Why Therapy is like Running a Marathon

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If you want to get me talking about something, ask me about running. I guarantee that my eyes will light up, a huge smile will come across my face, and I will begin talking about everything from shoes to socks to hair ties to training plans to body glide to blisters to energy goo to proper breathing technique. I have spent years of my adult life deeply devoted to learning about this sport that I love, culminating in completing two marathons, a half-iron triathlon, and a few handfuls of shorter races. I have studied and trained, bled, cried (both happy tears and tears of pain), and have learned countless lessons along the way. As you can imagine, spending hours and hours in training gives me lots of time to ponder, and recently I have been processing and thinking through this subject about how approaching therapy, specifically music therapy in our case, could be looked at similarly to training for a marathon. 

When I first began running, I couldn’t make it around the track once. I am serious! I was a pretty sedentary kid and teenager, and started very slowly gaining ground in my fitness journey at the end of high school. I would start running at the park after school, and I felt my body changing and getting stronger and gaining more confidence and more endurance. I was hooked! I loved the feeling of being able to run a mile, then a few miles, and relatively shortly after that I could run for hours, so I signed up for my first half marathon when I was 19. Training for that first race gave me direction and purpose for my fitness goals, and forced me to have discipline in training that trickled down into all areas of my life. I just couldn’t get enough of it! 

Let’s think about the first race I signed up for. If I would have gone out there and tried to run 13 miles with no training, I would have probably collapsed, or sustained a major injury, or at the very least have had to quit and seriously hurt my pride. Training for a race is based on small steps (pun intended) and small victories as your muscles strengthen, as your lungs gain capacity, as your O2 volume increases, as you literally grow more blood vessels in order to handle the increased cardiovascular load (I told you I could talk about this for hours!). Any good training plan is going to have you SLOWLY gain traction and gain endurance… too much, too soon will have you sidelined. 

When we have the privilege of working with a client in music therapy, we do what any good coach does. We carefully evaluate the current levels of ability across all domains and in all areas, and build our knowledge of their family, friends, schooling, other hobbies, and so forth. We assess their unique strengths and abilities via a comprehensive assessment, and based on consultation with their parents and themselves if appropriate, we develop a treatment plan for them- our own version of a training plan. We have the ultimate goal of helping our clients reach their full potential, and gain as much independence in their lives as possible. However, just as someone who has the dream of running a marathon, we must as therapists start where our client is when they come to us and build from there in order to reach these goals. 

What does this look like in therapy? It means building a strong foundation. For example, in order for a client to gain the ability to speak in functional sentences, we may need to begin with exercises to build lung strength in order to sustain the air pressure needed to get through a word or two, and build from there. We may need to build abdominal strength to support increased airflow. After that, perhaps we practice singing one word in a familiar song, and then perhaps a whole phrase. See how these are baby steps? It is also very important to remember that progress for any major goal is SLOW and one skill must be mastered before moving on to the next. If we as therapists try to go to fast, and miss steps along the way in helping our clients grow and learn, we may end up building skills on shaky foundations… which will not lead to the lasting and sustainable change that we know is possible with music therapy.  

In running, you can’t skip a step in your training, or neglect the rest of the body as you train. If you spend hours and hours pounding the pavement, your legs and lungs will get stronger, but you may still get injured because your abdominal muscles aren’t getting stronger to support the massive amount of stress on your lower back that comes with running. Also, if your diet is bad as you train, your body won’t be able to rebuild torn muscles with healthy nutrients you get from eating. Did you know that the way you gain muscle is actually through tearing them? Similarly, in therapy, attempting to go too far too soon will lead to frustration at the very least for our clients, and in some cases could be painful or even traumatic. If we need to, we must take a step back when we realize we may be trying something too quickly for our client or something that is beyond their ability level at the moment, and re-evaluate where they are and adjust our approach accordingly.

