Baker, Felicity & Jeanette Tamplin (2006). Music Therapy Methods in Neurorehabilitation: A Clinician’s Manual
. London and Philadelphia: Jessica Kingsley Publishers.
Acquired brain injury presents huge challenges to our societies worldwide. Music therapists have been concerned with developing intervention strategies and trying out existing therapeutic approaches in the field of neurorehabilitation since the 1980’s (Gilbertson, 2005). There are reports of the seemingly amazing nature of retained singing ability by individuals who have through brain injury that date so far back as the end of the 1890’s in the chronicles of the famous Charité Hospital in Berlin, Germany. In many places in the world, music therapists have been working hard at progressing our knowledge and expertise in providing music therapy for people in neurorehabilitation.
With this new publication, Music Therapy Methods in Neurorehabilitation, A Clinician�s Manual, Felicity Baker and Jeanette Tamplin provide an extensive and highly informative presentation of a wide selection of music therapy interventions they have used in neurorehabilitation in response to the challenges of acquired brain injury. Building on many years of clinical experience, the authors provide descriptions and explanations of interventions related to a wide range of symptoms including altered states of consciousness, movement disorders, cognitive and behavioural impairments and challenges to communication and emotional adjustment.
Following a foreword written by Barbara Wheeler, the authors establish the background and purpose of the book within the context of clinical practice and the existing literature. It is at this point that the reader is provided with a description of the authors� core intention, “The main impetus for his manual arose from our desire to develop a useful resource that includes descriptions and detailed protocols of interventions we have found useful, and suggests evaluation methods” (p.16). And this is precisely what the book offers. Felicity Baker and Jeanette Tamplin have written this book about how to perform a selection of music therapy interventions for patients in altered states of consciousness (Chapter 2), for physical rehabilitation (Chapter 3), for cognitive and behavioural impairments (Chapter 4), for communication rehabilitation (Chapter 5) and to facilitate emotional adjustment (Chapter 6). The last chapter, written by Jeanette Kennelly, is focussed on music therapy in paediatric rehabilitation (Chapter 7).
Each chapter begins with an introduction to the specific topic followed by a structured overview of the related intervention covering patient need, therapist objectives, session length, intervention, music selections, specific strategies, contraindications and evaluation. At the end of each chapter there is a short list of useful references for further reading. The authors also provide a very useful glossary and list of references at the end of the book.
Though it is titled, Music therapy methods in neurorehabilitation, this book is about rehabilitation with people who have acquired brain injury. Under this title, some clinicians working in neurorehabilitation may expect a larger spectrum of illnesses and diseases of the central and peripheral nervous systems. During the past years there have been a collection of doctoral and post-doctoral research studies which have provided the basis for many publications covering multiple sclerosis by Wendy Magee, Wolfgang Schmid, spinal cord injuries by Anke Scheel-Sailer, neurodegenerative disease (Hanne Mette Ridder, traumatic brain injury by Felicity Baker, Simon Gilbertson and Gerhard Tucek and chronic aphasia by Monika Jungblut (for references to Schmid, Scheel-Sailer, Ridder, Gilbertson, Tucek and Jungblut please see Aldridge, 2005). This is by no means a failure of the books’ contents. If anything, the title may be considered by some readers to be too broad.
The Contents of the Book
Chapter 1 “Neurological Damage and Models of Rehabilitation” provides a clear and easy to read introduction to the brain, forms of brain damage, models of rehabilitation and processes of recovery. The chapter is well written and scientifically accurate and the material is presented in a very informative manner. I do miss references to the sources of the information and figures used, particularly about the brain and its’ structures. When provided, this would allow readers to further their reading and ground the text more firmly within the ecology of existing research.
