Music therapy services in neurorehabilitation: An international survey.
Pakdeesatitwara, Napak ; Tamplin, Jeanette
Music therapy services in neurorehabilitation: An international survey.
Background
The World Health Organisation (2017a) defines rehabilitation as
"a set of interventions designed to optimise functioning and reduce
disability in individuals with health conditions in interaction with
their environment" (p. 1). Neurorehabilitation is a subset of
rehabilitation specific to individuals with neurological disorders
(Dimyan, Dobkin, & Cohen, 2008; Polgar et al., 1997). Those with
neurological disorders demonstrate a variety of sequelae including
physical, cognitive, behavioral, and communication impairments, which
can lead to psychosocial and daily living difficulties (WHO, 2006). With
the broad definition of rehabilitation and the complexity of sequelae in
people with neurological disorders, the goals to be addressed in
neurorehabilitation are extensive.
Music therapy research in neurorehabilitation has steadily grown
since the 1980s and demonstrated potential to address the sequelae of
neurological disorders (Baker & Tamplin, 2006). For physical
impairments, Weller and Baker (2011) report a number of studies that
showed consistent positive and significant outcomes of music therapy
interventions (e.g. auditory stimulation, movement to music, active
music making) for physical rehabilitation of people with neurological
disorders. Music therapy studies have been conducted with people of all
ages across a wide range of neurological disorders including stroke,
cerebral palsy, Erb's palsy, Parkinson's disease, and Rett
syndrome (Freedland et al., 2002; Howe, Lovgreen, Cody, Ashton, &
Oldham, 2003; Jeong & Kim, 2007; Kwak, 2007; Luft et al., 2004;
Pacchetti et al., 2000; Rahlin, Cech, Rheault, & Stoecker, 2007;
Rochester et al., 2005; Schauer & Mauritz, 2003; Schneider, Schonle,
Altenmiiller, & Munte, 2007; Thaut et al., 2007; Whitall, McCombe,
Waller, Silver, & Macko, 2000; Yasuhara & Suyiyama, 2001). These
studies show the diversity of populations with whom physical
rehabilitation is addressed across both acquired and degenerative
neurological disorders. In particular, there are various dimensions of
physical rehabilitation which music therapy can benefit, such as
different movement types (e.g. gait, fine and gross motor movements in
both upper and lower extremities), and movement qualities (e.g. balance,
strength, dexterity, mobility, coordination, range of motion, functional
uses) (Magee, Clark, Tamplin, & Bradt, 2017; Tamplin, 2006; Weller
& Baker, 2011).
According to the Cochrane review by Magee et al. (2017), studies
using music interventions to target cognitive impairments, including
memory, attention, executive functioning, and orientation rehabilitation
for people with acquired brain injury (ABI) were examined (Pool, 2013;
Sarkamo et al., 2008; Mueller, 2013; Baker, 2001). The review shows that
orientation was the only outcome that had significant improvements in
response to live music listening (Baker, 2001; Magee et al., 2017). In
people with disorders of consciousness due to ABI, music therapy has
been shown to be effective in stimulating behavioural responses, such as
facial expression, blink, and respiratory rate (Fernandes et al., 2014;
O'Kelly, 2013). For behavioural problems, music therapy has
demonstrated effectiveness in reducing agitation and other challenging
behaviours in people with brain injury (Baker, 2001; Hitchen, Magee,
& Soeterik, 2010).
For communication impairments, Tamplin (2008) found that singing
and vocal exercise improved normative speech production, including
speech intelligibility and naturalness, in people with acquired
dysarthria. Music therapy has also been reported to improve speech
repetition, naming, reading, and verbal fluency in people with acquired
aphasia (Jungblut, 2004; Sarkamo et al., 2008; van der Meulen, van de
Sandt-Koenderman, Heijenbrok-Kal, Visch-Brink, & Ribbers, 2014).
Music therapy thus has potential to address both speech and language
aspects of communication impairments.
Music therapy also offers great benefits for emotional and social
domains in neurorehabilitation. Participating in group music therapy can
enhance mood, confidence, motivation, social engagement, peer support,
as well as reduce psychological distress for people with acquired
neurological injury. (Tamplin, Baker, Grocke, & Berlowitz, 2014;
Tamplin, Baker, Jones, Way, & Lee, 2013).
Although the existing studies demonstrate many benefits of music
therapy to address neurorehabilitation goals, there is limited
literature on the prevalence of music therapy services that are actually
provided in clinical practice. Tamplin (2006) examined the reason for
referral for 88 patients (aged 18-82 years) from a rehabilitation
hospital in Australia between 2004 to 2005. Most patients were referred
to music therapy to address social and emotional goals. Relaxation,
physical rehabilitation, communication rehabilitation, cognitive
rehabilitation, pain management, motivation, and sensory stimulation
were also common reasons for referral to music therapy. Although this
study reports on the scope of music therapy services provided in a
real-world situation, it was based only on one rehabilitation hospital
in Australia and was published over a decade ago.
Despite limited research on the real-world situation of music
therapy services in neurorehabilitation specifically, survey studies
have indicated a general growth of the music therapy profession
worldwide, with an increasing number of music therapists working in
neurorehabilitation (Jack et al., 2016; Kern & Tague, 2017). Kern
and Tague (2017) surveyed music therapists (N = 2,495) via the World
Federation of Music Therapy about the status of music therapy practice
and trends worldwide. Based on respondent answers to the question about
work settings (n = 2,331), 5.2% described their work setting as
rehabilitation in general, 19.6% of respondents worked with neurological
disorders, 12.4% worked in traumatic brain injury (TBI), 12.2% in stroke
rehabilitation (12.2%), and 10.6% worked with Parkinson's disease
(PD) (Kern & Tague, 2017). These clinical populations are
consistently represented in the music therapy neurorehabilitation
literature (Baker & Tamplin, 2006; Gilbertson, 2005; Thaut et al.,
1996; Weller & Baker, 2011). However, Kern and Tague (2017) did not
clarify the context of work where the music therapy services were
provided to these populations, except for the stroke rehabilitation
population. Also, as participants were able to provide multiple
responses, there could be some overlap among these populations. For
example, brain injury (e.g. stroke, TBI) could be categorised under
acquired neurological disorders, while PD could be categorised under
degenerative neurological disorders (Tamplin, 2015). Kern and Tague
(2017) separated these populations rather than listing stroke, TBI, and
PD as subcategories of neurological disorders. As a result, it is not
possible to determine the exact proportion of music therapists working
in neurorehabilitation around the world.
