“Any Dream Will Do” Special Needs Performing Arts presents You Can’t Stop the Beat: Broadway in 3 Acts

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ALPHARETTA, GA - April 18, 2019 - 20 teens with various neurologic, developmental, and learning differences will be presenting a staged performance of 3 musical theatre vignettes on Friday, April 26that 7:00PM, at the Alpharetta High School Auditorium in Alpharetta, Georgia. The performance is free and open to the public and press. The show will feature singing, dancing, and acting in both solo and group performances through highlights of three classic musicals: West Side Story, Pippin and Hairspray

The Any Dream Will Do Special Needs Performing Arts Group meets weekly throughout the school year in Roswell, GA. The group includes teens from Fulton, Forsyth, and Cherokee Counties and is a one-of-a-kind opportunity for these adolescents, who share a common love of music, dancing and theatre. It’s also a wonderful opportunity for performer’s families to celebrate their children’s access to the performing arts. “Any Dream Will Do” is directed by Jamie George, MM, LPMT, MT-BC with the assistance of nine other licensed and board-certified music therapists and community volunteers.

“It has always been a dream of mine to bring together the two of my passions, musical theatre and music therapy. This program is an incredible way to create community and facilitate individual growth by teaching our participants about music, movement, and acting through social games and interactions, improvisation, and the expressive arts. I could not be prouder of their accomplishments,” says Jamie George, Founder and Director of The George Center.

“Any Dream Will Do” is celebrating its 7th annual performance and is sponsored by The George Center Foundation and The Fulton County School Music Therapy Department.

 

About The George Center

From one-on-one therapy to full service music therapy programs for healthcare and educational facilities, The George Center has got Atlanta covered. With 3 convenient locations in Roswell, Cumming, and Norcross we are relentlessly, tenaciously, and passionately pursuing our mission to improve access to music therapy right here in Atlanta. Music therapists use music-based interventions to address individualized goals for their clients.  The George Center Foundation is a 501(c)3 tax exempt organization that provides scholarships to families, organizations, and programs who are not able to pay for music therapy services for those in need. 

 

About the Fulton County School Music Therapy Department

In 1991, the Fulton County School System created its music therapy program with a single music therapist. Now, Fulton County has fourteen music therapists working with thousands of students system-wide. In 1998, the county became an approved American Music Therapy Association National Roster internship site. The music therapy program is funded and supported through the music department. The music therapy department proudly supports the Fulton County School System’s mission to educate students to be responsible, productive citizens who through continuous learning will be able to adapt to an ever-changing, global society.

 

***All participants have audio/visual releases on file. Photos for public use attached.

 

For further information, please contact:

Jamie George, MM, LPMT, MT-BC

The George Center

Phone: 347-351-2703

jamie@thegeorgecenter.com

www.thegeorgecenter.com

 

The Autism Spectrum: A Changing Perspective

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Within the world of music therapy, behavioral, social, and communication needs in autism spectrum disorder have often been the focus of research and treatment. Sensory needs have been briefly studied, but not to the level of these other goal domains. However, as the understanding of autism is constantly evolving, it is important to keep up to date with new information and understand the shift in perspective from a social-behavioral disorder to a neurological disorder with underlying sensorimotor deficits that must be addressed first before significant progress can be made in other goal domains. So while we know all of these goals are important to work on, we are beginning to see that sensory processing and motor planning deficits may be the underlying factors contributing to the behavioral, social, and communication challenges that these individuals experience (Hardy & LaGasse, 2013). 

Sensory processing and integration deficits are present in individuals on the autism spectrum (American Psychiatric Association [APA], 2013), and manifest as sensory-seeking and sensory-avoiding behaviors (Baranek, et al., 2007; Baranek, et al., 2006). Deficits in sensory integration are more generally referred to as sensory dysfunction (Ayres, 1972). Sensory dysfunction refers to the inability to organize sensory input from the environment and one’s own body in an adaptive manner that allows one to respond to and navigate within the environment effectively. Research suggests that sensory dysfunction is prevalent in at least 70% of individuals on the spectrum (Adamson, O’Hare, & Graham, 2006; Greenspan & Wieder, 1997; Mayes & Calhoun, 1999; Tomchek & Dunn, 2007). Furthermore, study results indicate that individuals on the spectrum may present with a dysfunction in integrating proprioceptive input specifically (Blanche, Reinoso, Chang, & Bodison, 2012).

Research cites that sensory dysfunction present in individuals on the spectrum may be due to cerebellar differences (Allen & Courchegne, 2003). The cerebellum is involved in processing sensory input—including proprioceptive input— and appropriately modulating responses. However, while cerebellar differences in ASD are present, rhythmic synchronization abilities have shown to be unaffected in children and adults with cerebellar abnormalities (Molinari et al., 2005).

As rhythm is processed within the cerebellum, and auditory feedback from the environment can be utilized to aid in proprioceptive muscular control (Thaut, Kenyon, Schauer, & McIntosh, 1999), intact rhythm processing functions can have implications on sensory integration. Furthermore, auditory and proprioceptive input may work together to optimize sensory integration.

