Neurologic Music Therapy in Cognitive Rehabilitation

Author(s): Michael H. Thaut

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Source: Music Perception: An Interdisciplinary Journal, Vol. 27, No. 4 (April 2010), pp. 281-
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Music2704_05 3/25/10 9:52 AM Page 281

Neurologic Music Therapy in Cognitive Rehabilitation 281

N EUROLOGIC M USIC T HERAPY IN C OGNITIVE R EHABILITATION

M ICHAEL H. T HAUT emotional components in the therapeutic music expe-

Colorado State University rience, contributed to this lack of development.
Another factor that has slowed this research is more
NEUROLOGIC MUSIC THERAPY LAST CAME INTO research technical in nature. There were clear limitations to
and clinical focus via cognitive rehabilitation. New cognitive brain research from a neuroscience perspec-
imaging techniques studying higher cognitive functions tive before the advent of noninvasive research tools to
in the human brain ‘in vivo’ and theoretical advance- study the human brain in vivo. Brain imaging tech-
ments in music and brain function have facilitated this niques did not develop fully until approximately
development. There are shared cognitive and percep- between 1985 and 1990, and they were slow to become
tual mechanisms and shared neural systems between available to musical brain research. Today’s wide avail-
musical cognition and parallel nonmusical cognitive ability of brain-imaging equipment, together with the
functions that provide access for music to affect gen- considerable refinement in brain-wave measurement
eral nonmusical functions, such as memory, attention, techniques via EEG and MEG, has produced a new
and executive function. The emerging clinical literature basis for biomedical research in music cognition and
shows substantial support for these effects in rehabili- rehabilitation.
tative retraining of the injured brain. Key findings
relevant for clinical applications of neurologic music Links Between Music and Cognitive Functions
therapy to cognitive rehabilitation are presented and
discussed below. From these efforts a growing body of research has
emerged that sheds new light on intriguing links between
Received November 4, 2009, accepted December 14, 2009.
music and a variety of cognitive functions, including
Key words: neurology, music, cognition, rehabilitation, temporal order learning (Hitch, Burgess, Towse, & Culpin
brain, 1996), spatiotemporal reasoning (Sarntheim et al., 1997),
attention (Drake, Jones, & Baruch, 2000; Large & Jones,
1999), and auditory verbal memory (e.g., Deutsch, 1982;
Glassman, 1999; Kilgour, Jakobson, & Cuddy, 2000; Thaut
et al., 2005; Chan et al., 1998; Ho et al., 2003).

T
HE ROLE OF MUSIC IN COGNITIVE rehabilitation
(CR) has been the last domain to come into full Efforts have also been put forward to examine models
focus in neurologic music therapy. Applications how music can remediate cognitive functions. For exam-
of music to CR were not studied well in the past in ple, a large and consistent body of research in musical
comparison to, for example, music’s role in motor ther- attention has pointed to the role of rhythm in tuning
apies or speech/language rehabilitation. Several con- and modulating attention in music (e.g., Drake et al.,
ceptual problems probably accounted for the slow 2000; Jones, 1992; Jones, Boltz, & Kidd, 1982; Jones &
research development. In reviewing the music therapy Ralston, 1991; Klein & Jones, 1996 ). Rhythmic patterns
literature over the past 50 years, very few studies have entrain attention focus by interacting with attention
examined how music can influence cognitive functions oscillators via coupling mechanisms. Bonnel, Faita,
in a therapeutic context on a theoretical basis. Music Peretz, and Besson (2001) found evidence for divided
cognition has of course always been a field of very attention mechanisms in song between processing of
active scholarship, but no conceptual links have been lyrics and processing of music. Very important connec-
developed as to how cognitive processes in music per- tions between musical and nonmusical memory forma-
ception could be transferred to retraining cognition tion have been laid out by Deutsch (1982), showing how
and perception in therapy. The overwhelming reliance some of the fundamental organizational processes for
on broad—and often psychotherapeutically oriented— memory formation in music—based on the structural
concepts of music as a therapeutic tool for models of principles of phrasing, grouping, and hierarchical abstrac-
‘well being’ and therapeutic relationship building, as well tion in musical patterns—have their parallels in temporal
as an intuitive but mostly undifferentiated emphasis on chunking principles of nonmusical memory processes.

