ABSTRACT: Acquired and chronic neurological illness causes fundamental changes to all aspects of an individual's identity, starting with the physical self and extending through one's psychosocial existence. The descriptive literature on music therapy with acquired neuro-disabling conditions often describes the holistic effect of intervention on all areas such as communication, emotions, social and physical responses. However, the empirical research to date has isolated single variables which demonstrate functional improvement, even though functional goal-oriented techniques may not optimize the psychotherapeutic potential which music therapy possesses. This has created a gap between that which clinicians observe and report in the clinical literature, and the published outcomes in research studies.
This paper presents the results of an open coding analysis which is one stage of the grounded theory research paradigm. The findings provide evidence of the effects of music therapy in adults with chronic, progressive Multiple Sclerosis (MS). Emergent from data grounded in participants' experiences, central phenomena are revealed of how music therapy affects the emotional, physical, interpersonal and expressive self, and in particular, how music therapy can assist with the emotional consequences of acquired disability. The study offers novel information relevant to both researchers in this field and to clinicians working with adults with acquired neuro-disability.
Background and Literature Review
This paper offers novel theoretically and empirically derived insights into the study of music therapy in chronic neuro-disability. Using qualitative methodology, it offers evidence supporting anecdotal claims in the literature that music therapy addresses key self-concepts and feelings of identity which are left damaged after acquiring neuro-disability (Jochims, 1995; McMaster, 1991; Magee, 1995, 1999a, 1999b; Purdie, 1997; Purdie & Baldwin, 1994; Selman, 1988).
The lack of outcome studies and few descriptive studies of music therapy in MS prompted the authors to review literature with associated neuro-disabling conditions. This then includes similar degenerative neurological conditions such as Parkinson's Disease and Huntington's Disease, as well as acquired neurological conditions which do not have a degenerative component, such as stroke and traumatic brain injury, but result in reduced life spans nonetheless. These are placed together under the umbrella of 'chronic neuro-disability', although there are specific differences in pathology, as common factors exist in physical and cognitive changes with secondary communication and psychosocial changes.
To date, the music therapy research with such populations has demonstrated two main areas of benefit. The first of these is improvement in physical functioning through applying and modifying musical parameters (Miller, Thaut, McIntosh, & Rice, 1996; Thaut, Mclntosh, Prassas, & Rice, 1993; Thaut, Mclntosh, Rice et al., 1996) and the second has shown that music therapy can address neuro-communication disorders (Cohen, 1988, 1992, 1995; Cohen & Ford, 1995; Cohen & Masse, 1993; Pilon, McIntosh, & Thaut, 1998). These outcome studies have contributed to the validation of music therapy within health care services and provide an evidence base for the application of music therapy in neuro-disability. However, it would appear that in-depth case studies continue to be the most useful for the music therapy clinician in the description of techniques and processes which are readily applicable in clinical practice. In the authors' opinions, descriptive studies remain the most beneficial format for understanding the individual experience psychodynamically, behaviorally and physically in music therapy. This argument finds some support in a survey which revealed that music therapists found pubished research to be of little relevance to their daily clinical practice (Nicolas & Gilbert, 1980). …