Janice Harris, one of our local therapists, has started a blog radio show on music therapy. I love this idea! Her intent is to spread information about music therapy as she provides a platform for discussion about different aspects of the profession and music therapy strategies. The show is broadcast every Saturday at 4:00 Central time, but there is a show archive so that you can go back and listen to previous shows.
The program has already presented very useful information about music therapy referrals, performance wellness, drum circles and other topics I actively discuss here at Music Makes Sense. Janice also highlights some interesting historical facts about music therapy and provides links to helpful information around the worldwide web. I encourage therapists, parents and teachers to call in or e-mail Janice with questions and comments so that we can support the show and expand the discussion about the power of music in therapy.
See you on Saturdays!
Wednesday, May 28, 2008
Monday, May 19, 2008
Music for Birth and Labor: Lessons From the Labor and Delivery Floor
There are music therapists who specialize in using music for childbirth and for babies in neonatal intensive care. Although I have extensive experience working in hospitals, I had not specifically used music strategies as part of a birthing plan. I have read that some women develop detailed descriptions of what they would like to happen as labor progresses and delivery occurs. Medical details are often highlighted, such as when and if they wish to receive an epidural block or whether or not certain drugs should be used. From my understanding of what some music therapists do as part of the birthing plan, music can be integrated as a motivator or relaxation cue for different parts of the laboring process. As I proceeded to develop ideas for my part in a birth, the idea of making a detailed plan was beyond my expertise since I had only watched two previous deliveries many years ago. I did, however, identify some key moments when I thought music therapy strategies might be effective.
"The best-laid plans of mice and men..."
~John Steinbeck
I had diligently worked with the expectant mother to make two different play-lists on an ipod. One play list included her preferred songs for relaxing. Another play list titled, "Push it!", contained motivating music with fast tempos and an invigorating beat. I had envisioned that the relaxing music could be used with deep breathing and muscle relaxation techniques during needle sticks and the introduction of an epidural. The motivating music would be available for late in the labor process in the event that physical or mental fatigue presented itself. I should have heeded Steinbeck and thrown most of this limited birthing plan out the window!
The bright spot in the plan was that the relaxation music for needle sticks worked very well. Key elements for this success were that the patient did not need to listen to instructions given by the medical professional during the procedure. I was able to hold the patient's hand and encourage her to close her eyes and breathe in and out in slow, regular breaths that fell into her own comfortable rhythm. The patient listened to music through headphones to help mask environmental sounds and encourage mental visualization of a relaxing, comfortable scene. I further guided the patient in slightly tensing and releasing various muscle groups to help her feel the difference between tense and relaxed. She squeezed my hand and relaxed, tightened her face muscles and then let them feel loose, and released her jaw muscles so that her jaw and tongue were relaxed. Relaxing the jaw is a very good way to force the body to relax since it signals many other muscle groups in the body to either tense or relax.
There were many instances where shots, blood draws and an I.V. placement were necessary. In all these cases the patient was visibly more relaxed during the procedures and has not talked as much about the incidents afterwards as she had for previous needle sticks given without music and relaxation.
The epidural procedure involves introducing a long needle near the base of the spine and then placing a flexible tube over the needle. The anesthesiologist must use touch to guide the needle and catheter into the correct position since every person has slightly different anatomy. My client was highly anxious about potential pain and concern over complications that could occur during the procedure. She began by wearing headphones and listening to her selected relaxing music, but soon had to remove one earbud in order to listen to instructions from the nurse and anesthetist. My client lost the masking effect of the music by having to remove one ear piece, but also lost a strong focal point to help her focus her attention on something else besides the needle stick. The procedure requires a patient to arch her back and drop her head and arms forward and allow them to hang. Progressive muscle relaxation was therefore contraindicated since the patient must not move and should stay in a loose and relaxed state. The anesthetist continually provided instructions and asked questions, while requiring the patient to stay alert and verbally respond to the questions when appropriate. This arrangement precluded me from being able to provide verbal coaching or instructions to the patient in hopes of establishing relaxed breathing or facilitating relaxing visualization.
