Wednesday, January 30, 2008

What To Do and Not Do When Requesting a Music Therapy Assessment

I am frequently asked how to determine whether or not a student should be recommended for a music therapy evaluation. I will focus this discussion on assessment requests in the public education setting, but many of the ideas may be applicable across other settings such as working with clients in the home or in facilities like hospitals or nursing homes.

Teachers, parents, diagnosticians and other staff who would like to recommend a student for a music therapy evaluation should first realize that music therapy is a related service. As a related service, a school district is not required to provide music therapy unless there is sufficient evidence that music therapy will be a significant factor in the educational progress of the student. In other words, the student would experience slower or less pronounced success in meeting educational goals and objectives without the implementation of specially developed music activities.

Educators should understand that the key words to keep in mind are, "significant," and "unique." These ideas will help provide a framework for discussion about individual clients who seem to have responses to music. Here are some do's and don'ts while observing students before recommending them for music therapy assessments.

Don't think that your student needs to have music therapy just because he likes to watch children's cartoons like Bob the Builder or Blue's Clues. Television is often a powerful visual medium that most children enjoy, but their interest in the programs is not necessarily a result of the music in the shows.

Don't recommend your student for a music therapy assessment after observing that he frequently sings to himself. In my experience, this is often a stereotypic behavior and not an indication that singing could successfully be used to help the student make progress on educational objectives.

Don't suggest that a student needs an evaluation because parents have reported that he likes to listen to the radio in the car or seems to get excited about music stimuli.

Most children have an affinity for music and enjoy music-based activities. Music is often a powerful and effective way to complement regular teaching methods and should be used as long as it is effective. Establishing music therapy services as part of an Individual Education Plan or IEP, however, should be done with great care.

Do consider asking for a music therapy assessment if you have observed music stimuli or activities to be a unique and effective motivator. Many children with disabilities require consistent and concrete motivators in order to make an effort at working on educational goals. For some children, music is one of the few motivators that works with these students. I have provided therapy for several children who only responded to food rewards and music. Music stimuli and activities became very important when the food rewards were faded over time for health reasons.

Do make notes of unique instances where music activities and stimuli seem to increase appropriate verbalizations and vocalizations with students. Many students who qualify for music therapy will sing words they will not speak and will also provide verbalizations in response to music, but do not verbalize in the regular classroom setting when given non-musical prompts.

Do think about using music to help students who significantly increase there attention to music stimuli and provide more focus and attention to task during music activities. I have found that children who can focus better during music activities often decrease inappropriate behaviors and have a better chance for learning information.

Do record examples of students remembering academic concepts better when it is paired effectively with music. Music is often used in regular education to help teach skills and improve memory. For some children with disabilities, music is indispensable as a mnemonic hook for targeted academic information.

Preparing a decision to recommend a student for a music therapy evaluation should be undertaken as a team effort. I advise educators to independently record significant or unique instances where music seems to be a key element in a student's success. All of the observations can then be compared together to determine if there are enough instances of music being a prime factor in the progress of a student that an official assessment should be proposed. I have only listed a few examples of things to look for when considering a music therapy assessment recommendation, but they should help to make sense of the correct procedure. Further examples of how music significantly assisted various clients can be found in Schoolhouse Stories.

Tuesday, January 22, 2008

Supercharge Your Music Making With Older Adults!

One of my favorite places to facilitate music-making and foster growth and social interaction is at an Alzheimer's center or assisted living community. As a music therapist I bring a different perspective and methodology to the group experiences at these locations than the usual invited entertainers or activity leaders. I have been asked to come back to visit the Alzheimer's center based on the fact that I involve the residents in active music-making and encourage interaction and self-awareness. Given these reactions, I want to explore and recommend some of the strategies I use when approaching a group of older adults with dementia or Alzheimer's disease.

I say that these groups are some of my favorite clients to work with mainly because of the dramatic change in demeanor that occurs during the music activities. When I walk into a room full of thirty to forty residents and all I hear is the sound of silence, it is sometimes intimidating. In my experience it is kind of like being in a doctor's office waiting room where nobody talks to each other! This is a very sad situation for the residents because they see each other every day but just don't remember who their neighbor is or even where they are or why they are doing a certain activity. Then the "miracle" occurs during the music-making...

