I lost it! It’s gone!: Voice-less music therapy

I lost my voice entirely for three full days, however, like in the theater, the show must go on and the job must still be done. Despite not being able to vocalize anything above a soft whisper, I still had clients who needed services. Although not an ideal situation, sometimes things are out of your control. However, thanks to the support of a few wonderful supervisors and co-workers I was able to adapt and create voice-less sessions. I wouldn’t recommend losing your voice as a music therapist, but do as I say and not as I do. So, in case you have the unfortunate fortune of this 

happening to you too, I thought I would share a few tips I 

learned.

  1.    Recorded music is your friend

As music therapists we know that live is almost always better, because we can manipulate it for our needs on the spot. However, recorded music is better than no music. It will provide a steady beat and will likely give you different timbers than you can provide on your own. So play a game of name that tune or pass out instruments and rock out to an exciting song, with a bit of hidden exercise built in. Instruct clients to follow the music as you stop and start or get loud and soft. A little pre-recorded music can go a long way.

  1.    Drum roll, please!

Drum circles are great for all populations. They encourage prosocial, motor, and cognitive functions. So, take time to drum to a few pre-recorded songs. Maybe it’s a song that relates to the season or a holiday coming. Try rhythmic imitation or build group cohesions as everyone follows a leader who changes speed or stops and starts.

  1.    Yay for TIMP and PSE

If you are familiar with Neurologic Music Therapy (NMT) techniques, I would recommend using TIMP and PSE. No verbal explanation or continual prompting is needed to implement this technique. As long as a beet is present and clients can visually track your movement, the intervention can be carried out.

  1.    Embrace your inner mime

Because you will not have no way to communicate verbally, body language will be everything. Big body movements and exaggerated facial expressions will aid in your success. Having signs or something to write instructions on isn’t a bad idea too.

-Noriah Uribe

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Pattern Sensory Enhancement (PSE) from one Aspiring Scholar to Another *

Pattern Sensory Enhancement, or PSE, is a Neurologic Music Therapy (NMT) technique developed by Michael Thaut. This technique’s purpose is to elicit movement with musical cues through all elements of music (i.e. tempo, rhythm, dynamics, etc.). Those cues fall under three primary categories, spatial, temporal and force, and has a step by step procedure to follow. When done correctly, PSE can be very effective in not only engaging but driving movement and prompting full range of motion and functional motor movement.

Spatial cues are broken down into pitch, dynamics, sound duration and harmony. All of these elements indicate how the body should be moving in space in one capacity or another. If a music therapist wants to facilitate an arm swing up and down, they could use a legato scale crescendoing as the scale ascends to elicit the upward momentum of the arm and a decrescendo as the scale descends down on the release of the movement. Gravity naturally assists this lowering or downward motion of the arm meaning emphasizing the movement with rising dynamics and a connected melodic line are less of a necessity as the laws of physics state that what goes up must come down.

Temporal cues encompass tempo, meter, rhythmic pattern, and form. Matching the desired motion to these cues is important for the clarity and facilitation of the movement. For example, if a therapist’s objective is to maintain or improve lower body gross motor function in the legs, and therefore is facilitating leg lifts, using a duple meter march will depict the movement within the music. Duple meter because the natural cadence for walking goes 1. 2., 1.2. (i.e. leg goes up/down, up/down). An example of an appropriate song might be “When the Saints go Marching in”. It is in a duple meter and the downbeat is very strong and easy to pic out. The corresponding lyrics are convenient, although not necessary.

Force cues are musical elements like dynamics, harmony, and tempo. Although these elements are used as spatial and temporal cues, they can also be used to indicate where the “work” or exertion is in the movement (i.e. in the leg lift example above, lifting the leg requires more exertion to work against gravity). In other words these help to cue the points at which the muscles are either exerting or releasing energy. A dissonant chord, such as a diminished C, might be used at the moment a client needs to hold a position of tension. The chord resolving to C major would indicate the release or relaxation of the muscles.

