Music Therapy and Stroke Recovery

Music Therapy techniques can be imperative for aiding in post-stroke recovery. It can help improve speech, language, and motor function, as well as address cognitive deficits such as memory and attention. Additionally, music therapy can positively influence mood and emotional regulation, potentially accelerating neurological recovery. This research article explores, more in depth, the effects that music therapy can have on patients who have previously experienced strokes. During a stroke, many areas of bodily function are affected, specifically a person’s speech, movement, and memory. Rehabilitation from a stroke can be a lengthy process that consists of intensive and individualized programming. Stroke patients often work towards regaining functional abilities and levels of independence, rebuilding quality of life, and promoting the highest level of functioning possible.

The patient’s areas of needs, within the article, were increasing balance and gait disorders after a stroke. Patients before treatment had a short-term prognosis of requiring an assistive device to walk. Music therapists conducted a study using the music therapy intervention, Rhythmic Auditory Stimulation, developed by neurological music therapists. Rhythmic auditory stimulation interventions use a metronome or musical cue as an external trigger to elicit movement and to improve motor symptoms. In this specific study the therapists used a metronome to provide accented beats. Patients who received this intervention showed an increase in balance and improved motor skills both with and without a walking assistive device. Patients also reported an increase in quality of life through the increased autonomy they gained.

The applications of this research article are extensive when working towards movement and balance goals within a music therapy session. This intervention would work with any population working towards increasing walking distance and increasing smooth gait because the rhythmic auditory stimulation provides a steady pulse for clients to entrain to and thus increase smooth gait. Knowing this information increases the generalizability of the interventions used not only for stroke patients, but for any client who is working towards similar goals. This learning matters because it serves as evidence and provides the foundation for neurological rehabilitation and music therapy for patients who have experienced a stroke. In conclusion, Rhythmic Auditory Stimulation uses a steady pulse to improve balance, mobility, and gait while simultaneously improving functional independence and quality of life for patients who are post stroke.

-Rebecca Smith, Music Therapy Intern

References:

Editorial: Understanding stroke recovery to improve outcomes: From acute care to chronic rehabilitation. Frontiers in Neurology, 13, 1021033. https://doi.org/10.3389/fneur.2022.1021033

Gonzalez-Hoelling, S., Reig-García, G., Bertran-Noguer, C., & Suñer-Soler, R. (2024). The effects of rhythmic auditory stimulation on functional ambulation after stroke: A systematic review. BMC Complementary Medicine and Therapies, 24(1), 45. https://doi.org/10.1186/s12906-023-04310-3

Autism Spectrum Disorder and Sensory Integration

Music is a powerful tool for integrating sensory systems during a therapeutic session with individuals with Autism Spectrum Disorder (ASD). Autism Spectrum Disorder, according to the National Institutes of Health, is a condition characterized by difficulties in communication, flexibility in behavior, and social interaction These sensory based behaviors impact how one responds to auditory, tactile, and visual stimuli. ASD is a spectrum, and there is no one-size-fits-all method to aid sensory processing needs. Current research concludes that an individual's sensory needs must be met before a therapist can target developmental and social-emotional goals.

The link between music and the sensory system is through the nervous system. Music therapy helps by aiding in the disruption that occurs in the organization of sensory input. This is done through the perception of music throughout the brain combined with the emotional reaction music can produce.

Music therapy aids in working with individuals with ASD and maintaining sensory needs through many different interventions. A few of these interventions consist of:

• Movement to music supporting both proprioceptive and vestibular input.

• Tactile Input through musical instruments and props such as scarves, rain sticks, ocean drums, bean bags, stretchy bands, etc.

• Calming/ sensory music used to regulate, reduce frustration, and increase tolerance.

