Nearly two months after receiving a gunshot that passed through the left side of her brain and left many fearing the worst, Arizona Rep. Gabrielle Giffords is reported to be making steady progress, thanks in large part to music therapy.
According to the Houston Chronicle, Giffords has managed to mouth the words to "Twinkle, Twinkle, Little Star" and even sang "Happy Birthday" to her husband, astronaut Mark Kelly.
"Music can be applied as treatment to any kind of population with any kind of deficit or diagnosis," depending on how well a patient is assessed, said Dori Berger, a Norwalk, Conn.-based music therapist and founder of The Music Therapy Clinic.
Berger has worked with a variety of patients, including trauma victims like Giffords, children with autism and a patient suffering from multiple personality disorder. Through the careful application of the six elements of music - timbre, melody, rhythm, dynamics, form and harmony - music can be clinically applied to neurological and cognitive disorders, said Berger.
"It's not like I can say, go listen to Mozart and you'll feel better because you might not. First I have to find out who you are, what you're all about, what you like, what you don't like and then I can say to you, you need 45 minutes a week of simple drumming," Berger said.
For an autistic child who has inefficient upper and lower body coordination, simultaneous marching and drumming could directly address the abnormality, for example.
In Giffords' case, music therapy is one of a number of rehabilitation therapies she's receiving. Having a music therapist on board to help with treatment could bridge gaps other therapies may not be able to help, according to Connie Tomaino of New York's Institute for Music and Neurological Function.
"Hopefully the music therapist is working as part of an integrated team because each discipline has a certain way it addresses the rehabilitation goals and sometimes their approach may work in some respects very well, but in other respects, they may get stuck or the person may not be as responsive," Tomaino said.
While physical, occupation and speech therapy can require a certain level of understanding or ability on the part of the patient to execute complicated, multitask steps, music therapy can accomplish some of the same goals in a different, less intimidating way.
Tomaino gave the example of a patient being asked to form a sequential pattern with pegs. If each peg made a different tone, the patient could follow the tones, not only accomplishing the task but also engaging the brain in more ways.
"I think many times, all these therapists may work in isolation and not attain the full benefit of what the therapies can be, especially for music therapy. If their music therapist is just brought in as a consultant or working independently on the outside with the patient, they many not get the full benefit," Tomaino said.
More often than not, music therapy is interactive rather than simply receptive. Berger leans towards this approach.
"The auditory and the motor cortices are very close together, so the auditory immediately influences the motor. So even if in a patient that is totally paraplegic, that absolutely cannot move, I will try to stimulate that motor cortex by moving the arms," Berger said.
"The interactive music therapy becomes essential when the person's traumatic brain injury or autism or whatever the problem is needs the fine-tuning of the music in the moment to allow for maximal response. Without that interaction, that achievement may not take place," Tomaino said.
Though studies have shown that music therapy is effective, many critics still consider it an alternative form of treatment that needs more evidence to really prove its value. Misconceptions have challenged therapists for years.
"It's a big issue and I'm dealing with it every day," said Tomaino. "People need to understand that they can't put a generalization on the field of music therapy based on observing one or two music therapists or looking at a body of work that represents such broad possible applications."
She estimates there are about five thousand music therapists nationwide but said the relatively limited number of therapists has made it difficult for large-scale studies to be conducted, though the research that has been done has shown "incredible efficacy".
Berger has even started using the term "music clinician" instead of "music therapist" to distance the practice from its "soft" reputation.
"I'm personally trying to move away from the term ‘music therapy' because that sounds very passive. We're going to pat your back and make you feel good. It's beyond just feeling warm fuzzies," said Berger.
Music's reputation for being a recreational pursuit has hurt music therapy, in some ways.
"Everybody has an iPod. Everybody on the planet has music coming to them so where do we separate music when it's clinically applied, to music because we're romantic and because music is entertainment, music therapy is tended to be looked at as being more pacifying than a specific goal-oriented application of the elements inherent in music," Berger said.
Tomaino agreed. "I think people just see somebody playing the guitar and think, ‘Ah, this can't be science.' That's our challenge, but when they look at the science behind it and the intricacies of how much of the brain is involved and how much it dovetails and parallels and supports other aspects of functions, that's where the true essence of what music therapy can do is."