The residents literally begin stirring, lifting their heads, looking around, and moving their hands and feet to the rhythm of the music. Suddenly several people start singing words to the music and others begin playing tambourines and maracas that were laying in their laps. Smiles abound and laughter filters through the crowd. I love to see the recognition on faces when some of the residents realize that they are sitting next to someone, or when they are invited to dance by a caregiver! These events are short-lived, but I think incredibly powerful injections of humanity into a place and people that time forgot.

I keep the following ideas and strategies in mind when facilitating these groups:

1. Use a microphone -- I do not have a loud voice, so it is even more important that I use amplification, not only for my voice, but also for my guitar. Even with a microphone there will still be some who complain that they cannot hear very well. The sound of the live accompaniment should be strong and supportive whether it is from a guitar or a piano. I do not recommend using a digital keyboard, but a digital piano is just fine.

2. Use songs and music from the resident's young adult years -- Research with people who have Alzheimer's has shown that memory loss happens generally in retrograde fashion. It also seems that most people tend to have a connection with music especially from their teenage and young adult years. I currently use much music from the 1930's very successfully with my groups (i.e., Alexander's Ragtime Band, Side by Side, etc.)

3. Use song cards -- Make song cards with pictures on the front and the lyrics on the back. The song cards are a good visual to help cue the group about what they are singing. The song cards are also perfect for facilitating choice-making by individuals or the group.

4. "Pass the plate" -- Use something that necessitates interaction with your neighbor. I have used a big beach ball, a treasure box, or some other object that relates to a theme. Think of an item that is good for a show and tell. Pick a song or some recorded music that indicates that the object should move around the room. When the music stops, the person holding the item can choose a song or share a memory or story that comes to mind.

5. Themes -- Group activities built around thematic ideas are a perfect way to encourage reminiscing and discussion. Consider using holidays, seasons, news events and local traditions as the basis for the songs and music selections. One of my favorites is using the sun, moon and stars as a theme whenever the space shuttle takes off or there is an eclipse or meteor shower in the news. There are many songs that talk about the sun, moon or stars that the residents know and love!

6. Have a drum circle -- Community drum circles are appropriate for all ages and adaptable to almost any situation. The drum circle promotes group interaction and allows for individuals to be creative while participating at their ability level. Some clients will feel self-empowered by being drum circle facilitators. Please see my posts under the categories section for "drumming" for an extensive set of articles about how to use drum circles with groups who have disabilities.

7. Go with the flow! -- This concept may take some trial and error and experience, but planning is the key. Try to arrange the activities for the group experience into a contour of activity that begins and ends with less energy and has increased energy in the middle of the music session. The residents need time to wake up and begin feeling the music stimuli before they will be willing to dance and play instruments. It is also appropriate to help them return to a normal mental, emotional and physical energy state before stopping the group activities.

8. Shakers, drums and bells, oh my! -- Use as many different types of small percussion instruments that you can find so that everyone has something to make music with. Active music making is very important and cannot be left out. Playing instruments immediately changes the passive listener to a more focused participant who will be more likely to answer questions, make choices and provide spontaneous feedback.

9. Dance! -- Movement to music can also include dancing while sitting down. Props like scarves, ribbons, gloves and costume pieces are useful in cuing movement to music. Using recorded music for the activity can provide valuable time for you to personally interact with the group members.

10. Have fun! -- It will show, and your energy and excitement will be contagious.

Thursday, January 17, 2008

Schoolhouse Story: Scooby Doo Meets His Match!

A story about the power of live music and singing to help a boy with autism do his work.

Ricki is eight years old and spends most of his day in a classroom set up for children who have autism. He had been observed spending much of his time singing to himself, but also paying attention to songs and music activities that were part of the regular classroom instruction. His teacher requested a music therapy assessment to evaluate the potential to help Ricki make better progress on his academic and communication objectives.

The music therapy assessment included time observing Ricki in his classroom working without music as a stimulus as well as time spent participating in specially developed music activities. After the music therapy assessment activities were completed, I observed Ricki working on a math exercise in which he was supposed to trace the numerals 1-5 on a worksheet. After he had traced only one number he began singing about Scooby Doo. He turned his paper over and started writing the words, "Scooby Doo," repeatedly on the back of the paper. Ricki's teacher said that this was a common occurrence and that it was very difficult to refocus his attention back to the assignment.

