The arts therapies and neurologic music therapy (NMT) in particular can work seamlessly towards a rehab programme’s shared functional goals.

They also help to overcome the psychological blocks which may prevent 
a person fully engaging in rehab. A recent Cochrane Review (2017) found that “music interventions using rhythm may be beneficial for improving walking in people with stroke”.

It also noted “treatment delivered by a trained music therapist might be more effective than treatment delivered by other professionals”.

Daniel Thomas, of arts therapies provider Chroma, says: “Working across both the functional and psychological aspects
of a person’s rehabilitation towards 
shared goals is how the arts therapies optimise outcomes.

“Enabling the patient to re-frame their relationship with their own rehab also makes arts therapies such an effective tool within the multi-disciplinary team.”

Here Daniel answers our questions on the rise of arts therapies and their potential value to neuro-rehab professionals and their clients:

What are the arts therapies, are they regulated and who are they for?

They are a group of three distinct professions – art psychotherapy, dramatherapy and music therapy.

They are regulated by HCPC and are an allied health profession. Current training is based at MA level and includes medical studies, neuroscience, attachment, creating research, psychological models and assessment.

Job titles, such as music therapist, are protected in law and there are around 4,000 UK arts therapists.

Our organisation provides all three arts therapies across the UK to partners in the education, health and social care sectors.

Our therapists work with people of all ages and stages of life, from pre-term babies in NICU units, to adults and children with brain injuries and other neurological conditions, to families supporting an elderly relative within a palliative care setting.

What conditions do they work with?

The wide range of conditions treated by the arts therapies includes acquired and traumatic brain injuries (ABI/TBI), other neurological conditions, autism, mental health, stroke, dementia, learning difficulties, cerebral palsy, attachment and family issues, disordered eating and bereavement.

The arts therapies can facilitate the attainment of functional goals, for example gross/ ne motor skills within a neuro-rehab setting, while also working with the same patient to address some of the psychological barriers to their engagement with rehab, such as anger, hopelessness or depression.

Is there any evidence for the arts therapies?

There are thousands of published articles, papers, case studies, books and pieces of practice-based evidence to support the efficacy of the arts therapies.

There are a handful of RCT based
 studies too, but it’s often not a very 
helpful way to judge the effectiveness of the arts therapies.

By their very nature, they are a highly personalised form of non-pharmacological medication without side effects which should be facilitated by a trained professional.

Over the past few years there have been a number of positive Cochrane Reviews, including the 2017 review looking at ABI.

Within NMT, there are hundreds of published papers and research studies – it is the most comprehensively researched and evidence-based form of music therapy.

How did NMT emerge as a distinct approach?

About 20 years ago, neuroscience researchers started looking at music perception in the brain.

They began to see how the brain was impacted and changed by music, for example when we hear music with a strong regular beat.

When this happens, our auditory neurons interact with our motor neurons to produce a regular pattern of motor-neural ring, based on the musical pulse. This in turn allows us to tap our toes in time with the music.

Researchers started to see there were many more of these “automatic” processes that occur in a brain stimulated by music that could be used within neuro-rehab.

Dr Michael Thaut, who developed the 
NMT model alongside clinicians such as 
Dr Corene Thaut and Sarah Johnson, realised that by stimulating motor neurons with a regular auditory pulse, gait patterns in people with Parkinson’s became more symmetrical (Arias & Cudeiro 2008 / Bukowska et al 2015).

It’s easy to see this ‘disco effect’ in action – just notice what happens to your body when you hear music with a regular beat or, when jogging, how you tend to run to the beat or speed of the music.

This finding then led to other discoveries and the NMT model, with its 20 approved techniques, was born in the late 1990s.

Much of the research (over 200+ published articles) has been published
 in academic journals and proceedings, and much of it can be found via the NMT Academy website (www.nmtacademy.co).

How exactly can NMT optimise outcomes in neuro-rehab?

NMT is so effective within neuro-rehab because it utilises many of the automatic and
in-built ways that a brain responds to music.

Music therapists who have completed
 the additional neurologic music therapy training, and who are certified and registered with the NMT Academy, work towards shared treatment goals.

These cover the sensorimotor, cognitive 
and speech and language domains.
 One of Chroma’s NMTs will work closely with the MDT or case manager to understand what the shared treatment goals are, and work towards these.

It is by tapping into what neuroscience has told us about music and the brain that we are able to support neuroplasticity and re-wire or reconfigure neural pathways via engagement with music.

A simple example would be someone whose language ability has been damaged in an accident or a stroke.

Because they now find it impossible to remember the words they need, we can reteach functional everyday phrases through song. The known melody acts as scaffolding, from which the new phrases and words can be hung.

The tune from Twinkle Twinkle Little Star helps the client recall the phrase “Can I have a cup of tea” for example.

If a client already has physiotherapy, why bring in NMT?

Using music as a context for physiotherapy can re-engage a client in the process. This may be useful if a client needs re-motivating around their rehab.

For many clients, it is the way that NMT helps to re-frame their relationship to their own rehab that is so important.

We had a recent case where a child was having gait training, but was frustrated and upset with the pain of the exercises and also at the repetitive nature of what the physio was requiring.

He was actually only being compliant and engaging for about five minutes a session. One of our NMTs started to work 
alongside the physiotherapist and toward her goals.

The NMT designed a few musical interventions that helped the child to complete the required physio movements, but engaged him in an exciting musical dialogue.

He was able to bring playfulness into his physio sessions, and his dad loved seeing his son show some of his playful nature again.

In terms of the hard outcomes, the child’s step cadence went from 21 steps/minute to 56 s/m in less than three weeks.

We also have adult clients who increase the number of required movements from five per five minutes to 18 per five minutes as
 a result of including NMT within their rehab programme.

Re-contextualising rehab so that the client has a new positive relationship with it is ultimately what NMT allows to happen.

What about clients who are stuck and won’t engage with rehab? Can arts therapies work with them?

There are all sorts of reasons why clients struggle to engage. Some will be practical, and a big part of NMT is reframing the rehab in a more creative and engaging way.

But it is really important not to forget the psychological impact of loss and change, and this is an area the arts therapies work particularly well with.

Arts therapists have a background in emotional and mental health and will bring a real understanding of both the conscious and unconscious processes that can leave a client feeling stuck, demotivated and hopeless. Working creatively to address these feelings can help clients move through these issues.

This might be through song writing in music therapy, through the art work created in art therapy or through story or characters in dramatherapy.

What can really help is the distance provided by creativity.
 A dramatherapist might enable a client to create a story into which they project their experiences and feelings.

But because it is not about them directly, it is a story, they can manage and explore the feelings in a much more manageable way.

And through creating a story they can explore other options and possibilities that might feel impossible when thinking directly about themselves and their current situation.

For more info on arts therapies in neuro-rehab settings, contact Daniel Thomas of Chroma via daniel@wearechroma.com or 0330 440 1838. www.wearechroma.com.