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What is Neurologic Music Therapy®?

The Neurologic Music Therapy® (NMT™) System of Techniques is a standardized evidence-based clinical treatment system of 20 techniques that is driven by advances in applied auditory music neuroscience and the clinical understanding of music perception, production, and cognition.

 

The NMT™ System targets specific functional behaviours in the areas of cognition, sensorimotor, and speech and language based on a client’s diagnostics and treatment goals. The NMT™ system provides structured music-based exercises that are not only relevant to NMT™ music therapists but exemplify how music can be integrated into intervention practices for all allied healthcare professionals, in the disciplines such as physical therapy, occupational therapy, neuropsychology, and speech-language pathology.

 

The Transformational Design Model (TDM)™ is the clinical model that guides the selection of NMT™ technique based on client diagnostics, functional assessment, client long-term goals and short-term objectives, and the understanding of overlapping parallel mechanisms between the non-musical behaviour and the musical translation.

Frequently Asked Questions

NMT™ works on functional non-musical goals through structured musical exercises in a variety of in-person and Telehealth settings, including:

  • neurologic rehabilitation
  • neuropediatric
  • neuropsychiatric
  • neurodevelopmental

NMT™ Professionals often work in conjunction with other allied healthcare professionals in order to address rehabilitative, adaptive, and developmental goals. Allied Professionals who have taken the NMT™ training may also use the principles and NMT™ techniques within their own professional scope of practice.

The NMT™ Techniques are implemented by NMT™ Professionals who have received advanced professional training through the Academy of Neurologic Music Therapy® and have completed and maintained the professional affiliation license requirements. Professional Affiliation categories define representation, responsibility, and the level of expertise and engagement in the advance practice of NMT™ and include both music therapists and allied health care professions. All Neurologic Music Therapy (NMT)® training and designations must be acquired directly through the Academy of Neurologic Music Therapy®. There are no training or certification programs outside of the Academy that grant licensed permission to use the NMT™ designation or NMT™ System of Techniques.

Communities served by NMT™ include, but are not limited to:

  • Acquired brain injuries
  • Movement disorders
  • Developmental disorders and Autism Spectrum disorder
  • Mental health populations
  • Alzheimer’s disease and other related dementia

Click here to read more about how NMT™ serves each of these communities.  

NMT™ Professional Affiliates can be found working in 67 countries around the world. The Academy of Neurologic Music Therapy® maintains a directory with all current NMT™ Professional Affiliates. You can also make a request for specific NMT™ services.

 

The principles of Neurologic Music Therapy® are of exceptional value and warrant protection. To uphold and maintain best practices of the Neurologic Music Therapy® (NMT™) System of Standardized Techniques, safeguard both the consumers of NMT™ and the public at large, and to preserve and protect the integrity of NMT™ for future generations, NMT™ professional affiliates must maintain the terms and conditions of the license and professional affiliation program. If you have any concerns about misuse or misrepresentation of Neurologic Music Therapy®, please reach out to ethics@nmtacademy.co.

The Neurologic Music Therapy® System of Standardized Techniques Organized by Domain

Sensorimotor Techniques

Rhythmic Auditory Stimulation (RAS)® is a technique of rhythmic motor cuing to facilitate training of movements that is intrinsically and biologically rhythmical. In humans, the most important type of these movements is gait. Therefore, RAS™ is almost exclusively used for gait rehabilitation. It uses rhythmic cues in 2/4 or 4/4 meter, presented either as pure metronome beats or as strongly accentuated beats in complete musical patterns, to cue gait parameters such as step cadence, stride length, velocity, symmetry of stride length and stride duration, and double and single support time of leg stance.

Patterned Sensory Enhancement (PSE)® is a technique which uses the rhythmic, melodic, harmonic and dynamic-acoustical elements of music to provide temporal, spatial, and force cues for movements which reflects functional movements of daily life activities, or the fundamental motor patterns underlying these activities. PSE™ is applied to movements that are not rhythmical by nature (e.g., most arm and hand movements, functional movement sequences such as dressing or sit-to-stand transfers). PSE™ uses musical patterns to assemble single, discrete motions (e.g., arm and hand movements during reaching and grasping), into functional movement patterns and sequences. During a PSE™ exercise, the temporal, spatial, and muscular dynamics of a movement are trained through musical gestalt patterns which enhance and regulate the performance of the movement parameters. PSE™ is often used to work toward goals to increase physical strength and endurance improve balance, posture, improve coordination, increase range of motion, and address functional motor skills of the upper and lower limbs (Thaut, 2014). PSE™ addresses the facilitation of both simple movement patterns and complex movement sequences which consist of several discrete movements. These two aspects of PSE™ are often referred to as exercise PSE™ and functional sequence PSE™.

