A-Z List

Head Injury

Goals & Methods

Closed head injury patients have a variety of needs to be met on their way to recovery. Because the damage that is caused by a head injury varies so much from patient to patient, careful evaluations must be made before deciding on a therapeutic plan. Patients health should be evaluated in all of the following areas.

  1. Ability to communicate
  2. Cognitive abilities/memory
  3. Physical strength and abilities
  4. Emotional/social/spiritual well-being

Most likely, the patient will need some work in all of the areas listed above. Music Therapy is a very successful tool to use with the head injured patient in every area.

This paper will break down these four areas and give examples of Music Therapy activities that could be used to address these concerns.

1.  Ability to communicate.

Nonverbal Communication is one of the first goals to be met by the patient. This type of communication can range from simple eye contact, to smiling, to using gestures. The goal of the therapist is to do their best to initiate contact with the patient. Singing or playing a song with deep emotional meaning for the patient, can be an effective way to do this. It is very important for the therapist to speak with family and friends in order to find the most familiar songs to the patients. Once the patient is responding, less intense, less emotional songs should be used.

Verbal Communication
is the next goal to be reached by the patient. This may not be speaking. Even a moan or a grunt should be praised in the beginning. There are several different methods used in Music Therapy to establish successful verbal communication. Listed below is a helpful article and examples of activities that can be used.

2. Cognitive Abilities/Memory

Cognitive Abilities/Memory are often a struggle for head injured patients. The patient may be confused and have trouble performing everyday tasks. It is important to work on understanding of both concrete ideas and also abstract ones.
Concrete concepts and ideas can be worked on by teaching the patient songs that have repetition and basic ideas. Songs for simple tasks such as dressing and hygiene are helpful to patients who have trouble with sequencing. Songs that use "First we…..second we….then we…." Etc. help to keep confusion to a minimum and are easier for the patient to remember than simple verbal commands.
Abstract ideas are another important area that should be addressed. Patients and therapists can write songs together to help with this area. For example, a therapist can begin the song by saying someone has a problem and asking the patient, "what are they going to do?" This can be an enjoyable way for the patient to begin to grasp larger concepts.

3. Physical Strength and Abilities

Fine Motor Skills are often lost or decreased after a head injury. The goal’s when working in this area are to improve grasp, to use thumb and finger in opposition, independent finger movement and wrist rotation. Methods involve using different types of instruments to meet these goals.

Cymbals and mallets that are specially made with big knobs are helpful when first beginning this therapy. Therapist’s should record improvement and, with time, change the instruments to sizes that are more difficult to grasp. It is important to keep challenging the patient so that he/she will have the chance to improve as much as possible.
Wrist rotation, flexion and extension can all be worked on using maracas or tambourines.

Gross Motor Skills include those of walking and making large movements with<be> the arms. Many head injured patients face the challenge of learning to walk all over again. Michael Thaut has done extensive study on the effect of a steady beat on persons with gait disorders. His findings show that a steady rhythmic pulse, alone, helps hip and shoulder alignment and eveness of steps.

An activity that can be used for upper body motor skills needs to be done in a group. Music is played by the therapist, or a recording and patients sit in a circle with a parachute. A beach ball is place in the center and the goal is to not let it fall to the ground, while keeping the parachute going up and down in time with the music. This is not only good for upper body strength, but provides an enjoyable group activity.

Respiratory Functioning is important to maintain for patients who have little chance to leave their beds. There are four areas that should be addressed: inspiratory/expiratory, peak flow, vital capacity and total lung volume. Music Therapy is an excellent way to improve these areas.

There are many musical activities that improve respiratory functioning. The most obvious is singing. This can be paired with many other therapeutic activities, such as speech. Simple hissing sounds to familiar rhythms of songs helps to increase breath support. Harmonica playing is also very effective. Since a harmonica makes sound both when releasing air and when taking it in, the patient is able to work on inspiratory and expiratory problems.

4. Emotional/Social/Spritual well-being

While communication, cognitive abilities, and physical abilities are of extreme importance to the recovering head injury patient, the emotional aspects of recovery should never be ignored. This well-being may be what "pulls the patient through." It may be what gives them the will to go on. Music with all of its sensitivity and power to touch emotions and bring happiness to even the worst situations, can help to make recovery a more pleasant experience.

Expressing Emotions is something that patients often struggle with. Songwriting can be an effectiveway for a patient to do just that, in a non-threatening way. The patient and therapist can together write completely new songs about the patients experience and how he/she feels, or they may choose to incorporate a "fill-in-the-blank" format. This is also a good way for the therapist to keep a record of how the patient is improving cognitively. By bring the same song back several times during the time the patient is being treated, the therapist will be able to see improvements through what the patient has written in the blanks.

Social Interaction is something that patients often have little chance to participate in. Musical sing-alongs or concerts given by patients within a hospital are a perfect opportunity for this interaction. Music has the power to bring joy and possibly even humor to a usually depressing situation.

Spiritual well-being is a concern that many patients have a need to address. Many patients begin to look at life in a different way after their injury. They may be frightened, awakened or angry about their experience. Patients with religious beliefs will often find comfort in religious songs and ceremonies. Other patients will find that music is an excellent aid in relaxation.