A Little Bit About Me

Hello! My name is Janelle Lockney, and I am so excited to be Therabeat, Inc.’s newest intern. I am currently enrolled at Belmont University in Nashville, Tennessee. My primary instrument at university was french horn, but I also enjoy playing piano, guitar, and singing. Before applying to college, I had never heard of music therapy. I always wanted a career in music, and my family encouraged me to find a career working with the special needs population because they saw how passionate I was about it. Discovering music therapy was the beautiful combination I had been looking for. Ever since my sister was diagnosed with autism spectrum disorder, I have been volunteering and working with the special needs community and have found a passion for helping those with diverse needs achieve their goals. Therabeat, Inc. came to me through recommendations from friends and professors who believed this internship would help me thrive and grow as a music therapist working with diverse populations. I fell in love with everything they offer and am very grateful I have been given the opportunity to intern with them.

My first week has flown by! I have absorbed so much while observing the talented therapists on staff and have greatly enjoyed learning more about the other disciplines here. I have always known music therapy can work in conjunction with other disciplines, but I never had the chance to see how. I am very excited to learn more about how music therapy can support other therapeutic disciplines and new methods of facilitating music therapy for a variety of kiddos.

-Janelle Lockney, Music Therapy Intern

The Effects of Child Abuse and How Music Therapy can Help

Each year, thousands of children are victims of some form of child abuse. Whether it be neglect, sexual abuse, emotional abuse, or physical abuse, the maltreatment of children has become a hidden epidemic. Music therapy is a proven tool to help children combat the emotional, physical, and social repercussions brought on by multiple forms of child abuse through the use of music interventions and the incorporation of other behavioral techniques.

When looking into the effects of child abuse, there are both immediate and long-term effects that can occur. These effects are present in a child’s physical, emotional, and behavioral well-being and can carry over into adulthood if left untreated. Some of the common effects reported in children and adults who have experienced abuse in their childhood are anxiety, depression, low self-esteem, aggression, social withdrawal, and PTSD. In severe cases, when child abuse has gone unnoticed or improperly addressed, children are at a higher risk for death.

Some of the aftereffects of child abuse might result in goal areas of increasing management of pain, self-esteem, and social skills, as well as decreasing outbursts of anger. Through music therapy, this can be accomplished with interventions such as music listening for sustained focus, music-assisted relaxation, music-guided imagery, and singing client-preferred songs (Bradt). The purpose of these interventions is to refocus attention away from the pain that the client is feeling. For example, music listening for sustained focus shifts the attention away from the pain and puts it on the music. The music therapist will play the client's chosen music usually accompanied by a guitar and observe the client as they listen to the music, making sure to take note of relaxed breathing or facial expressions as a sign of improvement.

Another area in which music therapy can be helpful is improving the low self-esteem caused by abuse. Oftentimes, children who have gone through physical, emotional, sexual abuse, or neglect will blame themselves for the maltreatment that they are receiving and go on to carry shame and self-contempt, leading to an overall low level of self-esteem. In this area, a multimodal treatment can be used, for example, the combined use of music therapy and cognitive behavioral therapy (CBT). CBT is an effective psychotherapy treatment that helps with identifying and changing current negative thoughts or behaviors.

In combination with music therapy (CBMT), it can prove to be beneficial in the treatment of abused children. Some possible CBMT interventions used for increasing self-esteem are songwriting, emotional identification and expression through instruments, musical dialogues, and lyric analysis. For example, in the treatment of a 6-year-old girl who experienced physical and sexual abuse, songwriting, along with the use of art, was used to increase the child’s self-esteem while also providing her with a safe emotional outlet (Christenbury). The music therapist begins by allowing the client to color a picture of an emotion of their choice, followed by the music therapist composing a song about the contents of the drawing.

Socialization with peers is a major part of a child’s developmental growth; however, that can be taken away due to abuse. Music therapy, often in the form of group treatment, can provide great ways to address social skills in children. In a group music therapy session, some interventions may include instrument turn-taking, collaborative instrumental play, drum circles, and collaborative songwriting. These interventions allow the participants to work on team-building and appropriate social behaviors. In instrument turn-taking, the music therapist begins with everyone playing their given instrument and singing along to a familiar song, followed by giving each child the opportunity to have a solo with either just their instrument, with singing, or with both. This allows the children to work on patience, impulse control, and building confidence amongst their peers.