Therapeutic Instrumental Music Performance (TIMP)® uses playing of musical instruments to exercise and simulate functional movement patterns in motor therapy. Musical instruments and spatial configuration of instruments and motor patterns for playing are selected on the basis of functional considerations to train appropriate ranges of motion, endurance, strength, limb coordination, and functional movements entailing finger dexterity, grasp, flexion/extension, adduction/abduction, rotation, supination/pronation, etc.

Speech and Language Techniques

Melodic Intonation Therapy (MIT)™ is a therapy technique using melodic and rhythmic elements of intoning (singing) phrases and words  to assist in language recovery for patients with aphasia. Functional phases or brief statements/utterances are sung or intoned by the patients whereby the musical prosody should be modeled closely to the normal speech inflection patterns of the verbal utterance. The basic rationale for MIT™ emphasizes the use of rhythmic- musical elements to engage language-capable regions of the undamaged right hemisphere. MIT™ was developed by a group of neurologic researchers in the early 1970s (Albert et al., 1973; Sparks et al 1974; Sparks & Holland, 1976) and has been continually further developed and adapted (Helm-Estabrooks & Albert, 2004).

Musical Speech Stimulation (MUSTIM)™ is a Neurologic Music Therapy® (NMT™) technique for non-fluent aphasia, that utilizes musical materials such as songs, rhymes, chants, and musical phrases to simulate prosodic speech gestures and trigger automatic speech (Thaut 2005). In many patients with aphasia, non-propositional reflexive speech is still in tack, and over-learned musical phrases or songs can be used to stimulate spontaneous speech output. MUSTIM™ is an appropriate technique selection for patients who do not meet the criteria of a good candidate for Melodic Intonation Therapy (MIT)™ due to decreased cognition or dementia related primary progressive aphasia. MUSTIM™ can also be an appropriate technique for a patient who is beginning to show increased functional language after MIT™ in order to increase spontaneous output of non-propositional speech.

Rhythmic Speech Cuing (RSC)® is a rate-control technique that uses auditory rhythm (metronome form or embedded in music) to cue speech. The impelling and anticipatory action of a rhythmic stimulus sequence can also help to initiate speech. RSC™ has been shown to be effective in fluency disorder rehabilitation for stuttering and cluttering, in rate control to enhance intelligibility in dysarthric patients, and in facilitating rhythm sequencing in apraxia.

Vocal Intonation Therapy (VIT)® is the use of vocal exercises to train, maintain, develop, and rehabilitate aspects of voice control due to structural, neurological, physiological, psychological, or functional abnormalities of the voice apparatus. This includes aspects of vocal control such as: inflection, pitch, breath control, timbre, and dynamics. Many exercises implemented in VIT™ are designed similarly to those that a choir director, voice teacher, or trained vocalist would use to warm up and practice vocal control. Therapeutic applications of VIT™ may also include relaxation exercises incorporating the head, neck, or upper trunk and diaphragmatic breathing (Thaut, 2005).

Therapeutic Singing (TS)™ in the Neurologic Music Therapy® (NMT™) system of techniques refers to the generalized use of singing tasks for a wide range of therapeutic objectives (Thaut, 2005). TS™ is not a one-dimensional task, but a holistic process that targets multiple vocal subsystems at a time (e.g., respiratory, phonatory, resonatory, articulatory). It can be further conceptualized as an integrative approach to speech and language rehabilitation that can synthesize goals previously worked on in neurologic music therapy (e.g., Rhythmic Speech Cuing (RSC)®; Oral Motor and Respiratory Exercises (OMREX)™; and Vocal Intonation Therapy (VIT)®).

Oral Motor and Respiratory Exercises (OMREX)™ is a Neurologic Music Therapy® (NMT™) technique that uses musical materials and exercises, mainly through sound vocalization and wind instrument playing, to enhance articulatory control and respiratory strength and function of the speech apparatus. These techniques may be applied in developmental disorders, dysarthria, muscular dystrophy, and other disorders affecting speech motor control and respiratory function.

Developmental Speech and Language Training Through Music (DSLM)® is the specific use of developmentally appropriate musical materials and experiences to enhance speech and language development through singing, chanting, playing musical instruments, and combining music, speech and movement (Thaut, 2005). DSLM™ interventions may target the development of appropriate use of speech sounds, words, or non-verbal augmentative devices; vocabulary development; pragmatics of speech; classification and discrimination (e.g., colors, shapes, numbers, prepositional location, etc.); or educational concepts (beginning reading, math, etc.)