Chapter 2, “Interventions for patients in altered stages of consciousness” describes five interventions targeted at patients in various stages of coma and patients with post-traumatic amnesia. The interventions are based on improvised singing and the singing of songs and the authors provide well-though out considerations for the treatment of people who are minimally conscious, distressed or agitated coma patients, moderately responsive coma stages, and patients who are distressed and agitated with post-traumatic amnesia. This section really does meet the intentions of the authors and provides very good information and instruction for the clinical application of music with these patients. Some readers may miss reference to early music therapy work with patients in coma and post-coma states carried out in the late 1980s/early 1990s by pioneers such as the team of music therapists at the Holthausen Klinik (Gilbertson, 1999), Dagmar Gustorff (2000) and Silke Jochims (1990, 1992, 1994, 1995, 2005) in Germany. Most of Gustorff’s and Jochims’ significant work has however only been published in the German language and is therefore unfortunately not accessible to non-German speakers. This is also the case with the important work of the German music therapists and authors Ansgar Herkenrath (2002) and Baumann and Gessner (2004). This may be an issue that needs to be solved by translating major texts about neurorehabilitation into more languages as this will support the growth of music in this field on a global basis.
Chapter 3 is concerned with “Interventions for physical rehabilitation.” There are nineteen interventions that cover finger, hand, arm, bilateral upper limb ability, and interventions for sitting, standing, gait and relaxation activities. There are many unique and innovative interventions described in this chapter that are accompanied by established models of intervention. The interventions described in this chapter are accompanied by photographs of a model (one of the authors?) that are very helpful to understand the involved movements and targeted results. Interventions targeted at single movement patterns are difficult to select in the clinical setting because of the complex nature of movement disorders related to acquired brain injury. The authors remind the reader that, “When reviewing this intervention, and the other interventions within this chapter, bear in mind that we are presenting interventions that target isolated movements. Sometimes these require prerequisite physical abilities in other areas”. And this is significant advice that needs to be considered seriously.
The catalogue of interventions presented in this and other chapters of the book demand a deeper understanding of neurological disorders than a book about music therapy can provide. This book represents the first, and in my opinion, an excellent development in the communication of a selection of interventions applied in music therapy in neurorehabilitation. When accompanied by the advice and collaboration of related professionals, this book will help the music therapist gather valuable experience and proficiency in meeting the needs of people with movement disorders related to acquired brain injury.
Chapter 4 presents “Interventions for cognitive and behavioural impairments.” The functions targeted are attention, anasognosia (neglect of awareness of illness), preservative behaviour and memory. Not only do the authors describe twelve clinically relevant interventions, but they also provide additional resources in the form of example song texts, a list of useful recordings (discography) and music notation of an example song.
Chapter 5 is an absolute highlight in this book and builds upon Felicity Baker’s pioneering work in her research into the use of music in communication rehabilitation. There are 13 interventions described in this chapter and each is accompanied by extensive and clear descriptions of the targeted symptom, intervention and assessment techniques. The areas covered are aphasia, apraxia of speech, dysarthria, dysprosodia, fluency and rate of speech and the pragmatics of speech. These interventions include unique and established strategies, and also examples of how the authors have developed and adapted established interventions and include Baker’s adaptation of Melodic Intonation Therapy (p.149) and Tamplin’s music therapy protocol for dysarthria (p.165).
The authors provide useful tools such as an assessment chart for verbal pragmatics (p.182) and a worked example of software tools for speech and voice analysis, showing how to record voice data, edit audio wave files, and analysing results which can be used to setting targets of improvement. This is a great example of how research originating from questions in clinical practice can be re-incorporated into advanced clinical practice. This is a prime example of clinically relevant research that will ultimately help the clinician to provide better therapy.
Chapter 6 is concerned with “Interventions to facilitate emotional adjustment.” Emotional adjustment is a core issue for people affected by acquired brain injury. As the term suggests, traumatic brain injury is not only unforeseen or sudden, but is also catastrophic and disastrous for those injured and those affected by the trauma: family, friends, and the society in general. This chapter is well founded and provides information about primary issues in emotional adjustment, theories of adjustment and also provides extended information on the use of songwriting techniques. Readers particularly interested in these techniques should refer also to an earlier book on songwriting written by Felicity Baker and Tony Wigram (2005). There are two interventions targeted on emotional expression and anxiety management (using a well-known progressive muscle relaxation technique by Bonny and Savary).
