Thank you CBS46 for your coverage of our Giving Tree program! Thanks to The Goddard School for sharing your kiddos with us! And as always, thank you to Arbor Terrace at Crabapple for letting us provide this program in your community! Research shows that intergenerational programs benefit everyone involved. For young people, it provides a positive view of aging, making them less likely to stigmatize the elderly. For older adults, it can reduce the likelihood of depression and social isolation, improve communication, and strengthen feelings of self-worth. #TheGivingTree #MusicTherapy
“That looks like fun!” Many may comment as they watch a group of clients in the pavillion beating out rhythms on bucket drums during The George Center’s summer Bucket Drumming program. It certainly is fun, but is that the only purpose it serves?
Ga Eul Yoo and Soo Ji Kim recently published an article in the Journal of Music Therapy addressing that very question, “Dyadic Drum Playing and Social Skills: Implications for Rhythm Mediated intervention for Children with Autism Spectrum Disorder.”
As I read this article, I was excited to see that Yoo and Kim comment on the reclassification of ASD as a a motor disorder rather than a social disorder, justifying the use of rhythm as a tool for treatment. This is a reassuring sign that music therapists as far as South Korea are embracing the new concept of ASD as a neurodevelopmental condition rather than a social disorder. Now, the focus is shifting to how best to treat it as a neurological condition. Because rhythmic cueing - defined as “the provision of regularly paced external stimulation” such as to a metronome or steady beat - has been so effective with other neurological conditions, Yoo and Kim hypothesize that it can be helpful in improving the social skills of clients with ASD through scaffolding their movements with rhythm in drumming.
Drumming is a great tool for working on social skills through rhythm. Dyadic drum playing is defined as when “two individuals coordinate their movements in time with each other” (p. 344). For clients with ASD, this behavior is significant! The client must connect with their partner, perceive their movement, and coordinate his/her own movement to synchronize within the musical context. This type of motor control and joint attention is essential for engaging in social interactions on a daily basis.
Yoo and Kim conducted two studies that are discussed in the article. Study 1 investigates the question, “What is the relationship between dyadic drum playing and social skills performance in children with and without ASD?” (p. 345). Study 2 investigates the next question, “Are there changes in social skills of children with ASD after participating in the developed rhythm-mediated intervention?” Participants in both studies were measured on an electronic drum pad for how closely they could synchronize with another person’s rhythm at varying tempos as well as with and without external rhythmic cueing.
In comparing the results of experimental and control groups for Study 1, Yoo and Kim labelled “factors” to describe the different skill sets required to accurately imitate rhythmic patterns in dyadic drumming. Three “factors” were identified for the control group: (1) Embodied intersubjectivity, (2) Motor representation, and (3) Anticipatory adjustment. Yet, in addition to these three factors, the experimental group received a fourth “factor”: self-regulation (p. 356). Before they could begin to give attention to the other three factors, children in the experimental group had to gain and maintain control over their body movements, just as it is necessary when trying to interact and communicate on a daily basis.
It is interesting to note that the ASD group synchronized most closely during tapping to rhythmic cueing and synchronized the least during interpersonal synchronization without rhythmic cueing. Yoo and Kim point out that fast tempos increase demand on motor planning, but too slow makes equally makes it harder to plan movements without the presence of a clear beat. A slower tempo with rhythmic cueing enables clients with ASD to synchronize best.
In the second study, Yoo and Kim put these conclusions to the test in individual music therapy sessions with 8 children with ASD.They observed the greatest increase with engagement in joint action and increases in the presence of target behaviors. They conclude that the use of music and rhythmic structure is very effective and immediate in facilitating joint action and engagement, but continued and consistent treatment with the intervention is required to maintain the ability and transfer the effects.
Interestingly, in study 2, the parent-reports on the effects on clients with different levels of functioning varied. Parents of children who were lower functioning expressed a great appreciation for the intervention and remarked a notable difference in their children’s stereotyped behaviors (decreased hand flapping and wandering) and attention to others’ actions. Parents of children who were higher functioning remarked that their children enjoyed music more after the intervention, but some expressed a desire for “more direct changes in social behavior and communication skills.”
As I reflect on how this article can affect my clinical work, I am amazed by how many contexts this article can apply to. I conduct rhythm and drumming activities with all of my individual clients, but normally addressing the motor and cognitive domains of functioning. I also teach a whole drumming class to a group of high-functioning students, many of whom are on the spectrum but are working towards appropriate social skills and behaviors. Yoo and Kim provide interesting suggestions on how to approach designing dyadic rhythm interventions, such as by beginning with exploring rhythmic movement and then beginning a joint activity in rhythmic movements with a partner. Slower tempos with rhythmic cueing will prove the easiest for clients with ASD to synchronize with, but steadily removing supports and increasing the difficulty will challenge them and help them grow over time. Within the design of a single activity, changing the tempo is also an excellent way to assess the client’s engagement with their partner while maintaining the rhythmic structure that supports gross and fine motor planning.
