Music Therapy Methods with Children, Adolescents, and Adults with Severe Neurobehavioral Disorders Due to Brain Injury
Magee, Wendy L., Baker, Felicity, Daveson, Barbara, Hitchen, Holly, Kennelly, Jeanette, Leung, Maggie, Tamplin, Jeanette, Music Therapy Perspectives
ABSTRACT: The purpose of this paper is to illustrate the application of music therapy intervention in neurobehavioral treatment programs with pediatric, adolescent and adult populations through the presentation of six case reports, with special reference to post-traumatic amnesia. Severe behavioral disorders stemming from brain injury are challenging for both the affected individual and their support network. Managing neurobehavioral disorders requires specialist skills and knowledge of various strategies to minimize behavioral incidents and decrease episodes of agitation. Music therapy interventions are effective in increasing orientation and decreasing agitation in people with post-traumatic amnesia following brain injury (Baker, 2001). However, there is little published guidance or research on music therapy interventions for use in interdisciplinary rehabilitation programs for patients with short-term or chronic neurobehavioral disorders following traumatic brain injury. Music therapy is well-placed as a part of interdisciplinary rehabilitation with this population, offering opportunities to enable emotional expression and improve pragmatic communication skills and social interaction. This case material provided illustrates how music therapists integrate family members into treatment programs, and work with others to enable multidisciplinary and interdisciplinary outcomes.
Impaired regulation of mood and behavior remains one of the greatest barriers to community integration following traumatic brain injury (TBI1) (Giles & Manchester, 2006). Neurobehavioral problems following TBI arise when the frontal lobe control mechanisms are not able to regulate emotional impulses. In such cases, minor triggers in the everyday environment, which would otherwise be managed, can provoke aggressive or socially inappropriate behaviors which are exaggerated or seem disproportional to the trigger (Ylvisaker et al., 2007). Irritability, aggression, disinhibition, sexually-inappropriate behavior, reduced anger control, immature behavior in relation to age expectations, rigidity, social awkwardness, impaired social perception, and egocentrism are frequently listed behavioral problems following TBI (Rothwell, La Vigna, & Willis, 1999; Ylvisaker et al., 2007). As these behaviors are externally expressed, they can be challenging for those caring for the person.
Other internalized behaviors such as withdrawal, apathy, initiation, impairment, and depression can also trouble the individual, preventing engagement in social relationships, meaningful interests, education, or rehabilitation (Ylvisaker et al., 2007). Secondary factors also can influence presenting behavior, including: premorbid substance/alcohol abuse, poor social functioning, concurrent traumatic complaints, and severity of brain injury (Alderman, 2007). Chronic neurobehavioral disorders enduring past the period of post-traumatic amnesia (PTA) can result in exclusion from rehabilitation programs and care settings, as the safety of other patients and staff can be highly compromised (Alderman, Knight & Henman, 2002).
Systematic approaches to rehabilitation and management of neurobehavioral disorders are illusive as interventions with this population are typically multicomponent and highly individualized to patients' specific problems (Ylvisaker et al., 2007). Much of the evidence about this type of work relies on individualized treatment descriptions (Alderman, 2007). The lack of homogeneity within this sub-group of the acquired TBI population is widely acknowledged with treatments needing to be linked to specific patient problems. This lack of homogeneity makes it difficult to complete research studies with this group. However, program components that are reported to reduce neurobehavioral problems include having a structured program, engaging the collaboration of the patient in setting goals, and regularly reviewing activities (Rothwell et al., 1 999). …