Music may play a significant role in the rehabilitation of patients who have lost movement control, according to a study investigating the therapeutic benefit of combining physical therapy and music.

The study by The University of Edinburgh found that using musical cues to learn a physical task significantly develops an integral part of the brain responsible for sound and movement.

In the study, 30 right-handed volunteers were dived into two groups and given the task of learning a new movement using the non-dominant left hand. One group learned the task to musical cues while the other group practised the task without music.

The study showed that participants who practised a primary movement task to music showed increased structural connectivity between the regions of the brain that process sound and control movement.

Dr Katie Overy, who led the research study, said: “The study suggests that music makes a key difference. We have long known that music encourages people to move. This study provides the first experimental evidence that adding musical cues to learning new motor tasks can lead to changes in white matter structure in the brain.”

A physiotherapist’s observation of music in therapy.

Michael Dermansky, Senior Physiotherapist and Director of MD Health, said on the odd occasions when music is not present during therapy, such as when a patient requests quiet, or the speakers are not working, there is a noticeable difference in the atmosphere.

“When music is in the background, the sessions always seem more lively, easier to relax with the patient and conducive to a positive environment that makes it easy for the patients to do their exercises and relate to the physiotherapist.

“When the music is not present, all the exercises feel like hard work.  It seems much more like a chore.

“What the client would normally do easily, they take much longer to do; they find it more difficult and it makes it more difficult to build rapport with the patient.

“It is hard to give the exact reason why, but there is a distinct difference in the “feel” of the practice.

“The music we play does vary, but in general we play radio music in the background.  Popular music, that’s generally upbeat, not too heavy and not too slow makes a difference.

“Playing slower, easy listening music doesn’t work and brings down the mood of the practice.  After trial and error over many years, the hit music stations seem to be most popular,” said Mr Dermansky.

Inherent benefits of music during physiotherapy

There are many practical and therapeutic reasons music is beneficial during physiotherapy, according to physiotherapist Jason Bradley of BodyWorx Physio.

Background noise: In an open-plan clinic, music helps create background noise and provides a greater sense of privacy for patients by muffling conversations.

Soften the 'clinical' atmosphere of a treatment space: Music helps patients feel more relaxed in the clinical setting.

A rapport builder: Patients and therapists often discuss songs during lulls in conversation which helps develop a rapport with the patient. This is especially useful in chronic or long-term WorkCover patients who are therapist-fatigued.

Patient relaxation: Many patients often like to relax and get lost in the music, especially during unpleasant treatments such as dry needling and mobilisations.

A prime motivator for incorporating music is to create a relaxing, fun and pleasant atmosphere that’s conducive to building trust and rapport, said Mr Bradley.

“I think the age of the white-coated professional clinician is gone. They are no longer patients, but discerning clients who have a choice in where they go and whom they receive treatment from and being an amazing clinician is not enough.

“You need to provide an enjoyable clinic space, develop attachment and genuine interest in the patient outside their injury and display some of your interests and personality.

“Music in the clinic is part of creating a more personalised and supportive approach to patient care,” said Mr Bradley.

Music therapy: more than just a tune.

Music motivates and entertains, but according to neurologic music therapist Bethany Best, the right type of music has essential therapeutic applications that directly targets sensorimotor, cognitive, speech and language training.

In a rehabilitation context, music therapy and physiotherapy can become critical allies in meeting and addressing the needs and goals of patients, as music activates multiple areas of the brain, including the motor cortex which is an area of the brain that’s responsible for physical movement.

“When music is used in a rehabilitation setting, appropriately targeted music ‘primes’ the motor cortex, getting it ready to move or act.

“The strong rhythmic pulse and structure of music provide the preparation, activation and re-activation of specific and targeted movement patterns. These movement patterns are further enhanced, guided and shaped by physiotherapy.

“When the skills and expertise of physiology and body kinematics used by physiotherapists are combined with specialist knowledge of rhythm and sensory processing of music therapists, rehabilitation becomes a multifaceted, empowering and holistic approach.

“Using a multidisciplinary approach, music therapists and physiotherapists can work together to address movement disorders, motor planning, gait training, patterning, strength, control and endurance through the use of repetitive, structured and rhythmic music, metronomes, instruments and familiar songs,” said Ms Best.

Combining music and physiotherapy: a physiotherapist’s insight

Ara Saggers, a physiotherapist at Metro North Hospital and Health Service, said she found the combination of music therapy and physiotherapy complimentary in her joint sessions with Ms Best.

“Bethany was able to bring a different range of tools to help elicit and enable movement in the severe acute brain injury population we were treating.

“I was amazed at the impact music had on some the clients’ ability to keep time, despite the severity of their injuries.

“Music therapy provided not only therapy tools, but added a more enjoyable element for the clients, especially those interested in music,” said Saggers.

Even patients who weren’t able to keep time and those less passionate about music enjoyed and benefited from the joint sessions, according to Saggers.

“The amount of practice required to make gains in the acute brain injury population is significant. Finding new and novel ways to practise the same task made it more enjoyable for clients and helped keep them motivated and engaged in therapy.

“This additional motivation increased their practise and improved their gains. Collaborating and performing joint sessions also enabled us to communicate client goals to each other clearly, to ensure that our separate sessions were targeted towards the same outcomes.

“Even when tasks were more music therapy focused, we were able to find ways to complete the therapy which allowed the increased practise of physiotherapy-based tasks and exercises.

“The collaboration in planning sessions and brainstorming was also beneficial, as Bethany brought a different perspective,” said Saggers.

Rhythm important in music therapy

Rhythm is a critical component of music that not only prepares the neurons, nerves and muscles but also keeps them firing and driving the motor movement, said Ms Best.

“Walking is a fundamentally rhythmic activity. With disturbances to gait, the use of strong, compelling and structured rhythm will entrain the neural connections and subsequently the action – walking. Not only will the rhythm compel the neurons into synchronicity but also the gait movement for the duration of the rhythm and beyond.

“The use of rhythm, therefore, raises the rehabilitation concepts of neuroplasticity – neurons that fire together, wire together – and therefore the working relationship between the knowledge and application of music and rhythm and the knowledge of the body and movement patterns which is critical for the targeted rehabilitation approach,” said Ms Best.

Psychosocial benefits of music and physiotherapy

Beyond the sensorimotor integration and rhythmic entrainment mechanisms, music therapy offers a psychosocial aspect to the physiotherapy integration, said Ms Best.

“Through music and the effects of some music on the brain, connections to emotions, memories and thoughts are part of the patient’s experience. Within this context, some patients become less aware of the pain and how many repetitions have been achieved.”

Consequently, the patient can perform and complete movement patterns with greater ease and a more optimistic sense of the duration, time and effort expended during physiotherapy sessions, said Ms Best.

“Music also provides opportunities to enhance concentration on targeted exercises and conversely provides a meaningful and purposeful distraction to assist with fear and anxiety.

“All in all, it is a mutual win-win experience for patients and therapists of music and physiotherapy when they work together collaboratively to achieve an engaged process with clearly guided patient rehabilitation goals.”