Should we be using music therapy for gait training in persons who have had an acquired brain injury? How about music therapy for arm function, speech production, emotional adjustment? A recent Cochrane Review has shown which of these has more evidence supporting use in clinical practice.
The results of this Cochrane Review by Bradt et al. 2010 showed that Rhythmic Auditory Stimulation may be beneficial for gait improvements in persons who have had a stroke. However, the authors state that more Randomized Control Trials are needed to inform clinical practice. The RAS review included seven studies with a total of 184 participants. There were not enough qualified studies in any other areas of functioning to complete a review of effectiveness (cognition, arm rehabilitation, etc…).
What does this mean for the clinician? We have a good start with RAS literature, with indications that RAS may improve gait in persons who have had a stroke. Those of you who have recently attended a NMT training have seen a lot of this research and have learned how to implement RAS. More research is needed before any such claims can be made for music therapy treatment for other functional areas.
Note on CR Articles: The clinician with limited time can easily read abstracts on the CR website in order to get excellent research updates. Reviews include high-quality research (usually RCT and quasi-RCT) and the authors take an honest look at the extant literature. If you choose to purchase access to the review you can read the entire review including a listing of studies included in the review, the authors in-depth review of the different articles, their clinical recommendations, and research recommendations. You can also go to the CR website and just search articles on any given topic and read the abstracts for free.
References:
Bradt J, Magee WL, Dileo C, Wheeler BL, McGilloway E. Music therapy for acquired brain injury. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD006787. DOI: 10.1002/14651858.CD006787.pub2.
Good review and good note about checking out the Cochrane Review abstracts. It is much harder for clinicians who are not affiliated with a university to get access to research articles. In response to your comment about needing more research in the areas other than gait, I tend to say that there is some research to suggest that music therapy is beneficial for these areas. Then, if you take standardized measures AND document functional changes, it becomes pretty clear whether you are making a difference or not. I feel it is our ethical duty to only continue therapy if it is working, and on the flip side, we can’t wait until there are plenty of RCT on every technique in order to apply something which will likely help a patient. If you can get enough research to suggest it may be helpful, and then get measurable change in the clinic, then you have evidence that the application is beneficial for the client.
Completely agreed, Sarah. I think we just have to be careful about saying we are using “best-practice” or that a technique is “evidence-based” when we don’t have the research to backup what we are doing. The CR article took an in-depth look at the arm studies, cognitive studies, and emotional studies (RCT and quasi-RCT) and showed that there wasn’t enough research to even do an analysis. While I agree that we can’t sit around waiting for RCT to appear, I think it is our ethical duty to really look at the studies available to see if there is research support for what we are doing before we call it “evidence-based”.
If you are using standardized non-musical measures in the clinic this is a nice way to show treatment efficacy; however, that alone does not constitute as an evidence-base. If you fine research to support what you are doing then, yes, this is a step toward EBP. The question is – did you find studies showing it didn’t work as well? Were those weighed against the “pro” studies. Do the “pro” studies have enough participants to be considered generalizable? We are a new profession, so this process will take awhile…
Oh, and THANK YOU for your comment!