Download Neuromusicology and Combat-Induced Traumatic Brain Injury

Neuromusicology and CombatInduced Traumatic Brain Injury
Brittany Neuser and Elisabeth Spinniken
Western Michigan University
Outline

General Overview of Conventional Traumatic Brain Injury

Conventional vs. Combat-Induced Traumatic Brain Injury

Blast-Related Traumatic Brain Injury
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
Types
Cognitive/Affective Outcomes
Physical/Motor Outcomes

History of Music Therapy in Military Facilities

Neuromusicology and Neurologic Music Therapy

Current Music Therapy Practices in Military Facilities

Conclusions
Traumatic Brain Injury

Affects millions of Americans each year (directly and indirectly)

Common Causes

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Motor vehicle accidents
Falls
Violence
Sports-related incidents

Improved medical support  fewer fatalities

General Outcomes
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Cognitive
Emotional
Behavioral
Physical
Classification of TBI

Mild
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Moderate
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Severe


Penetrating
 Entrance of foreign object into brain
 More localized damage
Closed Head
 Coup contrecoup injury
 Rapid and forceful backward/forward movement
 Diffuse axonal damage
 Less localized damage
Centers for Disease Control and Prevention (2012). Injury prevention and control: Traumatic brain injury.
Conventional TBI vs.
Combat-Induced TBI

New focus on combat-induced TBI due to Global
War on Terror

“Signature injury” of this war

Many combat-induced TBIs are blast-related

Most prominent difference between civilian and
military TBI

Context of injury acquirement
Taber, K.H., Warden, D.L., & Hurley, R.A. (2006). Blast-related traumatic brain injury: What is known? Journal of
Neuropsychiatry and Clinical Neurosciences, 18(2), 141-145.
Types of Blast-Related TBI

Primary (barotrauma)

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Secondary (ballistic trauma)


Direct result of atmospheric pressure changes
Hit with shrapnel or other objects put into motion as a
result of blast forces
Tertiary

Person is forced into motion from blast waves and
thrown against solid objects
Taber, K.H., Warden, D.L., & Hurley, R.A. (2006). Blast-related traumatic brain injury: What is known? Journal of
Neuropsychiatry and Clinical Neurosciences, 18(2), 141-145.
Prevalence

Estimated 22% of wounded soldiers returning from
Middle East have suffered from a TBI

Number may be larger due to lack of diagnosis

Number does not include all returning soldiers  only
those who experienced additional injuries
Okie, S. (2005). Traumatic brain injury in the war zone. The New England Journal of Medicine, 352(20), 2043-2047.
Blast-Related TBI &
Cognition/Affect
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General Cognitive/Affective Symptoms
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Memory deficits
Attention deficits
Irritability
Anxiety
Depression
Personality Changes
Sleep disturbances
Headaches and/or dizziness
Frequent comorbidity of TBI and PTSD

Evidence for correlational relationship
Rosenfeld, J.V., & Ford, N.L. (2010). Bomb blast, mild traumatic brain injury and psychiatric morbidity: A review. Injury, 41(5), 437-443.
Blast-Related TBI &
Cognition/Affect

Research is limited  concern in this area is growing

Scheibel et al. (2011)


Compared brain activation levels of soldiers who were
deployed but not exposed to blast to the levels of soldiers
who had been deployed and had been exposed to blast
forces
Found generally increased levels of activation in soldiers
who had been exposed to blast waves
 Specific areas noted: Anterior cingulated gyrus, medial
frontal cortex, and posterior cerebral areas
 Accuracy did not differ
 Increased activation levels result from inefficient
processing  form of compensation, increased effort
Scheibel, R.S. et al. (2011). Altered brain activation in military personnel with one or more traumatic brain injuries following blast. Journal of
the International Neuropsychological Society, 18(1), 89-100.
Blast-Related TBI & Motor
Functioning

General Motor Outcomes
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Difficulty with ambulation (walking)
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Impaired postural stability
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Poor coordination