As therapists, I hope that we can keep this always in mind. We have the capability to take our clients on an incredible journey! The feeling of accomplishing something you have worked hard for is absolutely exhilarating, and I hope to be able to allow my clients to experience that feeling as we work towards their goals and dreams together. 



Singing with Parkinson’s Choral Program presents “Music Across the Pond: Songs of the British Isles and the Americas”

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Roswell, Georgia – June 10, 2019 - Singing with Parkinson's is Atlanta's first therapeutic choir for individuals with Parkinson's Disease. This choir is made possible through the generous support of the Thanks Mom & Dad Fund, the Alchemy Sky Foundation, and The George Center Foundation.

About one million Americans are thought to have Parkinson’s. This is more than those affected by multiple sclerosis (MS), muscular dystrophy (MD), and amyotrophic lateral sclerosis (ALS) combined. Every year, about 60,000 Americans are diagnosed with Parkinson’s and this does not reflect the thousands of cases that go undetected. [1]

 Neurologic Music Therapy (NMT) has proven to be particularly effective for people with Parkinson’s disease (PD). Research in both music therapy and neuroscience has shown that music synchronizes neural activity, and can improve patients’ cognitive motor, sensorimotor, and speech/language symptoms [2]. Furthermore, studies show that music stimulates the production of dopamine and serotonin — two neurotransmitters that are severely diminished in PD patients. Unlike most daily activities, music engages multiple areas of the brain at once and specific elements of music can be utilized to stimulate plasticity in targeted brain regions. PD patients report that participation in singing activities and music with a strong rhythm has improved their: gait [3], breath support [4], swallowing and respiratory function [5], mood and symptoms of depression [6], motor control, ability to perform consecutive tasks [7].

 Our Parkinson's Choir is designed by Neurologic Music Therapists to address limitations and struggles that occur with Parkinson's Disease and improve participants quality of life.

 We invite you to take a musical trip across the pond as our Singing with Parkinson’s Choir presents songs celebrating the British Isles and Americas. Come enjoy this incredible group of singers! The concert is FREE and open to the public on Sunday, 6/23/19 3:00 pm at North River Baptist Church.

 The George Center, a renowned music therapy practice based in Roswell, GA facilitates the program which began in 2018. “We are excited to positively impact the lives of older adults living with Parkinson’s Disease through this research-backed, fun-filled program” said Jaye Budd, Executive Director of the Alchemy Sky Foundation. “As a community, we engage in singing a variety of music each week and use this emotional outlet to address the physical and neurologic symptoms of PD and to foster relationships between our members. We have been privileged to perform in the community at events such as the 2018 Parkinson's Moving Day and the 2019 Living Well with Parkinson's Symposium,” noted Claire Morison, LPMT, MT-BC, who is a licensed and board-certified music therapist.

 

About Alchemy Sky Foundation Alchemy Sky Foundation brings the healing power of music to those who need it. ASF partners with organizations in the community as well as a broad network of music and health professionals to create needs-based programs for its clients. The Alchemy Sky Foundation is a 501(c)(3) non- profit organization.

 

About Thanks Mom & Dad Fund® The Thanks Mom & Dad Fund is a charity created to honor parents, grandparents and mentors by supporting programs and services for the aging population. It works to improve the quality of life for older adults and honors the contributions of older adults one generation to another by raising funds and making grants to agencies serving them.  

 

About the George Center Foundation provides scholarships to families, organizations, and programs who are not able to pay for music therapy services for those in need. Thanks to donors and volunteers - quality, licensed, and board certified music therapy programs that could not otherwise be afforded are accessible to children, adolescents, teens, adults, and grandfriends in the metro Atlanta area.

