Neurologic Music Therapy and Group Psychotherapy for Treatment of Traumatic Brain Injury: Evaluation of a Cognitive Rehabilitation Group

Cognitive rehabilitation therapy (CRT) has developed into a scientific, evidence-based approach, dedicated to improving the cognitive functioning of persons with neurological illnesses and injuries (Cicerone et al. 2000, 2005, 2011; Gordon et al. 2006). Techniques used in CRT have been researched and presented in practical form (see, for example, Ben-Yishay, Piasetsky, & Rattock, 1987; Bennett, Raymond, Malia, Bewick, & Linton, 1998; Eslinger, 2002; Malia & Brannagan, 2007a,b; Prigitano, 1999; Raskin & Mateer, 2000; Sohlberg & Mateer, 2001; Wilson, 2009). Standards of evidence-based practice have been established and communicated to practitioners of CRT (Cicerone et al., 2000,2005,2011; Malia et al., 2004) so that effective strategies and techniques for rehabilitation are now readily available.Neurologic music therapy (NMT) also is a "therapeutic application of music to cognitive, sensory, and motor dysfunctions due to neurologic disease of the human nervous system" (Thaut, 1999, p. 2). Like other scientific approaches to rehabilitation, NMT is based on research demonstrating the benefits of musical interventions for the human nervous system (De I'Etoile & LaGasse, 2013; LaGasse & Thaut, 2012; Thaut, 2000, 2005; Thaut & Hoernberg, 2014). There is evidence that musical interventions improve attention (Gregory, 2002; Groene, 2001; Knox, Yokota-Adachi, Kershner, & Jutai, 2003; Robb, 2003; Sarkamo et al., 2008), memory (Baur, Uttner, llmberger, Fesl, & Mai, 2000; Carruth, 1997; Chan, Ho, & Cheung, 1998; Claussen & Thaut, 1997; Cowles et al., 2003; Gfeller, 1983; Haslam & Cook, 2002; Ho, Cheung, & Chan, 2003; Peterson & Thaut, 2007; Silverman, 2012; Thaut, Peterson, & McIntosh, 2005; Thaut, Peterson, McIntosh, & Hoernberg, 2014; Wallace, 1994), executive function (Bugos, Perlstein, McCrae, Brophy, & Bedenbaugh, 2007; Hedge, 2014; Hitchen, Magee, & Soeterik, 2010; Lane-Brown & Tate, 2009; Miller, 2007; Thaut et al., 2009), and emotional adjustment (Hedge, 2014; Lesiuk, 2010; Thaut et al., 2009; Unkefer & Thaut, 2002). Like CRT, NMT offers evidence-based strategies for neurological rehabilitation (Thaut & Hoernberg, 2014). By combining the evidence-based approaches of CRT and NMT, practitioners in neurological rehabilitation gain additional power to improve cognitive skills. NMT principles assert that even after injury or illness, the brain normally remains able to respond to and benefit from music (De I'Etoile, 2010). The dimensions added by musical interventions recruit additional areas of the brain to engage in the exercises used (Levitin, 2013). Parallel structures of the brain are brought into action that, without music, would not normally be involved. By enhancing the organizational structure of the brain, music increases the brain's efficiency. NMT also heightens the effectiveness of CRT by adding emotion and motivation to the exercises (Gardiner & Thaut, 2014a,b; Thaut, 2005, 2010; Thaut & Gardiner, 2014). In addition, NMT offers the Transformational Design Model (TDM), in which the clinician conducts a standard assessment of the cognitive skill targeted for intervention, chooses an evidence-based intervention from the CRT realm, then designs and executes a musical strategy to add the benefits of music to the cognitive intervention. Finally, the TDM emphasizes generalizing the skills learned in rehabilitation to the everyday life of the person being trained (Gardiner, 2005; Thaut, 2014). NMT may also strengthen group psychotherapy, as evidenced by mood changes that result from NMT interventions (Hedge, 2014; Thaut et al., 2009). By engaging in NMT immediately prior to group psychotherapy, the participants are exposed to musical interventions designed to decrease depression, anxiety, and anger, emotions that often accompany traumatic brain injuries. With negative feelings under control and often replaced by feelings of peace, joy, and happiness, the participants are likely better prepared and motivated to engage in and benefit from group psychotherapy. …