Music Perception VOLUME 27, ISSUE 4, PP. 281–285, ISSN 0730-7829, ELECTRONIC ISSN 1533-8312 © 2010 BY THE REGENTS OF THE UNIVERSITY OF CALIFORNIA . ALL
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Music2704_05 3/25/10 9:52 AM Page 282

282 Michael H. Thaut

We can now begin to postulate that the mechanisms subjects showed that the musical mnemonics condition
that drive cognitive processes in music, such as in atten- induced significantly higher oscillatory synchrony in
tion and memory, are shared by equivalent processes in the lower alpha band rhythms in bilateral prefrontal
nonmusical cognition. One of the most important neural networks underlying memory than the spoken
shared mechanisms may refer to rhythm as a temporal condition. The finding of increased neuronal synchrony
structuring and patterning process in perception and in cortical networks in multiple sclerosis is very interest-
learning (Conway, Pisoni, & Kronenberger, 2009; ing since the disease is characterized by demyelination
Jakobson, Cuddy, & Kilgour 2003; Janata, Tillmann, & processes that interrupt network dynamics of neuronal
Bharucha, 2002). cell assemblies.
Recent research also has shown that musical memories
Shared Mechanisms and Brain Systems may survive longer than nonmusical memories and may
be functionally available and accessible for persons with
Based on these shared processes we can now formulate neurologic memory disorders such as dementia or
hypotheses about how music training can access and Alzheimer’s disease (AD) (Baur, Uttner, Ilmberger, Fesl,
modulate cognitive functions in a rehabilitation context. & Mai, 2000; Crystal, Grober, & David, 1989; Cuddy &
The Rational Scientific Mediating Model (RSMM) was Duffin, 2005; Halpern & O’Connor, 2000; Haslam &
developed to provide a systematic epistemology for trans- Cook, 2002; Samson, Dellacherie, & Platel, 2009; Son,
lational research in music and rehabilitation (Thaut, Therrien, & Whall, 2002; Vanstone & Cuddy, 2010;
2005). For example, could “musical chunking” be used as Vanstone, Cuddy, Duffin, & Alexander, 2009). That this
a mechanism to enhance verbal learning and rehabili- function may extend to learning new musical materials
tate verbal memory? Could attention training in music was proposed in a case study of a violinist diagnosed
enhance auditory attention control in nonmusical con- with AD and profound anterograde and retrograde
texts based on principles of attention process training memory deficits who not only continued to perform
(Sohlberg & Mateer, 1989)? Can music create strong syn- familiar music but learned to play a new, unfamiliar
chronized connectivity between different areas of the piece (Cowles et al., 2003). Of considerable importance
brain to help in more efficient rehabilitative relearning for the use of musical memories in therapy is the evi-
and training (Bhattacharya, Petschke, & Pereda, 2001)? dence that they may help access nonmusical autobio-
graphic recall (Foster & Valentine, 2001; Irish et al., 2006)
Memory Studies also report that accessing musical memories
provides a tool for musical memory training to
Research has shown that music can serve as an effective enhance access to nonmusical recall and knowledge
mnemonic device to facilitate verbal learning and recall (Rainey & Larsen, 2002).
in healthy persons, patients with memory disorders, It is well known that emotional context enhances learn-
and children with learning disabilities (e.g., Claussen & ing and recall (Bower, 1981). It is also well known that
Thaut, 1997; Gfeller, 1983; Maeller, 1996; Wallace, 1994; positive mood states enhance memory function (Jensen,
Wolfe & Hom, 1993). One of the theoretical models for Lewsi, Tranel, & Adolphs, 2004). Therefore, the access that
this effect proposes that the highly developed temporal musical memories provide to triggering nonmusical (e.g.,
structure in musical stimuli—songs, chants, rhymes— verbal or autobiographical) materials is most likely based
functions as a metrical template that helps to organize on strong associative learning mechanisms that utilize
and chunk information into more manageable units. music as a highly salient conditioning stimulus.
“Chunking” is a helpful mechanism not only in declar- In this context, interesting data have come from recent
ative learning and recall, but also in motor learning studies that show preserved short term memory func-
(Verwey, 2001). Indeed ‘chunking’ is probably an innate tioning in patients with Alzheimer’s disease—where a
feature across a broad phylogenetic range of nervous network of prefrontal-amygdala connections was acti-
systems (Matzel, Held, & Miller, 1988). vated compared to healthy subjects in which prefrontal-
In a recent study of patients with multiple sclerosis, hippocampal networks typically were activated (Grady,
we were able to show that word lists from Rey’s Furey, Pietrini, Horwitz, & Rapoport, 2001; Rosenbaum,
Auditory Verbal Learning Test (RAVLT) were signifi- Furey, Horwitz, & Grady, 2004). Since amygdala func-
cantly better learned and recalled when presented and tions are highly implicated in processing emotional
rehearsed via song as a rhythmic-melodic template vs. stimuli, emotional context and saliency of memory pro-
the usual spoken presentation and rehearsal (Thaut et cessing may preserve longer residual memory functions
al., 2005). Furthermore, EEG recordings of the study in Alzheimer’s disease. Music-based memory training in
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Neurologic Music Therapy in Cognitive Rehabilitation 283

