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

NMT vs NR

Avoiding Ruts when Session Planning

          It is very easy to get stuck in a musical rut when planning therapeutic sessions. We all know to use client preferred music, but it can become too easy to use the same go to list of 5-10 songs we keep for each population and decade. On top of that, it may feel like all your creativity may be running dry. But how do you solve this problem? I’m glad you asked! Theme your sessions. Pick a topic that is relevant to the time of year, location, weather, or holiday and build your repertoire around songs that can connect to that. 

          Picking a theme for your session will bring continuity to it. With that continuity comes a level of predictability, which can be especially helpful if you are working with a population that thrives when given a routine and a plan. 

          Planning themed sessions can be an effective way to work on and reinforce reality orientation, especially if that theme is related to a time of year or holiday. Additionally, reinforcing reality orientation can be an engaging way to bring a socialization element to your session as well by providing an opportunity to reminisce and/or make music about activities or traditions associated with your theme.While reality orientation may not be a goal for every population or group, many populations, such as memory care patients, or clients with intellectual disabilities, will greatly benefit from this added component. 

          Your client’s goals should already be set, now you are working on interventions that move you towards reaching them. From the therapist’s perspective, themes can make session planning easier as it provides a starting point and structure for the session and the interventions within. An important component of planning thematic sessions is to assess what music will best fit the client demographic and assist in reaching the goals of the session. With a theme in mind, your musical quest is narrowed and only a google search away.

          Last but not least, thematic sessions are fun. Therapy is about the client, of course. But if you are not enjoying your work, the client is most likely not having fun either. Who knows, you may discover new music that your client’s love, or be reminded of some you had forgotten. I hope that this post will help you expand your therapeutic repertoire so that you can find yourself climbing out of that rut. 
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Speaking of themes, check out these helpful tool for creative programming: “The Joy of music in Maturity”, “Musically Engaged Seniors: 40 Session Plans and Resources for a Vibrant Music Therapy Program

-Noriah Uribe

Strengths and their Shadows

I took the Clifton Strengthsfinder 2.0 test going into my freshman year of college. My school required every student to take it as a means to gain insight into ourselves, and to provide a building block to grow from. According to the test my top strength out of 34 is empathy. A short description of this strength, as defined by Strengthsfinder, is “People who are especially talented in the Empathy theme can sense the feelings of other people by imagining themselves in others’ lives or others’ situations.”

My Empathy strength is something I greatly value  and appreciate in myself and try to cultivate in a healthy way. It is what has driven me into a helping profession, music therapy. I attribute a lot of the ease in building rapport with clients and my ability to reach out to the underdog to it.  However, every strength has an evil twin sister and I would like to talk about the shadow side of empathy. I truly do view this natural propensity as one of my greatest assets, but I also know at times it can be my fatal flaw.

I am not always aware of when I am taking on the feelings of others. There are often times when I will be perfectly fine, but then enter into a conversation between two people that is tense and immediately feel stressed myself. Once I “take on that feeling,”  it can be very difficult for me to shake it off. Sometimes I will carry that stress through the day, constantly feeling on edge.

These “shadows” don’t take away from what empathy is. Discovering it in myself also means learning how to separate myself from it when necessary as well. My first step has been becoming aware of it and how it affects me. I’ve learned that with

this awareness, my next move forward is to set healthy boundaries for myself; something that I am in the process of learning currently. I have also discovered that when something feels off, it’s not necessarily because of me and that’s ok. In the words of the great Kelly Clarkson, “What doesn’t kill you makes you stronger”!

-Noriah Uribe

Adapted Music Lessons vs Music Therapy Sessions

Here at the Music Therapy Center of California (MTCCA) we do not only offer music therapy sessions but also adaptive lessons. But, you may be wondering, how are adaptive lessons different than a music therapy session, and what makes lessons adapted?

While both an adaptive lesson and a music therapy session will need to consider the student’s ability level, the focus  of each are entirely different. While the goal of a lesson is to learn an instrument, the goals of music therapy sessions will vary (e.g. speech goals, attention goals, etc.). Adaptive lessons are also different from traditional music lessons. The way in which musical concepts are tailored to fit the student’s strengths, needs and ability levels, Where the outcome of an adapted lesson is focused on learning and playing an instrument, outcomes of music therapy sessions are non-musical and focused on the process, not the product.

When a student has special learning needs and abilities, it’s important to find someone who knows how to present concepts in a way that will ensure successful experiences. Teaching adapted lessons is not unique to just music therapists. However part of the training that a music therapist receives ensures that they are well equipped to consider the diagnosis, learning needs and best practices to help students be most effective.  A music therapist will also likely have more experience incorporating multiple senses and techniques to present music concepts in a more creative way to further the ultimate goal of learning the instruments.

At MTCCA, our approach includes a multimodal and nontraditional approach to teaching. For example, lessons may include a variety of different instruments and a faster pacing of songs. If the student has challenges with fine motor skills such as finger strength and dexterity, skills necessary to play the piano, desk bells, can be a fun way to approach this skill with each finger in isolation (bells are played by pressing the button on top of the bell). Or having a student play finger cymbals or castanets, along with a preferred song, can build finger strength and develop a pincer grip (a skill necessary for writing). Once these “warm ups” are practiced, the skills learned can be transferred over to the piano.

-Noriah Uribe

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

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