Wednesday, December 19, 2007

Read and Sing for Christmas: Up On the Housetop

Up on the housetop the reindeer pause
Out jumps good old Santa Claus
Down through the chimney
With lots of toys
All for the little ones Christmas joys.

Ho, ho, ho! Who wouldn't go,
Ho, ho, ho! Who wouldn't go
Up on the housetop
Click, click, click
Down through the chimney
With good Saint Nick.

This song is great for teachers and parents alike as it is flexible for a variety of musical settings and ability levels. The song naturally provides several instances for using instrument sounds to compliment the story. I use bells for the reindeer, a rain-stick for Santa going down the chimney and rhythm sticks or sand blocks for the, "click, click, click." My adaptations include using a Bigmack switch to record the, "Ho, ho, ho," for non-verbal participants and using body percussion such as patting or snapping for the, "Click, click, click."

Adding instrument sounds to go along with parts of a story in a song can be used to address many different educational objectives:

1. Sequencing skills. I have used a story board approach to see if students can arrange pictures into the correct order after singing the song. Instrument sounds can be used for non-verbal cues to help in the sequencing process.

2. Focus of attention and waiting skills. Individual students in a small group setting must practice taking turns and waiting for the appropriate times to play their instruments.

3. Problem solving. Students with more advanced skills may be able to choose instruments they feel will compliment the parts of the story. I facilitate this by providing a variety of appropriate instruments to choose from.

These are just a few of the ways I have used this song to help clients this year. Christmas and other holiday songs are very effective music choices for therapy since they are usually familiar and many of them have simple melodies. The song, "Up on the Housetop" has been very successful in groups of children who have autism or groups with children who have a mixture of different disabilities.

Ho, ho, ho!

Monday, December 17, 2007

Pain - Forget About It! Using Music Effectively to Manage Pain.

Everyone dreads the dentist chair when they know they have a cavity. Sometimes even a sound that reminds you of a dentist's drill can cause perceived pain! I have worked with clients at the doctor's office, in hospital rooms, and at home to help them with pain management. These patients have been dealing with everything from needle sticks to chronic pain from disease and in many cases using music to help them relax and ignore the pain has been very effective.

The main theory behind using music to help with pain management is centered around the "Gate Control Theory of Pain." This theory establishes that a person cannot actively think about two different information streams at the same time. Pain is a perceived idea in our cognitive thought process. Without cognitively focusing on the pain, the sensation can be greatly diminished. The Gate Control Theory is useful in that it promotes using focus of attention to distract from pain. Active music listening or music used for relaxation are very effective ways to focus attention.

Music provides a preferred and pleasant stimulus for focus of attention. The sound of music can mask unwanted environmental sounds such as medical staff talking about procedures or the clanking of surgical equipment. Music may also act as a trigger for positive memories and associations. The choice of music, therefore, is key to successfully utilizing it as a tool for distraction from pain. In order to further enhance the success of using music to distract from pain, a person may also choose whether they want to use upbeat and highly preferred music or sedative music to use for pain management.

Upbeat or stylized music may be a better choice for masking environmental sounds and promoting active listening. Familiar lyrics and memories associated with favorite songs may more easily hold active thought patterns and form "trains of thought" to other memories. Sedative music may be recommended for highly stressful situations where anxiety and tension are contributors to pain. In most cases, muscle tension will increase pain sensations by heightening physical awareness and pulling the thought pattern towards thinking about environmental sensations. Tightening the muscle fibers can also cause more painful procedures such as needle sticks or shots into the muscle tissue. Music facilitated relaxation provides a distraction as well as helping to relax the muscles.

I suggest using music listening during dental procedures, blood draws and before surgery to help with a variety of issues, including pain management. All of these settings easily accommodate headphones and family, friends or a therapist who can be there to help.

Friday, December 14, 2007

The Importance of Using Music as Part of the Lifestyle Change After a Heart Attack or Serious Cardiac Event

Research has recently begun catching up with the conventional wisdom that mental stress after having a heart attack can greatly increase the chances for future cardiovascular problems and incidents. The emotional strain and life altering consequences after having a heart attack or cardiac related surgery are only the first challenges. Daily events produce additional physical, emotional and mental stressors that are documented to lengthen recovery times.

