ACTIVE MUSIC THERAPY, ACQUIRED BRAIN INJURY, AND
INTERPERSONAL COMMUNICATION COMPETENCES
Randomized cross-over study on active music therapy and neurological rehabilitation
Purpose
Participant Flow chart
It is widely acknowledged that ABI to a large extend affects psychosocial functioning (Morton and
Wehman, 1995). Research indicate that active music therapy can have an positive effect on interaction
competences (Barker and Brunk, 1991, Nayak et al., 2000, Purdie, 1997)
Musical interaction relies on many different networks of the brain working together(Peretz and Zatorre,
2005). When persons with ABI actively do music, they are offered an opportunity for simultaneous
activation of the emotional-, motoric-, cognitive- and communicative structures of the brain.
Søren Hald – Denmark
hald@hum.aau.dk
When client and music therapist play music together, their musical interaction behavior is continually
adjusted. When interacting musically they use interpersonal communication competences such as
empathy, self-disclosure, social relaxation, expressiveness, empathy, etc. It is the studies general
hypothesis that an overall gain in doing music therapy in neurological rehabilitation is improved
interpersonal communication competences.
Rating musical exercises
Two music therapy students were trained in using Brusia’s
(1987) Improvisation Assessment Profile (Autonomy), and
assigned ICCS-music rater questions. The four musical exercises
(dialog, follow, hold on, and free impro.) done pre and post 20
sessions were analyzed by the two raters. The raters fist
evaluated the four exercises with the ICCS – music rater tool,
followed by IAP autonomy rating. The raters were blinded in
regards to pre/post order of video clip.
Music therapy method
The client’s rehabilitation needs are clarified using a proxy Rehabilitation Needs Questionnaire(RNQ)
addressing; physical, cognitive, psychological, and social rehabilitation needs. The therapists adapts and
develop music therapy methods to address rehabilitation needs. Verbal dialog in music therapy addresses
issues from; everyday life, rehabilitation needs, musical performance and interaction. The client's
preferences of music and instruments is an important guideline in choosing intervention. In this study
group therapy ended with a concert.
Research question
•What effect does music therapy have on interpersonal communication competences in people with
acquired brain injury?
•What is the effect of 20 music therapy sessions on interpersonal communication
competences in musical improvisations?
•What is the effect of 20 music therapy sessions on interpersonal communication
competences in daily life?
•Is there a correlation between interpersonal competences in music and daily life?
Design
The correlation hypothesis was tested on 18 participants having suffered from ‘medium’ to ‘servere
acquired brain injury (ABI). To test the interpersonal effect of music therapy a randomized cross-over
design (AB-BA) was assigned on 11 participants who have lived with their injury for more than five years.
‘A’ was twenty group music therapy sessions and ‘B’ was 4-5 months of standard rehabilitation. 3
participants got very ill and left the study.
The 7 participants who had acute ABI were allocated to music therapy condition or standard
rehabilitation, based on treatment considerations. Communication competences in daily life was
measured with an altered version of Rubin and Martin (1994) Interpersonal Communication Competence
Scale (ICCS) deployed on relatives, staff and participants. Interpersonal communication competences in
music were measured by blinded raters using an adapted version of Bruscia’s (1987) Improvisation
Assessment Profile -autonomy profile (IAP-Aut.) and an alteration of the ICCS questionnaire into musical
means.
Measurements
Questionnaires
•ICCS_Proxy - Staff and relative evaluation of ICC in daily life
•ICCS_ABI - Self evaluation of ICC in daily life
•ICCS_MU - Music therapist evaluation of client after MT assessment
•ICCS_MU_OWN - Self evaluation after MT assessment
•RNQ – Relatives, Staff and self evaluation of rehabilitation needs
Musical exercises
•Dialog (self chosen instrument)
•Follow the therapist (on piano)
•Hold on to a phrase while the therapist challenge
•Free improvisation
Blinded rating
•ICCS_RAT - Blinded rater evaluation of ICC based on the four musical exercises.
