Neurologic Music Therapy Techniques Targeting Speech and Communication for Individuals with Down Syndrome.

Neurologic Music Therapy (NMT) is an evidence-based system of music therapy that uses neuroscientific research targeting music’s effect on the brain. Neurologic music therapy techniques focus on areas such as cognition, speech and language, and motor dysfunctions caused by neurologic impairments or neurodevelopmental disorders. A music therapist with training in NMT techniques can help individuals accomplish their non-musical goals by using specific music interventions to reroute neuropathways.

Individuals diagnosed with Down Syndrome, also known as Trisomy 21, can have delayed speech and language development or display difficulties in their articulation and pronunciation. This can be an area where NMT techniques for speech or language could provide beneficial results in treatment. One case study conducted by Blythe LaGasse found that using NMT techniques with a child with Down Syndrome can show beneficial results in expressive communication and oral motor movements after 12 months of treatment.

Three specific NMT techniques that are useful in this population are Oral Motor Respiratory Exercises (OMREX), Developmental Speech and Language Training through Music (DSLM), and Therapeutic Singing (TS).

1. Oral Motor Respiratory Exercises (OMREX) are techniques that focus on the strengthening of the individual's facial muscles. These muscles, essential in the production of speech, can be strengthened by the vocalization of sounds through the use of wind instruments. Another aspect of OMREX looks to improve respiratory control, which can be accomplished through inhalation and sustained exhalation through the same wind instruments. To accomplish these, a music therapist might use  harmonicas, recorders, melodicas, or kazoos to create fun exercises for their client to engage in. 

2. Developmental Speech and Language Training through Music (DSLM) is another NMT technique that focuses on the improvement of functional communication and is especially useful with children. Singing, chanting, and instrument play are key areas used in treatment but come alongside engaging materials and experiences to promote the production of speech. A music therapist might use an engaging book and sing through its contents, providing musical stimuli while also prompting the repetition of sounds or words.

3. Therapeutic Singing (TS) is another useful NMT technique in promoting speech production in individuals with Down Syndrome. Singing through client-preferred songs is an essential part of most music therapy sessions; however, in the case of individuals with Down Syndrome, it can be useful in promoting the use of specific words or phrases through song. A music therapist can focus on areas such as breath control, pacing of speech, and even visual scanning as a client follows along to the presented lyrics.

Overall, there are several beneficial ways a music therapist can use NMT techniques to achieve great results when working with an individual with Down Syndrome when targeting speech and communication goals. The music therapist can take these techniques and add fun components such as visuals, props, or games to create a setting in which the client is working hard on these neurologic tasks while still having fun in the process.

-Beatriz Leal, Music Therapy Intern

References

Bruscia, K. E. (2012). Case examples of music therapy for developmental problems in learning and communication. Barcelona Publishers.  http://ebookcentral.proquest.com/lib/uiwtx/detail.action?docID=3117658

Key elements of the NMT evidence-based system. (2018, May 12). The Academy of Neurologic Music Therapy. https://nmtacademy.co/key-elements-of-nmt/

Thaut, M. H., & Hoemberg, V. (Eds.). (2014). Handbook of neurologic music therapy. Oxford University Press.

WHAT IS NEUROLOGIC MUSIC THERAPY. (n.d.). NMTSA. Retrieved February 17, 2024, from https://www.nmtsa.org/what-is-nmt

Hello!

Hello there! My name is Beatriz Leal, and I am one of the new interns at Therabeat, Inc.! I’m originally from San Antonio, TX, pursuing my bachelor’s degree in music therapy from the University of the Incarnate Word. My principal instrument is the piano, but I also enjoy playing the ukulele, guitar, and singing. After following Therabeat, Inc. on social media these past few years, I decided I wanted to take on the challenge to relocate and pursue my passion for this incredible profession. Music has always been a big part of my life, but I was never sure exactly how I wanted to incorporate it as a career until I discovered music therapy. This field opened my world to the power behind music and the skills that can be learned to enhance the lives of so many people through such a unique form of therapy.

My first week as an intern went by so fast but I loved every minute of it! From observations and fast-paced note-taking to meeting so many new friendly faces, each of these experiences has made my first week of internship so special. It’s been so interesting to see first-hand the way the music therapists create a safe space for each individual all while allowing them to musically express themselves and work towards their goals in a fun way. Another part of my first week consisted of observing other modalities of therapy such as physical therapy, speech therapy, and occupational therapy. Each of these experiences provided a unique perspective on how a team can come together to work towards a common goal of enhancing the life of one person through multiple levels of support. I had never seen a co-treatment session between music therapy and another form of therapy until I arrived at In Harmony Pediatric Therapy. Seeing how each therapist supports the other for the benefit of the individual was amazing to witness and something I look forward to being a part of during my time here.

