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 

 

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Camp Jam!

Greetings everyone! 

Last week we had one of the most fun and busiest weeks- Camp Jam!! (Inserted this blog post are interactive links, where you can find out some more information about Camp Jam and our team if you’re interested!) 

Camp Jam is a music therapy camp run by The Music Therapy Center of California, and is designed to provide group music therapy experiences for children with special needs. We had children of all different ages, ranging from 3-14 years old. This camp was especially unique because all of our campers were paired with a camp counselor, so that everyone had 1:1 attention. All of our counselors were passionate about music and working with children, and were able to get to know their campers really well by the end of the week. Seeing friendships blossom and the bright smiles on all the kids’ faces by the end of the day made all of the hard work well worth it! 

Each morning started with an opening “welcome” circle, where the campers participated in songs to learn about camp rules, self control, body check, and how to be a good friend. It was always a wonderful way to pump everyone up in the morning! Afterwards, we divided the kids up into an older and younger aged music therapy group. I had the opportunity to work with both groups, which were a lot of fun! Below, I have included some photos of one of our music therapists, Ms. Angie, working with the younger group of children. Some different domains addressed in her music therapy interventions were body awareness, taking turns and sharing, and following one-step directions. 

After the different music therapy groups in the morning, we had craft and snack time, followed by a movement activity. A lot of great impromptu experiences happened during craft and snack time, which was a time allowed for the campers to express their creative freedom and have a bit of down time. One of the most memorable moments was when one of our counselors sang “5 Green & Speckled Frogs” in Spanish, and a lot of our campers were fully engaged and awe-stricken by this experience! Below is a photo of one of our craft time experiences, where our campers created photo frames for our group Camp Jam picture. 

The last day of camp, we provided different water activities for the campers, instead of our usual playground experience. This is where we saw a lot of our shy campers really shine! It was incredible to see them react positively to playing with water balloons with their peers, and the smiles on their faces. It was a great way to provide a different sensory experience for the campers who have a variety of sensory needs.

I would recommend Camp Jam to any parent who is considering this as an option for their child, as it is a wonderful time for your child to have unique social experiences through music. A variety of different domains are targeted during Camp Jam, including social, motor and attention skills. I loved being a part of this experience and getting to know all of the kids, and I know all of our staff members and camp counselors did as well! 

-Juliana Hsu

 

Full-time student to full-time intern: transitioning lifestyles!

Hello everyone!

It has already been almost 4 whole weeks since I started life as a music therapy intern! I thought I would write my first blog post about my still fresh experiences of what it is like to transition from being a full-time student to a full-time intern, and give some helpful tips of how to prepare for your brand new life and schedule!

First thing’s first- giving yourself enough time to move! If your internship is in a different location than where you currently are, especially if it is in an unfamiliar place, give yourself enough time to secure a place to live and to physically move your stuff and get settled. I was living in Lawrence, KS, so I had quite a long journey to go to get to San Diego. I flew out to California about a month before my internship started, and gave myself a week to find somewhere to live. Before I left, I compiled information with different apartment options, and a plan for visiting each one. Even if there seems like there aren’t many options online, once you are driving around the area, you will notice that there are complexes around every corner! It is especially helpful going at night to see if it is a place that you feel safe in.

I moved in about a week before my internship started, which I felt for me personally, was an ideal amount of time to get settled. Power through and try to get everything unpacked in the first few days- it’ll really help your new home actually feel like home! Take the rest of the time to really relax and explore the city before you are in full-blown internship mode! 

(^ Don’t let this be you)

Some important things to consider before your internship starts includes practicing driving to the office during the typical time you would have to get there, especially if that time is during rush hour. Do you usually have to go into work at 8 am and it takes you about 20 minutes to get there? Practice getting up early one day and head out around 7:30 and see if that gives you enough time! Remember, being early is on time, and being on time is late. I have found that the app “Waze” is really helpful. There is an option in the app where you can put what time you have to be at a certain destination, and it will tell you exactly what time you should leave based off of typical traffic patterns. 

Scope out the area around your office too- look for restaurants, grocery stores, walking trails- anything you think will be beneficial for you during your time during internship. I have an hour every day for lunch, and one thing I have been doing is going on at least a 30 minute walk every day during my break at a nearby park. It really helps me recharge, get some fresh air, and energize myself for the rest of the day! 

As for internship starting- what everyone says is definitely true. I thought after four years of going to school for 12 hours every day, I would be prepared for anything that was coming my way…

The kind of energy you need for music therapy sessions all day every day is very different. This is where self care is key (I know, I’m sure you’ve heard that millions of times, but it’s true!) Make sure you take the time to schedule in things you need to relax and unwind. Also, meal prep!!! It will save you lots of time and money. Not having to worry about what I am going to eat throughout the week is a huge time and headache saver. Also, always carry lots and lots of water on you, and keep snacks in your car if you are commuting to different facilities! 

