Monday, July 26, 2010

Cochrane Review Validates Music Therapy for Brain Injury

This Cochrane Review is basically a database for meta-analyses of research on different medical topics. What is a meta-analysis, you may ask? A meta-analysis is a review of research studies about a certain topic that compiles the data results from the different research studies and then evaluates the data results to find overall trends or significant findings. This month, the Cochrane Review published a meta-analysis of seven research studies involving music therapy and brain injury: Music therapy for acquired brain injury. The results of the meta-analysis showed that a certain kind of music therapy intervention, termed "Rhythmic Auditory Stimulation (RAS)," is an effective treatment for improving measures of walking. RAS is an acronym used to standardize the vocabulary and terminology for music therapy interventions such as using rhythm and tempo to affect gait training after brain injury from a stroke. RAS is a relatively new term from what is being called Neurologic Music Therapy (NMT). This movement within the field of music therapy seeks to do research that documents and explains how music psychologically and physiologically influences human behavior. The field of NMT has tried to codify and standardize much terminology such as "RAS."

The establishment of music therapy interventions in the Cochrane Review is important because the Review is often used as a reference when developing protocols for medical treatment. The Cochrane Review can also be used as supportive documentation for setting up music therapy as a reimbursable service. This latest publication regarding music therapy is a welcome development!

Tuesday, July 20, 2010

Repeat Signs: 7 Great Posts from the Past!

Rachel Rambach over at Listen & Learn Music recently took up a challenge by ProBlogger to publish a list of 7 links to posts that you and others have written that respond to 7 specific categories. I took up Rachel's challenge to continue the effort first started by Darren Rowse over at ProBlogger. Here are the seven categories:

1. Your first post.
2. A post you enjoyed writing the most.
3. A post which had a great discussion.
4. A post on someone else's blog that you wish you had written.
5. Your most helpful post.
6. A post with a title that you are proud of.
7. A post that you wish more people had read.

1. My first post was Schoolhouse Strategy: Counting Using Music. I wrote this on October 30, 2007! I can't believe it was that long ago! This blog was inspired by my work with teachers in special education. While I was doing music therapy in the school system I would often get asked similar questions by different teachers. I wanted a place where I could write down my answers and ideas so that I could provide teachers with a reference after we talked. The blog has become so much more than that over the years, but I love my roots in special education!

2. I enjoy writing my blog so this was a hard call! I loved writing about the gathering drum because it was a "staple" in my bag of tricks as I merrily went from school to school doing music therapy. I wrote a post about ten great ways to use the gathering drum: Schoolhouse Rock: Ten Great Ways to Use the Gathering Drum. I really enjoy writing posts that provide ideas that teachers and other therapists can use.

3. I think parents and sometimes teachers feel that there is a little mystery surrounding music therapy assessments and recommendations. Often people do not understand why a child is or is not recommended for music therapy services as part of an Individual Education Plan. I wrote a brief outline of what happens in a music therapy assessment to try and provide some information about the logistics and process for a music therapy assessment: FAQ: What Happens in a Music Therapy Assessment? I received several comments on this post from a wide range of people and enjoyed writing back to them.

4. Rachel listed one of Kat Fulton's blogposts as one that she wished she would have written. I must do the same! Kat is a wonderful writer and blogs about a variety of subjects. She wrote a great post about the differences between Music Therapists and Drum Circle Facilitators. She has some great insight into the subtle differences between drum circles led by these different facilitators and there is also a great video about "Bongo" Barry Bernstein at the end of the post. Drum Circle Facilitation and Music Therapy.

5. My most helpful post would have to be the one I wrote about music and memory. This post gets almost as many hits as my post about using a parachute or my post about music in a spin class. This post has also been part of a class reading list assignment for an online university music class. Memory Booster! Using Music to Memorize Lists and Facts.

6. Post titles are sometimes difficult to get just right. You are supposed to include pertinent information that is easy for search engines to find, but you don't want all the titles to be the same boring format. I like my Schoolhouse Story series and especially this one: Schoolhouse Story: Scooby Doo Meets His Match! This post talks about a client who has autism and the title doesn't exactly spell that out for search traffic, but I like the title anyway.