Research illustrates that the cerebellum is cited as a primary neural structure involved in proprioception and rhythm processing, thus implying that proprioceptive input and rhythmic stimuli can be utilized to target activation within the cerebellum. The presentation of multi-sensory input—specifically, the combination of tactile and proprioceptive input—that relies on similar neural regions has resulted in heightened neural responses (Kavounoudias et al., 2008). Thus, the combination of proprioceptive input with rhythmic stimuli, both processed in similar neural regions, could enhance neural processing of such stimuli (Bruce, Desimone, & Gross, 1981; Downar et al., 2000; Kavounoudias et al., 2008; Macaluso & Driver 2001). Additional studies have suggested that combining proprioceptive and rhythmic input promotes and optimizes sensory integration by appealing to multiple perceptual channels within the cerebral cortex (Bruce, Desimone, & Gross, 1981; Downar et al., 2000;  Kavounoudias et al., 2008; Macaluso & Driver 2001; Thaut, 1984). In other words, as evidence suggests that proprioceptive input and rhythmic stimuli improve self-regulation and neural processing, these stimuli in combination may have positive effects on sensory integration.

Thus, music therapists have an integral tool to their disposal that may be the key to improving sensory integration in individuals with ASD: rhythm. Rhythmic auditory stimuli may influence how other stimuli are perceived and integrated, which can ultimately assist in one being able to modulate adaptive responses (Ayres, 1972; James et al., 1985).

 Currently, not much research exists examining the combined effects of rhythmic auditory stimuli with other sensory input to enhance sensory integration in individuals with ASD. I had the pleasure of utilizing the aforementioned research studies as a theoretical framework for my master’s thesis, which examined the effects of rhythmic proprioceptive input on sensory integration and attention in children with autism spectrum disorder.

Two randomized groups with ASD— one receiving a protocol integrating rhythmic auditory stimuli with proprioceptive input via bouncing on a therapy ball in rhythm to music with physical assistance from the therapist (rhythmic proprioceptive input) and one receiving proprioceptive input alone without an auditory or physical cue— were compared on visual and auditory sustained and selective attention outcomes post intervention. The rhythmic proprioceptive input group performed better than the proprioceptive input group on all assessments and significantly better on visual sustained attention measures. While further research is needed to support the effects of this intervention, initial evidence supports rhythms role in conjunction with proprioceptive input to support sensory integration and attention. Rhythm may provide a structure via an organized temporal stimulus to enhance cognitive focus, create a sense of expectation, and provide an additional layer of sensory stimulation that further engages the cerebellum and enhances sensory integration (Lockhart, 2017).

I want to make sure to emphasize that more research is needed, but preliminary evidence supports the use of rhythmic auditory stimuli to enhance sensory integration. However, that does not mean we can’t translate current evidence into music therapy practice. Utilizing what we know, music therapists can assist in sensory integration by providing interventions which incorporate multi-sensory input, and in particular, utilize rhythm as the underlying foundational framework. Within a music therapy intervention, this could involve bouncing or rolling on a therapy ball, providing deep pressure via body mapping, or utilizing any other movement or motor planning intervention combined with rhythmic auditory stimuli in the form of a metronome or appropriate live or recorded music. Rhythmic structures that are repetitive and simple, utilizing mostly binary forms and minimum syncopation, and utilize the same meter and similar tempos throughout the intervention have currently proven to be most beneficial (Hardy & LaGasse, 2013; Hardy, 2016; Kalas, 2012; Molinari, Leggio, & Thaut, 2007; Stevens & Byron, 2009; Thaut, Kenyon, Schauer, & McIntosh, 1999).

 With all the new and ever changing autism research out there, music therapists working with this population should make sure they keep up with current research and most importantly, be thoughtful of the sensory seeking behaviors they observe in their clients on the autism spectrum. These behaviors serve a purpose, and rather than stopping a client from stemming, be creative and think of ways that you can optimize the sensory integration experience in a functional, adaptive manner.  

References

Adamson, A., O’Hare, A., & Graham, C. (2006). Impairments in sensory modulation in children with autistic spectrum disorder. British Journal of Occupational Therapy, 69, 357-364

Allen. G., & Courchesne, E. (2003). Differential effect of cerebellar abnormality on cognitive and motor functions in the cerebellum: An fMRI  study of autism. The American Journal of Psychiatry, 160(2), 262-273.

American Psychiatric Association. (2013). Autism spectrum disorder. In Diagnostic and statistical manual of mental disorder (5th ed.) (pp.50-59). Arlington, VA: American Psychiatric Association.

Ayres, A.J. (1972). Sensory integration and learning disorders. Los Angeles: Western Psychological Services. 

Baranek, G.T., Boyd, B.A., Poe, M.D., David, F.J., & Watson, L.R. (2007). Hyper-responsive sensory patterns in young children with autism,  developmental delay, and typical development. American Journal of Mental Retardation, 112, 233-245.