Based on the parents’ responses, I believe a great lesson from this study is how an intervention that has significant and notable effects for one level of functioning may not have as great an impact for another. Yet this is not a reason to abandon the intervention all together. In many cases, augmentation is required to make it more challenging and beneficial for higher functioning students.
Overall, this article renews my confidence that the activities we bring to our clients can have a positive effect in ways that other therapies or lessons may not. How many activities involve every group member doing the exact same thing at the same time, connecting to each other through careful attention and coordinating the motor planning to synchronize with peers? The required careful attention to the other people in the room and the rhythmic framework of the activity make drumming a valuable tool for therapeutic success in the social domain.
Yoo, G. E & Kim, S. J. (2018) Dyadic Drum Playing and Social Skills: Implications for Rhythm-Mediated Intervention for Children with Autism Spectrum Disorder. Journal of Music Therapy. 55 (3). 340-372.
Article Review #2: Autism – What It Really Is… and How Rhythm is the Key
Since beginning at The George Center, I have come to realize that autism spectrum disorder (ASD) is so much more than what appears on the surface. From my undergraduate studies and interactions, I was familiar with some of the common symptoms: hypersensitivity, echolalia, repetitive movements and behaviors, but that was barely the tip of the iceberg. In the past month and a half, I have learned more about ASD than I have in the past 3 years at university. I am realizing how much scientists, parents, and the public know – and don’t know – about autism. For example, many think that people with autism are generally emotionally detached and have little interest in social interactions. However, if you read some of our clients’ blogs, it is very clear the answer is no. Any apparent lack of emotion is more likely due to a difficulty in planning the motor movements to show emotion: to smile, to frown, to speak, to touch gently. Try telling your loved ones how you felt about them if you couldn’t move a muscle with intentionality. Chances are you would smack them in the face or not move at all. If this is news to you, you might be wondering, “It’s a motor disorder? How?”
Lagasse and Hardy present an extensive amount of research into the neurological phenomena in the brains of people with autism. Although they report that the findings are not always consistent, they discuss some common areas of neurological difference in people with autism. (I am about to use some neurological terms, but please don’t run… I’ll explain).
Firstly, the cerebellum is significantly smaller in persons with autism. The cerebellum is the “general purpose device” that communicates with other neural systems and prepares for movement (Lagasse & Hardy, 2013, p. 68). Thus, deficits in the cerebellum impede a person’s ability to plan their movements – to smoothly and quickly target an object with the appropriate force and direction or to calculate the path of a stimulus. Also, Lagasse and Hardy highlight that researchers have noted larger brain volume in the early childhood of people with autism (p. 68). This could indicate inefficient pruning of unneeded synapses. Lastly, connectivity within the brain is often different in people with autism. Both underconnectivity and overconnectivity have been reported, one of the complicated results of ASD being a spectrum disorder. Underconnectivity between parts of the brain that are far away from each other can cause motor delays or deficits, difficulties with motor sequencing, planning, motor inhibition, and motor execution (p. 69). Overconnectivity creates clutter and static that make communication between various brain structures inefficient. A frequently traversed and stronger pathway may “hijack” a signal travelling along a weaker connection. Because of this mixture of underconnectivity and overconnectivity, a person with ASD may be hyposensitive to some stimuli and hypersensitive to others. Similarly, some movements may be very easy to execute, whereas other are very difficult.
Thus, the neurologic research suggests that autism is a deficit in processing sensory information from the environment and a difficulty in planning movements in response. This information significantly affects the treatment approach that therapists should take to effectively help clients progress. It is not that clients do not understand or care about the world around them. They are just trapped in their own bodies, trying to get the words out!
Music therapy is a unique tool to help my clients with motor planning. Entrainment – the phenomenon of your brain and body instinctively synchronizing to a given beat – has already been extensively explored in the gait regulation of clients with stroke (p. 71). Rhythm provides a framework for planning motor movements. It tells a person exactly how long it should take for them to move their limb from point A to point B, and most importantly how to pace the movement that comes in between.
Other musical elements may also facilitate motor planning (p. 72). For example, dynamics – the loudness or softness of sound – can cue the force of a movement. The range of pitches – how high or low – can cue the size of the movement. And of course, the style of the song itself can increase the client’s motivation to execute the movement.