In addition to these interventions, many principles that set up a music therapy session for success. This enables the therapist to more effectively address the sensory needs of their clients. These principles consist of:

• Creating emotional attunement through music by altering the music, voice, and arousal level 

• Scaffolding interactions musically by using musical, verbal, visual, or physical cues to support the needs of the client

• Targeting goals through interventions the clients enjoy by altering affect in tone of voice, facial expressions, musical actions, and gestures

-Rebecca Smith, Music Therapy Intern

References:

Geretsegger, M., Holck, U., Carpente, J. A., Elefant, C., Kim, J., & Gold, C. (2015). Common Characteristics of Improvisational Approaches in Music Therapy for Children with Autism Spectrum Disorder: Developing Treatment Guidelines. Journal of Music Therapy, 52(2), 258–281. https://doi.org/10.1093/jmt/thv005

Marco, E. J., Hinkley, L. B. N., Hill, S. S., & Nagarajan, S. S. (2011). Sensory Processing in Autism: A Review of Neurophysiologic Findings: Pediatric Research, 69(5 Part 2), 48R-54R. https://doi.org/10.1203/PDR.0b013e3182130c54

Perrin, F., & Magee, W. L. (2023). Music as Sensory Stimulation and Therapeutic Intervention. In C. Schnakers & S. Laureys (Eds.), Coma and Disorders of Consciousness (pp. 99–113). Springer International Publishing. https://doi.org/10.1007/978-3-031-50563-8_6

Simhon, V., Elefant, C., & Orkibi, H. (2019). Associations between music and the sensory system: An integrative review for child therapy. The Arts in Psychotherapy, 64, 26–33. https://doi.org/10.1016/j.aip.2018.11.005

The Role of Music Therapy in Infant Development in the NICU

From the womb to the NICU, early sensory experiences, especially those involving sound, play a vital role in an infant's neurological and emotional development. While full-term babies often benefit from natural bonding and soothing environments, premature infants in the NICU may face sensory challenges that can impact their growth and well-being. Music therapy offers evidence-based practice as a way to bridge these gaps, supporting both infants and their caregivers through carefully tailored auditory interventions.

The Challenges of the NICU

After birth, calming sensory experiences and close physical contact, such as skin-to-skin care, are essential in promoting healthy neurodevelopment. However, for premature infants in the NICU, these early bonding opportunities are often limited or delayed. Instead of a soothing environment, NICU babies may be exposed to frequent and unpredictable stressors, including sudden alarms, harsh lighting, medical procedures, and persistent background noise.

This kind of overstimulation during such a vulnerable period can have significant consequences. Early auditory experiences are critical for brain development, and excessive noise in the NICU has been associated with physiological distress in infants. These responses may include irregular heart rates (either tachycardia or bradycardia), apnea, reduced oxygen saturation, increased muscle tension, elevated blood pressure and intracranial pressure, disrupted sleep, and agitation. Over time, these stressors may also impact long-term outcomes, including hearing and speech development. In fact, studies have shown that infants who remain in the NICU for more than four days are at an increased risk for hearing loss.

Music Therapy in the NICU

Music therapy can help restore some of the sensory and emotional experiences that NICU infants miss. It can help support both babies and their caregivers.

For Infants, Music Therapy Can:

• Reduce stress

• Relieve pain

• Improve feeding behaviors

• Support vital signs (like breathing, oxygen saturation, and heart rate)

• Shorten NICU stays

• Strengthen the infant-caregiver bond

For Parents, Music Therapy Can:

• Decrease anxiety

• Provide emotional and bereavement support

• Teach coping strategies

• Offer NICU education and training

• Support the transition to home through discharge planning

Music Therapy Interventions for Premature Babies

Music therapists work closely with families and medical teams to design personalized interventions. They especially incorporate the parent’s voice, which is comforting and neurologically beneficial for the baby.

Passive Music Listening
For babies 28 weeks gestation and up: Soft lullabies, often sung live by the mother or therapist, help lower stress and regulate vital signs.

• Passive Music Listening
  For babies 28 weeks gestation and up: Soft lullabies, often sung live by the mother or therapist, help lower stress and regulate vital signs.

• Multimodal Neurological Enhancement (MNE)
  For babies 32 weeks and up: Combines soothing music with gentle touch, movement, and visual cues to promote sensory integration.