Baranek, G.T., David, F.J., Poe, M.D., Stone, W.L., & Watson, L.R. (2006). Sensory experiences questionnaire: Discriminating sensory  experiences in young children with autism, developmental delays, and typical development. Journal of Child Psychology and  Psychiatry, 47, 591-601.

Blanche, E.I., Reinoso, G., Chang, M.C., & Bodison, S. (2012). Proprioceptive processing difficulties among children with autism spectrum  disorders and developmental disabilities. The American Journal of Occupational Therapy, 66(5), 621-624.

Bruce, C., Desimone, R., & Gross, C. G. (1981). Visual properties of neurons in a polysensory area in superior temporal sulcus of the macaque. Journal of Neurophysiology, 46(2), 369–384.

Downar, J., Crawley, A. P., Mikulis, D. J., & Davis, K. D. (2000). A multimodal cortical network for the detection of changes in the sensory environment. Nature Neuroscience, 3(3), 277–283.

Greenspan, S.I., & Wieder, S. (1997). Developmental patterns and outcomes in infants and children with disorder in relating and communicating: A chart review of 200 cases of children with autism spectrum diagnoses. The Journal of Developmental and Learning Disorders, 1(1),                                              1-38.

Hardy, M.W. (2016). Guest Editorial. Music Therapy Perspective. Advance online publication. doi: 10.1093/mtp/miw008

Hardy, M.W., & LaGasse, B.A. (2013). Rhythm, movement, and autism: Using rhythmic rehabilitation research as a model for autism. Frontiers  in Integrative Neuroscience, 7(19), 1-9.

James, M.R., Weaver, A.L., Clemens, P.D., & Plaster, G.A. (1985). Influence of paired auditory and vestibular stimulation on levels of motor skill  development in a mentally retarded population. Journal of Music Therapy, 22(1), 22-34.

Kalas, A. (2012). Joint attention responses of children with autism spectrum disorder to simple versus complex music. Journal of Music Therapy, 49(4), 430-452.

Kavounoudias, A., Roll, J.P., Anton, J.L., Nazarian, B., Roth, M., & Roll, R. (2008). Proprio-tactile integration for kinesthetic perception: An fMRI study. Neuropsychoelogia, 46, 567-575.

Lockhart, A. (2017). The effect of rhythmic proprioceptive input on attention in children with autism spectrum disorder (ASD): An exploratory  study (Master’s thesis). Retrieved from  University of Miami Scholarly Repository Database. (661).

Macaluso, E., & Driver, J. (2001). Spatial attention and crossmodal interactions between vision and touch. Neuropsychologia, 39(12), 1304-1316.

Mayes, S.D., & Calhoun, S.L. (1999). Symptoms of autism in young children and correspondence with the DSM. Infants and Young Children, 12(2), 90-97.

Molinari, M., Leggio, M.G., Filippini, V., Gioia, M.C., Cerasa, A., & Thaut, M.H. (2005). Sensorimotor transduction of time information is preserved in subjects with cerebellar damage. Brain Research Bulletin, 67, 448-458.

Stevens, C., & Byron, T. (2009). Universals in music processing. In S. Hallam, I. Cross, & M. Thaut (Eds.) OxfordHandbook of Music Psychology (pp. 14-23). Oxford University Press. 

Thaut, M.H. (1984). A music therapy treatment model for autistic children. Music Therapy Perspectives, 1(4), 7-13.

Thaut, M.H., Kenyon, G.P., Schauer, M.L., & McIntosh, G.C. (1999). The connection between rhythmicity and brain function: Implications for therapy of movement disorders. Engineering in Medicine and Biology, 18(2), 101-108.

Tomcheck, S., & Dunn, W. (2007). Sensory processing in children with and without autism: A comparative study using the Short Sensory Profile. The American Journal of Occupational Therapy, 61(2), 190-200.

Speech vs. Song

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Tan, E. Y. P., & Shoemark, H. (2017). Case study: The feasibility of using song to cue expressive language in children with specific language impairment. Music Therapy Perspectives, 35(1), 63-70.

From the day each of us are born, we begin to communicate with others. But as we all grow, our styles and methods of communication begin to vary. For children with specific language impairment (SLI), developing effective communication and verbalization is often achieved through multiple therapies and approaches. The symptoms associated with SLI are not as a result of any hearing loss or other developmental delay; additionally, SLI affects an individual across all language domains, especially in syntax and morphology. In 2017, a small case study was conducted to demonstrate the feasibility of using singing as a tool to help develop speech in children with SLI.

Eugenia Yen Ping Tan is a qualified speech-language pathologist and a novice music therapist. In her observations with Dr. Helen Shoemark, they addressed goals relating directly to the domains of syntax and morphology to compare the use of singing versus speaking to teach verbal communication to children with SLI. While their sample size for this particular study was extremely small at only two participants, their intention with this study was to provide evidence and direction for their audience to consider in future trials and studies. Tan and Shoemark’s rationale in conducting this research has been supported in countless studies: music is relatable, interesting, and has a repetitive nature to it, which is especially important when learning to retain language skills. Especially for young children, keeping them engaged for the duration of an activity is key in finding meaningful results.

