A Musical Injection: How a young form of therapy can change the future of rehabilitation


Make way for Neurologic Music Therapy, a fairly young form of Music Therapy that’s blossoming in the clinical world. Music Therapists Brian Harris & Jeniris Gonzalez help paint a picture of NMT and its future. 


THE STORY

CT: 79-year-old Peter Roth had a stroke in November 2013 and began rehabilitation at Spaulding hospital. Brian Harris was the designated music therapist for Peter’s hospital floor during his stay. Joanne, Peter’s wife, says that Peter and Harris got along very well at Spaulding and decided to continue seeing Harris.

CT: General Music Therapy has been gaining momentum in the clinical world over the past few decades. It’s an expressive form of therapy that uses music as a therapeutic rehabilitation for a wide variety of emotional or physical problems.

CT: But there is a new section of Music Therapy that’s making its rounds in the field. Neurologic Music Therapy, or NMT, is the scientific side of music therapy. In essence, NMTs can help rewire the brain to learn how to speak again, or how to walk. Few people have heard of this new therapy, but Brian Harris hopes to change that.

Brian Harris: Always been a musician, I think you’re going to find that with everybody that you talk to that’s a music therapist. I knew that music education was not my thing and I knew that I didn’t really wanna go the performance route either. and then I heard about music therapy and I thought the idea of music therapy makes sense and I think it does to a lot of people just when you hear the term the first time.

CT: Harris founded and is the CEO of Boston-based company MedRhythms. He is one of 250 NMT fellows in the world. Right now, he is making house calls through MedRhythms, but he also works as a NMT at Spaulding Rehab Hospital in Boston. NMT is young, developed just 15 years ago. It is different from traditional music therapy, which addresses emotional well-being. Neurologic music therapy on the other hand addresses more physical or cognitive goals, such as stroke victims relearning language or Parkinson’s patients walking with a steady rhythm.

Brian Harris: For example somebody like Peter who had a stroke to the left hemisphere of his brain. And the left hemisphere is primarily where language is processed. Rhythm and melody are primarily right hemisphere functions. So by engaging his brain in music and language, we’re recruiting the right hemisphere to take over language functions. So because we’re adding elements of rhythm and elements of melody, he’s actually creating new pathways to language thru the principle of neuroplasticity. So picture you have a road from A to B. And the stroke is a block in the road and you can’t get through. He can’t get what he has in his head out through his mouth, so were taking a detour through his brain.

CT: At the Community Music Center of Boston, Jeniris Gonzalez works as a full time music therapist, teaching classes and doing outreach programs.

Jeniris Gonzalez: So people of all ages can come, I mean there’s baby lessons, there’s early intervention groups, early education programs. There’s something here for anyone, of any age. The music therapy department is the same, we see people from very little kids to elderly with any kind of need. So people with autism, people with intellectual disabilities, physical disabilities, ADHD, many different conditions and all ages.
So there’s a way to benefit anyone, but it depends on their need. I just think the overall positive aspect of music therapy is that it will always identify that goal and work towards it.

CT: She is a board-certified Music Therapist and certified as a Neurologic Music Therapist and Neonatal Intensive Care Unit Music Therapist.

Jeniris Gonzalez: So someone that might have no speech, we can actually find a way through music with specific interventions to access their brain pathways and get it to work, but they don’t suffer through it. It’s not painful, it’s not invasive, it’s not an injection, it’s not medicine, it’s something that can’t hurt it can only help. So I think thats a big benefit. It has no side effects, they won’t get anything bad out of it.

CT: So how does general music therapy work? It is not a music lesson, it’s a chance for a patient to work on whatever they need. Whether it’s communication, managing pain, calming nerves before an operation, and just becoming comfortable. Music Therapists are there to make it easier in any setting. Oftentimes, Music Therapists will visit children at the hospital and keep them company before a large procedure or during appointments. However, Gonzalez highlights the difference between general music therapy and Neurologic Music Therapy.

Jeniris Gonzalez: I’m a very big, big supporter of neurologic music therapy because it’s so scientific and so research-based that absolutely everything that we do has been proven and proven many many times to work because you know how the brain works. So it’s not a trial and error basis, and a lot of music therapy is adapted to the person, sometimes you’re trying things and it doesn’t work. But with neurologic music therapy, there’s specific techniques that you know if you use it with someone who had a stroke, they will regain some part of their speech. It will happen because you know what you’re doing with a certain part of their brain, it’s a very effective tool. It’s amazing. I do think thats a very big part of the future.

CT: The difference between traditional music therapy and neurologic music therapy, Harris says, is that traditional therapy is more of a social science while NMT looks at how music activates nonmusical functions of the brain.

Brian Harris: Not very many stimuli on the planet that activate your brain with such global activation as music does. So we know that your motor centers are engaged, your speech and language centers are engaged, your emotional centers are engaged. And things like memory, attention, those things are all engaged when you hear music. Your brain is actual plastic. It can move and shape and reform if something happens to it, like a damage.

CT: Even those not directly involved in the field say that music therapy has the chance to grow. Eileen McBride is a psychology professor at Emerson College who has not used expressive therapies but sees their potential.

