What is Patterned Sensory Enhancement
What is Patterned Sensory Enhancement and How Do I Use It?
Patterned Sensory Enhancement (PSE) is “a technique that uses the rhythm, melodic, harmonic, and dynamic-acoustical elements of music to provide temporal, spatial, and force cues for movement which reflect functional movements of activities of daily living, or the fundamental motor patterns underlying these activities” (Thaut & Hoemberg, 2016, p. 106). PSE is a technique that is used by board certified music therapists who have completed the Neurologic Music Therapy (NMT) training. Other practitioners such as occupational therapists, physical therapists, etc. can also take the NMT training to supplement their work as therapists. There are seven affiliation categories that define representation, responsibility, and the level of expertise and engagement in the advanced practice of NMT: Neurologic Music Therapist (NMT), NMT Fellow (NMT-F), NMT Allied Professional (NMTAP), NMT Allied Professional Fellow (NMTAP-F), NMT Scholar, NMT Educator, and Student. For more information on NMT and the NMT Info Sheet, click here.
It is important to understand that the music used in PSE is not meant to accompany movement, but facilitate it. The music therapist can use various elements of music to facilitate various aspects of movement. The three types of cueing are spatial, temporal, and force cues (Thaut & Hoemberg, 2016).
Spatial cues
The “spatial aspects” of movement refer to how the body moves in space. For example, one can move their arms up and down, lift their leg and put it down, or take a step as they walk. The spatial component of movement can be cued with the elements of pitch, dynamics, sound duration, and harmony.
Pitch
Pitch can indicate the direction in which a movement is going. When the pitch goes up or down, the movement follows. For example, one can facilitate the movement of the arms extending overhead with a chromatic or major scale that steps up and the arms moving down from overhead to the waist would be reflected in a descending scale.
Dynamics
“There are some movements for which pitch cannot accurately cue direction, but dynamics can be more effective in facilitating the spatial aspects” (Thaut & Hoemberg, 2016, p. 109).
For example, one can spread their arms out to the side and back towards their torso. One can use dynamic contrast to facilitate this movement, such as loud dynamics when moving the arms out to the side and softer dynamics when moving them towards the torso.
Sound Duration
In addition to pitch and dynamics, the duration of notes can be used to facilitate spatial aspects of movements. For example, if the therapist would like to help their client create fluid movements (such as arm swinging), they can use legato notes. If the therapist would like their client to make more jerky or rigid movements (such as stomping or hip flexion and extension), they can use staccato notes.
Harmony
Harmony is another element that can be utilized in the facilitation of spatial movements. “Harmonies that are closer together give a feeling of spatially closer movements, whereas movements that are more open would be better cued by more open harmonies” (Thaut & Hoemberg, 2016, p. 110). For example, moving the arms away from and back toward the body do not go up or down, but to the side and back towards the center of the body. The musical facilitation for moving the arms out to the side can be a more open-voiced chord (notes are not that close to one another). Similarly, the musical facilitation for moving the arms back towards the body can be a closed voiced chord (notes are close to one another). For more information on open and closed voice chords, click here.
Temporal Cues
The temporal cues are perhaps the most important elements to consider when implementing PSE. “If the music does not accurately match the temporal structure of the movement, it will be difficult for the client to use any aspect of the music to facilitate the movement” (Thaut & Hoemberg, 2016, p. 111). The temporal structure of a movement can include tempo (or timing), meter, rhythmic pattern, and form.
Tempo
The most important thing to consider before facilitating movement with music for a client is the tempo or the speed at which the client can comfortably complete the movement. Before setting the tempo, the therapist provides simple verbal cues to enable the client to understand the movement. Simple verbal cues can include “up and down” (e.g. for a bicep curl, leg lift or toe tap), “side to side” (e.g. for hip flexion/extension), or “in and out” to clearly indicate the important points in the movement and help frame the timing of the movement. It is also important to use a metronome at this point so one can identify the starting tempo for the music. A great tool for this is a metronome app with a tap function.