With the extensiveness and complexity of music therapy practice in
neurorehabilitation shown in the existing literature, it is important to
know the real-world situation of current music therapy services
provision in this field. Such knowledge may suggest pathways for
developing research and training curriculum that respond to clinical
need. Despite the growth of music therapy as a profession (Kern &
Tague, 2017), to our knowledge no study has yet examined the extent of
music therapy services provision specifically in neurorehabilitation.
Therefore, we conducted an international survey aiming to gather
descriptive data on the scope and prevalence of music therapy services
in neurorehabilitation. Specifically, in terms of populations served and
goals addressed, as well as music therapy approaches and interventions
utilised. Additionally, we conducted a qualitative content analysis to
determine the opinions of music therapists on training for future music
therapists in neurorehabilitation and general feedback.
This study received ethics approval from Human Research Ethics
Committee at the University of Melbourne.
Methods
Participants
The participants in this study were active professional music
therapists credentialed from a regulating music therapy organisation.
The participants needed to have experience working in
neurorehabilitation. A snowball sampling method was used to purposively
recruit the participants who met these inclusion criteria.
Participants were recruited in two ways. Firstly, an invitation,
plain language statement, and hyperlink to the online survey were
emailed to music therapy organisations then forwarded to their members.
These organisations included: The World Federation of Music Therapy,
Australian Music Therapy Association (AMTA), and academy of Neurologic
Music Therapy (NMT). Secondly, the recruitment package was sent to 74
registered music therapists (RMT) who identified their expertise as
neurological, rehabilitation, and/or NMT trained on the website of AMTA
(http://www.austmta.org.au).
Instrument design
We developed a 25-item online survey based on the existing
literature on music therapy in neurorehabilitation (See Appendix). The
first two items were for identifying eligibility and for the
participants to provide consent. The remainder of the survey was divided
into six parts according to the areas of investigation including:
1. Participant demographics
2. Professional background information
3. Populations served in neurorehabilitation
4. Goals of music therapy services in neurorehabilitation
5. Music therapy approaches and interventions used in
neurorehabilitation
6. Feedback on music therapy training in neurorehabilitation and
other feedback (optional)
The survey consisted of closed-ended multiple-choices, questions
with single and multiple answers, closed-ended questions with text
answers, Likert scale questions (i.e. never, rarely, sometimes, often,
or always), and open-ended questions. The option "Other" was
provided throughout the survey in case participants had other answers
which were unlisted. The draft survey was reviewed and then piloted with
two music therapy researchers at the University of Melbourne. The
finalised survey took approximately eight minutes to complete.
Data collection procedure
After deciding to take part in the study, participants clicked on a
hyperlink leading to the first page of the online survey on Google
Forms[R], where they had to first confirm their eligibility before they
could proceed to the plain language statement and consent form.
Participation in this study was completely voluntary. The participants
were allowed to withdraw from the study at any time as well as skip any
questions they did not wish to answer.
The survey was opened for four weeks, and a reminder email was sent
to the organisations, institution, and music therapists in the second
week. Additionally, the participants were encouraged to forward the
survey to other music therapists with experience working in
neurorehabilitation. All submitted survey responses were kept in the
password-protected database of Google Forms[R] and were completely
anonymous in order to protect participant confidentiality.
Data analysis
We used descriptive statistics and qualitative content analysis to
analyse the data. For the closed-ended questions, we used frequency
distribution and converted the data into percentages. For Likert scale
questions, we calculated the mean (M) of the responses in each question.
Then, we used the class interval to create five categories including
almost never, rarely, sometimes, often, and almost always in order to
define the calculated mean of each question. The calculated class
interval size was 0.8. Therefore, the means were defined as following:
1. The mean from 1.00 to 1.79 was defined as 'almost
never'.
2. The mean from 1.80 to 2.59 was defined as 'rarely'.
3. The mean from 2.60 to 3.39 was defined as 'sometimes'.
4. The mean from 3.40 to 4.19 was defined as 'often'.
5. The mean from 4.20 to 5.00 was defined as 'almost
always'.
For the opened-ended questions, we followed the procedure of
qualitative content analysis by (a) reading and re-reading the
responses, (b) identifying meaning units, (c) condensing the meaning
units, (d) formulating codes for the condensed meaning units, and (e)
categorising the codes into categories and sub-categories (Erlingsson
& Brysiewicz, 2017; Ghetti & Keith, 2016). Both authors
discussed the coding and categorisation process. The first author
conducted the first round of coding, and the second author conducted the
second round of coding. Inter-coder reliability was then calculated.
Results
The survey received 75 responses from people who identified
themselves as music therapists with professional experience working in
neurorehabilitation. Seven were excluded as they did not identify any
music therapy credential from a professional music therapy organisation.
Another three were excluded because they were inactive and retired.
Therefore, 65 survey responses were analysed in this study (N = 65). We
could not calculate the response rate because the snowball sampling
method used in this study did not allow us to record the number of
people who received an invitation to participate. As not every
participant responded to all questions, the number of participants who
responded to each question is provided.
Demographics and Professional Background
Demographic and professional background information is presented in
detail in Table 1. The majority of the participants were female (84.6%)
and represented all age ranges. Most participants were aged between
30-39 years (35.4%) and were practicing music therapy in Australia
(36.9%) or the USA (33.9%). Other countries represented (29.2%) included
Finland, Germany, Hong Kong, Canada, Japan, Poland, Argentina, China,
Netherland, and Russia with approximately 1-3 responses from each
country.
