Sample Undergraduate Physiotherapy Full Dissertation
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The Effect of Music Therapy on Recovery Following Brain Injury
Background of the Study
Music therapy can be defined as a branch of therapeutic techniques in which music is used as a medium to address and strive towards an individual’s developmental and rehabilitative goals (Ridder, Lerner and Suvini, 2015). Using music therapy, a therapist can design interventions for improvements in cognitive, physical, or neurological functions by using music as a tool for bringing improvements.
In severe cases like brain injury, music therapy can function as an enabling factor for getting considerable improvements (Magee et al., 2017). However, Hurt-Thaut (2016) has added that for music therapy to work effectively, there need to be three elements: the inclusion of scientific logic, therapeutic justification, and a certain level of creativity.
Without these elements, music therapy may not be as effective in devising goals or even in achieving those goals if the individual has a brain injury. Therefore, in this study, music therapy has been analysed as an essential recovery tool, to understand its efficacy for patients with brain injury.
Research Aim and Objectives
This study aims to analyse music therapy’s effects on patient recovery following a brain injury. The objectives for this study have been given as follows:
- To understand the effectiveness of neurological music therapy on patients with brain injury.
- To analyse music therapy’s effects on improving brain function domains, like cognitive, language, and sensory-motor skills of patients with brain injury.
- To provide ways of integrating music therapy interventions in current practices of physiotherapy such that better patient outcomes can be achieved.
- What is the effectiveness of neurological music therapy on patients with brain injury?
- What are the effects of music therapy on improving domains of brain function, like cognitive, language and sensory-motor skills of patients with brain injury?
- How can music therapy be integrated into current practices of physiotherapy, such that better patient outcomes can be achieved?
According to the study of Sun and Chen (2015), severe cases of brain injury that are in a coma can be encouraged towards re-consciousness with the help of music therapy. As music can promote functional outcomes through restoration of nerve cell damage, the patient’s cognitive and physical functioning can be improved considerably (Magee et al., 2017).
However, O’Kelly (2016) states that still persist, as traditional neuroscientific methods prioritise standardised pharmacological techniques over creative domains of music therapy. On the other hand, the innovative and patient-centered music therapy approach also does not make it feasible to be used by healthcare professionals (O’Kelly, 2016).
Therefore, in this study, the aspect of music therapy has been analysed as an effective therapeutic technique, such that methods of integration can be devised so that it can be used as commonly as standardised methods among patients of brain injury.
Structure of the Study
In this study, different chapters have been differentiated based on their function towards evaluating the research topic. In Chapter 1, essential aspects of music therapy have been given, the rationalisation behind conducting this study, and specific areas of the subject that is being analysed have been discussed in research aims.
For Chapter 2, methods used for identifying, collecting, and analysing data have been discussed. This chapter contains information on research design, data collection, analysis and search strategy for identifying the most relevant articles. This is followed by Chapter 3, in which results from the systematic review provide answers to all three research questions. This chapter also contains a discussion of results, which is done after comparing and contrasting them to literature. Finally, in Chapter 4, a credible and reliable conclusion has been given for the effects of music therapy on brain injury.
Research methodology is an integral part of scientific studies; it determines a systematic pathway of conducting research that reduces risks of error, and ensures results that are both credible and valid (Ørngreen and Levinsen, 2017). Therefore, a comprehensive research methodology has been used in this study, which has provided a layout containing research design, data collection, analysis and search strategy for the systematic review. This chapter gives an overview of methods, followed by justifications for using each aspect of the methodology.
Among the two types of research design, i.e., quantitative for numeric-based research and qualitative for text-based research, the one used in this study has been quantitative design. In quantitative studies, Leavy (2017) has highlighted that numerical and statistical information is used to maintain objectivity throughout the research process.
Therefore, the justification of quantitative research is also based on the objective nature of the research design, which enables the exclusion of personal opinion and social values that are irrelevant to the findings of the study. Petticrew (2015) has further added that in quantitative analysis based on a systematic review, the study area can be broadened, as more research subjects and scientific evidence can be easily collected. To include as much relevant material as possible and frame results reflective of reality, this study has made use of quantitative studies within the PRISMA framework designed for systematic review.
Systemic reviews aim to identify all relevant studies that fulfil the present research questions’ objective and synthesise the data related to design, biasness and the outcomes of those researches or studies. Subsequently, the findings of a systemic review critically depend on how data from these studies are presented and analysed.