Another effect commonly seen in children who have experienced child abuse is difficulty  managing anger or aggressive outbursts. With so much anger being projected onto a child through abuse, it is not a rare occurrence for that child to begin displaying similar acts or attitudes toward peers or authoritative figures. In music therapy, it can be helpful to address these issues with interventions such as drum dialogues, emotional expression through songwriting, and musical improvisation. One of the key factors in a lot of these interventions is the use of the Iso principle. This technique allows the client to release their current emotional state, whether that be anger, frustration, or sadness, and then, with the help of the music therapist, begin to find a way to gradually substitute in a desired emotion that is positive.

When looking at drum dialoguing, there are great opportunities for the child to engage in a non-verbal conversation with the music therapist. In doing so, they are working towards releasing their aggression and channeling it into a better form of coping. The music therapist can engage in a conversation through the drums or follow the lead of the child, providing support for the emotions that are being expressed. After this, the music therapist can bring the child back by asking open-ended questions about the feelings that they were experiencing while drumming. To end, the music therapist can give an example or prompt the child to show them a version of drumming opposite of what they just expressed.

To conclude, child abuse can have multiple immediate and long-term effects on a child’s life that can lead to complications throughout development. Through the use of music therapy along with cognitive behavioral techniques, children who have gone through abuse can receive treatment in a non-threatening way. The use of music interventions has been proven to be an effective treatment option for children who have experienced maltreatment because of the expressive outlet that provides the child with the opportunity to communicate their emotions and hurt in a fun and unique way.

-Beatriz Leal, Music Therapy Intern

References

Bradt, J. (2013). Guidelines for Music Therapy Practice in Pediatric Care. Barcelona Publishers.

Christenbury, K. R. (2017). I Will Follow You: The Combined Use of Songwriting and Art to Promote Healing in a Child Who Has Been Traumatized. Music Therapy Perspectives, 35(1), 1–12. https://doi-org.uiwtx.idm.oclc.org/10.1093/mtp/miv005

Goldbeck, L., & Ellerkamp, T. (2012). A Randomized Controlled Trial of Multimodal Music Therapy for Children with Anxiety Disorders. The Journal of Music Therapy, 49(4), 395-413. https://doi-org.uiwtx.idm.oclc.org/10.1093/jmt/49.4.395

Toth, S., & Manly, J. (2019). Developmental Consequences of Child Abuse and Neglect: Implications for Intervention. Child Development Perspectives, 13(1), 59-64. https://doi-org.uiwtx.idm.oclc.org/10.1111/cdep.12317.

Angelman Syndrome and the Potential for Management of Symptoms through Neurologic Music Therapy Techniques

Angelman Syndrome (AS) is a rare neuro-genetic disorder caused by a loss of function in the maternal UBE3A gene on chromosome 15 (Connor-Ahmad et al., 2023). Angelman syndrome causes significant impairment in developmental and behavioral areas as well as symptoms such as seizures, lack of verbal and expressive communication, sleep difficulties, poor fine and gross motor skills, and limited self-care abilities. With a prevalence of approximately 1 in 22,000 births, people with AS can live a long life, but not without continuous care. According to Sommese and Corrado (2021), around the age of six months, developmental delays are first noted, with clinical features not becoming noticeable until after the age of one. More than 80% of AS patients experience seizures with onset before the age of three. Mouthing objects, a happy demeanor, water attraction, hyperactivity, and a short attention span are all key characteristics of those diagnosed with AS.

Due to the severity of developmental delay, intellectual disability, and cognitive delay, it is highly recommended that individuals with AS seek early intervention services that target problematic symptoms (Ma et al., 2023). According to researchers, therapies such as physical therapy (PT), speech therapy (ST), occupational therapy (OT), and applied behavioral analysis (ABA) have all shown positive results in managing AS symptoms relating to development and behavior. 

