The Role of Music in the Rehabilitation of Persons with Neurologic Diseases: Gaining Access to 'Lost Memory' and Preserved Function Through Music Therapy

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Tomaino, C. (2002)
The Role of Music in the Rehabilitation of Persons with Neurologic Diseases.
Music Therapy Today (online), August, available at
http://musictherapyworld.net
8/1/02 1
The Role of Music in the Rehabilitation of
Persons with Neurologic Diseases: Gaining
Access to ‘Lost Memory’ and Preserved
Function Through Music Therapy
Concetta M. Tomaino
D.A., MT-BC Director, The Institute for Music and Neurologic
Function, Vice President for Music Therapy at Beth Abraham
Health Services
612 Allerton Avenue
Bronx, New York 10467 USA
(718) 519-4236
ctomaino@bethabe.org
http://www.musichaspower.org
1.0 Abstract
The music therapist must have an understanding of the various disease and neurological
processes to adequately assess functional ability and plan appropriate use of music for
the course of treatment. We have memories for not only the particulars of a song, such as
the melody or lyrics, but also the rich associations that keep the melodies alive for us
throughout our life. Memories are not actually lost with dementia or with other brain
injuries; rather, the ability to retrieve and gain access to these is damaged. As we possess
memories for factual information, we also possess memories or ‘motor templates’ for
physical movements. Through music therapy, we have the ability to help patients
reintegrate the sense of movement that they have lost. Despite the increased acceptance
and understanding of the therapeutic benefits of music therapy in work with persons with
neurologic impairments and challenges, more research needs to done to demonstrate it’s
efficacy in application with a wide range of diagnosis.
2.0 The role of music ...
Music therapists working with persons with neurologic diseases, including multi-infarct
dementia or Alzheimer s disease, have observed for years the dramatic responses that

Tomaino, C. (2002)
The Role of Music in the Rehabilitation of Persons with Neurologic Diseases.
Music Therapy Today (online), August, available at
http://musictherapyworld.net
8/1/02 2
occur when familiar music is presented to these individuals. Attention is maintained,
fragments of memories unfold, and a true connection to the ìself takes place. Even with a
specific diagnosis, the range of abilities and disabilities related to a neurological disease
can vary greatly with each individual. The music therapist must have an understanding of
the various disease and neurological processes to adequately assess functional ability and
plan appropriate use of music for the course of treatment.
The medical needs of neurologic patients appropriate for referral to music therapy include:
memory deficits, depression, balance/gait problems, fine motor problems, agitation/
aggressive behaviors, acute or chronic pain, poor attention, decreased vocal projection,
expressive aphasia, poor motivation, reduced muscle strength, Alzheimer's disease,
multiple sclerosis, Parkinson's disease, and stroke. The use of music as a therapeutic tool
for persons with neurologic disease has tremendous potential because of the many ways
the individual properties of music i.e.,rhythm, melody, and harmony, induce sometimes
predictable neurologic responses. Some examples of this are auditory cueing for gait
(Thaut & Mcintosh, 1992), and the use of music as a retrieval mechanism for those with
memory impairment (Tomaino, 1998).
Of the elements of music the two which have the most immediate effects on function are,
rhythm and melody (by melody I am referring to the power of a familiar melody to trigger
emotional responses and long-term memory retrieval) Various rhythmic stimuli can trigger
motor function and help in initiation in persons with stroke and Parkinson s disease. In the
book Music and the Brain
, by Critchley and Henson (1977), N. Wertheim states: ìThere is
no meaning to a rhythm without a message and the impact upon the listener depends on
this message carried by the rhythm, or else lent to it by the listener himself.. We know that
this particular area of the brain stem, the reticular system, is concerned with a regulation
of the cortical electrical rhythms...there are abundant connections between the reticular
formation and the auditory pathways. It may be that the rhythmical component of the
auditory input has an impact on the whole cerebral cortex and also on large subcortical
areas, via the extensive connections of the reticular formation with all these regions.
People's experience with music throughout their lives can influence how they will respond
to rhythm and sounds presented during therapy sessions. At times rhythmic cueing can be
as simple as a metronomic beat but at other times a person may be more responsive to the
more complex rhythms of African drumming. This indicates that rhythmic processing
may serve to cue attention as well as initiation, however more research needs to be done to
understand how complex rhythms are processed by the cortex as well as subcortical
regions. There is a strong connection between the auditory system and the limbic system.
This biological link makes it possible for sound to be processed almost immediately by the
areas of the brain that are associated with long-term memory and the emotions (Tomaino,
1993). Because processing occurs and/or is mediated at a subcortical level, some
information processing is possible despite higher cortical damage. This is evidenced
clinically by the strong emotional responses to familiar music we observe in person in

