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Music and brain activity (Part 2)

At the Institut Guttmann, music therapy has been implemented as part of the rehabilitation program for brain damage since October 2013, and for that we are based on the principles of the Neurological Music Therapy (NMT).

Music therapy

This branch of the music therapy is based on the neuroscientific model of musical perception, and it is included in the World Federation of Neurorehabilitation (WFNR), the European Federation of Neurorehabilitation Societies (EFNS) and the Society for Clinical Neuromusicology (CNM).

La NMT is dedicated to the study and development of specific techniques that incorporate music and its elements (sound, rhythm, melody and harmony) for the achievement of therapeutic objectives aimed at the attainment, recovery or improvement of motor, language and/or cognitive skills.

Until recently, only people with consciousness disorders and children who were users of the Institut Guttmann benefited from the music therapy service as a priority. Now, with the opening of the new Guttmann Barcelona (GBHI) centre, this service has been expanded and music treatment has been made possible for people with different neurological pathologies.

Reasons why Institut Guttmann has incorporated music therapy in its rehabilitation programs

Who can benefit from the service of neurological music therapy (NMT) at Guttmann Barcelona?

NMT techniques are divided into 3 main application groups:

  • speech and language rehabilitation
  • sensory-motor rehabilitation
  • cognitive rehabilitation.

The application profile for these techniques is very broad. It can benefit those people who need: neurological rehabilitation due to acquired brain damage (such as stroke or trauma) or a disease of the nervous system (such as multiple sclerosis or Guillain-Barré among others); children who require neuropediatric or neurodevelopmental services (such as in cases of attention, language or autism spectrum disorders); and also elderly people who want to have an active aging or who are facing neurodegenerative diseases (such as Alzheimer's or Parkinson's among others).

Which role does music play in the rehabilitation or acquisition of speech and language?

Until recently it was believed that language and music processing in the brain occurred in very distinct areas. It was thought that speech and language aspects were processed by the left hemisphere, while musical aspects were relegated to the right hemisphere, in charge of the less rational aspects. Today we know that these two activities are much more closely related than previously thought.

In a 2011 study, A.D. Patel proposes the OPERA acronym hypothesis to explain why music is beneficial for many language functions. OPERA stands for the five conditions that could drive plasticity in speech processing networks:

  • Overlap refers to the shared use of brain networks that are responsible for processing the sound characteristics of both music and speech;
  • "Precission": music is more demanding on these processing networks than speech;
  • "Emotion": musical activities involving this network elicit strong positive emotion;
  • "Repetition": musical activities involving this network are repeated frequently;
  • "Attention": musical activities involving this network are associated with focused attention.According to OPERA's hypothesis, when these conditions are met, neural plasticity causes the networks in question to function with a higher precision than that required for ordinary oral communication.

NMT has techniques focused on the development, improvement and rehabilitation of language and communication. Some techniques include the use of singing for speech recovery in patients suffering from aphasia, the use of rhythm for the improvement of dysarthria in people with acquired brain damage or suffering from Parkinson's Disease; or techniques using wind instruments for the control of muscle groups involved in vocal production.

 

The use of music for motor rehabilitation

When we listen to a song or a piece of music of our liking, our body tends to move following the rhythm of the music, without us hardly noticing it.

This phenomenon is due to the fact that the auditory pathway and the motor pathway share neural networks in our brain. As mentioned above, the shared neural networks help the rehabilitation process and can be used for their respective training.

In addition, music favours the planning and correct execution of movement, as it provides structure, temporality, and harmony. That is, it can provide a temporal guide to adhere to in order to structure and regulate damaged movement patterns, thus recovering functional movement patterns.

These exercises can also be performed with musical instruments adding a sound reinforcement and stimulating for the person who performs them.

Musicoterapia

How is music used for cognitive rehabilitation?

NMT proposes a series of techniques aimed at training the different cognitive abilities of the brain:

Firstly, we have techniques to train attention in its different domains (selecting, focusing, maintaining and switching between tasks). These incorporate active and passive exercises that include active listening, instrumental performance or improvisation.