Now that I understand that autism is a motor planning disorder, I can use the same principle of rhythm for organizing movement to help people with autism to plan their movement as well. Only with this essential foundation can we begin to address their ability to communicate and socialize!
At one time, I might have seen a person with ASD and assumed they were just clumsy and uncoordinated. Yet now, when I think about what really is happening within their brains, I realize it must be a scary experience to navigate their surroundings. Just as it is difficult to move around in your attic when it is full of junk from the past ten years, it can be difficult for signals in the brain to navigate amidst a clutter of synapses. I cannot begin to imagine the feeling of dreading every movement I made, not knowing whether I would hit the person next to me or grab a pencil too hard. For every object that approached, I would just be hoping it would pass me by and not knock me to the ground.
Remembering how rhythm, dynamics, range, and style can affect motor coordination will be essential in helping me to treat my clients. An important part of my role as a therapist when working with my clients with autism will be to provide steady rhythmic support during activities that require some motor response from them – which is essentially the whole session. Additionally, using live music will enable me to adapt musically to the client’s needs in the moment. Just as I try to help my clients execute intentional movements, every element of my music-making and facilitation will require intentionality.
A touching expression from Peyton Goddard, an autism activist with autism himself, recorded in Lagasse and Hardy’s article captures the need for we therapists to give attention to the motor system before all else: “Trying to be the real me, rhythm helps the motor frenzy madness to stop. You are all too musically gifted to ignore the importance of rhythm. Please know my body utmost lacks rhythm. In music therapy I’m benefitted by pairing to your upping rhythmic beats to motor my body. Trying to be me in harmony!’’
Lagasse, A. B. & Hardy, M.W.. (2013). Considering Rhythm for Sensorimotor Regulation in
Children with Autism Spectrum Disorders. Music Therapy Perspectives, 31, 67-77.
Returning at The George Center has been something I have been dreaming of for a good while, ever since I first discovered it and started volunteering in 2014. I remember sitting in the group for Any Dream Will Do!, assisting the participants, celebrating their successes as they maintained attention for the whole activity, tapped out a steady beat, socialized with peers, or expressed themselves and contributed to a song. I went home singing the songs, thinking to myself how simple yet effective they were. Would I ever write songs like that? Scaffold and elicit such responses as I saw every Tuesday night?
I have learned a lot since then in my undergraduate studies, but now upon my return to The George Center, I realize there is yet so much to learn! What skill do I need to develop the most? Designing music therapy interventions that are not too general but help achieve my clients’ goals and objectives in a S.M.A.R.T way! (That is, specific, measurable, attainable, relevant, time-oriented).
With this in mind, I reflected on an article that I had heard of in a conference session presented by one of The George Center’s very own interns about a year ago: “A Conceptual Methodology to Define the Therapeutic Function of Music” by Deanna Hanson-Abromeit, PhD, MT-BC. It discusses the function of different elements of music – such as melody, harmony, rhythm and dynamics – in the achievement of client’s objectives. Yet in the midst of the hectic clinical experience, when we are learning the basics of leading activities and writing goals and objectives, it can sometimes be easy to forget how these essential elements of music function in treating specific diagnoses and symptoms. It requires not only an in-depth knowledge and integration of all the musical elements, but also an understanding of the needs of the populations we serve.
To bridge this gap between knowledge and therapeutic intervention, Dr. Hanson-Abromeit has developed the Therapeutic Function of Music (TFM) Plan worksheet, which she provides in her article and explains its relevance and how to use it. This worksheet is primarily intended to be a training and research tool for a student music therapist who is learning how to get the most therapeutic value out of music’s elements for a given population. Additionally, it can be useful for advocating music therapy to other medical and educational professionals. So often, music therapists must defend their practice when presented with the question, “Why music?” especially when there are so many other alternative therapies available. The TFM helps even the nonmusical reader to see the relationship between elements of music and their effect on human response (p. 26).
The first step of filling out the TFM Plan Worksheet is the “Problem Statement.” This includes the general goal desired for the client or population, such as to “improve speech,” to “improve gross motor skill,” or to “improve cognitive skill,” as well as an explanation of why this goal is appropriate. Next on the TFM are the Musical Elements: timbre, rhythm, tempo, pitch, melody, dynamics, lyrics, form, harmony, and style. For each of these elements, the MT must explain the why, what, and how under three headings. (1) “Theoretical Framework” discusses why the musical element is necessary and includes supporting research. (2) “The Purpose of the Musical Element” describes what the element will do to support the goal. And lastly, (3) “The Explicit Description of the Music Element” outlines exactly how it will be structured in a given intervention.
