I’m a Believer (in the transformational design model)

As music therapists, advocating for the profession is an incredibly significant aspect of the job. While it’s nice to be considered a “happy music person,” there’s much more to the job description than just playing feel good music for others all the time! Now enter *drum roll please* the Transformational Design Model.

The Transformational Design Model (TDM), designed by Dr. Michael Thaut, provides a system for translating the scientific model to functional music therapy practice, specifically in regards to Neurologic Music Therapy. There are five steps to the model including:

1. Diagnostic and functional assessment of a patient or client (find client strengths and weaknesses)
2. Development of therapeutic goals/objectives
3. Design functional, nonmusical therapeutic exercises and stimuli
4. Translation of step 3 to functional therapeutic music experiences (incorporate music interventions to address the goals)
5. Transfer the therapeutic learning to functional, nonmusical real world applications (generalize)

Piggybacking off the song “Believer” by Imagine Dragons to list the 5 steps of TDM during symposium

The TDM is beneficial because of its functionality. It provides the ability for music therapists to address a client’s nonmusical goals (ex: social, emotional, cognitive, motor skills) with music interventions. In other words, TDM provides a model for music therapists to efficiently translate the scientific model by applying music to achieve the therapeutic goal. The TDM is significant in terms of advocacy because it puts the focus in the specific goals and objectives of a client, which can be assessed and measured, and less on the music activity presented. Music exercises that are isomorphic, or similar in structure, to non-music exercises are incorporated into a session so the goals (socialization, mood vectoring, gait training, etc) can be addressed and interventions chosen by the therapist are validated.

Here are examples of an activity-based approach in comparison to one based off of the TDM:

1. ACTIVITY BASED APPROACH: The music therapist chooses a popular song that the client knows. After choosing the activity, the therapist then decides that playing the piano can be helpful in improving finger dexterity and fine motor skills which can be beneficial for the client to improve upon.
2. TDM APPROACH:
   1. The music therapist assesses the client’s strengths and weaknesses, noting that the client appears to have minimal dexterity.
   2. The client shows need for improvement with muscle tone, fine motor skills and coordination with the fingers and hands.
   3. The MT may collaborate with other disciplines to determine if they have similar goals for the client and how they are addressing said goals in their therapeutic practice.
   4. At this point, the MT decides that incorporating a piano playing activity in the session plan may be a beneficial intervention for reaching the client’s goal/objective.
   5. The MT can then generalize ways for the client to apply the skills learned by playing piano in the session to the client’s daily life.

As music therapy is an evidence-based practice, the TDM is a model that helps make sure the goals and objectives of each client that need to be addressed are actually being addressed in the therapeutic setting.

Thaut, M. H. (2008). Rhythm, music, and the brain: Scientific foundations and clinical applications. Abingdon: Routledge.

Until next time,

Katherine

Nordoff-Robbins and Neurologic Music Therapy: What are they?

NMT Techniques: MUSTIM!

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!

– Juliana 

 

Neurologic Music Therapy (NMT) …Demystified: MACT

Musical Attention Control Training: MACT

What is MACT?

Musical Attention Control Training, or MACT, is the use of music experiences and/or musical elements to practice a specific type of attention.

To really understand MACT, we’re going to take a closer look at the “A” in that acronym, for attention.

 Attention is the selective awareness of or selective responsiveness to the sensory environment around you. The ability to choose where you focus your attention is the first step in the learning process, and we all differ in our abilities to control our attention. The good news: we can develop attention control skills like building blocks through structured practice! We can conceptualize the types of attention as a pyramid, starting with focused attention as the base:

 

 

What does MACT look like in a music therapy session?

Music therapists tailor MACT exercises to suit their clients’ interests and clinical needs. As a result, MACT can look very different from session to session or client to client. MACT exercises may entail the use of many different music-based therapeutic music experiences.

For example, music therapists may facilitate sustained instrument-playing incorporating preferred and (the ever tricky) non-preferred instruments. Alternatively, a sustained attention exercise may call for the client and therapist to play instruments while the client adjusts their playing style (e.g. fast vs. slow, loud vs. soft, high vs. low, etc.) in response to musical cues (ideally without verbal prompts) from the therapist. A music therapist may target selective attention by introducing extraneous sound “distractors” to a music experience and challenge the client not to respond to (e.g. turn head to look at) the distractors.

Alternating attention exercises may require a client to shift their attention between two tasks, like tracking visual notation (e.g. sheet music) and playing an instrument simultaneously. At the end of the day, MACT could refer to a wide range of active or receptive music experiences, as long as they are designed to practice one or more types of attention, and utilize music as a delivery medium.

How music makes it work:

Active and receptive music experiences share powerful patterns of brain activation in the bilateral frontal lobes, brainstem, and attention systems in the cerebral cortex. This overlap ensures that the attention skills practiced with music will translate to other contexts, like school or vocational skills. Furthermore, music experiences like instrument-playing, singing, or improvising are often intrinsically motivating, allowing music therapists to get our “foot in the door” to engage with clients and bolster attention skills. Finally, music, as an organized auditory stimulus, brings timing, grouping, and temporal organization so that attention can be sustained and strengthened over time.

 

Thanks for reading!

~Esther