Hello everyone, welcome to another blog post!
Today, I will be writing about a recent symposium topic: speech & language NMT techniques! For those who may not be familiar with NMT, here is a quick rundown. NMT stands for “Neurologic Music Therapy”, and consists of 20 clinical techniques for sensorimotor, speech, language, and cognitive training. The treatment techniques used in NMT are based on the scientific knowledge in music perception and production, and the effects on nonmusical brain and behavior functions. Some common populations where NMT can be implemented include stroke and TBI patients, older adults with Alzheimer’s disease, and people with Parkinson’s, cerebral palsy and Huntington’s disease. For more information on NMT, click this link!
There are 7 NMT techniques that directly target speech and language. For today, I will be focusing on MUSTIM, but this blog post contains information on the other 6 techniques.
For the sake of the length of this blog post, I will be focusing on MUSTIM (musical speech stimulation), which is the speech and language technique that I am most familiar with. We frequently implement MUSTIM in our older adult sessions. MUSTIM directly correlates with music that is extremely familiar for the clients, which gives them a burning desire to fill in the blanks! This is can be an important skill for older adults to stimulate speech and long term memory.
For example, if I just sang “Twinkle, twinkle little star, how I wonder what you …..”, and then I just stopped singing, your brain’s natural response is to immediately respond with “Are”. This is a great technique to use with older adults to stimulate long-term memory and speech!
One song that I have been using this week is “Don’t Fence Me In” by Bing Crosby. I usually introduce the song by saying, “For this next song, we have a very special part for you all to sing. I will start singing the song and see if you can catch on. “Oh give me land, lots of land, under starry skies above …..” This is usually when the clients automatically fill in “Don’t Fence Me In”. After the clients fill it in on their own, you can provide positive praise, and reinforce the instructions again by saying something like, “Every time we get to the part ‘don’t fence me in’, I want you to sing out nice and loud!”. After the clients fill in just that phrase, usually their long term memory kicks in and assists them in remembering the other lyrics.
Some other songs that I have used in the past that works great for MUSTIM include “Home on the Range”, “You Are My Sunshine”, and “God Bless America”. Usually traditional and folk songs work great as a MUSTIM intervention because the lyrics are over learned.
I want to hear from you! What are some songs that you frequently use when implementing MUSTIM?
Happy session planning and see you in the next post!
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.
- 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.)
- 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.)
- I.E. up and down, out and in
- Continue the verbal cues while gently bringing music in.
- Fade out the verbal prompts and let the music facilitate the movement.
- Optional: add a song, but never compromise the beat!
*Source by Tara Harwell
You’ll hear music therapists tell you time and time again, “Music therapy is an EVIDENCE BASED field!” What we do it backed by empirical research, and we’re very proud of this fact. However, the fact that the field is supported by research showing the efficacy of using music as a therapeutic tool for accomplishing non-musical goals does not make music therapy a lone-ranger in the world of therapies. There’s a key phrase I used in the previous sentence: “non-musical goals”. This means that the goals we are addressing in music therapy are similar to the goals our client’s are working on in their other therapies (speech, occupational, physical, behavioral, and cognitive rehabilitation therapies, etc.). So, in the Neurologic Music Therapy branch of our field, in particular, when setting up our interventions for addressing a non-musical goal, we like to use a model called the Transformational Design Model (TDM).
Transformational Design Model! It sounds like a superpower. And in a way, it is. It’s the superpower model that transforms non-musical interventions into musical interventions. Because music therapy has the same functional structure as other therapies, music therapists use this model to see where the overlap is with other fields, and then how the addition of music to a treatment intervention can benefit the client. But wait, there’s more! This superpower model transforms the functional music intervention into functional, non-musical real-world application. In short, we’re not going to let you walk around singing the steps to making conversation. We’re going to help you generalize the information you learned through music, so that when you apply it to everyday life, you’re doing it in a socially acceptable and sustainable (functional) way.
I know you’re dying to find out how one mere mortal can acquire such a superpower. Well, lucky for you, we can let you in on the bare bones of the model. I take myself through these steps every time I develop an intervention for a client, and it helps ensure the quality and efficacy of my interventions. Ok, are you ready to be transformed?
- Asses the client’s strengths and needs
- Develop the goals and objectives
- Research how a non-music therapist addresses this same goal and design a functional non-musical intervention
- Translate step 3 into a functional musical intervention
- Transfer step 4 to functional, non-musical real-life application
This model is a superpower not just in the fact that it transforms a non-musical skills into a musical experience and then back into a non-musical skill, but also in the fact that it allows multiple therapeutic fields to see their overlap. The more therapists from varying fields can work together, the more well-rounded the treatment plan becomes, and the more the client will benefit. Go transform something!
