After years in the dark – or rather, the vacuum – U.S. healthcare is finally re-acknowledging something which many of the cultures that comprise its make-up have known for decades: Music can have healing properties. While the ’40s and ’50s first saw the emergence of professional music therapy – adhering to scientific research methods, training, and clinical standards – managed healthcare movements at large hospitals in the ’70s dramatically reduced the number of music therapy programs.

Intent on reducing healthcare costs and creating a uniform standard of care, many hospitals ousted music therapy programs, along with writing and visual art therapy, as “extra” or “adjunct” services. However, in light of the fact that managed-care techniques have largely failed in the overall goal of controlling medical costs, several facilities, concerned with how managed care has impacted the quality of healthcare delivery, are bringing music therapy back to the forefront of patient rehabilitation regimens.

More and more, music therapy is being implemented in hospitals, hospice centers, youth counseling centers, and correctional facilities across the nation. While this form of therapy isn’t mainstream medicine yet, it is once again becoming an increasingly popular way to help people heal.


Letting the Music Speak

In addition to the ongoing research following music therapy as a relaxation and stress-reduction exercise – or as a healthier alternative to opioid painkillers – music therapy has also returned to the hospital setting for the rehabilitation of speech impairments. Singing and speech share common elements, and research has shown that instruction in basic singing techniques, such as correct breathing patterns, coordinated phonation, and diction, may improve speech production more effectively than singing without these techniques.

Among those breaking ground in collaborative therapy is Laurel Terreri, MT-BC, activities coordinator at the Santa Monica UCLA Medical Center and Orthopaedic Hospital in Los Angeles, who works in the pediatric cleft palate clinic and leads a speech-based music therapy group, which is entirely geared toward speech production. According to Terreri, “I use a lot of oral-motor props in that group.”

Additionally, she says, “I use slide whistles – plastic pipes with colored string so when they blow into it, the string spins around – bubbles, kazoos, [and] train whistles. And the reason for these props is twofold: One is to wake up their mouth because, sometimes, the patients are self-conscious of using their voice, or they may not even be cognizant about using the muscles in their mouth. The props help to bring their attention to their oral-motor muscles, and also it’s much more fun for kids – if its more engaging, patients are more willing to explore.”

Terreri continues, “A second reason for these props is because it moves air through their mouth, which is what is needed to speak. Air has to move from the diaphragm over the vocal cords and out the mouth to produce sound, so these props [help patients] achieve these first steps in speech production.” Also working privately with children with developmental disabilities, she uses songs to teach cognitive and social skills, expressive and receptive language skills, as well as self-expression.

One thing she’s found in her practice is that live – as opposed to prerecorded – music is more beneficial to patients because it can be personalized. For instance, Terreri describes how cerebral palsy patients may be motivated to walk toward a rhythm instrument that they can play. Collaborating with a physical therapist, the music therapist can play a song to match the patient’s gait, helping their walking to become more fluid.

She also cites the numerous benefits of incorporating music into a speech therapy regimen. “I love working with speech therapists because I feel there’s so much to learn from them and, hopefully, they’re learning something from me, as well,” she says. “There is just a really great ‘give-and-take’ of professional ideas. [Music therapists] also work alongside physical, occupational, recreational, and art therapists, as well as social workers, chaplains, nurses, doctors, and teachers.”

Terreri credits the nurses, in particular, with being extremely influential in renewing music therapy at Santa Monica-UCLA Medical Center and Orthopedic Hospital.  “[They] are so receptive to music therapy for their patients. And we’re incredibly respectful of each other, realizing that everybody has the best interests of the patient in mind,” says Terreri.

Furthermore, she says that if nurses come into the room while she is working with a patient, the interruptions are usually kept to a minimum. And, the pendulum swings both ways: Music therapy can actually benefit the nurses, as well. For instance, music can ease both the patient and the nurse’s nerves when inserting or removing an IV. If the patient is engaged in music during the medical procedure, all parties involved can relax.

Back with the Beat

Music therapy is also changing the dynamic of brain injury rehabilitation. For instance, frontal lobe injuries, related to problem-solving, executive function, behavioral management, and other higher cognitive functions often result from motor vehicle accidents. In addition, violent movement of the brain inside the skull can also cause serious injury beyond the site of impact, resulting in an enormous range of possible symptoms and impairments.

Many therapists cite a patient’s “reduced awareness of deficits” as one of the biggest roadblocks to rehabilitation, in which impairments to self-awareness, cognition, and judgment cloud the patient’s ability to take an active role in therapy. Moreover, impairments in social behavior and communication create barriers to establishing an effective therapeutic alliance – patients may become resistant to accepting concrete, focused, or even painful forms of rehabilitation, such as speech, physical or occupational therapy. Fortunately, leading facilities around the nation are trying to combat this unfortunate trend.