Most participants held the credential of MT-BC (50.8%) following
with the credential of RMT (47.7%) and had been working for 15 years in
neurorehabilitation (49.2%). Few participants (9.1%) reported other
credentials (e.g. CMT, DMtG, LPMT, MTA) (1). The majority of
participants held a Master's degree (49.2%) and provided
neurorehabilitation music therapy services in hospitals (52.3%). Others
worked in a private business setting (33.8%), private venue (e.g. home)
(30.8%), or aged care organisation (23.1%). Other settings (23.1%)
included community organisation, university, rehabilitation-specialised
institution, kindergarten, and non-profit clinic.
A great majority of participants had completed additional training
in NMT (80%), 7.7% for GIM training, and another 7.7% for NICU-MT
training. Other training (10.8%) included Author Hull Drum Circle, RBL,
MTACB, MATADOC, MTE, Hypnomusictherapy, EBQ instrument, sound massage,
and functional music therapy (2).
Every participant reported interprofessional collaboration when
working in neurorehabilitation with incidence of collaboration by
discipline shown in Figure 1.
Figure 1. Collaborated professionals in music therapy services in
neurorehabilitation
Collaborated Professionals (65 respondents)
Speech Pathologist 87.7%
Occupational Therapist 86.2%
Social Worker 65.6%
Nurse 63.1%
Physiotherapist 61.5%
Neuropsychologist 46.2%
Clinical Psychologist 41.5%
Pastoral Care Worker 29.2%
Psychiatrist 20.0%
Counsellor 12.3%
Other 13.5%
Note. Multiple responses were allowed. Other professional
collaborations included child life therapists, recreational therapists,
medical practitioners, special education resource teachers,
neurologists, pulmonologists, art therapists, early intervention
keyworkers, and nutritionists.
Note: Table made from bar graph.
Populations served
The populations served by music therapy services in
neurorehabilitation represented all age groups. The participants mostly
worked with ABI (M = 3.89). Clinical symptoms addressed by respondents
are also presented in Table 2.
Goals of music therapy
The music therapy goals in neurorehabilitation addressed by
respondents were divided into six categories as presented in Table 3.
Attention (M = 4.25) was the most prevalent goal.
Music therapy approaches and interventions
The participants reported a variety of music therapy approaches
being applied when working in neurorehabilitation. NMT (87.7%) was the
most prevalent as presented in Figure 2.
The prevalence of music therapy interventions used in
neurorehabilitation by respondents are presented in Table 4. Singing (M
= 4.44) was the most commonly used intervention.
Figure 2. Approaches for music therapy services in neurorehabilitation
Music Therapy Approache (65 respondents)
NMT 87.7%
Humanistic Approaches 56 9%
Cognitive-B ehavioural Approaches 33.8%
Developmental Approaches 30.8%
Resource-Oriented Music Therapy 27.7%
Creative Music Therapy 26.2%
Behavioural Approaches 26.2%
Community Music Therapy 24.6%
Psychodynamic Approaches 20.0%
Biomedical Music Therapy 15.4%
Culture-Centered Music Therapy 12.3%
BGTM 7.7%
Not applicable or not sure 1.5%
Other 3 0%
Note. Multiple responses were allowed. Other approaches included
family-centered, patient-centered, existential-integrative, and
solution-focused approaches.
Note: Table made from bar graph.
Qualitative content analysis
Forty-seven participants provided suggestions for the development
of music therapy training for preparing future music therapists to work
in the field of neurorehabilitation. These are listed in Table 5. The
inter-coder reliability of this question was .92.
Eleven participants provided general feedback covering multiple
topics as presented in Table 6. The inter-coder reliability of this
question was .85.
Discussion
Importance of inter-professional collaboration
The results from this survey showed that all participants reported
collaboration with other professionals when working in
neurorehabilitation. This can be supported by the nature of practice in
neurorehabilitation where inter-professional collaboration is promoted
and considered as the key strategy to successful rehabilitation
(Tamplin, 2006; WHO, 2006; Wirz & Rutz-Lapitz, 2015). A perceived
need for more training in music therapy courses on inter-professional
collaboration in neurorehabilitation was presented in the qualitative
content analysis. Speech pathology and occupational therapy
collaboration strategies could be prioritised as these were most
frequently reported.
The scope of clinical populations served
Music therapy services provided in the context of
neurorehabilitation cover a vast range of clinical populations. Our
survey results showed that the respondents worked with clients who had
neurological disorders ranging from acquired conditions, degenerative
conditions, congenital disorders, and post-neurosurgery conditions. The
range of clinical populations found in the survey may not fit within
some definitions of rehabilitation. In some literature sources,
rehabilitation is defined as the process of restoration to the optimal
state of functioning after acquiring conditions that cause the loss of
capabilities and/or debilitation such as illness, injury, or trauma
(Bruscia, 2014; Dirckx, 2012; Loewy, 2013; Martin, 2015). Although this
definition focuses on people with acquired neurological conditions,
music therapy interventions used in this context may also benefit people
with congenital and degenerative neurological disorders (Baker &
Tamplin, 2006; Wade, 2015). On the other hand, the World Health
Organisation (2017a) defined rehabilitation as "a set of
interventions designed to optimise functioning and reduce disability in
individuals with health conditions in interaction with their
environment" (p. 1). Health conditions in this context were defined
as acute or chronic disease, disorder, injury, trauma, and other
conditions related to congenital anomaly, and genetic predisposition
(WHO, 2017b). In line with this, rehabilitation-focused music therapy
has been described with people who had degenerative and congenital
neurological disorders (e.g. PD, dementia, cerebral palsy, Erb's
palsy, Rett syndrome) (Alves-Pinto, Turova, Blumenstien, & Lampe,
2016; Staum, 2000; Wang et al., 2013; Weller & Baker, 2011).
