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Music Therapy and Neurorehabilitation: Performing Health

br2005_62Aldridge, David (2005). Music Therapy and Neurorehabilitation: Performing Health. London: Jessica Kingsley Publishers.

Two hundred and sixty pages, ten chapters, and eight experienced music therapy clinicians and researchers are what makes up David Aldridge’s latest text Music Therapy and Neurorehabilitation: Performing Health. The profile of music therapy within the neurorehabilitation field is mounting and this text contributes to the growing body of knowledge supporting this emerging clinical area.

Aldridge has contributed the first three chapters in order to set the frame for the remaining chapters. At times I felt that I had read this all before in his previous books although on further reflection there is a definite development in his thinking which is presented here. Further, I still found it a helpful reminder of his philosophies about human existence, music, and health. The terms ecology of communication – mutual performers – are reiterated throughout. Similarly, Aldridge speaks about dialogue emphasizing that it may mean going beyond the verbal, to gestural, and that the clinician should look for developing patterns of gesture. Finally, there is a constant (and necessary) reminder of the need for consistent documentation and reporting of case material so that a body of research can build.

Hanne Mette Ridder provides a concise and methodologically strong systematic review of the literature of music therapy with people who have dementia. It begins with a useful overview of the clinical condition before sharing the results of 92 studies she has reviewed. In particular, she provides a summary table of the interventions, and more importantly, categorizes the general purposes of music therapy into four functions – evaluative, regulative, stimulative, and communicative. These are explained clearly.

Simon Gilbertson also shares a systematic review of the literature pertaining to publications on traumatic brain injury. Among other things, this chapter provides a good description as to how a researcher or student could approach a systematic literature review. He details each of the 46 reported studies, this being a handy resource for the clinician or researcher to scan. Perhaps most valuable is the text box on p. 137 which summarizes the “core aspects of music therapy with people who have experienced traumatic brain injury” – this is so succinct that I have pinned a copy of this on the notice board in my office!

The chapter by Ansgar Herkenrath focuses on the work with people in persistent vegetative states. Apart from Magee’s recent contribution in the journal Neurorehabilitation, not much has been written about this specialized group of patients for some time, so I was excited to see this included. His motto is “Sono ergo sum – I sound, therefore I am” (p.139) and this is reinforced throughout his chapter. I was particularly fascinated by his challenging of concepts such as consciousness – as being more than merely a brain mechanism and his focus on basic responses such as respiration as being reactions and intentional activities.

Wolfgang Schmid also focuses on a clinical population that is not prominent in music therapy – multiple sclerosis. He presents the findings of his qualitative study discussing the model of contact – a reminder of the importance of human contact for MS patients. Many of Schmid’s “parameters of contact” (p.173) emerging from his research could easily be applied with other clinical populations, or at least be a stimulus for similar research with other clinical populations.

Monika Jungblut’s chapter presents her findings of a controlled study with aphasic patients. This study was truly inspiring and I question – why is it published in a book? – this material should be published in a journal where other health professionals can access these findings. Perhaps it already is…In summary, her study found that her method – SIPARI Singing to Intonation to Speech Adequate Intervention – was effective in 75% percent of chronically aphasic patients. Given the long-standing communication impairments these patients had, these results are significant.

Gerhard Tucek’s chapter on “traditional oriental music therapy” was by far the most difficult for me to engage in. He discusses the use of techniques with origins in Islamic culture, with traumatically brain injured people. This is a tough read.

The final chapter by Anke Scheel-Sailer describes a qualitative study with paraplegic patients. Again this is a clinical population that is rarely described in the literature, so it is important that her work is here. Her motivations lie in her perceived need for affordability of health care, determining the required number of sessions and length of therapies as well as establishing what factors and criteria should be considered when planning for music therapy services to be implemented. She provides a useful model of the phases that paraplegic patients move through in early recovery and the timeframes typical for each of those phases.

One aspect that this text does achieve is uniformity in the authors’ philosophies and approaches to music therapy treatment, the “performing health” being the aspect reiterated throughout. Aldridge acknowledges that this was what he aimed for, descriptions of studies where the authors had a “mutual understanding of therapy” (p.12). While homogeneity may be its strength, it is also a limitation. Music therapy in neurorehabilitation is still in its infancy, Gilbertson himself illustrates this showing that in 1990, there were only 8 documented publications whereas by 2002, this had grown to 42, and therefore, the book may have been enhanced with contributions from a broader range of music therapy researchers working within the field. Other key clinicians and researchers such as Wheeler, Magee, Jochims, Kennelly, Tamplin, and those from the Colorado group Thaut et al. are noticeably absent.

In summary, Aldridge’s latest text is worth a read both for learning about research approaches with neuro-populations, but also to learn from the useful clinical reflections presented – performing health.

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