IAP_AUT - Blinded rater evaluation of autonomy in improvisation
Development of ICCS questions
ICCS – ABI. version
(adapted from Rubin and
Martin (1994))
Self-disclosure
How often do you show
friends who you really
are?
How often do you feel
that you are understood
by others?
Etc.
ICCS - Proxy
(¤=he/she, #=client
name)
How often does # show
friends who ¤ really is?
How often does #
experience being
understood?
Etc.
Self disclosure in music
Did the clients music
express who he/she really
is?
Did you ‘understand’ the
client’s music?
Etc.
ICCS - Client after
assessment
ICCS- Music rater
(improvisation)
Did your music express
how you felt?
Was the client’s music
congruent with body
language? (free)
Did you experience
clarity/focus in the
clients’ music? (dialog)
Etc.
Did you experience, that
your music was
understood?
Etc.
Improvisation Assessment Profile - Autonomy
Time point in free
improvisation
.10
.20
.30
.40
.50
1.00
1.10
1.20
1.30
1.40
1.50
Dependant -2
Follower -1
Partner 0
Leader 1
Resister 2
Score
Score/min
Volume
Rhythmic
ground
Tonal and
melodic
Phrasing
Total
%
Leader
Leader
Partner
Partner
Partner
Partner
Partner
Partner
Partner
Partner
Partner
0
0
9
2
0
2
1,1
Leader
Leader
Partner
Partner
Partner
Leader
Leader
Leader
Leader
Leader
Follower
0
1
3
7
0
6
3,3
Leader
Leader
Leader
Partner
Leader
Leader
Leader
Partner
Partner
Leader
Follower
0
1
3
7
0
6
3,3
Leader
Leader
Partner
Partner
Leader
Leader
Leader
Leader
Leader
Leader
Follower
0
1
2
8
0
7
3,8
0
3
17
24
0
21
11,45
0,0
6,8
38,6
54,5
0,0
Preliminary results from cross over study
IAP - Autonomy subgroups pre/post
Autonomy in free improvisation IAP pre/post
100
3.5
90
Volume
3
80
Interpersonal Communication
Competence Scale (ICCS)
2.5
70
(Rubin and Martin, 1994)
The communication experts Rubin and Martin (1994) made a search for common understanding of
interpersonal communication competences and ended up with ten subgroups regarding interpersonal
interaction. Their work resulted in a 30 items questionnaire with a five point Likert type scale (Almost
always (5), often (4), sometimes(3), seldom (2), and almost never (1)). The ICCS subgroups are:
60
resister
50
leader
40
partner
follower
30
20
Self-disclosure
Being open and personal
Empathy
Feeling as, and with others
Social relaxation
Feeling relaxed with others and the ability to deal with their oddity without stress
Assertiveness
Express yourself and your point of view in an appropriate manner – plus the ability
to stand on ones rights
10
ICCS in daily life Client
90
ICCS in MT Client
85
Flexibility and attention to the others thoughts and nonverbal signals
75
Expressiveness
Verbal (finding the right words), nonverbal (facial expressions, prosody, gesture,
etc.)
65
Non judging, open, spontaneous and problem solving
55
ICCS in daily life Staff and relatives
ICCS in MT Therapist
70
ICCS in music Blinded Raters
60
Pre MT & Post MT &
Std. Rehab. Std.Rehab.
Immediacy
Eye contact, open body language, obligingness
Environmental
control
Ability to solve problems together with others and make others go for ones ideas
Phrasing
1
Post 20 MT sessions
12
95
Interaction
management
1.5
ICCS - Self disclosure results
100
80
Melodic
ground
Pre 20 MT sessions
Post 20 MT sessions
ICCS - Total score results
Negotiating subjects, taking turns, starting and ending
2
0
0
Alter centrism
Rhythmic
ground
0.5
Pre 20 MT sessions
Supportiveness
ICCS - Music therapist
proxy after assessment
Pre
Post
Std.Rehab. Std.Rehab.