Some participants reported non-neurological disorders under the
"Other" choice in clinical populations. However,
non-neurological disorders including lupus and hematological disorders
may have an impact on the nervous system (Muscal & Brey, 2010;
Sussman & Davies-Jones, 2014). Some participants also responded to
the "Other" choice in clinical population question using
categories such as developmental disorders, cancer, and genetic
disorders which are umbrella terms that may cover neurological
disorders, disorders that may impact the nervous system, and disorders
that may spread to the nervous system. Several participants reported
that music therapy services were provided to clients with autism in a
neurorehabilitation unit. Grob (1998) suggested that the music therapy
services with clients on the autism spectrum may fall into the
rehabilitation category if the clients are responsive to facilitated
communication and show a degree of abstractive ability because it could
be considered as restoring or gaining access towards an untapped
ability. Although autism is usually categorised as a developmental
disorder, it involves neurological or neurophysiological factors
(American Psychiatric Association, 1994).
Our results indicate that music therapists working in
neurorehabilitation predominantly work with patients living with ABI.
Other clinical populations served include other acquired neurological
conditions, degenerative neurological conditions, congenital
neurological conditions, post-neurosurgery conditions, and other
conditions that relate to and/or have an impact on neurological
impairments. These findings challenge several existing definitions of
rehabilitation because the clinical populations served by music
therapists who responded to this survey were not limited to acquired
neurological conditions. It is possible that participants lost track of
the scope of the survey and provided responses based on their experience
outside the neurorehabilitation context, however the questions contained
a reminder of the scope of the study throughout the survey.
The prevalence of clinical symptoms and goals vs. the existing
literature
A recent Cochrane review of music interventions for ABI (Magee et
al. 2017), revealed moderate quality evidence for music interventions
for gait velocity and length rehabilitation; low quality evidence
towards other aspects of gait rehabilitation and quality of life; very
low-quality evidence towards arm movement and overall communication; and
no strong evidence on cognitive rehabilitation for people with ABI.
However, our survey found that speech, motor, and cognitive impairments
were all highly prevalent clinical symptoms addressed by respondents.
The prevalence of speech and cognitive impairments in neurological
populations, and the limited evidence of studies on music therapy
interventions in these areas indicates the need for further research.
However, Magee et al. (2017) reviewed only clinical trials in ABI,
whilst our survey gathered data on the overall practice of music therapy
in neurorehabilitation. Although we found that ABI was the most
prevalent clinical population served, our results on the clinical
symptoms and goals may have related to other clinical populations
served. Therefore, future studies could also survey music therapy
services provided to the ABI population specifically and/or use other
statistical methods.
The prevalence of Neurologic Music Therapy (NMT)
Neurologic music therapy (NMT) was the most frequently reported
music therapy approach that participants drew upon and was a frequently
reported suggestion for future music therapy training. The majority of
survey participants were NMT-trained. However, as the survey was
distributed via the academy of NMT, the results were likely to favor NMT
approaches and training. Some NMT techniques, especially Rhythmic
Auditory Stimulation, are very well supported by neurorehabilitation
research (Altenmuller & Schlaug, 2013; Magee et al., 2017; Weller
& Baker, 2011). This evidence base may explain the prevalence of NMT
techniques used by respondents. A small number of non-NMT-trained
participants reported that they still drew upon the NMT approach (as
presented in Table 1 and Figure 2). Therefore, NMT clearly has a strong
influence on music therapy practice in neurorehabilitation.
Limitations
Although this study received responses from participants that
represented all regions of the world, the global representativeness is
questionable due to the high representation from the USA and Australia.
The international survey by Kern and Tague (2017) gathered information
on music therapy practice status and trends from over 18 countries
around the world. This present study gathered responses from only 12
countries using a snowball sampling method. It is possible that music
therapy in neurorehabilitation is more frequently practiced in the
countries represented in our survey, however, it may just be that our
sampling method did not adequately reach a representative sample of
countries. Future surveys could be circulated via all national music
therapy organisations and/or via the World Federation of Music Therapy
in order to achieve a wider distribution.
Using a pre-defined definition of neurorehabilitation from the
literature may help participants focus on a particular aspect of their
clinical experience. As this study aimed to survey current clinical
practice, we avoided providing any pre-defined definition of
neurorehabilitation so as not to influence participant contributions.
However, this meant that neurorehabilitation may have been interpreted
quite differently by participants. Finally, as the survey was only
distributed in English, this limited international participation and
likely situates the research findings within specific cultural contexts.
Conclusions
In conclusion, this international study explored the current scope
and prevalence of music therapy services in neurorehabilitation. We used
the survey method to gather information from the real-world practices of
the participating music therapists. The survey outcomes suggest that
inter-professional collaboration, especially with speech pathologists
and occupational therapists, is vital in the work of music therapists
working in neurorehabilitation. Moreover, music therapists can expect to
see an extensive range of clinical populations with neurological
impairments when working in this field. Further research on music
therapy for cognitive and communication rehabilitation is highly
recommended in order to respond to the prevalence of the clinical
symptoms found and goals formulated in this context. Also, the survey
outcomes suggest that NMT is frequently applied by the participating
music therapists and recommended by some participants for future music
therapy training. Furthermore, future research and training could focus
on therapeutic singing techniques which were the most prevalent
techniques being used by our participants in their neurorehabilitation
work. Finally, the results of this study should be considered by
academic teachers in building the curriculum for the future music
therapy students and by music therapy researchers in providing research
to respond to the needs in the practice.
Acknowledgements
This study would not have been possible without generous support
from the staff at the University of Melbourne. I would like to
profoundly express my gratitude towards Dr. Jeanette Tamplin, the
co-author, who contributed her precious time supervising me and
collaboratively editing this article. Moreover, I would like to thank
Dr. Katrina McFerran who introduced me to the world of music therapy
research and participated in the pilot trial of this survey. Also, I
would like to thank Dr. Felicity Baker who taught me the survey design
and participated in the pilot trial of this survey. Finally, Dr. Tamplin
and I would like to wholeheartedly thank all participants for
contributing their valuable time, knowledge, and experience to this
study and to the field of music therapy in neurorehabilitation.
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Appendix: The Online Survey Questionnaire
Music Therapy Services in Neurorehabilitation Study
This study is part of the Master of Music Therapy program at the
University of Melbourne.
(*) Required
Are you a music therapist with experience working in
neurorehabilitation? (*)
Mark only one oval.
[??] Yes (Please continue)
[??] No (Do not continue with survey - please leave the survey now.
