Collaborative Treatment

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Music therapy, speech therapy, physical therapy, occupational therapy, feeding therapy, and the list goes on and on…. But when it boils down to it, are all of these therapies independent of each other or can they all work cohesively to improve the quality of life for an individual receiving multiple services?

What do we mean by collaborative treatment?

If your child has ever attended any of the summer camps that GCMT is involved with, such as FOCUS+Fragile Kids Camp Hollywood or Camp CreARTive, you’ve been able to see collaboration of services in a fun, lively environment. At Camp CreARTive, we partner with an adaptive art teacher, a speech-language pathologist, an occupational therapist, a recreational therapist, and of course a Music Therapist to provide an artistic avenue for children to learn and grow. Due to the various programming needs, they are a great example of a collaborative relationship between a handful of various professionals.

Just as the phrase may imply, collaborative treatment is the idea of professionals and therapists coming together in a cohesive manner to best serve the client. For example, one of our fellow North Fulton Wellness Alliance members is Precision Chiropractic. When Precision gives their clients a series of exercises and stretches, our music therapists can utilize Neurologic Music Therapy techniques to incorporate those assigned exercises into the client’s music therapy session. Now the client is not only executing those exercises during their chiropractic session once a week or a few times in the home but are able to do them through another venue while being supported by the rhythmic stability offered in music therapy. When doing these exercises in MT sessions, it primes the brain to complete these patterns in a timely and organized fashion that the motor system executes easier than without MT intervention. The same concept can be applied to speech therapy, occupational therapy, recreational therapy, and again the possibilities are endless!

Collaboration does not have to stop with simply opening dialogue between therapists either. Music therapy can also provide support during other therapy sessions. Research has been done with music therapist “pushing in” or providing support during physical therapy settings. The most common example of this has been when a music therapist provides live music during a patient’s gait training. This allows the physical therapist to facilitate gross motor movements while the client is being cued by an aural stimulus he/she can entrain to. Another example of collaboration can be between other healthcare professionals offering support during music therapy sessions. Personally, I have had the pleasure of collaborating with a couple speech therapists during a group setting in the public school system. It was amazing, not only to have the additional support during the session, but to see individual students receive additional prompting that reinforced their IEP goals. It also allowed the speech therapists to experience what music therapy entails.

How Does GCMT fit into this model?

Did you know that GCMT also offers music therapy services at some other locations in the metro-Atlanta area? Building Bridges located in Cumming, GA is a facility that strives to offer families services for diverse needs in one central location. Their other services include speech, occupational, feeding, ABA and physical therapies, and as well as allowing us to rent space to provide music therapy. Their mission is to provide a “collaborative environment to work as a team to provide the best services for our clients” (direct quotation from Building Bridges website). Because they foster a collaborative environment, this has allowed GCMT music therapists to be in conversation about shared clients with other therapists. Due to the shared space, our music therapists even get to converse while transitioning clients from one therapy session to the next, creating a cohesive afternoon of treatment!

The George Center also offers services at ReClif. Located in the Peachtree Corners/Norcross area, ReClif is a fitness based therapy and community center that offers “a variety of services that include physical, social, therapeutic, and intellectual opportunities”. Per its website, ReClif describes themselves as: “a space that allows every participant to thrive to the best of their ability.” Their programs include therapeutic yoga, special fit, interactive metronome, spelling to communicate, traditional speech and occupational therapy, and fit light. Similarly to Building Bridges, this cooperative environment lends itself to several therapies combining forces to best serve the client.

How can I be a part of a collaborative treatment environment?

If your child is receiving a few different services, maybe you’d like to look into one of the two facilities mentioned above. We do have appointments available at both of locations! If you are interested in receiving services at either Building Bridges Therapy in Cumming or ReClif in the Peachtree Corners/Norcross area, feel free to contact our office to make an appointment today!

For our families who receive treatment at GCMT, our team is always willing to collaborate with your child’s fellow healthcare providers. We already attend IEP meetings, share notes, and speak with other therapists and health practitioners when provided with releases from our families. The George Center places a high value on a holistic, team-based approach to therapy by collaborating with members of our clients’ therapy teams, so let us know how we can support your family in the best way possible!





Singing with Parkinson’s – More than Just a Choir

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I consider it a privilege to be able to witness and play a part in The George Center’s Singing with Parkinson’s – a therapeutic choir designed specifically to address the needs of people with Parkinson’s disease (PD). It has been less than a year since the start of the choir, and yet the impact it has had on its members to me is impressive and exciting. Many think of Parkinson’s as a motor disorder – which it is! – but “motor” encompasses more than just the movement of your fingers, arms and legs. Speech is a motor function, along with breathing. In addition to motor symptoms, people with PD often battle apathy and depression. A therapeutic choir is a wonderful way to address all of these issues! Do not take my word for it. Let’s look at the research.

In addition to discussing their own study, Yinger and LaPointe talk about the needs of people with PD and present compelling points from previous research in their article “The Effects of Participation in a Group Music Therapy Voice Protocol (G-MTVP) on the Speech of Individuals with Parkinson’s Disease.” A common speech symptom associated with PD is hypokinetic dysarthria, which makes their speech softer, more monotone, hoarse and unclear. Additionally, people with PD experience lower vocal range and voice arrests. Thus, speaking can be a struggle. Multitasking can also be difficult and even dangerous (p. 26).

Thus far, the most effective treatment for speech impairments of PD has been speech therapy, specifically the Lee Silverman Voice Treatment (LSVT). Yinger and LaPointe suggest that the success of the technique is largely due to its five principles that promote neural plasticity: (1) intensity, (2) complexity, (3) saliency of treatment, (4) “use it or lose it,” and (5) timing of the intervention (p. 26).