Meter
In music, meter refers to regularly recurring patterns and accents such as bars and beats. Meters are commonly in two, three, four, or six. The timing of each movement has a meter. Movement such as skipping or weight shifting are typically in 6/8, whereas movements like marching or walking may be in 2/4. When performing an arc/swung pattern such as moving pelvic tilts side to side (or a seated weight shift), one can use a 3/4 time. The meter can often change depending on how fast or slow the movement is being carried out by a client.
Rhythmic Pattern
When cueing a movement, the music therapist does not need to provide a musical cue on every beat within the measure. Within the meter, there may be a rhythmic pattern that emphasizes the movement being made. It is emphasized by the timing of the rhythmic pattern, where the beginning of one move stars can be beat 1 and the movement ends on beat 4. For example, when prompting a client to shift their weight side to side while sitting in a chair, the music therapist might provide a cue at the outer ends of the movements in 6/8 meter (when shifting to the left, there is a cue in the form of a chord on beat one and shifting to the right, another cue is provided on beat four). This helps the client to time their movement so they can match the movement to the rhythmic pattern within the meter.
Form
Form refers to the “structure of the whole temporal pattern that is being used to cue a movement” (Thaut & Hoemberg, 2016, p. 112). Some movements may have multiple components that require different rhythmic structures. For example, when practicing leg raises, a client might need four beats to raise the leg, two beats to lower it, and two beats in rest before starting again. Form can also refer to the larger structure of a piece of music. If a therapist is facilitating two different movements in a song, they might utilize an ABA or ternary form. For example, the verse of a song might cue a client to bicep curls while the chorus might cue the client to make arm raises.
Force/Muscular Dynamics
The final aspect of cues include muscular dynamics. A good question to consider is “Where is the work for the client when they are doing a particular movement?”. The aspects of music that influence how much force is behind a given movement include tempo, dynamics, and harmony.
Tempo
Tempo can have a significant impact on the amount of force behind a given movement. It is important to consider the potential advantages and disadvantages of fast and slow tempos. For example, if a therapist is helping a client to stand up from a sitting position, a fast and forceful tempo may be appropriate. If the therapist is helping the client to sit down from a standing position, a slow and controlled tempo might be more appropriate to ensure the safety of the client.
Dynamics
Dynamics can be very effective in creating a feeling of the force behind a movement. For example, a crescendo can convey a feeling of increasing muscle force in a movement, and a continuous loud dynamic may help to sustain a holding position. Likewise, a decrescendo can help to create a feeling of decreasing muscle force, and a continuous soft dynamic may convey the feeling of a resting position.
Harmony
Tone clusters and unresolved harmonies can be very effective in creating muscular tension. “When a chord creates some tension in the harmony, it can cue the muscle to continue working until the harmony is resolved, at which point it cues the muscle to relax” (Thaut & Hoemberg, 2016, p. 113). For example, when facilitating a progressive muscle relaxation, the music therapist can play a dominant 7 chord when prompting the client to tense their muscles. Likewise, the therapist can resolve the harmony when prompting the client to release the tension. An example of this could be to use a G dominant 7 chord and a C chord when releasing the tension.
Helpful Hints
- Go through the movement with your client and get an idea of their optimal tempo while tapping the tempo into the metronome.
- Using the metronome, talk the client through the movement rhythmically, using simple verbal cues such as “up and down”, “side to side”, and “forward and back” ,
- Maintain your verbal cues while slowly bringing the music elements in. Keep the music simple to begin with, and then gradually layer the music in order to cue the spatial, temporal, and force cues.
- Fade out your verbal cues and let the music facilitate the movement.
Adaptations for working with individuals with cognitive disabilities/delays
- Model the movements as clearly and simply as possible. Sometimes, gestural prompts are more effective than verbal prompts.
- Use client preferred music. A client might be much more motivated to perform an exercise when the exercise is timed with their favorite song.
- Consider using visuals to help facilitate the movement. One might use visuals with commands in the form of words or a picture of someone performing the movement if verbal processing is difficult for the client.
Reference
Thaut, M., & Hömberg, V. (2016). Handbook of Neurologic Music therapy. Oxford University Press.
Written by Alec Johnson, Music Therapy Intern