1. How Music Therapy Is Used In Physical Rehabilitation Ann P. Gervin, MT-BC HealthSouth Lakeshore Rehabilitation Hospital

2. Music Therapy is not: Entertainment For patients who are bored

3. Music Therapy is: The systematic use of instruments and music, in any of it’s forms, to help patients achieve non-music goals improving their cognition, physical function and ability to communicate.

4. Sessions focus on: – communication – physical abilities – cognitive functioning – eliciting responses from non or minimally responsive patients – adaptations – patient/family education Individual, Group, Co-treatment

5. Focused attention Consistency of automatic verbal responses Phonation Vocal strength Oral-motor strength Laryngeal elevation Speech rate Breath support and breathing patterns Communication

6. Focused attention

7. Phonation

8. Oral Motor Strength

9. Breath support

10. Breathing patterns

11. Gross/fine motor coordination/endurance Functional object/instrument use Active/passive range of motion - AROM/PROM – Patterned Sensory Enhancement (PSE) – Therapeutic Instrumental Music Performance (TIMP) Balance/gait patterns – Rhythmic Auditory Stimulation (RAS) Physical abilities

12. Large drum

13. Hand chimes

14. PROM with maraca

15. Harmonica

16. The properties of music… Can facilitate predictable neurologic responses as in: – Auditory cueing for gait using Rhythmic Auditory Stimulation (RAS) which enhances walking speed balance control of muscles and extremities to achieve more functional gait patterns

17. RAS to facilitate gait

18. LE strengthening exercises

20. Instruments and music are used to: Facilitate Motivate Structure specific responses from the patient

21. Multiple tasks can be addressed in each activity Sitting posture Focused attention Grip strength UE flexion/extension Alternating/unison mov’ts Eye-hand coordination Speed of execution Impulse control

22. Cognition Structural characteristics of music… – Rhythm – Melody – Harmony – Tempo – Dynamics Stimulate attention and concentration Facilitate learning to improve comprehension, problem solving and memory

23. Cognitive techniques Paper-pencil tasks, lyric writing Multi-task exercises

24. Music that is: Repetitive Predictable Familiar…. ….structures activities, helps focus attention and can act as a device to assist with recall.

25. Decreasing L neglect Playing on lyric cues

26. Use of sound and color to decrease left neglect or right inattention

27. Cognitive Goals Increase – focused attention to task – ability to control impulsivity – awareness of affected side – initiation/spontaneity – level of orientation – ability to integrate aspects required to play instruments or participate in an ensemble effort – memory of session events

28. Physical Abilities Music and particularly rhythm can: – Provide cues to reintegrate a sense of movement by stimulating alternate motor pathways or serve as auditory cues to influence timing/readiness leading toward more precise/sustained movements – Facilitate spontaneous movement to help decrease possible contractures or atrophy

29. Singing… …“involves strong/fast inspirations followed by extended regulated expirations” Makes repeated demands on diaphragm Resulting sequence of controlled breathing and respiratory muscle exertion has potential to change pulmonary function of COPD pts. International Journal of COPD, 4/09,University of Sao Paulo, Brazil

30. Pulmonary Group Improve pulmonary function by increasing: awareness of correct sitting posture awareness of exhalation effort through party blowers and harmonicas vocal projection deeper breathing patterns to sing familiar songs

31. 30 Minute Group, Mon-Fri., 11:00-11:30 Group includes: – Stretching – Vocal warm-ups – Diaphragmatic resistance exercises – Singing – Projection work – Wind instruments (harmonicas) HLRH Pulmonary Group

32. Seven therapeutic outcomes from group singing that benefit Alz pts: Communication: – Involves entire body – Strengthens neural connections to voice/breath – Non-threatening Cognition – Challenges memory and concentration – Addresses motor planning (action songs) – Addresses word finding (substitution) Group Singing Journal of Dementia Care,2006 C. Montgomery-Smith

33. Relationships – Group has shared purpose – On equal ground – Develop friendships – Find/give support Empowerment – Group interaction – Greater feelings of control – Regaining abilities – Sense of accomplishment – New role Group Singing

34. Exercise and Stress Reduction – Exhaling: good technique to reduce stress Increases circulation as diaphragm massages internal organs Releases endorphins Improves immune response (changes in salivary Immunoglobulin A and Cortisol) Group Singing

35. Improve pulmonary function by increasing: awareness of correct sitting posture when singing awareness of exhalation effort (party blowers/harmonicas)

36. Session Structure Warm-ups provide…Mild diaphragmatic resistance

37. Oxygen Saturation Taken at the beginningTaken at the end

38. Postural Exercises

39. Projection

40. Visual cues mimic volume

41. Song Selections Familiar Age appropriate Longer phrasing Sustained lyrics (appear naturally or added at phrase end) Positive/uplifting themes Look for opportunities for gross motor movements

42. Primary Group Goals Improve: Breath support/vital capacity Vocal strength for more audible communication Endurance for singing (5 min. intervals) Level of participation Awareness of body mechanics Sitting posture Effectiveness of cough O 2 saturation levels at session end Reduce dependence on O 2

43. Increase: – Energy conservation through pacing w/exertion – Knowledge of benefits of improved pulmonary function (cognition, healing, endurance) – Socialization – Affect – Use of UEs/LEs through AROM as paired with singing. – Orientation to time, place, circumstance – Memory for session events Secondary Goals