By the time the student music therapist or researcher has filled out the TFM Plan worksheet, it becomes clear how music uniquely functions in the achievement of the population’s specific goal. For example, if the goal is “to improve speech” in a client with Down syndrome, a completed TFM will highlight how the musical element pitch can help (p. 33). (1) Why is it necessary? Children and teens with Down syndrome tend to lack speech affect and speak in a low-pitch range. Yet, they can imitate pitches in melodies they sing (2) What will pitch do? The pitch in the melody should be in an appropriate range and should imitate the inflectional pattern of the each word. (3) How will pitch be implemented? The music presented should be between notes A3 and A4. Each pitch will reflect the inflection of each word, such as in the word “today.” The pitch for “to” should be lower than the pitch on the accented syllable “day.” The emphasized contour will help the client practice accenting the appropriate syllable, and in turn improve speech affect in daily life.
Using the TFM Plan worksheet as a guide, the MT must develop S.M.A.R.T. objectives that utilize the musical elements in optimal ways. From there, the MT will develop therapeutic interventions that give the client opportunities to achieve the objective each session. Only when these objectives are established can the therapist, client and family see measurable progress and determine whether the specific approach/intervention is effective. The TFM plan provides information that is broad enough to help create multiple objectives related to the same long-term goal.
I would really like to use this worksheet as I develop interventions with my various client groups. Being in a private practice has exposed me to more ages and populations than I have ever worked with in all my undergraduate studies, and all at once! Perhaps the greatest challenge with TFM Plan worksheet is the amount of research required to learn about the population and their needs. It can be time consuming, and no student or intern ever has enough of that precious commodity! But the quality of the intervention can be greatly improved when the student MT makes the effort to use this tool. I feel that it will be an investment in my clinical knowledge which will help me to be more effective and more instinctively use the marvelous gift of music to heal people of all sorts.
Hanson-Abromeit, D. (2015). A Conceptual Methodology to Define the Therapeutic Function of Music. Music Therapy Perspectives, 33, 25-38.
Elizabeth L Stegemöller, Tera R Hurt, Margaret C O’Connor, Randie D Camp, Chrishelda W Green, Jenna C Pattee, Ebony K Williams; Experiences of Persons With Parkinson’s Disease Engaged in Group Therapeutic Singing, Journal of Music Therapy, Volume 54, Issue 4, 30 December 2017, Pages 405–431, https://doi.org/10.1093/jmt/thx012
As I sit down to write my last journal article review for The George Center, I am filled with gratitude as I reflect on the growth I have experienced during my time here! The professionalism and clinical skills I have been been able to train under truly have prepared me for whatever the next steps will be in my music therapy career. I am beyond thankful to The George Center for the variety of populations and settings I have been able to work with over these past six months. That said, one of the final additions to my internship caseload has been assisting with a Parkinson’s Choir, which is facilitated by two Board-Certified Music Therapists from The George Center. The primary goal of this choir has been to increase support systems amongst the individuals with Parkinson’s disease community and decrease diagnosis-related symptoms through therapeutic techniques.
Parkinson’s disease (PD) is defined as a progressive neurodegenerative disorder that leads to altered neural control of movement, including the control of voice, respiration, and swallowing (Stegemöller et al., 2017). Research shows that there is up to 90% prevalence of voice and swallowing difficulties in persons with PD, and neither medication nor deep brain stimulation surgery has proven to effectively treat such symptoms. Therefore, the need to provide therapy for voice, respiration, and swallowing difficulties remains a constant need amongst this population. Music therapy gives individuals the opportunity to strengthen and maintain current function within these areas of impairment through interactive, music-supported interventions.
This particular article fascinated me, as it highlighted the personal experiences and benefits of 20 individuals who participated in singing interventions for 8 weeks. The individuals ranged from ages 47 to 82. There were 14 male and 6 female participants (Stegemöller et al., 2017). After 8 weeks of weekly sessions, each participant was given the opportunity to share how the group impacted him or her physically, emotionally, and socially during a private interview. The overall results were positive, as individuals reported improvements in their volume of speech, communication, as well as a growth in their PD support system.