For this particular study, a boy and a girl, both at the age of 6 years old, were selected from a group of children from a school for those with speech and language disorders. Both participants have moderate-to-severe SLIs and have no other diagnoses. Using the Renfrew Action Picture Test (RAPT), Tan assessed the children and recorded samples of their speech. Tan also used the Language Assessment and Remediation Procedure (LARSP) to assess these samples in greater detail. A total of 12 goals were set to observe the participants’ use of syntax and morphology. The participants then each attended 6 bi-weekly, 30-minute sessions with the first half of each session focusing on syntax and the last half focusing on morphology. For the first sessions, the researcher randomly selected which modality would be implemented in the session, speech or song. The procedure used for every session was a fairly typical 4-step method for helping a child learn to repeat a phrase or behavior. Tan began by demonstrating the phrase, either by speaking or singing, and then invited the client to repeat the phrase in unison with the therapist. The third time, Tan asked the client to repeat the phrase again with the therapist and then would fade out to allow the child to complete the phrase alone. Lastly, the client was to repeat the phrase independently. Throughout this procedure, Tan provided 14 related images to assist in eliciting a relevant response. Using this behavioral approach, Tan also provided preferred activities throughout the session as positive reinforcement.

Following the completion of each of the individuals’ six sessions, a post-intervention assessment was administered to observe an overall effect on the children’s language development. These tests showed that both individuals doubled or nearly doubled their initial assessment scores. Overall, this study was able to show that using song to develop speech and language is certainly an acceptable and practical method. However, as was expected, it was not possible for the researchers to determine statistical significance due to the limitations of participants and a shorter time period. In regards to the clinical goals observed in this study, 3-4 syntax goals were met, but no morphology goals were met regardless of the modality used during the session. Tan believes that with a longer trial, we should begin to see the effects of this approach as it relates to morphology. Because of the success in meeting some of the syntax goals, it can be said that using song is at least as effective as using speech to cue in a syntax intervention.

Moving forward as a young professional, I look forward to learning more about how to help children develop speech and communication skills in my own caseload. While this case study was small and less focused on the clinical results, there are several points I will be able to take away and use in many of my sessions throughout my internship at The George Center. I especially plan to revisit the 4-step procedure used in this study to help my clients learn and develop desired behaviors and speech patterns. This procedure very clearly and simply outlines how to break down one action to make it easier to teach and to learn. A few of the clients on my caseload tend to have the most difficulty developing morphology skills rather than syntax; for instance, many clients often cannot distinguish between singular and plural forms of words. Based on the suggestions from this study, I am going to explore how the use of music dynamics can help our clients further develop these skills. For those of my clients continuing to develop their syntax skills, I believe that providing strong rhythmic association and implementing the 4-step procedure as they described it will help my clients to further develop their language skills in this domain. I hope to see more studies conducted that go in-depth about all of the language domains and how to isolate them using music interventions.

Reaching the Person Inside: Music for Memories

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“Wow! She can’t say anything, but she can sing it!” Such words are very common among the caretakers and family of individuals with Alzheimer’s disease (AD) and other memory care diagnoses. Many have seen the powerful effects of music to elicit verbal output from those who are otherwise unresponsive. Even if they have not heard the song for years, even decades, their memories associated with music remain intact.

When one thinks of Alzheimer’s disease (AD), the first symptom that comes to mind is progressive memory loss, but this is just one of the symptoms that accompanies the disease. Over time with deterioration of structures in the brain, language deficits begin to manifest, such as when having difficulty naming people or objects, speaking fluently, comprehending speech, and deteriorating in the ability to produce spontaneous speech (Dassa, 2014, p. 132). The result is often a communication divide between the person with AD and their family, friends and caretakers. They are unable to express themselves clearly, to understand others clearly, and to maintain a sense of time and context. Hence, it is not surprising that four of the common areas of concern for people with AD are agitation, anxiety, aggression, and apathy, also known as “the four A’s”. Combined with the lack of inhibition caused by neural deterioration, the four A’s are understandable symptoms exacerbated by social isolation.

In this study conducted in Israel with individuals with AD, Dassa (2014) reports on one of the many ways that music can overcome the barriers to communication and self-expression that AD presents. Music is a unique back-route to nearly every part of the brain. Musical activity stimulates nearly every region and neural subsystem (p. 134). Thus, while pathways for language abilities generally undergo more damage, the “roads” necessary for music skills and prosodic (melodic) aspects of language remain intact. Hence, a person with severe dementia may be able to sing a song perfectly whilst they are only able to produce inflected strings of “empty speech” -- words or babble that convey little meaning to the listener (p. 132).

Music is incredibly valuable for improving quality of life for people with AD. It is their bridge to communication in several ways. Music is a mnemonic device with melody, harmony and rhythm assisting in the recall of lyrical information, preserving their ability to sing strings of language content. Songs also often have strong associations with memories and can provide the person with AD access to mood, memories and thoughts (p. 133). Additionally, music can ground people with AD emotionally. It reinforces their sense of belonging as they sing familiar songs with those around them and provides an escape from social isolation and distress (p. 134). It enables them to finally engage with the world outside! Such group singing and reminiscing has been found to reduce symptoms of depression.

