Neurologic Music Therapy: An Overview and Intervention Ideas

MTI Project
Written By Nicole Keller

Our intern, Mary, will be diving into a variety of music therapy topics to increase her knowledge as her final project! She not only is gathering this information for herself, but also to share with you in the form of a blog post. Thanks for reading! Please note that as a music therapy intern, I am not certified in neurologic music therapy techniques, and I am providing this information as a general overview of the field. 

Research

Neurologic Music Therapy (NMT) is a clinical technique that utilizes the field of neuroscience and the understanding of musical elements to adapt and influence brain functioning through 20 different techniques (Academy). The Academy of Neurologic Music Therapy is devoted to protecting the authenticity and integrity of the field of NMT through research and training. The Academy offers various virtual and in-person training events throughout the year. While these training sessions are a wonderful opportunity, they are not always available to everyone. This blog contains an overview of the basic principles of Neurologic Music Therapy as well as NMT-based interventions to use in music therapy. As an intern, I have the opportunity to learn from one of my supervisors, Victoria Hockemeyer, MT-BC, Neurologic Music Therapist, and observe another one of Aspire’s music therapists, Katie Smith, MT-BC, Neurologic Music Therapist. Through conversations with Aspire’s therapists and my own research, I gathered information on NMT that may be helpful for students, interns, and professionals looking to learn more about the field. Additionally, NMT serves as proof for the efficacy of music therapy. 

Music & the Brain

“The therapeutic function of music” is a phrase that often comes up in regard to NMT. The therapeutic function of music is the justification for using music over other therapeutic models. Have you ever had someone question the effects of music therapy or wonder why music can have such a profound effect on the brain? The proof can be found in NMT. During one of my assisted living facility groups this fall, I had a client share how amazing it is that she remembers all the lyrics to a song from when she was younger while she can’t recall activities from her day. My supervisor stepped in and provided an explanation for this client, sharing how music has the power to activate all brain areas, including the centers for memory and movement. 

The group seemed intrigued by this fact, and they are not the only ones who can benefit from this knowledge. In order to streamline the field of music therapy, we can take a neurologic approach. 

Maddocks (2024) says that music can release brain chemicals and has the power to uplift and also depress moods based on client preferences. NMT utilizes science to consider how the brain responds in neurotypical individuals compared with people with neurological deficits. Musical elements such as timbre, pitch, and dynamics play a role in NMT. This powerful ability music offers is another reason why it is important to have a trained and certified NMT providing these services. Use these facts as your proof and reasoning behind the effectiveness of music therapy the next time someone asks you!

Populations/Diagnoses that could benefit from NMT include, but are not limited to, stroke patients, Traumatic Brain Injury (TBI) patients, Parkinson’s disease patients, Huntington’s disease patients, Alzheimer’s disease and various forms of dementia patients, autistic clients, multiple sclerosis patients, clients with mental health conditions, and anyone with a disease affecting neurological, motor, and cognitive functioning. Goals that could be met through NMT include motor skills, cognitive skills, speech and communication skills, and many more. Treatment is determined based on the client’s diagnostics and functional goals (Hurt-Thaut & Johnson, 2014). NMT also includes the transformational design model (TDM), which is used to decide the best musical techniques and interventions for the client. The TDM includes the 5 steps of assessment, functional goals and objectives, nonmusical therapeutic experiences, therapeutic music experience, and transformation. The end goal of NMT is to “transfer functional behavior into the client’s everyday life” (Hurt-Thaut & Johnson, 2014, p. 224). NMTs are trained to aid clients in reaching non-musical goals through musical techniques. NMTs often co-treat with other professionals, such as physical, occupational, and speech therapists 

Techniques & Intervention Ideas

Think of the following techniques as “skeletons” for the NMT and co-treating field to add on to! The techniques are divided into three categories: cognitive, sensorimotor, and speech and language. 