Management of care and rehabilitation methods are the main focus of treatment for those with AS since there is currently no cure for this diagnosis (Sommese & Corrado, 2021). Because most who are diagnosed with AS have limited to no speech capabilities, researchers are still looking for the best communication method for these individuals. Speech therapy is one option that attempts to promote nonverbal communication methods through the use of alternative augmentative communication (AAC). In 2020, Roche and colleagues looked at three different types of AAC models and their effects on children with AS. The study found that enhanced natural gestures (ENG), picture exchange communication systems (PECS), and multi-modal ACC interventions all offered beneficial results in the development of communication methods for AS patients. It was suggested that other forms of therapy, identified by families of those with AS, have presented positive results in AS symptom management (Sommese & Corrado, 2021). These alternative therapies include hippotherapy, cranial osteopathy, aromatherapy, reflexology, hydrotherapy, and music therapy. However, current research supporting the effectiveness of these therapies with AS patients is extremely limited.

Within the field of music therapy, there are several neurologic music therapy (NMT) techniques that have explored targeting similar AS symptoms such as cognitive delay and lack of verbal speech and communication. Musical Sensory Orientation Training (MSOT), Auditory Perception Training (APT), and Musical Attention Control Training (MACT) are all NMT techniques that focus on cognitive goals (Thaut & Hoemberg, 2014). In the handbook of NMT, MSOT is used with developmental disorders to improve cognitive processing by using musical instruments to provide sensory stimulation and assistance in orienting a patient to time, place, and person (Myskja, 2014). Auditory perception training is integrated by having patients differentiate different components of sound, such as timbre, tempo, duration, pitch, and rhythmic patterns (Mertel, 2014). Musical Attention Control Training targets various kinds of attention, such as selective, divided, and sustained, by directing a patient with musical stimuli (Thaut & Hoemberg, 2014).

In one study focusing on the effectiveness of music therapy on individuals with Rett Syndrome, music therapy was shown to be beneficial in treating areas such as verbal and non-verbal communication, social skills, behavioral play, grip capabilities, eye contact, and epilepsy (Chou et al., 2019). The music therapist in this study used MSOT, APT, and MACT, as well as movement and music, in their treatment. The results of the study showed improvements in socialization and communication skills, as well as hand skills and eye gaze. Three out of the eleven participants with refractory epilepsy experienced a decrease in seizures, with two participants reducing by more than 50% and one participant being completely seizure-free during the 6-month follow-up.

While there is currently little research that tests the use of these specific neurologic music therapy interventions with AS, many individuals with a similar diagnosis have shown positive results in treating similar AS symptoms. More research is needed in this area; however, these results are a positive indication of another avenue of support for those living with Angelman syndrome.

-Beatriz Leal, Music Therapy Intern

References

Chou, M.-Y., Chang, N.-W., Chen, C., Lee, W.-T., Hsin, Y.-J., Siu, K.-K., Chen, C.-J., Wang, L.-J., & Hung, P.-L. (2019). The effectiveness of music therapy for individuals with Rett syndrome and their families. Journal of the Formosan Medical Association, 118(12), 1633–1643. https://doi.org/10.1016/j.jfma.2019.01.001

Connor-Ahmad, S., Tjeertes, J., Chladek, M., Newton, L., Symonds, T., Clinch, S., Vincenzi, B., & McDougall, F. (2023). Developing Angelman syndrome-specific clinician-reported and caregiver-reported measures to support holistic, patient-centered drug development. Orphanet Journal of Rare Diseases, 18(1), 156. https://doi.org/10.1186/s13023-023-02729-y

Ma, V. K., Mao, R., Toth, J. N., Fulmer, M. L., Egense, A. S., & Shankar, S. P. (2023). Prader-Willi and Angelman Syndromes: Mechanisms and Management. The Application of Clinical Genetics, 16, 41–52. https://doi.org/10.2147/TACG.S372708

Mertel, K. (2014). Auditory Perception Training (APT). In M. H. Thaut & V. Hoemberg (Eds.), Handbook of Neurologic Music Therapy (pp. 227–256). Oxford University Press.