dementia and Alzheimer’s disease may therefore facilitate studied neurologic music therapy techniques related to
a shift in accessing this amygdala-based neuroanatomical musical attention training, musical executive function
network, again due to the nature of music as a highly training, and musical memory training. Data were
salient emotional stimulus. measured before and after a single therapy session and
compared between the music condition and a standard
(In)attention and Neglect neuropsychology condition. After a single intervention,
memory and attention did not show any significant
Some evidence for music as an effective training modal- improvement in either condition. However, executive
ity exists also in the areas of neglect training. For function was significantly improved. This finding was
example, Hommel, Peres, Pollak, and Memin (1990) also further supported by statistics showing signifi-
proposed the beneficial effect of musical stimulation cantly improved self-efficacy ratings in executive func-
for overcoming visual neglect as a result of right hemi- tion by the patients, indicating a stronger sense of
spheric lesions due to stroke or traumatic brain injury. self-confidence in their executive function abilities.
Music stimuli were superior to other sensory and cogni- Furthermore, several areas of psychosocial adjustment
tive cues, such as instructions and speech or tactile cues. improved significantly in neurologic music therapy
The researchers suggested that the arousal effects of over the control group in the areas of depression, anx-
music—specifically on the right brain hemisphere, iety, and sensation seeking. Other measures, for example,
which is lesioned in visual neglect states—may underlie hostility, positive affect, and global emotional improve-
this positive outcome. In this context Robertson ment, showed more limited or nonsignificant results.
Mattingley, Rorden, and Driver (1998) have shown that Taken together, the data provide the first more compre-
unilateral neglect can be dramatically altered by chang- hensive view on music in cognitive rehabilitation, albeit
ing the functioning of the brain’s arousal system, and on a short term intervention basis. Nevertheless, these
have used these findings to develop other arousal-based data are important in increasing our knowledge of
neglect training techniques, including auditory-based music’s beneficial role in cognitive therapy, especially in
techniques (Robertson, Nico, & Hood, 1995). Frassinetti the area of executive function that had previously not
and colleagues (Frassinetti, Bolognini, & Ladavos, 2002; been studied at all.
Frassinetti, Pavani, & Ladavos, 2002) have provided In conclusion, we can look at emerging data that
remarkable evidence that auditory stimuli can enhance point to a functional and useful role for music training
visual perception in neglect states. in cognitive rehabilitation. Based on a new direction
that links music cognition and perception research to
Executive Function and Emotional Adjustment models of music and learning—and finally, linking
music learning to retraining the injured brain—a new
Attention to the psychosocial functioning of patients as model has finally emerged that allows us to study and
part of their overall executive control has always been a apply music efficiently as a complex multisensory stim-
critical aspect of treatment. For example, many patients ulus to cognitive rehabilitation.
with traumatic brain injury will suffer from anxiety,
depression, sense of loss, and other areas in need of Author Note
coping. There is evidence that neuro logic music therapy
can successfully be used to address psychosocial treat- This work was supported in part by a grant from the
ment issues (Kleinstauber & Gurr, 2006; Nayak, Wheeler, Charleen B. Flood Memorial Research Fund.
Shiflett, & Agostinelli, 2000).
In a recent exploratory study (Thaut et al., 2009), we Correspondence concerning this article should be
examined whether specific techniques in neurologic addressed to Michael H. Thaut, Center for Biomedical
music therapy could improve cognitive retraining in Research in Music, Colorado State University, Fort Collins,
traumatic brain injury rehabilitation. Specifically we CO 80523. E-MAIL: [email protected]

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