In this article, Dassa reports on how singing familiar songs encouraged conversation among people with middle to late stage AD. (This was just one part of larger study that analyzing the effects of singing on language abilities of people with AD.)

Common themes of conversation included memories related to patriotic events, social gatherings, family and the participants’ homes, and musical experiences. Participants in the group also made spontaneous comments on how they felt impacted by singing. These touching remarks included:

“Perhaps we feel better because we came here. There’s nothing like singing to make us feel better.”

“When I sing, I can remember the words of the song.”

“I know these songs from years ago, everyone knows them.”

“Don’t forget to remind us when we can meet again.”

Participants even encouraged each other and made comments on how to improve the quality of their singing. One said, “I think we stop too much, we have to sing more.” In essence, these comments indicated that singing promoted their sense of well-being, self-esteem, and belonging.

Dassa reports how the conversation topics were closely related to each song’s content and musical features. It appears that lyrics communicated specific ideas while the music cued emotions. For example, songs that triggered memories related to social gatherings had a triple meter that evoked the feeling of togetherness, such as around a campfire while swaying and singing.

I work a great deal with people receiving memory care services, and I foresee to do much more work with them in the future. In my experience in my internship, people with Alzheimer’s often have a lot to say about their history once they are appropriately prepared. Dassa’s study reveals the importance of song selection and musical characteristics. I often think about the physiological effects of musical elements in my song selections, such as the tempo or instrumental texture, but categories of songs can also affect what types of memories are elicited. When selecting repertoire to use with my clients, I have to ask myself, “When and where would they have heard this song? What memory could it be related to? What emotions do the musical elements evoke?” For example, swing and dance music might be associated with memories of social events, such as when going out with friends or with a date. The musical elements may make them want to dance, which will also aid in the recall of such autobiographical memories.

Additionally, Dassa’s questions when analyzing the songs begin very specific to the content of the lyrics, such as “What type of flowers in the garden are mentioned in the song?” These not only have clear, concrete answers, but also check accuracy of language output and begin to stimulate deeper thought on the lyrics which may in turn trigger memories. In addition to asking my typical open-ended questions about their autobiographical experiences, I would like to try this approach to song discussion with my clients in the future. Perhaps drawing closer attention to the familiar lyrics will improve their ability to share their stories.

The greatest joy comes from helping a person with AD to connect with the world around them. When I hear comments such as the ones mentioned above, it is heartwarming to see that the person inside is still there and still able to find a sense of self and delight through song.

Reference

Dassa, A., and Amir, D. (2014). The role of singing familiar songs in encouraging conversation among people with middle to late stage Alzheimer’s disease. Journal of Music Therapy, 51(2), 131-153.



Infant Brain Injuries & Music Therapy

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Before we are born, we are faced with many circumstances that have the potential to have major effects on our development in positive and negative ways. One of the many circumstances that could impact the development of a newborn infant is a brain-related injury that leads to brain damage within the child. Brain damage is complicated and comes with a variety of unknown factors, but as we dive deeper into the types of brain damage and the effects they may cause, I hope you gain a better understanding of how we can promote the wellbeing of the little humans that are welcomed into this large world of “unknowns”.

CAUSES OF BRAIN DAMAGE

Oxygen Deprivation:

  • The most frequent brain injury that occurs at birth is due to oxygen deprivation (e.g. anoxia, hypoxia, and birth asphyxia).

  • Two stages of injury may occur: Brain cell damage is the first stage that occurs within a few minutes of insufficient oxygen. Reperfusion injury occurs once the blood and oxygen flow has been restored.

  • A stroke is experienced if a disruption of the blood flow and oxygen to the brain occurs.

Brain Hemorrhage:

  • Typical causes of brain hemorrhages include: head trauma, high blood pressure, aneurysm, blood vessel abnormalities, blood disorders, liver disease, or brain tumors.

Jaundice:

  • When untreated, jaundice can lead to kernicterus. Kernicterus (acute bilirubin encephalopathy) refers to a type of brain damage that can cause athetoid cerebral palsy, hearing loss, vision and teeth problems.

Physical Trauma:

  • Infants are most at-risk for physical injury upon labor and delivery

  • Physical trauma can occur due to improper use and placement of birth-assisting tools (e.g. forceps or vacuums) or a rapid delivery.

Infections:

  • Maternal infections such as pelvic infections, fevers, preeclampsia, cystitis can lead to brain damage if left untreated.

In terms of birth traumas, the most common brain-related injury is cerebral palsy (CP) which can develop after, oxygen deprivation, infant stroke, and infections.

EFFECTS OF BRAIN DAMAGE

Due to the complexity of the brain and varying degrees of damage, the effects of these brain injuries have the potential to manifest later in the development of the child. However, symptoms of brain damage include abnormal temperament, abnormal physical appearance, or delayed development of the child.

