Welcome, Intern Kennedi!

Hello everyone! My name is Kennedi Walz. I am extremely excited to be doing my internship at Therabeat! I was uncertain of what my internship would look like during these trying times, but I am very thankful I was welcomed at Therabeat. I am originally from Manchester, TN, but have called Chattanooga, TN my home for the past four and a half years. I love to be outside and enjoy warm weather! I love to hike and travel. I am a huge animal lover with a dog named Kupcake and four guinea pigs (that’s a whole other story)! I am a huge Disney fan! Growing up, my family trips would either be to Disney or the beach, probably a huge reason behind what I love now. Family time is always something I have cherished and I believe I always will. They have each made impacts in my life that have molded me into the person that I am today, which has guided me to where I am now. 

I was introduced to music therapy whenever I was a senior in high school. I researched it and instantly knew that it was something I was very interested in. Music therapy combines my two passions: music and helping others. I have always been passionate about the two my whole life. I had many encounters and experiences on my journey on figuring out my life purpose, and quickly realized music therapy was it. I began college at Chattanooga State Community College where I received my Associates of Fine Arts in Music. I then transferred to the University of Tennessee at Chattanooga where I will graduate in Summer 2021! I will be the first student to graduate from the university with a degree in music therapy. I am beyond thankful for my time at UTC and the experience and knowledge I gained from being there. 

My primary instrument is voice, but I also play the guitar, ukulele, and piano. I have had the pleasure of working with older adults with Parkinson’s Disease, children affected by cancer, adolescents with various special needs, and adults with IDD during my time in college. I also found a love of volunteering with the Miracle League of Chattanooga assisting children and adults with various special needs with playing baseball. Miracle League will forever hold a special place in my heart. No matter the day I am having, being able to help someone and “amplify [their] life” will always make my day brighter. 

Starting at Therabeat was life changing for me. Moving somewhere where I know no one is very different for me and transitioning from a student in a classroom to an intern constantly moving has definitely been an adjustment. I have loved every minute of being at Therabeat. The atmosphere is extremely welcoming and it feels like I’ve been there for so much longer than a week. I have already experienced and learned so many new things! I love that I am able to learn from each music therapist, and that they are so helpful. Being adaptable and flexible is something I have been told all throughout my time as a music therapy student and, to all the MT students out there, I lived it my first week! The fast moving pace at the clinic is so much fun though and I love seeing all the smiling faces I pass daily; makes each day brighter. I know I will grow to be the best music therapist I can be here and I am excited for this adventure! Here’s to the next six months! 

Love the life you live! 

Best wishes, Kennedi Walz, Music Therapy Intern

Music Therapy & Behavioral Disorders

Research has shown that music therapy can be an effective tool for helping patients who have emotional behavioral disorders. Music can be used to help students with social skills, self-esteem, and academic support (Roley, 2017). The IDEA (individuals with disabilities education act) gives five characteristics that describe a child with a severe emotional disturbance:

1. An inability to learn which cannot be explained by intellectual, sensory, and health factors

2. An inability to build or maintain satisfactory relationships with peers and teachers

3. Inappropriate types of behavior or feelings under normal circumstances

4. A general pervasive mood of unhappiness or depression

5. A tendency to develop physical symptoms or fears associated with personal or school problems (6).

This diagnosis makes up only about 1% of student populations due to this population being underidentified, underserved, and there not being a clearer understanding of what a severe emotional disturbance means (6). There are many risk factors that make it more likely that a child will develop this disorder and those include: socioeconomic status or demographics, unsafe home and school environment, environmental or psychosocial events (divorce, death, etc), and psychological make-up (7-8). There are many ways that music therapy can not only help students with behavioral and emotional disturbances but also be a tool for managing inappropriate behavior. 

Music interventions can help students express emotion, create group association, integrate social organization, symbolize representative beliefs and ideas, and support educational purposes (Parker, 2018). Some different music therapy techniques and approaches that could be useful with this population are the Behavioral Music Therapy Theory, The Bonnie Method of Imagery and Music, Nordoff Robbins Music Therapy, Psychodynamic Music Therapy, and Cognitive Behavioral Music Therapy (17-20). 