Myskja, A. (2014). Musical Sensory Orientation Training (MSOT). In M. H. Thaut & V. Hoemberg (Eds.), Handbook of Neurologic Music Therapy (pp. 221-226). Oxford University Press.

Roche, L., Sigafoos, J., & Trembath, D. (2020). Augmentative and Alternative Communication Intervention for People With Angelman Syndrome: A Systematic Review. Current Developmental Disorders Reports, 7(1), 28–34. https://doi.org/10.1007/s40474-020-00187-w

Sommese, M., & Corrado, B. (2021). A Comprehensive Approach to Rehabilitation Interventions in Patients with Angelman Syndrome: A Systematic Review of the Literature. Neurology International, 13(3), Article 3. https://doi.org/10.3390/neurolint13030036

Thaut, M. H., & Hoemberg, V. (Eds.). (2014). Handbook of Neurologic Music Therapy. Oxford University Press.

Article Review: Music Therapy Supports Children with Neurological Diseases during Physical Therapy Interventions

Music and physical therapy are two professional disciplines that both play a vital role in the growth, rehabilitation, and enhancement of many patients' lives. In their own respects, they offer specific techniques and skills to better help their patients. Music therapy uses music as its primary tool to reach the non-musical goals of its patients. These goals can include, but are not limited to, motor movement, communication, emotional identification, social skills, and cognition. Physical therapy accomplishes goals through positioning and exercises that target assisting patients in their ability to move. These goals usually look to improve range of motion, balance, gait training, sitting and standing, pain management, and the strengthening of muscles. When these two successful disciplines come together, there is opportunity for great results.

One recent study looked to test the ability of live music therapy to improve the vital signs of child patients during their physical therapy treatments (Kobus et al.). This study took seventeen children between the ages of 1 to 11 years old, with hospital admission due to severe neurologic diseases, to attend two sessions per week, receiving both music therapy and physical therapy simultaneously. This was compared to two other physical therapy sessions without live music therapy. The data that was taken during each session looked at each patient's heart rate, respiratory rate, and oxygen saturation, taken 15 minutes before and 15 minutes after treatment. The purpose of the study was to see how these vital signs would be affected by having music therapy present versus not.

The primary goals of the physical therapy sessions were to obtain functional skills and improve the mobility of the patient. Exercises during treatment utilized positionings such as prone, back, and side positions. Other areas addressed were grasping and handling, turning around, getting up, and walking or running. According to the article, “the aim is to strengthen the child’s independence.” The physical therapist looks to create a genuine relationship with the patient during this process to better understand and influence positive attitudes toward treatment.

When looking at the music therapy side, the music therapist would come alongside the physical therapist by providing improvised playing for infants on softer-sounding instruments such as the sansula. The music therapist would use soft humming tones followed by adjusted tempos based on the breathing and heart rate of the child. In premature infants, it was shown that their vital signs would improve during these interventions. In contrast, during difficult physical therapy exercises, the music therapist would play faster and more upbeat music to match the energy needed by the patient to accomplish their task or exercise.

After a total of 256 sessions, 128 with live music therapy, and 128 without, the results of this study showed that the incorporation of live music therapy during physical therapy treatment was a beneficial option for improving the vital signs of children going through neurological rehabilitation. Significantly lower heart and respiratory rates with a mean difference of -8.0 beats per minute and -0.8 breaths per minute were a result of this study. In the area of oxygen saturation, improvement was seen by a higher level mean of +0.6%.

Both music therapy and physical therapy are great rehabilitative occupations that work toward similar goals. In the case of working together, especially on the rehabilitation side of patients, it is evident that coming together creates beautiful work that benefits their patients greatly and proves to show positive results.

-Beatriz Leal, Music Therapy Intern

References

Kobus, S., Bologna, F., Maucher, I., Gruenen, D., Brandt, R., Dercks, M., Debus, O., & Jouini, E. (2022). Music Therapy Supports Children with Neurological Diseases during Physical Therapy Interventions. International Journal of Environmental Research and Public Health, 19(3), 1492. https://doi.org/10.3390/ijerph19031492

Music Therapy within Assisted Living Facilities and Memory Care Groups and the Use of Songwriting Methods to Promote Quality of Life.