For this study, specific therapeutic exercises were used during each session. Some of these included lip buzzing, glissandos, a vocal intensity (i.e., loudness) exercise, articulation exercises, and group singing (Stegemöller et al., 2017). Lip buzzing is explained as a useful intervention with this population because it requires a minimum amount of air pressure to maintain lib vibration. Over time and with practice, this can be strengthened for each individual, resulting in the ability to add pitch and more overall vocal control to the activity. Glissandos can be explained as sliding between pitches vocally. For this technique, the music therapist started out with a small range of 3 notes apart, and over time was able to increase the pitch range to 8, which is a full octave on the piano. Vocal intensity exercises during this study used a decibel meter to systematically increase loudness each week. The duration of the vocal intensity was produced in 2 second intervals. The last technique applied weekly was an articulation exercise, which are designed to focus on the articulation muscles of the lips, tongue, and jaw. Starting with singing the consonants, “mee, meh, my, moh, moo” the music therapist was gradually able to get participants to replace “m” with the consonants “t,” “d,” “s,” and “k”. Engaging pitch control and air pressure together can be challenging for this population due to the progression of the disease that can impact the muscles that control vocal usage. Therefore, warm-up exercises are important to implement with regular practice. In addition to these exercises, subjects were given CDs of breathing and vocal exercise to do at home twice a week.
During the Parkinson’s Choir I currently assist with, one method I have seen used in exercises is the addition of movement. Participants are sometimes instructed to move their arms up and down with the pitch, or progression of the musical phrase. Another exercise that has been implemented that focuses on vocal pitch, sustaining breath, and volume is a vocal siren. Vocal sirens are essentially producing pitches while letting breath out in a yawn-like fashion. The sound is first produced softly, then gradually to the loudest sustainable volume, and back to a soft volume, like a siren. Throughout this exercise patients are encouraged not to breathe between volume changes, in order to strengthen the vocal muscles that are engaged during the exercise as well as increase breath control.
From this article, I took away the importance of consistency, which over time built vocal and respiratory endurance in participants. Participants regularly attended the group and completed the CD exercises twice a week. Many of the individuals referred to singing as a ”work out” and I would agree with that statement. Posture, breath support, and core muscles all have to be used to produce loud and sustained vocalizations. Singing is unique to the body in that it is able to work such minute, but essential mechanisms. Strengthening the oral motor functions through singing is especially effective for Parkinson’s patients because it can prevent future regressions in functions like swallowing. Being able to complete singing and respiratory tasks gives individuals a chance to “work out” their body, while also building confidence in their ability to develop skills in spite of their degenerative condition.
In addition to physical benefits, group music therapy in this form can also be extremely social. Emotional support is particularly important for people coping with any type of disease. The nature of degenerative diseases like Parkinson’s tends to increase the likelihood of individuals becoming less social, decreasing their support systems, becoming dependent on a small number of caregivers, and potentially even feeling embarrassed of their physical symptoms in typical social settings (Stegemöller et al., 2017). All of these possibilities heighten anxiety, increase depression, and decrease overall quality of life as individuals have the propensity to feel hopeless as the disease progresses. Music therapy provides an opportunity for empowerment and support of individuals living with all stages of such conditions. As emotional and physical domains are mutually impacted, the therapeutic value of music for this population is unique compared to all other options. I was thrilled to find this study and look forward to seeing the Parkinson’s Choir continue to grow during my remaining time at The George Center.
As a new professional, I will continue to study research and integrate the best practices in the treatment of my clients. I will continue to implement interventions as the ones mentioned previously, as they have shown positive effects in the short amount of time I have been involved with the choir. This article was a wonderful reminder of the many benefits group treatment can have for individuals living with a degenerative diagnosis. It is a great reference for professionals starting a music therapy program or ensemble with this population. I look forward to more research developing to support these practices with Parkinson’s disease. As more research is done, music therapy as a nonpharmacological treatment option will hopefully increase for this population as well.
Book Review- Out-of-Sync Child Grows Up: Coping With Sensory Processing Disorder in the Adolescent and Young Adult Years
Kranowitz, C.S. (2016). Out-of-Sync Child Grows Up: Coping With Sensory Processing Disorder in the Adolescent and Young Adult Years. New York, NY. The Penguin Group.
In Carol Kranowitz first book The Out-of-Sync Child, many challenges and strategies of living with sensory processing disorder (SPD) are brought to light. It was an enlightening read that I would recommend to professionals, parents, and friends that interact with individuals of all ages, stages, and diagnosis involving SPD. Based on the overall knowledge I gained from that book, I was excited to read Kranowitz’s sequel The Out-of-Sync Child Grows Up. The material is very applicable to the age groups and backgrounds that I have been privileged to work with at The George Center thus far. After learning more about sensory processing, I was left with several specific questions. This book answered many of them!
Before jumping into details of the book, think with me first to back when you were or teenager or young adult. The hormone changes, the emotions, the desires or disappointments, the perspective you had on life, how you compare yourself to others, maybe even how you judged others around you, and so on. Teenage years can be an awkward time of maturing and an exciting time of development, but they can also be a painful stage if support systems are not present. We can all remember mentors, parents, siblings, teachers, and coaches that influenced and encouraged us. But, what if you were different physically? What if you couldn’t wear clothes that were in style because they irritated your skin or you couldn’t participate in extracurricular activities due physical challenges? What if people didn’t understand and support you? Not having certain opportunities in this stage of life can feel confusing, unfair, and often hurtful, as peers are not always accepting of anything or anyone deemed “different”. This is something that individuals with SPD face, especially considering that SPD is often diagnosed alongside other diagnosis such as autism, obsessive-compulsive disorder, and attention deficit disorder.