Eileen McBride: I’m assuming it’s more open-ended and interpretive and not so directive. It’s not like the expert is telling you…here let me take notes on your problem now I’m going to tell you your problem. I imagine it’s more of an exploration. And music is just one of the ways of both allowing and supporting emotional expression but also understanding yourself more, that’s how I would understand it. But I know you are also talking about that neurological use of it which is different because that seems to be using music to stimulate memory. And it’s very interesting. I’ve seen videos of people who are sort of non communicative and are listening to music and suddenly can remember the lyrics and they have the rhythm and I think it’s a different kind of use for music.

CT: Joanne, and Peter, are seeing exactly those kind of results. Joanne says that Peter used to be a beautiful singer and was part of their church choir. In just 7 short months, Peter’s voice transformed from mumbles to melodic singing.

CT: Their sessions last an hour to an hour and a half. They face each other and start with a song that Peter knows. Then Harris will play guitar while they both sing. Harris will incorporate common phrases into the songs so Peter can form the words in a melody.

Brian Harris: It does stick. So obviously it’s an intensive process. And they have to have therapy like they would have speech therapy, or PT, or OT. And when they do, they do have good carryover. So NMT is only focused on nonmusical functions and the carryover. The other really neat thing we know about how the brain responds to rhythm. we know that theres a direct correlation between auditory neurons and motor neurons when we hear a steady rhythm. So when you hear a tap, your auditory neurons and your motor neurons fire at the same time. And so walking to a beat is a lot easier than walking not to a beat. That’s a universal phenomenon across cultures, across abilities, disabilities, age, male, female doesn’t matter. It’s ingrained in the human brain. It’s a hardwired language of our brain. So 97% of humans can respond this way, to rhythm. That when you hear a steady rhythm, you’re gonna have a motor response that lines up with that auditory signal because auditory neurons and motor neurons have been proven to that they can entrain, fire at the same time. We can help re-engage the brain in a new way to help fire some damaged neurons or to fix a damaged motor system through rhythm. And we do the same thing when someone has a stroke and they have one side that’s weak or paralyzed, or brain injury the same thing can happen. and we can teach them to walk again.

CT: Spaulding Rehab is the only facility that uses NMT, says Harris, but he’s hoping to change that. Music therapy has been around for years, some argue centuries, neurologic music therapy is in its toddler years. The first research study was done at MIT in 1976 on melodic intonations. The credibility isn’t the problem.

Brian Harris: A, it’s awareness, and B, we don’t have enough people doing it. So A, a lot of people, like you said, don’t know that it even exists. Once people are aware of it, and they see the research, they’re not going to question that it works. Just awareness that it’s out there is the biggest problem and often times health care can be a slow moving beast. But I wouldn’t even say that’s the biggest problem, the biggest problem is the awareness that it works. and we don’t have clinicians doing NMT.

Jeniris Gonzalez: We’re all aware in music therapy, in our community, we all know that music has a stigma, people think that music is for fun not medicine. It’s very hard to be taken seriously. I think the future is just more research. Hopefully it will become a very accepted complimentary arts therapy, like others are. Like art therapy, dance therapy, and on the same level as physical therapy, occupational therapy.

Eileen McBride: I think all of these therapies should be done in combination.

CT: Psychology professor Eileen McBride, supports a multi-therapy approach to patients.

Eileen McBride: So i think we should be open to what works. So if I was working with someone with….say I was working with someone with addiction, which is such a tough area, such a tough problem to recover from. If you could do work on past trauma or loss and help them connect to their body and to use music or art to explore who they are. None of those contradict each other. It’s all…all that integration just makes sense to me.

CT: McBride says that people today rely too heavily on medications to deal with their illnesses. Music therapy is a welcome change to that well-worn path. And it’s fun for everyone, according to music therapists.

Brian Harris: One of my favorite things is we get to work with people just after their stroke. And they’ve been working and they have lost all language. And to hear somebody speak their first word again after having had their injury, is probably one the most rewarding things we see. And that’s not necessarily an uncommon thing either. But to see someone struggling, who has lost language, who can understands that they don’t have language. During our music therapy interventions, to speak their first word again, it’s quite a powerful experience and be a part of.

CT: Gonzalez also says it’s the best job in the world.

Jeniris Gonzalez: We get to do music everyday. We get to meet amazing people everyday. We get to work with people that are usually seen as deficient in some way, and we get to see what’s well with them. And I think that’s the best part. The majority of the people that we see have some kind of medical need or neurological need but when they come in here, especially in the music center, there’s no stigma. So no one is seen like that, it’s just a big community. So they come in and have fun but we also know and are trained to have a therapeutic goal in mind. So it helps to know that not only are we having fun with people and giving them joy but we’re making them better in some way.

Brian Harris: So the more that people understand how music affects the brain… I 100% believe that it’s going to change neurorehabilitation. NMT is going to become a household name, just like PT, OT, speech, people are going to talk about NMT. Like I said, the more research that comes out, the more people know that this exist, it’s going to change how people think about rehabilitation for people with brain injuries, stroke, Parkinson’s.

THE PEOPLE & PLACES

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