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neurologic music therapy

Every Thursday, I spend a majority of my day at a retirement/memory care facility in the community. I have the pleasure of working with two memory care groups, a resident choir, and a keyboard  class. This facility has introduced me to some of the kindest, funniest, most musically inclined and  gentle spirited people. I have found that there is truly something special about the way music brings out the personalities and emotions of those residents living with memory loss. There is so much joy in small interactions or exchanges that remind me that I love doing what I do. 

Some of my favorite moments happen very subtly amongst the memory care residents. The residents in these groups have a wide range of physical, cognitive and verbal abilities depending on their stage of memory loss. I tend to take my time interacting with those clients with further progressed memory loss, specifically those that are non-verbal and typically non-responsive in conversational situations. 

In my second month, I was co-leading with a team member  and she was singing the folk song ‘I Love the Mountains’. The chorus of the song has a catchy phrase of ‘boom dee ah da, boom dee ah da, boom dee ah da, boom dee ah da’ that the residents love to join in on. One of the further progressed residents that is non-verbal and oftentimes looking off into the distance during group began to light up as the group continued singing the song. I had never heard her sing or talk, even when asked direct questions and had observed her as having low engagement or response during sessions. After the 3rd or 4th repetition, her face was alive and she was singing the boom dee ah da chorus. I could hardly contain my joy! 

There are several moments where clients have alertly sat up after a cat nap when they hear the group singing, and even join in themselves by singing, clapping or tapping their foot. Or moments where residents interject in discussions or songs to swear that they had met the artist that wrote it or performed it. These moments of spontaneous engagement aren’t limited to passive participation, they also come alive during more structured and interventions like TIMP interventions. 

During TIMP (Therapeutic Instrumental Movement Performance) interventions, each client gets an instrument (typically a maraca, small tambourine or hand bells) and is prompted to follow along with my visual, musical or verbal movements. I have had several laughing fits when residents begin to freestyle/improvise dance moves. You would never expect to see a 90+ year old man in a wheelchair to stand up and shimmy while you’re singing ‘Shake Senora’. 

If there’s one thing I’ve learned as a Music Therapy intern, it’s that sometimes the best moments aren’t the ones you expect and play for, but they’re the ones that happen spontaneously, amidst the laughter, smiles, jokes and music that we create together. 

  • Mia Falcon

Pattern Sensory Enhancement, or PSE, is a Neurologic Music Therapy (NMT) technique developed by Michael Thaut. This technique’s purpose is to elicit movement with musical cues through all elements of music (i.e. tempo, rhythm, dynamics, etc.). Those cues fall under three primary categories, spatial, temporal and force, and has a step by step procedure to follow. When done correctly, PSE can be very effective in not only engaging but driving movement and prompting full range of motion and functional motor movement.

Spatial cues are broken down into pitch, dynamics, sound duration and harmony. All of these elements indicate how the body should be moving in space in one capacity or another. If a music therapist wants to facilitate an arm swing up and down, they could use a legato scale crescendoing as the scale ascends to elicit the upward momentum of the arm and a decrescendo as the scale descends down on the release of the movement. Gravity naturally assists this lowering or downward motion of the arm meaning emphasizing the movement with rising dynamics and a connected melodic line are less of a necessity as the laws of physics state that what goes up must come down.

Temporal cues encompass tempo, meter, rhythmic pattern, and form. Matching the desired motion to these cues is important for the clarity and facilitation of the movement. For example, if a therapist’s objective is to maintain or improve lower body gross motor function in the legs, and therefore is facilitating leg lifts, using a duple meter march will depict the movement within the music. Duple meter because the natural cadence for walking goes 1. 2., 1.2. (i.e. leg goes up/down, up/down). An example of an appropriate song might be “When the Saints go Marching in”. It is in a duple meter and the downbeat is very strong and easy to pic out. The corresponding lyrics are convenient, although not necessary.

Force cues are musical elements like dynamics, harmony, and tempo. Although these elements are used as spatial and temporal cues, they can also be used to indicate where the “work” or exertion is in the movement (i.e. in the leg lift example above, lifting the leg requires more exertion to work against gravity). In other words these help to cue the points at which the muscles are either exerting or releasing energy. A dissonant chord, such as a diminished C, might be used at the moment a client needs to hold a position of tension. The chord resolving to C major would indicate the release or relaxation of the muscles.

To effectively implement PSE, it is important for the music therapist to follow these 4 steps.

    1. Demonstrate the movement with your client and set a tempo on a metronome that matches their natural cadence (i.e. If you will be marching, introduce it verbally but also demonstrate what the movement should look like.)
    2. Following the metronome, give your clients rhythmic verbal cues. (i.e. Give your verbal cues in the corresponding meter. If you have a metronome that allows for tapping in the beat, do so.)
      1. I.E. up and down, out and in
    3. Continue the verbal cues while gently bringing music in.
    4. Fade out the verbal prompts and let the music facilitate the movement.
  • Optional: add a song, but never compromise the beat!

-Noriah Uribe

 

 

*Source by Tara Harwell