During this labor, the patient did not require motivating music. Although it was a long labor (34 hours), she did not lose energy to push at the request of the nurse or doctor. I believe that music would have been problematic since it was necessary for the nurse to count out loud and provide verbal instructions throughout the birthing process. The patient also had a spouse acting as verbal coach so there were already competing focal points.
There was one point during labor when the patient was instructed to breathe through the contractions and not push. In retrospect, this may have been another opportunity for the relaxation music and protocols. The main thing to remember is that assistance through music can be available as a strategy when needed, but it should not be forced into situations just because it is part of a "birthing plan."
The result of my short foray into music assisted childbirth was holding a beautiful newborn baby.
Related Posts:
Relaxation Strategies for Pre-operative Settings
A Guide to Sedative Music
~John Steinbeck
I had diligently worked with the expectant mother to make two different play-lists on an ipod. One play list included her preferred songs for relaxing. Another play list titled, "Push it!", contained motivating music with fast tempos and an invigorating beat. I had envisioned that the relaxing music could be used with deep breathing and muscle relaxation techniques during needle sticks and the introduction of an epidural. The motivating music would be available for late in the labor process in the event that physical or mental fatigue presented itself. I should have heeded Steinbeck and thrown most of this limited birthing plan out the window!
The bright spot in the plan was that the relaxation music for needle sticks worked very well. Key elements for this success were that the patient did not need to listen to instructions given by the medical professional during the procedure. I was able to hold the patient's hand and encourage her to close her eyes and breathe in and out in slow, regular breaths that fell into her own comfortable rhythm. The patient listened to music through headphones to help mask environmental sounds and encourage mental visualization of a relaxing, comfortable scene. I further guided the patient in slightly tensing and releasing various muscle groups to help her feel the difference between tense and relaxed. She squeezed my hand and relaxed, tightened her face muscles and then let them feel loose, and released her jaw muscles so that her jaw and tongue were relaxed. Relaxing the jaw is a very good way to force the body to relax since it signals many other muscle groups in the body to either tense or relax.
There were many instances where shots, blood draws and an I.V. placement were necessary. In all these cases the patient was visibly more relaxed during the procedures and has not talked as much about the incidents afterwards as she had for previous needle sticks given without music and relaxation.
The epidural procedure involves introducing a long needle near the base of the spine and then placing a flexible tube over the needle. The anesthesiologist must use touch to guide the needle and catheter into the correct position since every person has slightly different anatomy. My client was highly anxious about potential pain and concern over complications that could occur during the procedure. She began by wearing headphones and listening to her selected relaxing music, but soon had to remove one earbud in order to listen to instructions from the nurse and anesthetist. My client lost the masking effect of the music by having to remove one ear piece, but also lost a strong focal point to help her focus her attention on something else besides the needle stick. The procedure requires a patient to arch her back and drop her head and arms forward and allow them to hang. Progressive muscle relaxation was therefore contraindicated since the patient must not move and should stay in a loose and relaxed state. The anesthetist continually provided instructions and asked questions, while requiring the patient to stay alert and verbally respond to the questions when appropriate. This arrangement precluded me from being able to provide verbal coaching or instructions to the patient in hopes of establishing relaxed breathing or facilitating relaxing visualization.
During this labor, the patient did not require motivating music. Although it was a long labor (34 hours), she did not lose energy to push at the request of the nurse or doctor. I believe that music would have been problematic since it was necessary for the nurse to count out loud and provide verbal instructions throughout the birthing process. The patient also had a spouse acting as verbal coach so there were already competing focal points.
There was one point during labor when the patient was instructed to breathe through the contractions and not push. In retrospect, this may have been another opportunity for the relaxation music and protocols. The main thing to remember is that assistance through music can be available as a strategy when needed, but it should not be forced into situations just because it is part of a "birthing plan."
The result of my short foray into music assisted childbirth was holding a beautiful newborn baby.
