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Communicating with Nonverbal Clients

I (Molly) recently had the amazing opportunity to attend the American Music Therapy Association’s national conference in Minneapolis, Minnesota.  The conference is an opportunity to meet other professionals, share ideas, and learn from cutting-edge research. Today I’d like to share a few things I learned from Peggy A. Farlow’s presentation on strategies to communicate with nonverbal clients.

It can take considerably more time and effort to communicate with nonverbal individuals, but it is essential to provide opportunities for self-expression.  When clients are unable to express their needs, desires, and preferences to those around them, maladaptive behaviors tend to increase in frequency and severity.  Whatever signals your nonverbal client uses to communicate, make sure to verbally state what you see to make sure you understood the client’s meaning. If a signal is unclear, ask for clarification by saying something like, “Did you mean yes?”  If the client gives several unclear signals, they may want to ask or answer a different question. It’s okay to ask, “Is there something else you’d like to talk about?”

The most common communication system for nonverbal clients is direct selection, which allows the client to communicate by pointing to a picture on a language board.  In order to use direct selection, clients need to have selective attention to visual stimuli and motor ability to indicate a choice.  If the client is not able to isolate one finger to point to a symbol on a language board, they can indicate their choice with a stylus, head movement, eye gaze, or even a laser pointer!

Direct selection can also work with more advanced language boards.  For example, clients who spell can use an alphabet board like the one pictured above to spell out questions and answers.  The therapist should verbally state each letter to make sure they understood the client’s signal.

Indirect selection works well for clients with very limited motor ability.  The client communicates by giving a yes signal when the therapist points to the desired picture on the language board.  Usually, the therapist will point to each row of the language board until the client gives a yes signal. Then the therapist will point to each column until the client gives the yes signal.  In this way, the client can communicate without pointing to the language board.

My favorite part of Farlow’s presentation was learning about the ETRAN system, which stands for eye transfer.  The therapist holds up a transparent language board, and the client uses eye gaze and/or head movements to select a symbol on the board.  High-tech ETRAN systems use a large, plexiglass board, but you can make a low-budget version with sheet protectors!

You can find the slides for Farlow’s entire presentation here.  I hope you’re as inspired as I was!

-Molly, Music Therapy Intern

Festive Interventions for your Holiday Session Plans!

Hello everyone! I don’t know about you, but I have been waiting ALL FALL to be able to finally do holiday interventions. I think it is so fun to plan sessions around a theme, especially for holidays! I have done several holiday sessions so far, so I wanted to share some fun interventions for your own session planning! 

Holiday Themed Name that Tune: 

One of my favorite ways to structure a session is to start with “Name that tune” before each intervention I lead. I love to do this by using my Kazoo to play the melody for the group, then following with that song and a fun exercise ! Below are lots of ideas for interventions to put to various Holiday songs

Frosty the Snowman-Sustained Attention/Focus Intervention:

Materials: Frosty the snowman pieces (hat, nose, eyes, mouth, scarf) 

Plan: 

1. MT passes out pieces to Frosty the Snowman so that each client has one piece. 
2. MT begins to sing Frosty the Snowman, accompanying on guitar. 
3. As MT sings song, clients listen for their item to be listed in the song. When they hear their item, MT brings large drum over to them and they toss their item into the drum.. 
4. MT continues to sing until all items have been collected 
5. You will see success when clients are engaged and focused for the entire song and puts their item in the drum without needing additional prompting. 

Example: 

Frosty the snowman was a jolly happy soul

With a corncob pipe (*client with pipe puts item into drum)

 and a button nose (*client with nose puts item into drum)

And two eyes made out of coal (*client with eyes puts item into drum)

For this exercise, I found a snowman kit at Target! I am sure you could find this other places as well, such as Amazon or other stores. If you can’t find a kit, I suggest creating one out of paper or felt! I have attached a photo of my kit for your reference below:  

Deck the Halls: Falalala attention intervention

1. MT plays melody on Kazoo, clients guess the title of the song 
2. MT says: “Now I have a special role for you in this song. I want you to hold your instrument in the air and play along only on the part that says “falalalala”. Anytime you hear that phrase, lift and play! Let’s practice” 
3. MT sings first line of song and visually prompts clients to raise and play instruments on “falalala” section.
4. MT sings song, accompanying on guitar, prompting clients to play along. 