I have developed a workshop called, Music for the Heart, that seeks to address the specific stress-inducing events that surround cardiovascular health problems. Recent research has emphasized the need for a holistic approach to health after heart attacks and cardiovascular surgery. I present tools and guidance in the workshop to help patients elevate their mood, learn to relax and introduce music as a leisure-time tool to help them make the post-cardiac event lifestyle change. Dr. Barry Bittman, MD, and the developer of the Health Rhythms program said, “Recreational music-making provides an extraordinary opportunity for people to regain a sense of balance and wholeness conducive to improved well-being.” (San Francisco Chronicle, September 28, 2001, Rhythm of Life: Pleasant Hill drum circle participants say monthly playing is therapeutic.)

I have had the opportunity to present the Music for the Heart program to several cardiologists and surgeons. There are several recent research studies that I point to in my discussions with the doctors about the potential for using music to facilitate the lifestyle changes for their patients. John C. Barefoot, PhD and Marianne Schroll, MD, DMSc conducted a study, "Symptoms of Depression, Acute Myocardial Infarction, and Total Mortality in a Community Sample," which concluded that high levels of depression are associated with greater chances for heart attack and mortality. This study was conducted over twenty-seven years with a large sample size of over seven hundred participants. Depression and negative mood are often the result of mental stress.

Two other studies have indicated that mental stress indicates a greater chance for myocardial ischemia and mortality after someone has already had a heart attack. One of these studies is, "Mental Stress-Induced Myocardial Ischemia and Cardiac Events." In this study more than one hundred patients with coronary artery disease were followed for up to five years. The researchers concluded that the presence of mental-stress induced ischemia is associated with significantly higher rates of later fatal and non-fatal cardiac events. Another study, "Mental Stress-Induced Ischemia and All-Cause Mortality in Patients With Coronary Artery Disease," found that patients with ischemia had a greater risk of dying when they were having mental-induced stress.

The evidence is clear that a patient's lifestyle is extremely important after a cardiac event. Cardiac rehabilitation programs encourage lifestyle changes that include stress-management strategies. I believe that music facilitated relaxation is a powerful tool to help people with managing stress. Music of some type is enjoyed by almost everyone and is an easy and appropriate way to help manage stress and elevate mood states. Related articles for using music in relaxation may be found in the
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Tuesday, December 11, 2007

Henry Sings For Success: A Schoolhouse Story About Singing and Stimming Behaviors

Henry is a delightful boy in the second grade. He has recently been labeled as having an autism spectrum disorder and his behaviors are consistent with many of the common characteristics of autism. One of these characteristics is his desire for self-stimulation through hand flapping, visual and verbal perseveration, muscle flexing and in Henry's case, singing. For the purpose of this article, I will refer to these behaviors by the more official term, stereotypy, since "stimming" is not a word currently listed in the dictionary.

Henry has been observed to sing to himself almost all the time. He is a very good singer with excellent pitch accuracy and the ability to remember many lyric phrases. His teachers have been working with Henry to have him sing more quietly outside of the classroom or at times when he should be quiet. His teachers have noticed that when Henry is working with his hands on tasks that involve objects with significant tactile stimulation, he stops singing. He will stop singing, for example, when he is putting his hands in shaving cream or trying to button a sweater. He also decreases his stereotypic singing when he is on a therapy ball during physical therapy or adapted PE.

I have worked with Henry during music therapy sessions and observed his eager participation in the activities. He seems to crave the sensory input provided by the music stimuli. Fortunately, Henry is able to participate in music activities in more significant ways than only absorbing it as sensory stimulation. Henry has demonstrated that he can follow sung directions during movement to music activities and can start and stop singing or playing instruments as part of group activities and highly structured musical activities. In general, Henry stops his stereotypic singing for the duration of music therapy groups, approximately thirty minutes. He has also been observed to be less restless and stay in his seat better during the music therapy sessions. His teacher said that Henry has the best waiting skills during music therapy than any other time or activity of the day.

