The Transformational Design Model (TDM)

The TDM is a model music therapists use for designing clinical protocols. It was created by Michael Thaut as a model for neurologic music therapists to design clinical interventions that are scientifically valid by providing an effective assessment, accurately targeting a specific function with a non-musical exercise, transforming said activity into a musical exercise, and ensuring the skills / functions developed in the clinical session transfer to activities of daily living (ADL’s) (Thaut & Hoemberg, 2016). 

The TDM is a six-step process:

1. Diagnosis and functional / clinical assessment of the patient

2. Development of therapeutic goals and objectives

3. Design of functional, non-musical therapeutic exercise structures and stimuli

4. Translation of step 3 into functional therapeutic music exercises

5. Outcome assessment

6. Transfer of therapeutic learning to functional applications for “activities of daily living” (ADL)

A few key points to consider when using the TDM are to:

1. Ensure clinical efficacy

It is absolutely essential for clinical interventions to be informed by the latest scientific literature. By staying up to date on the latest research regarding a given diagnosis / population, the music therapist is providing the best possible care and benefit to their client.

2.     To individualize treatment protocols

Individualization is a crucial step in the creation of clinical interventions. By prompting the client to engage in a given behavior, the music therapist is essentially facilitating plastic change in the brain. Neuroplasticity is the change in neural structures that enables an individual to develop / rehabilitate a skill, function, or behavior. Neuroplastic change in one function might not necessarily translate to another, so the therapist must target the function with precision. 

Another important consideration regarding individualization is the optimization of the treatment process by leveraging a client’s personality type, cultural orientation, and personal interests. The exploitation of idiosyncratic propensities can help to expedite the treatment process tremendously. 

3.     Leverage the special effect music has on the brain

Music has a very special effect on the brain. The brain consists of a plethora of “processing units”, each having a designated function. In any given activity, a certain combination of these areas are engaged and coordinated in order to process information and carry out a given function. The areas involved in most daily activities are typically confined to a relatively constrained number of networks. In music, however, the brain operates in a very different way. In order to process and produce music, the brain must coordinate a much wider range of processing units. It requires sensory sophistication, multi-modal integration (the communication between sensory processing and motor coordination, for example), executive functions, memory, emotion, and attention. By transforming a given exercise into a musical activity, the music therapist is capitalizing on the special effect music can have on the brain. 

4.     Transfer to ADL’s

The last step of the TDM is focused on transferring the targeted skill / function / behavior into a functional skill that can apply to activities of daily living. This involves fading the music, and transforming the activity back into a non-musical exercise. This is a crucial step because musical activity is not the goal of the intervention, but a scaffold. We use music to facilitate the development / rehabilitation of a given function, and take the music away so the function can stand on it’s own.

Written by Alec Johnson

Bibliography

Thaut, M., & Hoemberg, V. (2016). Handbook of Neurologic Music Therapy. Oxford University Press.

What is Neurologic Music Therapy?

One can think of the brain as comprised of a plethora of mini super-computers, each having a designated function (sensory processing, motor planning and coordination, executive functions, memory, emotion, etc.). In any activity, a certain combination of these brain areas are engaged, coordinated, and synchronized in order to perform the task. 

For example, when watching TV, our visual and auditory systems are engaged to watch the content hear the sounds. If one is playing a video game, we add in the motor component to activate the controller. Depending on the content, we might also be engaging the executive functions of problem solving and decision making. In speech, we have the speech area: motor planning, memory, verbal processing, etc. With each of these activities, the brain areas engaged are relatively local and lateral (meaning in a certain part of the brain, not the whole brain). For example, speech is primarily only processed in the left Broca’s and Wernickes areas. 

Now, with music, something special happens. Music processing requires global engagement (the entire brain), as all of the above-mentioned functions are essential components in both listening to and playing music. It engages sensory systems (visual, tactile, auditory), motor planning and coordination, memory, emotion, executive functions (planning, decision making, navigating music theory, engaging socially, etc). This is why music can be a very effective tool to facilitate the development of the brain (you can think of the brain’s cognitive, speech, sensory functions as muscles that need to be developed in the gym); and why it is an effective tool to facilitate therapy for those with disabilities or neurologic injuries. 