Let it Snow: Upper Body Movement

Materials: snowflakes or scarves

1. MT passes out visual snowflakes to the group
2. MT demonstrates desired movement with snowflake (arm extensions, bicep curls, etc.)
3. MT sings through song, accompanying on guitar, while cueing group for movement. 

For this activity, I printed out snowflakes that I found on Google images, and laminated them for use with clients! Another fun idea is using scarves as snowflakes and “winter wind”

Walkin’ In a Winter Wonderland: Lower Body Movement: 

1. MT explains that group will be walkin’ in their own winter wonderland” by exercising their  lower body. This is important to daily life so that clients maintain lower body strength to prevent falls and independence. 
2. MT demonstrates toe taps and cues group to follow 
3. MT sings song, accompanying on guitar, while continuing to cue movement 
4. MT demonstrates seated marches, and cues group to follow 
5. MT sings through song again

I love both of these movement interventions because they add a fun twist to typical movement activities. Incorporating visuals such as snowflakes helps to motivate clients to participate and helps with orienting them to the season, and using a song about walking encourages clients to move their lower body!This song is also great for encouraging reminiscence and utilizing technology such as a smart board or iPad to show YouTube videos or photos of winter scenes. 

Joy to the World: Vocal warm-up:

1. MT prompts group to sing along to “Joy to the World” 
2. MT explains to clients that we will now work out our speaking and singing muscles by adding some different words to the song. This is important to strengthen and maintain good articulation and breath support so that others can understand what one is saying and to keep oxygen flowing through the body!
3. First, replace original lyrics with “la” 
4. Next, replace lyrics with “doo”
5. Replace lyrics with “wow”
6. Sing original words one final time

I have used this intervention with a couple of my older adult groups, and I love it because it uses a song and melody that they know well, and is great for working vocal muscles. Plus it is tons of fun to add in silly words or sounds. My favorite one to use is “meow” or “wow” because it has several sounds within it, making it great for working on articulation!

We Wish You a Merry Christmas/Holiday Songwriting

Since Christmas isn’t the only Holiday that happens around this time of year, I think it is a great idea to try and incorporate other holidays into sessions. One idea is to use the well-known song “We Wish You a Merry Christmas” and after singing through the original, changing the lyrics to “We Wish You a Happy Hanukkah” and then “We Wish You a Happy Kwanzaa.” This is a fun way to end your session with an upbeat song.

I hope this gives you some ideas for your own holiday themed sessions! 

See you in the next post,

Audrey

5 Ways to Use “ The Lion Sleeps Tonight” in Music Therapy

One of the songs I play the most in music therapy sessions is “The Lion Sleeps Tonight” as recorded by The Tokens in 1961.  This is one of those rare songs that isn’t limited to a specific age group or population, which makes it very versatile. Here are five ways I’ve used this song in music therapy settings:

1. MUSTIM: Because this song is so well-known and has simple lyrics, it is a great song for the neurologic music therapy technique Musical Speech Stimulation (MUSTIM).  This technique uses fill-in-the-blanks to encourage clients to speak or sing.  When I use this song to stimulate speech, I pause before saying the last word in the phrase and prompt the client to complete the phrase.  For example, I might sing, “In the jungle, the mighty jungle, the lion sleeps…” and wait for the client to sing or say “tonight.”
2. Articulation: When I use this song in groups with one or more nonverbal clients, I like to vocables (non-words) for a verse to encourage non-speakers to sing.  This can be a motivating opportunity to mass practice CV or CVC sounds. If the group doesn’t have an articulation goal, I’ll often use a bilabial sound such as /b/ or /m/ since these sounds are often the first to develop.  Additionally, this lengthens the intervention for groups working on sustained attention goals.
3. Songwriting: When working with clients on making and communicating choices, offer choices for different animals, places, and actions to put in the song.  For example, I ask clients, “Should we sing about a lion or a penguin?” while showing a visual of each one. When clients express choices verbally or gesturally, I place their choices on a dry erase board with the lyrics, then lead the group in singing our new song.
4. Receptive language: Sing several verses, each about a different animal.  Challenge clients to find or match a visual to the animal in the verse from an appropriate field (2, 3, or 5).
5. MACT: This is a fun song to use for sustained attention and 1- or 2-step direction following.  It’s fun and easy to embed directions in this tune. For example, the therapist can sing which instrument to play (“[client name] plays the drum” or “[client name] plays tambourine”).  The therapist can also embed verbal directions for dynamic or tempo changes (loud, soft, fast, slow, etc.). When working on sustained attention with groups, I often embed directions in 2 or 3 verses, then up the challenge by leading musical changes without verbal prompts.

