Goal! How Neurologic Music Therapy™ can be a perfect partner for Physiotherapy

Joint NMT/Physiotherapy work

At TIV, we use a lot of songwriting when working to help clients to retrieve speech after a brain injury. Perhaps a less prominent application for songwriting in NMT™, however, is in joint work with physiotherapists. I have recently started writing a song which makes use of Neurologic Music Therapy™ techniques - Patterned Sensory Enhancement or PSE™ and Temporal Instrumental Musical Performance or TIMP™. 

The first technique uses music to embed the desired physio goal into the structure of the song and then TIMP™ makes strategic use of musical instrument positioning to serve non-musical, functional goals. Here's how I used the Transformational Design Model™ to create the intervention when co-treating a client who is in rehabiliation after a traumatic brain injury. I have changed personal details to protect the anonymity of the client.

Step 1 – Assessment of the functional goal

• Functional goal: To repeatedly practise active dorsiflexion and plantarflexion of the right foot (lifting and lowering the toe) in order to ease pain, promote flexibility, build muscle strength, and improve tolerance in the standing frame (identified by physiotherapist)

• Current status: the client can initiate movement when requested, with effort, but fatigues quickly and lacks motivation in standard physiotherapy drills.

Step 2 – Identify non-musical therapeutic exercise

• Conventional physiotherapy task: Repeated lifting and lowering of the toe while seated or standing, with verbal prompts (“lift, lower, lift…”).

• This is repetitive, fatiguing, and may be difficult and discouraging for the client.

Step 3 – Designing of the musical analogue (equivalent) of the exercise

• Using the structure of a pop song that embeds the movement cue within meaningful, motivating context.

• The song is very upbeat 'think 'Waka, waka!' and uses Manchester United references to favourite team members etc. (a huge motivator for him).

• On the key lyric “GOAL!” the client is cued to lift the toe (strike down on the drum pad foot pedal'

• The music mirrors the rhythm and timing of the movement, giving strong external structure and making use of auditory-motor entrainment.

• For this client we will incorporate lots of plosive consonants because he is working on these in SLT sessions - we might as well incorporate another goal here.

Step 4 – Therapeutic music exercise

• The song is composed with strong beat (tempo set at physiologically appropriate pace for his toe-lifting ability).

• Each phrase builds towards the word “goal!” making use of anticipatory structure.

• On the word “goal!” → client lifts and lowers his toe, striking the drum pad foot pedal to make the movement audible and rewarding.

• Social reinforcement: After each “goal,” an applause sound effect is triggered. This provides positive reinforcement and mirrors the social-emotional excitement of football.

Step 5 – Transfer to functional domain

• After practising with the song, we will gradually fade musical cues so that the client can initiate and sustain toe lifting without the external structure.

• Eventually, we will carry over the movement into standing frame physiotherapy without music, using the residual motor pattern built through rhythmic entrainment.

• The association with success and enjoyment (football / scoring) reduces stress and increases desire to take part.

Step 6 – Generalisation

• Client begins to use toe lifting in other contexts

• Care team and family can join in with singing at home, embedding exercise in daily routine application

Here at This Inner Voice Music Therapy Ltd., we are all about embedding Neurologic Music Therapy™ into music that is motivating and fun for the client whilst constantly considering the therapeutic, non-musical outcomes we are working towards.

Songwriting is not easy.. but it is such a valuable therapeutic tool. I've always done it the old-fashioned way, but HCPC-registered music therapists might be very interested in trying out, and giving feedback, on 'Flow' - an amazing therapeutic songwriting app created by Felicity Baker. This is going to have a big impact on our ability to create songs for clients in the future: Flow by Unsung Studios

NMT is a perfect partner for physiotherapy

Please do get in touch if you would like to discuss a referral. We have a lovely, small team of dedicated therapists and we would be delighted to hear from you. info@thisinnervoice.com

This Inner Voice Music Therapy Ltd. website