Recently, I observed Henry working in the classroom in order to obtain data about his behavior and skills outside of music therapy. I was able to see how Henry worked on writing skills, matching words and quantities and following directions. Henry was guided by picture schedules to help him stay on task, but also to allow choices and provide rewards for work completed. One of his work tasks was to match word strips to pictures. He seemed to know how to match correctly, but he took a long time because he was singing to himself throughout the entire work activity.

I had noticed that Henry preferred familiar children's songs with attractive melodies rather than chants or repetitive melodies with little variance in pitch. I composed an original melody, ad lib, that was reminiscent of songs like, "The Itsy, Bitsy Spider," or "Oh Where, Oh Where Has My Little Doggie Gone." I wanted to use this song to help him with his word to picture matching activity. Henry quickly began singing the song with me after only one example and we began matching his words to pictures. Henry stopped singing to himself and immediately switched to the song I had composed and sang along with me. I sang with Henry for several word matches and then gradually stopped singing with him. He was able to continue singing the new melody with each new word and finished the matching exercise with amazing speed. Before I introduced the song, he had been sitting with his work folder for five minutes just moving the word strips around without actively matching. In Henry's case, I was able to combine his need for sensory input with active learning. His singing stopped being an impediment to his productive use of time, and instead, accelerated his work.

Tuesday, December 4, 2007

Schoolhouse Story: William Learns to Walk Like a Man

I am fortunate that many behavior problems disappear during music therapy activities. The teachers I work with often joke that I remain around longer so that their students continue to pay attention and remain sitting appropriately. These students do not have bad teachers, but the power of the music activities is often strong enough to maintain order during the music therapy session without many of the behavioral interventions that are necessary during regular classroom activities.

William is a student in second grade who I have often observed demonstrating defiant and oppositional behavior in the classroom. William has a rare brain disorder that affects his gross motor skills, but he is fully capable of walking. His teacher reported, however, that William was having great difficulty walking to the bus. William frequently decided to practice the safety protocol for when you are on fire and, "stop, drop and roll," in the hallway on the way to the bus!

William did not respond to music activities immediately when school started in the Fall, but he seemed to be listening and demonstrating good eye gaze toward the music therapist and the activities. Approximately half way through the school-year, William suddenly began performing all the movement to music activities that were part of the general music therapy session routine. He did not require prompts and seemed excited to participate. In light of this behavior, I adapted the lyrics to the song by Frankie Valli, "Walk Like a Man," in an effort to teach him more appropriate behavior. The song went something like, "Walk like a man, fast as you can, walk like a man my friend... stand straight and tall, walk never fall, walk like a man, William!"

I began using this song as one of the movement to music activities during the weekly music therapy sessions. William was very excited to practice walking around the room and did not demonstrate any inappropriate behaviors. I recorded the song with guitar accompaniment onto a tape so that the teachers could use the recording for William after school. The tape worked beautifully and William seemed to forget that he had ever had any problem going to the bus. This strategy continued to be successful more often than not for the remainder of the school year.

One of the advantages of using music is that it is "moveable." In the case with William, the sound of the guitar and upbeat accompaniment was a key to the successful result. Sometimes, simply singing a song and clapping along is all that is necessary to use music successfully as a therapuetic strategy. Many children will respond in a unique and significant ways to music stimuli and familiar songs with corresponding actions can effectively be used across settings. Social stories are often used with children who have autism, for example, to help them practice appropriate social skills. Sometimes adding a melody to a social story can be even more effective. This social story can then be sung anywhere, at any time to help encourage desired behaviors.

Monday, December 3, 2007

Schoolhouse Story: Wendy and the Power of Melody

I am often called upon to conduct assessments to see if a student will qualify for music therapy as a related service. "Wendy" was referred for a music therapy assessment after her teacher observed that Wendy significantly increased her focus of attention during songs at circle time activities. Wendy has mild to moderate mental retardation and speech impairments. As part of the music therapy assessment process I observed Wendy working in the classroom during various group activities as well as some individual work.