At the end of this chapter there are three short paragraphs about the importance of support and consideration of the family during the treatment process and the great significance of emotions experienced by family members that include “depression, anxiety, denial, anger and guilt. Personality and behavioural changes are perhaps the greatest source of strain and distress for families. They must mourn the loss of a family member who has not actually died but no longer has the same personality as before” (p.218).
I am drawing attention to this short passage in the book to amplify the significant message contained in these short three paragraphs as loudly as is possible. Though the authors have not expanded this topic in this book, they have mentioned, in my opinion, one of the most important themes in music therapy in neurological rehabilitation. No intervention is ever of sole significance to the individual who has acquired brain injury. All therapeutic endeavours actually affect the individuals’ ability to ‘re-become’ and to remain being an active member of his or her family unit and our shared society and cultures. Each step made by the person with acquired brain injury in rehabilitation moves us forward as a society, within and around the family unit.
Before 2005, there has been no mention of the provision of music therapy for the families of those with acquired brain injury (Gilbertson, 2005). At that time, it was discussed that “the dramatic nature and severity of traumatic brain injury generates specific forms of trauma for family members and relatives. I suggest that music therapy may offer a relevant and appropriate form of therapy for these people too” (Gilbertson, 2005, p.133). We must care for the whole family affected by acquired brain injury. Our therapeutic activities in music therapy in rehabilitation will be a measure of our willingness to cooperate with all members of our society, and in the context of neurorehabilitation, not only those who have experienced acquired brain injury, but also those affected by acquired brain injury. I am certain that the provision of music therapy for families affected by acquired brain injury will receive a great deal of attention during the coming decade and though only covered with a few words in this book, the authors have echoed a highly significant theme for music therapists working in neurorehabilitation in the future.
Chapter 7 is written by Jeanette Kennelly and focuses on “Music therapy in paediatric rehabilitation.” Kennelly provides an introduction to childhood brain development, incidence of acquired brain injury in children, processes of recovery, and factors related to child development in the family. These sections will be helpful for clinicians wanting to further their knowledge about processes in paediatric rehabilitation. There is a short overview of the literature and information is given about appropriate musical styles and instruments. This section is short (about one page), but it covers a wide range of instruments, both acoustic and electronic. Although this chapter does not follow the same structured format of reporting and describing concrete interventions, Kennelly provides examples of interventions which included “Considerations when working with paediatric patients and their families” in table form (p. 229). There are four examples of songwriting techniques using song parody method for expression, a song to assist in preparation for standing with physiotherapy and occupational therapists, a song related to balance/trunk control, and a song created to prepare for leaving hospital and returning home. Jeanette Kennelly also provides useful references to literature about paediatric rehabilitation at the end of the chapter that is highly recommended reading.
Summary
This book is the first to provide an in-depth view into processes of music therapy and clinical interventions for individuals with acquired brain injury and will help the music therapist extend their repertoire of treatment skills. Causes of damage to the brain include road traffic incidents, falls, sporting accidents, violence and war and statistics show that the number of people living with acquired brain injury is rising. In particular, road traffic accidents are responsible for over 50% of the most severe brain injuries and have been projected to become the fourth most common cause of disability in the developed regions and the second most common cause of disability in developing regions by 2020 (Murray and Lopez, 1997). We must wait to see if these figures are accurate, what is certain is that there are an increasing number of people surviving acquired brain injuries who will need relevant and effective strategies of rehabilitation in the future. This book makes a significant and unique contribution to the continuing development of music therapy intervention strategies for people with acquired brain injury.
This book has been written and published at an optimal point in time for many reasons. Acquired brain injury is responsible for a wide range of challenges in health care systems. The application of music therapy has seen such a development in the diversity of clinical interventions in the treatment of people with acquired brain injury interventions during the past decade (Gilbertson, 2005) and, before this book, there has not been a comprehensive documentation of the state of the art in the literature. This book will help to reduce this deficit by increasing awareness for researchers, clinicians, educators and students of the role music therapy can play in the rehabilitation of people with acquired brain injury.