• Contingent Music
  For babies around 34 weeks who struggle with feeding: Use tools like the Pacifier Activated Lullaby (PAL), which plays music when the baby sucks on a pacifier, encouraging proper sucking and feeding skills.

-Asila Folds, Music Therapy Intern

Resources:

Krueger, C,. & Garvan, C. (2014). Emergence and retention of learning in early fetal development. Infant Behavior and Development, 37(2), 162-173.

Blackburn, S. (2017). Maternal, fetal, and neonatal physiology (5th ed.). Saunders.

Standley, J. M. (2023). Evidence-based music therapy for premature infants (3rd ed.).

Hearing Loss and Music Therapy

Hearing loss affects nearly one in five children by age 18 in the U.S., and without intervention, it can significantly impact speech, language development, education, and cognition. It can be congenital, delayed-onset, or acquired. Timely intervention is crucial for optimal outcomes, and a range of rehabilitation options—including hearing aids, cochlear implants, bone-anchored devices, and assistive technologies like frequency-modulating systems—can help mitigate the adverse effects of hearing loss and support a child’s communication and developmental needs.

Music therapy offers significant benefits for children with hearing loss by enhancing their auditory perception, communication skills, and overall development. The structured use of music can help these children strengthen their ability to detect, differentiate, and interpret sounds, particularly when integrated with assistive listening devices like hearing aids and cochlear implants. Music therapy enhances  speech development, articulation, and language acquisition through rhythmic training, vocal exercises, and instrumental play.

Common Music Therapy Goals for Clients with Hearing Loss:

1. Goal: Language Development

   • Objectives:

     • Increase and appropriate use of vocabulary.

     • Increase and appropriate use of vocabulary.

     • Improve sentence structure.

     • Develop pragmatic language skills.

   • Interventions:

     • Songwriting: Clients create lyrics to familiar melodies using target vocabulary words to reinforce word usage and sentence formation.

     • Interactive Instrument Play: The therapist introduces vocabulary by labeling and describing musical instruments (ex: "This drum is round and big") while encouraging children to use these words in conversation.

     • Movement to Music: Clients respond to spatial concepts by incorporating directional movements (ex: reaching high, moving to the left, behind) while listening to songs with embedded cues.

     • Musical Categorization: Children use musical instruments to represent different categories such as shapes (round tambourine for a circle, rectangular drum for a rectangle) and sizes (small shaker for small, large drum for big), reinforcing conceptual understanding through music.

2. Goal: Speech Production

   • Objectives:

     • Increase vocalization and expressive speech.

     • Improve natural speech rhythms, pitch, and inflections.

     • Enhance production of target speech sounds in commonly used vocabulary.

   • Interventions:

     • Singing: Clients sing along to songs that emphasize articulation and pitch variation, helping to improve speech clarity.

     • Children’s Songs with Speech Sounds: Songs like Old MacDonald Had a Farm emphasize repetitive phonemes, aiding in speech sound production.

     • Call-and-Response Exercises: The therapist sings a phrase or makes a vocal sound, and the child echoes it, reinforcing speech rhythm and articulation.

     • Group Music Making with Vocal Cues: During instrument play, clients take turns and vocalize simple phrases (ex: "My turn" or "Your turn") before playing an instrument to encourage verbal engagement.

3. Goal: Improve Listening Skills

   • Objectives:

     • Enhance sound detection and differentiation

     • Improve sound identification and comprehension

     • Strengthen auditory memory and sequencing

   • Interventions:

     • Stop-and-Go Activity: Clients move to the beat of a rhythmic instrument and freeze when the sound stops, reinforcing attentiveness and sound recognition.

     • Instrument Sound Discrimination: Clients listen to two different instruments and determine if the sounds are the same or different, improving auditory discrimination skills.

     • Follow-the-Sound: The therapist plays an instrument in different locations, and the client must turn their head or point toward the sound source, encouraging localization.

     • Movement-Based Listening Games: Clients engage in movement-based activities that require responding to auditory instructions embedded within songs, enhancing comprehension and reaction to spoken language.