Thank you)
Welcome to My Survey
Music therapy has potential in addressing various needs in
neurorehabilitation. Besides, the music therapy profession has grown
recently according to the increasing numbers of graduates, referrals,
and positions opened. A large number of music therapists registered with
Australian Music Therapy Association are working with a vast range of
neurological patients. Therefore, it is possible that music therapy
services in neurorehabilitation may have expanded
This study aims to survey the music therapists working in
neurorehabilitation and collect data regarding to music therapy services
from a larger number of registered music therapists who work in
different settings with different populations. The outcomes will provide
data regarding the current scope of work and prevalence of music therapy
services in neurorehabilitation. The outcomes can be applied to music
therapy training and to the research area of music therapy in
neurorehabilitation.
If you agree to participate, you will be asked to complete an
online survey that will take approximately 8 minutes. The questions will
be about the populations served, music therapy goals, music therapy
techniques, and your music therapy approaches in neurorehabilitation
according to your experience.
(*) None of this will impact on your relationship with the
University of Melbourne, and your participation in this study is
completely voluntary. Your answers will be completely anonymous, and the
Human Research Ethics Committee has approved this project.
Should you require any further information, or have any concerns,
please do not hesitate to contact the Chief Researcher (Prof Katrina
McFerran) on the numbers provided below. Should you have any concerns
about the conduct of the project, you are welcome to contact the
Executive Officer, Human Research Ethics, The University of Melbourne,
on ph: +61 3 8344 2073.
If you would like to participate, please show that you have read
and understood this information by ticking the box below. If you have
any questions, please feel free to ask, either now, or at any time
during the process.
By submitting this online survey, you are giving consent for your
responses to be used in this study.
Thank you for your participation and your contribution to the
training of music therapy students at the University of Melbourne.
The survey will be closed on 30th September 2017 at 11.59pm
(AEST--Australian Eastern Standard Time UTC +10)
Sincerely,
Prof Katrina Skewes McFerran
(Supervisor and Coordinator of Minor Thesis in Music Therapy)
Melbourne Conservatorium of Music
Ph: +61 3 8344 7382
Dr Jeanette Tamplin
(Supervisor of Minor Thesis in Music Therapy)
Melbourne Conservatorium of Music
Ph: +61 3 8344 3003
Mr Napak Pakdeesatitwara
(Music Therapy Masters Student)
Melbourne Conservatorium of Music
Email: nnakdeesatit@student.unimelb.edu.au
Ph: +61 4 5003 2910
Mark only one oval.
[??] Yes, I have read and understood the plain language statement,
and I agree to participate.
[??] No, I do not (Do not continue with the survey--please leave
the survey now, Thank you)
Demographics
What is your gender?
Mark only one oval.
[??] Male
[??] Female
[??] Decline to state
[??] Other:
What is your age?
Mark only one oval.
[??] 20-29
[??] 30-39
[??] 40-49
[??] 50-59
[??] 60+
What is your country of practice?
Professional background information
Please indicate your music therapy license type.
Check all that apply.
[??] MT-BC
[??] RMT
[??] ACMT
[??] CMT
[??] Inactive
[??] Retired
[??] Other
How many years have you been working as a music therapist in the
field of neurorehabilitation?
What is the highest level music therapy qualification you have?
Mark only one oval.
[??] Bachelor's
[??] Post Graduate Diploma
[??] Master's (coursework)
[??] Master's (research)
[??] PhD or Doctorate
[??] Other:
What is the type of the facility in which you provide music therapy
services in neurorehabilitation? (multiple answers possible)
Check all that apply.
[??] Hospital
[??] School
[??] Aged care organization
[??] Community organization
[??] Private home/venue
[??] Private business
[??] University
[??] Corporate business
[??] Not applicable
[??] Other:
What is your role title? (multiple answers possible)
Check all that apply.
[??] Music therapist
[??] Educator
[??] Researcher
[??] Administrator
[??] Not applicable
[??] Other:
Do you have any additional training in music therapy? (multiple
answers possible)
Check all that apply.
[??] Neurologic Music Therapy (NMT)
[??] Guided Imagery and Music (GIM)
[??] No additional training
[??] Other:
Which of these professionals do you have experience working in
collaboration with? (multiple answers possible)
Check all that apply
[??] Physiotherapist
[??] Occupational therapist
[??] Speech pathologist
[??] Social worker
[??] Pastoral care worker
[??] Nurse
[??] Clinical psychologist
[??] Neuropsychologist
[??] Counsellor
[??] Psychiatrist
[??] Not applicable
[??] Other:
Populations served
Please rate the prevalence of the age groups of your clients in
neurorehabilitation.
Mark only one oval per row.
Never Rarely Sometimes Often Always
Infants [??] [??] [??] [??] [??]
Preschoolers [??] [??] [??] [??] [??]
Children [??] [??] [??] [??]` [??]
Adoiescents [??] [??] [??] [??] [??]
Adults [??] [??] [??] [??] [??]
Older adults [??] [??] [??] [??] [??]
Please rate the prevalence of the conditions you work with in the field
of neurorehabilitation.
Mark only one oval per row.
Never Rarely Sometimes Often Always
Acquired Brain Injury (ABI) [??] [??] [??] [??] [??]
Spinal Cord Injury (SCI) [??] [??] [??] [??] [??]
Parkinson's disease [??] [??] [??] [??] [??]
Huntington's disease [??] [??] [??] [??] [??]
Multiple sclerosis [??] [??] [??] [??] [??]
Dementia [??] [??] [??] [??] [??]
Other (please specify) [??] [??] [??] [??] [??]
If you have experience working with other conditions in
neurorehabilitation, please specify.
Please rate the prevalence of the clinical symptoms you work with in
the field of neurorehabilitation.
Mark only one oval per row.
Never Rarely Sometimes Often Always
Altered states of [??] [??] [??] [??] [??]
consciousness
Post-traumatic amnesia [??] [??] [??] [??] [??]
Motor impairments [??] [??] [??] [??] [??]
Speech impairments [??] [??] [??] [??] [??]
Language impairments [??] [??] [??] [??] [??]
