by Melissa D. Carter, Attorney at Law
Music Therapy and Traumatic Brain Injury
It has been over one year since the Tucson shooting spree that killed six people and injured twelve, including Arizona Rep. Gabrielle Giffords, who survived a gunshot wound to the left hemisphere of her brain, occurred. Interestingly, although she was not able to talk, she began finding her voice just 5 weeks after the shooting, through song. Music has been demonstrated to help certain patients with traumatic brain injury, stroke or other neuromuscular problems in dramatic ways, including even regaining the ability to walk.
Protocols like music speech stimulation and melodic intonation therapy have helped patients like Giffords with damage to the brain’s communication center learn to speak again. In an interview with ABC News, Giffords’ music therapist (“MT”) and certified brain injury specialist at TIRR Memorial Hermann Rehabilitation Hospital in Houston, Meaghan Morrow, said, “It’s creating new pathways in the brain. Language isn’t going to work anymore, so we have to go to another area and start singing and create a new pathway for speech.”[i] Music is also linked to the brain’s areas that control memory, emotions, and even movement. “The thing about music is that it’s something that’s very automatic — part of our old brain system,” Morrow said. “If I play a rhythm, I can affect the rest of the body. The body naturally aligns with a rhythm in the environment.”
Indeed, a person who has suffered an injury due to stroke or trauma may have difficulty speaking, but be able to sing. “Patients can be essentially mute, unable to utter a single word, but put on the Beatles’ ‘All You Need is Love,’ and suddenly patients can sing. Substitute some of the words and now patients are speaking again,” said Dr. Michael De Georgia, director of the Centers for Neurocritical Care and Music and Medicine at University Hospitals Case Medical Center. “Music is very powerful.”[ii]
Evidence supporting a healing role for music in the recovery from traumatic brain and spinal injury is mounting. But many people remain skeptical, and currently, few insurers will cover it.
Music Therapy Following Spinal Fusion Surgery
A recent study (Charmaine Kleiber & Mary Adamek (The University of Iowa)[iii]) observed the effects of music therapy on adolescents who undergo spinal fusions for adolescent idiopathic scoliosis (AIS). This therapy was intended as an intervention to decrease postoperative pain intensity in adult samples. In the study, the MT visited AIS patients on postoperative day 2, when the adolescent got out of bed and moved into a chair for the first time.
Teens’ reported changes in perceptions of pain and mood following music therapy, with most experiencing decreased pain and decreased negative emotions such as anger and anxiety. They commented on the importance of individualizing therapy, including the ability to choose preferred music. The presence and interaction with the MT was perceived to be an important part of the therapy. Preparation for surgery was a strong theme. Most participants thought that it would be useful to know about music therapy before surgery. Suggestions were to hear advice from previous AIS patients, know how music therapy would help, bring preferred music, and practice relaxation with the music preoperatively.
How Does Music Therapy Help Those Affected By Trauma?
Music therapy benefits patients across the spectrum, from premature infants in neonatal intensive care units responding to lullabies to swing band numbers increasing elderly Alzheimer’s patients’ moods and appetites. Music therapy has been shown to have a significant effect on an individual’s relaxation, respiration rate, self-reported pain reduction, and behaviorally observed and self-reported anxiety levels. A coordinated program of music and music therapy interventions in response to trauma, designed and implemented by a qualified MT, provides opportunities for:
- Non-verbal outlets for emotions associated with traumatic experiences
- Minimizing or alleviating pain
- Promoting movement for physical rehabilitation
- Anxiety and stress reduction
- Positive changes in mood and emotional states
- Active and positive participant involvement in treatment
- Enhanced feelings of control, confidence, and empowerment
- Positive physiological changes, such as lowering blood pressure, reducing heart rate, relaxing muscle tension, and inducing sleep
What Do Music Therapists Do?
MTs use music and music therapy interventions, both instrumental and vocal, designed to facilitate changes that are non-musical in nature. Music therapy programs are based on individual assessment, treatment planning, and ongoing program evaluation. The professionally trained MT utilizes individualized music experiences and interventions to assess, treat, and evaluate patients. Frequently functioning as members of an interdisciplinary team, MTs implement programs with groups or individuals addressing a vast continuum of outcomes.
The Music Therapist’s Road to Accreditation
The first music therapy degree program was founded at Michigan State University in 1944 and a professional organization, The American Music Therapy Association (AMTA), was founded in 1998. The AMTA was founded to progressively develop the therapeutic use of music in rehabilitation, special education, and community settings. Predecessors to the AMTA included the National Association for Music Therapy, founded in 1950, and the American Association for Music Therapy, founded in 1971. The AMTA is committed to the advancement of education, training, professional standards, credentials, and research in support of the music therapy profession.[iv]
There are over 70 approved music therapy programs in the nation’s universities and colleges. Graduates are eligible to take a national examination administered by the Certification Board for Music Therapists (CBMT), an independent, non-proﬁt certifying agency fully accredited by the National Commission for Certifying Agencies. After successful completion of the CBMT examination, graduates are issued the credential necessary for professional practice, Music Therapist-Board Certiﬁed (MT-BC). In addition to the MT-BC credential, other recognized professional designations are Registered Music Therapists (RMT), Certiﬁed Music Therapists (CMT), and Advanced Certiﬁed Music Therapist (ACMT) listed with the National Music Therapy Registry.
MTs offer services in medical hospitals, skilled and intermediate care facilities, rehabilitation hospitals, adult day care centers, senior centers, hospices, psychiatric treatment centers, drug and alcohol programs, schools and other facilities. Some MTs are self-employed and work as independent contractors, while others may be full or part-time employees.
Traditionally unaccepted as a therapeutic modality, and subsequently denied by insurance companies for treatment of traumatic injuries, music therapy is on the raise and becoming more accepted throughout the country as an effective (and, oftentimes, covered) treatment method for patients. The skepticism, however, is changing rapidly. With the rise of music therapy programs at the university level (Seattle Pacific University recently adopted the first undergraduate music therapy program in the state of Washington, for example), along with the recent media exposure of this treatment method for patients suffering from traumatic brain injury, such as that for Gabby Giffords, music therapy is now becoming a recognized treatment approach around the country and locally.
For more information on music therapy programs and MTs in the greater Seattle area, please see the Music Therapy Association of Washington (ww