Group Music Therapy

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.

 

G.R.O.W. is BACK!

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Friends, I have the BIGGEST news to share with you.

G.R.O.W. is BACK!!!!

If you’re new to these parts and you would like me to take a step back, I’d be happy to! G.R.O.W. stands for Girls Reaching Our World….. Through music! It is a GIRLS ONLY 9 week summer music course focused on GIRL POWER! We’ll make music and build friendships as we explore empowerment, self-advocacy, and social skills.

 

Here are the deets:

Who: Your rock star daughters, rising 4th-12th grade

When: Monday afternoons from 4:15 - 5:15 pm

Where: Building Bridges Therapy in Cumming, GA

 

So, here’s the deal: we’re going to use our favorite music - I’m talking Taylor Swift, Katy Perry, Moana, Frozen, and MORE! - we’re going to use that music to develop friendships and skills using evidence based techniques in music therapy. This will look like sing-alongs, musical games, instrument play, drumming, you name it! We hope you’ll join us for this non-stop fun class as we explore powerful music to discover the power in us individually and as a team! The most fun part might be getting to share a moment of this class with your girl on our last day of class when we show off some of our favorite activities from the summer. It truly is a can’t miss opportunity. We can’t wait to see you there!

For more information, or to REGISTER, visit TheGeorgeCenter.com/GROW or email HannahR@TheGeorgeCenter.com

 

 

Camp CreARTive at The George Center

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It’s that time of year again, my friends! It’s that time of year where all the summer camps are getting planned and everyone at the George Center is getting STOKED for our 2018 hosting of Camp CreARTive! As a new employee to the George Center last summer, I was lucky to be able to lead music in every day of camp and am here to tell you about how great it was!

 

 

One thing that sets Camp CreARTive apart from other camps is its emphasis on making art. We spend every part of the day being creative by exploring different mediums art, whether that is through playing music, moving to music, making crafts, etc. Camp is led by an Adaptive Art Teacher, a Music Therapist, an Occupational Therapist, a Speech Therapist, and a Recreational Therapist. With all these creative individuals leading camp, your child can’t help but have a good time!

 

Every day of camp is set to a theme that serves as an influential emphasis for the art to be made that day. Last year’s themes included themes such as Australia Day, Native American Day, and my personal favorite, MOANA Day. One of the highlights of last summer for me (and for most of the campers) was Moana Day! This day was particularly special in that we got to use ALL of the music from the movie within our music therapy sessions. That means all the hits such as “How Far I’ll Go” and “You’re Welcome”. The campers also made their own Hawaiian demigod masks and even Maui’s infamous hook. Did I mention we also learned how to dance the hula?!

 

With all this being said, you might be thinking “how can it get any better?”. Well, my favorite moment of camp was the last day of camp when all of the parents showed up for our final performance of the week where we not only showcased all the art that we had made that week, but got to show off our music skills in front of all the parents. We sang, danced, and played instruments, but couldn’t help ourselves in including all the parents. We capped off a magical week of art making with a full on drum circle! That means all the campers, therapists, parents, and families all making music together. Considering music is a universal behavior, everyone got to experience the power of music one last time before camp ended.

 

This camp is special one. You’re kiddos will leave each day feeling accomplished by their creations, empowered by their interactions, and excited to come back! Our goal is to provide an avenue to learn and grow through art and music. After my first experience with camp last year, I can’t wait to be back this summer for a full week of non-stop art creation and music-making!

 

Songs, Sensory, and Social Skills: Group Music Therapy for Children with Autism

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The possibilities that music brings to the therapeutic process are endless. Communication, motor movement, processing, stimulation, sensory elements, and so much more are easily accessed through the use of music alone. As a new intern, my first weeks at the George Center have been full of observing all of this in action.  My mind seems to be more full than ever of examples of how music therapy is used to benefit the lives of individuals everyday. Considering all of this, as I chose my first journal article, I decided to pick something that addresses one of many populations that I am passionate about: children with autism.

In my experience, Autism Spectrum Disorder (ASD) presents itself differently in every child. There is beauty in this, but it definitely does NOT make an easy job for science. This diagnosis can still be a highly controversial in many settings and even homes. The history of therapy for this population can be both inspiring and heartbreaking to those who know how far the world of healthcare has come in regards to individuals with ASD. All of this is exciting as we see research lead to successes being documented, especially with music therapy.

According to the  article Effects of a Music Therapy Group Intervention on Enhancing Social Skills in Children with Autism, statistics show that 1 in 88 children in the United States are diagnosed with ASD (LaGasse, 2014). Since this study statistics have changed. According to the Center of Disease Control and Prevention 1 in 68 children now meet the criteria for ASD. Autism is defined in short, as a neurodevelopmental disorder. Current research suggests that neurological aspects influence specific features of ASD. Some of these directly relate to motor deficits and difficulties with sensory processing. However, research also confirms that individuals with ASD demonstrate different musical processing skills, in that the activation of their brain surpasses that of neurotypical or normally developing individuals (LaGasse, 2014). So, good news: music is a multisensory medium!  