 
1 https://parkinsonsnewstoday.com/parkinsons-disease-statistics/

 2 E.L. Stegemöller, P. Hibbing, H. Radig, J. Wingate (2017). Therapeutic singing as an early intervention for swallowing in persons with Parkinson's diseaseComplementary Therapies in Medicine, 31: 127 DOI: 10.1016/j.ctim.2017.03.002

 3 A. Hayashi, M. Nagaoka, Y. Mizuno (2006). Music therapy in parkinson's disease: Improvement of parkinsonian gait and depression with rhythmic auditory stimulation. Parkinsonism & Related Disorders, 12:2, S76. DOI: 10.1016/j.parkreldis.2006.05.026

 4 Iowa State University (2017). "Music therapy helps people with Parkinson's build strength through song." ScienceDaily. ScienceDaily, 2 www.sciencedaily.com/releases/2017/08/170802153940.htm

 5 E. Stegemöller, H. Radig, P.Hibbing, J. Wingate, & C. Sapienza (2017) Effects of singing on voice, respiratory control and quality of life in persons with Parkinson’s disease, Disability and Rehabilitation, 39:6, 594-600, DOI: 10.3109/09638288.2016.1152610

 6 https://www.webmd.com/parkinsons-disease/news/20000620/music-helps-parkinsons-patients#1

 7 Raglio A. (2015). Music Therapy Interventions in Parkinson's Disease: The State-of-the-Art. Frontiers in neurology6, 185. DOI: 10.3389/fneur.2015.00185

 

 For further information, please contact:

Jamie George, LPMT, MT-BC

The George Center Foundation

(678) 701-1203

jamie@thegeorgecenter.com

www.TheGeorgeCenter.com

 

Community in Action: Social Benefits of Group Music Therapy

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April was an extremely busy and extremely wonderful month here at the George Center for Music Therapy (GCMT). Therapists and clients were traveling to the Southeastern Regional American Music Therapy conference, and two of our programs had their semester performances. On April 12, Singing with Parkinson’s presented a program of Celtic and American music for the Gwinnett APDA support group. And on Friday, April 27, our Any Dream Will Do Performing Arts Group presented “You Can’t Stop the Beat!: Broadway in 3 Acts” at Alpharetta High School.

As I sat down to write this article, I was considering the vast diversity of populations we serve at GCMT and I found these two very different programs on my mind. One, a therapeutic choir for individuals with Parkinson’s Disease (PD), where adults from the greater Atlanta area congregate once a week to engage in Neurologic Music Therapy exercises and learn music specifically chosen to support their vocal production and maintenance. The other, a social skills performing arts group for teens and young adults with Autism Spectrum Disorder (ASD), Down Syndrome, and other developmental and neurological conditions designed to facilitate interpersonal interaction and socialization. What could these groups have in common?


Community.


Community is a word that means many different things to many different people. It can elicit the image of a neighborhood, a choir, a church, a baseball team. It can refer to a geographical area as vast as metro-Atlanta, or a group of twelve individuals that come together to make music once a week.


At GCMT, we often provide music therapy via individual sessions, designing very specific treatment plans and harnessing the vast and complex power of music to accomplish individualized goals for our clients. But we also have developed and are continuing to develop therapeutic programming that brings people together. In fact, our Summer Bucket Drumming and GROW (Girls Reaching our World) Social Skills Groups start NEXT WEEK! As mentioned above, these programs still target specific therapeutic goals related to motor functioning, communication, and cognition. But they also provide the therapeutic benefit of establishing and building a social network, or a community. And research suggests that this is just as important.


If you have ever been a part of a team, a choir, or a theater group, you probably have a sense of the benefits of community and consistent interaction with a social peer group, such as improved mood, a greater sense of purpose, etc. But research shows real implications for the psychological and physical benefits of socialization and community, and the detriments experienced when these things are lacking. A study published by Xie et al. (2005) demonstrated positive correlations between perceived peer isolation (PPI) in teens and levels of depression. Additional studies suggest that social isolation can be detrimental to the immune system (Liu & Wang, 2005; Hermes et al., 2005), and a 2015 meta-analysis of existing literature presented findings that social isolation corresponds with increased mortality rates (Lundstad et al., 2015). In other words, lack of a social network (i.e. community) can seriously impact your physical and mental health in a negative way. Conversely, research shows that positive social support correlates with decreased stress, strengthened immune systems, and increased recovery speed in cases of illness (Comer, 2015).