Memory is a cognitive skill that can be impaired due to neurological damage or disease. Music can play a special role in its rehabilitation by improving the functioning of brain areas used for learning.

Numerous studies have been described in the scientific literature, showing the positive effect of music and its elements in the rehabilitation of different types of memory. It was observed, for example, that rhythm and melodies provide cues for the retrieval of verbal and semantic content. Also, listening to classical music improves episodic memory retrieval in patients with Alzheimer's disease or other dementias, and song composition also has an impact on their memory skills.  Singing has been shown to be a memory-enhancing activity for nouns and verbs; and even, in some studies, it has been shown that just listening to music can help improve verbal memory along with sustained attention.

On the one hand, NMT provides mnemonic exercises that use music to work on memory skills in patients with neurological damage or disease. On the other hand, it also offers other working techniques that use music for the induction of mood states, with the aim of stimulating the recall of important episodes in the patient's life.

Executive functions are at the top of the cognitive abilities. They are those that allow us to create new aspirations, set goals and plan to achieve them, motivate and organize ourselves to act, inhibit behaviours that prevent us from reaching our goal, initiate and carry out plans, monitor results and, in some cases, make adjustments to complete proposed plans.

After a neurological damage or disease these abilities can be affected, resulting in serious difficulties to reintegrate into community life. Neurological Music Therapy offers improvisation and musical composition exercises, both individually and in groups, to practice the skills of these executive functions such as organization, problem solving, decision making, reasoning and comprehension. NMT also offers techniques for working on sensory, visual, and auditory perception and psychosocial development.

NEUROLOGICAL MUSIC THERAPY

The music therapists specialized in NMT at the Institut Guttmann are specialists in techniques and stimulations applied to a wide range of behavioural, developmental, and neurological disorders. They work in a joint and interdisciplinary way with physicians, neuropsychologists, speech therapists, physiotherapists, and other professionals, in teams that are oriented to the treatment of patients in our institution.

 

BIBLIOGRAPHIC REFERENCES

Gordon, W. A., Cantor, J., Ashman, T., and Brown, M. (2006). Treatment of post-TBI executive dysfunction: application of theory to clinical practice. Journal of Head Trauma Rehabilitation, 21, 156-67.

Impellizzeri, F., Leonardi, S., Latella, D., Maggio, M. G., Foti Cuzzola, M., Russo, M., Sessa, E., Bramanti, P., De Luca, R., & Calabrò, R. S. (2020). An integrative cognitive rehabilitation using neurologic music therapy in multiple sclerosis: A pilot study. Medicine99(4), e18866. https://doi.org/10.1097/MD.0000000000018866

M.Thaut and V. Hoemberg. (2014). Handbook of Neurologic Music Therapy.

Patel A. D. (2011). Why would Musical Training Benefit the Neural Encoding of Speech? The OPERA Hypothesis. Frontiers in psychology2, 142. https://doi.org/10.3389/fpsyg.2011.00142

Schwartz, A. E., van Walsem, M. R., Brean, A., & Frich, J. C. (2019). Therapeutic Use of Music, Dance, and Rhythmic Auditory Cueing for Patients with Huntington's Disease: A Systematic Review. Journal of Huntington's disease8(4), 393–420. https://doi.org/10.3233/JHD-190370

Teppo Särkämö, Mari Tervaniemi, Sari Laitinen, Anita Forsblom, Seppo Soinila, Mikko Mikkonen, Taina Autti, Heli M. Silvennoinen, Jaakko Erkkilä, Matti Laine, Isabelle Peretz, Marja Hietanen, Music listening enhances cognitive recovery and mood after middle cerebral artery stroke, Brain, Volume 131, Issue 3, March 2008, Pages 866–876, https://doi.org/10.1093/brain/awn013

Van der Steen, J. T., Smaling, H. J., van der Wouden, J. C., Bruinsma, M. S., Scholten, R. J., & Vink, A. C. (2018). Music-based therapeutic interventions for people with dementia. The Cochrane database of systematic reviews7(7), CD003477. https://doi.org/10.1002/14651858.CD003477.pub4

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