Abstract
What is captivating about music? What is it about the rhythm, melody, harmony or combinations thereof that captures our attention? Which are the elements of music that make it neurologically salient, and how can these be used to benefit our clients? If any of these questions sound familiar, then the Handbook of Neurologic Music Therapy, edited by Michael H. Thaut and Volker Hoemberg, is a good place to start finding answers.
Neurologic Music Therapy (NMT) is a specialised method of working, and requires a significant amount of investment in terms of time, training and finances, and once trained, a ‘continuous personal updating through web searches and professional networking is recommended’ (Thaut, p. 65). While this shift change may feel daunting for some, others may find the use of a more medical language useful in describing their work or liaising with other Allied Health Professionals.
For any newly qualified Neurologic Music Therapist, the Handbook of Neurologic Music Therapy is required reading. And rightly so: the training process to become certified in NMT is intensive but brief, the amount of ground to cover is significant and questions will inevitably arise, either as soon as you get home or perhaps even years later. The Handbook is meticulously detailed, comprehensive and crystalline in its layout, making it a helpful companion to which one can return again and again.
Thaut discusses the potential change in therapist and patient relationship ‘from that of “treater” to that of teacher or coach’ (2014: 8). Rather than representing an undoing of their training, music therapists might find it useful to consider the use of his evidence-based approach as a means to support the best practise in their current work. Readers will certainly find a number of similarities between NMT and more traditional music therapy techniques, while being offered some scientific rationale and evidence for those clinical decisions.
After four introductory chapters that lay out the theoretical and evidence-based foundations upon which NMT was built, the book sets out to systematically outline each of the 20 NMT techniques. Each technique is given its own chapter, essentially laid out as a Who, What, Why and How. The near-uniform set-up of each chapter is as follows:
A definition of the technique (what)
The target populations with whom it can be most successfully used (who)
A summary of the research findings and the therapeutic mechanisms (why)
The therapy procedure, referred to in some chapters as the clinical protocol (how)
This straightforward and consistent structure is especially helpful given that the writing style is relatively heavy. For example, NMT (and therefore the Handbook) employs acronyms for every technique, so the first page of the Handbook is a directory for the 85 abbreviations and acronyms that are peppered throughout the text. The use of acronyms serves to create NMT’s own codified and therefore easily referenced language, but any new reader should expect to spend a lot of time flipping back and forth to this page as they take a while to memorise.
The chapters are all fairly concise (sometimes three or four pages), with a few longer texts ranging between six and eight pages. The only sections that run longer include accompanying illustrations: photographs or step-by-step procedures with illustrated figures, diagrams and music notation. As a companion to the text, OUP has included a media page with audio examples for Chapter 13 on its website: a helpful resource, though it seems strange to provide audio examples for only 1 of the 20 techniques. Although most of the techniques are well articulated in terms of application, most practitioners might still appreciate having access to simulated audio (or ideally video) examples, especially when newly certified, or first beginning to implement the techniques.
Music therapists will be familiar with much of the content presented in Chapter 4. Written by Edward A. Roth, the chapter provides practical examples of Clinical Improvisation in Neurologic Music Therapy. While Thaut (2008) maintains that the uniqueness of NMT techniques lies in the Transformational Design Model (TDM), which involves the ‘transference of functional non-musical stimuli and experiences into functional therapeutic music stimuli and exercises’ (2014: 25), the interventions offered resemble standard techniques of clinical improvisation as currently taught on graduate training courses. Furthermore, the interventions outlined by Roth are not dissimilar to the musical activities described by John Bean and Amelia Oldfield (1991) in Pied Piper.
Written 27 years ago, Pied Piper offers similar pragmatic musical activities that aim to develop listening and concentration, a sense of self and awareness of others, social skills and motor control. Roth’s example of Musical Executive Function Training (MEFT) can be compared with the ‘Conductor’ activity (Bean and Oldfield, 1991: 39), while the session overview replicates the overall structure used in Pied Piper.
The book does not explore the possibility of therapists using single line, orchestral instruments. Using first instruments (a therapist’s primary and most proficiently played instrument) is an important aspect of music therapy in the United Kingdom, as it ensures that therapists are able to offer a high standard of musical intervention. It would have been interesting to hear if and how NMTs are incorporating orchestral instruments into their clinical work.