Muscle spasticity
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Muscle weakness
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Diminished executive functioning (motor planning)
Blast-Related TBI & Motor
Functioning
Area of the Brain
Type of Functional Motor Deficits
Frontal Lobes
•Loss of simple movements/paralysis
•Inability to sequence complex movements
Parietal Lobes
•Lack of awareness of certain body parts and/or
surroundings
Brain Stem
•Impaired balance and movement skills
Cerebellum
•Inability to coordinate fine motor skills
•Loss of functional walking skills
•Inability to reach and grab objects
•Inability to make rapid movements
Lehr, R. P. (2011). Brain Function. Centre for Neuro Skills.
Blast-Related TBI & Motor
Functioning

Fausti, Wilmington, Gallun, Myers, and Henry
(2009)
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High rate of auditory damage

Motor outcomes resulting from auditory damage
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Vestibular dysfunction  impaired balance

Restoring gait is often primary goal of
rehabilitation in returning soldiers (Scherer
2007)
Fausti, S. A., Wilmington, D. J., Gallun, F. J., Myers, P. J., & Henry, J. A. (2009). Auditory and vestibular dysfunction associated with
blast-related traumatic brain injury. Journal of Rehabilitation Research & Development, 46(6), 797-810.
Scherer, M. (2007). Gait rehabilitation with body weight-supported treadmill training for a blast injury survivor with traumatic brain injury.
Brain Injury, 21(1), 93-100.
Treatment of TBI

Importance of interdisciplinary team



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Wide spectrum of outcomes
Holistic approach  may lead to more desirable treatment
outcomes
Team members may include
 Speech/Language Pathologists
 Occupational Therapists
 Physical Therapists
 Psychologists
 Physicians
 Music Therapists
Need for cost-effective treatments and interventions
History of Music Therapy
in Military Facilities


Music introduced in treatment facilities between WWI
and WWII

Focused on influencing patients’ mood states

Music “accompanied” other events (OT, anesthesia) or
simply provided a more enjoyable environment
Goals of music-based activities expanded during WWII

Included improving self esteem and social functioning
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Three main methods
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Active participation: music making
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Passive participation: listening and discussing
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Audio-Reception: recreational music listening
Tyson, F. (1981). Music therapy in hospitals. Psychiatric Music Therapy. New York: Creative Arts Rehabilitation Center, 7-12.
Walter Reed General
Hospital: 1944
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First official research study involving the use of music in
therapy
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Experimental, exploratory study  Does music aid in working
toward predetermined, nonmusical goals?
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What was done?
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Soldiers provided with live music performance by professional
musicians and an opportunity to discuss the experience
Music chosen based on soldiers’ mood states
 More stimulating or relaxing music was played based on
soldiers’ needs (iso principle)
Detailed musical and behavioral data recorded each session
Found that 74% of the 50 soldiers included in the published
report displayed noteworthy improvements
Rorke, M.A., (1996). Music and the wounded of world war II. Journal of Music Therapy, 33(3), 189-207.
Neuromusicology

Study of biological responses of the brain and
nervous system to musical stimuli
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Music processing
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Neurotransmitter processes
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Increases and decreases in levels of neurotransmitters
in response to musical stimuli
Clinical application of neuromusicology
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Neurologic Music Therapy
Neurologic Music Therapy

NMT is the “therapeutic application of music to
cognitive, sensory, and motor dysfunctions due to
neurologic disease of the human nervous system”
(Thaut, 2005, p. 126)

Rationale behind NMT involves scientific models of
music perception, production, and influence of
music on nonmusical functioning

Evidence-based therapeutic music interventions
applied in clinical setting  work toward nonmusical
goals and objectives
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Practiced by trained and certified music therapists
Thaut, M. (2005). Rhythm, music, and the brain. New York: Routledge.
NMT: Motor Interventions