Lastly… sleep! When you’re in school, you may only have to worry about facilitating sessions once or twice a week, but soon, you’ll have many back to back sessions every day! A healthy and working voice is very important, and sleep is the key to this. (And water… hydrate or diedrate!) 

I am really excited and looking forward to this new adventure for the next 6 months- happy reading and see you in the next post! And if you are also an intern or about to start your internship soon- congratulations! You can do it!!

-Juliana Hsu 

Goals for goals!

Step one to helping our clients achieve their goals is writing a great goal for them to be successful! This can be a tedious job, as goals and objectives are intended to be precise, detailed targets. There many components to a solid goal, and each are equally important and serve a unique role. There are goal-writing checklists that can be adapted to any client and population to help us create goals that are rational and intentional.

The SMART goal checklist guides the writer through the major pieces of creating a goal. According to SMART, goals must be Specific, Measurable, Achievable, Relevant, and Time limited. The infographic below provides a bit more information about each part.

SMART goals

Let’s look at the following goal:

By December 2018, Client A will improve cognition skills by improving sustained attention through playing an instrument for 2 consecutive minutes without stopping in 3 out of 4 trials with minimal prompting (no more than 1 verbal, gestural, or physical prompt).

First is the time deadline, which is when the goal is to be achieved by. This could vary by setting. Hospitals might have shorter time frames, schools will probably line up with IEPs. In this case, the client and therapist are aiming to achieve this goal in December of 2018.

After assessing the client, we identify the specific goal area (e.g. cognitive, motor, speech, etc.), and add details of the desired skill/behavior. Do we want it to increase, decrease, maintain functioning? This describes the what of the goal. In this case, it’s cognition skills through sustained attention.

Then, we can look at the how. How are we going to help the client achieve this goal? What means of exercise or intervention will we use? And how often will they participate? Out of how many trials will they be successful? This is where we think about measurability and achievability. Here, the how is ‘playing an instrument for 2 consecutive minutes.’

Along with these components, we must also include our type and level of prompting. The prompting in this goal would be ‘minimal prompting’, and the three types of prompts to choose from are verbal, gestural, and physical. Don’t forget about the option of independency! Our purpose is to help the client achieve the highest level of independence possible, so aiming for independence is the ultimate achievement.

“Big goals are important. You should always have a clear vision of where you would ultimately like [the client] to be. But be sure to set a number of smaller goals along the way. Accomplishment drives ambition.”

– Beau Taplin

– Patty

No Therapy Is An Island

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.

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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?

  1. Asses the client’s strengths and needs
  2. Develop the goals and objectives
  3. Research how a non-music therapist addresses this same goal and design a functional non-musical intervention
  4. Translate step 3 into a functional musical intervention
  5. 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!

-Chiara

Something’s Touching Me!

Your body is always touching SOMETHING. What an interesting thought that most people don’t spend too much time dwelling on. That’s because the brain with a well-regulated tactile sense only briefly makes note of the thing that the body is touching, and then ignores it in favor of more important thoughts and sensations it needs to process. But for a person whose tactile sense is out-of-sync, the textures of certain fabrics or presence of a tag on their clothing may be a source of extreme discomfort and the cause for much distress. Or they may lunge at you for a bear hug because they crave the feeling of deep pressure squeezes. Or they may not seem to notice that their hand is on a hot pan until they have a third degree burn. These are only a few examples, of course. The main point is, our tactile sense helps us determine what we are touching and if the things touching us at every moment of every day are harmful or helpful. An out-of-sync tactile sense may make a person overresponsive to stimuli, underresponsive to stimuli, sensory seeking, or a combination of these, or may make it difficult to determine what the tactile stimulus is or where it is touching.

How does this affect my work as a music therapist? I can start by considering the environment of my treatment space. What is the client’s reaction to the texture of the chair he/she is sitting in? For some of my clients with tactile sensory needs, sitting on a fuzzy pillow that buzzes provides the tactile sensations they need to be aware and in control of their bodies. For other clients, sitting on a rubbery and bumpy cushion serves this same purpose. What is the client’s reaction to the carpet? I have clients who prefer to have their shoes off during sessions. One such client likes having the afore mentioned rubbery cushion under his feet. From which direction is the air conditioning blowing and is it blowing directly on my client? I’ve barely scratched the surface of tactile elements to consider in the environment of the treatment room, but you get the picture.