Considering the nature of this study, the method of data collection used has been secondary, in which data from the existing literature is explored. The justification for this method has been given by Johnston (2017), based on which it can be stated that secondary searches allow the researcher to have several perspectives.
As primary data is limited to only include the view of their sample size, secondary studies can be conducted with greater criticality (Igwenagu, 2016). Therefore, secondary data collection has been used to ensure that the effects of music therapy, along with advantages and disadvantages, can be appropriately understood.
In terms of data analysis, a systematic review method has been used to structure a format for collecting and analysing data. The systematic review method has been proven to be effective for scientific studies, as Snyder (2019) has highlighted that it ensures a clear and comprehensive pathway of conducting research, which reduces the chances of researcher bias. Therefore, to ensure that only one aspect of music therapy is not emphasised, this study has used a systematic review for data analysis.
The central core of the systemic review is the thriving construct search strategy. The search strategy is an organised configuration of key terms used to search a database. The search strategy syndicates the main concepts of the research question to retrieve exact outcomes. Although, the search strategy accounts for all the probable search, keywords, terms, and phrases (Street et al., 2020).
In this research, the search engines had been used for searching the relevant articles that full fill the aim and objective of this research based on the inclusion and exclusion criteria are the EBSCOhost, CINAHL, SPORTd, Medline, AMED. Following are the critical term that had been used for searching the retrieved articles: music therapy or music intervention or musical therapy, brain injury or head injury or traumatic brain injury or acquired brain injury, physiotherapy interventions for brain injury.
Results and Discussion
In this chapter of the study, the findings that had been collected with the help of a prima chart based on inclusion and exclusion criteria, discuss in detail. There are nine relevant studies, out of which six are quantitative synthesis based and three are qualitative synthesis based.
These are the retrieved articles that complete the requirement of the research questions that would be answered in this research. However, the interpretation of the findings is based on these retrieved articles. Below is the table of the relevant studies, which are analysed and discussed in detail.
Table 1: Evidence Table of the Retrieve Articles
|Author (Year of publication)||Study Type||Number of Patients||Patient Demographics||Intervention||Comparison||Length of follow up||Outcome measures||Treatment outcome|
|Magee et al., (2017)||Systematic review||775||All patients had brain injuries. They also had impaired domains of functioning.||Music interventions||Standard care||Five years||If music therapy improved gait parameters after stroke||Music therapy improved upper extremity timing for patients|
|Park, Williams, and Lee (2015)||Experimental design||14||All patients had cognitive impairment after severe brain injuries||Preferred music therapy||Relaxation music intervention||Three days||If preferred music was more effective than relaxation music in alleviating cognitive impairments for brain injury patients||Preferred music an effective in alleviating cognitive impairments|
|Thaut et al., (2015)||Systematic review||15||Patients with brain injury and cognitive impairment||Neurologic music intervention||Standard care||30 years||If music alleviated cognitive, language, and speech impairment||Music was an effective therapy for brain rehabilitation|
|Baker et al., (2019)||Experimental Design||47||Half patients with acquired brain injury and half with spinal cord injury||Song intervention||Standard Care||Twelve session||Measure baseline, post-intervention||Substantial and Significant effect sizes from baseline to post among the patients with brain injury.|
|Froutan et al., (2020)||Experimental Design||60||Half patients with traumatic brain injury and half are the healthy population||Music and Auditory Stimulatory Intervention||Intensive Care||Six days||Physiological Parameters||Integration of music therapy with family remembrance may adequate physiological parameters.|
|Roddy et al., (2018)||Experimental Design||5||All patients with acquired brain injury||Music Therapy Intervention||Standard Care||Six weeks||Self-concept, subjective well-being, and distress||Patients show a high gain across subjective well-being; self-concept and in case of distress|
|Kamioka et al., (2014)||Systemic Review||21||Patients with brain diseases||Music Therapy Intervention||Standard Care||Twelve weeks||Emotional Functioning||MT treatment is improved the EF in brain diseases|
|Siponkoski et al., 2021||Experimental Design||40||Patients with Traumatic Brain Injury||Neurological Music Therapy||Standard Care||Three months||Emotional Functioning||The results of this study show that EF is improved in patients with TBI|
|Altenmüller et al., (2013)||Systemic Review||20||Patient with acquired brain injury||Music Therapy||Standard Care||Five months||Emotional Function, and Behavioural Action||The results show that both the patients’ emotional function and behavioural action improved.|
Effectiveness of Neurological Music Therapy
As mentioned above, the studies related to the efficiency of neurological music therapy reveal that music therapy has a positive influence on the overall EF and can improve brain functioning after brain injury (Thaut and Hoemberg, 2017). Similarly, Siponkoski et al., (2020) identified the same results in their study: the individuals with brain injury experienced enhanced emotional functioning on the level of daily life activities and social interactions (Siponkoski et al., 2021).