IMPLICATIONS OF MUSIC THERAPY

At such a young and vulnerable age, infants process music in such a powerful way that can lead to many positive outcomes. Music is IN US. As early as 25 weeks, an infant begins to process music in utero (....wow….). Music can be facilitated and promoted by a board certified music therapist to optimize their developmental potential. Music Therapy can be utilized in the hospital as well as through early childhood development.  

Music Therapy in the Neonatal Intensive Care Unit (NICU)

Upon arrival, premature infants are faced with a plethora of stressors and complications that impact their development. Due to the stressors they endure, premature infants are at high-risk in obtaining a birth-related brain injury due to the underdevelopment of their organs. Amidst the chaos of their hospital stay, music therapy can be a grounding and supportive therapeutic experience to promote, maintain, and encourage a positive development for the infants as well as an opportunity to promote bonding and provide a sense of control to their parents and caregivers. Research has proven the length of stay of a premature infant decreases significantly when provided music therapy services. Music Therapy within the NICU aids in increasing opportunities for auditory processing, neurological growth and development, and language input. When provided by a trained professional, interventions may include: music listening, neurodevelopmental stimulation (also known as multimodal stimulation), pacifier-activated lullaby (PAL), infant stimulation, and parent counseling.

Music Therapy in Early Childhood

Music is part of our being. At an early age, infants inherently move to music in a rhythmic way, sing a song through cooing or babbling, or move towards a rattle out of curiosity or exploration. Music is motivating, it is fun, it is stimulating. Music has an ability to stimulate all the senses within a human being, facilitating a multitude of developmental skills. Music is processed in both hemispheres of the brain which promotes cognitive functioning. This stimulation of cognitive functioning can be an important tool when an infant is faced with a brain injury at birth. When an infant faces challenges in their development, music can access multiple areas of the brain and essentially override the damaged neural pathways, creating new pathways and optimizing the plasticity of the brain.

Music therapy and early childhood could incorporate a variety of elements (all depending on the age and development of the child): receptive listening, facilitation of movement, a source of stimulation for communication (singing), facilitation of independent play, instrumental playing in gross and fine motor movements, promotion of cognitive development through labeling, and much, much more.

THOUGHTS

You may ask, “Why does this matter to me?”. On average, there are 130 million babies born each year around the world and millions of these precious babies are affected by birth-related brain injuries. Do all of these children receive music therapy? Absolutely not. Why? Because the funds are not there and recognition of our established profession is not there. This is important to know because advocacy for our profession is a constant act. We need you to understand and promote the positive impact that music therapy can have on these little humans so we (music therapists) can help optimize their potential in their lives and overall well being. Music is powerful. Help us to empower our future generations.


TERMS

  • Birth asphyxia- an insufficient amount of oxygen and nutrients occur in an infant’s brain and other organs

  • Anoxia- an absence of oxygen

  • Hypoxia- insufficient amount of oxygen delivered to the tissues

  • Ischemia- insufficient blood flow to the brain

  • Jaundice- build up of a chemical called bilirubin occurs in an infant’s blood due to an underdeveloped liver (the build up causes the skin to have a yellow coloring)

  • Preeclampsia- high blood pressure and a presence of protein in the urine

  • Cerebral Palsy (CP)- damaged or abnormal development of the brain that affects an individual's ability to control his/her muscles.

  • Brain Hemorrhage- the effects of a stroke causes the blood to flood the brain leading to cell death


SOURCES

How Non-Profits Intersect With Music Therapy

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I just read that it costs $250,000 to raise a child to age eighteen. That is just for one, neurotypical child. That doesn’t even account for if your child happens to want to be involved in an especially expensive hobby… like horseback riding or scuba diving!

For a family with a child with special needs, this number can quadruple, according to The U.S. Department of Agriculture. That equates to almost one million dollars to raise a child with special needs. These costs can include anything from medical and hospital bills, tutors, prescription costs, assistive and adaptive equipment around the house, private schools, and therapies.

Since there are so many therapy options available for a child with special needs, families can find themselves desperately wanting to help their child as much as possible, and, with best intentions, enroll their child in several different therapies. These bills quickly add up, with some being covered by insurance and some being paid for out of pocket.

For us in the field of music therapy, we do not have the luxury to be considered a “mainstream” therapy yet, such as Speech Therapy or Occupational Therapy, so we aren’t afforded the luxury of being a “given” when it comes to insurance reimbursement. We have come a long way, and it certainly helps that we are gaining recognition at the state level with licensure, including here in Georgia. At The George Center for Music Therapy, we work hard to bill insurance and are quite successful receiving insurance reimbursement for many families for our services. Some families use one of various waivers for services, and some families pay for music therapy out of pocket. Regardless of their funding source, inevitably, there may come a time in which a family must discontinue services due to financial reasons. Their deductible may renew, they may run out of funds through their waiver, or a family emergency must take financial precedence over therapy services for a period time. It is heartbreaking to hear that a family must stop services for financial reasons.

This is where… drum roll please…. Our non-profit comes in- The George Center Foundation!

The Foundation was started as a way to help those in need to receive access to quality music therapy services. In 2018, we were able to donate about $10,000 in scholarships to families and organizations in need. That is AMAZING! It has been so wonderful to be able to have an avenue to receive donations that go straight back to the community and to our clients who benefit from and love what we do.