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What about my choice of instruments I use with my clients? Does the client seem to want to touch textured things? I have many clients who are more engaged in our interventions when they play an instrument like the cabasa (picture below), which allows them to rub their fingers along the bumpy beads. Other ideas of instruments with great sensory feedback are guitar strings, chimes, hand drums, ocean drums, and resonator bells. The cabasa is one of my favorite instruments because it acts as a great massager, providing sensory input to arms, legs, backs, and soles of feet. For clients who are seeking tactile sensory stimulation, instruments like the cabasa can provide this in an appropriate way. Encourage the client to play the cabasa (or other instrument) and use it to provide sensory input independently. This way, the client is learning to self-regulate his/her out-of-sync sensory systems.

 

3317_cabasa_a.jpgOr for clients with an overresponsive tactile sense, choose instruments that don’t have a rough or uneven texture. Then encourage them to explore tactile sensations using the texture and vibrations of various instruments. This could help reduce defensiveness to certain tactile sensations.
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As with all other sensory systems, there are so many things to consider when your child or client has an out-of-sync tactile system. Hopefully the ideas and considerations discussed here have sparked some ideas and increased your awareness of needs related to the tactile sense. Now, I challenge you to stop every now and then and become aware of the sensations on your skin and the things touching your body. Then imagine what it would be like if you could not seem to get enough of or control one of these sensations. How would you fix that?

-Chiara

Reflections

What a journey the past 6 months of internship has been!  One year ago at this time I had no idea I would be moving to San Diego and building a life here.  I had no idea how intense life as an intern would be or how exciting the process of stepping out of the intern shoes and stepping into life as a new professional would be.  These past 6 months have taught me patience, confidence, and what it means to be invested in your dream.  There have been many lessons I’ve learned throughout internship, and I did my best to summarize my top learnings below.

1.      Your therapeutic relationship with the client is most important
While this may seem obvious, it was a valuable lesson I was reminded of through my experience as an intern.  So often it’s easy to jump into sessions with clients and get so absorbed in the goals and interventions that you forget that you haven’t yet earned the client’s trust.  The therapeutic relationship is really what makes music therapy effective – it is 100% essential to the clients success within therapy.  With time, I learned to breathe, be more present, be more aware of the client’s responses/what they are giving me and became comfortable adapting in the moment.  I also learned a great deal about building rapport with a wide range of personalities and different individuals.  Some clients connect with you through silliness/cutting loose a bit, some through structure, and others simply with time.  I learned to get to know my client’s and give the relationship time to grow before expecting them to trust/listen to me.

2.      Importance of professionalism and communication with parents/families
My experience in the field so far has taught me the vital importance of professionalism and communication.  I value clear and open communication and have come to understand how important this is in the workplace.  I have learned to communicate clearly with parents and families and (when possible) always keep them in the loop.  Within this lesson, I learned the importance of consistency, timeliness, and honesty/transparency as a measure of communicating respect and professionalism to the families with which you are working.

3.      Know your professional values
I have held several jobs in music therapy since beginning my degree.  Each has taught me more and more about what I value as a professional.  Sometimes the administrative end of music therapy can be equally as important as the therapy itself.  Sometimes small, logistical details determine whether you will be happy and well balanced, or overworked and burnt out.  I am learning to advocate for myself in these areas as well as cultivate a reputation for myself based on my personal values as a music therapist.

4.      Actively build/expand your skill set
There is always room for improvement, or as my mom told me often growing up “Learning is a lifestyle”.  I realized throughout internship how easy it is to get into a groove or routine where you’re comfortable, you and your clients know the drill and you rarely feel the need to mix it up.  However, mixing it up is where you’re challenged and where you grow!  I am inspired to expand my skills (particularly on guitar) as well as my repertoire of music.  Because we are in such a unique and fun line of work, it is a joy to get to be creative every day in the way you lead songs, present information, and address goals.

5.      Love where you are –> trust the process
The universe kept hitting me hard with this lesson, especially throughout internship, until it started to begin to scratch the surface of making it’s way into my head.  Many times we wish we were someplace we’re not – gotta learn to love and accept where we are.  Even if I don’t have years of experience (one day I will!) or am not the most knowledgable on certain subjects, I have to remind myself to breathe and accept where I am and be gracious with myself.  This proved to be particularly tricky when dealing with families or facilities who also wish you had more experience than you do.  All in time, all in time.  The difficulties will pass, the knowledge and expertise will come with experience, just trust that you are where you need to be.  I am where I need to be.

While reflecting on these lessons, I was drawn to record a piano piece that in a way represents the ebb and flow of internship for me.

 

Here’s to the future and all that lies ahead!

-Marissa