Music Therapy after Brain Injury
Motivation through Music Therapy
By Rick Soshensky, MA, MT-BC, NRMT, CBIS
What does music have to do with brain injury and neurology?
Music makes us feel good. We play music. As such, it appears inconsistent with the principles of serious work but the effects of music are multi-dimensional, including physiological. Some of these effects are of particular relevance to persons who are recovering from a brain injury. Negative affect states such as depression, boredom, loneliness and worthlessness have been reported to be the most common post-injury emotional reactions (Gagnon, 2006). Positive self-esteem has been identified as a primary predictor of psychosocial readjustment (Tate and Broe, 1999) and music has been shown to increase dopamine levels that current neuropsychological theories associate with positive affect and feelings of well-being (Menon & Levitin, 2005).
An ever-increasing body of literature indicates there is a strong and consistent pattern of activity throughout the brain that enables the creativity associated with music. Dr. Charles Limb of Johns Hopkins University School of Medicine, quoted in an article in Medical News Today (2008), said, “It is almost as if the brain ramps up its sensimotor processing in order to be in a creative state.” Research is uncovering the fact that music is a “whole brain” phenomenon. Music researcher, Daniel Levitan (2006), relates that music listening, performance and composition engage nearly every area of the brain that has so far been identified, and involves nearly every neural subsystem. Neuro-researchers have discovered that the brain’s capacity for reorganization following trauma, called neuroplasticity, vastly exceeds what was once thought. Music’s wholistic activation of the brain, thus, becomes an extremely noteworthy phenomenon according to Levitan as regional specificity may be temporary with processing centers for important mental functions actually moving to other regions after brain damage (p.87).
Motivation through music therapy
A major study recently sponsored by the Dana Arts and Cognition Consortium (2008) concluded that an interest in the performing arts generates high states of motivation that lead to improvement in other domains of cognition. Deficits of motivation are recognized as a significant clinical problem following brain injury but a client may often be willing to engage in a music-making process even if he or she is resisting more conventional forms of rehabilitation. The various aspects involved in music and its potentials – singing, playing instruments, songwriting, deciding on the emotional quality and style of the music, working with a group, recording, performance – all challenge and strengthen vital personal and community skills essential to community reintegration following brain injury, such as:
- managing relationships and effective collaboration
- handling difficult feelings such as frustration, competition, insecurity
- expressing one’s ideas within an artistic form
- speech articulation and sensimotor processing
- maintaining concentration, andexecutive function.
Music builds bridges in the community
An emerging model in music therapy known as Community Music Therapy is defined by Dr. Kenneth Aigen (2005) as a holistic understanding of music that leads people both inward in exploration of their inner lives as well as outward towards participation and connection within community. Once a client has developed some confidence in his or her creative capabilities, the aim in this approach, according to music therapist, Gary Ansdell (2002), is to assist clients in accessing a variety of situations and to accompany them as they move between traditional therapy approaches and the wider social contexts typically involved in music making.
The fact that music is strongly identified with the entertainment industry means that, by taking part in music within a community, the client is doing something that’s culturally idealized. In this way, as music therapist David Ramsey (quoted in Aigen, 2005) points out, the perception of being disabled can be almost instantly transformed. If a friend, family member, visitor, caregiver, or peer witnesses someone singing or playing at a community event or listens to music recorded by the individual, they may subsequently think of that person differently. It expands the context of relationships, of self-perception and of the community’s perception of that person. Even if one’s talent is unconventional or untrained, the willingness to take a risk and share one’s music with others not only differentiates, but also connects the individual to the community.
If the client is willing to record music, publicly sharing the client’s music (with his or her consent) through those recordings adds another dimension, creating an opportunity for people from all walks of life to hear it. The artist’s musical talent, the artist as musician, becomes the persona, and that persona is not defined by injury or disability, but by the music they create – music to which all people can relate. The fact that the performer may have a disabling injury becomes irrelevant to the experience of the music. This is the value in challenging people, not just to make music, but to transcend limitations by becoming musicians, musical artists.
Sharing music publicly through performance or recordings also advances the spirit of inclusion wherein the general public is able to witness individuals with disabilities contributing in meaningful, indeed, inspiring ways to mainstream and artistic culture. Contemporary brain injury rehabilitation methodologies stress this principle of inclusion, meaning the individual is incorporated into the community, irrespective of actual or perceived disability. This is differentiated from the idea that people need to be alike, fit in, or reach for similar standards to be commercial in the contemporary music business. According to Condeluci & McMorrow (2004):
Inclusion brings people to the community regardless of their differences.
It does not try to change or alter differences against a person’s will or capacity. It does not try to create forced similarity. Inclusion suggests that people join in as they are. Inclusion respects differences, honors diversity, and invites full community participation. It is a term that implies a welcome to all (p.24).
I have found that participants in a creative musical process can come to see themselves as being “intact in spite of a TBI” (Nochi, 2000). Weakness becomes strength. The traumatic part of the story becomes essential; the very fuel of the creative act. The client can begin to integrate the trauma rather than living in unending bitterness and grief over what has been lost or altered. Healing can occur. Participants become less likely to regard themselves as disabled and more so as creative, involved and enthusiastic people.
The dominant message is that being an individual with a disability does not preclude having active, creative and interesting experiences in life. As we empower those who might otherwise be marginalized to project their authentic voices proudly into the world, self-acceptance is nurtured. Self-acceptance is a stable sense of one’s worth regardless of external circumstances or the opinions of others and may be considered to be the single most important characteristic of well-being and development for those confronting a life altering challenge.
Aigen, K. (2005). Music-Centered MusicTtherapy. Gilsum, NH: Barcelona Press.
Bragg, M. (2007). The Last Remaining Avant-Garde Movement. Society Guardian, December 11. www.guardian.co.uk.
Condeluci & McMorrow (2004). Philosophy of Rehabilitation. In Certification exam preparation course. American Academy for the Certification of Brain Injury Specialists.
Dana Consortium Report on Arts and Cognition (2008). Learning, Arts, and the Brain. New York, NY: Dana Press.
Gagnon, J & Bouchard, M. et al. (2006). Inhibition and Object Relations in Borderline Personality Traits after Traumatic Brain Injury. Brain Injury. 20 (1): 67-81.
Levitin, D. (2006). This Is Your Brain on Music: The science of a human obsession. NY, NY: Penguin Press.
Medical News Today. (2008). Large Portion of Brain’s Prefrontal Region “Takes 5” to Let Creativity Flow in Jazz Improvisation. February 27. www.medicalnewstoday.com.
Menon & Levitin (2005). The Rewards of Music Listening: Response and physiological connectivity of the mesolimbic system. NeuroImage 28 (1): 175-184.
Nochi, M. (2000). Reconstructing self-narratives in coping with traumatic brain injury. Social Science & Medicine: 51 (12): 1795-1804.
Tate & Broe (1999). Psychosocial Adjustment after Brain Injury: What are the important variables? Psychological Medicine. Boston, MA: Cambridge University Press. 713-725.
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