Shoptalk: Assessment of Music Skills and Responses

The process for music therapy assessments has not been standardized, although it includes certain basic elements. One of the basic elements in a music therapy assessment is to try and ascertain if a client has certain unprompted responses to musical elements. Some assessment procedures also include levels of response to music based on the number and type of verbal, visual and physical prompts. This information is helpful since many clients do not have many unprompted behaviors and so may qualify for music therapy services based on a difference in the number of prompts or self-initiated behaviors between music activities and non-music activities. I feel that it is important, however, to evaluate the power of music without prompts so that it can be argued very clearly that music stimuli alone is having an effect.

Music therapy in the public school setting, for example, requires that in order for a client to receive music therapy there must be a demonstrated effect of music to help the client achieve educational objectives. Over time, I have adapted from other assessment templates some groupings of music that I consider when evaluating a client for music therapy services. For each song or activity, I record my observations with a simple "yes" or "no" if the client exhibited responses without non-musical prompts.

Song/Activity:	Code		Code
Singing Vocalizes by:		Listening
Humming		Alerts to sound
Whispering		Attends to sound
Speaking		Responds/differentiates to dynamics
Singing on Sounds/Syllables		Responds/differentiates to timbres
Imitates		Follows one step lyric directions
Sings on Pitch		Follows two step lyric directions
Sings off pitch, but follows melodic pitch contour.		Responses to Musical Structure
Sings 2(+) note melodic phrases		Takes turns in call and response exchanges
Indicates song preferences		Responds to pauses in songs
Melody		Uses rhyming words
Motivated to complete melody		Motivated to complete chord/rhythmic cadence
Sings up/down a musical scale		Starts and stops to sound cues
Remembers lyrics with melody		Responds to 7th chords, suspensions to resolutions
Rhythm		Supplies sequential information
Maintains basic beat		Social Skills
Imitates 2 beat rhythm		Engages with adult during musical play
Responds to changes in tempo		Engages with peers during musical play
Moves body to rhythm		Maintains appropriate eye contact
Completes rhythmic sequence		Imitates gestures
Instrument Playing
Indicates instrument preference
Plays instruments appropriately
Plays instruments in rhythm with accompaniment

After each activity is scored, the data may be compiled for all the activities to give an idea of what music elements are most effective. The more unprompted responses, the greater likelihood that the client will respond to specially developed music activities. The unprompted responses also indicate that certain music stimuli are unique in aiding the function of the client. My template is still a work in progress, but I invite other therapists to comment about the idea.

Research: Review: Effect of Music on State Anxiety Scores in Patients Undergoing Fiberoptic Bronchoscopy

I recently read the following article as I was looking through research, "Effect of Music on State Anxiety Scores in Patients Undergoing Fiberoptic Bronchoscopy," by Henri G. Colt, MD, FCCP; Anne Powers, NP and Thomas G. Shanks, MPH. I think that the research study was well organized and the researchers earnest in their attempt to discover the effects of music on anxiety, but they did not consider the power of preferred music in their development of the study.

The researchers looked at sixty patients divided into two equal groups. Each patient wore headphones that played music or nothing at all during a bronchoscopy procedure. The study did not find a statistically significant difference in pre and post STAI anxiety scores between the experimental and control group. This is not surprising since the research protocol did not use any method to deliver preferred music styles to each patient and limited the music to piano music from one recording. Although the music used was slow in tempo, sixty beats per minute, there was no other attempt to classify and present "sedative" music.

The researchers admitted that they did not use preferred music and stated that it would have required a much larger population sample in order to add preferred music as a variable. They erroneously wrote that using preferred music, "...could have changed the focus of the trial to addressing what type of music is effective, rather than answering the more straightforward question of whether or not music reduces FFB-related state anxiety." They continued their argument that further studies would be unnecessary and concluded that music would primarily be beneficial in waiting rooms and procedure suites as a way to "soften" the atmosphere.

I think it is unfortunate that so much time and effort, as well as professional prestige were used for this study since it sends the incorrect message that music is not effective in helping patients cope with anxiety during surgeries and painful procedures. Preferred music is a key element in using relaxation to reduce anxiety. Sometimes the music does not even need to be "sedative" in nature if the preferred music is effective in distracting the patient from pain or environmental factors. Music alone is not a proven aid to helping reduce anxiety, but combined with other relaxation techniques such as progressive muscle relaxation or imagery it can be very powerful. I urge medical professionals and music therapists to continue the research in using music to help alleviate anxiety with the hope that larger studies can be developed to address all the variables.

Shoptalk: Staying in Tune

Music therapists working in the public school setting often see up to eight individuals or groups in one day. This type of schedule requires therapists to build up their physical and vocal stamina and use some tips to help them reduce the the physical strain, especially on their voices. I have a list of strategies that I share with the music therapists I supervise to help them maintain vocal and physical health. These tips are not new, but are easily forgotten in the day to day routine without reminders:

1. Maintain good posture: Try not to hunch over the guitar or lean on it for support. If you are standing up and wearing a guitar strap be very careful to stand up straight.
2. Practice good breath support: Activities during a music therapy session can move very fast and you need to take time to breathe.
3. Sing in the middle to higher part of your vocal range: For example, I am a tenor, so I usually capo up three frets on the guitar if I am playing in the key of D. Please stay aware, however, of the vocal range of your clients and try to find a happy medium so that you are all able to sing comfortably.
4. Use folder activities while singing a cappella: This provides some nice variety in a session and allows your hands to be free to help clients or perform actions to music. You can do clapping, snapping or other body percussion to jazz up the songs. Folder activities help you to vary your seating position since you can put the guitar down and stretch or stand up and move around.
5. Use your fingers to strum or pick the guitar. I suggest not using a guitar pick to help reduce the chance of vocal strain from trying to sing over a loud guitar sound.
6. Talk using a light voice with varying pitch. Do not talk in a monotone voice or in a low range with a "gravelly" tone. My voice teacher advised me to try and talk with a raised soft pallet, a little like the secretary on the Beverly Hillbillies. It is not necessary to sound silly, but talking can be very stressful on the vocal chords without proper attention to how you talk throughout the day.
7. Employ strategic group management. If you have 7-8 clients ins a group, do not try and talk over them if they are all playing instruments. I suggest providing instrument choices from quieter instruments or controlling the group as much as possible through gestures or other non-verbal cues.
8. Warm up! Use time in the car to sing and do your favorite vocal exercises. This can be especially helpful in the morning before the first music therapy session.
9. Drink plenty of water throughout the day!