Knowing these facts, what if one could use music to methodically facilitate the development or rehabilitation of skills, behaviors, and functions? Well, thankfully, a lot of very smart people have already built the foundation of this practice. It’s called Neurologic Music Therapy.

Neurologic Music Therapy (NMT) is a clinical therapeutic modality that uses music as the primary tool to facilitate education and rehabilitation. To understand it, let’s forget about music for a second. In therapy, we devise activities to target specific functions (speech, sensory, motor, cognitive, etc). These activities are non-musical, as the functions we are targeting are non-musical in nature. We then transform those activities into musical exercises, which skillfully employs the benefit of the neurological effects of music previously outlined. We then fade out the music, transforming the activities back into non-musical exercises. We then make sure these skills cultivated during therapy can be transferred to activities of daily living. The clinical goals and activities are individualized to target the specific needs of each individual to ensure they benefit the individual practically. This process is called the Transformational Design Model (TDM), and can be applied to the activities devised by any therapeutic modality (physical therapy, occupational therapy, speech therapy, etc.)

If you’re interested in more information or NMT training, visit https://nmtacademy.co

Music therapy can do so much for an individual and the community as a whole. It can help to facilitate language development, motor learning, sensory-motor integration, emotional regulation and expressivity, social skills, memory, and attention. Musical activities and learning can help to bring people together to nurture healthy social connections, cultivate good character, and develop steadfast discipline. Furthermore, when music education or clinical therapy is facilitated by a neurologic music therapist, the benefits of the musical training are greatly enhanced. They can also help to tailor the training to an individual’s specific needs and desires. Ultimately, music therapy can help a child or adult to build a robust nervous system, which will serve one very well for the rest of their life.

Written by Alec Johnson

Proloquo2go: A Brief Overview for Music Therapists

Communication is vital to living in this world. We rely on each other when there are things we can’t do on our own. For those who cannot vocalize their needs or have delays in speaking – this can be frustrating not only for them but also for their caregivers and loved ones. 

Enter Proloquo2go – Proloquo2go is an AAC (Augmentative and Alternative communication) app created to assist teachers, therapists, and caregivers to help those who cannot vocalize their needs. The format consists of icons on a grid that allow the user to set up certain “words” or “phrases” that they can touch to help “voice” what they want. As music therapists, we can use this platform to provide an opportunity for clients to express their needs and wants such as preferred songs or instruments they enjoy. It can also be used to enrich a session by providing words/phrases/pictures that may be difficult for the client to express otherwise. Giving them a voice to communicate and make choices can be motivating for them in sessions and to generalize this skill outside of music.

Image courtesy of Assistive Ware https://aaccommunity.net/2018/01/starting-out-with-proloquo2go/ 

It is important to remember that while apps like these can be very helpful in assisting with verbal communication – they are not a replacement for helping to learn body language, social cues, and other forms of non-verbal communication. However, by providing an opportunity to communicate needs and meet the person where they’re at verbally we can create an environment ripe for growth, development, and communication. In music therapy sessions, we can use these as intraverbals (call and response) or requests for songs they would like to hear. There is never a bad opportunity to encourage communication. 

According to the website Proloquo2go is $249.99 on the US Apple store (currently unavailable on android). However there is a discount for schools if 20 or more copies are purchased. For more information visit: https://www.assistiveware.com/products/proloquo2go. If purchasing Proloquo2go is not an option due to financial reasons or perhaps the parents or school do not want to pay for it, there are much lower costing alternative options such as PECs boards (Picture exchange communication system). 

Here is an example!: https://www.storyboardthat.com/articles/e/pecs-boards

These resources are relatively easy to put together and just as customizable as Proloquo2go although you will not get a voice reading the words if it is a physical copy rather than a digital one.

Sources: 

Proloquo2Go – AAC app with symbols 

https://www.assistiveware.com/products/proloquo2go

Eric Amparo, Music Therapy Intern