Neurologic Music Therapy as a Tool for Effective Communication Development

Communication is a central focus for many of our clients, whether through verbal speech, sign language, or alternative communication devices. At Musical Bridges, we utilize a variety of Neurologic Music Therapy techniques to help clients enhance, expand, and strengthen their communication skills.

In the following sections, we will delve into the specific techniques we use and the research that highlights the powerful role of music in fostering communication development.

MUSIC AND SPEECH

Music has been used as a communication medium for as long as we have a record of human history. Oral traditions have utilized song to pass down generations’ worth of knowledge and wisdom, and much of early development consists of learning via song. These are known as musical mnemonics where information is taught via song. The first song most children learn to sing is the Alphabet, and it serves a multitude of purposes: language acquisition, sound production, memory recall, and early academic skills just to name a few.

When introducing music therapy to those who are unfamiliar with it, one of the most common questions we receive is about its impact on speech production. Given music’s deep-rooted connection to communication, it’s only natural that speech improvement is often top of mind for many.

SPEECH AND MUSIC BRAIN PROCESSING

There are multiple areas of the brain that house communication. Speech production is handled by Broca’s Area, a spot on the left hemisphere of the brain. Here, the primary aspects of speech are fluency of speech and the ability to articulate sentences. If someone has a complication with Broca’s Area, it does not necessarily mean that their comprehension skills are also impaired. Language comprehension is handled by Wernicke’s Area. Someone with an impairment to only Wernicke’s Area would have challenges comprehending what is spoken or communicated to them, but have full ability to communicate themselves. In disorders such as autism, these areas of the brain may show signs of abnormal behaviors or connections to other parts of the brain, manifesting in challenges with both speech production and speech comprehension.

Music is processed in several areas of the brain due to its multiple characteristics; Rhythm is processed in the basal ganglia, cerebellum, and prefrontal cortex

EARLY LANGUAGE ACQUISITION

The process of early language acquisition unfolds through several key stages, beginning at birth.

Pre-Linguistic Stage: The journey starts with the pre-linguistic stage, typically spanning from 0 to 12 months. During this time, infants begin to coo and babble—initial attempts at communication. These aren’t just random, adorable sounds; they represent purposeful efforts by the infant to engage with their surroundings and make their presence known.

Holophrastic Stage: Following that, the holophrastic stage occurs between 12 and 18 months. In this phase, children start using single words, often mimicking those around them. Though these words may appear simple, they carry profound meaning, as they are the child’s way of expressing needs, desires, and emotions. The weight of a single word is far greater than its literal interpretation.

Two-Word Stage: Between 18 and 24 months, children enter the two-word stage, where they begin combining words into simple phrases. This marks a significant leap in communication, allowing them to express more complex ideas and needs. As a result, their speech becomes clearer, making it easier for others to understand their intentions.

Telegraphic Stage: From 24 to 30 months, children begin forming simple sentences to communicate. These phrases often lack essential elements like verbs, adjectives, prepositions, and articles, and are typically not grammatically correct. Despite these omissions, the sentences allow children to express more complex ideas, though they are still in the early stages of mastering language structure.

Early Multi-word Stage: Beginning around 30 months and extending until about three years of age, children experience a significant expansion in their vocabulary. As they continue to learn, their grammar improves, and their sentences become more complex and descriptive. This stage marks a transition from simple phrases to more nuanced expressions, with a growing ability to convey detailed thoughts and ideas.

Later Multi-word Stage: Between the ages of three and four, children show notable improvements in grammar, incorporating more complex elements such as conjunctions and prepositions into their speech. During this stage, their use of vocal prosody—elements like pitch, tone, and rhythm—also becomes more refined, allowing for more natural and expressive communication.

Mature Age: By the age of five and beyond, children’s communication skills have significantly advanced. Their speech is clearer, making them easier to understand. Grammar continues to improve, and they become more confident in their ability to communicate effectively, expressing their ideas with greater accuracy and clarity. This stage marks a strong foundation for more sophisticated language use as they grow.