I tried verbal encouragement and reinforced my verbal requests with visual gestures and even gentle physical elbow and shoulder prompts to try and gain Ricki's attention. Ricki provided some eye contact, but continued his self-made Scooby Doo activity instead of returning to his work assignment. In addition, Ricki began pacing the room.

During the music therapy activities that were conducted before Ricki's work assignment, I had observed that he quickly learned new songs and seemed to enjoy singing. He was also very interested in strumming the guitar and playing other instruments such as shakers and drums. Based on these observations, I felt that I could use music to help Ricki refocus his attention.

I began by singing an improvised song about sitting back down and counting pictures. Unfortunately, Ricki just continued singing and verbalizing about Scooby Doo and ignored my singing. I picked up my guitar and added guitar accompaniment to my improvised song and started walking to match Ricki's pacing around the room. I immediately seemed to gain his attention and sang about Ricki sitting back down in his chair. Ricki followed the instructions of the song and continued by counting the pictures and tracing the numbers as the song directed.

I found it significant that Ricki only responded to singing that included instrumental accompaniment. I believe that it was also important that I was able to move around the room with Ricki while playing the guitar and singing. The power of music and this specific intervention are clearly evident, but this example also provides some reminders about why music as therapy is so powerful when a trained music therapist is involved in the process.

Most of the teachers I work with do not consider themselves singers and definitely don't play the guitar. They can use some recorded music and simple instruments like drums or even small keyboards to help them employ songs in the classroom, but there are limitations to what they can do. Improvisation in music is a skill and a talent that is often a key strategy in using music to help children with autism make progress on goals and objectives. I encourage the teachers I work with to explore different options and help them practice using music in their classrooms, but I am glad that I am also there to meet the needs of clients who require specially developed music strategies on the spot!

Scooby Doo, we've got some work to do now!

Friday, January 11, 2008

Schoolhouse Rock: Teachers Make Music With the Suzuki Q-Chord!

Music therapists in the school setting usually spend one or two times per week working with a client who has disabilities. Many teachers continue to use music strategies with their students throughout the week when the music therapist is not there. The majority of teachers that I work with are very creative and dedicated professionals and do their best using audio recordings and a cappella singing to assist them in music activities in the classroom. These teachers often lament their singing ability and wish for the live guitar accompaniment I am able to provide for the music therapy sessions.

I have had much success in introducing teachers to using the Q-chord to help them enhance their classroom music activities. The teachers I have worked with agree that audio recordings are often too fast in tempo or do not allow enough time for children with special needs to make appropriate responses. The Q-chord changes this dynamic by allowing the teacher to set the tempo and even pause whenever necessary in order to facilitate responses from the children. Using the Q-chord also introduces live music into the environment and provides a music-making instrument for physical interaction.

Here are five highlights I tell my teachers about when introducing them to the Q-chord:

1. Making music with the Q-chord is as easy as pushing one button at a time! Most children's songs are very simple in musical structure and usually only have three to four chords per song. In my work as a therapist, I use song cards with pictures on the front and large print lyrics on the back. I have also placed the letter names of the chords over the appropriate lyric words for reference. The Q-chord has buttons labeled with the letters A, B, C, D, E, F, G which correspond to musical chords. The person playing the Q-chord simply has to push the letter button indicated on the back of the song card and the appropriate music is created. Teachers can immediately be successful without much practice. I have also had some students be able to press the letter buttons to accompany singing.

2. Choose your own tempo! I recommend the Q-chord because the tempo of the music can be slowed down with the simple turning of a dial. Teachers find this very useful as they are learning to play and the students are able to participate better at tempos that match their abilities. The Q-chord also has many different kinds of rhythm backgrounds that keep the music unique and interesting.

3. Strum away! The Q-chord strum-plate is one of its best features. The strum-plate requires only a small amount of touch in order to activate a sound. Small finger taps or large dragging motions work equally well to produce pleasing sounds. The Q-chord comes pre-programmed with a variety of sounds so that teachers and students can make their preferences known. Another nice feature is that one person can push the chord buttons while another person strums the strum-plate.