One such organization, the Fine and Performing Arts Department of the Northeast Center for Special Care (NCSC) in Lake Katrine, N.Y., exclusively serves those patients suffering from traumatic brain injuries as well as spinal cord injuries. The director, Rick Soshensky, MA, MT-BC, NRMT, CBIS, a music therapist with 16 years of experience working with developmental disabilities, emotional/behavioral disturbances, and traumatic brain injury, has developed a unique approach for these patients using music.

According to Soshensky, the purpose of the program is to provide an interactive experience. “I do not play music for people, nor would I have a preconception regarding the type of music to use with a [patient] based on diagnosis or preexisting information, other than the person’s musical interests. The bedrock of the practice is the engagement of the [patient] as a musically creative person and involvement in an artistic community.”

Soshensky has combined a variety of clinical arts theoretical perspectives into a single effective model. Utilizing artistic production, such as recording original music, writing poetry, exhibiting fine art, and performing publicly, Soshensky’s program evokes creativity from the most primitive and emotional regions of the brain, so that even individuals with extremely damaged cognition, communication, and social ability can surmount these barriers through the arts.

“Upon meeting a [patient] for the first time, I will get an impression of what type of impairments the individual is dealing with,” says Soshensky. “I don’t usually do this initially from charts or from a medical or neurological perspective – but simply observationally. Movement restrictions, restlessness, memory problems, speech/language disorders, cognitive disorders, [and] instability of behavior and mood are fairly apparent. The primary question to keep in mind is: ‘How can this person make music?’ And secondarily: ‘How will this music help the person to make progress with their impairment?’”

At NCSC, patients begin to make the psychosocial shift from disability to ability. In clinical examinations of their songs, poems, visual artwork, as well as personal interviews and written reflections, participants were less likely to regard themselves as disabled, but instead view themselves as active, creative individuals. Deficits in motivation, social integration, and self-awareness were also not evident in the artistic pieces.

“From my perspective, there is no correlation between the nature or severity of injury and a person’s capability to be helped by music therapy,” says Soshensky. “In some cases, music therapy can help when nothing else can. Music affects neural activity at almost every level, from the most primitive and emotional regions of the brain to the more evolved regions thought to be distinctly human, and in so doing, it literally engages a person from the inside out.”

Music for the Masses

Although experts typically recommend that music therapy practitioners are board-certified, less formal music programs can benefit patients, as well. For instance, Nancy Morgan, MA-TLA, director of the arts and humanities program at the Washington, D.C.-based Lombardi Comprehensive Cancer Center, affiliated with Georgetown University Medical Center and Georgetown University Hospital, says her centers have taken a nontraditional approach to music therapy.

“We have what we call ‘atrium performances,’ which happen in the lobby and can include all types of music, intended to give everyone – doctors, nurses, patients – a little bit of a respite,” says Morgan. “When someone hears the music and comments, ‘Oh, that’s a Brahm’s piece; it’s one of my favorites,’ suddenly they are no longer talking about cancer. Instead, they’re connecting on a completely different level, which is very meaningful in establishing trust between patients and staff.”

Programs like the implemented at Lombardi Comprehensive Cancer Center are rapidly spreading across a variety of healthcare facilities. Cancer programs, in particular, are often receptive to the kinds of humanities programs because they promote a life-affirming perspective for patients and caregivers with activities, resources, education, and environments that encourage a creative and constructive response to illness. Music offers an avenue of expression that can assist with coping, transition, emotional expression, communication, and problem-solving.

“We have drumming therapists who come in, sometimes for staff, sometimes for patients, and again that’s, in a sense, a stress reliever, but it also allows for personal expression,” says Morgan. “We also have a wonderful flutist, Laura Sperling, who comes in for one-on-one sessions with patients who are unable to participate in other more physical types of activities. Even apparently limited to a solo performance, [Sperling] plays to the beat of the monitors.”

Morgan continues, “It’s amazing to see what she does: to relax their breathing, to calm them if they’re anxious, to cheer them up. She has said that by the end of her session, two patients separated by a curtain who never talk to each other are singing along with the music and get to know each other. So, there’s a wonderful community-building aspect to the music, as well.”

Music therapy is becoming a key therapeutic tool employed at most large cancer centers across the United States. When used in conjunction with various cancer treatments, music therapy has been found to help patients better communicate their emotions surrounding their diagnoses and better manage stress – all the while alleviating physical pain and discomfort.

After two decades of gradual decline in major hospitals, music therapy is once again becoming an integral element of complementary healthcare programs. In addition to providing a sedative experience for patients in distress, music therapy is also being recognized as an excellent crossover therapy – with practitioners breaking ground in a variety of therapeutic settings, including patient rehabilitation programs.

— Bob Stott is a staff writer for Therapy Times. Questions and comments can be directed to bstott@therapytimes.com.