Note on Individual Variation: It’s important to remember that these stages represent a typical pattern of language development, but they do not account for variations due to speech disorders, diagnoses, or individual differences. Each child develops at their own pace, and progress can look different for everyone. Language acquisition is a unique journey, and children may reach these milestones in a variety of ways.

SPEECH DISORDERS

There are numerous speech disorders, each arising for different reasons. Some of the most common ones encountered in a music therapy setting include:

Aphasia: This disorder impairs a person’s ability to understand or produce language due to damage to specific areas of the brain.

Apraxia: A speech sound disorder that affects an individual’s ability to convert conscious speech plans into motor plans, leading to difficulty and limited speech production.

Stuttering: Characterized by involuntary repetitions, prolongations of sounds, syllables, words, or phrases, as well as involuntary pauses known as "blocks," where the person is unable to produce speech sounds.

Mixed Receptive-Expressive Disorder: This communication disorder affects both receptive (understanding) and expressive (production) aspects of language to varying degrees, ranging from mild to severe.

Dysarthria: A motor speech disorder caused by neurological damage to the motor components of speech production, leading to poor articulation of sounds.

Each of these conditions can be addressed using specialized Neurologic Music Therapy (NMT) techniques tailored to improve speech and communication abilities.

CO-TREATING

Most music therapists, particularly those who are NMT certified, work closely with other professionals on a client’s treatment team to ensure that therapeutic goals are achieved within a unified, cohesive system.

At Musical Bridges, we embrace a collaborative approach, reviewing all relevant information provided by a client’s other treatment team members. We also share our own treatment plans to ensure alignment. This open exchange of information allows us to integrate therapy across various settings, ensuring that clients receive comprehensive support to thrive and make progress in all areas of their development.

In many cases, therapeutic goals overlap across different modalities. This overlap enables us to address goals from multiple perspectives, ensuring that clients receive the holistic support they need for well-rounded progress.

When it comes to communication goals, we work closely with clients' Speech-Language Pathologists to ensure a cohesive approach across therapies. Whether clients are working on single words, phrases, prosody, enunciation, or other speech-related skills, we can incorporate these goals into Music Therapy. By aligning our efforts, we strengthen the overall therapeutic process, helping clients make progress in various areas of communication.

ALTERNATIVE FORMS OF COMMUNICATION

Not only do we support clients working on producing verbal speech, but we also work with clients who communicate using sign language or alternative communication devices (AAC). We ensure that all forms of communication are supported and integrated into therapy, helping clients express themselves in the way that works best for them.

When working with sign language and AAC in music therapy, the process is similar to that of verbal speech. We incorporate these communication methods into songs and activities, making slight adjustments—such as allowing for longer pauses—to ensure clients can fully participate and express themselves.

We incorporate the specific sign language vocabulary or AAC device items that have been identified by the individual, their family, other professionals, and ourselves as areas of focus in therapy. This ensures that the client is working on the communication tools most relevant to their needs and goals.

NMT VS. TRADITIONAL MUSIC THERAPY

Neurologic Music Therapy (NMT):
NMT is a specialized form of music therapy that is grounded in neuroscience and focuses on using music to address specific neurological goals. In speech and communication, NMT involves structured, research-based techniques that target brain areas associated with speech production and comprehension. NMT utilizes evidence-based music interventions to enhance speech patterns, improve prosody (intonation, rhythm, stress), and promote articulation. It is often used to retrain the brain to restore lost or impaired communication abilities due to neurological damage.

Traditional music therapy:

Traditional Music Therapy can encompass a wide range of techniques, including improvisation, songwriting, and playing instruments. In the context of speech and communication, it often focuses on creating a therapeutic environment that enhances emotional expression, social interaction, and communication skills. This approach is generally more flexible and client-centered, tailored to the individual’s preferences and needs without the specific neurological framework found in NMT.

