An Introduction to Music Therapy Advocacy

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Webster's defines advocacy as - “the act or process of supporting a cause or proposal : the act or process of advocating something.”

When I started studying my career in school and as I entered the workforce, I don’t think I fully understood what it meant to advocate for my music therapy. Mainly, I’m not sure I knew how many aspects of it would need advocacy.

I entered a young profession that is only officially 6 or so decades old. Which means that there is still a large population of people who have never heard its name, music therapy.

Inherently, music therapy can conjure images of circle singing and hand holding and maybe even a peace sign or two. Rather than the accurate alternative of therapists in scrubs or professional attire who have a guitar and several alternative pitched and unpitched musical items to address non-musical goals with patients from the NICU to hospice and everywhere in-between. The first thought about music therapy is one of the hardest obstacles to overcome, to be heard speaking scientifically about musical qualities when an assumption keeps you from being heard as a licensed and certified allied health profession. And fun fact: contrary to popular belief, I have never sung kum-by-yah in any of my sessions.

So as the first obstacle is the name, the second comes from the true motivations behind using music as the modality to address a patient's goals. While there are several ways to use music therapeutically to address emotions and psychiatry, the list doesn’t even come close to stopping there. My day in and day out focuses more on the regulation, sensory, motor, and cognitive skills of my patients. I work mainly with populations that have neurologic dysfunction and due to music having such great ability to access the brain and an to simultaneously engage many aspects of functioning, you allow the plasticity of the brain to have optimal opportunities to reroute through damaged areas. Whether you’re addressing gait, fine motor skills, visual tracking, cognitive concepts, or awareness of body you are able to exercise the brain using music to support its most efficient means to recovery.

The last, and to me the most difficult, piece of advocacy comes in the form of advocating for my clients. As I mentioned, my populations mainly fall in the neurological category which can include autism, TBI, parkinson’s, degenerative neurologic disease such as alzheimer's, and more. There is new research everyday that challenges traditional understandings of these diseases and dramatically change treatment. The more you learn about how to treat these varying diseases, the more you learn about the abilities often overlooked due to the outside picture gathered from a simple glance. As you get to know your patients, you learn about their rich lives, their hopes and dreams, and the people that love them. You gain a window into their everyday lives and you not only want to make their lives better using your medium, but you want the world to know who they are. This simple article is more than introduction to music therapy advocacy, but an awareness to what is possible when you believe in what you do, and the people you get to do it with.

The Giving Tree in the News!


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

Drumming for Social Skills

“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.

Works Cited

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.

Singing Drills for Motor Skills: An Article Review

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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: The Out of Sync Child

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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.

 

 

 

 

 

 

 

 

 

 

 

 

 

Speak to the Beat

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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!

 

Summertime Services

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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:

  1. Therapeutic Value

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!

  1. 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.

  1. Increased Flexibility

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!


EDITOR'S NOTE**

We are still accepting donations for our SOS Financial action campaign. See our DONATE page to learn more!

Music, Memory, & Healing: An Article Review

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Carme Solé, Melissa Mercadal-Brotons, Adrián Galati, Mónica De Castro; Effects of Group Music         Therapy on Quality of Life, Affect, and Participation in People with Varying Levels of         Dementia, Journal of Music Therapy, Volume 51, Issue 1, 1 March 2014, Pages 103–              125, https://doi.org/10.1093/jmt/thu003

 

 

Music is present in every stage of a person’s life. Think of when you listen to the radio and a song from childhood comes on. Oftentimes songs from the past  are the ones that people know the best. Music stimulates our brains in a way that long-term memory is accessed so that we can use it when we hear a familiar particular song. Long-term memory is located in various parts of the brain, the hippocampus being the catalyst. When we are able to make music with others through singing, and enjoy knowing every word of a song we haven’t heard in years, we also experience positive feelings. There is enjoyment and comfort in knowing the music we hear. Individuals living with dementia do not get to experience the easiness of knowing in everyday life due to the nature of their diagnosis. Dementia affects orientation and overall awareness. Even in early stages of dementia, individuals may experience the uneasiness that feeling overly forgetful can bring.

As an intern at the George Center for Music Therapy I am involved with several memory care groups and get to observe multiple settings where dementia patients receive music therapy services. This article topic stuck out to me because it poses important questions and sets a foundation for future research, while validating therapeutic approaches already being used. Through the article, “Effects of Group Music Therapy on Quality of Life, Affect, and Participation in People with Varying Levels of Dementia”, music therapists examined how music therapy positively impacts the lives of individuals living with dementia. The study included 16 individuals with dementia. The Global Deterioration Scale was used to measure cognitive functioning amongst the 16 participants (Solé, Mercadal-Brotons, Galati, & De Castro, 2014). Their functioning levels ranged from mild (9) to moderate (5) and severely impaired (2).

