The multi-disciplinary music group in neuro-rehabilitation: addressing therapy goals in a creative setting

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Aims & Objectives Within this multi-faceted group, the aims of the group are:

  • To encourage use of upper and lower limbs with musical instruments and sensory aids.
  • To encourage choice making, verbalisation, attention and focus and social interaction.

Contact Details

Rosanne Tyas rtyas@rhn.org.uk Royal Hospital for Neuro-disabilty (RHN) www.rhn.org.uk

Funding Sources

Partly funded by the RHN Charity and NHS funding via some AHP therapists.

Intervention Timescale

This group initially commenced in 2011 as a music therapy group. It then developed into a music exercise group; and in 2013 into a group run by a number of therapists to incorporate wider aims. It lasts for  45-minutes plus time to set up and for clinical note taking. Reviews of clinical notes and group aims occur once every three months.
Location and Setting The group occurs on the neuro-behavioural (NRU) ward at the hospital.

Type of arts intervention

Live music – tailored to the choices of patients and relevant to the particular activity. Also there is use of percussion instruments, visual aids, sensory materials and props e.g. parachute to engage the patients in a wide variety of sensory experiences. Intervention offers multi-sensory media in the forms of music, singing, visual arts, and literary.

Description of the arts activity

The multi-disciplinary group is set in the NRU at the RHN in London, UK. The RHN serves people with severe neurological impairment due to physiological and/or traumatic brain injury. The hour-long group uses sensory aids relating to chosen themes. Interventions incorporate selected neurologic music therapy techniques (Thaut, M.H.,1999, Training Manual for Neurologic Music Therapy). The unit as a whole employs a positive behaviour approach (Institute of Applied Behavioural Analysis, 2012). The emphasis of this approach is on developing pro-active strategies that help to minimise the probability of challenging behaviours occurring whilst developing reactive strategies. This philosophy is applied within the facilitation of this group.

The structure of the each group is as follows:

  • Welcome / orientation song – one familiar song and one composed song.
  • Choice making and vocalisation e.g. song choices offered and supported with visual aids of music artists, singing of lyrics / phrases encouraged.
  • Physical movement  to live music e.g. use of upper limbs as indicated in therapy goals incorporating musical instruments and therapy equipment; and use of lower limbs as indicated in therapy goals incorporating ball kicking to live musical stimulus. o Guided visualisation / relaxation e.g. script read out with appropriate musical accompaniment.
  • Closing song- same song each week- verbalisation encouraged

Details of the project participants

On average eight individuals attend the group presenting with differing cognitive and physical impairments, and demonstrating behaviours which challenge due to neurologic damage. Challenging behaviours often affect the rehabilitation process, which may include anxiety, disinhibit ion, disengagement, verbal and physical aggression.

Project management

Themes are set in advance by the staff members and resources created. Following the group, there is a group review by facilitators and clinical note writing. Staff involved include an occupational therapist, occupational therapy assistant, music therapist, music therapy assistant, psychologist and psychology assistant. Not all staff attend each week. 

Ethics and consent

Patients are given the opportunity to attend or decline group attendance. They are encouraged to be involved in each part of the group but not coerced. They may leave the group at any time by choice, or when necessary with facilitation. No material is used without patients’ consent.
Evaluation methods and findings

Evaluation methods and findings

In 2013, a task analysis observation form was created to record responses on a weekly basis. This form shares some common elements for all patients and other elements tailored to individual goals. Therapy goals set by the multi-disciplinary team are incorporated into group interventions; and responses monitored by staff are recorded on the task analysis observation form. The group has a review every three months to check the overall effectiveness of structure and to update therapy goals for the patients.  

The multi-disciplinary group is viewed as an effective format for encouraging rehabilitation within a shared multi-modal sensory environment. Responses observed thus far include: increased social interaction, verbal choice making, decreased instances of agitation and improved motivation to use upper and lower limbs. The group continues weekly at the present time.

Supported using public funding by the Arts Council England