Self disclosure in
daily life - client
11
10
Self disclosure in
MT - client
9
Self disclosure in
daily life - Staff
and relatives
Self dislclosure in
MT - Therapist
8
7
6
Self disclosure in
music - Blinded
raters
5
4
Pre MT & Post MT &
Std. Rehab. Std.Rehab.
Pre
Post
Std.Rehab. Std.Rehab.
References:
Høskoven
Trænings-, Bo-,
og Aktivitetshus
BAKER, F. & TAMPLIN, J. (2006) Music therapy methods in neurorehabilitation, London, Jessica Kingsley Publishers.
BARKER, V. L. & BRUNK, B. (1991) The Role of Creative Arts Group in the Treatment of Clients with Traumatic Brain Injury. Music therapy perspectives, 9, 26-31.
BRUSCIA, K. E. (1987) Improvisational models of music therapy, Springfield, Ill., Charles C. Thomas.
MORTON, M. V. & WEHMAN, P. (1995) Psychosocial and emotional sequelae of individuals with traumatic brain injury: a literature review and recommendations. Brain Injury, 9, 81-92.
NAYAK, S., WHEELER, B. L., SHIFLETT, S. C. & AGOSTINELLI, S. (2000) Effect of music therapy on mood and social interaction among individuals with acute traumatic brain injury and stroke. Rehabilitation Psycholog
PERETZ, I. & ZATORRE, R. J. (2005) Brain organization for music processing. Annu.Rev.Psychol, 56, 89-114.
PURDIE, H. (1997) Music Therapy with Adults who have Traumatic Brain Injury and Stroke. British Journal of music Therapy, 11, 45-50.
RUBIN, R. B. & MARTIN, M. M. (1994) Development of a Measure of Interpersonal Communication Competence. Communication Research Reports, 11, 33-44.
WIGRAM, T. (2004) Improvisation : methods and techniques for music therapy clinicians, educators, and students, London ; Philadelphia, J. Kingsley Publishers.
Søren Hald - Aalborg University - 2011
Interpersonal Communication
Competences (ICC)
Self-disclosure
(Rubin and Martin, 1994)
Being open and personal
Empathy
Feeling as, and with others
Social relaxation
Feeling relaxed with others and the ability to
deal with their oddity without stress
Assertiveness
Express yourself and your point of view in an
appropriate manner – plus the ability to stand
on ones rights
Alter centrism
Negotiating subjects, taking turns, starting and
ending
Interaction management
Flexibility and attention to the others thoughts
and nonverbal signals
Expressiveness
Verbal (finding the right words), nonverbal
(facial expressions, prosody, gesture, etc.)
Supportiveness
Non judging, open, spontaneous and problem
solving
Immediacy
Eye contact, open body language, obligingness
Environmental control
Ability to solve problems together with others
and make others go for ones ideas
Interpersonal communication competence questions
ICCS – ABI. version (adapted from ICCS - Proxy
Rubin and Martin (1994))
(¤=he/she, #=client name)
ICCS - Music therapist proxy after ICCS - Client after assessment
assessment
5 ALMOST ALWAYS, 4 OFTEN, 3
SOMETIMES, 2 SELDOM, and 1 ALMOST
NEVER
5 HIGEST, 4 GREATER, 3 MEDIUM, 2 LESS,
and 1 MINIMUM grade
5 ALMOST ALWAYS, 4 OFTEN, 3
SOMETIMES, 2 SELDOM, and 1 ALMOST
NEVER
Self-disclosure
ICCS- Music rater (improvisation)
5 HIGEST, 4 GREATER, 3 MEDIUM, 2 LESS, 5 ALMOST ALL, 4 A LOT, 3 SOME, 2 LITTLE,
and 1 MINIMUM grade
and 1 ALMOST NONE of the time.
Self disclosure in music
1
How often do you show friends who you
really are?
How often does # show friends who ¤
really is?