Dementia is defined in general as a neurodegenerative disease that is characterized by the progressive loss in memory as well as other mental functions including language and judgment. Due to the of the nature of these types of diseases, therapeutic techniques that involve multiple parts of the brain are important. According to this study Alzheimer’s disease is the leading type of dementia that affects people in the United States. It has been reported that 60 percent of all dementia cases are of the Alzheimer’s disease (Solé, Mercadal-Brotons, Galati, & De Castro, 2014). This study further supports the importance of research in these areas where music therapy is involved. Individuals with dementia that are receiving services deserve the most effective interventions. Music therapy provides just that! As I continued to read the article, it became evident how an individual’s quality of life is positively affected by music therapy in a group setting.

Although this study had a small sample size of 16 individuals, three groups according to stage of dementia were formed. These stages were low, moderate, and high levels of dementia.  Each group met for 12 weeks and received 45-50 minutes of music therapy once a week (Solé, Mercadal-Brotons, Galati, & De Castro, 2014). Documentation was done through the help of registered nurses before, during, and after each group session. Quality of life was measured using the Government of Catalonia (GENCAT) questionnaire. This questionnaire consisted of 69 questions revolving around eight different dimensions. These dimensions were emotional well-being, interpersonal well-being, material well-being, personal development, physical well-being, self-determination, social inclusion, and equal rights. The individual’s scores in these domains reflected their overall quality of life. Participation was measured through data collection as well as through video analysis. Sessions 1, 6, and 12 were video recorded and analyzed for each group. But enough of the data details, let’s dive into the music therapy specifics!

For each group the music therapy interventions used centered around stimulating cognitive functions, social interactions, and motor skills. Motor skills were addressed through instrument playing. Other musical activities during each group included singing, listening to music, movement to music, and improvisation (Solé, Mercadal-Brotons, Galati, & De Castro, 2014). The music used for the groups was selected based off of personal preferences of the group members. In my experience using familiar music is especially important with this population when trying to evoke active participation. Each session included opening activities, like a hello song, one main activity, and a closing activity.

As data continued to be collected weekly, it became obvious which areas of the patient’s lives were being most influenced during the study. Participation and affect amongst the group was measured through observation. During observation the categories being measured were verbalizations, physical contact, visual contact, active participation, and emotions (facial affect and body expressions). Each group recorded the same pretest and posttest weekly, and each domain within the test was tracked statically. Some of the areas to show the largest changes were emotional well-being and personal development. However, emotional well-being was the only domain to show a statistically significant increase, recorded as Mdn=21 pretest to Mdn=23 posttest (Solé, Mercadal-Brotons, Galati, & De Castro, 2014). Although the personal development domain did not reap significant results, the data still presented interesting outcomes. I felt it was worth noting that the medians for all groups in that measurement either stayed the same or increased. The extent of these results was interesting and sets a wonderful foundation for future research.

As I near the midpoint of my internship at The George Center, I continue to learn more about every population and clinical environment we serve as music therapists. Since personal development and emotional well-being had such positive outcomes in this study, I would like to close by briefly discussing those in the memory care setting. As this study emphasizes, every part of the therapeutic interaction and participation within a group is important. I especially loved that this study used primarily patient preferred music and that the comfort that can bring was reflected in the patient’s emotional responses. When patients have decreased levels of anxiety or have the opportunity to increase their overall mood, this benefits the whole body. I have experienced firsthand the benefits of group music making with dementia patients. Although personal development is hard to measure with this population due to the degenerative nature of dementia, there are still many promising examples. It is always a special moment when an individual comes out of their shell to sing several verses of a song from memory, or passionately plays an instrument with peers. After a moment like this, many times that individual sustains attention and participation for the rest of that session.

Working with the George Center I have learned so much about this population and I feel confident about the interventions we use within each session. I can leave the facilities knowing we left a positive and lasting impact. This article simply confirms the importance of group music therapy in the healthcare of individuals with dementia. It screams, Music therapy works- pass it on! And that I will do! Before reading this article I was relying on past experiences and learning as I went with this population. I have learned that patient preferred music and being able to play in the original styles of songs evokes more of a positive response in memory care groups especially. As a new professional a big challenge is expanding my repertoire. This article was a great reminder that I can never know enough music. I look forward to passing on more research like this and continually retaining knowledge through the clinical experiences this internship offers.