May 2015

Sensorimotor Techniques in NMT

Sensorimotor techniques are another common area in Neurological Music Therapy (NMT). Music and rhythm can be used to enhance motor behavior and responses. Rhythm plays an important role by providing timing as a foundation for movement, while auditory stimuli activate the brain and triggers the different senses. Musical patterns and instruments are common within the sensorimotor techniques as a way of addressing various motor movements. Brief descriptions of the three sensorimotor techniques in NMT are included below.

Rhythmic Auditory Stimulation (RAS): Rhythmic motor cuing is used to help with a person’s movement development, such as gait. Patterns using a steady beat provide cues for the person to step with. Music in 2/4 and 4/4 meters are most common. The rhythmic cues can either be a steady beat provided by a metronome, or strongly accented beats in a musical pattern.

Patterned Sensory Enhancement (PSE): A variety of patterns are used for this technique, including rhythmic, melodic, harmonic, and dynamic-acoustical patterns. These patterns provide cues for temporal and spatial movements, as well as for regulating or developing functional movements. Rhythmic cuing, much like in RAS, helps with timing of movement, while melodic patterns can help cue the changing of spatial positions. Harmonic and dynamic patterns can stimulate the development of muscle tone by applying force.

Therapeutic Instrumental Music Performance (TIMP): This technique focuses on the use of musical instruments to facilitate exercises and functional movement. Instruments are used for the client to hit or play in an effort to exercise range of motions, endurance, flexion/extension, and strength. For example, clients may address arm extensions by having to punch a tambourine. The sound of the instrument provides an auditory stimulus for the client and can help motivate them to continue.

-Tara

Techniques for Speech and Language

One of the main goal areas targeted by Neurologic Music Therapy (NMT) techniques is speech and language. Speech and language goals may include to improve muscular control of the speech and respiratory apparatus; to improve articulation; to improve initiation of speech sounds; to stimulate speech production; to improve pitch, inflection, breath control, or volume; and to improve speech intelligibility. There are several NMT techniques to address these goal areas, and I will share a short summary of each of them and how they may be used:

Developmental Speech and Language Training through Music (DSLM) – the use of developmentally-appropriate musical materials and experiences to enhance speech and language development. This technique is appropriate for clients who have little to no functional language, children with autism, and children with disabilities that have a severe impact on language.

Melodic Intonation Therapy (MIT) – a three-level approach to improve fluent output of language for clients with severe Broca’s aphasia.

Musical Speech Stimulation (MUSTIM) – the use of musical materials (like songs, rhymes, and chants) to stimulate non propositional speech. This may be done by having clients with aphasia or any speech disorder filling in the blank at the end of a phrase.

Oral Motor and Respiratory Exercises (OMREX) – sound vocalization exercises and wind instrument playing to work on strength and coordination in making speech sounds. This technique is appropriate for clients with apraxia, cerebral palsy, and people with respiratory problems.

Rhythmic Speech Cueing (RSC) – the use of metric or patterned rhythmic cues to control speech rate, and to facilitate initiation of speech. This technique is appropriate for clients with apraxia, dysarthria, and fluency disorders.

Symbolic Communication Training through Music (SYCOM) – the use of structured experiences in instrumental or vocal improvisation to train communication behavior. This technique is appropriate for clients who may not develop speech, but could still master or re-gain language concepts.

Therapeutic Singing (TS) – singing activities to practice speech articulation and improve respiratory function. This technique is appropriate for clients with apraxia, dysarthria, and medical conditions.

Vocal Intonation Therapy (VIT) – controlled singing and other vocal control exercises to improve inflection, pitch, breath control, vocal timbre, and volume. This technique is appropriate for clients with voice disorders, medical conditions, and dysarthria.

-Nerissa

The Transformation Design Model

Learning about the Transformational Design Model (TDM) in the symposium allowed me to better understand the steps involved in creating an effective plan for clients. The TDM provides a template for sessions, where music therapists can clearly state the steps they will take to help a client achieve functional therapeutic goals. Beginning with assessing the client’s strengths and needs as step one, a goal is determined as step two. For step three, the music therapist describes what will hopefully be the results, determined by the goal. An important note about this step is that the result should be a nonmusical behavior. It is in step four that the therapist describes how he or she will incorporate musical experiences to help the client work towards the goal. Interventions and preferred techniques, such as Neurologic Music Therapy (NMT) techniques, are included in step four. Finally, the TDM concludes with ways the client will take what they accomplished musically and transfer it back to the real world in a functional manner. Step five requires the music therapist to fade out the music, and then the client will complete the goal on their own. This symposium topic was of great interest to me and now I understand the TDM more clearly. It is helpful to music therapists to provide structure in their session planning. But most importantly, it is beneficial to clients, due to the structure leading them to achieve the desired result in real life situations through the encouragement of music.

-Tara

The Transformational Design Model

This week’s symposium topic was an introduction to the Transformational Design Model and Neurologic Music Therapy techniques. The Transformational Design Model (TDM) sets a template to ensure that music therapy techniques are well-thought out and have functional therapeutic outcomes. The first step in the TDM is to state the client’s strengths and needs. Based on the client’s needs, a goal area is determined for step 2. The third step is to describe the desired result based on the gaol. This is what the client should be able to accomplish at the end of the therapeutic experience, and it should be a non-musical behavior. The fourth step is to describe the therapeutic music experience. This is where the music therapist describes what he/she is doing in sessions with the client to work on the desired goal area. This is also where a Neurologic Music Therapy (NMT) technique is listed and explained. The NMT technique should have functional, musical, and scientific logic that supports the non-musical goal. The final step is to describe how the client will be able to transfer this skill to real life outside of the session. In this final step, the music therapist fades the music and the client should be able to complete the desired result independently. The TDM ensures that music therapists are accountable for the interventions they are leading and can justify why it is beneficial to the client’s outcome.

-Nerissa