To continue our exploration of NMT in movement, I thought we could explore the benefits of NMT with people who have had a stroke. Chances are you know someone who has experienced this medical crisis considering that according to the CDC’s 2015 report, more than 750,000 people in the United States experience a stroke each year. About three-quarters of those strokes are occurring in people that have never experienced one before. That’s over 600,000 people experiencing a stroke for the first time each year! In regards to movement during the recovery phase of a stroke, it is typical for people to attend physical and occupational therapy to address things ranging from weakness to paralysis. The research tells us that when NMT is added into the treatment plan, recovery is enhanced. (I will offer more proof than just my word below!)
Three NMT techniques utilized to improve movement in stroke recovery are:
· Rhythmic Auditory Stimulation (RAS)
· Patterned Sensory Enhancement (PSE)
· Therapeutic Instrumental Music Performance (TIMP)
Between the three of these techniques, NMT’s can facilitate movement utilizing the elements of music (rhythm, tempo, dynamics, timbre, etc.) in both the lower and upper body, with discrete movements or cyclical movements, and even gait training.
If we start at the top and move down, we are looking at upper-extremity movements. Think reaching for a cup or putting something away in a cupboard. This can become enormously difficult to do utilizing the affected limb. Utilizing PSE, an NMT can design a musical phrase to provide cues and prompts that provide important feedback elements to assist in relearning these movements, (Thaut & Hoemburg, 2014a). Imagine if someone designed the perfect theme song for your morning routine- nice light slow music to wake up to as the sun rises, then the song builds energy as you step into the shower, and by the time you’re eating breakfast you are dancing along to a jig while you’re flipping pancakes! (I like to imagine that everyone has a Leave It To Beaver style life.) PSE bottles this feeling and provides it in a rehabilitation setting. In addition to the important feedback created- there is also rhythm! Always rhythm! (If you are unsure of why rhythm is important, please see the first post about movement!) The rhythm creates a timeline necessary for the movement to happen within and forces the brain to create the shortest path possible (the most efficient movement). *ANALOGY ALERT* Your brain is acting just like Google maps (or is Google maps acting like your brain?!) You tell maps that you need to arrive at your destination using public transportation by 3:45. It then calculates all of the possible routes and offers you the fastest available route that gets you to your destination on time! Your brain does the same thing when provided with an arrival time, or the beat. Moreover, Massie describes Thaut et al.’s 2002 study in which kinematic motion analysis testing showed improvements in stroke survivor’s reaching movements when they were provided with a rhythmic auditory cue. (Thaut & Hoemburg, 2014a).
To continue on the rhythm on feedback road, TIMP is also quite effective when utilized with upper-extremity movements as well as lower-extremity movements. When implementing the TIMP technique, instruments are utilized in the movement. For instance, kicking a tambourine that is placed in a strategic area to create the leg movement necessary to increase movement, flexibility, strength, etc, to rhythm of your favorite song. In Thaut and McIntosh’s 2014 paper, they explain that TIMP is advantageous when compared to nonmusical motor training due to reasons including the auditory feedback that occurs when the instrument is struck in correct way as well as the anticipation and timing forced by rhythm that was previously mentioned with PSE, (2014b). Mertel explains this effectively in the NMT handbook by stating, “While playing an instrument, sound-induced priming of the motor system, auditory feedback from playing the instrument, and entrainment via rhythmic cues create a feedforward-feedback loop, which enables the patient to plan, anticipate, and execute their movements in a more efficient way,” (Thaut & Hoemburg, 2014a).
We’ve made it down to the bottom half of the body now - so let’s get gait training! RAS is effective here just as it is with Parkinson’s. In fact a 2009 study indicated when implementing RAS into a conventional physical therapy protocol with stroke survivors, “measurement outcomes show improvements over time in all subject groups,” (Hayden, Clair & Johnson) when control groups consisted of waiting 10 or 20 sessions before employing RAS. In RAS rhythm is coming into play again as a key element. The ability to anticipate the beat gives the NMT patient a huge advantage over nonmusical gait training. It allows the brain and body the time and cues they need to more simply execute the movements necessary in gait.
As we wrap up this blog post, I hope you are coming away with a greater respect for what music and rhythm can do for your brain, and in turn your body! Keep moving, and if you’re having a hard time doing so, NMT might just be the secret ingredient you need!
Hayden, R., Clair, A.A., & Johnson, G. (2009). The effect of rhythmic auditory stimulation (RAS) on physical therapy outcomes for patients in gait training following stroke: A feasibility study. International Journal of Neuroscience, 119, 2183-95. doi: 10.3109/00207450903152609
Thaut, M., & Hoemburg, V. (Eds.), (2014a). Handbook of Neurologic Music Therapy. Oxford, UK: Oxford University Press.
Thaut, M.H. & McIntosh, G.C. (2014b). Neurologic music therapy in stroke rehabilitation. Current Physical Medicine and Rehabilitation Reports, 2. doi: 10.1007/s40141-014-0049-yCDC Wonder Online Databasehttp://www.cdc.gov/stroke/statistics_maps.htm