Music therapy has gained traction in medical fields in recent years. As an Occupational Therapist I mostly hear about music therapy in connection with paediatric rehabilitation and child development, or about the use of music with older adults within care facilities or day centres. Some formally (provided by a music therapist), and others informally - my mother runs a music group in a care home and tells of the fantastic results for individuals with advanced dementia who are able to reengage and gain improved quality of life. In recent years I have witnessed music therapy being used for clients with persistent disorders of consciousness (PDOC) and with other neurological conditions, like stroke or dementia.

Access to a music therapy, however, can be limited. It is not always well-understood, nor readily available and so this might not be as well-known as more common allied health professional roles (for example, Physiotherapy or Occupational Therapy). But there is merit - music therapy can enhance engagement and wellbeing whilst addressing particular therapeutic goals. This blog will explore what music therapy is, who can provide this, and what the benefits are.

What is music therapy?

Music therapy is the application of music to enhance function, engagement and quality of life.  Music therapy is increasingly being recognised within physical medicine and rehabilitation (Paul & Ramsey, 2001) to assist in the “physical recovery and health maintenance of clients.” Music therapy can enhance participation in rehabilitation, but is not only applicable for physical rehabilitation.

If I think about music, I know that certain music can lift my mood and make me feel energised; it helps me maintain a walking/running pace when exercising and help with motivation. There are days when music ‘speaks’ to my state of mind – I can be feeling sad and music helps to express how I feel. There are times when music brings back vivid memories of school shenanigans and events – a favourite song with my best friend, a set of songs that were played on a road trip. There are times when music also calms and aids relaxation when I’m feeling stressed or anxious or experiencing pain. Music can be many things and it is these musical properties and how they impact on psychological, motor and behavioural functions that validates this as a therapeutic medium. I have used music within sessions purely to elicit a ‘feel-good’ factor and help with pacing, but I am not a music therapist, only trying to apply some of the principles to promote well-being and participation.

A bit of theory:

Brancatisano, Baird and Thompson (2020) write that efficacy of music-based interventions can be investigated within four areas (listed below) and that treatment plans can be developed to consider individual capacities to target specific neurological symptoms:

• therapeutic contexts (individual or group therapy settings, listening or actively participating in music creation),
• active ingredients (or ‘capacities’ of music to effect motion and emotion, be highly accessible to all, induce physical movement, provide a non-linguistic form of communication) - music is “engaging, emotional, physical, personal, social, persuasive, and encourages synchronization of movement and speech” and these are the seven capacities of music that underpin it’s therapeutic value,
• neural mechanisms (how the brain processes music and how music can result in neural pathways being activated to enhance, for example, memory and language or neuroplasticity), and
• benefits (psychosocial, behavioural, cognitive and motor domains)

They developed the Therapeutic Music Capacities Model (TMCM - see Figure 1 below) to provide a framework that helps illustrate the core music components or capacities that account for its therapeutic benefits; they conceptualise how music is effective.

Figure 1 Therapeutic Music Capacities Model (https://ars.els-cdn.com/content/image/1-s2.0-S014976341930243X-gr1.jpg)

 The TMCM illustrates how capacities are combined within music to provide therapeutic benefit, using similar capacities/components that are used within behaviour therapies, motor learning, psychotherapy and other rehabilitative practices. However, where an activity may make you feel emotionally better, adding music can enhance motor, social and emotional systems in a greater manner, thereby effecting greater impact.

Who can provide music therapy?

A recognised music therapist provides music therapy. To become a music therapist the UK National Careers advises that you have a degree in music, although a degree in education or psychology would be considered for individuals with high musical ability. A registered Music Therapist will have completed a post-graduate qualification in music therapy and registered with the Health and Care Professions Council (UK) or similar in other countries.

In the UK, there is a British Association for Music Therapy which provides additional information about music therapy and which Music Therapists can become members of.

What are the benefits of music therapy?

As highlighted in the TMCM (Figure 1) music can yield benefits in four functional domains:

• Cognitive (memory, attention, visual awareness, prevention of decline)
• Psychosocial (decrease in depression & anxiety, improvement in identity, empathy)
• Motor (verbal fluency and physical movement)
• Behavioural (decrease in agitation and isolation, increase in communication and bonding)

How we self-regulate our emotions, respond to stimuli, communicate or move relies on neural pathways within our brain, which music can influence in a therapeutic manner because it’s seven capacities:

1. Engaging
2. Emotional
3. Physical
4. Synchronous (including movement and speech)
5. Personal
6. Social
7. Persuasive

Music therapy, like other therapies, can be restorative (to help regain skill or function), compensatory (to compensate for a loss in function along with other tools such as memory aids), or psycho-social-emotional (to facilitate emotional expression and adjustment to disability). Music can reach us on a personal level to enhance the therapeutic approaches.