Role of music

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Arousing/priming motor areas of brain
 Enhances, promotes, and/or elicits movement
Provide temporal structure
 Cues for elements of movement: Time, space, and force
Motivation
Interventions
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Rhythmic Auditory Stimulation (RAS)
Patterned Sensory Enhancement (PSE)
Therapeutic Instrumental Music Performance (TIMP)
NMT: Speech/Language
Interventions
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http://www.youtube.com/watch?v=tiJ9X_wLSWM
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Role of music
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Music = processed in both hemispheres of brain
Speech/Language primarily processed in the left
hemisphere
Strengths in undamaged areas of the brain aid in improving
areas of deficit
Interventions
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Rhythmic Speech Cuing (RSC)
Musical Speech Stimulation (MUSTIM)
Oral Motor and Respiratory Exercises (OMREX)
NMT: Cognitive
Interventions
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Role of Music
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Similar to Motor and Speech/Language Interventions

Musical structure aids in information processing,
provides motivation
Interventions
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Music Mnemonics Training (MMT)
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Music Executive Function Training (MEFT)
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Music Psychotherapy and Counseling (MPC)
Current Research: MT in
Military Facilities
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Very limited published literature

Bensimon, Amir, & Wolf (2008)
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Drumming with soldiers experiencing PTSD
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Participants
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Methods
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Data collection
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Results
Bensimon, M., Amir, D., Wolf, Y. (2008). Drumming through trauma: Music therapy with post-traumatic soldiers. The Arts in Psychotherapy,
Current Research:
Soldiers’ Reactions

“Once you beat the drum, although you don’t know anyone, it gives a feeling of
togetherness…”
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Participant B: “Maybe a drum . . . bom bom bom bom bom can remind me of the
trauma . . . because the noise stresses me. That’s what happened there at the
moment of the fire”
Participant B led group instrumental improvisation (using drums).
[After the group playing] Participant B: “It reminds me exactly the chaos that was
there.”
Participant C: “It was frightening, it reminds me of war”

“It’s as if you’ll go naked in front of them. Yes! Exactly! As if they saw everything,
so I can tell them all about myself. If I spoke about personal issues it’s only due to
the group drumming which enabled us to open up”

Quotes from Bensimon, Amir, & Wolf (2008) p. 38
Current Practices: MT in
Military Facilities
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Operation Oak Tree (Illinois)
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Mission Statement
 Empower individual expression
 Strengthen interpersonal connection between family
members
 Strengthen coping strategies for families
 Encourage families to seek community support
Warrior Transition Wellness Program (Hawaii)

Mission Statement
 Provide comprehensive wellness program
 Ease transition from deployment to civilian life
 Provide coping mechanisms, recreational activities,
minimize stress, anger management strategies
Music Institute of Chicago (2010). Military family services. Retrieved from http://www.musicinst.org/military-family-services
Robbins, D. (2009). FMWR and Tripler work together to provide wounded warrior programs.
Role of Music in the Lives
of Soldiers

High levels of appreciation for music and recognition of
its positive effects

Music in combat environments

Historical Uses

drums on battlefield used to…
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signal commands

maneuver troops
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inspire troops for combat

intimidate the enemy
Pieslak, Jonathan. (2010). From combat to healing: The music of War. Army, 60(2), 49-51.
Role of Music in the Lives
of Soldiers

Current Uses


Master Sgt. Isaac Alexis

Performer, Songwriter
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Performs for fellow comrades, hopes to convey positive
message
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Set personal goals involving the completion of a CD for
his next deployment time
Sgt 1st Class Ted Bentley
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Performs and teaches guitar lessons
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Fort Sill Warrior Transition Unit in Oklahoma
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Soldiers reported feeling therapeutic effects as a result
of participating in the guitar lessons
Sauret, M. (2008). Soldier’s commitment to music impacts lives. Retrieved from http://www.army.mil/article/10649
Sherman, B. (2012). Music helps soldiers begin healing process. Retrieved from http://www.army.mil/article/76880
Role of Music in the Lives
of Soldiers