Did the clients music express who ¤ really Did your music express how you felt?
is?
Was the client’s music congruent with
body language? (free)
2
How often do you feel that you are
understood by others?
How often does # experience being
understood?
Did you ‘understand’ the client’s music?
Did you experience, that your music was
understood?
Did you experience clarity/focus in the
clients’ music? (dialog)
3
How often do you reveal to others how
you feel?
How often does # reveal to others how ¤
feels?
Did the client put emotions into the
music?
Did you put emotions into your music?
Did the client seem to reveal emotions in
the music? (free)
Empathy
Empathy in music
4
How often are you able to put yourself in
others’ shoes?
How often is # able to take the stance of
others?
Did the client understand the emotion the Did you understand the conditions the
therapist played?
therapist expressed in music?
5
How often do you have troubles
understanding others feelings? (R)
How often does # have troubles
understanding others feelings?(R)
Did the client have troubles understanding Did you have difficulties understanding the Did the client have difficulty matching the
the feelings the therapist played?
feelings that the therapist played? (R)
musical style of the therapist? (follow)
6
How often do others feel that you
understand them?
How often does # understand how you
feel?
Did the client make an effort to be
compassionate in the music?
Social relaxation
Did you make an effort to be
compassionate in the music?
Did the client match the rhythm of the
therapist? (follow)
Did the client give musical signals of
understanding (copy, mirror, develop)?
(dialog)
Social relaxation in music
7
How often is it comfortable for you, to be
together with others?
How often is it comfortable for #, to be
together with others?
Did the client seem comfortable playing
music together with you?
Were you comfortable playing music with Did the client seem comfortable?(free)
the therapist?
8
How often do you feel relaxed in small
groups?
How often does # seem relaxed in small
groups?
Did the client seem relaxed when you
played music together?
Did you feel relaxed playing music?
9
How often do you feel insecure when you How often does # feel insecure when in
are in groups of strangers? (R)
groups of strangers?(R)
Did the client seem insecure playing music Do you feel insecure when you play music Did the client seem insecure playing music
with a unfamiliar person?
with people you don’t know? (R)
with the therapist?(dialog)
Assertiveness
Assertiveness in music
Did the client seem relaxed in the shared
music making? (hold on)
10 When someone has wronged you, how
often would you confront the person?
When someone has wronged #, how often Did the client react musically on things
would ¤ confront the person?
that seemed to annoy in the music?
Did you react musically on things that
annoyed you in the music?
When the therapist was challenging in the
shared music, did the client maintain
playing phrase? (hold on)
11 How often do you have trouble standing
up for your rights? (R)
How often does # have trouble standing
up for own rights?((R)
Did you have difficulty in achieving
independence in the music? (R)
Did the client get affected musically by
challenging playing of the therapist?(R)
(hold on)
12 How often do you stand up for your
rights?
How often does # stand up for own rights? Did clients create own musical space?
Were you able to establish your own
musical space?
Did the client establish musical
independence? (hold on)
Altercentrism
Did the client have trouble being
independent in the music?
Altercentrism in music
13 How often are conversations about your
own topics? (R)
How often are conversations about #’s
topics? (R)
Did the client play more than listen?(R)
Did you play more than listen? (R)
Was the client primarily into own music?
(R)(diaog)
14 How often do you let others know that
you understand what they are saying?
How often does # let others know that ¤
understand what they say?
Did you and the client’s music
complement each other?
Did yours and the therapist music
complement each other?
Did the client’s music accompaniment/
relate to the therapist’s?(dialog)
Did you experience the client being
present when you played?
Did you have a sense of being present
while playing?
Did the client seem concentrated and
focused? (hold on)
15 How often does your mind wander during How often dos # mind wander during
conversations?
conversations?
Interaction Management
Interaction management in music
16 How do you shift from one topic to the
next without problems?
How often is shift of topic in #’s
conversations without problems?
17 In conversations, how often do you take
charge by negotiating talk topics?