Key Differences:

1. Scientific Foundation:

   • NMT: Rooted in neuroscience, with structured techniques targeting specific brain regions involved in speech and language.

   • Traditional Music Therapy: Focuses on emotional, social, and communicative goals, often through creative and flexible methods without a primary focus on neurological mechanisms.

2. Techniques:

   • NMT: Uses research-backed techniques such as Rhythmic Auditory Stimulation, Melodic Intonation Therapy, and Speech Syllable Training.

   • Traditional Music Therapy: Involves a variety of techniques, including improvisation, singing, and instrument playing, to enhance overall communication.

3. Goal Specificity:

   • NMT: Has very specific goals, with measurable outcomes related to speech and communication that are based on brain function.

   • Traditional Music Therapy: Goals are generally broader and focused on emotional, social, and cognitive communication skills.

WHY MUSICAL BRIDGES?

At Musical Bridges, all of our therapists are certified Neurologic Music Therapists (NMTs), and are highly trained to apply advanced techniques that enhance and improve communication skills. We prioritize ongoing professional development, regularly maintaining our certifications and continuing our education to stay at the forefront of emerging therapies and best practices. We focus on communication in various forms for the majority of the clients we serve, addressing areas such as vocalizations, phrases, AAC use, conversational skills, prosody, enunciation, vocabulary, and more. Below, you'll find a list of the techniques we use to help our clients achieve their individual communication goals.

Left-Right: Ms. Melissa, Ms. Lydia, Ms. Proctor, and Ms. Savannah

Melodic Intonation Therapy (MIT):
MIT is a technique developed for expressive aphasia rehabilitation. It leverages a patient’s ability to sing, which is often unimpaired, to facilitate spontaneous and voluntary speech. Through sung and chanted melodies that mirror natural speech intonation patterns, MIT aims to improve the linguistic or semantic aspects of verbal utterances, ultimately helping patients regain their ability to speak (Sparks et al., 1974; Thaut, 2005).

Musical Speech Stimulation (MUSTIM):
MUSTIM uses musical materials such as songs, rhymes, chants, and musical phrases to simulate prosodic speech gestures. This technique helps stimulate non-propositional speech (speech that’s not used to convey new information, like social exchanges). It often involves the completion or initiation of familiar song lyrics or musical phrases, prompting functional speech responses. For example, a therapist might use a familiar tune to elicit a phrase like "You are my..." or "How are you...?" (Basso et al., 1979; Thaut, 2005).

In this video, the Music Therapist is using a familiar song with the client, intentionally dropping out at specific points to allow the client to fill in the blanks. This approach simulates prosodic speech gestures, creating a call-and-response interaction. By having the client complete the phrases, the therapist helps expand vocabulary and supports the development of speech production skills.

Rhythmic Speech Cuing (RSC):
RSC utilizes rhythmic cues to control the initiation and pace of speech. The therapist may use the client's hand, a drum, or a metronome to prime speech patterns or regulate the rate of speech. This technique is useful for individuals with apraxia (difficulty planning motor movements), dysarthria (speech motor control problems), or fluency disorders like stuttering (Thaut, 2005).

In this video, the client is working on the specific phrase "I need help." The Music Therapist uses a steady beat while incorporating movement, having the client play the beat along with her. Gradually, the therapist drops out her voice and the steady tempo, encouraging the client to independently use the phrase in rhythm. This technique helps build confidence and supports the client’s ability to express themselves with greater independence.

Vocal Intonation Therapy (VIT):
VIT focuses on intoning phrases to simulate the prosody, inflection, and pacing of normal speech. Vocal exercises help train voice control, including aspects like inflection, pitch, breath control, timbre, and dynamics. For example, a therapist may use a five-note scale and gradually adjust the starting pitch to help a child with a limited pitch range. The exercise can then be expanded with a functional sentence such as, "Let's go out and play" (Thaut, 2005).

