Infant Brain Injuries & Music Therapy

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Before we are born, we are faced with many circumstances that have the potential to have major effects on our development in positive and negative ways. One of the many circumstances that could impact the development of a newborn infant is a brain-related injury that leads to brain damage within the child. Brain damage is complicated and comes with a variety of unknown factors, but as we dive deeper into the types of brain damage and the effects they may cause, I hope you gain a better understanding of how we can promote the wellbeing of the little humans that are welcomed into this large world of “unknowns”.

CAUSES OF BRAIN DAMAGE

Oxygen Deprivation:

  • The most frequent brain injury that occurs at birth is due to oxygen deprivation (e.g. anoxia, hypoxia, and birth asphyxia).

  • Two stages of injury may occur: Brain cell damage is the first stage that occurs within a few minutes of insufficient oxygen. Reperfusion injury occurs once the blood and oxygen flow has been restored.

  • A stroke is experienced if a disruption of the blood flow and oxygen to the brain occurs.

Brain Hemorrhage:

  • Typical causes of brain hemorrhages include: head trauma, high blood pressure, aneurysm, blood vessel abnormalities, blood disorders, liver disease, or brain tumors.

Jaundice:

  • When untreated, jaundice can lead to kernicterus. Kernicterus (acute bilirubin encephalopathy) refers to a type of brain damage that can cause athetoid cerebral palsy, hearing loss, vision and teeth problems.

Physical Trauma:

  • Infants are most at-risk for physical injury upon labor and delivery

  • Physical trauma can occur due to improper use and placement of birth-assisting tools (e.g. forceps or vacuums) or a rapid delivery.

Infections:

  • Maternal infections such as pelvic infections, fevers, preeclampsia, cystitis can lead to brain damage if left untreated.

In terms of birth traumas, the most common brain-related injury is cerebral palsy (CP) which can develop after, oxygen deprivation, infant stroke, and infections.

EFFECTS OF BRAIN DAMAGE

Due to the complexity of the brain and varying degrees of damage, the effects of these brain injuries have the potential to manifest later in the development of the child. However, symptoms of brain damage include abnormal temperament, abnormal physical appearance, or delayed development of the child.

IMPLICATIONS OF MUSIC THERAPY

At such a young and vulnerable age, infants process music in such a powerful way that can lead to many positive outcomes. Music is IN US. As early as 25 weeks, an infant begins to process music in utero (....wow….). Music can be facilitated and promoted by a board certified music therapist to optimize their developmental potential. Music Therapy can be utilized in the hospital as well as through early childhood development.  

Music Therapy in the Neonatal Intensive Care Unit (NICU)

Upon arrival, premature infants are faced with a plethora of stressors and complications that impact their development. Due to the stressors they endure, premature infants are at high-risk in obtaining a birth-related brain injury due to the underdevelopment of their organs. Amidst the chaos of their hospital stay, music therapy can be a grounding and supportive therapeutic experience to promote, maintain, and encourage a positive development for the infants as well as an opportunity to promote bonding and provide a sense of control to their parents and caregivers. Research has proven the length of stay of a premature infant decreases significantly when provided music therapy services. Music Therapy within the NICU aids in increasing opportunities for auditory processing, neurological growth and development, and language input. When provided by a trained professional, interventions may include: music listening, neurodevelopmental stimulation (also known as multimodal stimulation), pacifier-activated lullaby (PAL), infant stimulation, and parent counseling.

Music Therapy in Early Childhood

Music is part of our being. At an early age, infants inherently move to music in a rhythmic way, sing a song through cooing or babbling, or move towards a rattle out of curiosity or exploration. Music is motivating, it is fun, it is stimulating. Music has an ability to stimulate all the senses within a human being, facilitating a multitude of developmental skills. Music is processed in both hemispheres of the brain which promotes cognitive functioning. This stimulation of cognitive functioning can be an important tool when an infant is faced with a brain injury at birth. When an infant faces challenges in their development, music can access multiple areas of the brain and essentially override the damaged neural pathways, creating new pathways and optimizing the plasticity of the brain.

