Speech and Language Therapists (SLTs) are required to work within the medical model and simultaneously be creative in their approaches. A growing body of research indicates that SLTs and Music Therapists (MTs) working collaboratively, is the way forward for providing our clients with the best outcomes. With an aging population (and therefore increase in strokes and dementia) as well as health services being stretched, it is vital that professionals be given the opportunities to link up and share their skills, for the benefit of clients.
Benefits of Music
It is well-documented that music is the foundation of communication, a concept that is of great interest to SLTs. Chen-Hafteck (1997) describe babies as being able to listen and vocalise without being able to distinguish between speech and singing or music and language. Speech includes rhythm in the form of syllables and melody in the form of intonation. Early language development is naturally supported by singing nursery rhymes to young children, as there are limited key words and lots of repetition to encourage imitation. Music is fun and motivating and therefore contributes to social development and rehabilitation.
Professor Jane Edwards, a highly regarded Music Therapist and President of the International Association for Music and Medicine once said:
“It [music] can play a very important part in rehabilitation and treatment. Reports suggest many of the first utterances from children emerging from comas and a high number of the first intentional verbalisations from children with autism are made during music therapy sessions.”
Music is an international language that crosses all barriers. It is a way to reach out to people of any background who struggle to express themselves as the result of communication impairments. Communication is the ability to request/reject, socialise and simply participate in life. Without it, one becomes incredibly isolated. Music has been shown to assist communication rehabilitation in people with strokes, brain injuries, developmental delays, autism, language/intellectual/hearing impairments, dementia, neurological/degenerative conditions (e.g. Parkinson’s Disease), voice disorders and stuttering. There are also many mental health benefits associated with both the use of music and the subsequent ability to communicate.
Background to Exploring Neurologic Music Therapy
As a student, I clearly remember working with a gentleman with Broca’s Aphasia who could understand more than he could say. Naturally, this was incredibly frustrating for him, as his speech was limited to simple inconsistently articulated words such as “yes” and “no” One week, his Aphasia Group was playing hangman, with the clue being ‘song titles’. My client knew the answer but could not verbalise it …so he spontaneously sang, “Singing in the rain, just singing in the rain…”
This sparked an obsession with wanting to understand more about the link between singing, and the possibility of utilising this within communication rehabilitation following a brain injury. I attended the World Congress of Music Therapy and later visited Music Therapists in various settings around Australia, Canada, New York and the UK, learning how to stimulate and support communication skills. This resulted in being the first British Speech and Language Therapist to be awarded a Churchill Fellowship.
The Winston Churchill Memorial Trust was established shortly after Sir Winston’s death in 1965, as his national memorial and living legacy. Since then it has awarded hundreds of Travelling Fellowships. These directly support British citizens who want to travel overseas to gain knowledge, experience and best practice to benefit others in their UK professions and communities, and society as a whole.
Successful applicants must demonstrate the commitment, the character and the tenacity to travel globally in pursuit of new and better ways of tackling a wide range of current challenges facing the UK, and upon their return work to transform and improve aspects of today’s society.
A travelling sabbatical for people with the drive, determination and desire to help others, can further their leadership and role model abilities.
During my time in Canada, I learnt of The Academy of Neurologic Music Therapy (the world leader in collating research worldwide in this exciting field). They provide post-graduate training to MTs wanting to become Neurologic Music Therapists, as well as other professionals interested in learning how music can support their clients. I later completed the training and I now actively work alongside Neurologic Music Therapists. This has resulted in being invited to present globally on the benefits of the two professions collaborating.
Melodic Intonation Therapy (MIT)
Melodic Intonation Therapy (MIT) is just one of many treatment approaches used in communication rehabilitation by MTs and SLTs. It is particularly effective in patients with non-fluent aphasia (e.g. Broca’s aphasia) who have experienced a brain injury affecting the left side of the brain (e.g. stroke).
Gabrielle Giffords (the US Congresswomen who sustained a brain injury from a gunshot wound in January 2011) has successfully been receiving treatment from Dr Nancy Helms-Estabrooks, the highly regarded SLP who developed a manual for Melodic Intonation Therapy (1989). Her injury affected Broca’s area on the left side of the brain. Melodic Intonation Therapy is thus an effective treatment approach, as it relies on the right cerebral hemisphere being unaffected. The right side of the brain in thought to be responsible for the more musical aspects of verbal communication, such as the melody of intonation and the rhythm of speech.