To effectively implement PSE, it is important for the music therapist to follow these 4 steps.

    1. Demonstrate the movement with your client and set a tempo on a metronome that matches their natural cadence (i.e. If you will be marching, introduce it verbally but also demonstrate what the movement should look like.)
    2. Following the metronome, give your clients rhythmic verbal cues. (i.e. Give your verbal cues in the corresponding meter. If you have a metronome that allows for tapping in the beat, do so.)
      1. I.E. up and down, out and in
    3. Continue the verbal cues while gently bringing music in.
    4. Fade out the verbal prompts and let the music facilitate the movement.
  • Optional: add a song, but never compromise the beat!

-Noriah Uribe

 

 

*Source by Tara Harwell

AEFCT – Learnings from Applied Behavior Therapists

Behavior serves a function.  From infants to the elderly, humans behave the way they do for a reason.  When it comes to our clients, addressing the reason can sometimes be the first step towards making progress in their goal areas.

Recently in symposium, Shannon Wallace and Maryann Le of AEFCT came to present to our staff on “Function of Behavior Training”.  (Find out more about AEFCT here: http://aefct.com/)  Their presentation opened my eyes to several important factors to consider while working with clients.

A key concept in knowing how to address the behavior of a client is understanding the function of the behavior.  I learned that this is a phrase commonly used amongst behavior therapists that basically answers the question: why is the client doing what they are doing?  Is their behavior seeking to gain the attention of somebody or to meet a physical need (are they hungry.. thirsty.. need to use the restroom)?  What is their specific purpose for what they are doing?  Sometimes this can be a very tricky question to answer.

Consider the fact that many of the behaviors we as therapists view as “challenging” are behaviors the client probably views as functional, because engaging in them gets their needs met in one way or another.  Maybe screaming at the top of their lungs in the store gets them the toy they wanted (mom gives in to alleviate the situation).  Maybe engaging in disruptive behavior in the classroom gets them out of doing difficult work (they are removed from classroom for disciplinary purposes).

The 3 functions of behavior are:

  1. Positive reinforcement (behavior produces an outcomes that is desired by the child)
  2. Negative reinforcement (maladaptive behavior like escape or avoidance)
  3. Sensory Regulation (maladaptive behavior occurs in order to regulate the level of input from environment)

First determining the function of behavior helps us understand how to appropriately address it.  According to Shannon and Maryann, “When we know the antecedents and consequences of behavior, we can intervene in ways that provide an appropriate behavior that achieves the same function.”  This was one of the biggest lessons I learned through this presentation: the importance of providing an appropriate alternative to undesired behavior.  Since this time, I have been applying this principal in many of my sessions.  This includes things like redirecting a client who hits the table vigorously with his palms to playing a drum in order to receive that sensory feedback as well as redirecting a client who constantly asks what’s next by helping them give positive compliments to other group members.  Always be thinking how you can provide clients with a functional, appropriate alternative.

One final important aspect to consider is being on board with the parents with your strategies and approach towards behavior.  It is important that you are handling the behavior in a way that is congruent with how the parents are handling it at home.  Although this is not always possible, when it is, it can be extremely effective for the client.  Discuss strategies and approaches with your client’s family in order to determine what is best for them.

I’ll leave you with a short story of how these ideas have manifested themselves over the past month of my internship.  I have been working for 5 months with a non-verbal 8 year old client who, ever since I started with him, will manage to have a handful of my hair at some point in almost every session.  I have worked so hard on developing my “mom” voice, being stern, changing my affect, letting him know that is not okay, singing songs about having “gentle hands” and practicing what that looks like, redirecting him to a drum or other instrument or ignoring the behavior.  Although some of these tactics have seemed to work in the moment, we had a session 2 weeks ago where we were in the middle of an intervention at the piano together and I felt like we were connecting more than we ever have – he was sustaining eye contact, following directions, smiling at me – we were communicating so much nonverbally to each other through our playing.  I look down at him and he’s smiling so huge and then suddenly he reaches out and grabs two handfuls of my hair.  In this moment I realized that my assessment of the function of his behavior may have been off all along – maybe the reason he is engaging in this behavior is because he wants to communicate something to me and doesn’t have a way to do so.  I didn’t struggle against him or whip out my stern voice and say “not okay”, I instead maneuvered my head so that I could make eye contact with him and just looked at him with a neutral affect, locking eyes – simply letting him know I was there and present with him.  After a moment, he let go, no words were said and we continued with the intervention.  Since this time, I have been motivated to give him absolutely every opportunity to make a choice, communicate with his device, and request activities in an attempt to provide him with a means to communicate whatever it was he was trying to say by grabbing my hair.  Through my clients I am learning countless lessons about the function of behavior, communication and human connection.