You may ask, “What is one of the biggest challenges for children with ASD?” I would venture to say that one of the largest areas of focus in general is socialization and communication. Although this is a large focus, to achieve goals in this area the regulation of the sensory system is what current research has shown to be most important. Therefore, it may be language development we are trying to foster; other times it is socialization skills and interactions that are required on a daily basis that we are trying to build on or make more tolerable through music therapy. The areas of expressive, receptive, verbal, and nonverbal language all fall under social and communicative areas of development. One way music therapy can help children that battle issues like this is through group interventions. This article by LaGasse exemplifies recent successes in this area, so let’s jump into the details!

Studies show that music therapy can improve social behaviors and joint attention in children with ASD. LaGasse delves into what impact music therapy has in a group setting along with areas of focus within the groups relating to social skills, which included eye gaze, joint attention, and communication. To examine this in the study children ages 6-9 with ASD were assigned a music therapy group or a non-music therapy group. The children participated in two 50-minute sessions per week for 5 weeks, for a total of ten sessions during the study. Each group was designed to target social skills.

Social skills are important to be addressed in children with autism because the lack of development in these skills will have lifelong implications (LaGasse, 2014). It is stressed that social skills are needed in every relationship and activity. Noting this, another important piece of research is referenced in this article, stating that, “ The notion that persons with ASD do not want to be involved in their environment is being challenged as self-advocates with autism indicate that it is not a matter of wanting to interact; rather, they have an inability to follow through or tolerate the desired interaction” (Goddard & Goddard, 2012). Key words there are inability and desired.  As research like this advances, it is becoming more apparent that by helping develop these skills in children with ASD, we are also giving them tools to enhance their overall quality of life.

The outcome of this study was very interesting. Through the use of uniform scales to measure the changes in social behaviors, the results found over this brief period of time that the music therapy group showed more improvements. Positive differences primarily showed up in attention with peers and eye gaze towards individuals (LaGasse, 2014). After 10 sessions the mean for eye gaze variable in the final calculations increased by 3.73 for the music therapy group. The mean decreased 14.75 for the non music social skills group. The explanation of these results pointed toward musical structure being able to maintain children’s attention to their peers more than the prompts and visuals used in the nonmusical group.

These results are important because they validate techniques being used in music therapy and highlight an issue that has a lasting impact on the ASD population. In the music therapy group of this study, some intervention tools used were rhythmic cueing, rhythmic deep pressure exercises with songs, instrument playing, as well as music and movement. For both groups the goals were the same, however, outcomes for the music therapy group were different. Both groups had interventions revolving around group interactions, cooperative play, and sensory experiences. The rhythmic and structural components of music can provide a cue or foundation externally that assists individuals with ASD in organizing their responses to their surroundings (LaGasse, 2014). This fact only supports why the music therapy group had higher positive outcomes.

This article is one of many that scientifically support the use of music therapy for children with ASD. This type of research impacts my work as a future music therapist and as an advocate for individuals I serve because it supports the use of music as a therapeutic tool to reach nonusical goals. Going forward, I will continue to observe and participate in ASD groups with the mindset that this type of research gives of hope and a solid foundation to what possible benefits music therapy services can bring. There are opportunities everyday to observe success happening at the George Center. I appreciate the proactiveness, integrity, and assumed competence I have observed each therapist treat ASD clients with at this facility.

The importance of early intervention and consistent complimentary treatments like music therapy cannot be advised enough by professionals.  It is my hope that through being able to share small pieces of this, that parents, teachers, and current therapists will continue to take initiative and stay updated on ASD research. For this relates to our professions, our caregivers, our community, and most importantly our loved ones impacted by this diagnosis everyday. It is our job to advocate and support these children that cannot always access the ability to do so for themselves.   

 

 

A. Blythe LaGasse (2014). Effects of a Music Therapy Group Intervention on             Enhancing  Social Skills in Children with Autism, Journal of Music Therapy,         51,(3). 250–275.     


Goddard, P., & Goddard, D. (2012). I am intelligent: From heartbreak to healing- A         mother and daughter’s journey through autism. Guilford, CT: Skirt!

About "Singing with Parkinson's"

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In just a few short weeks, we at the George Center for Music Therapy, in partnership with The Alchemy Sky Foundation, will be kicking off Atlanta’s first Singing with Parkinson’s choir!  Singing with Parkinson’s is a therapeutic choral experience designed by neurologic music therapists to address the symptoms of Parkinson’s Disease (PD) all within a setting that is sure to provide a sense of community and a multitude of opportunities for growth.