Cognitive Rehabilitation

Cognitive Rehabilitation works to develop one’s learning abilities and cognition, due to the unique power music has to influence memory, attention, affect, and orientation. Cognitive techniques could be used to aid patients with stroke, Alzheimer’s disease, hearing impairments, and other related needs. 

  • Musical Sensory Orientation Training (MSOT) describes providing live or recorded music to stimulate one’s alertness, arousal, and responsive levels.

    • Intervention example: The NMT works with an Alzheimer's patient, playing a preferred song on guitar, in order to increase the patient’s orientation to person, place, and time. 

  • Musical Neglect Training (MNT) includes structured instrument play in order to bring awareness and improvement to affected visual field areas. 

    • Intervention example: The NMT moves a drum around affected and unaffected visual fields, accompanies on the guitar, and encourages a stroke patient to play the drum to challenge their coordination of their left and right visual fields (Hurt-Thaut & Johnson, 2014).

  • Auditory Perception Training (APT) is the use of musical exercises, such as movement-to-music and instrument play, to aid clients in identifying aspects of sound.

    • Intervention example: The NMT co-treats with the SLP to assess which instruments a child with a cochlear implant can hear. They then practice audibly identifying instruments that are placed out of view to develop and increase the client’s auditory perception. 

  • Music Attention Control Training (MACT) practices attention, engagement, and sustainment through facilitating a musical cue and response.

    • Intervention example: The NMT facilitates a start/stop experience in which the therapist and client play a drum simultaneously, then the therapist cues the client to stop and start by modeling this action. (Hurt-Thaut & Johnson, 2014).

  • Musical Mnemonics Training (MMT) utilizes musical content and exercises to practice memory recall, encoding, and decoding. Musical content could be presented as a rhyme, chant, melody, or mnemonic device. Think Schoolhouse Rock!

    • Intervention example: An NMT provides a unique mnemonic device during a session with an Alzheimer’s patient to improve their memory to take their pills each morning. 

  • Associative Mood and Memory Training (AMMT) focuses on the aspects of one’s mood through utilizing musical techniques to practice memory recall and reach “associative mood and memory function” (Hurt-Thaut & Johnson, 2014, p. 230). 

    • Intervention example: An NMT plays a familiar, uplifting song in order to promote a positive mood during the memory recall process for a patient with Huntington’s disease.

  • Musical Executive Function Training (MEFT) can be provided in an individual or group setting and utilizes musical interventions such as composition and improvisation to address organization, reasoning, decision making, problem solving, etc. (Thaut, 2005). 

    • Intervention example: An NMT facilitates a songwriting experience in a mental health music therapy group, including directions for each member to add to the creative story and emphasizing social interaction. 

  • Music in Psychosocial Training and Counseling (MPC) addresses psychosocial aspects such as orientation, affect, and social interaction with musical interventions. 

    • Intervention example: An NMT sings a breathing song in a session with an autistic client in order to aid them in practicing and developing coping skills (Perfect Harmony Health).

Sensorimotor Rehabilitation

 Sensorimotor Rehabilitation is used to address motor skill development, such as mobility issues, gait control, strength building, coordination, balance, etc. 

  • Rhythmic Auditory Stimulation (RAS) is most often used to rehabilitate one’s gait through providing tempo to assist when a step is taking place. Offering a musical structure with gait training can provide a unique predictive pattern of movement for the brain to follow (Maddocks). 

    • Intervention example: An NMT adds RAS to a stroke patient’s PT session could include rhythmic musical cues as well as familiar songs and improve the patient’s gait pattern, posture, and coordination (Hurt-Thaut & Johnson, 2014).

  • Patterned Sensory Enhancement (PSE) emphasizes the musical elements of melody, harmony, rhythm and dynamics to provide cues that aid a client in developing activities of daily living (ADLs)

    • Intervention example: An NMT utilizes the piano to provide a “dynamic musical stimulus” (Hurt-Thaut & Johnson, 2014, p. 225) to accompany physical therapy exercises for a patient with Parkinson’s disease. Familiar songs will increase participation and motivation.

