Music Therapy

Autism – What It Really Is… and How Rhythm is the Key

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Article Review #2: Autism – What It Really Is… and How Rhythm is the Key

Since beginning at The George Center, I have come to realize that autism spectrum disorder (ASD) is so much more than what appears on the surface. From my undergraduate studies and interactions, I was familiar with some of the common symptoms: hypersensitivity, echolalia, repetitive movements and behaviors, but that was barely the tip of the iceberg. In the past month and a half, I have learned more about ASD than I have in the past 3 years at university. I am realizing how much scientists, parents, and the public know – and don’t know – about autism. For example, many think that people with autism are generally emotionally detached and have little interest in social interactions. However, if you read some of our clients’ blogs, it is very clear the answer is no. Any apparent lack of emotion is more likely due to a difficulty in planning the motor movements to show emotion: to smile, to frown, to speak, to touch gently. Try telling your loved ones how you felt about them if you couldn’t move a muscle with intentionality. Chances are you would smack them in the face or not move at all. If this is news to you, you might be wondering, “It’s a motor disorder? How?”

Lagasse and Hardy present an extensive amount of research into the neurological phenomena in the brains of people with autism. Although they report that the findings are not always consistent, they discuss some common areas of neurological difference in people with autism. (I am about to use some neurological terms, but please don’t run… I’ll explain).

Firstly, the cerebellum is significantly smaller in persons with autism. The cerebellum is the “general purpose device” that communicates with other neural systems and prepares for movement (Lagasse & Hardy, 2013, p. 68). Thus, deficits in the cerebellum impede a person’s ability to plan their movements – to smoothly and quickly target an object with the appropriate force and direction or to calculate the path of a stimulus. Also, Lagasse and Hardy highlight that  researchers have noted larger brain volume in the early childhood of people with autism (p. 68). This could indicate inefficient pruning of unneeded synapses. Lastly, connectivity within the brain is often different in people with autism. Both underconnectivity and overconnectivity have been reported, one of the complicated results of ASD being a spectrum disorder. Underconnectivity between parts of the brain that are far away from each other can cause motor delays or deficits, difficulties with motor sequencing, planning, motor inhibition, and motor execution (p. 69). Overconnectivity creates clutter and static that make communication between various brain structures inefficient. A frequently traversed and stronger pathway may “hijack” a signal travelling along a weaker connection. Because of this mixture of underconnectivity and overconnectivity,  a person with ASD may be hyposensitive to some stimuli and hypersensitive to others. Similarly, some movements may be very easy to execute, whereas other are very difficult.

Thus, the neurologic research suggests that autism is a deficit in processing sensory information from the environment and a difficulty in planning movements in response. This information significantly affects the treatment approach that therapists should take to effectively help clients progress. It is not that clients do not understand or care about the world around them. They are just trapped in their own bodies, trying to get the words out!

Music therapy is a unique tool to help my clients with motor planning. Entrainment – the phenomenon of your brain and body instinctively synchronizing to a given beat – has already been extensively explored in the gait regulation of clients with stroke (p. 71). Rhythm provides a framework for planning motor movements. It tells a person exactly how long it should take for them to move their limb from point A to point B, and most importantly how to pace the movement that comes in between.

Other musical elements may also facilitate motor planning (p. 72). For example, dynamics – the loudness or softness of sound – can cue the force of a movement. The range of pitches – how high or low – can cue the size of the movement. And of course, the style of the song itself can increase the client’s motivation to execute the movement.

Now that I understand that autism is a motor planning disorder, I can use the same principle of rhythm for organizing movement to help people with autism to plan their movement as well. Only with this essential foundation can we begin to address their ability to communicate and socialize!

At one time, I might have seen a person with ASD and assumed they were just clumsy and uncoordinated. Yet now, when I think about what really is happening within their brains, I realize it must be a scary experience to navigate their surroundings. Just as it is difficult to move around in your attic when it is full of junk from the past ten years, it can be difficult for signals in the brain to navigate amidst a clutter of synapses. I cannot begin to imagine the feeling of dreading every movement I made, not knowing whether I would hit the person next to me or grab a pencil too hard. For every object that approached,  I would just be hoping it would pass me by and not knock me to the ground.

Remembering how rhythm, dynamics, range, and style can affect motor coordination will be essential in helping me to treat my clients. An important part of my role as a therapist when working with my clients with autism will be to provide steady rhythmic support during activities that require some motor response from them – which is essentially the whole session. Additionally, using live music will enable me to adapt musically to the client’s needs in the moment. Just as I try to help my clients execute intentional movements, every element of my music-making and facilitation will require intentionality.

A touching expression from Peyton Goddard, an autism activist with autism himself, recorded in Lagasse and Hardy’s article captures the need for we therapists to give attention to the motor system before all else: “Trying to be the real me, rhythm helps the motor frenzy madness to stop. You are all too musically gifted to ignore the importance of rhythm. Please know my body  utmost lacks rhythm. In music therapy I’m benefitted by pairing to your upping rhythmic beats to motor my body. Trying to be me in harmony!’’