Some particular highlights within this book include Corene Thaut’s chapter on Patterned Sensory Enhancement (PSE), which clearly articulates how to use the rhythmic, melodic, harmonic and dynamic elements of music to drive spatial and temporal cues for discrete movements that can be translated into activities of daily living. Chapter 7, on Rhythmic Auditory Stimulation (RAS), by Miek de Dreu, Gert Kwakkel, and Erwin van Wegen, gives examples of its application for a number of gait disorders, and provides a six-page meta-analysis of cross-sectional and randomised trials found in the literature. Chapter 13 by Stefan Mainka and Grit Mallien outlines the technique referred to as Rhythmic Speech Cueing (RSC) wherein speech rate is controlled using a metronome to improve fluency, articulation rate and intelligibility. Chapter 14 by Kathrin Mertel is an extremely compelling presentation of Oral Motor and Respiratory Exercises (OMREX) – the application of sung phonemes, or use of wind instruments, as an intervention for oral motor dysfunction and respiratory issues. Chapter 21, by Michael Thaut and James C. Gardiner, on Musical Attention Control Training (MACT) does an excellent job of outlining which musical elements can be used to cue different musical responses in order to practice sustained, selective, divided and alternating attention functions.
These chapters are not only particularly helpful resources for applying the described techniques, but they also provide excellent and clear-cut examples that can be shared with colleagues to illustrate the efficacy of NMT. In his introduction to the Handbook, Thaut lays down a statement of intent: ‘NMT is interdisciplinary. Music Therapists can meaningfully contribute to and enrich the effectiveness of treatment teams’. (p. 2)
This is reflected in the Handbook’s list of contributing authors: the eight Fellows of the NMT training programme (six of whom are Board-Certified music therapists) are in the minority as 12 contributors are leading experts in a range of clinical and research fields including Physiotherapy, Speech and Language Pathology, Rehabilitation Medicine, Neurology, Music and Cognition, Neuropsychology, and Gerontology. This is especially heartening given that an oft-lamented frustration among music therapists is the misconception of exactly what we do. Every music therapist must be an advocate and an educator, as well as a clinician, ever questioning how best to communicate the unique value of what we offer to our colleagues.
Thaut states that, ‘The brain that is engaged in music is changed by engaging in music’. He goes on: ‘Music processing in the brain does not stop at music. Music processing can engage, train, and re-train the non-musical brain and behaviour function’. (p.3) Over the course of 27 chapters, the Handbook illustrates this very point, scrupulously demonstrating how specific elements of music can affect neurological functioning, and can, when wielded with rigour and care, be harnessed to advance patient progress with theoretically based, scientifically investigated protocols that marry art and science. This work helps to substantiate why music therapists deserve a fixed place on a treatment team, and to demonstrate the kind of work they can expect from us.
The longer-term investment of this book is well worth considering, and for those who already use NMT techniques, it remains an excellent reference book that can be used time and time again. The clear structure of the three domains and their techniques – Motor skills, Speech and Communication and Cognition – means that you can easily check which techniques are suitable for a new client. It is the research base behind each technique which makes it unique within music therapy and the step-by-step protocol and instruction of each technique means that each therapist should work in the same, or a similar way, offering a more consistent approach to the client. The step-by-step instruction is also useful for anyone who hasn’t done the training but wishes to try out session ideas or improve their skill set when working in a more targeted way.
This book is thoroughly recommended to anybody interested in exploring the foundations and value of NMT, or who seeks to further develop their understanding of the neurological underpinnings of music. However, as with any clinical resource, there are always updates that can be made. It is worth bearing in mind that, based on the musical examples, this book appears to have been written with a fairly specific client demographic in mind. Most of the musical examples are from the Western canon or The Great American Songbook, and if you work in a diverse area, you may struggle to find any of the suggested songs familiar to, or culturally appropriate for the patients you work with. Likewise, there are sections dedicated to using NMT with children with specific musical examples and resources, but there are very few, if any, songs in the Handbook that would be applicable for teenagers or adults.
For a book introducing a set of techniques to be used in the field of music therapy, it would be reasonable to expect that the Handbook would cite the most up-to-date clinical research findings published in the music therapy literature. While the Handbook boasts a bibliography of almost 800 texts, only 112 of these (15%) are from the field of music therapy. More curious still, only 58 of the cited texts (7% of the Handbook’s referenced literature) were published within the past 15 years. The Handbook has been criticised in the past for presenting NMT as a new and wholly unique model, when several of its techniques have been built upon methods that are commonplace either in traditional music therapy practice or in related allied health disciplines. Ours will not be the only review to note that it would have been gallant of the Handbook’s authors to allow a little more space to acknowledge that lineage.
Although the title may put a number of potential readers off, the neuroscientific research behind the use of NMT techniques offers all music therapists the opportunity to educate and empower themselves in understanding why what we do in music therapy works! Instead of marking the either/or territory between the NMT approach and other music therapy approaches, readers may find that the technique chapters of the book contain a treasure trove of ideas for sessions that can be easily adapted to different client groups and ages. One of the most important aspects of a music therapist’s work is looking at whether music, in any or all of its forms, can bring about a positive change for a client. The Handbook of Neurologic Music Therapy offers some alternative tools for everyone to try and use, and does not need to alter the way we approach our sessions or change our core values of supporting the emotional well-being of our clients.