Specific interventions that could be used to help work on these students' goals could include “playing an instrument for on task behavior, using a small group setting to allow for interpersonal interactions, teaching turn taking, and sharing space while playing instruments to aid in impulse control” (Roley, 2017). One study by Sausser & Waller worked on 8 different goals: create a structured and safe musical experience for students, establish group cohesion, provide planned sessions to focus on group needs and individuals Individualized Education Plans (IEP’s), Music therapy and Emotional behavioral disorders, 13 facilitate group movement to enhance motor coordination and overall physical fitness, and allow for students to explore personal musical interests (12-13). 

Roley states that music therapy can “positively affect social skills in adolescents labeled EBD” (27). The literature showed that group music therapy proved to be most effective as well as improvisational techniques. Roley says that “The final theme re-occurred throughout the literature, which stated the lack of research within the effectiveness of music therapy, within all settings and among all populations. The existing research shows positive effects music therapy can have on patients with mental health needs, especially in children and adolescents with autism” (29). The research points us in the direction of music therapy being an effective tool for the students. However, to continue to advocate for this field and to be able to validate the reasoning behind music therapy with this population, more research needs to be done. 

-Sara Demlow, Music Therapy Intern

Roley, A. (2017). Music Therapy in the Treatment of Adolescents with Emotional and Behavioral Disorder: A Systematic Review. 1-34.

Parker, F., III. (2018). Music Therapy as a Behavior Modification for Students with Severe   Behavior. 1-20.

Music Therapy and Hearing Impairments

The concept of providing music therapy for those who have hearing impairments or use a cochlear implant seems like a far-off and impractical concept to many people. This is a big misconception because most people believe that a large percentage of individuals with hearing impairments can not hear at all, which is not true. Although having a hearing impairment is a far greater communication and sensory handicap that hearing people realize, there are still many challenges that can be overcome. Alice Ann Darrow (1989, p. 61) writes that “blindness” is ‘an environmental handicap’ while deafness is a social disorder that keeps one from people”. This post is going to cue in on how individuals with cochlear implants are able to enjoy music and what methods of music therapy work best when working with these individuals.

Cochlear implants (CI) focus on transmitting only sounds that are essential to speech recognition. This means that most aspects of music are not transmitted, making it difficult for individuals with CIs to percieve timber and pitch (Hidalgo, Pesnot, Marquis, Roman, & Schön, 2019). The one aspect of music that is transmitted the best is rhythm (Gfeller & Knutson, 2003). Rap music is a common preference of teenagers with implants and line dancing music is a common preference of adults with implants because both rap and line dancing music usually have strong, steady beats (Gfeller & Knutson, 2003). Rap music also typically has rhythmically spoken lyrics over the steady beat. This is important to note because the rhythmicity of the words make the songs more easily recognizable. Individuals with cochlear implants have an easier time identifying songs with lyrics and a harder time identifying instrumental songs.

(http://www.vancouversun.com/health/should+cochlear+implant/7502865/story.html)

Since cochlear implants focus mainly on speech, individuals with cochlear implants can also have a hard time discriminating timber of instruments, tone quality, and pitches. These difficulties can vary based on relative health of the auditory nerve, the cause of deafness, whether a full insert of the implant was possible, whether all the implant channels are active, the age at implantation, cognitive and perceptive abilities, etc. For implant users, it is easier to compare the timbre of instruments to each other rather than listening to an instrument alone. The skill of instrument identification could possibly strengthen after listening practice (Gfeller & Knutson, 2003). Some people with cochlear implants say that the tone quality of most instruments sound “unnatural or tinny” (Gfeller & Knutson, 2003). Differentiating pitches, when listening or singing, is perceived to be one of the most difficult aspects of music listening for implant recipients. Studies show that adults with CIs are more self-conscious than children about singing in public and that they find it very difficult to sing along with an external pitch (Gfeller & Knutson, 2003). 