4. Plug and play! Song cartridges can be ordered separately that plug into the Q-chord. There are many different styles of music and songs that can be obtained and most cartridges have ten or more songs. The advantage to these cartridges is that the preloaded songs can still be slowed down or sped up in tempo and strumming sounds can be added to them. A teacher using a cartridge would not have to push any chord buttons and could focus on having children strum, sing or otherwise interact with the music at a pace that is appropriate.

5. Take it on the road! The Q-chord is very light and easy to to have in your lap. It can be used with batteries or an AC adapter, so power is not an issue. In many classrooms I go to, the students may be in wheelchairs or other special seating arrangements with tray-tables or other obstacles. I have often found that the Q-chord is more accessible than even my guitar or a keyboard as I am going up to these clients and trying to encourage their involvement in the music making.

A Q-chord really makes sense for teachers who want to increase the use of music as a strategy for learning, communication and social interaction!

Monday, January 7, 2008

Five Ideas For Using Music Therapeutically With Children Who Have Visual Impairments

I have the opportunity to work with many clients with visual impairments in the public schools. These children often enjoy music as a primary motivator and independently seek out music stimuli in their environment. In my work as a music therapist I am usually asked to find ways to help these children and their teachers use music stimuli more effectively to aid students in making progress on non-musical objectives. Many students who are singularly challenged with visual impairments pursue music in a traditional way as a hobby, leisure skill or career. We all know about the success and talent of people like Ray Charles, Stevie Wonder, etc., but how do we use music to connect with those children with multiple disabilities?

Children who have visual impairments or blindness combined with disabilities such as mental retardation, autism, Down and other syndromes present unique challenges for using music therapeutically. Traditional adaptations for learning music as a skill may not work with these children. Many of the children I work with may only be able to learn a very short rhythm or melodic sequence by rote and do not read braille due to cognitive impairments. These children also tend to have more acute sensory defensive behaviors towards objects in the environment. Therefore, I often employ music strategies to address non-musical objectives instead of trying to teach music as a skill.

Here are 5 ideas that can easily be used in the classroom:

1. Use braille for song card titles - I use song cards with a picture and title on the front and the lyrics for the song on the back of the card. These song cards facilitate choice-making since they can be presented in fields of 2 or more. Many children with disabilities have limited braille reading skills, but may be in a pre-braille learning stage. Simply having them feel the raised bumps on the top of a song card provides a concrete step in associating a card with a song. Very simple choices can be facilitated by providing one card for each hand. Some children with sensory defensive tendencies may be motivated to feel the braille while they are singing the song for the chosen song card.

2. Instrument playing for the sensory defensive - I have found a number of unique instruments to be more successful with students who are very sensory defensive to touch and textures. Students who recoil from almost anything else will often explore instruments like the African shekere, a cabasa, an ocean drum, and the guitar. The shekere and cabasa offer beads to feel with the cabasa also providing a cool, metallic feeling. The ocean drum has a gentle vibration that permeates through the smooth surface of the drum head as the drum is tilted slowly from side to side. A live guitar fills the air with sound vibrations and the smooth surface of the wood or the rough strings provide many options to explore as the music is playing. Many of the children I work with will try to strum the guitar strings in an attempt to help a song continue.

3. Movement to music - Spatial awareness is taken for granted by those with sight. Children with disabilities have a much more difficult time learning concepts for left and right, up and down, high and low, etc. Songs that use lyrics linked with memorable melodies can facilitate and motivate students to learn these concepts. I also try to choose music that intrinsically teaches concepts like up and down, or high and low, by using high and low notes for the appropriate actions.

4. Drumming - As I have previously mentioned, drumming can sometimes be very effective with children who are sensory defensive. Paddle drums or larger drums that provide more vibration are often good choices. Paddle drums can be used with mallets or played with your hands. In either situation, the vibrations will be passed through the drum handle to the drummer. Gathering drums are also good choices for drumming. They provide much vibrational feedback and can also be used to facilitate sharing and the idea of personal space when a group of children play on the same gathering drum.

5. Social skills - Most gestures as part of social interaction are visual in nature. Actions such as raising your hand, waving, smiling, hand shaking, etc., are difficult to teach to children who are blind. Action songs are a very good way to practice social gestures in a motivating environment where song lyrics can provide instructions and the rhythm and beat of the music can provide timing and structure to the movements.

Once again, music makes sense to use in a variety of settings with many different types of individuals!

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