Tomaino, C. (2002)
The Role of Music in the Rehabilitation of Persons with Neurologic Diseases.
Music Therapy Today (online), August, available at
http://musictherapyworld.net
8/1/02 3
persons with memory deficits, such as traumatic brain injury, multi-infarct dementia or
Alzheimer's disease. Familiar songs become a tool for connecting to seemingly lost parts
of the personality by providing a necessary link to the "self".
We have memories for not only the particulars of a song, such as the melody or lyrics, but
also the rich associations that keep the melodies alive for us throughout our life. Memories
are not actually lost with dementia or with other brain injuries; rather, the ability to
retrieve and gain access to these is damaged. Music, then, can provide access not only to
specific moods and memories, but also to the entire thought-structure and personality of
the past. In a clinical study (Tomaino, 1998), when personally preferred music was
presented to persons with medium to late stage Alzheimer’s Disease, each participant
demonstrated the ability to spontaneously verbalize fragmented information about their
past. One of the participants, Molly, who was non-verbal at the beginning of the music
therapy intervention, began to speak after hearing an Irish tune repeated for the third time.
Although she only stated “That’ s nice”. It was the first coherent remark she had made.
At that point the therapist asked Molly where she was from and she replied from Ireland
and then continued to talk about her family and what a nice town it was. Even though the
phrases were fragmented the images and ideas Molly was trying to present were clearly
connected.
As we possess memories for factual information, we also possess memories or ìmotor
templates" for physical movements. Many adults are institutionalized following a stroke
that leaves them with a weakness or paralysis on one side of the body. Even persons with
dementia may lose the ability to initiate movements. By stimulating a similar but
neurologically different physical activity, music, with a strong rhythmic base, can allow
for spontaneous movement, thus keeping limbs and joints free from possible atrophy and
contractures. Music, and in particular rhythm, can play a essential role in treatment by
providing the necessary cues to reintegrate the sense of movement. The loss of neurologic
function can trigger the activation of compensatory mechanisms, which have been lying
dormant within the brain, to partially or completely ‘ take over’ the absent function. This
phenomenon is known as ‘neural plasticity’. There are many alternate nerve pathways
and connections that can be used to re-establish behaviors. Damasio (1994) indicated that
neurologic function includes the recruitment of certain neural pathways, depending on the
type of stimulus or the subsequent response. In persons with hemiparesis ( a weakening of
one side of the body) it may be possible to stimulate alternate motor pathways with the
"right" music/rhythm. For example, walking and dancing, though both physical
movements, use different postural schema. Through music therapy, we have the ability to
help patients reintegrate the sense of movement that they have lost. The following clinical
example illustrates this point:
Sam was a man in his late 60’s recovering from a recent stroke. He was on physical
therapy and was considered a ìguarded walker --he could walk independently with a quad
cane. The discharge team was concerned that Sam’s uneven gait might cause him to

Tomaino, C. (2002)
The Role of Music in the Rehabilitation of Persons with Neurologic Diseases.
Music Therapy Today (online), August, available at
http://musictherapyworld.net
8/1/02 4
stumble if he walked on an uneven surface like a typical concrete pavement. His was
referred to music therapy in hopes that he could improve his proprioception and regain his
ability to lift both legs enough to manage the challenges of walking out-of-doors. Sam
was able to communicate well and provided information about his past experiences with
music including how, as a teenager, he used to go dancing every week. However, he had
not danced in over 40 years. The physical therapist tested Sam’s gait and I found some
music with a tempo that matched the pace of his stride. The music was familiar to him and
he felt comfortable walking to the tempo. As he became more confident of his
movements, he began to add dance steps, sliding his feet or clicking his heels. As the
sessions progressed, he became more inventive in his movements and within several
weeks, of meeting two times a week, he began to lift his left foot off the floor. He was not
aware of this but stated that he was able to feel the tempo in his leg and thought that he
was able to actually feel the floor with his left foot. Previously he had mentioned that one
of the most frustrating things for him was to go to the entertainment programs here and
have his right foot tap away, while his left foot remained immobile. He was regaining
sensation in that side. We worked together, twice a week for two months. At the same
time he continued in physical therapy where the therapist used Sam’s internal memory of
the music to cue his gait. Sam was soon discharged and moved to an apartment in the
community.
Despite the increased acceptance and understanding of the therapeutic benefits of music
therapy in work with persons with neurologic impairments and challenges, more research
needs to done to demonstrate it’s efficacy in application with a wide range of diagnosis.
Clinical research in parallel with basic scientific studies which investigate the underlying
neural mechanisms stimulated by components of music must continue so that a new
understanding of music and the brain will emerge. This knowledge may influence how
music can best be applied therapeutically. As technology advances, especially in the area
of neuro-imaging, and as clinical research continues, we will be able to fully understand
the multiple processes of memory, the complexity of neural networks, and mostly, how
music connects to essential neurologic function.
3.0 References:
Damasio, A. R. (1994). Descartes ' error.- Emotion, reason and the human brain. New
York: Grosset-Putnam Books.
Wertheim, N.(1977) Is there a anatomical Localization for Musical Faculties. In
Critchley and Henson (eds.)Music and the Brain.
London: William Heinemann Medical
Books. p.293.
Thaut, M. H., & Mclntosh, G. C.(1992). Effects of rhythmic auditory cueing on stride and
EMG patterns in normal gait. Journal of Neurologic Rehabilitation, 6, 185-190.

Tomaino, C. (2002)
The Role of Music in the Rehabilitation of Persons with Neurologic Diseases.
Music Therapy Today (online), August, available at
http://musictherapyworld.net
8/1/02 5
Tomaino, C. M. (1993). Music and the limbic system. In F. J. Bejjani (Ed.), Current
research in arts medicine. Chicago: A Cappella Books.
Tomaino, C. M. (1998). Music on their minds: A qualitative study of the effects of using
familiar music to stimulate preserved memory function in persons with dementia.
Unpublished doctoral dissertation, New York University. New York.
Tomaino,C.M. (1998). Music and Memory. In Tomaino (ed.) Clinical Applications of
Music in Neurologic Rehabilitation. St. Louis: MMB Music, Inc.
Tomaino, C.M. (1999). Active Music Therapy. In C.Dileo, (Ed.) Music Therapy and
Medicine: Theoretical and Clinical Applications. American Music Therapy Association,
Inc.
This article can be cited as: Tomaino, C. (2002)
The Role of Music in the Rehabilitation of
Persons with Neurologic Diseases.
Music Therapy Today (online), August, available at
http://musictherapyworld.net