4. Goal: Social Skills

   • Objectives:

     • Improve turn-taking and cooperative play

     • Strengthen ability to follow multi-step directions

     • Develop appropriate expression through music

   • Interventions:

     • Instrument Play in Pairs or Groups: Clients take turns playing instruments and engage in call-and-response drumming activities to foster teamwork.

     • Collaborative Songwriting: Clients work together to create a song, using musical elements to express feelings appropriately.

Additionally, music therapy provides a multi-sensory experience by incorporating visual, tactile, and kinesthetic elements, making it accessible for children with varying degrees of hearing loss. Therapists also tailor interventions to match each child’s hearing profile, ensuring an inclusive and effective approach.

In conclusion, music therapy serves as a valuable tool for improving listening skills, facilitating language development, and promoting social-emotional growth in children with hearing loss. Through structured and engaging interventions, children with hearing loss can develop essential communication skills in a fun and meaningful way, empowering them to navigate the world with greater confidence and ease.

-Asila Folds, Music Therapy Intern

References:

Lieu, J. E. C., et al (2020). Hearing loss in children: A review. JAMA, 324(21), 2195–2205.

Edwards, J. (Ed.). (2016). The Oxford handbook of music therapy (pp. 225–248). Oxford University Press.

Schraer-Joiner, L. (2014). Music for children with hearing loss: A resource for parents and teachers. Oxford University Press.

Melodic Intonation Therapy for Aphasia Recovery

Aphasia is a language disorder that often results from brain injuries such as strokes, head trauma, brain tumors, or infections. It occurs when key brain areas responsible for speech processing and production—such as Wernicke’s and Broca’s areas—are damaged. This condition affects an individual's ability to produce and comprehend speech, as well as their reading and writing skills, leading to varying degrees of communication difficulty. The severity of aphasia can range from mild challenges to cases where verbal communication becomes nearly impossible.

Growing evidence suggests that music therapy can support individuals with neurological disorders in improving their communication skills. Singing, in particular, has been found to be beneficial for individuals with aphasia due to several factors: (1) it is an innate human ability, (2) it shares overlapping neural networks with speech, (3) it engages broader neural circuits that may remain functional after a stroke (Pillay & Dunay, 2017). These insights contributed to the development of Melodic Intonation Therapy, a structured, music-based rehabilitation approach used to treat language disorders.

Melodic Intonation Therapy (MIT) utilizes musical elements to aid speech recovery by helping individuals form and organize words into sentences. It facilitates speech production by reinforcing the connection between sounds, word structures, grammar, and vocabulary.

With the support of a music therapist, patients undergoing MIT first practice maintaining the rhythm of spoken phrases initially sung by the therapist. They then attempt to replicate these phrases while preserving prosody, intonation, and rhythm. As therapy progresses, the therapist gradually reduces their support, and the patient transitions away from using musical cues. The ultimate goal of MIT is to help individuals regain natural, independent speech.

In a study led by Popescu et al. (2022), Melodic Intonation Therapy (MIT) was found to be effective in improving language expression in individuals with post-stroke aphasia, particularly in tasks like repetition of words and phrases. The therapy was shown to have a small to moderate effect on non-communicative language expression, meaning it helped patients in tasks where they had to produce speech without necessarily engaging in everyday conversation. MIT was most effective when it focused on speech repetition, and the study noted that spontaneous recovery (the natural improvement that occurs with time after a stroke) could influence the results.

-Asila Folds, Music Therapy Intern

References:

Pillay, S. B., & Dunay, M. (2017). Aphasia and the neural basis of language impairment. International Journal of Neuroscience, 127(11), 993–1002

Haro-Martínez, A., et al. (2021). Melodic intonation therapy for post-stroke non-fluent aphasia: A systematic review and meta-analysis. Frontiers in Neurology, 12, 700115

Popescu, T., et al. (2022). Melodic intonation therapy for aphasia: A multi-level meta-analysis of randomized controlled trials and individual participant data. Annals of the New York Academy of Sciences, 1484(1), 130-148.