Literature Review: Use of Music Therapy with People with Physical Disabilities

Written by Peggy A. Farlow, while a Music Therapy Intern
Matheny School and Hospital, Peapack, New Jersey
August 1999

Music therapy has been used effectively in many different settings with people with many different types of disabilities. Research has been conducted using music therapy with people with mental, emotional and physical disabilities. This paper will concentrate on research that deals with the role and use of music therapy techniques with people with physical disabilities. The literature reviewed for this paper will include an overview of the role of music therapy in physical rehabilitation programs and the use of music with restrained patients. This review will then focus on music therapy techniques that have been used with people with physical disabilities. Techniques discussed in this paper include: keyboard improvisation, keyboard instruction, rhythmic movement and song writing.

Role of Music Therapy in Physical Rehabilitation

In her article “The Role of Music Therapy in Physical Rehabilitation Programs,” Marilyn Sandness (1995) gives a review of clinical and research literature that documents the effectiveness of music therapy in physical rehabilitation settings. This article begins by describing accreditation standards established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Commission on Accreditation of Rehabilitation Facilities (CARF) that will most likely affect music therapists working in physical rehabilitation programs. Sandness states that while music therapy is not specified in the JCAHO standards for physical rehabilitation, numerous areas in required assessments and treatments are routinely addressed by music therapists. In CARF’s description of chronic pain management programs, the expressive therapies, including music therapy, are specified. This article also states the standards of assessment that have been set by each agency. Measurement tools, such as the Functional Independence Measure (FIM) and the Glasgow Coma Scale used in assessment are described along with an overview of physical rehabilitation programs in general. Areas identified as potential treatment areas for music therapy in the physical rehabilitation setting include: cognition, communication, physical functioning, activities of daily living, and psychosocial functioning. This article stresses that music therapy is valuable in the physical rehabilitation setting as it not only addresses the physical needs of the patients, but also the patients’ activities of daily living skills, and their behaviors and feelings as they relate to their disabilities. The article concludes by advocating for more music therapy services to be offered in physical rehabilitation programs.

Use of Music with Restrained Patients

To examine the potential use of music interventions with restrained patients in a physical rehabilitation setting, Janelli, Kanski, Jones and Kennedy (1995) presented a case study of an older adult medical-surgical patient who was restrained with a Posey vest and bilateral wrist restraints to prevent him from pulling out his multiple intravenous lines and Foley catheter. In their article, “Exploring Music Intervention with Restrained Patients,” Janelli, Kanski, Jones and Kennedy described using Roy’s Adaptation Model as an assessment tool for examining the issue of restraints and their potential effect on the older patient. The patient in this study was determined to be at possible risk for depression and social withdrawal due to use of restraints. Prior to any music intervention, the patient was also asked to complete the Short Portable Mental Status questionnaire (SPMSQ). Results of the SPMSQ determined the patient to be alert and mentally intact. Music as a nursing intervention was chosen because it has been proven effective in decreasing patient anxiety and discomfort. Music was also noted for being a means of communication not requiring a high intellectual ability in order to be effective. The goal of the music intervention was to encourage the patient to adapt in a positive way to environmental changes he experienced due to use of restraints. The patient was observed before, during and after music intervention using a Behavior Instrument checklist. For 10 minutes before the music intervention began, the patient demonstrated 10 positive behaviors. The patient was then given a choice of music from four tapes (band, classical, country-western or popular). His restraints were removed and he listened to music of his choice for 50 minutes using a tape player and headphones. During the music intervention he displayed 12 positive behaviors. After intervention, restraints were reapplied and he was again observed for 10 minutes. He demonstrated 8 positive behaviors during this time. No negative behaviors were observed before, during, or after music intervention. The authors stated that this patient overcame his anger and made no attempts to pull out his tubes while listening to music and concluded the results of this case study demonstrated the effectiveness of using music with restrained patients.

