Physically disabling conditions & neurological music therapy

cerebral palsy

• non progressive disorder of movement and posture; caused by damage to the motor areas of the brain

• About 85%-90% of such brain damage occurs during pregnancy or birth

• 1 out of 1,000 children are born with cerebral palsy / 1 of 7 children do not require special treatment

7 types of cerebral palsy

1. spasticity

2. athetosis

3. rigidity

4. ataxia

5. tremor

6. mixed type

7. antonia

muscle dystrophies

• a progressive weakness of all muscles in the body, which can be attributed to a degeneration of muscle cells and their replacement by far and fibrous tissue

• most common is the Duchenne type

• approximately 250,000 persons suffer from muscular dystrophies in the United States

• early signs include: awkward and clumsy movements, poor posture, and tiptoeing

spina bifida

• an open defect in the spinal column caused by abnormal fetal development; the defect is covered by skin

• the most disabling condition in children

• caused by a failure of the back arches of the vertebra to close before the before’

• the higher the location of the defect along the spinal column, the greater the likelihood that paralysis of the trunk and pelvis will manifest

clubfoot

• the most common of all congenital orthopedic disabilities, with an incidence of about 1 in every 700 births

• the entire foot is inverted, with the heel drawn up, and the forefoot bent inward (adducted)

• casting, bracing, splinting, and surgery can often correct the condition

congenital dislocation of the hip

• caused by an abnormal fetal development of the hip bones

• it can be so mild it is not detected until the child begins to walk

• corrective treatment— surgery, casting, and splinting

• in most cases, the child will spend extended periods fo time immobilized and hospitalized in casts or splints

arthrogryposis

• a congenital disease in which affected children are born with rigidly fixed joints and weak muscles

  • shoulders may be turned in, elbows are straightened, and wrists are flexed and turned inward

  • children may or may not be able to walk, BUT even with their limited mobility and movement awkwardness, they can function well and have no pain associated with their deformities

juvenile rheumatoid arthritis

• a disease that affects children, usually before the age of 11, with two peaks of incidence between the ages of 2 and 4, and between 8 and 11

  • girls are affected by this disease 3 to 5 times more often than boys; but most child sufferers will be free from active disease within 10 years after onset

• one or more joints will be inflamed during the disease; some forms of the disease are also associated with fever and skin rashes.

  • acute episodes of joint inflammation; the joints are swollen, discolored, and tender

dwarfism (little people)

• due to abnormal sketch development and is characterized by impaired physical growth

• physical mobility is rarely restricted other than by height, and the intelligence is normal or above average

osteogenesis imperfecta

• brittle bone disease; characterized by weak bones and short limbs that deform easily

  • the joints are excessively mobile because of greater elasticity of muscle tissue and skin

  • physical activities are severely restricted

thermal injuries

• can be caused by fire, chemicals, electricity, radiation, and prolonged contact with extreme degrees of hot or cold liquids

• one of the most difficult problems for burn victims to cope with is the deformed physical appearance, which sets them apart from other persons

spinal cord injuries

• results in different types of paralysis of parts of the body categorized by paraplegia or quadriplegia (paralysis caused by an interruption of the nerve pathways going from the brain to involved limb via spinal cord)

  • frequent causes are: motor vehicle accidents, sports accidents, bullet wounds, or junkies from falling from a height

acquired amputees

• most elective amputations occur between ages 12-21

  • common causes: motor vehicle accidents, farm accidents, power tool accidents, and gunshot injuries)

  • other causes: cancer, infections, bone tumor, or muscular conditions like gangrene

• MAIN GOAL: enable him/her to develop and grow as normally as possible and enjoy a meaningful quality of life

poliomyetis

• a viral infection that attacks the motor cells in the spinal cords

  • at the onset of the infection, fever, painful muscle spasms, and muscle stiffness occur

• rehabilitation includes strength training for weakened muscles, the use of braces to support weakened joints, and the use of crutches and wheelchairs for mobility

rhythmic auditory stimulation (RAS)

• a technique used to facility the rehabilitation of movements that are intrinsically and necessarily rhythmic, such as gait

  • ex. gait training using RAS involves instructing the child to walk to an auditory rhythm while assisted in regulating hi/her movements, in this case the alternating leg, heel, and toe movements foundational to walking

• strongly established for stroke patients, person suffering from Parkinson’s disease, and individuals with traumatic brain injuries

• the music therapist walks with the patient (typically with assistance of a physical therapist) while either applying a simple metronome click based on the patient’s individual cadence, or playing a song in 2/4 or 4/4 meter with a dominant beat in order to cue gait parameters

patterned sensory enhancement (PSE)

• uses temporal, visual-spatial, and dynamic patterns in music to provide a structure for cuing discrete movements and facilitating longer movement sequences

• especially useful in exercises aimed at improving hand and arm movement

• the qualities of the music must be matched to the movement pattern that is to be practiced

therapeutic instrumental music playing (TIMP)

• unites emotion and intellect with rhythm and motor skills though the creation and performance of music

• allows the patient and therapist to work on endurance, timing of movements, strength, flexibility, and range of motion