Although, it is not unanticipated that the involvement effects occurred in the region of behavioural regulation, the music therapy mainly consisted of the instrument playing in close contact with the therapist (Thaut and Hoemberg, 2017). Similarly, monitoring the individual’s behaviour lies at the actual principle of learning to play an instrument (Altenmüller and Schlaug, 2013).
Again, Jentzsch et al., (2014) performed a cross-sectional study inspecting amateur musicians and revealed that in comparison to non-musicians, the instrumental musicians are well able to identify errors and conflicts as by a systemic upsurge in the amplitude of the N200 in EEG and the error-related negativity (Altenmüller et al., 2015).
Grounded on these findings, the author proposed that playing a musical apparatus could enhance the capability to monitor the behaviour and regulate responses efficiently when needed. So, for the effectiveness of neurological music therapy, it is crucial for the therapist that he must be aware of the instrument’s functioning. This also plays a significant role in the effectiveness of the therapy (Lorusso and Porro, 2020).
Effect of neurological music therapy on domain functioning
From the above findings, the outcome related to the effect of neurological music therapy on domain functioning reveals that music therapy positively improves the cortex function and helps to recover the brain injury (Bientzle et al., 2021).
Until currently, it was mainly believed that the cortex part of the adult brain was static in the context of structure. In the current era, although, there has been extensive evidence to recommend that the human brain is proficient of self-modification and substantial reorganisation following neurological trauma or brain injury (Altenmüller et al., 2015).
Although, cortical reorganisation is related to the development of new networks in possibly new areas of the brain that may be used to assume the tasks no longer able to be done by the individual. However, this reveals that therapy disquiets redeveloping the same skill instead of those findings that alternate achieving the task.
The treatment procedures concerning the neurological music therapy approach are founded on both the clinical and scientific research associated with the production and perception of the music. And its succeeding effects on the behaviour functioning and brain (Siponkoski et al., 2021). Similarly, most of the researches revealed that the use of music to retain the function of the motor part of the brain is improved after brain deterioration or injury (Kamioka et al., 2014).
Integration of neurological music therapy into physiotherapy
From the above findings, it has been interpreted as that currently, neurological music therapy is used as an effective therapy of physiotherapy (Kamioka et al., 2014).as pain is one of the foremost challenging issues in the field of physiotherapy. The pain can be modulated at various levels of the neuraxis, including the dorsal and peripheral horns and brain stem; some researchers reported that pain is reduced in the approach involving music and music relaxation (Roddy et al., 2018). Similarly, another researcher revealed that music played during pain therapy or pain rehabilitation sessions appeared to enhance the level of mental and physical activity and verbal expression of the patient (Froutan et al., 2020).
It has been suggested that music affects all three psychological dimensions of pain. However, the motivational affective dimensions have the potential to change unpleasant emotional aspects like depression and fair (Baker et al., 2019). Although, the sensory evaluation component of the pain is to re-conceptualise the painful experience. That is why the patient may dissociate herself or himself from the pain by concentrating on music. Due to these advantages of music as it dramatically improves pain that is why neurological music therapy is integrated into physiotherapy (Baker et al., 2019).
This brief review of literature related to neurological music therapy directs that music therapy programmes are also integrated into physiotherapy have concentrated on developing compensatory assistances and various on the restoration of reduced function (Magee, 2019).
Although, these findings indeed have suggested that providing neurological music therapy programmes that permit or even encourage the patients to use their integral abilities may limit their brain reorganisation processes or recovery (Mishra et al., 2020).
For instance, when an individual has persistent lesions within the brain due to injury and results in hemiplegia on any one side of the body, providing him with neurological music therapy assessment whereby he is strengthening the unaffected side of the body so that it can accomplish the role that the now affected side can no longer do probably the upper limb, can prevent the recovery of the affected limb (Swaney, 2018).
