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Neurologic music therapy in medico-legal cases

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Recent advances in neuroimaging and neuroscience mean we are now able to better understand how music and auditory stimulation are processed in the brain.

To date, research has shown that nothing else stimulates so many areas of the brain simultaneously, as music. This makes it a particularly unique tool for rehabilitation as new neural networks can be built around areas damaged by disease or injury.

This reinforces the strong evidence-base for using music to improve client outcomes, assist with rehabilitation and support adaptation to injury. It is this principle on which standardised clinical techniques within Neurologic Music Therapy have been researched and developed.

The use and application of relevant NMT techniques gives clients with brain injury the best opportunity to respond and, in medico-legal cases, this has significant implications when assessing both cognitive capacity and
rehabilitation potential.


Shamsa*

In 2015, Shamsa sustained a serious traumatic brain injury (TBI) following a motor vehicle accident where she was a pedestrian. To help with determining future needs, she was referred for an NMT assessment.

This involved four clinical sessions where a range of NMT cognitive, speech and language and sensorimotor techniques were explored. Ongoing sessions were then agreed and arranged in blocks, with regular reviewing of outcomes now occurring throughout this intervention.

During initial assessment, no vocal or verbal responses were elicited. Observed non-verbal communication included direct eye contact and a range of gestural responses.

Other purposeful responses included active engagement with a range of live and virtual instruments made physically accessible by directly facilitating/positioning as appropriate.

As well as joint interaction, these activities also provided a suitable context to assess wider communication skills such as initiating.

Communication goals following assessment focused on the further development of non-verbal social skills and, in collaboration with speech and language therapy, a more focused exploration on respiratory control and potential oral motor/vocal responses.

At the point of referral, she was unable to stand or walk independently and required the use of a wheelchair.

Assessment focused on targeted fine motor activities, with a view to developing control to activate adaptive switches for functional communication and to further assess the potential of foot movement to be used for interaction and/or support activities of daily living.

Cognitive activities focused on increasing awareness of her neglected left side, assessing sustained attention and executive function skills, and identifying effective strategies to support reliable choice- making.

Since 2016 Shamsa has made incredible gains in her rehabilitation through NMT.

Her communication has progressed from spontaneously mouthing along to simple words during native Middle Eastern songs, to developing respiratory control using accessible blown instruments, vocalising, and now engaging in melodic intonation therapy to produce simple functional phrases to express her needs.

Her motor function has progressed through a range of targeted movements using sensorimotor techniques in joint-work with physio and OT to now be able to walk with her carer to the local shop while choosing her shopping items, showing a growing development in both her communication and executive function skills.

* name changed for anonymity

For more on Irwin Mitchell see www.irwinmitchell.com.

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