Addressing Aphasia And much more Music Therapy & stroke Addressing Aphasia And much more

What is music therapy? The use of music to meet non-musical goals, under the direction of a board-certified music therapist. Non-musical goals may focus on maintaining and improving: - Speech, language, and communication skills Fine and gross motor skills (e.g. strength & coordination) Cognitive skills (e.g. sequencing, attention) Emotional domains (e.g. depression, anxiety, anger) Sensory domains (e.g. managing pain) Music Therapists perform assessments, create treatment plans, take objective data, and evaluate the results of therapy.

What do people do in music therapy? Play instruments (drums, percussion, guitar, chimes) Sing alone or in a group Write & record original music Play games or create your own Use music technology (e.g. iPad, recording equipment) Listen to relaxing music Learn about music Experience music from your culture, and other cultures Read and discuss song lyrics Explore album art, mix tapes, and other media

It’s the relationship that heals Music Quality of life matters! The participant’s music preferences are integral! Therapist Participant Music Therapy is individualized, whole-person treatment!

How to become a music therapist Bachelor’s degree or higher in Music Therapy Academic music studies: music theory, music history Music performance: piano, guitar, autoharp, percussion, voice, conducting, composition, etc. Therapy courses: psychology, human development, counseling, ethics, research methods, anatomy, etc. Internship (1,040 hours = roughly 6 months, 40 hours a week) Board Certification Exam (MT-BC) Renewal of Board Certification through continuing education Additional training in specialized areas, such as neuro rehab.

Neurologic music therapy (nmt) - research-based system of 20 standardized clinical techniques for sensorimotor training, speech and language training, and cognitive training. - Treatment techniques are based on scientific knowledge of music perception and production and their effects on nonmusical brain and behavior functions. - NMTs serve people affected by: stroke, TBI, Parkinson’s and Huntington’s disease, cerebral palsy, Alzheimer’s disease, autism, and other neurological diseases affecting cognition, movement, and communication (e.g., MS, Muscular Dystrophy, etc.). Therapeutic goals and interventions address rehabilitation, development, and maintenance of functional behaviors.

NMT: Motor Rehabilitation RAS – gait training PSE – functional movements in the arms and hands TIMP – instrument playing

Rhythmic Auditory Stimulation (RAS) Rehabilitation of movements that are natural rhythmic – Gait, arm swing Walking with therapists AND appropriately timed music can address: - uneven muscle tone – upper & lower body - toe drag - improve coordination and balance - increase postural and trunk control - decrease contractures & limitations on range of movement - increase symmetry in stride length, weight bearing RAS uses the neurological capacity for entrainment – a state when the brain fires in time with the music.

Patterned Sensory Enhancement (PSE) Uses rhythm, melody, harmony, and dynamics of live music to provide temporal, spatial, and force cues for movements used in ADLs Used to combine discrete arm and hand movements into a functional motor sequence (e.g. sit-to-stand transfers, dressing) Used to increase strength and endurance, improve balance and posture, increase functional motor skills in the arms & hands

Therapeutical Instrumental Music Performance (TIMP) Playing musical instruments to regain motor control and coordination Playing with therapist 1:1 or in a group Drums placed in unusual positions May require grasping a mallet

Nmt: Speech/Language Communication Melodic Intonation Therapy (MIT) Musical Speech Stimulation (MUSTIM) Symbolic Communication Training through Music (SYCOM) Rhythmic Speech Cueing (RSC): uses rhythm to improve timing of speech via chants or speaking with a metronome Oral Motor & Respiratory Exercises (OMREX): improves articulatory control, respiratory strength, function of the anatomy used in speech; may use singing or playing wind instruments Vocal Intonation Therapy (VIT): uses exercises similar to choral warm-ups to address specific needs in rehabilitating vocal control Therapeutic Singing (TS): singing alone, with therapist, or with a group for a variety of therapeutic goals

Symbolic Communication Training through Music (SYCOM) designed for survivors with a severe loss of expressive language allows for symbolic communication through music performance Opportunity to practice non-verbal communication behaviors such as turn- taking, gesturing, listening before responding, and question/answer dialogue

Melodic Intonation Therapy (MIT) - Especially indicated for survivors with Broca’s aphasia Therapist and survivor sit 1:1 and sing brief, functional phrases (“I want water”). The melody sung mimics the natural intonation of the spoken phrase. Therapist taps on survivors hand, and/or survivor taps their hand to the rhythm. Therapist and survivor begin by humming only, and tapping their fingers. Therapist and survivor progress to singing the phrase together. Therapist eventually fades, allowing survivor to sing independently, eventually fading all musical cues.

Musical Speech Stimulation (MUSTIM) Uses music, songs, and chants to trigger automatic, reflexive speech Can be used for survivors that MIT is not suitable for: e.g. survivors with global aphasia or cognitive impairments Can be a follow up technique after MIT Survivor fills in words of a familiar song, “Happy birthday to ___” Can build to alternating lines back and forth, imitating conversation “Do you want something to eat?” “I want to eat” or “No, I’m not hungry.”

Other uses of music therapy Increase relaxation skills: progressive muscle relaxation, music and visualization, music and meditation, etc. Increase coping skills: use music to explore ways to cope with the problems of life, addressing depression, anxiety Increase leisure skills: example: adapted music lessons Increase socialization: participation in music performance, movement, or music appreciation groups provides opportunities for positive, structured socializing Improve pain management: using music to cope with chronic or acute pain Increase self-expression: express complicated emotions through music experiences, explore recorded music and lyrics

How to find a music therapist Go to MusicTherapy.org (website of the American Music Therapy Association – AMTA) and click on the purple bar “Find a Music Therapist.” http://www.musictherapy.org/about/find/ Search the online directory for MTs located near you. OR Contact AMTA at findMT@musictherapy.org and they will provide you with a list of currently qualified MTS free of charge. Please remember to include the location you are looking in, and to include your postal or email address. Ask your doctor or case manager for assistance with a referral.

Is MT reimbursAble? Medicare: since 1994, music therapy has been identified as a reimbursable service under benefits for Partial Hospitalization Programs (PHP). Medicaid: MT is covered in some states. Private Insurance: Companies like Blue Cross Blue Shield, United Healthcare, Cigna, and Aetna have all paid for music therapy services at some time. Additional sources for reimbursement and financing of music therapy services include: many state departments of mental health, private auto insurance, employee worker’s compensation, foundations, grants, and private pay.

Questions ?