Although, these outcomes point to the probability that compensatory assistances must not be working at all. Although, there are circumstances when this methodology should be implemented (Reddy et al., 2017). For instance, when a patient has not retorted to the primary trail of the reducing deficit area and is not making any functional improvement in the target area of functioning, substitute solutions should also be required (Vaudreuil et al., 2019).
When considering the studies by some other researchers, it is indistinct as to how long post-injury the patient labelled were. Conceivably their patient’s injuries were long-lasting, and restoration of normal function had not happened (Martinez-Molina et al., 2020).
Nevertheless, the patient in Magee’s research was only eight months post-injury is a fact in recovery where neuroplastic variations were possibly too active when she began to see the patient. Consequently, directing restoration of function was suitable for the patient (Bronson et al., 2018).
A similar fact manifests in Baker’s patients who were two and three months post-injury when they were referred to neurological music therapy (Raglio et al., 2017). So, from neurorehabilitation, Nudo supports the theme that compensation is essential to recovery of function.
They anticipated that recovery is not merely grounded on the techniques of neuroplasticity but slightly encompasses at least three distinct but collaborative procedures: the determination of diaschisis that is the neural shock and initial swelling that temporarily obstructs neural tracks that have endured the trauma (Street et al., 2020). They explained that temporary recovery that is in hours and days succeeding the trauma could be revealed at least partly by determination of the pathology in the acute stages of conditions like diaschisis (Vik et al., 2019).
However, most of the researches still reveal that neurological music therapy is still adequate for the treatment of brain injury and also become the part of physiotherapy as it effectively relief the pain by providing relaxation to the patient, especially in emotional complications during the process of physiotherapy of painful spinal conditions (Vik et al., 2018).
The findings related to the effectiveness of neurological music therapy from the above- mentioned studies revealed that music therapy has a positive consequence on the general EF and can improve brain functioning after brain injury. The treatment procedures with the neurological music therapy approach are grounded on both the clinical and scientific research related to the production and perception of the music.
And its successive effects on the behaviour functioning and brain. Similarly, most of the investigations revealed that the use of music to retain the function of the motor part of the brain is improved after brain deterioration or injury. Due to these advantages of the music as it significantly improves the pain, that is why neurological music therapy integrated into the field of physiotherapy
Music therapy be defined as a branch of therapeutic techniques. Music is used as a medium to address and strive towards an individual’s developmental and rehabilitative goals. This study aims to analyse the effects of music therapy on patient recovery following a brain injury.
There are nine relevant studies out of which six are quantitative synthesis based and three are qualitative synthesis based. These are the retrieved articles that complete the requirement of the research questions that have been answered through this research.
The findings related to the effectiveness of neurological music therapy from the above-mentioned studies revealed that music therapy has a progressive effect on the over-all EF and can improve brain functioning after brain injury. Due to these advantages of music as it prominently improves pain, that is why neurological music therapy is integrated into physiotherapy.
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Altenmüller, E., Finger, S. and Boller, F., 2015. Music, neurology, and neuroscience: Evolution, the musical brain, medical conditions, and therapies. Elsevier.
Baker, F.A., Tamplin, J., Rickard, N., Ponsford, J., New, P.W. and Lee, Y.E.C., 2019. A therapeutic songwriting intervention to promote reconstruction of self-concept and enhance well-being following brain or spinal cord injury: pilot randomized controlled trial. Clinical Rehabilitation, 33(6), pp.1045-1055.
Bientzle, M., Restle, A. and Kimmerle, J., 2021. Perception of Purposeful and Recreational Smartphone Use in Physiotherapy: Randomized Controlled Trial. JMIR mHealth and uHealth, 9(4), p.e25717.
Bronson, H., Vaudreuil, R. and Bradt, J., 2018. Music therapy treatment of active duty military: an overview of intensive outpatient and longitudinal care programs. Music Therapy Perspectives, 36(2).
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Raglio, A., Zaliani, A., Baiardi, P., Bossi, D., Sguazzin, C., Capodaglio, E., Imbriani, C., Gontero, G. and Imbriani, M., 2017. Active music therapy approach for stroke patients in the post-acute rehabilitation. Neurological Sciences, 38(5), pp.893-897.
Reddy, B.U., Phanisree, P., Priyanka, M., Kavitha, D., Indira, S., Bhandarkar, P., Samudrala, V.D. and Agrawal, A., 2017. Effect of music therapy in patients with moderate-to-severe traumatic brain injury. Journal of Datta Meghe Institute of Medical Sciences University, 12(1), p.51.
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