Sensory obstacles come in all forms. There are sensory modulation disorders, sensory discrimination disorders, and sensory-based motor disorders (Kranowitz, 2016). No matter the form, everyday tasks like getting dressed, eating meals, and travel have unique challenges. Many normal daily activities may be painful, over stimulating, or physically challenging to individuals with SPD. Considering this, Kranowitz emphasizes the importance of family relationships amongst this population.
For the purposes of this review I would like to focus mainly on what Kranowitz shares about coping with relationships and gaining self-acceptance. Often individuals with diagnoses that cause them to perform differently than others also are perceived differently, which can have a large emotional effect. Through working with multiple populations that face SPD, especially motor movement differences and speech challenges, I know from experience not to assume anything based off of what is perceived on the outside. There is always more going on with the body and mind of a person than what we perceive from the outside. This book exemplifies this reality through research review and testimonial compilation.
Let’s talk about negativity. Many different emotions, for example shame and guilt, stem from negativity. For individuals with sensory differences, these feelings are a huge issue (Kranowitz, 2016, p. 44). This is important for teachers, peers, caregivers, and especially family of individuals with SPD to be aware of. Although SPD has no found cure, individuals and families can learn to make adaptations and live in a way that works for them. Instead of frustration when it takes longer for an individual with SPD to complete classwork, there should be encouragement. Kranowitz shares one adult male’s testimony with SPD, saying, “Stop listening to those that don’t understand you” (Kranowitz, 2016, p. 51). The individual went on to encourage people to research their symptoms, reframe their situation, and seek out effective therapeutic resources to help them overcome big challenges. This individual had friends and family that supported him throughout an occupational therapy journey. Over time he was able to report feeling hopeful instead of hopeless in a world of sensory obstacles.
As teenagers with SPD struggle emotionally, so can their close family members. It is not easy when a parent lacks understanding for the way their child reacts to certain situations or stimuli (Kranowitz, 2016, p. 155). The family dynamic can be negatively affected if therapeutic approaches and lifestyle adaptations are not utilized. An example shared was a teenager who grew up feeling distant from her parents and siblings because she was misunderstood. Her reactions to scratchy clothes and loud noises were treated as misbehaviors. When she had a meltdown and received additional attention from her parents, her siblings teased her and exhibited jealousy towards her. It wasn’t until later in life that she was diagnosed with mild autism and SPD. She was thankful to finally have an answer to why she felt so out of place (Kranowitz, 2016, p. 157).
This is where music therapy becomes a wonderful option, because it creates a therapeutic atmosphere that is client centered, effective, and generalizable in the home. Music also becomes a means of sensory integration and coping through the support of music interventions. In chapter 13 individuals share examples of their successes and thriving careers. After years of therapy, supportive families, informed teachers, and applied coping strategies, they were able to overcome challenges to accomplish their goals. Several of them mention music in their excerpts. There is a drummer and a singer, both advocates in the SPD community. They share about how music was their lifeline, as it restored order in their bodies when other activities were too much (Kranowitz, 2016).
One of many skills I have been able to work on during my time at The George Center has been counseling. Counseling techniques are important because many of the patients we serve not only want to improve and meet their therapeutic goals, but there is also an element of coping with a diagnosis that is a constant battle in many of their lives. Kranowitz elaborates on the emotional impact living with SPD can have on individuals sharing pieces of personal testimonies, as well as sharing therapeutic success stories from professionals. Applicable coping strategies for life skills and emotional trials are also shared in each chapter. Some of these topics include daily activities, relationships, and transitioning into adulthood. The last section of the book focuses on specific treatment and shares multiple examples of therapies as well as lifestyle changes that have benefited individuals with SPD in the long run. Although music therapy is not explicitly referenced, the importance of music is mention multiple times.
I think it is important to note that this book has a strong occupational therapy focus, but encourages all options. After reading the many testimonies and complimentary terminology to music therapy, I was ready to research more. I would LOVE to find the music therapy based equivalent of this book. Music therapy fits in so well with this population, and I have seen first hand sensory success made in music therapy sessions. One beneficial technique mentioned throughout this book is deep pressure. In music therapy we utilize a similar technique, called rhythmic body mapping. Other techniques used are lyric analysis, sensory integration using music and instruments, movement to music, music performance, and therapeutic singing.