• examples

  • percussion instruments can be used to practice gross motor functions like flexion/extension of arms and legs

  • the therapist will place two waist high congas on the left and right side of the patient. DUring the exercise, the patient has to sway from side to side and hit the congas to the rhytm of the song.

rhythmic speech cuing

• uses rhythmic cuing to control the initiation and rate of speech

• can be performed using only a simple metronome or a beat embedded in music— demonstrated success in the treatment of fluency disorders such as stuttering, cluttering, and dysarthria

• in the case of slurred speech patterns, separating the words into syllables can enhance the phoneme articulation as well as improve the timing for initiating the not word or syllable in a sentence

vocal intonation therapy (VIT)

• addresses the rehabilitation of abnormal pitch, loudness, timbre, breathing, and prosody of speech

therapeutic singing (TS)

• a technique that involves the unspecified use of singing activities to facilitate initiation, development, and articulation in speech and language as well as to increase the functions of the respiratory apparatus

oral motor and respiratory exercises (OMREX)

• addresses the improvement of articulatory control, respiratory strength, and function of the speech apparatus though sound vocalizations and wind instrument playing

• often used with patients suffering form developmental disorders, muscular dystrophy, and dysarthria

speech stimulation (STIM)

• often used to elicit function speech responses through musical phrases and to bring out the association of words with familiar tunes

• patient initiates singing song lyrics or is instructed to complete lines of lyrics, such as “twinkle, twinkle little _____”

  • *finish the phrase

• can assist patients with aphasia in stimulating non-propositional speech patterns

• can be applied to encourage the development of functional context related verbalizations

  • “I want ___” or “this is ___”

• can be a useful tool for helping expand vocabulary

  • “This is a ____”

developmental speech and language training through music (DSLM)

• the specific use of developmentally appropriate musical materials and experiences to enhance speech and language development through singing, chanting, playing musical instruments, and combining music, speech, and movement

symbolic communication training through music (SYCOM)

• the use of musical performance exercises using strutted instrumental or vocal improvisation to train communication behavior, language pragmatics, appropriate speech gestures, and emotional communication in a nonverbal language system that is sensory strutted, has strong affective salience, and can stimulate communication structures in social interaction patterns in real time.

  • ex. musical dialogues using drums, turn taking through eye contact, or composing patterns for question-answer games

musical sensory orientation training (MSOT)

• the goal of this method is to facilitate the training of basic cognitive skills such as attention and concentration

• the therapist uses music to stimulate arousal and reconvert of wake states and to encourage the patients active involvement as well as orientation to person, place, and time

• can increase vigilance and train basic attention maintenance with emphasis on the quantity than quality of response

musical neglect training (MNT)

• addresses patients who, due to injury or disease, neglect one side of their body and/or perceptual field

• accomplished thought exercises using musical instruments to produce a structured tempo, time, and rhythm, while the spatial configuration of the instruments helps to focus attention to the neglected side of the patient’s body or visual field

• can also involve receptive music listening to stimulate hemispheric brain arousal while performing nonmusical exercises aimed at correcting visual neglect or inattention

auditory perception training (APT)

• consist of the discrimination and identification of different sound components

  • ex. a child may be asked to identify which of two presented tones is higher in pitch, or he/she could be asked to repeat the faster of two rhythm patterns

• can be organized through active musical exercises such as playing from symbolic or graphic notation, using tactile sound transmission or integrating one’s movement to music

musical attention control (MACT)

• includes structured active or receptive musical exercises involving rehearsed performance or improvisation in which musical exercises involving rehearsed performance or improvisation in which musical elements cue different musical responses

• each the five types of attention can be addressed

focused attention

the ability to direct one’s mind to a particular thing at the exclusion of another stimuli

selective attention

the ability to avoid distractions while focusing on one point of interest

sustained attention

“concentration”; the ability to hold attention over time

shifting attention

the ability to alternate one’s attention form one object to idea to another.

• ex. providing a guitar and firm to both the therapist and the child. The task of the child is then to select whichever instrument the therapist is playing at the moment and play along. When the therapist switches his/her instrument, the patient must also switch

musical mnemonics training (MMT)

• the therapist uses musical exercises to address various memory encoding or recall functions through educational.instructional songs, chants, or activities that combine speech and movement

• musical stimuli are used as a mnemonic device or memory template in form of a song, rhyme, or chant to facilitate learning of non musical information by sequencing and organizing the information in temporally structured patterns or chunks

  • “a is for apple” song

associative mood and memory training (AMMT)

involves musical moof induction techniques

1. to establish congruent mood states to facilitate memory recall

2. to access associative mood and memory function through inducing a positive emotional state in the learning and recall process

musical executive function training (MEFT)

• the therapist uses improvisation and composition exercises in a group or individual setting to practice the aforementioned executive function skills

• can help facilitate the transfer of these skills into nonmusical everyday contexts

• playing a musical instrument requires the use of cognitive abilities such as organization, problem solving, decision making, reasoning, and comprehension; ____ can help children practice and develop these abilities