We begin rehearsals on Monday, April 9th, from 6:30-7:30 PM at the beautiful Renaissance on Peachtree in Buckhead (complimentary valet parking is provided).  We will rehearse each Monday evening at the same time and location from April 9th to August 20th, with all our hard work and fun culminating in a community performance!

Singing with Parkinson’s is open to all those living with PD, and you do not need a musical background to participate.  We will begin each rehearsal with vocal and physical warm-ups led by a neurologic music therapist incorporating techniques designed to address the symptoms of PD.  Throughout our time together, we will explore a broad spectrum of repertoire, including genres spanning from folk, pop, and Broadway tunes to choral music. There is sure to be something that will challenge and engage participants from a range of backgrounds, as well as opportunities to build new and meaningful relationships.

Registration for Singing with Parkinson’s is currently open and will remain open until March 31st so if you are interested in joining, please click here and fill out a registration form.  If you have questions you’d like to ask, please contact us at Claire@thegeorgecenter.com.  We’d love to have you join us in this therapeutic opportunity to blend backgrounds, experiences, and voices in a rich and beautiful music-making experience.

Hope to see you there!

 

Singing With Parkinson’s: Therapeutic Benefits and Potential

This April, we at the George Center for Music Therapy are thrilled to be partnering with The Alchemy Sky Foundation for our inaugural season of Singing with Parkinson’s! Singing with Parkinson’s is a unique choral experience designed to address various symptoms of Parkinson’s Disease (PD) in an engaging, holistic approach. The program is designed by Neurologic Music Therapists to specifically meet the individual needs of participants with PD, and promises to be a source of community, fun and treatment for all participants. (For more information on the kinds of music we’ll be doing, check in with our next write up in a couple of weeks!)

PD is a neurodegenerative disorder that primarily manifests through impaired motor abilities for those with the diagnosis. Individuals with PD frequently experience a variety of movement-related symptoms, include tremor, gait dysregulation, bradykinesia (slower-than-normal movement), impaired speech production, difficulty swallowing, and muscle rigidity. In addition, individuals with PD are at risk for mood disorders, including depression and anxiety (Tan, 2012), which can further affect quality of life for the individuals and their families. As of 2018, there are approximately one million Americans with a diagnosis of PD.

 

Fortunately, there is a vast body of research supporting the use of music therapy to address these various symptoms. Studies have shown that music accesses various areas of the brain, and that rhythm synchronizes neural and motor activity in humans in general, regardless of diagnosis. This means that your body has an innate response to music, and is activated to respond in predictable ways based on musical input and interaction. Music therapy, and Neurologic Music Therapy in particular, use these intrinsic responses to facilitate both neural rehabilitation and motor regulation. In relation to PD, research shows that music therapy is an effective means addressing multiple symptoms, including improving gait regulation (Lindaman and Abiru, 2013), reducing bradykinesia (Pacchetti et al., 2000), facilitating speech production (Yinger & LaPointe, 2012), and decreasing mood disturbances and depression (Raglio et al., 2015), to name a few.

 

So what does this mean for Singing with Parkinson’s? It means that we will be using evidence-based methods to maintain and improve functioning with our members so that they can maintain their best quality of living outside of the rehearsal. Furthermore, we hope to provide members with an engaging, quality musical experience within rehearsals using a variety of repertoire and activities. And we hope to provide a place where various individuals of the Atlanta area can come together and experience a community of support, encouragement, and fun. When we make music together, we acknowledge our commonality, our ability to come together from a diverse range of backgrounds and experiences to produce something beautiful.

We are so excited about this amazing program. And we are so excited to have you join us.

See you there!

 

Citations:

Lindaman, K., & Abiru, M. (2013). The Use of Rhythmic Auditory Stimulation for Gait Disturbances in Paitents with Neurologic Disorders. Music Therapy Perspectives, 31(1). 35-39.

Pacchetti, C., Mancini, F., Aglieri, Ro., Fundarò, C., Martignoni, E., & Nappi, G. (2000). Active Music Therapy in Parkinson’s Disease: An Integrative Method for Motor and Emotional Rehabilitation. Psychosomatic Medicine, 62(3). 386-393.

Raglio, A., Attardo, L., Gontero, G., Rollino, S., Groppo, E., & Granieri, E. (2015). Effects of music and music therapy on mood in neurological patients. World Journal of Psychiatry, 5(1).

Tan, L.C.S. (2012). Mood Disorders in Parkinson’s Disease. Parkinsonism & Related Disorders, 18. S74-S76.

Yinger, O.S., & Lapointe, L.L. (2012). The Effects of Participation in a Group Music Therapy Voice Protocol (G-MTVP) on the Speech of Individuals with Parkinson’s Disease. Music Therapy Perspectives, 30(1). 25-31.

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