Quality of life, defined by the National Library of Medicine, refers to a concept that looks at the well-being of a person’s life in which both positive and negative aspects are measured during one period of time (Teoli and Bhardwaj, 2024). A few notable examples of these areas measured include health, relationships, autonomy in decision-making, independence or freedom, wealth, and physical surroundings. A common population in which quality of life is often measured is among older adults, especially those residing in assisted living or memory care centers. At this stage of life, a person’s independence begins to be taken away, and their health often declines, sometimes at a rapid pace. Health difficulties that commonly appear within this population are in the form of Alzheimer’s disease and dementia, arthritis, hearing loss, depression, and anxiety.

During a Pew Research survey on what areas influence a person’s quality of life as they age, areas such as the ability to feed oneself, ability to talk or communicate, maintenance of short- and long-term memory, being able to dress oneself, live without pain, life enjoyment and feelings of accomplishment were all rated. Results of the survey showed that all age groups rated the ability to talk or communicate as being the most important in maintaining quality of life throughout aging (van Leeuwen, et al., 2019).

Music therapy is a great avenue for enhancing an individual’s quality of life by providing them with opportunities for their voices to be heard through expressive communication. One intervention that can be used to accomplish this is songwriting. Songwriting can be an exciting yet intimidating concept to observers, preventing them from ever getting the chance to experience its unique and creative properties. A music therapist is able to break down these barriers and make them accessible and achievable by simplifying the process. For example, for a group of individuals within an assisted living facility, a music therapist might use visuals such as scenic photographs or physical objects to spark both lyrical and musical inspiration. The presented picture or objects may be passed around the group, prompting each resident to share what they think of when they see them. Common contributions will be from reminiscent memories or aspects of the picture or object that stands out to them as significant or beautiful. The music therapist can then take those words or phrases and create a personalized song based on the group's responses. This is a collaborative process in which control is placed in the hands of the residents. It can go further by giving different musical options to choose from, such as rhythm, tempo, and chord progressions.

For others that might require more support, such as a memory care group, allowing room for expressive communication can be in the form of lyric substitution in familiar songs. Some examples might be singing well-known classics such as “She’ll Be Coming Round the Mountain” or “Here Comes the Sun,” followed by the music therapist prompting the group with a question. Using a familiar tune can provide a sense of comfort, while the play on words allows for preferences and opinions to be acknowledged and heard. A question prompt might be “What is your favorite part of this season?”  by rewriting to the familiar tune:

“She’ll be Coming Round the Mountain”

• “There will be lots of beautiful flowers in the spring”

• “We’ll all have fun at picnics in the spring”

“Here Comes the Sun”

• “Here comes the rain”

• “Here come the flowers”

Overall, whether it’s creating a completely unique song from scratch or rewriting existing ones, songwriting is a positive way to improve the quality of life for older adults. It has the potential to meet an individual’s preferences and promote creativity, all while giving them back some form of control throughout a decline in independence.

-Beatriz Leal, Music Therapy Intern

References

Author, N. (2013, November 21). Chapter 6: Aging and Quality of Life. Pew Research Center. https://www.pewresearch.org/religion/2013/11/21/chapter-6-aging-and-quality-of-life/

Clark, I. N., Stretton-Smith, P. A., Baker, F. A., Lee, Y.-E. C., & Tamplin, J. (2020). “It’s Feasible to Write a Song”: A Feasibility Study Examining Group Therapeutic Songwriting for People Living With Dementia and Their Family Caregivers. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.01951

Teoli, D., & Bhardwaj, A. (2024). Quality Of Life. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK536962/

van Leeuwen, K. M., van Loon, M. S., van Nes, F. A., Bosmans, J. E., de Vet, H. C. W., Ket, J. C. F., Widdershoven, G. A. M., & Ostelo, R. W. J. G. (2019). What does quality of life mean to older adults? A thematic synthesis. PLoS ONE, 14(3), e0213263. https://doi.org/10.1371/journal.pone.0213263