Best Practices Practical Techniques and Trending Research in
Best Practices, Practical Techniques, and Trending Research in Music Therapy Hannah Bronson, MT-BC Rebecca Vaudreuil, Ed. M, MT-BC 29 th Annual Brain Injury Association of Maryland 23 March 2017
Presenters • Hannah Bronson, MT-BC Board-Certified Neurologic Music Therapist Contractor, Americans For The Arts, in support of Intrepid Spirit One, National Intrepid Center of Excellence Satellite, Fort Belvoir Community Hospital • Rebecca Vaudreuil, Ed. M, MT-BC Board-Certified Music Therapist, Neurologic Music Therapy Fellow Neonatal Intensive Care Unit/Music-Assisted Child Birthing Certified, Contractor, Americans For The Arts, in support of the National Intrepid Center of Excellence, Walter Reed National Military Medical Center & Creative Forces Tele-rehabilitation Initiative
Learning Objectives At the conclusion of this presentation the participants will be able to: • Recognize the evolution of music therapy, from historic scope and purpose to current clinical application, innovative interventions, and treatment trends. • Identify music therapy interventions and the applicable context for utilization in an interdisciplinary or co-treatment setting. • Demonstrate knowledge of neurologic music therapy (NMT) interventions and interpret the need and use of music therapy in allied health care on a national scale through real-time experiential examples.
Opening Experiential ~Breathing to Music • Featured instruments o Reverie harp, guitar, HAPI drum, viola • Instruments selected specifically for abilities to be rhythmic and incorporate soothing melody • Goals o Facilitation of breath-connection to induce relaxation response o Internal entrainment of respiratory rate (55 -70 breaths per minute), blood pressure, heart rate to external auditory stimuli o Intentional listening for enjoyment
Presentation Outline • Section 1: Emerging trends in health care utilizing creative arts therapies as adjunctive treatment and standard of care • Section 2: Current clinical implications from neurologic music therapy interventions across multiple patient populations and platforms of care • Section 3: Intervention experiential and research questions
History of Music Therapy • World Wars I and II • Veteran clinics o Combat fatigue, shell shock • Response to volunteer musicians • Physician, nurse, mental health referrals • First music therapy course at Columbia in 1919 • 72 accredited colleges and universities o 49% offer graduate degrees • Certification Board for music therapists o Board Certified Music Therapist (MT-BC) Image source: The Oakland Press http: //www. theoaklandpress. com/arti cle/OP/20160119/NEWS/160119471 Image source: Resounding Joy, Inc.
Where do Music Therapists Work? • • • Hospitals Neurorehabilitation Programs Military Treatment Facilities Schools (Special Education) Older Adult Establishments Centers for Developmental Disorders http: //www. wellspringeducation. org/musictherapy/
Music Therapy Treatment Goals • • • SOCIOBEHAVIORAL Pain/anxiety management Relaxation/stabilization of vital signs • REHABILITATION (PHYSICAL, NEUROLOGICAL) • Speech and language Self-awareness/expression • Sensorimotor Emotional regulation • Cognition/Memory Appropriate communication Learning coping strategies • Social engagement/group cohesion • Positive sense of self/accomplishment • (Re)integration to self/family/community/country
Rationale for Music • 100+ billion neurons in the brain o Scientists in recent years have found that listening to music activates neurons in nearly every region of the brain. (Levitin, 2006) • Effective throughout the lifespan
Rationale Continued… • Bodies entrain to rhythm due to the natural response and entrainment of • • • motor system. Humans physiologically respond to music. Music “taps” into emotions. Music helps improve attention/executive function. Music shares neural circuitry with speech. Music is a social experience. Music is non-invasive, safe and motivating. Image source: http: //www. androidwallpapercentral. com/downloa ds/Android. Wallpaper. Music. Lifeline. jpg
Contexts of Music Therapy Facilitation • Individual vs. Group Dynamics o Self insight Social engagement • Inpatient vs. Outpatient Rehabilitation Setting o Maintaining engagement of both mandatory and volunteer participation in music therapy programming • Acute vs. Long-term Care o Improvisation, adapted instruction, songwriting, performance • Stages of Trauma Awareness o Kübler-Ross model (the five stages of grief) (Kubler-Ross, 1969) § Denial, anger, bargaining, depression, and acceptance ØEntry at all levels ØDifferent musical interventions to accompany different stage/progression through processes
4 -Week Acute Intensive Outpatient Program Model at the National Intrepid Center of Excellence
