Music Therapy: Seeing – and Hearing – is Believing

by Beth Hampshire Coule NMT, MT-BC

Summer is a wonderful time to add new and fun activities to your child’s repertoire. As the hustle and bustle of the school year winds down, your child may benefit from adding a little tune to his world.

Cameron walking, Noah singing a tune, Pablo waving hello, Ryan listening and following directions, Jack asking questions, Michael performing a minuet on the piano… These are all magical occasions I’ve experienced working as a music therapist. Experiences like these make it easy to see the successes of music therapy. Explaining how it works is more complex. The American Music Therapy Association (AMTA) defines music therapy as “an established healthcare profession that uses music to address physical, emotional, cognitive, and social needs of individuals of all ages.” In other words, music therapy is the use of music by a trained professional to achieve therapeutic goals.

What music can offer
Music is a universal way of communicating and is shared and understood by people from many different backgrounds. Since music is a non-verbal communication, language skills are not needed to participate. The structured rhythms and tempos in music are organizational, just like the rhythms and tempos of our pulse and respiration. Music is also motivating and, as all therapists and parents know, sometimes motivating a child is half the battle! Since music is temporal (existing in present time), participation requires children to practice awareness, attention and flexibility all at the same time. Music is also neurologically unique since it is encoded in both hemispheres of the brain. Typical activities in a session are: singing, chanting, playing instruments, dancing, moving, composing, analyzing lyrics and improvising.

Choosing a music therapist
Competent therapists will have completed an approved academic music therapy curriculum, conducted 1200 hours of clinical training and passed the national examination offered by the Certification Board for Music Therapists (CBMT). Look for MT-BC (music therapist – board certified) after a therapist’s name to ensure that he has the above credentials. Most music therapists have extensive education and training in applications of music to assist in developmental improvement and/or rehabilitation. While a physical therapist uses a variety of therapeutic exercises and activities to address one area of development (motor), music therapists use one medium (music) to address all areas of development.

Therapy or lessons?
Music therapy is used to promote and improve non-musical skills, for example, answering “wh” questions. The music is a part of the process of therapy, not the product. Music therapy services will also have goals and objectives which track progress. In contrast, music lessons teach music performance on an instrument. A possible end goal of music lessons is playing a Mozart sonata on the piano, while a possible goal of music therapy is improved fine motor skills. Adapted music lessons combine music skills and therapy. Adaptive lessons teach music literacy (e.g. playing guitar), while also addressing non-musical goals (e.g. finger isolation). Sometimes the non-musical goal is addressed specifically; sometimes it is embedded in the music lesson itself. In a music therapy session, it is a happy accident if a child learns long and short notes. In an adaptive lesson, the student learns that these are called quarter and half notes.

Personal Stories of Growth
The following information has been shared with permission from the families.

Cameron
Cameron is a cheerful 13-year-old, whose spirit touches everyone he meets. He was diagnosed with a metabolic disorder that resulted in a severe seizure disorder, visual impairments and global delays. He is unable to independently dress, walk, eat or talk. He has been doing speech, physical and occupational therapy for most of his life. Three years ago, his physical therapist (PT) brought me in for a consultation. She felt music could help Cameron’s pre-walking skills and wanted some guidance for this task. I brought an Autoharp™ into the room and played a simple greeting song. Cameron immediately sat up, looked at the Autoharp™ and was instantly engaged. His mother was amazed at his immediate, powerful response to the music. Because music reaches him so deeply, he has been participating in weekly music therapy sessions for about three years. During this time, music has helped him focus and shape his vocalizations, activate his communication device on cue, increase his attention and awareness, and walk with assistance. To really understand how music therapy played a role, here are two illustrations.

Cameron is now able to activate his communication device on cue. When we began working on this skill, I adapted a song called “Sing Hi” specifically for this task. The word “hi” is at the end of each musical phrase. At each session, “hi” was recorded onto the device. At first, he was given physical assistance to use his device in time to the music. As Cameron became familiar with the song structure and more practiced with the motor task, he was able to use his communication device to sing “hi” during the song! Coordinating this movement is very difficult for him because of his neurological impairments. The structure of the musical phrases helps Cameron anticipate and organize his responses.

Cameron is now able to walk with assistance. His physical therapist and I work together with him twice a month to facilitate this goal. We are using a technique called “rhythmic auditory stimulation” or RAS. RAS uses the physiological effects of auditory rhythm on the motor system to improve the control of movement, in this case gait training. With the help of a metronome, I play music at the appropriate tempo while the PT physically assists. After some warm-up steps, Cameron entrains (matches his walking pattern) to the tempo and is able to walk with a more steady cadence, velocity and stride length.

Jack
Jack is a handsome, 8-year-old boy who has been diagnosed with Autism. Like many individuals on the Autism spectrum, Jack is musically gifted and blessed with perfect pitch. He began adaptive piano lessons in May 2007. At that time, his mom was convinced he had a possible talent in music and was hoping music therapy could help him discover that talent. She reported that Jack had always been responsive to music and was even picking out tunes on their keyboard at home. He quickly learned the fundamentals of music theory and the piano, all the while demonstrating good attention and focus skills. Jack is now able to play elementary-level piano pieces, transpose songs, and is even beginning to improvise with his own melodies. He showcased his talents at the winter recital in December. Besides learning how to play the piano, Jack is also learning some non-musical skills during these lessons. Through his piano playing, Jack has learned to use multiple fingers – a very difficult task for many children. When we play duets, Jack is now able to play in time with me. Using parallel attention is a difficult social skill for most people with Autism. Learning to play from printed music is also assisting him with his visual-motor coordination and reading skills. He has also learned some social communication skills. Each week, Jack and I start our session with a “getting to know you” song. When we began this song, he was having difficulty even listening, but now he is able to sing the lyrics, answer open-ended questions and is even beginning to ask me questions!

Pathways Academy
Music therapy can also be offered in a school setting. At Pathways Academy in Marietta that specializes in the education of children with reading, writing and spelling difficulties, a weekly music session is offered. Lesson plans are geared toward specific educational support. Some lessons assist with general skills, such as sequencing or decoding. One of the favorite activities of the students is musical ensembles, where groups of students play different parts of the same song from symbolic notation. Some lessons assist with specific skills, such as learning the months of the year. To learn these, we borrowed the tune “Battle Hymn of Republic” and superimposed the months of the year as the lyrics. Musical mnemonics is the way all of us learned our ABCs.

Music can be very therapeutic no matter how it is used, but knowing the difference between music therapy, adaptive lessons and music lessons can help parents determine the best option for their child. It could provide the beginning of improvements in a child’s skills and the start of a lifetime of enjoyment of music.