Music therapy, however, is emerging as another effective treatment modality. Music therapist Haneishi (2001) began developing a music voice protocol (MTVP) based on the same principles as LSVT to improve the speech characteristics of people with PD in individual sessions. The 60-minute protocol includes opening and closing conversation, facial and breathing warm-ups, vocal exercises, singing exercises, practice sustaining vowel sounds, and speech exercises. Both Haneishi and another music therapist, Perez-Delgado, who adapted MTVP for Spanish-speaking individuals with PD, found that the treatment “increased breath control, voluntary speech production, and voice volume” (p. 28). Other music therapy studies have found a background of singing can delay the age-related decline in speech skills; that stimulative songs decrease the rate of speech while sedative songs improve “rhythm, initial consonants, final consonants, and continuity of speech”; and that singing can improve intelligibility of speech, as much as 21% (p. 27).

Yinger and LaPointe in their study used MTVP in a group setting and found improvements in intensity (loudness) of speech, especially in men, and prosody of speech in conversation in women, in spite of the progressive nature of the disease! (p. 29-30).

Looking at how these ideas relate to The George Center’s Singing with Parkinson’s choir, I see Claire Morison, who currently directs the choir, does an excellent job at incorporating the research-based format and techniques into the weekly rehearsals. These are things that I will need to keep in mind if I ever have the opportunity to lead a choir with a similar population. For example, I will need to make adaptations during rehearsals to accommodate for the needs of individuals with PD, which may include limited mobility, impaired vocal functioning, and potential neuropsychiatric complications related to PD or the medications used to manage the disease. Because multitasking is difficult and potentially dangerous, I may need to simplify tasks for choir members so they can focus on the quality of their singing. Multitasking is typical in the choir setting, such as when flipping through music while reading lyrics and singing. Hence, Claire displays the lyrics and music on a TV, at times scrolled by an assistant to eliminate the need for visual tracking. Lastly, I will need to be familiar with the vocal changes that may occur as a result of age and disease.

There are always ways we can make something good even better, especially as the choir continues to grow and thrive. For example, the fourth principle of neuroplasticity mentioned above, “if you don’t use it, you lose it,” emphasizes the need to regularly practice speech skills. In LSVT, clients are sent home with homework and exercises. In our choir, perhaps sending our members home with a recording of the accompaniment to vocal warm-ups as well as music in print to practice may encourage them to continue practicing at home and hopefully further aid in slowing the decline.

Yet to me, the most unexpected and impressive benefit of the choir is the emotional enjoyment it brings to the clients and their families. I am sure most of the appointments that our clients must attend on a weekly basis can be tedious and discouraging. We encourage caretakers to join in on rehearsals, elevating the choir to more than a therapy but also a socially enriching activity that can boost their confidence in their existing abilities. It is heartwarming to watch as choir members linger after rehearsals, talking and joking and sharing their stories with one another. Music does not just treat the physical ailments but the whole person and community. More than that, the choir gives clients a sense of achievement in ways they did not think still possible. One client commented that the choir has allowed him to sing again, a gift that he thought he had lost forever. Now, one of the major sources of his joy is within reach again. He is not the only one. Many have thanked us for the choir saying, “You don’t know how much it means.” Such moments are priceless.

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. 25-31.



Welcome to our student interns!

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We are ecstatic about the launch of our student internship program this past fall! It has long been a dream of ours to not only provide the support through music therapy for our clients that give them the opportunity to generalize life skills, but to provide practical application of those skills in the form of an internship program. We are pleased to announce that our current interns, Angad and Cole, have been the perfect candidates to help us pioneer this program and have provided vital support to our team through the jobs they complete weekly. When we get new members of our team, we like to introduce them so everyone knows who they might meet when they visit our office, but also to give you some insight on what makes everyone on our team so special and valuable. It is only appropriate that our student interns get the opportunity to introduce themselves, and if you see them around the office make sure to say ‘Hi!’

Angad

What is your role at The George Center?

  • I scan, and shred paper, and help Ms. Jamie and Ms. Jeannie set up. 

Why is this opportunity important to you?

  • To learn how to be an intern. 

What is your favorite part about being on The George Center team?

  • It is my favorite thing to do to work here, to play music, and help the whole team. 

What is something you'd like everyone to know about you? 

  • I am good, happy, and proud. I like to make my family happy. I have a brother and a dog Abby, and my mom and dad. 

What is your favorite hobby? 

  • Vacuum, clean the house, feeding the animals food, cleaning the stairs, bathroom, sink, and making the bed. 

What is your favorite thing to do for fun?

  • Play video games. My favorite is Just Cause 4.

Cole

What is your role at The George Center?

  • I I file papers.

  • I clean the waiting room.

  • I work on the computer. 

Why is this opportunity important to you?

  • It is important because I am learning wonderful job skills. I am happy that everyone is taking me seriously.

What is your favorite part about being on The George Center team?

  • I love working in such a positive environment.

What is something you'd like everyone to know about you? 

  • I want everyone to know that I am a hard worker.

What is your favorite hobby? 

  • I love music and I love to sing.

Welcome, guys! We love having you on the team!

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.

M-U-S-I-C

Every year, we are proud to put together a video that features some of the incredible power and science behind using music as a therapeutic modality. We hope you have fun watching and learning and that you’ll share it with a friend! We do not own the rights to this music and have re-written the lyrics to apply to our mission of advocacy for music therapy. Thanks to Jimmy Fallon and the Roots for the stylistic interpretation!

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.

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.