Wendy was observed to provide very short attention to her teacher unless given direct verbal prompts. When she was prompted, she was able to maintain her eye gaze focus to the teacher or task for less than one minute for most tasks. I watched Wendy become very focused, however, during familiar songs that employed accompanying gross motor movements. Wendy began singing the songs and performing all the motions without prompts. Wendy had not verbalized any other words throughout the activities until the singing activity except for saying some numbers during a counting exercise. One of the songs the group sang used the melody from Skip to my Lou. Wendy performed motions in the air as if she was drawing each number from one through four. The lyrics to the song described the motions for the number four as, "down, across, one more down...that is the numeral four."

After the group activities, Wendy was tracing the numeral 4 with a pencil for one of her assignments. Her teacher used hand over hand prompts to help Wendy focus her attention and trace the numbers. Wendy's teacher was verbalizing the same instructions as repeated in the lyrics of the song, but Wendy was not paying attention to the verbal instructions. I suggested that the teacher try to sing the melody along with the instructions. The teacher tried this and immediately gained Wendy's attention to the task, although she was still required to provide hand over hand guidance for Wendy's tracing.

I wanted to build on the progress that the teacher made simply by adding the melody back to the instructions for writing the number four. I had observed that Wendy was successful with larger gross motor movements and so suggested that we use a white board to write the number as we sang the song. Wendy was able to sing and draw the number 4 several times on the white board as I sang along with her. Her numbers were messy since she did not have reference points to trace over, but she clearly drew the number 4 without assistance and was fully engaged in the activity.

In Wendy's case, melody and scale were the key elements to enabling her success. She had been observed to respond to some elements of rhythm during chanting and counting activities in group activities, but she was unable to resist singing and moving to music when the melody was added during songs. I believe that by starting out with her drawing large numbers and gradually decreasing the size of her motions to write smaller characters that she will be successful in writing numbers with her pencil on paper. Singing may further enhance this process if the singing is louder for the large drawing on the white board and gradually softer for writing smaller characters.

Sing...sing...sing for success!

Sunday, December 2, 2007

FAQ: Suggestions for Sedative Relaxation Music

I am frequently asked about how to use music for relaxation. One of the most effective types of music for relaxation is classified as sedative. Sedative music is defined in part by having a fairly slow underlying tempo or pulse, around or below 80 beats per minute. The melody should be free of sudden jumps in pitch and without extreme high or low notes. The overall effect of the song should not be distracting, but still have aesthetic value.

Sedative music can be difficult to find on one album or in a single collection of songs. The proliferation of digital music, however, has made it much easier to separate sedative music from a collection and place it with other music for the purpose of relaxing. I have compiled a list of some music that can be considered sedative. The music can be used in any order and it is important that any music that will be used for relaxation be something related to personal preference. This list is not all inclusive and is limited in genre. There is much music available that can be effectively used for relaxation and the following examples may prove helpful.


  1. Nicamer Zabaleta: Concerto for the Harp and Orchestra in G major
  2. Mozart: Adagio, Sonata in E-flat
  3. Henry Purcell: Adagio from the Fairy Queen
  4. Mozart: Andante K. 525
  5. JS Bach: Air on a G String
  6. Mozart: Concerto for Clarinet and Orchestra in A
  7. Brahms: Lullaby, Cradle Song, Opus 49
  8. JS Bach: Arioso in F
  9. JS Bach: Concerto in D minor, Siciliano
  10. Schumann: Scenes from Childhood, Foreign Lands and People

New Age:

  1. Seasons: Sisters of Paradise, Guitar and Chamber Nouveau, Steven Pasero
  2. Seasons: Silhouettes of Dawn
  3. Rocky Mountain High: John Denver, Winter – Spring
  4. Watermark: Enya, Watermark
  5. Picture This: Jim Brickman, Sweet Dreams
  6. Forest: George Winston, Walking on Air
  7. Winter Solstice: Snow in the Prairies
  8. Red River Crossing: Marshall Styler, Red River Crossing
  9. Red River Crossing: Marshall Styler, Ballad of Brenham Road
  10. Reflections of Passion: Yanni, A Word in Private

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