I’m so excited to be part of team Therabeat, Inc. for these next six months and to see the clinical and musical areas I will grow in as I take these next steps in becoming a music therapist!

-Beatriz Leal, Music Therapy Intern

Introduction

Hello! My name is Teresa Dominguez and I am a music therapy intern at Therabeat Inc. I am from Sandy Springs, Georgia and I got my music therapy education from Queens University of Charlotte. My primary instrument is voice, but I can also play the guitar, piano, and percussion instruments. I enjoy spending time with family and friends, being outdoors, and karaoke.

My first experience with music therapy was when my brother received through his school. Throughout his treatment he gained confidence, improved his speech, and expressed himself. Seeing my brother reach his goals inspired me to become a music therapist to help others reach their goals. I enjoyed learning from my professors at Queens and I will now be using what I have learned to continue to grow as a music therapist at Therabeat Inc. Being a part of the Therabeat team is a great opportunity to work with music therapists along with specialists in other disciplines such as speech therapy, occupational therapy, and physical therapy.

My first week at Therabeat Inc. was fulfilling and brimming with new experiences. The people here at Therabeat are welcoming and always have time to answer questions. I have had the opportunity to observe many different types of sessions and I was amazed to see the variety of therapists under one roof. Some sessions had two therapists from different disciplines, and while watching these sessions; I developed a better understanding of how therapists can work together to help reach clients’ goals.

During the week, I observed music therapy sessions both in the clinic and at different schools. There are variety of experiences here, for instance, I spent time observing transition classes, individual sessions, and co-treatment with other therapists. I am looking forward to leading sessions and learning each day from the Therabeat team!

-Teresa Dominguez, Music Therapy Intern

So Long, Farewell

With my internship at Therabeat finally coming to a close, I have been reflecting on all of the amazing experiences and memories that I have made along this journey. Therabeat has taught me so much about improving my therapeutic technique, professionalism, and musical interventions. It also taught me about maintaining patience, communication, choosing joy, and showing love to others.

During my internship, I have had the opportunity to work with a variety of individuals all with different ages, diagnoses, and backgrounds. Each of them has incredible talent and a love for music. I have loved experiencing thirty minutes to an hour with each of my friends and I am beyond grateful for the lessons they taught me along the way. I have learned patience for when the session takes a turn and does not go my way. I have learned how to communicate, and be open-minded to the way that others communicate as well. I have learned about how to be flexible when there are sudden changes or when something unexpected happens.

My incredible supervisors during this internship, as well as the other women in the clinic, (and Matt), have taught me how to be punctual. How to take extra steps to remain prepared and organized. How to communicate effectively with my peers. I have learned so much about how to shift from a student mindset to becoming the therapist in the room. I have also learned how to have compassion for others and how to show love through careful listening and consideration for others. I have learned how to be an encourager and how to be a good friend.

One year ago, I could not have even imagined getting to this point of completing my internship and graduating from college. It flies by so quickly. This experience is truly what you make of it along the way. I will never forget my experiences here and the friends that I have made along the way. I am so blessed to have had this opportunity, and I will miss it just a little too much.

Thank you, Therabeat. Until we meet again!

-Mallory McDonald, Music Therapy Intern

The Effects of Music on Insomnia

Insomnia is a sleep disorder that can cause mental disorders, a reduced quality of life, and health issues. Around 30% of the population experiences insomnia symptoms, and about 6-20% experience symptoms from an insomnia disorder (Jesperson, 2019). Sleep is a basic physiological need that must be met to maintain good physical and mental health. (Dos Santos, 2022). Music therapy and music therapy interventions have been shown to improve sleep quality and reduce the effects of insomnia (Kavurmaci, 2020; Dos Santos, 2022). Music can be used to calm the mind for sleep, but how can it treat insomnia and its effects?

Sleep is a basic human need that people spend around a third of their lives fulfilling, and the body needs to function properly. When the body does not receive enough sleep, it will have “physical, cognitive, and affective depression” (Kavurmaci, 2020). Other symptoms include fatigue, attention deficit, sensitivity towards pain, irritability, nonlogical thoughts, hallucinations, and a lack of appetite. Disordered sleeping occurs when there are changes in sleeping patterns that negatively affect health (Kavurmaci, 2020). In a recent study, researchers suggested that insomnia has become extremely prevalent in college students due to their poor sleep routines and negative emotions such as depression and anxiety (Dos Santos, 2022).