Symbolic Communication Training through Music (SYCOM)™ is a technique in Neurologic Music Therapy® (NMT™) which utilizes music performance exercises to simulate and train appropriate communication behaviors, language pragmatics, speech gestures, and emotional expression through a nonverbal ‘language’ system. SYCOM™ exercises are designed for patients with a severe loss or impairment of expressive and/or receptive language (i.e., after a brain injury or stroke), or for patients with dysfunctional or a complete lack of development of functional language. SYCOM™ exercises simulate and practice rules of communication through musical exercises such as structured instrumental or vocal improvisation. These exercises can effectively be used to train structural communication behavior such as dialoguing, using questions and answers, listening and responding, appropriate speech gestures, appropriate timing of initiation and responding, initiating and terminating communication, appropriate recognition of a message being communicated, and other communication structures in social interaction patterns in real time.

Cognitive Techniques

Level 1-Sensory Stimulation
Level 2-Arousal Orientation
Level 3-Vigilance and Attention Maintenance

MSOT™ is a technique that uses live or recorded music to stimulate arousal and recovery of wake states and to facilitate meaningful responsiveness and orientation to time, place, and person. In more advanced recovery or developmental stages, active engagement in simple musical exercises increases vigilance and trains basic attention maintenance with emphasis on quantity rather than quality of response. It includes sensory stimulation, arousal orientation, and vigilance and attention maintenance. 

Musical Neglect Training (MNT)® is a technique which involves active performance exercises on musical instruments that are structured in time, tempo, and rhythm, and is in appropriate spatial configurations, to focus attention to a neglected or unattended visual field. A second application type consists of receptive music listening to stimulate hemispheric brain arousal while engaging in exercises addressing visual neglect or inattention.

Musical Attention Control Training (MACT)™ is a Neurologic Music Therapy® (NMT™) that includes structured active or receptive musical exercises involving pre-composed performance or improvisation in which musical elements cue different musical responses to practice focused, sustained, selective, divided, and alternating attention functions.

Level 1- Auditory Perception
Level 2-Sensory Integration

Auditory perception training (APT)™ focuses on auditory perception and sensory integration. It consists of two sub-techniques. The core of APT™ is composed of musical exercises that help to identify, discriminate, and improve one’s acuity in the perception of different components of sound such as time, tempo, duration, pitch, rhythmic patterns, and speech sounds. The sensory integration subtechnique of APT™ has two aims. One set of music-based exercises focuses on augmenting auditory perception through additional sensory channels, (e.g., tactile vibratory in hearing impairment). The second exercise component addresses challenges in the integration and coordination of auditory perception with other sensory modalities (e.g., auditory and visual or auditory and vestibular).

Musical mnemonics training (MMT)™ uses music as a mnemonic device to sequence and organize information and add meaning, pleasure, emotion, and motivation in order to enhance the person’s ability to learn and recall the information involved (Thaut, 2005). MMT uses rhythms, songs, rhymes, chants, etc. to enrich learning and to increase our chances of successful remembering.

Associative Mood and Memory Training (AMMT)™ uses musical mood induction techniques are used a)to produce mood-congruent mood states to facilitate memory recall, b) to access associative mood and memory networks to direct specific memory access, and c) to enhance learning and memory function through inducing positive emotional states in the learning and recall process.

Musical Executive Function Training (MEFT)® includes improvisation and composition exercises presented individually or in groups to practice executive function skills such as organization, problem solving, decision making, reasoning, and comprehension. The musical context provides important therapeutic elements, such as performance products in real time, temporal structure, creative process, affective content, sensory structure, or social interaction patterns.

MPC™ is a Neurologic Music Therapy® (NMT™) technique which uses active and receptive music-based interventions to facilitate and improve psychosocial functioning by addressing therapeutic needs surrounding mood control, affective expression, cognitive coherence, reality orientation, and appropriate social interaction. Therapeutic exercises used in MPC™ are based on models derived from affect modification, associative network theory of mood and memory, social learning theory, classical and operant conditioning, and mood vectoring/isoprinciple techniques and may include musical performance, guided music listening, musical role playing, and expressive improvisation or composition exercises to address therapeutic goals (Thaut, 2014). Interventions in MPC™ can be designed for individuals, specific groups or whole populations.

i. Mood Induction and Mood Vectoring
ii. Cognitive Reorientation
iii. Affective Behavior Training
iv. Social Competence Training
v. Musical Incentive Training for Behavior Modification

Musical Echoic Memory (MEM)™ training uses immediate recall of musical sounds presented by singing, instrumental playing, or recorded music to retrain echoic memory.
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