Cognitive impairments [??] [??] [??] [??] [??]
Challenging behaviors [??] [??] [??] [??] [??]
Social difficulties [??] [??] [??] [??] [??]
Emotional difficulties [??] [??] [??] [??] [??]
Loss of identity [??] [??] [??] [??] [??]
Psychological trauma [??] [??] [??] [??] [??]
Pain [??] [??] [??] [??] [??]
Other (please specify) [??] [??] [??] [??] [??]
If you have experience working with other symptoms in
neurorehabilitation, please specify.
Goals of music therapy
Please rate the prevalence of the music therapy goals.you work
towards in neurorehabilitation:
Goals for physical rehabilitation
Mark only one oval per row.
Never Rarely Sometimes Often Always
Upper extremity gross motor [??] [??] [??] [??] [??]
movement
Upper extremity fine motor [??] [??] [??] [??] [??]
movement
Lower extremity gross motor [??] [??] [??] [??] [??]
movement
Lower extremity fine motor [??] [??] [??] [??] [??]
movement
Gait rehabilitation [??] [??] [??] [??] [??]
Balance and posture [??] [??] [??] [??] [??]
Range of movement [??] [??] [??] [??] [??]
Strength [??] [??] [??] [??] [??]
Endurance [??] [??] [??] [??] [??]
Coordination [??] [??] [??] [??] [??]
Relaxation [??] [??] [??] [??] [??]
Pain management [??] [??] [??] [??] [??]
Dexterity [??] [??] [??] [??] [??]
Activities of Daily Living [??] [??] [??] [??] [??]
(ADLs)
Other (please specify) [??] [??] [??] [??] [??]
If you have experience working towards other physical
rehabilitation goals, please specify.
Goals for cognitive rehabilitation
Mark only one oval per row.
Never Rarely Sometimes Often Always
Orientation [??] [??] [??] [??] [??]
Stimulating response [??] [??] [??] [??] [??]
Spatial exploration [??] [??] [??] [??] [??]
Memory [??] [??] [??] [??] [??]
Attention [??] [??] [??] [??] [??]
Executive functioning [??] [??] [??] [??] [??]
(mental flexibility)
Skills learning [??] [??] [??] [??] [??]
Following instruction [??] [??] [??] [??] [??]
Other (please specify) [??] [??] [??] [??] [??]
If you have experience working towards other cognitive
rehabilitation goals, please specify.
Goals for behavioral management
Mark only one oval per row.
Never Rarely Sometimes Often Always
Managing agitation [??] [??] [??] [??] [??]
Managing perseveration [??] [??] [??] [??] [??]
Managing impulsivity [??] [??] [??] [??] [??]
Other (please specify) [??] [??] [??] [??] [??]
If you have experience working towards other behavioral goals,
please specify.
Goals for communication rehabilitation
Mark only one oval per row.
Never Rarely Sometimes Often Always
Respiratory [??] [??] [??] [??] [??]
function/strength/control [??] [??] [??] [??] [??]
Speech rate control [??] [??] [??] [??] [??]
Intelligibility [??] [??] [??] [??] [??]
Speech naturalness [??] [??] [??] [??] [??]
Speech repetition [??] [??] [??] [??] [??]
Naming [??] [??] [??] [??] [??]
Verbal responses to [??] [??] [??] [??] [??]
questions
(Responsive speech)
Articulation [??] [??] [??] [??] [??]
Prosody [??] [??] [??] [??] [??]
Verbal fluency [??] [??] [??] [??] [??]
Speech comprehension [??] [??] [??] [??] [??]
Written language [??] [??] [??] [??] [??]
Other (please specify) [??] [??] [??] [??] [??]
If you have experience working towards other communication
rehabilitation goals, please specify.
Goals for emotional adjustment
Mark only one oval per row.
Never Rarely Sometimes Often Always
Exploring self-concept [??] [??] [??] [??] [??]
Mood management [??] [??] [??] [??] [??]
Identifying and expressing [??] [??] [??] [??] [??]
emotional difficulties
improving seif-confidence [??] [??] [??] [??] [??]
Improving self-esteem [??] [??] [??] [??] [??]
Other (please specify) [??] [??] [??] [??] [??]
If you have experience working towards other emotional goals,
please specify.
Social goals
Mark only one oval per row.
Never Sometimes Often Always
Rarely
Encouraging patients to socially
interact with others (e.g. [??] [??] [??] [??]
relatives, peers)
Offering appropriate environment [??] [??] [??] [??]
for social interactions
Facilitating social skills [??] [??] [??] [??]
learning
Other (please specify) [??] [??] [??] [??]
If you have experience working towards other social goals, please
specify.
Music therapy approaches and techniques
Which of these theoretical approaches do you align yourself with?
(multiple answers possible)
Check all that apply.
[??] Psychodynamic Approaches
[??] Humanistic Approaches
[??] Behavioral Approaches
[??] Cognitive-Behavioral Approaches
[??] Developmental Approaches
[??] Creative Music Therapy
[??] Bonny Method of Guided Imagery and Music
[??] Neurologic Music Therapy
[??] Community Music Therapy
[??] Biomedical Music Therapy
[??] Resource-Orientated Music Therapy
[??] Culture-Centered Music Therapy
[??] Not applicable or not sure
[??] Other:
Please rate the prevalence of the music therapy techniques you use.
Mark only one oval per row.
Never Rarely Sometimes Often Always
Rhythmic Auditory Stimulation [??] [??] [??] [??] [??]
Movement to music [??] [??] [??] [??] [??]
Music making on a musical [??] [??] [??] [??] [??]
instrument
Music as a mnemonic device [??] [??] [??] [??] [??]
Music-based attention [??] [??] [??] [??] [??]
training
Instructional song [??] [??] [??] [??] [??]
Song story [??] [??] [??] [??] [??]
Song reminiscence [??] [??] [??] [??] [??]
Music listening [??] [??] [??] [??] [??]
Improvisation [??] [??] [??] [??] [??]
Singing [??] [??] [??] [??] [??]
Oral motor exercise or vocal [??] [??] [??] [??] [??]
exercise
Music-based speech and [??] [??] [??] [??] [??]
language activities
Songwriting [??] [??] [??] [??] [??]