Use of Music with Keyboard Improvisation

Another music therapy technique that has been used effectively with people with physical disabilities is improvisation. L. K. Miller and G. Orsmond have conducted research using keyboard improvisation with children with physical disabilities. Results of their research have been written about in two articles. “Assessing Structure in the Musical Explorations of Children with Disabilities” (1994) examined whether different levels of musical organization could be discerned in spontaneous musical behavior and whether differences in musical interest correlated to the children’s later improvised musical performance. This study examined children with varying physical disabilities and explored the use of music improvisation by having the children play portable keyboards linked to computers. These computers then provided a detailed record of each child’s musical explorations. Children who were perceived as having a musical interest by their teacher’s were compared with children who were perceived as not having a musical interest. The authors concluded that children who demonstrated a musical interest prior to the study did appear to engage in more musically sophisticated interaction with the keyboard. In their 1995 study, “Correlates of Musical Improvisation in Children with Disabilities,” Orsmond and Miller used a similar approach as in their earlier study but expanded on their original findings by examining a larger sample of children over a longer period of time. Their hypothesis was that: “(a) musical improvisation samples of children nominated as musically “inclined” would show more musical sophistication, assessed by the amount of harmonic and melodic structure evident in the improvisations, and would show stability over time; and (b) children exhibiting more musically sophisticated improvisation samples would be distinguishable on the basis of measures of spatial rather than language abilities.” (p. 155). Overall results determined that children identified as musically inclined produced more organized and sophisticated keyboard explorations. The authors also stated that results suggested that a spatial/musical link may be present across a range of disabilities and that a link between some aspects of verbal behavior and music may exist. The authors concluded that some children with disabilities appear to have an inclination toward musical activities, and that this interest does translate into actual ability or a higher level of musical organization.

Use of Music and Keyboard Instruction

Music therapy techniques using the piano keyboard have also been discussed by Howell, Flowers and Wheaton in their article, “The Effects of Keyboard Experiences on Rhythmic Responses of Elementary School Children with Physical Disabilities” (1995). For this study, keyboard instruction using the Instant Pleasure music software program was used to examine rhythmic responses of children with physical disabilities. Eight elementary students with orthopedic disabilities were studied in order to answer the following questions:

Is there an effect from school music instruction and home experiences on the ability of students with physical disabilities to maintain a consistent “fast” rhythm of 500 ms between beats (120 bpm)?
Is there an effect from school music instruction and home experiences on the ability of students with physical disabilities to maintain a consistent “slow” rhythm of 937 ms between beats (64 bpm)?
Is there an effect from school music instruction and home experiences on the ability of students with physical disabilities to maintain a consistent “personal” rhythm? (p. 95).

During a pretest, student data was collected to measure the student’s ability to produce rhythmic switch activations either in response to generated tones or to their own rhythmic patterns. Three subtests were given and students’ responses were recorded in the following areas: 1. Tempo fast (students heard a metronome tone of 120 bpm and tried to match it), 2. Tempo slow (students heard a slow beat of 64 bpm), and 3. Tempo self (students were asked to keep a steady beat on their own). Students and their parents were then given instruction on how to use the Instant Pleasure music software program. Instant Pleasure separates technical skill from expressive control in electronic keyboard performance and allows for the transfer of expressive control from the small muscles of the fingers and hands to other muscle groups. The music system equipment was made available to students both at school and at home. Over a 10-week period, students received 10-15 minutes of individualized music instruction using Instant Pleasure twice a week at school. Instruction focused on music-making rather than simple repetition of a motor task (i.e., beat keeping). Also, once a week, a music educator visited each student’s home for 30 minutes to provide assistance to the families with guided practice techniques. At the end of the 10 weeks, students were given a post-test. Comparison of the pre-test and post-test data showed mixed results. The authors concluded that: 1) motivation may have played a pivotal role in student performance; 2) the tempo slow test may provide the clearest indication of consistent improvement in rhythmic responding for students with physical disabilities; and 3) the tempo self test indicated a trend toward improvement in consistent rhythmic responding.