  • Therapeutic Instrumental Music Performance (TIMP) includes selecting specific instruments to accompany and focus on one’s range of motion, strength and endurance, dexterity and coordination. 

    • Intervention example: An NMT encourages a TBI patient to reach and step towards instruments (i.e. playing a tubano) in order to maintain a standing balance while moving their limbs.

Speech & Language Rehabilitation

Speech & Language Rehabilitation is used to aid the rehabilitation and development of verbal and nonverbal communication skills for people with diagnoses such as apraxia, aphasia, and voice disorders.

  • Musical Speech Stimulation (MUSTIM) is the use of musical lines, including rhymes, songs, chants, and phrases to “stimulate nonpropositional and eventually propositional speech” (Hurt-Thaut & Johnson, 2014, p. 226).

    • Intervention example: An NMT uses a familiar melodic line to encourage a stroke patient to complete the sentence, such as “you are my _____.” (Thaut, 2005).

  • Musical Intonation Therapy (MIT) was developed by speech therapists with the intent of rehabilitating aphasia patients through encouraging spontaneous singing and chanting, which resembles a natural speech pattern. 

    • Intervention example: An NMT creates a musical replication of a common phrase, such as “I’d like a cup of coffee,” for a stroke patient with expressive aphasia. The melodic phrase should emphasize the natural speech patterns of the phrase. Through tapping the beat and repeating after the therapist for an extended period of time, the patient can eventually state this phrase independently. 

  • Rhythmic Speech Cuing (RSC) uses rhythmic cuing to control one’s rate of speech through a metronome, drum, or hand tapping.

    • Intervention example: An NMT uses a hand drum to cue muscular coordination for a patient with dysarthria, modeling a directed speech pattern.

  • Vocal Intonation Therapy (VIT) includes intoned phrases that imitate the “prosody, inflection, and pacing of normal speech” (Hurt-Thaut & Johnson, 2014, p. 227).

    • Intervention example: An NMT works with a client who presents with limited pitch in their speaking voice and encourages improvement by providing a five note scale for the client to follow, then moves the starting pitch up and down by half-steps (Thaut, 2005). 

  • Therapeutic Singing (TS) works to build speech and language and increase respiratory apparatus functioning through singing experiences.

    • Intervention example: The NMT takes turns singing one line from a preferred song for a client with multiple sclerosis (MS) in order to improve her quality of life and increase communication abilities (Hurt-Thaut & Johnson, 2014). 

  • Oral Motor and Respiratory Exercises (OMREX) utilizes vocalizations and playing wind instruments to build strength and control of the respiratory system and speech apparatus (Thaut, 2005).

    • Intervention example: The NMT encourages their client with muscular dystrophy to improvise or repeat a modeled vocal exercise.

  • Developmental Speech and Language Training through Music (DSLM) utilizes various forms of music such as songs, chants, and instruments to build speech and language development. Often combines music and speech with movement as well.

    • Intervention example: An NMT works with their client with a speech disorder to simultaneously chant and march around the room.

  • Symbolic Communication Training through Music (SYCOM) is structured improvisation for non-speaking forms of communication. SYCOM works to improve “communication behavior, language pragmatics, appropriate speech gestures, and emotional communication in nonverbal language system” (Hurt-Thaut & Johnson, 2014, p. 228).

    • Intervention example: An NMT facilitates a structured, referential instrumental improvisation around the theme of “freedom” for a TBI patient.

Neurologic Music Therapy Certification

To become a certified NMT, you must already be a board-certified music therapist and be willing to go through this advanced form of training. The training comes with a financial cost but also counts as continuing music therapy education credits, if these happen to be covered by your place of employment! 

For more information on available trainings, head to the NMT Academy website: https://nmtacademy.co/training-opportunities/ 

Resources Cited:

Related Blogs:

Nicole Keller
Previous

Music Therapy Tips and Interventions for Termination of Services
Next

Communication in Music Therapy: Interventions and Ideas