Article: The music therapy that helped Gabby Giffords speak again is getting dementia patients movin
This intriguing article, written by Stacey Burling of the Philadelphia Inquirer, shines a light on a model of the music therapy practice known as Neurologic Music Therapy. Wheeler (2016) broadly defines it as “the therapeutic application of music to cognitive, sensory, and motor dysfunctions due to neurological disease of the human nervous system.” Many know NMT as its results are commonly rapid and evident. But the “buzz” for NMT, as we see it shared often within the media, could be attributed to its structure, evidenced-based properties and rapid results for those experiencing it. Former congresswoman Gabby Giffords witnessed its impact firsthand as it allowed her to regain much of her speech and language after a traumatic incident.
In my own words, I see this practice as the toolkit needed to recreate impaired neurological pathways- all while utilizing motivational qualities of music!
But what IS NMT? What does it look like?
One of the most important aspects of the article is the way specific Neurologic Music Therapy techniques are explained. For those new to this model, Burling states that the process “…employs changes in rhythm, pitch and volume to cue movement” It also has implications for speech, language and cognitive processes, but the focus within this article is physical movement. Some examples of this might include:
-Strumming increasingly faster on guitar → increased walking speed
-Singing a melody that climbs higher in pitch → arms lift up into the air
-Growing louder in volume on piano → larger strides while walking
To get even more technical, NMT-trained (and star-studded member of the Keynote team) therapist Heath Marvel shared with me about his top 3 most implemented techniques in his current practice.
1. Associative Mood and Memory Training (AMMT): Adults with Alzheimer's disease and related dementias become increasingly confused and often agitated or aggressive as a result of their declining neurologic status. I often lead groups in skilled nursing facilities in which residents experiencing dementia can sing along to songs that they associate with positive memories that they can remember well. I will typically encourage reminiscing about the past when residents are able. Participants' caregivers and families often report improved mood and greater cooperation lasting several hours after the group.
2. Musical Attention Control Training (MACT): Recent evidence suggests that deficits in attention and motor skills in individuals with Autism Spectrum Disorder are likely the underlying cause of impaired social-emotional and communication skills. I have found this to be the case with a client of mine who participates in an intervention focusing on selective attention. I’ll play a song on guitar while he improvises on a drum. He is instructed to stop playing his drum whenever I randomly strike a triangle and then continue improvising when I play the triangle again. This intervention musically imitates an environment in which the client needs to be able to selectively focus on one person or thing in order to be successful, such as a classroom or a restaurant.
3. Patterned Sensory Enhancement (PSE): Many clients and patients of mine have impaired motor function due to neurologic impairments such as stroke, brain injury, and cerebral palsy. PSE uses the rhythmic, melodic, harmonic, and dynamic elements of music to provide cue for movement reflecting functional movements. With a patient with cerebral palsy who is working on moving from sitting to and from stand, I often do a PSE intervention using “The Elevator Song.” Patients are instructed to stand on the word “up” during the line “We go UP the elevator” and to sit with the word “down” during the line “We go DOWN the elevator”. I strum my guitar forcefully with ascending pitches on the “up” to musically cue the dynamic strength required to stand and then strum my guitar gently in descending pitches on the “down” to cue the controlled strength required for sitting down without a plop.
Hopefully by now it is becoming clear; the implications for Neurologic Music Therapy are widespread and diverse, supporting MANY areas of movement, healing and growth!
Circling back to the article, Burling takes the time to sit in and observe a music therapy group session led by Molly Bybee, a music therapist in the city of Philadelphia. As a music therapist, I definitely appreciate the journalist getting their information through direct observation and jumping right into a session. The group members were older adults with memory care needs with the goal area being increasing physical movement. Burling reports her biggest impression being that therapist Bybee was able to encourage multiple styles of movement, all while staying within the music.
Although this is a wonderful introduction and glimpse into the practice of Neurologic Music Therapy, readers should be informed that it is simply the tip of the iceberg! There are so many other ways this process and its specific techniques can be incorporated into work with various populations.
If you would like to learn more, check out these great resources:
Wheeler, Barbara. Music Therapy Handbook. 2016.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3610079/ (Research by Michelle Hardy and Blythe Lagasse surrounding rhythm, movement and neurologic music therapy for those with Autism Spectrum Disorder)