7. I have many posts that I wish more people had read, but I think that is how every blogger feels! I would like to introduce more people to Carly, a blogger who has autism. I think that her story opens up all of us to the possibilities that may occur with our clients, friends, and family who have disabilities. So many people discount them for their disabilities, but sometimes it is just a matter of engaging with them or providing a certain facilitation device or strategy that unlocks their interaction with the world. Carly definitely helps us understand more about autism! Carly Fleischmann: Blogger Extraordinaire!

Thanks for offering up the challenge Rachel! This was a fun post to think about!

Sunday, July 11, 2010

Therapy in the Psychiatric Hospital: Music for the Mind, Body and Soul

One of my readers recently asked me a great question. She is a music therapy graduate student working in a psychotherapy setting and would like to know some activities she can do for group activities. I have not written much about the psychiatric setting, although I did complete my internship at a psychiatric hospital and currently do some activity therapy at an in-patient facility. I think that my reader has reached out for ideas because in-patient psychiatric patients can often be a challenging population. Here are some of the things I consider as I develop group activities for clients in an in-patient setting:

1. Although there are many written examples of music therapy case studies with individuals with mental illness, group activities are often described as task analysis and not in narrative format. This makes it important to search out the research literature and try to transfer and apply the findings to practice. This leads to what is termed "evidence-based practice." My first idea is to look at some of the new research by Dr. Michael J. Silverman at the University of Minnesota. The latest issue of Music Therapy Perspectives, for example, published an article by Dr. Silverman that listed therapeutic goals and music therapy interventions by coordinating them with the medical goals and treatment objectives. Dr. Silverman has many other published articles and research papers about using music therapy with this population.

2. Another resource I go to is the edited book by Robert Unkefer and Michael Thaut: Music Therapy in the Treatment of Adults With Mental Disorders: Theoretical Bases and Clinical Interventions. In the back of this book there is a taxonomy of psychological symptoms with corresponding music therapy interventions. I sometimes look through this section to help focus my activities on a particular issue or symptom (i.e., disturbed affect and mood, psychomotor agitation).

3. Music therapy for the mind. One of the most difficult considerations for group music therapy is that the clients (also often called "consumers") have wide ranging states of cognitive ability. Consumers with dual diagnosis (drug and/or alcohol addiction plus mental disorder) and people with intellectual disabilities are often grouped with single diagnosis consumers. Medication changes and time on the unit can also affect cognitive abilities. I have found that the best approach to this problem is to be prepared with multiple activities or activities that can be implemented at different cognitive levels or utilize higher functioning clients as "peer" helpers. I do one fun activity called "Disco Nerf" where a ball is passed around while music is playing and then participants have to make up dance moves if they have the ball when the music stops. The clients who cannot dance can be chosen to be the "DJ" and are put in charge of starting and stopping the music. More advanced clients can be assigned to help their peers make up dance moves or keep the circle going if the music therapist has to leave to help the DJ. I have successfully done this activity in the admissions group as well as more stable step-down groups.

4. Music therapy for the body. Consumers at in-patient facilities often lament the fact that they are stuck inside with little or no exercise. Their diets even have to be closely watched so that weight gain does not become a problem. In some facilities there are outdoor areas or courtyards that can be utilized by clients who have permission. Almost any activity seems to be more fun and engaging when it is done outside (assuming the weather is nice, of course!). Music and movement activities are also perfect for groups in any stage of treatment or stabilization. Aerobics, work-out videos, line dancing, progressive muscle relaxation and even the Wii Fit are all good options.