Music therapy and early childhood could incorporate a variety of elements (all depending on the age and development of the child): receptive listening, facilitation of movement, a source of stimulation for communication (singing), facilitation of independent play, instrumental playing in gross and fine motor movements, promotion of cognitive development through labeling, and much, much more.

THOUGHTS

You may ask, “Why does this matter to me?”. On average, there are 130 million babies born each year around the world and millions of these precious babies are affected by birth-related brain injuries. Do all of these children receive music therapy? Absolutely not. Why? Because the funds are not there and recognition of our established profession is not there. This is important to know because advocacy for our profession is a constant act. We need you to understand and promote the positive impact that music therapy can have on these little humans so we (music therapists) can help optimize their potential in their lives and overall well being. Music is powerful. Help us to empower our future generations.


TERMS

  • Birth asphyxia- an insufficient amount of oxygen and nutrients occur in an infant’s brain and other organs

  • Anoxia- an absence of oxygen

  • Hypoxia- insufficient amount of oxygen delivered to the tissues

  • Ischemia- insufficient blood flow to the brain

  • Jaundice- build up of a chemical called bilirubin occurs in an infant’s blood due to an underdeveloped liver (the build up causes the skin to have a yellow coloring)

  • Preeclampsia- high blood pressure and a presence of protein in the urine

  • Cerebral Palsy (CP)- damaged or abnormal development of the brain that affects an individual's ability to control his/her muscles.

  • Brain Hemorrhage- the effects of a stroke causes the blood to flood the brain leading to cell death


SOURCES

How Non-Profits Intersect With Music Therapy

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I just read that it costs $250,000 to raise a child to age eighteen. That is just for one, neurotypical child. That doesn’t even account for if your child happens to want to be involved in an especially expensive hobby… like horseback riding or scuba diving!

For a family with a child with special needs, this number can quadruple, according to The U.S. Department of Agriculture. That equates to almost one million dollars to raise a child with special needs. These costs can include anything from medical and hospital bills, tutors, prescription costs, assistive and adaptive equipment around the house, private schools, and therapies.

Since there are so many therapy options available for a child with special needs, families can find themselves desperately wanting to help their child as much as possible, and, with best intentions, enroll their child in several different therapies. These bills quickly add up, with some being covered by insurance and some being paid for out of pocket.

For us in the field of music therapy, we do not have the luxury to be considered a “mainstream” therapy yet, such as Speech Therapy or Occupational Therapy, so we aren’t afforded the luxury of being a “given” when it comes to insurance reimbursement. We have come a long way, and it certainly helps that we are gaining recognition at the state level with licensure, including here in Georgia. At The George Center for Music Therapy, we work hard to bill insurance and are quite successful receiving insurance reimbursement for many families for our services. Some families use one of various waivers for services, and some families pay for music therapy out of pocket. Regardless of their funding source, inevitably, there may come a time in which a family must discontinue services due to financial reasons. Their deductible may renew, they may run out of funds through their waiver, or a family emergency must take financial precedence over therapy services for a period time. It is heartbreaking to hear that a family must stop services for financial reasons.

This is where… drum roll please…. Our non-profit comes in- The George Center Foundation!

The Foundation was started as a way to help those in need to receive access to quality music therapy services. In 2018, we were able to donate about $10,000 in scholarships to families and organizations in need. That is AMAZING! It has been so wonderful to be able to have an avenue to receive donations that go straight back to the community and to our clients who benefit from and love what we do.

We are having our very first large-scale fundraising effort this month, called the Shamrock Shindig. It will be held at Peach and The Porkchop, which is a delicious restaurant right down stairs from our office. We have partnered with more than 15 organizations in the community to receive items for our silent auction, and we will be having live music, performances by our very own Teen Rock Band, drinks, appetizers, a raffle, and a respite for children with special needs provided by Reclif. This is a fundraiser that you do not want to miss, as the proceeds will go straight to families and organizations in our community to open the door for them to receive music therapy services. It will be so much fun, and you will be able to see all your favorite music therapists from GCMT there!  

Our dream is one day be in a position where money is no longer a hindrance for people to receive music therapy services. Fundraisers such as the Shamrock Shindig is a step in that direction for us, and we truly hope you can join us!

For more information and to buy your tickets please visit our website at https://www.thegeorgecenter.com/shamrock



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