I hope these uses of “The Lion Sleeps Tonight” spark some ideas for you and your clients!  Do you have any other uses for this song? Let us know in the comments!

-Molly, Music Therapy Intern

A Song for Every Season

The songs we pick as music therapists are tools to orient clients to the day of the week, weather, month, season, upcoming holidays, and more.  Themes can also tie sessions together and provide opportunities for reminiscence.  Here is my running list of themes by category.  I hope it sparks some ideas for your individual and group sessions!

Weather

Rain/Storm

• “Singing in the Rain”
• “Pennies from Heaven”
• “Over the Rainbow”
• “Catch a Falling Star”
• “Raindrops Keep Falling on My Head”
• “A Foggy Day”
• “Blown Away”
• “Hurricane”

Sun/Sunny Weather

• “Here Comes the Sun”
• “Sunny Side of the Street”
• “You Are My Sunshine”
• “Walking on Sunshine”
• “Blue Skies”
• “Hot, Hot, Hot”

Time of Day

Morning

• “Good Morning” (Singing in the Rain)
• “Oh, What a Beautiful Mornin’”

Evening

• “Goodnight, Ladies”
• “Goodnight, My Someone”

Seasons

Winter:

• “Frozen Penguin”
• “I’ve Got My Love to Keep Me Warm”
• “Let It Go”
• “Snow” from White Christmas

Spring

• “April Showers”
• “Blue Skies”
• “When the Red Robin Goes Boppin’ Along”
• “Edelweiss”
• “It Might as Well Be Spring”
• “Spring Will Be a Little Late This Year”
• “I’m Looking Over a Four-Leaf Clover”
• “April in Paris”
• “While Strolling Through the Park One Day”

Summer

• “It’s Summertime”
• “In Summer”
• “Summertime” (Gershwin)
• “The Summer Wind”
• “My Bonnie Lies Over the Ocean”
• “Beyond the Sea”
• “Under the Boardwalk”
• “Summer Song” (Brubeck)
• “Those Lazy Hazy Crazy Days Of Summer”
• “In the Summertime” (Mungo Jerry)
• “Hot Hot Hot”
• “Jump in the Line”
• “Summer of ‘69”
• “Surfin’ Safari”
• “Memphis in June”

Fall

• “Autumn Leaves”
• “Colors of the Wind”
• “She’ll Be Coming Round the Mountain”
• “He’s Got the Whole World in His Hands”
• “Wagon Wheel”
• “Country Roads”

Holidays

Patriotic Songs (for President’s Day, Memorial Day, Flag Day, Fourth of July, Veteran’s Day, etc.)

• “My Country Tis of Thee”
• “Battle Hymn of the Republic”
• “You’re a Grand Old Flag”
• “Proud to be an American”
• “God Bless the USA”
• “Stars and Stripes Forever”
• “God Bless America”
• “Yankee Doodle” and “Yankee Doodle Boy”
• “Star-Spangled Banner”
• “America the Beautiful”
• “Boogie Woogie Bugle Boy”
• “This is Worth Fighting For”
• “Courtesy of the Red, White, and Blue”
• “Over There”
• “You’re In the Army Now”
• “Home on the Range”
• “Caissons Go Rolling Along”
• “Anchors Away”
• “Marine’s Hymn”
• “Semper Paratus”
• “The U.S. Air Force”

Easter:

• “Easter Parade”
• “A Tisket, A Tasket”
• “Here Comes Peter Cottontail”
• “On the Good Ship Lollipop”
• “The Candyman”
• “I Want Candy”

Money/Tax Day

• “Three Coins in the Fountain”
• “Pennies from Heaven”
• “Side by Side”
• “Money, Money, Money”
• “If I Were a Rich Man”