Long-Term Progressive Program Model at Intrepid Spirit Center Fort Belvoir
Neurologic Music Therapy • “A Brain that is engaged by music, is changed by engaging in music…In music Neurologic music therapy, music as a therapeutic agent does not operate as a cultural artifact, but rather it operates as core language of the human brain…music engages widely brain distributed neural networks that are shared with general “non-musical” cognitive, motor, and language function” (Thaut, 2014)
Rational Scientific Mediating Model • Musical Response Model: • Investigation of neurobiological and behavioral processes underlying music perception and performance • Parallel Non-Musical Response Models: • Investigating overlaps and shared processes between musical and non-musical brain/behavior function • Mediating Models: • Investigating whether, where shared and overlapping processes are found, music can influence parallel non-musical brain/behavior functions • Clinical Research Models: • Where mediating models are found, whether music can influence (re)learning and (re)training in therapy and rehabilitation
Common NMT Interventions: • Cognitive • Associative Mood and Memory training (AMMT) • • Auditory Perception Training (APT) Echoic Memory in Music (EMM) Music Attention Control Training (MACT) Music Executive Function Training (MEFT) • Music Psychosocial Training and Counseling (MPC) • Musical Mnemonic Training (MNT) • Motor • • Musical Neglect Training Patterned Sensory Enhancement (PSE) Rhythmic Auditory Stimulation (RAS) Therapeutic Instrumental Music Performance (TIMP) • Speech • Melodic Intonation Therapy (MIT) • Oral Motor and Respiratory Exercises (OMREX) • Rhythmic Speech Cuing (RSC) • Therapeutic Singing (TS)
The Intersection of Goals & Intervention to Inform Function
Cognitive: Auditory Perception Training (APT) • (Central) Auditory Processing Disorder – Developmental, common in military blast TBI • Focused on auditory perception and sensory integration • Developing treatment program with Speech and Language Pathologists
Cognitive: Musical Mnemonic Training (MMT) • Uses music as a mnemonic Device to sequence and organize information enhancing persona ability to recall information • Functional Example: “ABC” song, School House Rock Something patients often can relate to…
Remembering morning routine… • Wallet • ID • Cell phone • Coffee • Breakfast • Medication • Brush teeth • Shower • Pack lunch • Backpack
To the tune of “Smooth Criminal” • “Wake up brush my teeth, take a shower, eat some breakfast. Pack a lunch, make coffee, take my medication. Gotta grab my wallet, my ID and my cell phone. Put them all in my backpack, out the door, and I’m ready to go!”
Speech and Language: Oral Motor and Respiratory Exercises • OMREX involves the use of musical materials and exercises, mainly through sound vocalization and wind instrument playing, to enhance articulatory control and respiratory strength and function of the speech apparatus • Commonly used for people with dysarthria, and muscular dystrophy • Functional Example: Video Play Video
Music Therapy News Feature Patient Testimonial: “For me it is a time where I can get out of my pain, grief, and some of my darkest thoughts in almost a cryptic manner without being judged by others. It’s like I open myself up to explore my thoughts, put them in a bottle, and seal it up as a finished project allowing me to let go of some things and reflect on others. ” PLAY NEWS FEATURE (Davis, B. , verbal communication, 4/6/14)
Songwriting in Music Therapy • “Songwriting in therapy consists of a process of creating the song and all the musical, verbal, and bodily communication involved in that process. ” • (Baker & Wigram, 2005, p 98). • Ethical obligation of clinician to ensure that the client can further process experiences of residual effects, be they positive or negative. • Strong emphasis on expression, communication, agency. http: //www. wellspringeducation. org/musictherapy/
Tele-Music Therapy Using Cyberspace to Connect
Defining Tele. Health • • Interest peak of telehealth in public and private sectors since 1996 • • Technologies include videoconferencing, the internet, terrestrial and wireless communications. Use of telecommunication technologies to disseminate electronic information to support long-distance clinical health care, patient and professional health-related education, public health, health administration, etc. . . Increase/improvement of telehealth to meet needs of underserved people by: • • • Fostering partnerships within HRSA, federal, state and private sector groups. Providing technical assistance. Evaluating the use of telehealth technologies and programs. Developing telehealth policy initiatives to improve access to quality health services. Promoting knowledge exchange about "best telehealth practices. ” ~US Dept Health & Human Services, 2012 Health Resources and Service Administration (HRSA) http: //www. hrsa. gov/ruralhealth/about/telehealth/glossary. html