In this video, our client is engaging in beatboxing as a vocal exercise to enhance his vocal prosody, breath control, and dynamic range. By incorporating rhythm and vocal manipulation, beatboxing provides an effective way to improve his control over pitch, volume, and timing, while also strengthening his respiratory support. This exercise not only aids in refining his overall vocal technique but also promotes greater coordination between breath and sound production.

Therapeutic Singing (TS):
Therapeutic singing involves singing activities designed to facilitate the initiation, development, and articulation of speech, as well as to strengthen the respiratory system. TS can be used for a variety of neurological and developmental speech and language disorders, helping with both speech production and respiratory control (Glover et al., 1996; Jackson et al., 1997; Thaut, 2005).

In this video, we are using Therapeutic Singing to support the development of speech production and respiratory control. The client engages with a familiar song in various ways to enhance her ability to produce speech sounds.

Oral Motor and Respiratory Exercises (OMREX):
OMREX incorporates musical exercises, such as sound vocalizations or wind instrument playing, to enhance articulatory control and respiratory strength. This technique is beneficial for individuals with developmental disorders, dysarthria, or conditions like muscular dystrophy (Hass & Distenfield, 1986).

In this video, the client is using a recorder to work on breath support, with the goal of improving speech production and fluency. He faces challenges with motor planning and forming the correct mouth shapes for rounded sounds. By playing the recorder, which requires him to maintain specific mouth shapes to produce sound, he is effectively strengthening and reinforcing the muscles needed for these sounds.

Developmental Speech and Language Training Through Music (DSLM):
DSLM focuses on using developmentally appropriate musical materials and experiences to enhance speech and language development. It incorporates singing, chanting, playing musical instruments, and integrating music, speech, and movement, helping to promote overall speech and language skills in a musical context (Thaut, 2005).

In this video, our client is using her AAC device to respond to and answer prompts from the Music Therapist (MT), aligning with the principles of Developmental Speech and Language Training Through Music (DSLM). The MT incorporates a familiar song to encourage the client to communicate by making choices that are integrated into the song. In this instance, the client is asked to choose different body parts to "wash." The MT uses a scarf to incorporate movement, mimicking the client’s chosen body parts and enhancing the interaction. This approach blends music, speech, and movement to support speech and language development in a musical context

In this video, the Music Therapist is using a familiar song to help the client work on longer phrases, a key component of Developmental Speech and Language Training Through Music (DSLM). By encouraging the client to sing entire phrases rather than just single words, the MT is helping expand his vocabulary and improve speech production. Additionally, number identification is incorporated into the song, using both musical elements and visual aids to reinforce learning. This approach, grounded in the principles of DSLM, integrates music, speech, and movement to foster overall speech and language development.

Symbolic Communication Training Through Music (SYCOM):
SYCOM uses musical performance exercises, such as instrumental or vocal improvisation, to train communication behaviors, language pragmatics, and appropriate speech gestures. It supports emotional communication through nonverbal language systems, using structured, sensory-rich, and affectively engaging exercises that simulate communication structures in real-time social interactions (Thaut, 2005).

In this video, our client engages in a dynamic activity with the therapist, taking turns playing a drum mat. This exercise is designed to target the non-verbal aspects of communication, such as practicing turn-taking and sharing attention, which are essential skills for effective interaction in conversations. By incorporating rhythmic play, the client develops these communication skills in a fun and interactive way

Each of these techniques is designed to address specific aspects of speech and communication by leveraging the brain's response to music, providing a structured yet adaptable approach to speech rehabilitation and development. NMT offers a holistic way to target speech deficits, combining the power of music with neuroplasticity to support individuals with a variety of speech and communication challenges.

At Musical Bridges, we are committed to using our knowledge and training to provide the best support for our clients. Communication is one of our primary goals, and each therapist on staff is highly equipped to address a wide range of communication needs. We strive to tailor our approach to ensure every client receives the personalized support they need to thrive.

If you or someone you care for is looking to improve communication skills, Neurologic Music Therapy can provide an excellent complementary therapy to Speech Therapy. Please reach out to learn more about the services we offer!