Song discussion [??] [??] [??] [??] [??]
Group music making (either [??] [??] [??] [??] [??]
vocal or instrumental)
Community group music making [??] [??] [??] [??] [??]
(e.g. community choir)
Music and imagery [??] [??] [??] [??] [??]
Guided Imagery and Music [??] [??] [??] [??] [??]
(GIM)
Traditional Oriental Music [??] [??] [??] [??] [??]
Therapy
Other (please specify) [??] [??] [??] [??] [??]
If you have experience using other techniques, please specify.
For future music therapists
This is the last section of the online survey. By submitting this
online survey, you are giving consent for this data to be used in this
study.
Additionally, the following questions are optional, but your
opinion will be greatly valuable to the future music therapy training as
well as to the music therapy students.
In your opinion, what should the music therapy training focus on in
order to prepare the future music therapists for the field of
neurorehabilitation? (optional)
Please provide any other comments you have about music therapy
services in neurorehabilitation, or any feedback you have about this
survey (optional)
Napak Pakdeesatitwara and Jeanette Tamplin
Faculty of Fine Arts and Music, The University of Melbourne,
Australia
Address correspondence to:
Napak Pakdeesatitwara napakmt@gmail.com
To cite this article: Pakdeesatitwara, N. & Tamplin, J. (2018).
Music therapy services in neurorehabilitation: An international survey.
Australian Journal of Music Therapy, 28, 62-90. Retrieved from
https://www.austmta.org.au/journal/article/music-therapy-services-neurorehabilitation-international-survey
In plain language:
Neurorehabilitation is an extensive field of music therapy practice
serving diverse clinical populations and addressing complex clinical
needs. Since music therapy research and practice have developed over
time and shown benefits for people undergoing neurorehabilitation, it is
important to explore the current state of music therapy services being
offered in this field. This article presents the results of an
international survey examining the scope and prevalence of populations
served in neurorehabilitation, goals formulated, and approaches and
interventions being used by credentialed music therapists. The
discussion suggests pathways for developing future research and training
curriculum in response to the current practice of music therapy in
neurorehabilitation.
(1) The credentials included Music Therapist--Board Certified
(MT-BC), Registered Music Therapist (RMT), Certified Music Therapist
(CMT), Deutsche Musiktherapeutische Gesellschaft (DMtG), Licensed
Professional Music Therapist (LPMT), and Music Therapist Accredited
(MTA).
(2) The acronymic additional trainings included Neurologic Music
Therapy (NMT), Guided Imagery and Music (GIM), Neonatal Intensive Care
Unit--Music Therapy (NICU-MT), Rhythm, Breath, Lullaby (RBL), Music
Therapy-Assisted Childbirth (MTACB), Music Therapy Assessment Tool for
Awareness in Disorders of Consciousness (MATADOC), and Music Therapy
Entrainment (MTE).
(3) Other clinical populations included muscular dystrophy, autism,
Guillain-Barre syndrome, cerebral palsy, Rett syndrome, cancer, blood
disorders, developmental disorders, brain tumor, brain cancer, motor
neuron disease, transverse myelitis, lupus, post-neurosurgery, profound
intellectual and multiple disabilities, intracranial pressure, genetic
disorders (e.g. Down syndrome), epilepsy, Chiari malformation.
(4) Other clinical symptoms included seizure and sensory
impairments.
Table 1. Demographics and professional background
Gender Female Male
55 (84.6%) 10 (15.4%)
Age 20-29 30-39 40-49 50-59
Range 17 (26.2%) 23 (35.4%) 13 (20%) 10 (15.4%)
Country of Australia USA Other
Practice 24 (36.9%) 22 (33.9%) 19 (29.2%)
Credential MT-BC RMT Other
33 (50.8%) 31 (47.7%) 6 (9.1%)
Year of Less than 1 1-5 6-10 Over 10
Experience 2 (3.1%) 32 (49.2%) 16 (24.6%) 15 (23.1%)
Qualification Bachelor's Master's Doctoral Other
18 (27.7%) 32 (49.2%) 9 (13.9%) 6 (9.2%)
Work Hospital Private Private Aged Care
Setting Business Venue Organisation
34 (52.3%) 22 (33.8%) 20 (30.8%) 15 (23.1%)
Role Title Music Other
Therapist
61 (93.8%) 22 (33.8%)
Additional NMT GIM NICU-MT Other
Training 52 (80.0%) 5 (7.7%) 5 (7.7%) 7 (10.8%)
Gender
Age Over 60
Range 2 (3.1%)
Country of
Practice
Credential
Year of
Experience
Qualification
Work Other
Setting 15 (23.1%)
Role Title
Additional None
Training 10 (15.4%)
Note. All 65 respondents answered the demographics and professional
background questions. Some participants reported multiple credentials,
work settings, role titles, and additional training
Table 2. Populations served in music therapy services in
neurorehabilitation
Population Number of Responses Mean Definition
(N = 65)
Age Range
Infant 53 2.04 Rarely
Preschooler 54 2.39 Rarely
Children 58 2.62 Sometimes
Adolescent 60 2.77 Sometimes
Adult 63 3.89 Often
Older Adult 58 3.81 Often
Clinical Population
ABI 64 3.89 Often
SCI 56 2.59 Rarely
PD 55 2.82 Sometimes
Huntington's Disease 54 2.00 Rarely
Multiple Sclerosis 54 2.39 Rarely
Dementia 57 3.39 Sometimes
Other (3) 30 2.60 Sometimes
Clinical Symptom
Altered States of 61 2.79 Sometimes
Consciousness
Post-Traumatic Amnesia 61 2.41 Rarely
Motor Impairments 64 4.17 Often
Speech Impairments 63 4.18 Often
Language Impairments 64 4.09 Often
Cognitive Impairments 64 4.16 Often
Challenging Behaviours 60 3.38 Sometimes
Social Difficulties 63 3.43 Often
Emotional Difficulties 64 3.72 Often
Loss of Identity 63 3.25 Sometimes
Psychological Trauma 63 2.92 Sometimes
Pain 62 3.16 Sometimes
Other (4) 17 1.35 Almost Never
Note. Participants were not required to answer all questions.