Labor Day

• “Nice Work if You Can Get It”
• “I’ve Been Working on the Railroad”
• “Whistle While You Work”
• “Working for a Living”
• “Nine to Five”
• “Car Wash”
• “Sixteen Tons”

Halloween

• “Thriller”
• “Addams Family Theme”
• “Ghostbusters”
• “Witchcraft”
• “Old Devil Moon”
• “Soul Man”
• “Time Warp”
• “Purple People-Eater”
• “Monster Mash”

Thanksgiving

• “Thankful”
• “Come On-A My House”
• “Shoo-Fly Pie”
• “I’ve Got Plenty to Be Thankful For”
• “Autumn Leaves”
• “Sweet Potato Pie”
• “We Are Family”
• “Be Thankful”
• “Blessed”
• “Autumn in New York”

Academic Concepts

Alphabet

• “Alphabet Song” (of course)
• “26 Letters in the Alphabet” https://www.youtube.com/watch?v=eY6JOnqxpyo
• “The alphabet is filled with consonants and vowels…” https://www.youtube.com/watch?v=36IBDpTRVNE

Parts of Speech

• “Pronouns Song” https://www.youtube.com/watch?v=hh62KQ7mujA
• “Verbs: That’s What’s Happening”
• “A Noun Is A Person, Place Or Thing”
• “Conjunction Junction”
• “Interjections”
• “Unpack Your Adjectives”
• “Lolly, Lolly, Lolly Get Your Adverbs Here”
• “Rufus Xavier Sarsaparilla”
• “Busy Prepositions”

Counting Songs

• “Who Stole the Cookies from the Cookie Jar”
• “10 Little Racing Cars”
• “5 Little Ducks”
• “10 Little Racing Cars”
• “The Ants Go Marching”
• “5 Little Apples/Cookies”
• “10 Little Monkeys Jumping on the Bed”

Travel/Transportation

Cars/Driving

• “Baby, You Can Drive My Car”
• “On the Road Again”
• “Life is a Highway”
• “Route 66”
• “Fun, Fun, Fun”
• “Little Deuce Coupe”

Trains

• “Chattanooga Choo Choo”
• “I’ve Been Working on the Railroad”
• “Long Black Train”
• “Take the A Train”
• “This Train is Bound for Glory”

Travel

• “Route 66”
• “Beyond the Sea”
• “You Can Drive My Car”
• “Life is a Highway”
• “Come Fly With Me”
• “Fly Me To The Moon”
• “Side By Side”
• “Wagon Wheel”
• “Sentimental Journey”
• “Leaving on a Jet Plane’
• “Yellow Submarine”
• “Surrey with the Fringe”
• “Row, Row, Row Your Boat”
• “Michael Row Your Boat Ashore”
• “Walking My Baby Back Home”
• “Old Grey Mare ”
• “In My Merry Oldsmobile”
• “Back in the Saddle Again”
• “Slow Boat to China”

Adventure/Exploration

• “They All Laughed”
• “Fly Me to the Moon”
• “Beyond the Sea”
• “Don’t Fence Me In”
• “Cruising Down the River”
• “I’ve Been Everywhere”

Places

Cities and US States

• “New York, New York”
• “Chicago”
• “Goodmorning, Baltimore”
• “I’ve Got a Gal in Kalamazoo”
• “April in Paris”
• “I Left My Heart in San Francisco”
• “A Foggy Day” (in London town)
• “Memphis in June”
• “Do You Know What It Means (to Miss New Orleans)”
• “Carolina in the Morning”
• “Georgia on my Mind”
• “Sweet Home Alabama”
• “Alabamy Bound”
• “Blue Hawaii”
• “Deep in the Heart of Texas”
• “All My ‘Exes Live in Texas”
• “Yellow Rose of TX”
• “Meet me in St. Louis”
• “Oklahoma”

Ocean

• “Octopus’s Garden”
• “Yellow Submarine”
• “Slippery Fish”
• “Surfin’ USA”
• “My Bonnie Lies Over the Ocean”
• “Beyond the Sea”
• “Under the Boardwalk”
• “Girl from Ipanema”
• “Red Sails in the Sunset”
• “Rock the Boat”
• “Knee Deep”

Animals

• “The Lion Sleeps Tonight”
• “La Cucaracha”
• “Crocodile Rock”
• “Disco Duck”
• “Eye of the Tiger”
• “Fireflies”
• “Barracuda”
• “Baby Shark”
• “Hound Dog”

What are your favorite themes or seasonal songs to use in music therapy sessions?  Let us know in the comments below!