Therapy requires that patients work through a hierarchy with the support of their MT and/or SLTs. This involves practising words and phrases that they want to be able to say and pairing this with a tapped rhythm and sung melody (which is eventually minimised to make it more natural). A growing body of evidence is revealing that this method has the potential to allow people to communicate longer phrases than if they attempted to say it with no strategies.
Australian MTs, Felicity Baker and Jeanette Tamplin (2006) discuss a range of treatment approaches that utilize music for supporting communication rehabilitation. Felicity Baker developed the idea of Modified Melodic Intonation Therapy (MMIT) for people with severe non-fluent aphasia who were not experiencing success with traditional MIT. Normally in MIT the melodic phrasing imitates speech prosody, but in MMIT a musical phrase that is more easily stored and retrieved in the brain is used (which may not be as subtle as the melody of intonation). The involvement of MTs in modifying the regular MIT approach would be beneficial for SLTs.
Besides MIT, there are other approaches that can be used with specific client groups. Examples include Vocal Intonation Therapy (VIT) for voice disorders and Rhythmic Speech Cueing (RSC), which is effective for clients who present with stammering, dysarthria or dyspraxia.
Collaboration between SLTs and Neurologic Music Therapists is the way forward for clients hoping to reach their potential with communication rehabilitation.
Furthermore, a growing body of research on the benefits of Music Therapy suggests that there is potential for allied health teams to utilise the skills of MTs in a wide range of clinical areas such as hearing impairments, language development, stammering, and even feeding in Neonatal Intensive Care Units (alongside paediatric dysphagia trained Speech & Language Therapists).
The long-term goal is for more health settings globally to include MTs trained in Neurologic Music Therapy within their multidisciplinary allied health teams.
References and Recommended Reading
Baker, F. (2000) ‘Modifying melodic intonation therapy programs for adults with severe non-fluent aphasia.’ Music Therapy Perspectives 2, 107-111.
Baker, F. and Tamplin, J. (2006) Music Therapy Methods in Neurorehabilitation: A clinician’s manual. London: Jessica Kingsley Publishers.
Chen-Hafteck, L. (1997) ‘Music and Language Development in Early Childhood: Integrating Past Research in the Two Domains’. Early Child Development and Care, Volume 130, 1997 – Issue 1, 85-97.
Helms-Estabrooks, N., Nicholas, M. and Morgan, A.R. (1989) MIT: Melodic Intonation Therapy Manual. Austin, Texas: Pro-Ed Inc.
Hull, R.H. (1992) Aural Rehabilitation (Second Edition). London: Chapman & Hall.
Sacks, O. (1995) An Anthropologist on Mars. London: Picador.
Sparks, R.W. and Deck, J.W. (1986) ‘Melodic intonation therapy.’ In R. Chipley (ed.) Language Intervention Strategies in Adult Aphasia. Baltimore, MD: Williams & Wilkins.
Thaut, M.H. and Hoemberg, V. (2014) Handbook of Neurologic Music Therapy. Oxford: Oxford University Press
Twyford, K. (2008). Integrated Team Working: Music Therapy as Part of Transdisciplinary and Collaborative Approaches. Jessica Kingsley Publishers: London.
Claire Bolton van Weert
Speech Pathologist, Churchill Fellow, Life Coach
2017 Winner of the (British) Best Business Women Awards: Best Business Woman in Health & Wellness
2017 Finalist of the (British) Best Business Women Awards: Best Customer Service
Claire is a generalist Australian-trained Speech Pathologist / Speech and Language Therapist with clinics on Harley Street (London, UK) and Chesham (Buckinghamshire, UK). She is the Founder of Apex Ability Limited and currently leads a team of Speech & Language Therapists. Her previous experience includes NSW Health (Australia) and NHS (UK).
A Churchill Fellowship allowed Claire to travel to Canada/U.S.A. to learn how music/singing within speech and language therapy can improve communication skills. She has received additional training from The Academy of Neurologic Music Therapy. Claire works closely with Chiltern Music Therapy (the UK’s largest team of Neurologic Music Therapists), supporting both adults and children with a broad range of communication needs.
Claire has been running popular workshops for Speech & Language Therapists/Music Therapists in London UK, with invitations to also share her skills/knowledge with colleagues all over the UK and Australia. In March 2017 Claire was invited to present at the Association of Speech and Language Therapists in Independent Practice Conference (UK) and at the British Association of Music Therapy conference. In May 2019 Claire will be presenting in Singapore and Sydney on the benefits of collaboration.