Music therapy enhances physical rehabilitation.
By Andrew Kensley
Under the close watch of his physical therapist, a stoic man marches up and down a four-inch step with admirable consistency. His left hand holds a walker for support, but his feet endure in their instructed endeavor; forward and backward, up and down, left and right.
The therapist says barely a word, but she doesn’t have to. This man — a victim of Parkinson’s disease and a stroke — heeds another master, a primal part of his brain that craves rhythm and symmetry.
The therapist, Sarah Johnson, is one of many University of Colorado Health rehabilitation professionals working to help patients get their groove back. Like most rehab therapists, she sports a sunny demeanor while touting the benefits of exercise and task-specific, functional training. But her patients march to a different tune — music.
Seeing potential in music
Since 1987, Johnson has expertly used a variety of musical-based techniques in conjunction with physical, occupational and speech therapists to improve stimulation of sensory and motor systems for patients injured by accidents or strokes, or suffer from diseases such as multiple sclerosis or Parkinson’s.
While Johnson and the music therapy program she helped build in northern Colorado are primarily based in the Rehabilitation Unit at Medical Center of the Rockies, she also sees patients at the region’s outpatient adult and children’s therapy services clinic.
Regaining function, say the experts, is the main goal of rehabilitation. And, as Johnson and her colleagues will attest, it often occurs faster — and better — when it’s set to music.
“We may do some singing, but I’m not trying to teach patients how to sing,” Johnson said. “We may be working on speech skills. I’m helping them use their air, develop their lung capacity. Using music can help our bodies move better, help our muscles work together in a more coordinated fashion, help us strengthen muscles that are weak, and help us retrain our neurologic pathways.
“The rhythm of the music helps support the movement to be more fluid and more natural. Then when you add the instruments into it, you get that visual, auditory and tactile feedback.”
Another major benefit is the natural opportunity for repetition. When you add a beat to a certain movement — reaching, stepping, lifting — patients become part of the creative process, Johnson explained.
“They have multiple opportunities to do what you’re asking them to do,” she said, adding that it leads to better performance, carryover into normal activities, and, quite often, a level of enjoyment rarely seen in the challenging process of recovery from debilitating injuries.
In 1987, Dr. Gerald McIntosh, a Colorado Health Medical Group neurologist and the then-director of Poudre Valley Hospital’s LifeSkills Rehabilitation unit, was curious about the use of complementary therapies in rehabilitation and hired Johnson to create a music therapy program from scratch.
Since then, the program has echoed outward from its origins in patient care to the research world — and beyond. Poudre Valley Hospital’s pioneer program in music therapy, in collaboration with Colorado State University, led to the creation of CSU’s Center for Biomedical Research in Music and Robert F. Unkefer Academy of Neurologic Music Therapy, both of which continue to promote the worldwide development of the field of NMT.
With a small grant from the Poudre Valley Hospital Foundation, McIntosh and Dr. Michael Thaut, a music therapist and CSU professor of music and neuroscience, initiated a research partnership between the two organizations. In 1990, physical therapist Ruth Rice joined the PVH rehab staff, bringing with her a neurologic rehabilitation background that allowed her to play an active role on the clinical side of the groundbreaking studies.
During the past 20 years, McIntosh has collaborated with Rice and Thaut in the publication of more than 40 articles illustrating the rehabilitative benefits of neurologic music therapy.
“I was naïve about music therapy; I had no idea it would be a physical enhancer,” Dr. McIntosh admitted. “But I observed that during treatment sessions, motor performance was improved with its addition. Dr. Thaut and I began research to demonstrate the effectiveness for music therapy to augment motor performance.”
They began with studies that demonstrated that walking performance improved with music therapy. They progressed to studies on stroke victims with one weak side, Parkinson’s patients, and children with cerebral palsy in collaboration with Children’s Hospital in Denver. And much of the newer research, some done by Rice, has confirmed their findings and shown a significant reduction in falls for patients involved in music therapy rehab programs at the hospital or at home.
Johnson, who in 2009 was awarded the American Music Therapy Association’s Professional Practice Award for her significant contribution to the profession, has hosted students and therapists from Europe, Asia, South America and Australia to observe UCHealth’s innovative program. Ruth Rice, along with McIntosh, Thaut and the CBRM staff have served as ambassadors of their brainchild by presenting research findings in various locations throughout the world.
Spreading the word
“I remember watching Sarah work, strumming down the hallway with her autoharp and a big smile on her face, watching her do amazing things with people’s walking,” Rice recalled. “I don’t think people realize that a lot of the research happened here in Fort Collins and CSU.”
In addition to devoting themselves to improving lives one chord at a time, Rice and Johnson continue to do their part in the world of academia. In 2013, they published “A Collaborative Approach to Music Therapy Practice in Sensorimotor Rehabilitation,” in the journal, Music Therapy Perspectives.
In the article, they stated that a collaborative approach among physical, occupational, speech and music therapies, with “each contributing unique research and clinical-based knowledge to the treatment team,” was unquestionably the best way to help patients achieve “functional real-world outcomes.”
Sarah Wild, a physical therapist in MCR’s Rehabilitation Unit with almost 20 years of rehab experience, said she was skeptical at first.
“I thought, ‘How could having someone sing and play an instrument during physical therapy really help, and, can I accomplish what I need to do in the same time frame?’” Wild said. “After working with neurologic music therapy for a number of years now, I am fully on board. I have found I can actually achieve more activities during sessions, especially with patients who have cognitive impairments. I also believe I have better outcomes, and the patients seem to leave the hospital sooner. I wish all therapists had the benefit of working with neurologic music therapy.”
This article was written by Andrew Kensley, a local freelance writer, published author and physical therapist for Poudre Valley Hospital. Photos were taken by Mary Pridgen of Bare Bones Photography in Fort Collins.