-Molly, Music Therapy Intern

Sensory Systems Song

We, the intern team, learned so much about sensory processing from Carol Stock Kranowitz’s (2005) book, The Out-of-Sync Child.  In this post, we’d like to talk about what we learned about the vestibular and visual systems.  You can find more information about other sensory systems in other posts.

The vestibular system determines the body’s position in space.  It tells us whether we’re up or down, what direction we’re moving, and how fast we are going.  The vestibular system sends the information to the central nervous system (CNS) so we can generate enough muscle tone to move smoothly and efficiently.  I learned that receptors for the vestibular system are hair cells in the fluid of the inner ear. They act as a carpenter’s level as our heads change in position.

We learned how important the vestibular system is to not only movement, but many other brain processes.  The brain processes all other sensory information in reference to the vestibular system. When the vestibular system functions inaccurately or inconsistently, other sensory information can be misinterpreted.  Individuals with sensory processing disorder may be overresponsive to vestibular input and are overstimulated by changing position, underresponsive and not be able to sense and react to falling sensations by extending an arm or leg to catch themselves, or constantly seeking vestibular input by climbing, hanging upside down, swinging, or spinning.

The visual system is one of the most complex systems in the brain.  It enables us to identify what is in the environment without touching it.  Additionally, it helps to guide and direct movement so we can interact, socialize, and learn in our environment.  We learned that eyesight is a prerequisite for vision, but eyesight is not the same as vision. Vision is something we develop as we learn to integrate our senses and make sense of what we see.  Individuals who are overresposive to visual stimuli tend to avoid contrasts, bright lights, shiny surfaces, flickering lights, or moving objects. Individuals with visual underresponsitivity may not notice novel stimuli such as decorations, not blink or turn away in response to bright light, or respond efficiently when something comes flying at them.  Individuals who seek visual stimuli, such as bright or flickering lights and extra screen time. Visual discrimination has a major impact on academic learning, nonverbal communication, and visual motor skills such as hand-eye coordination.

In our weekly symposium, we had the opportunity to put what we learned into song form!  Please enjoy “Out-of-Sync” to the tune of “A-B-C” by the one and only Jackson 4 (Angie, Megan, Juliana, and Molly).

https://youtu.be/N-TJTIWr140

-Molly and Juliana, MTCCA intern team

Processing Speed: What Music Therapists Should Know

What do you do when a client throws something or takes a swing at you?  How long does it take you, the therapist, to figure out what to do?  The amount of time depends on the therapist’s processing speed.  Processing speed is the amount of time between stimulation (seeing the wind up for a throw or punch) and beginning your response.  When clients presented challenging behaviors, I often felt that I took way too long to decide what to do. I wondered, Can I improve my processing speed, or is it a fixed trait?

Contrary to my initial belief, processing speed is something that can be improved with practice, and it is not correlated with intelligence.  What we mean by processing speed is how long it takes neurons to pass along information (Stevens, 2014). Strengthening connections between neurons allows neural impulses to travel faster (Stevens, 2014).  The brain makes connections while we sleep, which is one of the reasons why getting 7-8 hours of sleep per night is so important (National Institute of Neurological Disorders and Stroke, 2019). Sleep helps with learning, problem solving, and memory, all of which play into the amount of time it takes to interpret the situation and develop a response (NIH, 2019).  Long-term sleep deficiency can also increase the risk of vascular problems such as heart disease and high blood pressure, which can deprive neurons of oxygen and glucose, causing them to deteriorate (Walker, 2014).

Another reason adequate sleep is vital for increases in processing speed is that brain cells called glial cells grow and change the most during sleep.  Some glial cells wrap around axons to create myelin sheaths from proteins and fatty substances. Myelin sheaths insulate axons to keep electrical activity from inappropriately discharging, but more importantly, they substantially expedite the flow of electricity to the next glial cell.  Stevens (2014) writes that myelin sheaths are like flying to a destination instead of driving there. (Stevens, 2014)

Image: Stevens (2014)

While learning a new task (such as how to respond to challenging behaviors), glial cells increase in number and size.  Scientists do not yet know what causes glial cells to grow, but it is clear that they decrease the amount of time it takes for an electrical signal to pass to the next neuron in the network.  As the number of axons increases and the connections between cells grow stronger, the behavioral response becomes faster until it is automatic. This is why tasks such as driving take a lot of effortful processing at first, but over time become automatic. (Stevens, 2014).