5. Music therapy for the soul. Religious themes can be problematic in the psych setting for several reasons. One possible pitfall is that some hallucinations and voices associated with schizophrenia have religious overtones. Another reason is the simple fact that you may find a wide variety of religious ideas in one group. Religious differences have often been the stimulus for conflict throughout world history so it can certainly be the case in a group activity of people with mental illness! On the other hand, many clients respond positively to spiritual music and this can be a normalizing experience and a chance to share positive emotions such as hope, happiness and gratitude. I have not usually had any problems with using songs like Down By the Riverside or He's Got the Whole World In His Hands. Mood is an important component to address in overall health, especially when it is known that depressed mood can lead to greater risk of heart attack and depression. One of the easiest and most neutral ways to affect the "soul" is through teaching and practicing relaxation to counter stress and anxiety. You may still be able to use some sedative spiritual music, but the emphasis will be on the relaxation and not on the content of the music.

6. I also wanted to mention the possibility of co-treating with other therapies. In my experience, clients with mental illness enjoy doing art, dance and even drama. If you have the luxury of working with these other kinds of therapists, it is a good idea to explore combining music listening and music creating with art and drama interventions. One of my favorite things to do is having a group create a circle similar to the Hindu or Buddhist "mandala" by using themes from music selections to guide the creative process. The group can make one giant mandala on butcher paper by rotating the circle by one person for each new song or theme. Each person adds his or her own element to each section of the circle. It is nice to see a group combine for a single product and supporting each other with compliments and ideas!

Thursday, July 8, 2010

Get your Groove on!

November 21, 2010.
American Music Therapy Association National Convention, Cleveland.

I will have the pleasure of presenting a session at the music therapy conference in November. I am very excited about the opportunity and I hope that those of you going to conference will be able to attend. I will be talking about some strategies music therapists can use to help them be more confident and comfortable using drumming and percussion in therapy situations. My presentation is partially based on the curriculum I have developed for a music therapy drumming class at Florida State University. I also took data on student performance and self-assessment that has provided some evidence of the effectiveness of the curriculum and its implementation.

I only have one hour, but I hope to share some activities therapists can start using immediately. It should be a fun hour with a good mix of me sharing and the attendees actively participating. I hope you will join me if you can!

Monday, July 5, 2010

All Aboard the Opera Express!

I thought this was great! I love all the smiles and the people who did a little dancing with the cast members. At the end there is a great moment when one observer pumps her fist in the air! What a perfect way to demonstrate the power of music to inspire and improve mood. When was the last time you were smiling in the middle of a huge crowd while waiting for the train?!

Friday, July 2, 2010

A Deceptive Cadence? One of the Hidden Consequences of Obamacare

The website "Americans for Tax Reform" has the headline: Six Months to Go Until the Largest Tax Hike in History.

I usually do not introduce political topics on Music Makes Sense unless they impact things like education and health or other areas that have to do with people with disabilities or medical issues. I know that just mentioning government sponsored health care can send people running to their respective idealogical corners and that is not my intention here. I do think, however, that it is important to be informed about the issues, especially as it relates to all the new laws and policies that will be implemented with the new healthcare laws. If the news articles are true, then what are known as "Flexible Spending Accounts" will become much more limited starting in January 2011. Currently, Flexible Spending Accounts (FSAs), can be used for up to $5,000 in approved medical expenses. This amount will be cut in half starting in January.

The reason this is important to those of us who work with people with disabilities is that FSAs can help pay for special needs education. I do not know the rationale behind the lowering of the amounts people can contribute to their FSAs and we may never know since the healthcare bill was so large and went largely unread by the congressmen who signed it into law. The legislators may not have even realized what they were doing at the time, but it seems like a poor decision unless other accommodations have been arranged to help parents who have children with disabilities.

I like to help my readers understand music and how it works to affect behavior, mood, our physical functioning, etc. I think it is also important to try and make sense out of the laws and rules of society that govern how we can work as therapeutic professionals in schools, hospitals and other settings. I don't know how much music therapy was made possible through people's FSAs, but I do know that if people have to spend more money on special education because they lose their tax credit, then it may lead to them reducing their ability to pay for allied and adjunctive therapies like music therapy.

It is important for us to try and get informed about the new changes to healthcare. There is a lot to learn in a very short amount of time, but now we know at least one consequence that may affect some of the families we work with.

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