-Marissa

 

Move That Body – Patterned Sensory Enhancement

First of all, let me give a special thanks to Veronica May, MT-BC, NMT for coming to The Music Therapy Center to, in her words, “brickity break down” some Neurologic Music Therapy physical and sensorimotor techniques for us, and give us specific tools to use with our clients. The following information is based on her helpful instructions.

Music motivates movement! That is why there is a whole category of neurologic music therapy techniques that address physical and sensorimotor goals. One technique is Patterned Sensory Enhancement (PSE). PSE uses the elements of music – harmony, dynamics, rhythm, melody, tempo, and duration – to mirror a specific movement. It is used in motor rehabilitation, maintenance, or modulation.

In PSE, music is not only motivating movement, but it’s also illustrating the movements. When a music therapist chooses what type of music to play and how to play it in order to facilitate a specific movement, he/she must take all the elements of music into consideration: 1. Timing elements: meter, tempo, pattern, form; 2. melodic elements that indicate spatial aspects of movement: pitch, dynamics, sound duration, harmony. In addition to musical elements, the music therapist must also be aware of the elements of the movement his/her client is being prompted to do. What are the steps involved in making the specific movement? Where is the force of the movement coming from?

 

Enough with the technicalities! How about some examples for how MUSIC can ILLUSTRATE and FACILITATE MOVEMENT!

Example: Knee lifts from a seated positionSeatedKnRse2

First, where is the force of the movement? The LIFT, because this is going against gravity. Therefore, the “force” – or most emphasized – part of the music will be on the lifting motion.

 

Second, let’s think about the music.

  1. Meter: Knee lifting is like marching, so we would likely want a march meter (i.e. 2/4 or 4/4). Find a song, or plan your improvisation in that meter.
  2. Tempo: At what speed do you want your client making each movement? Choose the tempo that is most appropriate for your client’s age and motor challenge. Remember, slower tempos are sometimes harder for clients to maintain because there is less auditory info happening between each beat.
  3. Pitch: You want your client to make an upward movement, so instinctively, you play higher pitches to cue the lifting movement (e.g. a high C chord), and lower pitches to cue the lowering movement (e.g. low C).
  4. Dynamics: In this case, dynamics will help you emphasize the pitches that cue the lifting movement. Play the higher pitches louder and the lower pitches softer. E.g. Loud high C chord, soft low C.
  5. Duration: You can cue how long you want your client maintaining his/her knee in that lifted position by sustaining the high pitches (e.g. sustained high C chord), or making those same pitches very shor
  6. Harmony: Harmony doesn’t play a crucial role in this knee-lift example. But it can tie in to the emphasis piece. Emphasize the lifting motion by making the high pitch a chord (e.g. high C chord), and the low pitch just a single note. I’ll give another example. A clenching movement may be associated with a dissonant chord, while a relaxed/releasing movement may be associated with a consonant chord.

– Chiara (the new intern!)

We are all songwriters!