How often is # involved in negotiating talk Did the client both give space and take
topics?
charge in the music?
18 How often would you estimate that you
How often does # perceive both what is
perceive both what is said and what is not said and what is not said?
said in conversations with friends?
Expressiveness
Was the client’s music flexible and varied? Was your music flexible and varied?
Did you notice something that were not
expressed in the music?
Did the client play in a flexible and varied
way?(dialog)
Did you both give space and take charge,
playing music?
Did the client develop ideas in the
music?(dialog)
Did you notice something that was not
expressed in the music?
Did the client respond to changes in the
music?(free)
Expressiveness in music
19 How often do your friends notice if you
are happy or sad?
How often is it apparent if # is happy or
sad?
Was it in the client’s music noticeable how Was it noticeable in your music how you
he/she feels?
feel?
Did the client’s musical expression seem
clear?(free)
20 How often is it hard for you to find the
right words to express yourself? (R)
How often is finding the right words hard
for #?(R)
Was it difficult for the client to musically
communicate and express how he/she
feels?(R)
Was it difficult to communicate and
express what you feel in the music? (R)
Did the client seem “stiff” in matching the
therapist’s music? (R)(follow)
21 How often do you experience being good
at expressing you self verbally?
How often do you experience # being
good verbally ?
Did you experience the client as being
good at musical expression?
Did you experience being good at
expressing yourself through music?
Did the client seem to be good at
expressing him/her self musically?(follow)
Supportiveness
Supportiveness in music
22 How often is your communication
kindhearted – not evaluative?
How often does # respond kindhearted
(supportive) – not evaluative?
Did the client support the musical ideas of Did you follow the musical ideas of the
the therapist?
therapist?
Did the client’s music relate to the musical
output of therapist?(free)
23 How often do you make an effort to be
equal with others?
How often does # make an effort to be
equal with others?
Did you and the client maintain an equal
relationship?
Did you and the therapist maintain an
equal relationship?
Did the client intend to keep an equal
supporting relationship in their music
making?(free)
24 How often would others describe you as
warm and loving?
How often would you describe # as warm
and loving person?
Did you sense compassion and warmth in
the clients music?
Do you think that the therapist sensed
compassion and warmth in your music?
Did you experience a feeling of
interpersonal warmth coming from the
client?(free)
Do you think the therapist felt your care?
Did the client seem willing to participate in
the improvisation?(follow)
Immediacy
Immediacy in music
25 How often do your friends feel that you
care about them?
How often do you experience that # care
about you?
Did you feel the clients care?
26 How often do you try to look others in
their eyes when you talk to them?
How often does # try to look into your
eyes when you talk?
Did the client adapt his/her music to music Did you adapt your music to the music of
of the therapist?
the therapist?
Did the client look at the therapist?
(follow)
Did you experience immediacy from the
client?
Did you experience immediacy towards
the therapist?
Did the client seem attentive to the music
of the therapist?(free)
Did you express what you wanted in the
music?
Did the client seem satisfied with own
musical output?(Dialog)
Did the therapist pick up and use the
client’s musical ideas?(dialog)
27 How often do you tell others that you feel How often does # tell other that he feel
close to them?
close to them?
Environmental control
Environmental control in music
28 How often do you feel that you accomplish How often do you experience that #
what you want to in your conversations? communicate what ¤ wants?
Did the client express what he wanted in
the music?
29 How often can you persuade others to
your position?
How often can # persuade other to his/her Did the client influence the therapist to
position?
follow musical ideas?
Were you able to draw the therapist into
your musical ideas?
30 How often do you have difficulties
convincing others to do what you want
them to do? (R)
How often does # have problems
convincing others to do what # them to
do? (R)
Was it difficulty to draw the therapist into Did the client have difficulties signaling
your musical space?(R)
his/hers intentions? (R)(dialog)
Did the client have problems drawing the
therapist into own musical space
Søren Hald - Aalborg University - 2011
Søren Hald - Aalborg
University - 2011