Overall I was pleased with the information this book had to offer and I enjoyed the way the author connected the medical research to real life examples. It was a truly eye opening read as some of the testimonials were sad, but very real. For anyone wanting to read more into how it feels to live with SPD or a diagnosis with similar challenges, this is definitely the book for you.
A. Blythe LaGasse; Influence of an External Rhythm on Oral Motor Control in
Children and Adults, Journal of Music Therapy, Volume 50, Issue 1, 1
March 2013, Pages 6–24, https://doi.org/10.1093/jmt/50.1.6
One of the most undeniable elements of music is rhythm. Everyone experiences rhythm; whether it is through hearing it within music or feeling it through vibrations. Rhythm is also one of the most undeniable elements of our bodies. As humans we are rhythmic beings. From our heartbeat, blinking, walking, and to the way our breathing patterns changes, we operate with rhythm. This is something that excited me about music and how it impacts the body. Therefore, when I came across the article, Influences of an External Rhythm on Oral Motor Control in Children and Adults by LaGasse, I knew it would be an interesting and informative read.
Before jumping into all the technical details of this study, I will briefly discuss something the author references throughout the article, which is the concept of entrainment. Entrainment is basically our body’s ability to sync up with external rhythms, pulses or beats (LaGasse, 2013). We entrain to the rhythms around us all the time, but we are not always aware of it. A simple example of this could be tapping your foot to a familiar song, or beginning to walking in sync with someone you are walking next to. Our bodies are often able to anticipate as well as reproduce what is heard and felt around them through entrainment. It is important to preface with this, because the author goes on to discuss motor movements of the upper and lower extremities, as well as oral motor movements and how they relate to entrainment.
Rhythm in music therapy is one of our most valuable tools, especially with individuals that have neurological disabilities. Within my practice at The George Center, rhythmic auditory stimulation is used regularly to support and facilitate patients with motor and speech goals. Sometimes all it takes is tapping on the shoulder of a client while they vocalize. Other times entire interventions are centered around helping a patient entrain to a slower beat so that they can slow down their body enough to have success in later exercises. Body percussion throughout a song, or playing rhythm sticks are some way that this is implemented musically.
LaGasse touches on how rhythmic auditory cues have been supported in the field through research. Rhythm is beneficial in promoting the development of motor speech, which is an individual's ability to plan, control, coordinate, and produce speech. LaGasse also compares the limb motor responses to oral motor responses. This is important to note because just like our arms and legs entrain to rhythm, so can our mouth. The oral motor system is complex, but has much less research to support rhythmic impact within therapy. Therefore, this study in 2013 opened a door for others to continue researching the entrainment phenomenon in relation to oral motor movements.
The study focused on 26 children and adults ages ranging from 7 to 35 years old with no history of speech, language, or hearing impairments. The method used to measure kinematic (movement) data in these individuals was Peak Motus, a 3-camera system. The camera recorded markers that were placed on three points of the oral motor area, the upper lip (UL), lower lip (LL), and the mental protuberance of the mandible (J) (LaGasse, 2013). Digital cameras were also set up so that 60 samples would be taken per second. A metronome positioned in the same location near each patient, was used to produce the auditory stimulus, which was set at 60 decibels. The participants were asked to repeat the syllable /pa/ at a comfortable pace during one trial. This trial tracked oral performance at a self-selected tempo. Participants were instructed to produce the same /pa/ syllable with an external auditory stimulus provided through a metronome set to the beat of their previously self-selected tempo. The participants were also asked to produce the syllable with a faster tempo, at a 10% increase from their original preferred tempo. The trials were done in varying orders through random selection. This was done to decrease any effects due to learning or fatigue amongst the participants (LaGasse, 2013).
After the trials were completed, measurements were made to compare levels of entrainment. This was done through the use of program data, which measured movement and the amount of time between beats, as well as the distance between UL and LL during syllable production (LaGasse, 2013). In short, the technology used measured each individual’s oral movements in length, time, and distance to come up with an overall average for the subject. This was done for all 26 participants.
The results of this study were particularly interesting to me because they were calculated using such a raw element of music. Individuals were solely provided a computer-generated tempo to entrain to! This is cool because they had no melody or otherwise motivating musical theme to listen to, it was simply a constant “beep” that created the steady beat. For the synchronization aspect of the study, no significant differences were shown amongst children and adults. Asynchrony, which means the individual produced sound before the beat, was recorded for all groups, but was a result of anticipatory responses in all cases. However, these instances were milliseconds off of the beat (LaGasse, 2013).
