Amanda Thorpe, MT-MA, NMT-F, BAMT Member, BPA Member  – “Lose Yourself: Harnessing Music Therapy and Neuroplasticity to Improve Walking After Traumatic Brain Injury”

After a significant brain injury, cognitive impairments such as short attention spans, poor memory, impaired reasoning, and slower cognitive processing can interfere with rehabilitation. These impairments make it challenging for patients to follow instructions, complete tasks, or keep up with rehabilitation activities. 

Cognitive issues also impact motor planning and coordination, where the brain struggles to send correct signals to muscles, leading to clumsy or incorrect movements. This combination of cognitive and motor impairments increases the risk of falls, particularly during complex tasks like walking.

Rhythmic Auditory Stimulation (RAS) is a neurological music therapy technique that uses rhythmic cues, like counting, music, or a metronome, to improve motor control during rehabilitation. RAS helps patients synchronise their movements with the rhythm, enhancing gait and balance. However, impairments in temporal processing, possibly due to damage in areas like the basal ganglia, cerebellum, or prefrontal cortex, can make it difficult for patients to move in time with a beat. This challenge, known as impaired rhythmic synchronization, may stem from reduced attention or memory issues, leading to difficulties in using the beat as an external cue for movement.

In this case study, a patient with traumatic brain injury struggled to move in time to a beat. His impaired rhythmic synchronization was likely due to cognitive deficits such as reduced attention and short-term memory impairment, which hindered his ability to keep track of the beat and synchronize his movements. To address this, individualized music therapy was introduced, incorporating RAS, auditory training, and cognitive and motor rehabilitation. The patient engaged in rhythmic activities to promote neuroplasticity, encouraging the brain to form new connections that support improved rhythm perception and synchronization.

The use of patient-preferred music enhanced motivation, and the patient was encouraged to tap, clap, move his feet, sway, and play the drum to develop an internalized sense of rhythm. This helped reduce the cognitive effort required for movement. Collaboration with physiotherapists involved joint sessions that used Musical Mnemonics Training (MMT) for safe sit-to-stand exercises and RAS for walking goals, improving motor coordination and timing for more fluid gait patterns.

This case highlights the synergistic effect of combining music therapy with traditional physiotherapy to maximise recovery in TBI rehabilitation, emphasising the importance of motor learning and neuro-plasticity in therapeutic interventions.

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