Before starting my internship, most of the songwriting I had done with clients was in mental health populations – mostly adolescent and adult drug and alcohol rehab and clients with eating disorders.  It got very heavy at times, but was often extremely therapeutic and cathartic for many clients.  I believe this shaped my view of songwriting as something narrow and used primarily for deep, personal issues within therapy.  That being said, over the past 3 months I’ve come to view songwriting as an amazing expressive outlet for many young children with developmental disabilities.  Even simple song re-writing exercises (like “All you need is love” for Valentines Day) provide an opportunity for the client to make choices (MEFT – Musical Executive Functioning Training), exercising their executive functioning skills.

What I’ve come to observe, is that many clients with disabilities have the majority of things done for them by parents and caretakers.  When they are given a choice between two activities/songs/etc. they will choose, but when left with an open ended question like “What should we write a song about?” they often have a blank expression on their face and no idea where to start without being given suggestions of different ideas.  But once you help them get the ball rolling, they are full of ideas, imagination, and creativity and the end product is amazing!  For some clients, re-writing the words to a favorite song of theirs is the best bet because they have a clear idea of where the song is going and already enjoy how it sounds.  Other clients have the ability to help write (or independently write!) a chord progression/melody, and this is where you can challenge them to exercise their creativity.  Below is a helpful chart of chords to use in a variety of keys that can quickly spice up any songwriting session!

Somewriting tips

 

When writing songs with your clients, remember that every answer is valid!  As long as what the client suggests is appropriate and relevant, there is no better answer as to what to put in the lyrics than what they give you.  After all, it’s their creation and masterpiece and should have their unique personality written all over it.  If you can, think ahead about the wording of prompting questions you might ask your client in order to generate ideas.  It’s also helpful to think about the goal of the exercise – for example, is your client’s primarily reason for songwriting to express themselves or to practice decision making or leadership skills?  Determine what questions you will ask and how you will go about the process with their particular goal in mind.  If they are practicing leadership skills, let them lead you through the process and if they are struggling, challenge them to find a way to figure it out instead of offering a solution to them.  If their goal is self-expression, validate every answer they give you and do your best to reflect the sentiment of their words in the music you create.  It’s also always a fun idea to record your completed songs and give your client choices of what instruments to incorporate and how they’d like the finished product to sound.

I trust that the joy in your clients face when you play back the final version and they hear themselves singing and making music will be enough to fuel many more rewarding songwriting experiences in your sessions!

-Marissa

Music Lessons for All Needs

Our team recently met to brainstorm essential teaching components, strategies, adaptations, accommodations, methods, and resources for teaching adapted lessons. I want to share with you what I learned in the article “Ten Characteristics for Teaching Students with Special Needs” by Beth A. Bauer.

  1. Consistency is crucial. This consistency applies to the rewards we provide, routine, schedule, home practice routines, time of day and location of the lesson,.
  2. Adaptability, find something that makes sense in their world. Examples include; using stress balls to teach hand positioning for piano, or creating fun mnemonic devices to learn the notes of lines and spaces in the music staff.
  3. Flexibility is a MUST. This flexibility pertains to lessons plans, studio setup and pacing of the lesson. Some days a student may come into the lesson after having a rough day at school and have a melt down. As the therapist “you need to find a way to work on something that will redirect the student away from whatever is bothering them and still be applicable to the lesson.”
  4. Setting Expectations “for students with special needs should be no different from the expectations and goals for students who do not have disabilities. By setting consistent, high expectations for everyone, the students know that we believe in them and that we know that they can be successful.”
  5. Patience, is your  best friend. Patience with repetition, multiple methods, reinforcement and redirection, and patience with getting to know your students.
  6. Compassion. Tell the parents of your students what their children CAN do instead of what they CANNOT do. Treat the child as a person first, without regard for a disability label. Focus on the positive aspects of the lesson, even when there is a meltdown, there is at least one positive aspect to find and share with the parent.
  7. Have a Sense of Humor.
  8. Learn from your mistakes. “We should always try our hardest but know that you will make mistakes. Mistakes are acceptable and the important lesson is that you learn from those mistakes.”
  9. Lose the Ego. Perfection is not everything, and it is not about the therapist. We will learn far more from our students than they will ever learn form us.
  10. Have FUN!!

 

-Kristin