Now anybody can be at risk for decreased social interaction. But for the clients we serve at GCMT, these risks are exacerbated by their diagnoses. Individuals with ASD and developmental differences are often prevented from interacting with peers due to motor dysfunctions and atypical forms of expressive communication. Older adults with dementia and Alzheimer’s lose their connections to friends and family with whom they are familiar. Individuals with PD and TBI may lose access to community activities they could once participate in.


This is where the benefits of music therapy, particularly group music therapy, come in. In 2015, researchers Eiluned Pearce, Jacques Launay and Robin I. M. Dunbar published a study documenting the positive social implications of group singing. Findings suggested that individuals who participated in group singing sessions (in other words, choir rehearsals) developed a cohesive social bond with one another at a significantly faster rate than control groups. This means that the simple act of singing in a group with total strangers created a measurable sense of community and social support in a way that was more cohesive and efficient than other social activities and interventions. Additionally, qualitative results from a study published in the Journal of Music Therapy detailed the social and emotional benefits of weekly group singing interventions for individuals with PD (Elefant et al., 2012). Benefits included improved mood, development of relationships with individuals with similar diagnoses, and establishment of an emotional outlet.


Group musical activities also provides means of nonverbal collaboration for individuals who may have unreliable spoken communication or who may require significant support to interact with their peers in other environments. Through engagement in group musical activities such as group instrument play, group singing, or group dancing, participants are able to interact with one another in a structured and motivating environment. In fact, research suggests that synchronized musical output can improve social skills in clients with ASD in particular (Yoo & Kim, 2018). In other words, not only does music serve as a bonding agent to unite peers in  collaborative action, but it also provides context within which appropriate social skills can be fostered and developed.

These social bonds suggested by research are very perceptible realities that we see at GCMT every day. As the director of Singing with Parkinson’s, it has been a joy to watch the participants establish rapport with one another, exchanging jokes during rehearsals and going out to lunch with their fellow singers afterwards. Similarly, as one of the therapists leading Any Dream Will Do, it is incredible to watch the relationships developing between our students and their families, and to witness the immense support and love these amazing people offer to one another.

We know that we are social beings, inherently designed to live and interact with others as we learn from one another and taking emotional comfort and validation in our interaction with our peers. Community is a basic human right and necessity, without which we starve our brains and our bodies.


References:

Comer, R.J. (2015). Abnormal Psychology. (p. 342). New York, NY: Worth Publishers.

Elefant, C., Baker, F.A., Lotan, M., Lagesen, S.K., Skeie, G.O. (2012). The Effect of Group Music Therapy on Mood, Speech, and Singing in Individuals with Parkinson’s Disease - A Feasibility Study. Journal of Music Therapy, 3(49). 278-302.

Hermes, G.L., Rosenthal, L., Montag, A., & McClintock, M.K. (2005). Effects of social isolation stress on immune response and survival time of mouse with liver cancer. World Journal of Gastroenterology. 11(37). 5902-5904.

Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10, 227-237.

Pearce, E., Launay, J., and Dunbar, R.I.M. (2015). The ice-breaker effect: singing mediates fast social bonding. Social & Evolutionary Neuroscience Research Group, Department of Experimental Psychology, University of Oxford, Oxford, UK.

Xie, B., Chou, C.P., Spruijt-Metz, D., Liu, C., Xia, J., Gong, J., Li, Y., & Johnson, C.A. (2005). Effects of perceived peer isolation and social support availability on the relationship between body mass index and depressive symptoms. International Journal of Obesity, 29. 1137-1143.

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.    


