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A Music Therapy Intern’s Guide to Co-Treating with Physical Therapy

By Jocie Purcell, MusicWorx Intern

Music in the Human Experience

On a busy Wednesday morning in the ICU, I put on my protective gown and gloves and entered the room of a follow-up patient. I had corresponded with the Physical Therapist and suggested that we meet him together. It had been a month or so that I had been treating this man at bedside, and he had made recent strides in his progression. The patient glanced up at me as I walked in with my guitar and smiled, accepting music therapy services. He hadn’t been expecting me and it had been some time since our last session, so it was a bit of a surprise. The physical therapist assisted him with movements while I watched closely and accompanied him by playing percussive rhythms and adjusting volume to mirror his height as he shifted from sitting to standing. The patient appeared empowered by the music and eager to rebuild his strength. Later in the session, I strummed softly, guiding him in deep breathing while he rested in the chair. He looked up and said “I’m really glad I said yes to music today. It makes this much better.”

Involving music in learning and movement provides individuals with motivation, concentration, and relaxation. Research suggests that through playing percussion instruments with repetitive rhythmic patterns, music promotes spontaneity and verbal/emotional expression. Most cultures utilize music to teach infants the foundations of language, often through familiar nursery rhymes. Into adulthood we rely on our learned experiences to follow an internal rhythm of gestures and movements when interacting with others. Repetition of those rhythms makes those gestures and movements come naturally. If music can be used to help us learn basic skills, can’t we use it to relearn them in rehabilitation?

Music Therapy in Recovery

A well-known example of using music for rehabilitation is the case of former Congresswoman Gabby Giffords. In 2011, she was shot in the left hemisphere of her brain, causing aphasia, which is a condition that causes the inability to produce speech. She worked with a music therapist to build new pathways in her brain and relearn how to speak. The music assisted her improvement in memory and emotion, and visual/motor coordination. The music therapist applied speech therapy techniques to Gifford’s treatment to create engaging musical experiences for rehabilitation. 

Music is used to assist hospital patients in their recovery. Many unfortunate experiences accompany a lengthy hospital stay: overstimulation of the senses, unfamiliar procedures, absence of day/night sequences, physical discomfort, and lack of privacy, to name a few. All of these things have the ability to negatively impact a patient’s emotional and physical well-being. Fortunately, music therapists in a hospital can provide music as a distraction from the strenuous environment and pain, and as a tool to promote coping skills for anxiety.

Co-treating Experiences with Physical Therapy

Co-treating involves communicating and collaborating with other medical providers to provide a cohesive and supportive experience for a patient in a given setting. Techniques from both professionals are involved in co-treatment in a way that is geared toward the individual. More information about co-treating with other medical professionals can be found in this blog post by former MusicWorx intern Renee De Luca. 

Physical therapy (PT) is a type of physical rehabilitation administered by a certified physical therapist. Goals of PT include relieving symptoms, expediting recovery, and preventing further disability. At Scripps Hospital locations, the physical therapists (PTs) perform comprehensive assessments and develop individualized treatment programs. What I found to be particularly interesting is that the PTs whom I observed used a holistic approach and empowered each patient to succeed in their assigned movements during each session. Curious in finding the ways in which a patient can benefit from music therapy in a hospital setting, I sought out to observe and treat patients with physical therapists at Scripps La Jolla Hospital.

While observing, I noticed many similarities of treatment and goals between PT and MT. A common approach in music therapy is to center the session around the patient, aka patient-centered music therapy. Similarly, the outcome of each PT session is about what the patient needs. When a patient expresses fear of falling or getting injured, the PT reassures the patient that they are ready to handle the appropriate movement, reminding them that they have someone to help them as they complete the movements. In the sessions that I witnessed, the PT involved the breath to guide the patient when shifting their weight (i.e. exhale when moving from sitting to standing). This helped to engage the abdominal muscles and increase body function cohesion to maximize performance. An example of a basic session with a PT involves moving from sitting to standing, shifting weight on the feet, and standing at an appropriate angle for longer periods.

An important aspect of co-treating is that the patient agrees to receive services from both professionals. In several of my co-treating opportunities, after the PT introduced themselves to the patient, I offered music as an additional mode of support for the patient’s exercise: the patient accepted. The patient completed procedural PT exercises such as: 

  • moving from lying to sitting on the edge of the bed (and vice versa)
  • sitting still and standing still for about 30 seconds, and 
  • moving from a seated position to standing position. 

Music is helpful in assisting with these routine movements with the use of various improvisation techniques:

  • Synchronizing: This can be represented by modeling what the patient is doing in time, playing a rhythm that aligns with their movement pace, and matching the patient’s movement or breathing. For example, the music therapist (MT) might play individual tones on the higher strings of the guitar to accompany the patient’s movements such as moving the toes in and out. 
  • Pacing: Pacing may be applied by matching the patient’s energy level, responding to intensity, and preparing the patient for a shift. As a patient moves from sitting to standing, the MT can play the chords of a song softly and steadily on fewer and lower guitar strings. As they stand, the MT might play louder and more victoriously. Lower notes on the guitar are meant to provide a sense of grounding, preparing the patient for a shift in activity, and the use of more guitar strings expands the sound to encourage and empower the patient in their movements. The music matches the client’s energy level, responding to movements, and promotes self-awareness.  
  • Rhythmic grounding: Rhythmic grounding involves keeping a basic beat or providing a rhythmic foundation for the patient’s movements. Repeating a pattern of chords at a steady pace allows the patient to follow a structure while completing their movements.

Co-treating with other medical professionals in the hospital allows for coordination and integration of professional services, increasing awareness and understanding of the represented professions. Co-treating with PT also contributes to the knowledge of the patient and their physical and emotional needs. Moreover, music in the recovery process creates a pleasant, effective, and beneficial experience for all those involved. I hope to continue treating patients alongside PTs in the future and include patient-preferred music to facilitate changes in the musical elements that are enjoyable for the patient. By providing a musical environment for the individual, I can help them find their inner strength as they recover in the hospital.

References

Abcnews.go.com (n.d.) Retrieved from https://abcnews.go.com/Health/w_MindBodyNews/gabby-giffords-finding-voice-music-therapy/story?id=14903987

Bates, Debbie. (2013). Effective clinical practice in music therapy: Medical music therapy for adults in hospital settings. Journal of Music Therapy. doi:10.1093/jmt/50.1.53.

Carroll, D., & Lefebvre, C. (2013). Clinical Improvisation Techniques in Music Therapy: A Guide for Students, Clinicians and Educators. Charles C Thomas.

Hodges, D. A., & Sebald, D. C. (2020). Music in the human experience: An introduction to music psychology. Taylor & Francis.

Nobuko Shimizu, Tomohiro Umemura, Masahiro Matsunaga & Takayoshi Hirai (2018) Effects of movement music therapy with a percussion instrument on physical and frontal lobe function in older adults with mild cognitive impairment: a randomized controlled trial, Aging & Mental Health, 22:12, 1614-1626, DOI: 10.1080/13607863.2017.1379048

Scripps.org (n.d) Retrieved from https://www.scripps.org/locations/hospitals/scripps-memorial-hospital-la-jolla?tab=overview

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