This study supported movement data with graphs for all participants, which were especially interesting to view, as they created a picture of each movement. They were successful in measuring all participants through this method, which is exciting because this research will be able to be repeated in the future! This method proved to be a reliable way of tracking oral motor movements in individuals. When comparing oral motor synchronization to the same strategies done for limbs, LaGasse reported some slight differences among errors recorded. Overall, the data recorded was exciting to view and compare amongst children and adults.
As I reach the halfway point of my internship at The George Center, I can honestly say that the approaches I am being taught can be supported with this type of research. There is not a day that goes by that I am not reminded to, “let the music be your co-therapist” or to “use the rhythm”. Words like “entrainment”, “anticipation”, and “support” are constantly woven into the teaching of approaches being applied in the treatment setting. One clinical example of this would be using percussion, like drumming, with patients as a primer activity to get their body in sync with the beat of a song. Following this, I continue to play the guitar rhythmically to support them while we sing a song together. After the client is singing, I can fade out singing with them and use the rhythmic playing to cue responses. With clients that have speech and oral motor difficulties, techniques like this have proven to work very well. I am continuing to learn how to better manipulate and use the elements of music to elicit positive responses from each client. Rhythm is a major part of this beautiful process!
It’s that time again! The last 2 hectic weeks of the school year, and at the end of the long tunnel is the glimmering light of summer vacation! Many families are planning vacations and other travel opportunities, and several of our students are already excited about the camps they will be attending this summer. Here at GCMT, we are prepping for the many camps we’ll be leading music for across the community this summer, including FOCUS+Fragile Kids Camp Hollywood, Aurora Day Camp, Camp ImpACCt, and our own Camp CreARTive. We also have our weekly Bucket Drumming and GROW social skills groups meeting throughout the summer!
These last couple weeks of school can leave parents and caregivers feeling a bit frazzled and really looking forward to any planned vacations or unscheduled time that may be coming up (although a couple folks have let me know they are dreading the change in routine). It can be tempting to contemplate taking a break from services over the summer. Vacations and camps and all the things can definitely be a lot to juggle! However, we always encourage our families to try to maintain consistency in services over the summer for several reasons:
Often during the summer, we see an increase in progress toward therapeutic goals/objectives BECAUSE our students have time to practice and complete home exercises. They also can be less distracted or tired as they have not spent all day at school. You wouldn’t take off 3 months from working out or training for a marathon and then expect to pick right back up where you left off! Consistency over the summer keeps our students from having to relearn concepts and skills later, which is an efficient use of time and money! Many of our students thrive on routine, so keeping music therapy appointments consistent during the summer months is a good way to create that environment for them!
It’s MUCH MORE Than Just Fun Time!
Music Therapy services or Adaptive Lessons are much more than “Happy Music Fun Time” for our students. While it is definitely a motivating modality, we are working on so much more than just having fun! When the human brain perceives an experience as fun, the skills learned during that experience are more likely to be retained. Think about the last time you went to a concert or party, and then about the information you studied the last time you were preparing for a test. Bet you can probably recall the details from one more easily than the other! Summer can be the perfect time to really focus on our student’s goals and objectives, because we have the scheduling flexibility to have more frequent appointments, and our students are often in a more relaxed frame of mind. If your student is enrolled in Adaptive Lessons, talk with your student’s therapist about the possibility of addressing a wider variety of goals and objectives during the summer while time permits. Summer is also a great time for families to get involved in at-home practice to promote further progress towards goals.
Unfortunately, many of our families who do choose to discontinue services over the summer wind up losing their time-slot for the school year due to our attendance policy. Our therapists and office are always willing to work with families who may have tricky scheduling needs over the summer, and often have increased availability for rescheduling missed sessions or moving to an appointment time that works better for your schedule. Summer also provides opportunities for your student to work with another of our amazing therapists if they have someone subbing for them while they are out on vacation or working at a camp. This can give increased chances to work on transfer of skills and address goals in different ways! Call our office or talk to your therapist about rescheduling or working with a substitute. Summer is also the ideal time to apply for 3rd party funding resources to help pay for therapy services!
Summer can be a great time to take advantage of opportunities your student may not have during the rest of the year, and we’re not just talking about vacations! GCMT prides itself on providing our families with outstanding services, support, and communication throughout the year. We always want parents, caregivers, and other family members to be an integral and active participant in your student’s therapy and learn how to provide an environment for your student that will support continued development. Our intention is to move toward a level of independence within everyone’s abilities. As in all aspects of life and learning, steady progress toward our goals requires consistency in service provision. Of course, we know that everyone needs a break now and then, so give our team a call so we can coordinate a schedule that supports summer vacation fun and consistent appointment scheduling for the best of both worlds!