The Giving Tree Intergenerational Preschool Program - Award Winning Music Program Offers Free Summer Drop In Classes

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ROSWELL (May 9, 2019) – "Whether we're a preschooler or a young teen, a graduating college senior or a retired person, we human beings all want to know that we're acceptable, that our being alive somehow makes a difference in the lives of others." -Mister Rogers

The George Center for Music Therapy in conjunction with their Bloom in Music Community Music Program is pleased to announce the continued expansion of The Giving Tree intergenerational preschool music class.  Five of their nine locations in the metro Atlanta area and surrounding suburbs will be offering FREE summer drop in dates for families. The Giving Tree is an award winning intergenerational program that utilizes singing, dancing, and instrument play to facilitate interaction between residents of assisted living and memory care centers and local preschoolers. On any given day you may find them practicing “Somewhere Over the Rainbow” using sign language, playing instruments to a Frank Sinatra tune or singing holiday classics. Using music and activities that appeal to young and old alike, The Giving Tree connects these two generations through music and friendship.

Research in music-based intergenerational programming has shown benefits such as improved cross-age attitudes and cross-age interactions between younger and older generations.1 Intergenerational programs enrich the lives of participants while reaching across the perceived barriers of generational divides.2 For aging adults, intergenerational programs are a wonderful opportunity for community access.  The outside world can become distant for residents of nursing homes and assisted living facilities. By allowing preschoolers into their world, the feelings of loneliness and isolation are diminished by the innocence, joy, and playfulness that children bring to any atmosphere. For children, there is so much wisdom and life experience that “grandfriends” can share while simultaneously teaching the children that aging is normal and nothing to fear. 

“I’m amazed by this program. It makes our day. We are blessed by having these young children in our presence. I lost my children when they were teens so I don’t have any grandchildren to enjoy, but now I get to enjoy other people’s grandchildren! I love them.” Lillian Cumbaa, Arbor Terrace of Burnt Hickory Resident

Summer drop in classes are FREE and open to the public. Class locations, dates and time are listed below:

Summer 2019 Drop In Locations:

Arbor Terrace Crabapple

12200 Crabapple Rd, Alpharetta, GA 30004

Wednesdays 10:15-10:45 - 5/22, 5/29, 6/5, 6/12, 6/19, 6/26, 7/3, 7/10, 7/17, 7/24, 7/31, 8/7

Fridays 10:30-11:00 - 5/24, 5/31, 6/7, 6/14, 6/21, 6/28, 7/5, 7/12, 7/19, 7/26, 8/2, 8/9

Arbor Terrace Johns Creek

3180 Karen White Drive, Suwanee, GA 30024 

Mondays 9:45-10:15 - 5/20, NO CLASS 5/27 (MEMORIAL DAY), 6/3, 6/10, 6/17, 6/24, 7/1, 7/8, 7/15, 7/22, 7/29

Brookdale Chambrel

1000 Applewood Dr, Roswell, GA 30076

Tuesdays 11:00-11:30 - 5/7, 5/14, 5/21, 5/28, 6/4, 6/11, 6/18, 6/25, 7/2, 7/9, 7/16, 7/23, 7/30, 8/6

The Memory Center

12050 Findley Rd, Johns Creek, GA 30097 

Wednesdays 10:00-10:30 - 5/15, 5/22, 5/29, 6/5, 6/12, 6/19, 6/26, 7/3, 7/10, 7/17, 7/24, 7/31, 8/7

Arbor Terrace Burnt Hickory

920 Burnt Hickory Rd NW, Marietta, GA 30064 

Wednesdays 10:00-10:30 - 5/15, 5/22, 5/29, 6/5, 6/12, 6/19, 6/26, 7/3, 7/10, 7/17, 7/24, 7/31 

For questions about our summer drop in class locations, dates and times, please email Andrea@TheGeorgeCenter.com

1 Rosebrook, Dr. V. 2006 “Research Indicates: Intergenerational Interactions Enhance Young Children’s Personal/Social Skills.” Together. Generations United Newsletter, Volume 11, Number 2, 2006.

2 Developing an Intergenerational Program in Your Early Childhood Care and Education Center, A Guidebook for Early Childhood Practitioners. Penn State, College of Agricultural Sciences, 7.

“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.

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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.