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 position
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.
- 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.
- 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.
- 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).
- 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.
- 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
- 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!)
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!
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!
We all know those kiddos – even when they are (miraculously) sitting in their seat for more than 2 minutes at a time, they’re still squirming, sliding down in their chair or moving their body side to side. They are constantly seeking to interact with their environment. Or maybe you can relate to leading groups every week and feeling the urge to bring in something new and different for the clients to experience other than instruments. Lucky for us, the world of Neurologic Music Therapy has an answer in 4 simple letters: MSOT. Musical Sensory Orientation Training.
Thaut, in Rhythm, Music and the Brain, describes MSOT as follows:
“Musical Sensory Orientation Training (MSOT) is the use of music, presented live or recorded, to stimulate arousal and recovery of wake states and facilitate meaningful responsiveness and orientation to time, place, and person. In more advanced recovery of developmental stages, training would involve active engagement in simple musical exercises to increase vigilance and train basic attention maintenance with emphasis on quantity rather than quality of response (Ogata 1995).”
Let’s all say it together now: MSOT is my friend! It is so important to ensure that our clients are learning to self-regulate and getting the sensory input that their bodies crave. Sensory integration is a neurobiological process that refers to the integration and interpretation of sensory stimulation from the environment by the brain. Individuals with developmental disabilities often have either over- or under- reactive sensory systems, which can mean sensory input from the environment is not being organized properly in the brain. This makes the sensory experiences we as music therapists provide for them particularly important. Below are several MSOT strategies I’ve recently been exploring with clients – the possibilities are endless!
- Cabasa – I never understood the power of the cabasa until internship. It is an easy way to take a sensory “break” while keeping the music and instruments going throughout the activity. For my non-verbal clients I use a simple “I want ____” visual and have them choose a body part (i.e. hands, arms, legs, back) for where they want the cabasa. You can make up a simple song or chant about where you’re playing the cabasa and use a background loop to free up your hands to provide that input for the client. You can also use this same format but instead give deep pressure squeezes and simply substitute the lyrics to “I like squeezes on my arms”.
2. Therapy Ball – I love using the therapy ball because it’s a great way to incorporate sensory integration into whatever intervention you’re working on (like Bi-lateral drumming). This targets the the Proprioceptive System – helping our clients understand where their body is in space.
3. Get Creative – Have fun with exploring MSOT strategies! For adult groups, my co-intern and I have been enjoying bringing in essential oils (stimulating olfactory system), fun themed props for Spring Holidays (tactile), instruments like chimes, cabasa, and drums, bubbles, scarves, and scented squeeze balls. I hope you’ll find that this brings a fun, novel element to your groups.
Music making (with an instrument) naturally stimulates 3 out of our 5 senses (auditory, tactile, and visual). If you can add some type of olfactory element, we have 4 out of the 5 covered – a great goal to aim for while session planning. It’s great to have a variety of MSOT strategies in your tool-belt in order to adapt to what your client needs in the moment – get creative and have fun with it!
Michelle Hardy is a Board-Certified Music Therapist with a master’s degree in Music Therapy from Colorado State University, having received her bachelor’s degree in music therapy from Loyola University in New Orleans in 1995. Michelle has worked with children and adults with various neurological impairments and developmental delays, but her focus is with individuals with autism and sensory processing difficulties.
MTCCA staff and interns were given the opportunity to speak with Michelle Hardy, MM, MT-BC in our weekly symposium. My personal learnings taken from this meeting include the follwing;
What are the main diagnostic criteria of autism?
- Social deficits
- Deficits in communication
Did you know that motor movement is also a prominent diagnostic characteristic of autism? Michelle Hardy brought to our attention that motor movement is not included in the leading diagnostic criteria of autism in the DSM-IV not the DSM-V. However, motor movement deficit is a prominent characteristic in individuals with autism. This makes perfect sense because if you take a look at the parts of the brain that are affected by autism you will see that included are the cerebellum and the frontal lobe. These are the areas of the brain that help us with movement planning, grading, and executing. Before any deficits in attention, behavior, higher learning, or social skills can be improved in a child, their brain’s ability to integrate sensory information and program proper motor signals must be re-calibrated through brain activation modalities.
As a music therapist, treatment may include:
- Rhythm Training
- Use of a metronome
- Proprioceptive stimulation
By using rhythm in a purposeful way, we can access the frontal lobe and mend long distance connections within the brain. Rhythm also creates a sense of predictability and strengthens pathways in the brain.
A specific intervention to include all of the above treatment ideas, would be Bilateral Drumming. Here is an example of bilateral drumming with Michelle Hardy.
*Notice the use of rhythm, a metronome and the proprioceptive feedback given from hitting the drums and walking.