I’m sure within the past few minutes, you’ve touched your phone. You might have just scrolled through Facebook to see cute puppy videos (guilty here!). Or maybe you sent a funny meme or texted your friend to let them know the new fascinating, hilarious, and incredibly well written NMT Blog just posted (ahem). Whether it was on a new  iPhone 6 or not, I can guess with certainty that you picked up a smart phone, pressed the unlock button, and did…something.   That’s not really a big deal, right? Well it is because it took a lot of finger dexterity, fine motor control, and general coordination to do such an intensive task.

We button our shirts, we type on our computers, we write things down, we cook, and we drive. The fact is that we use motor skills, especially fine motor skills, almost every second of every day. These tasks that are easy and completely out of awareness can become severely limited and difficult to do after an injury to the brain. Individuals that have suffered from such an injury understand the incredible hardship when these functions that control many activities of daily living are disrupted.

Within the past decade, there has been a tremendous growth in research on how rhythm affects movement in the human brain. This research is the basis of Neurologic Music Therapy. But the purpose of this week’s blog is to discuss an NMT intervention for physical rehabilitation, specifically with the goal of increasing motor control for hands and arms after a brain injury has caused dysfunction.

Last week’s blogged focused on the NMT intervention, Rhythmic Auditory Stimulation. This intervention retrains walking patterns to be more functional and safe by using rhythm. Rhythm can help to initiate movement and cause it to be more fluid. This is because of the feed-forward mechanism where our brains interpret time intervals between beats, which help us prepare for the next beat in the sequence (See last week’s blog). So our internal timekeeper “entrains” to the external sound we hear. The principles of why this intervention works (rhythm to help motor control) can also be used for upper gross motor control (upper arm movement) and fine motor control like finger dexterity.

Using rhythm to improve motor coordination and motor planning facilitates the recovery of fine and gross motor skills. The NMT intervention of the week (hold your applause): Therapeutic Instrumental Music Performance (TIMP).   Patients can use pianos, guitar, drums, or other  instruments to improve movement patterns. Nothing like putting that old Casio in your attic to work!

TIMP utilizes entrainment research in conjuction with playing instruments to stimulate movement for motor rehabilitation. The instrument that is chosen for the intervention is dependent on the patient’s needs and goals of treatment. For example, during my 9-month internship at a neurorehabilitation hospital in Boston, there was a patient that suffered from a stroke. TIMP was used to help her regain fine motor movement of fingers in her right hand. A piano was the instrument of choice for this intervention. The patient was directed by the NMT to play certain patterns and notes on the piano. Simultaneously, the NMT facilitated entrainment by creating a steady rhythmic pattern of chords on the same piano. This exercised functional motor movement patterns because it isolated fingers that needed more strengthening in motor control. Also, the NMT can tell the patient which notes to play so that when they play along, they never play a wrong note (also no prior musical knowledge is necessary)! She was instructed to do various exercises with the goal of strengthening her motor movement and retraining her spatial configuration after an intense injury. The NMT’s emphasis of rhythmic structure during this intervention allowed the patient to engaged and entrain to the music.  Things like supination/pronation and flexion/extension (ways in which our muscles move) are also integral parts of TIMP.  The NMT can structure exercises using rhythm and the placement of instruments to engage supination, pronation, flexion, and extension.

A study by Yoo (2009) examined the use of TIMP on stroke patients and their upper extremity movement. Participants engaged in six 35-minute NMT sessions where flexion and extension exercises on drums were of focus. Their results demonstrated significant improvements on hand coordination.

TIMP can also be used in a group setting, where the activities/interventions can be targeted to benefit individuals within the group setting. In this case, patients can address their goals with the support of others in a similar situation, providing social support and even FUN! So the next time you see a drum circle; if it is facilitated by an NMT, there is probably a lot more going on than just a group of people playing instruments! And the next time YOU play in a drum circle, think about the potential of this very simple activity.

The best part about this kind of NMT intervention is that it provides an amazing opportunity for Neurologic Music Therapists to collaborate with Occupational Therapists. Big shout out to all you OTs out there! Occupational Therapists assist in rehabilitating individuals to be able to do everyday activities after an injury and often focus on upper extremities. They have a very important duty within the field of rehabilitation. But when the forces of NMT and OT unite (cue dramatic music) they can become a super-charged superhero team in the eyes of a patient. And it can’t get any better than combining two sets of skills and expertise when it comes to the care of our patients. #Musicitsscience #neurologicmusictherapy

Have any questions about NMT that you would like an answer to? Ask us!

Written by: Steph Mathioudakis, MedRhythms Blogger

References

Baker, F., Tamplin, J. (2006). Music therapy methods in neurorehabilitation: A clinician’s manual.London: Jessica Kingsley Publishers.

Yoo, Jeehyun. (2009). The role of therapeutic instrumental music performance in   hemiparetic arm rehabilitation. Music Therapy Perspectives , 27(1), 16-24.

http://www.aota.org/about-occupational-therapy.aspx

http://homepages.wmich.edu/~eroth/NMT%20Overview.pdf

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