Abbreviations: ABI - Acquired Brain Injury, SCI - Spinal Cord Injury,
PD - Parkinson's Disease
Table 3. Goals of music therapy services in neurorehabilitation
Goal Number of Responses Mean Definition
(N = 65)
Cognitive
Orientation 63 3.44 Often
Response Stimulation 62 3.68 Often
Spatial Exploration 62 3.24 Sometimes
Memory 64 3.91 Often
Attention 63 4.25 Almost Always
Executive Functioning 63 3.98 Often
Skill Learning 64 3.34 Sometimes
Instruction Following 63 3.62 Often
Other 18 1.17 Almost Never
Emotional
Exploring Self-Concept 63 3.33 Sometimes
Mood Management 64 3.69 Often
Identifying and 64 3.72 Often
Expressing Emotional
Difficulties
Improving Self-Confidence 64 3.95 Often
Improving Self-Esteem 64 3.95 Often
Other 18 1.44 Almost Never
Communication
Respiratory Function, 62 3.65 Often
Strength, and Control
Speech Rate Control 62 3.61 Often
Intelligibility 63 3.71 Often
Speech Naturalness 63 3.40 Often
Speech Repetition 59 3.36 Sometimes
Naming 60 3.20 Sometimes
Responsive Speech 60 3.53 Often
Articulation 61 3.82 Often
Prosody 62 3.57 Often
Verbal Fluency 63 3.62 Often
Speech Comprehension 60 3.42 Often
Written Language 62 2.39 Rarely
Other 19 1.74 Almost Never
Physical
Upper Extremity Gross 64 3.63 Often
Motor Movement
Upper extremity Fine 62 3.47 Often
Motor Movement
Lower Extremity Gross 62 3.48 Often
Motor Movement
Lower Extremity Fine 63 3.03 Sometimes
Motor Movement
Gait Rehabilitation 63 3.19 Sometimes
Balance and Posture 62 3.31 Sometimes
Range of Movement 62 3.63 Often
Strength 61 3.39 Sometimes
Endurance 62 3.55 Often
Motor Coordination 63 3.89 Often
Relaxation 62 3.44 Often
Pain Management 62 2.92 Sometimes
Dexterity 61 3.05 Sometimes
ADLs 62 3.03 Sometimes
Other 17 1.29 Almost Never
Social
Encouraging Interactions 64 3.80 Often
Providing Environment 64 3.63 Often
Social Skills 62 3.32 Sometimes
Other 19 1.53 Almost Never
Behavioural
Managing Agitation 62 3.23 Sometimes
Managing Perseveration 63 3.13 Sometimes
Managing Impulsivity 62 3.24 Sometimes
Other 20 1.65 Almost Never
Note. Participants were not required to answer all questions
Table 4. Interventions used in music therapy services in
neurorehabilitation
Music Therapy Intervention Number of Mean Definition
Responses
(N = 65)
RAS 62 3.53 Often
Movement to Music 59 3.95 Often
Making Music on a Music Instrument 60 4.05 Often
Music as a Mnemonic Device 60 3.25 Sometimes
Music-Based Attention Training 59 3.86 Often
Instructional Song 58 3.00 Sometimes
Song Story 58 2.66 Sometimes
Song Reminiscence 59 3.36 Sometimes
Music Listening 60 3.57 Often
Improvisation 60 3.55 Often
Singing 61 4.44 Almost Always
Oral Motor Exercise or Vocal 61 3.92 Often
Exercise
Music-Based Speech & Language 59 4.00 Often
Activities
Songwriting 61 3.33 Sometimes
Song Discussion 60 3.37 Sometimes
Group Music Making 59 3.48 Often
Community Group Music Making 58 2.72 Sometimes
Music and Imagery 58 2.35 Rarely
GIM 58 1.50 Almost Never
Traditional Oriental Music Therapy 56 1.25 Almost Never
Other 18 1.78 Almost Never
Note. As the participants were allowed to skip the question they did
not wish to answer, some participants did not answer to some questions.
Table 5. Suggestions for the future development of music therapy
training
Category and Subcategory Number of Percentage Example
Responses
(n = 47)
Theoretical Approaches 17 36.2%
NMT 15 31.9%
Resource-Oriented MT 1 2.1%
Integrated Approaches 2 4.3%
Inter-Professional 8 17.0% Collaborative work
Collaboration and professional
communication.
Therapeutic Skills 3 6.4% Interpersonal skills.
Neurological Foundations 11 23.4% Neuroscience,
neurology, and
body-mind connection.
Music Foundations 3 6.4% Music skills and
knowledge.
Practical Opportunities 4 8.5%
MT Interventions 3 6.4% Songwriting and
improvisation.
Anatomy 2 4.3%
Ethics 1 2.1% Human rights.
MT Teaching 3 6.4% Smaller class size and
standardisation of
training.
Neurological Aspects 7 14.9%
of Music Participation
Clinical Knowledge 4 8.5%
Music Psychology 2 4.3%
Up-to-Date Research 2 4.3%
Clinical Process 8 17.0%
Holistic Assessment 2 4.3%
Appropriate Goals 4 8.5%
Appropriate Use/ 4 8.5%
Modification
of Interventions
Evaluation of Progress 1 2.1%
Notes. 47 participants responded to this question. Some responses
covered multiple categories.
Table 6. General feedback
Category Number of Percentage Example
Responses
(n = 11)
Feedback on the Study 3 27.3% This is an
extensive survey.
Feedback on 1 9.1% Need more network
Professional Needs opportunities and
support.
Comments on the survey 2 18.2% Neurorehabilitation
should be defined.
Reflections on MT Practice 4 36.4% Great step forward
in Neurorehabilitation to promote
rehabilitation of
brain functions
through MT.
Suggestions for MT 3 27.3% I find that a
Practice in combination of
Neurorehabilitation approaches is most
useful and helpful.
Notes. Only 11 participants responded to this question. Some responses
covered multiple categories
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