Grounded in Tele. Medicine • Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status. ” (American Telemedicine Association, www. americantelemed. org) • Telemental Health (TMH) is a subset of telehealth that uses technology to provide mental health services from a distance. • Telepsychology, telepsychiatry, telebehavioral health. • Ensures that clinical care, medical education and monitoring, and provider consultations are available anytime, anywhere. • How are you integrating tele-music therapy into your practice? National Center for Telehealth & Technology, 2012 Defense Center of Excellence, www. dcoe. mil
Telemusic Therapy (TMT) • Provide music therapy interventions remotely for pts that are either homebound due to illness or live in rural areas. • Common TMT interventions: personal music inventory creation, lyric analysis, songwriting, relaxation, therapeutic singing, instrument performance, recording, producing, meditation & relaxation • Locate music-based services in pts communities that are accessible and in proximity to TMT pts. • Individual, Group, Families
Example: https: //www. arts. gov/artworks/2017/music-saved-my-life-how-arts -therapy-helped-master-sergeant-recoverwounds-war
Music Therapy Research Initiatives • Grammy Foundation - Supported research project exploring emotional regulation using music listening for service members with PTSD. This neuroimaging study will use the magnetoencephalograph (MEG) to show brain activity while listening to specific music. • Case Study to show the gains that this patient continues to make in a rehabilitation process involving an interdisciplinary team approach from inpatient (acute) to outpatient (long-term) settings. Through sharing this case example, we aim to demonstrate the benefit of multiple disciplines individually and highlight points of collaboration to provide total patient-centered care. This patient has selected music therapy as a modality that bridges his treatments together with consideration to speech, PT, and assistive technology.
Presenter Contacts Hannah Bronson, MT-BC Hannah. e. bronson. ctr@mail. mil Rebecca Vaudreuil, Ed. M, MT-BC rebeccamusictherapy@gmail. com
References u American Music Therapy Association (2002). Using music therapy in response to crisis and trauma. Silver Springs, MD: Author. u Baker, F. (2001). The effects of live, taped, and no music on people experiencing post-traumatic amnesia. Journal of Music Therapy, 38(3), 170 -192. u Baker, F. & Wigram, T. (Eds. ). (2005). Songwriting: Methods, Techniques and Clinical Applications for Music Therapy Clinicians, Educators and Students. Philadelphia: Jessica Kingsley Publishers. u Bensimon, M. , Amir, D. , & Wolf, Y. (2008). Drumming through trauma: Music therapy with post-traumatic soldiers. Arts in Psychotherapy, 35(1), 34 -48. u Carey, L. (2006) (ed. ) Expressive and Creative Arts Methods for Trauma Survivors. Philadelphia, PA: Jessica Kingsley Publishers. u Thaut, Michael. , Hoemberg, Volker. Handbook of Neurologic Music Therapy. Oxford University Press (2014). , New York, NY. u Taylor, D. , Biomedical Foundations of Music as Therapy (2 nd edition). Barton Publications (2010). Eau Claire, WI. u Gabrielsson, A. , “The relationship between musical structure and perceived expression”, Chapter 13. Oxford Handbook For Musical Psychology. Oxford University Press (2009), New York. pp. 141 - 150.
References Cont. . u Gabrielsson, A. , “The relationship between musical structure and perceived expression”, Chapter 13. Oxford Handbook For Musical Psychology. Oxford University Press (2009), New York. pp. 141 - 150. u Kubler-Ross, Elisabeth. (1969). On Death and Dying. New York, NY: The Macmillan Company. u Levitin, D. (2006). This is your brain on music: The Science of a human obsession. USA: Penguin. u Ng, Wang Feng (2005). Music Therapy, War Trauma, and Peace: A Singaporean Perspective. Voices: A World Forum for Music Therapy. Retrieved June 19, 2010, from http: //www. voices. no/mainissues/mi 40005000191. html u Sutton, J. (2002. ) (ed. ) Music, Music Therapy and Trauma; International Perspectives. Philadelphia, PA: Jessica Kingsley Publishers. u Sutton, J. , & De Backer, J. (2009). Music, trauma and silence: The state of the art. Arts in Psychotherapy, 36(2), 75 -83. u Vaudreuil, R. & Reuer, B. [ed. ] (2011). Music. Worx Toolbox: Music Therapy Progressive Curriculum; Working With Active Service Members. San Diego, CA: Music. Worx Inc.
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