We are having our very first large-scale fundraising effort this month, called the Shamrock Shindig. It will be held at Peach and The Porkchop, which is a delicious restaurant right down stairs from our office. We have partnered with more than 15 organizations in the community to receive items for our silent auction, and we will be having live music, performances by our very own Teen Rock Band, drinks, appetizers, a raffle, and a respite for children with special needs provided by Reclif. This is a fundraiser that you do not want to miss, as the proceeds will go straight to families and organizations in our community to open the door for them to receive music therapy services. It will be so much fun, and you will be able to see all your favorite music therapists from GCMT there!  

Our dream is one day be in a position where money is no longer a hindrance for people to receive music therapy services. Fundraisers such as the Shamrock Shindig is a step in that direction for us, and we truly hope you can join us!

For more information and to buy your tickets please visit our website at https://www.thegeorgecenter.com/shamrock



Collaborative Treatment

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Music therapy, speech therapy, physical therapy, occupational therapy, feeding therapy, and the list goes on and on…. But when it boils down to it, are all of these therapies independent of each other or can they all work cohesively to improve the quality of life for an individual receiving multiple services?

What do we mean by collaborative treatment?

If your child has ever attended any of the summer camps that GCMT is involved with, such as FOCUS+Fragile Kids Camp Hollywood or Camp CreARTive, you’ve been able to see collaboration of services in a fun, lively environment. At Camp CreARTive, we partner with an adaptive art teacher, a speech-language pathologist, an occupational therapist, a recreational therapist, and of course a Music Therapist to provide an artistic avenue for children to learn and grow. Due to the various programming needs, they are a great example of a collaborative relationship between a handful of various professionals.

Just as the phrase may imply, collaborative treatment is the idea of professionals and therapists coming together in a cohesive manner to best serve the client. For example, one of our fellow North Fulton Wellness Alliance members is Precision Chiropractic. When Precision gives their clients a series of exercises and stretches, our music therapists can utilize Neurologic Music Therapy techniques to incorporate those assigned exercises into the client’s music therapy session. Now the client is not only executing those exercises during their chiropractic session once a week or a few times in the home but are able to do them through another venue while being supported by the rhythmic stability offered in music therapy. When doing these exercises in MT sessions, it primes the brain to complete these patterns in a timely and organized fashion that the motor system executes easier than without MT intervention. The same concept can be applied to speech therapy, occupational therapy, recreational therapy, and again the possibilities are endless!

Collaboration does not have to stop with simply opening dialogue between therapists either. Music therapy can also provide support during other therapy sessions. Research has been done with music therapist “pushing in” or providing support during physical therapy settings. The most common example of this has been when a music therapist provides live music during a patient’s gait training. This allows the physical therapist to facilitate gross motor movements while the client is being cued by an aural stimulus he/she can entrain to. Another example of collaboration can be between other healthcare professionals offering support during music therapy sessions. Personally, I have had the pleasure of collaborating with a couple speech therapists during a group setting in the public school system. It was amazing, not only to have the additional support during the session, but to see individual students receive additional prompting that reinforced their IEP goals. It also allowed the speech therapists to experience what music therapy entails.

How Does GCMT fit into this model?

Did you know that GCMT also offers music therapy services at some other locations in the metro-Atlanta area? Building Bridges located in Cumming, GA is a facility that strives to offer families services for diverse needs in one central location. Their other services include speech, occupational, feeding, ABA and physical therapies, and as well as allowing us to rent space to provide music therapy. Their mission is to provide a “collaborative environment to work as a team to provide the best services for our clients” (direct quotation from Building Bridges website). Because they foster a collaborative environment, this has allowed GCMT music therapists to be in conversation about shared clients with other therapists. Due to the shared space, our music therapists even get to converse while transitioning clients from one therapy session to the next, creating a cohesive afternoon of treatment!

The George Center also offers services at ReClif. Located in the Peachtree Corners/Norcross area, ReClif is a fitness based therapy and community center that offers “a variety of services that include physical, social, therapeutic, and intellectual opportunities”. Per its website, ReClif describes themselves as: “a space that allows every participant to thrive to the best of their ability.” Their programs include therapeutic yoga, special fit, interactive metronome, spelling to communicate, traditional speech and occupational therapy, and fit light. Similarly to Building Bridges, this cooperative environment lends itself to several therapies combining forces to best serve the client.

How can I be a part of a collaborative treatment environment?

If your child is receiving a few different services, maybe you’d like to look into one of the two facilities mentioned above. We do have appointments available at both of locations! If you are interested in receiving services at either Building Bridges Therapy in Cumming or ReClif in the Peachtree Corners/Norcross area, feel free to contact our office to make an appointment today!

For our families who receive treatment at GCMT, our team is always willing to collaborate with your child’s fellow healthcare providers. We already attend IEP meetings, share notes, and speak with other therapists and health practitioners when provided with releases from our families. The George Center places a high value on a holistic, team-based approach to therapy by collaborating with members of our clients’ therapy teams, so let us know how we can support your family in the best way possible!