Use of Music with Rhythmic Movement

Rhythmic movement is another technique that has been used effectively with music to treat patients with physical disabilities. In their article, “Rhythmic Movement and Music for Adolescents with Severe and Profound Disabilities,” Boswell and Vidret (1993) discuss a rhythmic movement and music program designed to treat individuals with severe orthopedic and/or intellectual impairments during a summer day program. This program was developed for a group of adolescents with significant language dysfunction and pronounced delays in motor development. Students received one 45-minute movement/music session each week co-led by a movement specialist and a music therapist. Students also received individual movement/music therapy sessions three times each week by the music therapist. Specific goals identified for these students included improving psychomotor performance, enhancing rhythmic skills and encouraging speech sounds. Each class began with a warm-up activity, followed by a rhythmic skill activity, a speech sound activity and a closing activity. Activities were presented in a sequential progression and included the following steps: “1) focus attention–secure eye contact, 2) perform passive movements, 3) perform imitative active movements, and 4) perform original movement responses.” (p. 37). At the end of summer, the authors reviewed the rhythmic movement and music program and defined five important points for other facilities to consider when establishing similar programs. First, a Co-disciplinary Approach emphasizing musical elements with movement was important to help deepen each student’s experience. Second, finding avenues to encourage Self-Expression was essential to increase the communication potential of each student. Third, sequencing of activities based on each student’s Developmental Perspective was fundamental for the students’ success. Fourth, awareness of Reflective Interaction and using each student’s immediate responses to adapt to the moment was important to make the therapy meaningful for the students. And fifth, having an Appreciation of the Inner Person and working to discover the person inside the physical body was an integral part of the therapy.

Use of Music and Song Writing

The previous article emphasized the importance of allowing children with physical disabilities to use rhythmic movement and music as a way to promote self-expression. Another technique that has been proven effective in promoting self-expression is song writing. In her article, “Techniques in Song Writing: Restoring Emotional and Physical Well Being in Adolescents who have been Traumatically Injured,” Sheri Robb (1996) focused on song writing as a method to address the emotional needs of these children. Descriptions of song writing techniques were discussed and examples given. Song writing has been determined to be an important psychosocial intervention as it not only impacts the patients’ emotional health but their physical health as well. Therapeutic goals such as self-expression, adjustment to hospitalization, coping, self-esteem, socialization and/or cognitive-linguistic development and retraining were also identified as possible goals to be addressed through song writing activities. Songwriting techniques such as Fill-in-the-Blank Format, Improvisational Song Writing, Group Song Writing and Discharge Songs were described. Robbs also discussed how to introduce the song writing process to children and offered some techniques to help engage hospitalized adolescents in the creative song writing process. The article concluded by stating that song writing can be an integral part of a patient’s journey to wellness.

One of the primary services in any physical rehabilitation program is to enable persons with physical disabilities to achieve optimal mental health and physical functioning. Research shows that music therapy with patients’ in a physical rehabilitation setting can be used to address a person’s physical needs as well as his or her behavioral and emotional needs. Music therapy techniques that have proven to be effective with this population include keyboard improvisation, keyboard instruction, rhythmic movement and song writing. Music therapy can be an important part of any physical rehabilitation program as it has been proven to be effective in addressing the needs of the whole person.

References

Boswell, B. & Vidret, M. (1993). Rhythmic movement and music for adolescents with severe and profound disabilities. Music Therapy Perspectives, 11, 37-41.

Howell, R. D., Flowers, P. J., Wheaton, J. E. (1995). The effects of keyboard experiences on rhythmic responses of elementary school children with physical disabilities. Journal of Music Therapy, 2, 91-112.

Janelli, L. M., Kanski, G. W., Jones, H. M. & Kennedy, M. C. (1995). Exploring music intervention with restrained patients. Nursing Forum, 4, 12-18.

Miller, L. K. & Orsmond, G. I. (1994). Assessing structure in the musical explorations of children with disabilities. Journal of Music Therapy, 4, 248-265.

Orsmond, G. I. & Miller, L. K. (1995). Correlates of musical improvisation in children with disabilities. Journal of Music Therapy, 3, 152-166.

Robb, S. L. (1996). Techniques in song writing: Restoring emotional and physical well being in adolescents who have been traumatically injured. Music Therapy Perspectives, 14, 30-37.

Sandness, M. I. (1995). The role of music therapy in physical rehabilitation programs. Music Therapy Perspectives, 13, 76-81.

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