Many soldiers listen to certain types of music prior
to missions

Common genres
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Rap, rock, and heavy metal  focus on lyrics,
general sound characteristics
Effects of music listening

Helps soldiers to change mindset, set outside
themselves
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Provides adrenaline rush
Pieslak, Jonathan. (2010). From combat to healing: The music of War. Army, 60(2), 49-51.
Role of Music in the Lives
of Soldiers

75th Ranger Regiment, 2nd Battalion

“Glycerine” by Bush

“It’s not my time to wonder why”

“I’m never alone, I’m alone all the time”

“Should have been easier by three, Our old friend
‘Fear’ and you and me”

“Don’t let the days go by”
Conclusions

Increasing need for effective yet cost-efficient
treatment modalities for soldiers with TBI

Research involving NMT and TBI suggests that
music therapy may prove beneficial

Soldiers have recognized music’s potential to affect
their mental and emotional states

More research is warranted involving the use of
NMT specifically in military facilities
Acknowledgments

Professor Ed Roth, MM, MT-BC
Associate Professor of Music Therapy
Adjunct Professor of Occupational Therapy
Fellow- Academy of Neurologic Music Therapists
Director-Brain Research and Interdisciplinary Neurosciences (BRAIN)
Lab
School of Music: Western Michigan University

Ben J. Atchison, PhD, OTR, FAOTA
Professor
Co-founder, SW Michigan Children’s Trauma Assessment Center
Co-Director, Interdisciplinary Teacher Education Program
Department of Occupational Therapy: Western Michigan University
Questions?
References
Bensimon, M., Amir, D., Wolf, Y. (2008). Drumming through trauma: Music therapy with post-traumatic soldiers. The
Arts in Psychotherapy, 35, 34-48.
Centers for Disease Control and Prevention (2012). Injury prevention and control: Traumatic brain injury. Retrieved
from: http://www.cdc.gov/traumaticbraininjury/statistics.html
Fausti, S. A., Wilmington, D. J., Gallun, F. J., Myers, P. J., & Henry, J. A. (2009). Auditory and vestibular dysfunction
associated with blast-related traumatic brain injury. Journal of Rehabilitation Research & Development, 46(6), 797-810
Lehr, R. P. (2011). Brain Function. Retrieved from Centre for Neuro Skills:
http://www.traumaticbraininjury.com/content/understandingtbi/causesoftbi.html
Music Institute of Chicago (2010). Military family services. Retrieved from http://www.musicinst.org/military-familyservices
Okie, S. (2005). Traumatic brain injury in the war zone. The New England Journal of Medicine, 352(20), 2043-2047
Robbins, D. (2009). FMWR and Tripler work together to provide wounded warrior programs. Retrieved from
http://www.army.mil/article/24324
References cont.
Rorke, M.A., (1996). Music and the wounded of world war II. Journal of Music Therapy, 33(3), 189-207
Sauret, M. (2008). Soldier’s commitment to music impacts lives. Retrieved from http://www.army.mil/article/10649
Scheibel, R.S. et al. (2011). Altered brain activation in military personnel with one or more traumatic brain injuries
following blast. Journal of the International Neuropsychological Society, 18(1), 89-100.
Scherer, M. (2007). Gait rehabilitation with body weight-supported treadmill training for a blast injury survivor with
traumatic brain injury. Brain Injury, 21(1), 93-100.
Sherman, B. (2012). Music helps soldiers begin healing process. Retrieved from http://www.army.mil/article/76880
Taber, K.H., Warden, D.L., & Hurley, R.A. (2006). Blast-related traumatic brain injury: What is known? Journal of
Neuropsychiatry and Clinical Neurosciences, 18(2), 141-145.
Thaut, M. (2005). Rhythm, music, and the brain. New York: Routledge
Tyson, F. (1981). Music therapy in hospitals. Psychiatric Music Therapy. New York: Creative Arts Rehabilitation Center,
7-12