Singing with Parkinson’s – More than Just a Choir

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I consider it a privilege to be able to witness and play a part in The George Center’s Singing with Parkinson’s – a therapeutic choir designed specifically to address the needs of people with Parkinson’s disease (PD). It has been less than a year since the start of the choir, and yet the impact it has had on its members to me is impressive and exciting. Many think of Parkinson’s as a motor disorder – which it is! – but “motor” encompasses more than just the movement of your fingers, arms and legs. Speech is a motor function, along with breathing. In addition to motor symptoms, people with PD often battle apathy and depression. A therapeutic choir is a wonderful way to address all of these issues! Do not take my word for it. Let’s look at the research.

In addition to discussing their own study, Yinger and LaPointe talk about the needs of people with PD and present compelling points from previous research in their article “The Effects of Participation in a Group Music Therapy Voice Protocol (G-MTVP) on the Speech of Individuals with Parkinson’s Disease.” A common speech symptom associated with PD is hypokinetic dysarthria, which makes their speech softer, more monotone, hoarse and unclear. Additionally, people with PD experience lower vocal range and voice arrests. Thus, speaking can be a struggle. Multitasking can also be difficult and even dangerous (p. 26).

Thus far, the most effective treatment for speech impairments of PD has been speech therapy, specifically the Lee Silverman Voice Treatment (LSVT). Yinger and LaPointe suggest that the success of the technique is largely due to its five principles that promote neural plasticity: (1) intensity, (2) complexity, (3) saliency of treatment, (4) “use it or lose it,” and (5) timing of the intervention (p. 26).

Music therapy, however, is emerging as another effective treatment modality. Music therapist Haneishi (2001) began developing a music voice protocol (MTVP) based on the same principles as LSVT to improve the speech characteristics of people with PD in individual sessions. The 60-minute protocol includes opening and closing conversation, facial and breathing warm-ups, vocal exercises, singing exercises, practice sustaining vowel sounds, and speech exercises. Both Haneishi and another music therapist, Perez-Delgado, who adapted MTVP for Spanish-speaking individuals with PD, found that the treatment “increased breath control, voluntary speech production, and voice volume” (p. 28). Other music therapy studies have found a background of singing can delay the age-related decline in speech skills; that stimulative songs decrease the rate of speech while sedative songs improve “rhythm, initial consonants, final consonants, and continuity of speech”; and that singing can improve intelligibility of speech, as much as 21% (p. 27).

Yinger and LaPointe in their study used MTVP in a group setting and found improvements in intensity (loudness) of speech, especially in men, and prosody of speech in conversation in women, in spite of the progressive nature of the disease! (p. 29-30).

Looking at how these ideas relate to The George Center’s Singing with Parkinson’s choir, I see Claire Morison, who currently directs the choir, does an excellent job at incorporating the research-based format and techniques into the weekly rehearsals. These are things that I will need to keep in mind if I ever have the opportunity to lead a choir with a similar population. For example, I will need to make adaptations during rehearsals to accommodate for the needs of individuals with PD, which may include limited mobility, impaired vocal functioning, and potential neuropsychiatric complications related to PD or the medications used to manage the disease. Because multitasking is difficult and potentially dangerous, I may need to simplify tasks for choir members so they can focus on the quality of their singing. Multitasking is typical in the choir setting, such as when flipping through music while reading lyrics and singing. Hence, Claire displays the lyrics and music on a TV, at times scrolled by an assistant to eliminate the need for visual tracking. Lastly, I will need to be familiar with the vocal changes that may occur as a result of age and disease.

There are always ways we can make something good even better, especially as the choir continues to grow and thrive. For example, the fourth principle of neuroplasticity mentioned above, “if you don’t use it, you lose it,” emphasizes the need to regularly practice speech skills. In LSVT, clients are sent home with homework and exercises. In our choir, perhaps sending our members home with a recording of the accompaniment to vocal warm-ups as well as music in print to practice may encourage them to continue practicing at home and hopefully further aid in slowing the decline.

Yet to me, the most unexpected and impressive benefit of the choir is the emotional enjoyment it brings to the clients and their families. I am sure most of the appointments that our clients must attend on a weekly basis can be tedious and discouraging. We encourage caretakers to join in on rehearsals, elevating the choir to more than a therapy but also a socially enriching activity that can boost their confidence in their existing abilities. It is heartwarming to watch as choir members linger after rehearsals, talking and joking and sharing their stories with one another. Music does not just treat the physical ailments but the whole person and community. More than that, the choir gives clients a sense of achievement in ways they did not think still possible. One client commented that the choir has allowed him to sing again, a gift that he thought he had lost forever. Now, one of the major sources of his joy is within reach again. He is not the only one. Many have thanked us for the choir saying, “You don’t know how much it means.” Such moments are priceless.

Yinger, O. S. & LaPointe, L. L. (2012) The Effects of Participation in a Group Music Therapy Voice Protocol (G-MTVP) on the Speech of Individuals with Parkinson’s Disease. Music Therapy Perspectives. 30. 25-31.