My mother told me about a woman who had difficulty talking, but could sing phrases and how this became a method of communication between them. I have seen people with Parkinson’s Disease achieve a better walking rhythm when music is played. Music therapy can also have effects on “communication, swallowing, breathing … to improve the quality of life of people with PD” (Machado Sotomayer et al., 2021). I have experienced psychosocial and behavioural benefits and seen how music can elicit smiles and reminiscence in adults, or a boost of energy in children. Music can also reduce tone in individuals with spasticity (Jeba & Joshi, 2016) and facilitate relaxation and well-being.

Music is inherent in my life and many others’ lives, and one does not have to have a musical ability to appreciate it. The beauty of music is that it is readily accessible and we respond to music.

Although I play the piano (active participation and self-expression), I have a far more eclectic and varied appreciation of music that I listen to (passive participation, socialisation, communication). I have conversations with friends about a really lovely piece of music they’ve heard and when we get together we’re having to take turns to share our playlists of our favourites – we bond over music.

I have been incredibly fortunate to see music therapy becoming more common place for individuals with neurological conditions, considering the benefit it can have on individual functioning, as well as social inclusion when music therapists have complemented therapeutic teams by providing guidance for input and sessions, focusing on particular skills development and reinforcing transdisciplinary goals that the client has identified.

What next?

To further explore and understand music therapy I am very excited to be offering an online event with Elizabeth Nightingale, Music Therapist (https://www.chilternmusictherapy.co.uk/) where we will hear about music therapy in greater detail considering neurological conditions, touching on posture care management and applications of music therapy across all ages. This will be advertised on our website, LinkedIn, Facebook, Twitter and Instagram – follow us so you don’t miss out on the event!

 In the meantime, put on your music that speaks to you, motivates you, calms you. And if you or a loved one requires this valuable therapeutic tool, find a Music Therapist that can support you on your journey to achieve your goals.

Bibliography:

• Brancatisano, O., Baird, A., & Thompson, W. F. (2020). Why is music therapeutic for neurological disorders? The Therapeutic Music Capacities Model. Neuroscience & Biobehavioral Reviews, 112, 600–615. https://doi.org/10.1016/j.neubiorev.2020.02.008
• Brancatisano, O., & Thompson, W. F. (2019). Seven Capacities of Music That Underpin its Therapeutic Value in Dementia Care. In A. Baird, S. Garrido, & J. Tamplin (Eds.), Music and Dementia: From Cognition to Therapy (p. 0). Oxford University Press. https://doi.org/10.1093/oso/9780190075934.003.0003
• Gutgsell, K. J., Schluchter, M., Margevicius, S., DeGolia, P. A., McLaughlin, B., Harris, M., Mecklenburg, J., & Wiencek, C. (2013). Music Therapy Reduces Pain in Palliative Care Patients: A Randomized Controlled Trial. Journal of Pain and Symptom Management, 45(5), 822–831. https://doi.org/10.1016/j.jpainsymman.2012.05.008
• Jeba, C., & Joshi, D. (2016). Influence of music therapy on spasticity, functional independence and quality of life in subjects with hemiplegia: A randomized controlled trial. International Journal of Neurorehabilitation, 3(219), 2376–0281.
• Korhan, E. A., Uyar, M., Eyigör, C., Hakverdioğlu Yönt, G., Çelik, S., & Khorshıd, L. (2014). The Effects of Music Therapy on Pain in Patients with Neuropathic Pain. Pain Management Nursing, 15(1), 306–314. https://doi.org/10.1016/j.pmn.2012.10.006
• Kwak, E. E. (2007). Effect of Rhythmic Auditory Stimulation on Gait Performance in Children with Spastic Cerebral Palsy. Journal of Music Therapy, 44(3), 198–216. https://doi.org/10.1093/jmt/44.3.198
• Machado Sotomayor, M. J., Arufe-Giráldez, V., Ruíz-Rico, G., & Navarro-Patón, R. (2021). Music Therapy and Parkinson’s Disease: A Systematic Review from 2015–2020. International Journal of Environmental Research and Public Health, 18(21), Article 21. https://doi.org/10.3390/ijerph182111618
• Paul, S., & Ramsey, D. (2000). Music therapy in physical medicine and rehabilitation. Australian Occupational Therapy Journal, 47(3), 111–118. https://doi.org/10.1046/j.1440-1630.2000.00215.x
• Ray, K. D., & Mittelman, M. S. (2017). Music therapy: A nonpharmacological approach to the care of agitation and depressive symptoms for nursing home residents with dementia. Dementia, 16(6), 689–710. https://doi.org/10.1177/1471301215613779
• Redding, J., Plaugher, S., Cole, J., Crum, J., Ambrosino, C., Hodge, J., Ladd, L., Garvan, C., & Cowan, L. (2016). “Where’s the Music?” Using Music Therapy for Pain Management. Federal Practitioner, 33(12), 46–49.