Reference

Lagasse, A. B. & Hardy, M.W.. (2013). Considering Rhythm for Sensorimotor Regulation in

Children with Autism Spectrum Disorders. Music Therapy Perspectives, 31, 67-77.



Music Therapy: Music with a Purpose

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Returning at The George Center has been something I have been dreaming of for a good while, ever since I first discovered it and started volunteering in 2014. I remember sitting in the group for Any Dream Will Do!, assisting the participants, celebrating their successes as they maintained attention for the whole activity, tapped out a steady beat, socialized with peers, or expressed themselves and contributed to a song. I went home singing the songs, thinking to myself how simple yet effective they were. Would I ever write songs like that? Scaffold and elicit such responses as I saw every Tuesday night?

I have learned a lot since then in my undergraduate studies, but now upon my return to The George Center, I realize there is yet so much to learn! What skill do I need to develop the most? Designing music therapy interventions that are not too general but help achieve my clients’ goals and objectives in a S.M.A.R.T way! (That is, specific, measurable, attainable, relevant, time-oriented).

With this in mind, I reflected on an article that I had heard of in a conference session presented by one of The George Center’s very own interns about a year ago: “A Conceptual Methodology to Define the Therapeutic Function of Music” by Deanna Hanson-Abromeit, PhD, MT-BC. It discusses the function of different elements of music – such as melody, harmony, rhythm and dynamics – in the achievement of client’s objectives. Yet in the midst of the hectic clinical experience, when we are learning the basics of leading activities and writing goals and objectives, it can sometimes be easy to forget how these essential elements of music function in treating specific diagnoses and symptoms. It requires not only an in-depth knowledge and integration of all the musical elements, but also an understanding of the needs of the populations we serve.

To bridge this gap between knowledge and therapeutic intervention, Dr. Hanson-Abromeit has developed the Therapeutic Function of Music (TFM) Plan worksheet, which she provides in her article  and explains its relevance and how to use it. This worksheet is primarily intended to be a training and research tool for a student music therapist who is learning how to get the most therapeutic value out of music’s elements for a given population. Additionally, it can be useful for advocating music therapy to other medical and educational professionals. So often, music therapists must defend their practice when presented with the question, “Why music?” especially when there are so many other alternative therapies available. The TFM helps even the nonmusical reader to see the relationship between elements of music and their effect on human response (p. 26).

The first step of filling out the TFM Plan Worksheet is the “Problem Statement.” This includes the general goal desired for the client or population, such as to “improve speech,” to “improve gross motor skill,” or to “improve cognitive skill,” as well as an explanation of why this goal is appropriate. Next on the TFM are the Musical Elements: timbre, rhythm, tempo, pitch, melody, dynamics, lyrics, form, harmony, and style. For each of these elements, the MT must explain the why, what, and how under three headings. (1) “Theoretical Framework” discusses why the musical element is necessary and includes supporting research. (2) “The Purpose of the Musical Element” describes what the element will do to support the goal. And lastly,  (3) “The Explicit Description of the Music Element” outlines exactly how it will be structured in a given intervention.

By the time the student music therapist or researcher has filled out the TFM Plan worksheet, it becomes clear how music uniquely functions in the achievement of the population’s specific goal. For example, if the goal is “to improve speech” in a client with Down syndrome, a completed TFM will highlight how the musical element pitch can help (p. 33). (1) Why is it necessary?  Children and teens with Down syndrome tend to lack speech affect and speak in a low-pitch range. Yet, they can imitate pitches in melodies they sing (2) What will pitch do? The pitch in the melody should be in an appropriate range and should imitate the inflectional pattern of the each word. (3) How will pitch be implemented? The music presented should be between notes A3 and A4. Each pitch will reflect the inflection of each word, such as in the word “today.” The pitch for “to” should be lower than the pitch on the accented syllable “day.” The emphasized contour will help the client practice accenting the appropriate syllable, and in turn improve speech affect in daily life.

Using the TFM Plan worksheet as a guide, the MT must develop S.M.A.R.T. objectives that utilize the musical elements in optimal ways. From there, the MT will develop therapeutic interventions that give the client opportunities to achieve the objective each session. Only when these objectives are established can the therapist, client and family see measurable progress and determine whether the specific approach/intervention is effective. The TFM plan provides information that is broad enough to help create multiple objectives related to the same long-term goal.

I would really like to use this worksheet as I develop interventions with my various client groups. Being in a private practice has exposed me to more ages and populations than I have ever worked with in all my undergraduate studies, and all at once! Perhaps the greatest challenge with TFM Plan worksheet is the amount of research required to learn about the population and their needs. It can be time consuming, and no student or intern ever has enough of that precious commodity! But the quality of the intervention can be greatly improved when the student MT makes the effort to use this tool. I feel that it will be an investment in my clinical knowledge which will help me to be more effective and more instinctively use the marvelous gift of music to heal people of all sorts.

Works Cited
Hanson-Abromeit, D. (2015). A Conceptual Methodology to Define the Therapeutic Function of Music. Music Therapy Perspectives, 33, 25-38.

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!

 

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

 

 

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!

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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