Related Posts:
Relaxation Strategies for Pre-operative Settings
A Guide to Sedative Music
Tuesday, April 29, 2008
Music Therapy: Examples of the Power of Live Music
Music therapy in the public school setting is usually provided to clients on a weekly basis. Depending on the student, the therapist may see the client one to one or in a small group setting with peers. Music therapists are trained to provide specially developed music activities in a variety of different musical styles and have knowledge of a wide range of disabilities and health issues. Sometimes music therapy services will be provided as a consult service instead of direct service so that other educational staff may be trained in using music strategies. These strategies can help clients across settings and more frequently throughout the week when the music therapist is not present. I have seen many clients through a consult role with some success, but there are limitations to what teachers and other staff can accomplish when using music activities. I would like to provide some specific examples about how live music can be the key to successful intervention with music therapy. The following case studies are based on occurrences at schools, but live music is also important in working with adults in medical treatment and older adults in rehabilitation and assisted living settings. (Although these are stories about real students, names have been changed for confidentiality.)
1. Clint is an elementary student who has autism. He functions higher than average on the spectrum of autism disorders closer to Asperger's. Clint does well with established routines, picture schedules and a structured environment, but he is often lost in his own imagination, making sounds and repeatedly talking about a topic. In the classroom, Clint requires picture prompts and sometimes physical prompts combined with verbal instructions in order to remain in a designated work area.
Music therapy group time for Clint is very structured, following a similar routine of songs and providing movement to music activities and instrument playing to help Clint remain focused. Although Clint is more focused during music therapy activities than during work without music, he often leaves his chair or starts talking to himself off the subject. I generally have my guitar as my accompanying instrument and have used improvised singing to help Clint return to his chair or follow simple directions. Clint is very focused on predictable melodies that have an obvious musical conclusion. He would definitely be able to finish the happy birthday song if it was incomplete! Clint almost always looks up to me as I sing instructions and usually finishes singing the lyrics himself as he sits back down, raises his hand or follows through with the physical directions in the song. My ability to obtain Clint's immediate and unprompted compliance has always impressed his teachers. They generally remark that they wish they had the ability to sing and play the guitar. I have been able to provide them with some easy songs to sing and remember, but Clint is very sensitive to musicality and will not respond to music stimuli that is out of tune or incorrect. This is a great challenge for teachers who are not musically trained.
2. Travis, another student with autism, is in junior high school. His teachers have been having problems with him not wanting to wear his shoes at school. Travis did not usually have his shoes off in music therapy, but one day he came without his shoes on. I immediately made up a song with a lively beat that said, "Put on your shoes and sit up straight, Travis is getting ready for music!" The song had a repeating lyric structure and very simple melody so that Travis started singing the song with me. He was able to sing the lyric by himself after two times singing through the song and proceeded to follow the directions in the song as he sang them to himself while I played the accompaniment on the guitar. I have recorded the song for his teachers to use, leaving the last phrase blank so that he can, "get ready for ______," whatever class he is in.
3. Scott has autism and is a student in elementary school. He has been sitting and listening in the music therapy groups, but not participating with verbalizations or eye contact. In a recent session, I noticed that Scott was tapping his foot during an upbeat song. I quickly matched the tempo of my guitar playing to his foot tapping. Scott immediately looked up and provided meaningful eye contact. He changed his foot tapping faster and slower and began smiling when the rhythm of the guitar accompaniment followed the tempo he set. In subsequent sessions, Scott has seemed more aware of the music when it encourages body movements or playing instruments.
4. Lisa is a student with multiple disabilities. She is a high schooler who uses a four button communication device to make choices or indicate her wants and needs. Lisa is much more active in using her communication device during preferred music activities with one exception. She does not seem to like music in a minor key. Lisa participates in choir class with her peers, but has cried and become emotionally upset when the choir is singing songs in a minor key. Her teachers are careful to monitor recorded music used in class to make sure that songs will not play that are in a minor key. During music activities designed to address Lisa's educational objectives, I have been very careful to use songs arranged around major chords.
Music should be encouraged as a stimulus and structuring force for many different learning and therapy situations even if a music therapist is not involved. Try to recognize the unique power of live music and take advantage of music therapists when they are available.
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