I hope that clinicians reading this book will be inspired to learn the techniques described and to practice and add them to their therapeutic repertoire. It should also facilitate an increase in multi-disciplinary exchange and the integration of the described treatment strategies into existing multi-disciplinary treatment protocols. The book should also encourage other clinicians to document and publish their experiences. By doing so, we will increase our expertise in the provision of music therapy for people who have experienced acquired brain injury. As the first clinician�s manual in this field, this book certainly does.
References
Aldridge, D. (Ed.) (2005). Music therapy and neurological rehabilitation. London: Jessica Kingsley Publishers.
Baker, F. & T. Wigram (Eds.)(2005). Songwriting: Methods, techniques and clinical applications for music therapy clinicians, educators and students. London: Jessica Kingsley Publishers.
Baumann, M., Gessner, C. (Eds.) (2004). ZwischenWelten: Musiktherapie bei Patienten mit erworbener Hirnsch�digung [Music therapy with patients with acquired brain injury]. Wiesbaden: Reicher Verlag.
Gustorff, D. & H.-J. Hannich (2000). Jenseits des Wortes: Musiktherapie mit komat�sen Patienten auf der Intensivstation [Music therapy with coma patients on the intensive care ward]. Bern: Hans Huber Verlag.
Gilbertson, S. (1999). Music therapy in neurosurgical rehabilitation. In T. Wigram & J.De Backer (Eds.), The application of music therapy in development disability, paediatrics and neurology. London: Jessica Kingsley Publishers.
Gilbertson, S. (2005). Music therapy in neurorehabilitation after traumatic brain injury: a literature review. In D. Aldridge (Ed.), Music therapy and neurological rehabilitation: Performing health. London: Jessica Kingsley Publishers.
Herkenrath, A. (2002). Musiktherapie und Wahrnehmung: Ein Beitrag der Musiktherapie zur Evaluierung der Wahrnehmungsf�higkeit bei Patienten mit schweren Hirnverletzungen (Music therapy and perception: A contribution of music therapy in the evaluation of perceptive ability of patients with severe brain injuries). In D. Aldridge & M. Dembski (Eds.), Musiktherapie � Diagnostik und Wahrnehmung. Witten: Music Therapy World.
Jochims, S. (1990). Coping with illness in the early phase of severe neurologic diseases. A contribution of music therapy to psychological management in selected neurologic disease pictures. Psychotherapie, Psychosomatik, Medizinische Psychologie, 40(3-4), 115-122.
Jochims, S. (1992). Emotionale Krankheitsverarbeitungsprozesse in der Fruehphase erworbener zerebraler Laesionen [Emotional processes in coping with disease in the early stages of acquired cerebral lesions]. Musik-, Tanz- und -Kunsttherapie, 3(3), 129-136.
Jochims, S. (1994). Kontaktaufnahme im Fruehstadium schwerer Schaedel-Hirn-Traumen: Klang als Brucke zum verstummten Menschen. Krankengymnastik: Zeitschrift fur Physiotherapeuten, 46(10), 1316-1324.
Jochims, S. (1995). Emotional processes of coping with disease in the early stages of acquired cerebral lesions. The Arts in Psychotherapy 22(1) 21-30.
Jochims, S. (Ed.) (2005). Musiktherapie in der Neurorehabilitation: Internationale Konzepte, Forschung und Praxis [Music therapy and neurorehabilitation: International concepts, research and clinical practice]. Bad Honnef, Germany: Hippocampus Verlag.
Magee, W. & B. Wheeler (2006). Music therapy for patients with traumatic brain injury. In G. Murrey (Ed.), Alternate therapies in the treatment of brain injury and neurobehavioural disorders (pp. 51-74). London: The Hawthorn Press.
Murray, C. & A. Lopez (1997). Global mortality, disability, and the contribution of risk factors: Global burden of disease study. The Lancet 349, 1436-1442.
Schaefer, S., Murrey, M., Magee, W. & B. Wheeler (2006). Melodic intonation therapy with brain-injured patients. In G. Murrey (Ed.), Alternate therapies in the treatment of brain injury and neurobehavioural disorders (pp. 75-88). London: The Hawthorn Press.