therapy has gone through some dramatic shifts in the past 15 years, driven by new insights from research into music and brain function. These shifts have not been reflected in public awareness, though, or even among some professionals.
Biomedical researchers have found that music is a highly structured auditory language involving complex perception, cognition, and motor control in the brain, and thus it can effectively be used to retrain and reeducate the injured brain. While the first data showing these results were met with great skepticism and even resistance, over time the consistent accumulation of scientific and clinical research evidence has diminished the doubts. Therapists and physicians use music now in rehabilitation in ways that are not only backed up by clinical research findings but also supported by an understanding of some of the mechanisms of music and brain function.
Rapid developments in music research have been introduced quickly into neurologic therapy (see sidebar) over the past 10 years. Maybe due to the fast introduction, the traditional public perception of music as a ‘soft’ addition, a beautiful luxury that cannot really help heal the brain, has not caught up with these scientific developments.
But music can. Evidence-based models of music in therapy have moved from soft science—or no science—to hard science. Neurologic music therapy does meet the standards of evidence-based medicine, and it should be included in standard rehabilitation care.
Where We Started
While the notion that music has healing powers over mind and body has ancient origins, its formal use as therapy emerged in the middle of the 20th century. At that time, music therapists thought of their work as rooted in social science: The art had value as therapy because it performed a variety of social and emotional roles in a society’s culture. In this early therapy, music was used, as it had been through the ages, to foster emotional expression and support; help build personal relationships; create and facilitate positive group behaviors; represent symbolically beliefs and ideas; and support other forms of learning. In the clinic, patients listened to music or played it together with the therapists or other patients to build relationships, promote well-being, express feelings, and interact socially.
Because early music therapy was built upon these laudable and important but therapeutically narrow concepts, many in health care, including insurers, viewed it as merely an accessory to good therapy. For decades it was difficult to collect scientific evidence that music therapy was working because no one knew what the direct effects of music on the brain were. Now, however, the approaches that are central to brain rehabilitation focus on disease-specific therapeutic effects, demonstrated by rigorous research.
A New Scientific Model: Neurologic Music Therapy
Biomedical research in music has led to the development of “clusters” of scientific evidence that show the effectiveness of specific music interventions. Researchers and clinicians in music therapy, neurology, and the brain sciences have classified these evidence clusters into a system of therapeutic techniques that now is known as neurologic music therapy (NMT).17 This system has resulted in the unprecedented development of standard clinical techniques supported by scientific evidence. Because NMT is research-based, it will continue to develop, informed by new knowledge.
Five basic definitions articulate the most important principles of neurologic music therapy:
• It is defined as the therapeutic application of music to cognitive, sensory, and motor dysfunctions due to disease of the human nervous system.
• It is based on neuroscience models of music perception and the influence of music on changes in non-musical brain functions and behavior.
• Treatment techniques are based on data from scientific and clinical research and are directed toward non-musical therapeutic goals.
• Treatment techniques are standardized in terminology and application and are applied as therapeutic music interventions (TMIs), which are adaptable to a patient’s needs.
• In addition to training in music and NMT, practitioners are educated in the areas of neuroanatomy and physiology, brain pathologies, medical terminology, and rehabilitation of cognitive, motor, speech, and language functions.