The Collaboration of Music Therapy and Speech-Language Pathology in the Treatment of Neurogenic Communication Disorders: Part I-Diagnosis, Therapist Roles, and Rationale for Music
Hobson, Marly Rychener, Music Therapy Perspectives
This two-part article addresses collaboration of music therapists (MTs) and speech-language pathologists (SLPs), specifically in the treatment of neurogenic communication disorders (NCDs). Part I of this article will include the following: (a) definitions and descriptions of several NCDs relevant to music therapy practice; (b) a brief overview of SLP treatment approaches and techniques for these disorders; and (c) a rationale for applying music therapy methods with these disorders and discussion of several techniques commonly used.
When language is impaired due to neurological damage, it is referred to as a neurogenic communication disorder (NCD) (Brookshire, 2003). The term neurogenic is comprised of the prefix neuro-, meaning "related to nerves" or "the nervous system," and the suffix -genic, meaning "resulting from" or "caused by"; therefore, neurogenic communication disorders are disorders resulting from nervous system pathology (Brookshire, 2003, p. 1). Because communication is a primary treatment area, a patient with a NCD is likely to be referred to a speech-language pathologist (SLP) for assessment and/or subsequent habilitation or rehabilitation. Some of the treatment goals may be effectively addressed in music therapy as well; however, the role of the music therapist (MT), at present time, may be less clearly defined within the treatment team. Therefore, this two-part article will address defining NCDs, their treatment, rationale for the use of music with NCDs, and the role of SLPs and MTs respectively in collaborative treatment.
Music therapists likely have general familiarity with the role of SLPs: assessment, treatment, and referral services for individuals with communication and other related disorders, such as speech, language, voice, and swallowing disorders (ASHA, 20016; Brookshire, 2003). Beyond that, some MTs may lack a comprehensive understanding of what SLPs actually do. Conversely, SLPs may be unfamiliar with possible applications of music therapy for persons with communication disorders or may harbor concerns regarding whether MTs are professionally prepared to address the treatment objectives of this clientele. This lack of understanding can contribute to communication breakdown that can reduce provision of treatment options for clients who can benefit from a collaborative treatment approach. An understanding of NCDs and their characteristics can provide an important foundation for effective collaboration.
Neurogenic Communication Disorders
Neurogenic communication disorders can be further categorized in terms or neurogenic language disorders, including various forms of aphasia or neurogenic motor speech disorders, such as apraxia of speech and various forms of dysarthria (Brookshire, 2003; Hegde, 1998).
Neurogenic Language Disorders
Aphasia is a neurogenic language disorder resulting from acquired brain damage, such as cerebrovascular accidents (CVAs, i.e., strokes), brain trauma (e.g., brain injury from automobile accidents), brain tumors, or progressive neurological diseases (Brookshire, 2003; Hegde, 1998). Multiple definitions of aphasia can be found in the literature due to the various considerations of types of aphasia and varying definitions of language (Hegde, 1998); however, for the purposes of this article, aphasia can be defined as "a language impairment that crosses all input and output modalities" (Brookshire, 2003, p. 569) or a deficiency in the ability to understand and/or create language (Brookshire, 2003; J. Gordon, personal communication, September 16, 2002; Hegde, 1998). Aphasia can affect different aspects of language, such as speaking, comprehension, reading, writing, and gesturing, for example. There are several kinds of aphasia and differential diagnosis is often controversial (Hegde, 1998). In broad terms, aphasia can be categorized in terms of fluency or prosodie (melodic) aspects of speech. Individuals with a form of fluent aphasia speak naturally and with ease, incorporating more normal speech rate and emphasis, whereas individuals with a form of nonfluent aphasia speak slowly and laboriously with frequent pauses (Brookshire, 2003). …