The DSM-5 criteria for diagnosis include a dissatisfaction with the quantity or quality of sleep and one or more symptoms such as difficulty initiating sleep, maintaining sleep, and/or early-morning awakening. The two types of insomnia include short-term insomnia and chronic insomnia. Short-term insomnia may occur for just a few weeks at a time, while chronic insomnia can last for three months or longer. Insomnia can cause or be diagnosed along with mental health disorders such as Post-Traumatic Stress Disorder (PTSD), Anxiety Disorders, Autism Spectrum Disorder, and Depression (Dos Santos, 2022).

Music has been used to aid sleeplessness in many recent studies and has been hypothesized to alleviate anxieties and contribute to psychological and physiological effects on the body (Shaw, 2016). Many different aspects of music that can be utilized to get our minds and bodies to rest. One study offered that “music intervention uses the regular frequency changes of music to act on the cerebral cortex and has an effect on the hypothalamus and limbic system to regulate hormone secretion, thereby changing college students’ emotional experience and physical function state” (Dos Santos, 2022, p. 4). By regulating these parts of the brain, people with disordered sleep can see a reduction in sleeplessness and its symptoms. Several studies have suggested that utilizing music that is calming, slow, classical, and instrumental is the best type of music for promoting sleep (Lund, 2020). Music has the ability to promote sleep by calming the Autonomic Nervous System and lowering noradrenaline in the bloodstream (Amalsi et. al., 2022). This can lead to a decrease in rate of breath, reduced blood pressure, and a lower heart rate. Research also suggests that people who listen to music to promote sleep have shown reduced maladaptive sleep behaviors (Oxtoby, 2013).

Music interventions such as music listening and music therapy have been utilized to treat participants with diagnosed sleeping disorders. One study suggests that music should be “60 to 80 beats per minute, with no dramatic changes in volume and rhythm, and played at a volume of 30 to 40 decibels. In another study that utilized relaxing music listening interventions, the music was instrumental and was similarly characterized by “a slow tempo of 50-80 bpm, stable dynamics, and simple structure” (Jesperson, 2019, p. 4). Slow tempos are important for sleep-promoting music because they will assist in slowing down breath and heart rate. Preferences for the music played may be a more important  and most statistically relevant factor than specific characteristics of the music (Shaw, 2016). In most of these studies, the interventions all begin at night or bedtime, and they utilize calm, slow, simple, and instrumental music.

Researchers were able to provide some statistically significant evidence that music is able to calm the mind and improve sleep quality for several groups. These studies provide evidence that music is able to assist the brain in the sleeping process and aid symptoms or the effects from a lack of sleep. Symptoms such as anxiety, negatively toned cognitive arousal, fast heart rate, and fast breathing rate have been greatly reduced in these studies and have helped participants get to sleep. Due to new research suggesting that the effects of music increase over time, some studies had limitations because the length of the study only averaged around two weeks in duration. Overall, there are not enough studies that focus completely on the effects of long-term music therapy on individuals diagnosed with insomnia, but there is significant evidence that demonstrates the positive impacts of the therapeutic functions of music on treating symptoms of insomnia. 

-Lila Finke, Music Therapy Intern

References

Amalsi, M., Chehri, A., Fakoori, F., & Khazaie, A. (2022). The effectiveness of music therapy on sleep quality and insomnia in middle-aged people. Scandinavia Journal of Sleep Medicine, 2(1).

Dos Santos, L. M. (2022). Study on the intervention effect of music on insomnia of college students. Journal of Healthcare Engineering, 1–5. https://doi.org/10.1155/2022/4037240

Jespersen, K. V., Otto, M., Kringelbach, M., Van Someren, E., & Vuust, P. (2019). A randomized controlled trial of bedtime music for insomnia disorder. Journal of Sleep Research, 28(4), 1–11. https://doi.org/10.1111/jsr.12817

Kavurmaci, M., Dayapoğlu, N., & Tan, M. (2020). Effect of music therapy on sleep quality. Alternative Therapies in Health & Medicine, 26(4), 22–26.

Lund, H., Pedersen, I., Johnsen, S., Heymann-Szlachcinska, A. M., Tuszewska, M., Bizik, G., Larsen, J. I., Kulhay, E., Larsen, A., Grønbech, B., Østermark, H., Borup, H., Valentin, J. B., & Mainz, J. (2020). Music to improve sleep quality in adults with depression-related insomnia (MUSTAFI): Study protocol for a randomized controlled trial. Trials, 21(1), 1–10. https://doi.org/10.1186/s13063-020-04247-9

Oxtoby, J., Sacre, S., & Lurie-Beck, J. (2013). The impact of relaxing music on insomnia-related thoughts and behaviours. Australian Journal of Music Therapy, 24, 67–86.

Shaw, R. (2016). Using music to promote sleep for hospitalized adults. American Journal of Critical Care, 25(2), 181–184. https://doi.org/10.4037/ajcc201663