The bottom line is, there’s hope for slow processors like me!  As the connections in my brain grow stronger from repetition (aka clinical experience), it takes less time to interpret the situation and respond.  I’ve found it helpful to write in my session plans redirection strategies and sensory regulation interventions that have worked for the client before.  Sometimes I mentally rehearse short, efficient redirections ahead of time, especially for clients with limited receptive language. As I my processing speed increases, I can use more of each session to help the client work toward their goals.

-Molly, Music Therapy Intern

References

National Institute of Neurological Disorders and Stroke. (2019). Brain Basics: Understanding Sleep [Web page]. Retrieved from: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep

Stevens, A. P. (2014). Learning Rewires the Brain [Web page]. Science News for Students. Retrieved from: https://www.sciencenewsforstudents.org/article/learning-rewires-brain

Walker, H. (2014). Slow Processing Speed, and How Can the Rate Be Improved? [Web page]. Scientific American. Retrieved from: https://www.scientificamerican.com/article/what-causes-the-brain-to-have-slow-processing-speed-and-how-can-the-rate-be-improved/

Repertoire Refresh: Meet Caspar Babypants

When many of your clients are small children, it can be hard to keep your repertoire fresh.  What do you do if a client is tired of “Old MacDonald” and “The Itsy Bitsy Spider”? What can you as the therapist do if you need or want a break from classic children’s songs?  In this post, I’d like to share a little bit about one of my all-time-favorite but little-known children’s artists, Caspar Babypants.

The Seattle-based musician (formally known as Chris Ballew) used to be lead singer of the alternative rock group Presidents of the United States of America.  After being nominated for two Grammys, Ballew turned to children’s music under the silly stage name Caspar Babypants.

Many of Caspar’s songs transfer easily to helping clients achieve music therapy goals in individual sessions or groups.  One of Caspar’s most popular songs is “Run, Baby, Run.”  This song can be used to exercise one-step direction following and sustained attention by requiring clients to act out the movements in the lyrics (run, jump, swing, etc.).  If the client needs sensory regulation, the music therapist could choose movements that provide alerting, organizing, or calming sensory stimuli. The simple language in the song lends itself well to children with low receptive language skills, and the client’s name could replace the word “baby.”.  Additionally, instructions embedded in musical stimuli can be easier to process for children with autism spectrum disorder than spoken directions due to abnormal functioning in the left side of the brain.

One of the biggest hits from Caspar’s newest album, Flying High, is “Ants Can’t Dance,” a musical story about the first ant who learned to dance.  This song can be used to work on sustained attention and/or impulse control in a group session when each child waits their turn to attach a visual to a storyboard.  In an individual session, children can demonstrate sustained attention by matching a picture of each character to a storyboard.

Many of Caspar’s songs lend themselves naturally to working on speech goals.  Caspar often uses alliterations such as“More Moles,” “Drowsy Dopey Dozy Dog,” and “Jellyfish Jones.”  These songs provide opportunities for clients to fill in blanks of CVC words (such as dog) or blend words (such as drowsy).  Practicing tongue twisters like “drowsy dopey dozy dog” can be especially useful for children who have mastered CVC sounds but have trouble generalizing to longer words or phrases.

“Everything Has a Song” also provides many opportunities to practice speech sounds listed in the client’s goals.  For example, clients working on producing /b/ can sing about cars that go “beep” or bees that go “buzz.”  This song could also be used for children with auditory sensitivity to desensitize them and let them know when to expect loud noises such as fire alarms, horns, and hand dryers.  When helping clients develop auditory discrimination, music therapists can ask clients identify what sounds are loud, soft, high, low, etc.

I hope this post inspires you to add some Caspar Babypants songs to your repertoire!  Let us know what little-known children’s songs are your favorites.

-Molly, Music Therapy Intern