Listening to music and having repeated exposure to music stimuli can play a major role in how music can affect someone’s life (Gfeller & Knutson, 2003). With repeated exporesure, music would be able to be used in daily life and be more easily enjoyed by individuals with CIs. There is already emerging evidence that specific music training is able to improve music perception for people who use CIs (Jiam, Deroche, Jiradejvong, & Limb, 2019). The existing studies have used in-person training models and have not tapped into online resources yet (Jiam, Deroche, Jiradejvong, & Limb, 2019).

Music therapy can be extremely beneficial for those utilizing cochlear implants. One thing music therapists’ have to be very specific about when doing music therapy with individuals with CIs is the environment. Unlike when recording an acapella piece or singing with a choir, a music therapist would not want a very acoustic room. The room should be filled with many things that will absorb sounds and echoes. Without things like carpets and curtains, the sound will bounce around and cause distortion (Gfeller & Knutson, 2003). It is also important for therapists to dive into their patient musical preference. Just like individuals without CIs, individuals with CIs all like listening to different types of music. Music therapists’ want the patients to enjoy what they are listening to, not be turned away from it.

The four basic types of music therapy interventions used for patients with CIs are listening to music, moving to music, singing, and playing instruments (Gfeller & Knutson, 2003). Listening to music can be functional in many ways, such as providing opportunities for social interaction or even working on speech recognition. Moving to music also is a great avenue for increasing social interaction in a group setting. Singing can target many different essential areas, like socialization, articulation, and exploring one’s voice. Joining a choir can be a very social experience. Singing or saying rhythmic chants like “Going on a Bear Hunt” or “5 Little Ducks” can focus on the range of their speaking voice and articulation of speech. Using vocal exercises or therapeutic singing, music therapists can assess vocal intonation, vocal quality, range, awareness of nasal quality, volume of speech and singing voice, pitch matching, melody imitation, free vocalization, and can also exercise the diaphragm (Darrow, 1989, p. 64). Playing musical instruments is a fun way to work on understanding the sounds you are listening to and specifically focusing on those musical elements like instruments, tone quality, and pitches.

Music therapy can benefit those with hearing impairments in so many ways, especially when it comes to speech, language, and socialization. It is crucial as a music therapist when working with someone with a cochlear implant to understand how the implant works, what other factors in their life could affect therapy, and what objectives are most realistic for the patient to try and achieve.

-Amanda Brennen, MT Intern

References

Darrow, A. A. (1989). Music therapy in the treatment of the hearing-impaired. Music Therapy Perspectives, 6, 61–70.

Gfeller, K., & Knutson, J. F. (2003). Music to the Impaired or Implanted Ear.

Hidalgo, C., Pesnot-Lerousseau, J., Marquis, P., Roman, S., & Schön, D. (2019). Rhythmic Training Improves Temporal Anticipation and Adaptation Abilities in Children with Hearing Loss during Verbal Interaction. Journal of Speech, Language, and Hearing Research, 62(9), 3234–3247

Jiam, N. T., Deroche, M. L., Jiradejvong, P., & Limb, C. J. (2019). A Randomized Controlled Crossover Study of the Impact of Online Music Training on Pitch and Timbre Perception in Cochlear Implant Users. Journal of the Association for Research in Otolaryngology : JARO, 20(3), 247–262.

http://www.vancouversun.com/health/should+cochlear+implant/7502865/story.html (image)

Pediatric Music Therapy and Pain Management

One of the big responsibilities of music therapists in pediatric hospitals is to help work on pain management. There are multiple different types of pain that children may experience: procedural and postsurgical pain, pain from sickle cell disease, hemophilia, cystic fibrosis, cancer related pain, and trauma related pain (Bradt, 2013). Music therapy can’t replace the typical pain medications but can be used in conjunction to help manage the pain. Bradt states that a child's understanding of pain depends on the cognitive development of the child. These different stages can affect how you may implement music therapy with a child. Children in the preoperational stage (ages 2-7) have a more passive attitude towards pain. Children in the concrete operational stage (ages 7-12) begin to understand the negative emotions that come with pain. Children in the formal operational stage (above 12 years of age) possess the capability to reflect on pain in a more abstract way (22). Children tend to perceive most of their treatment as out of their control, “three categories of control-enhancing techniques have proven to be effective in the pediatric setting: behavioral, decisional, and cognitive control” (22). The biggest emotional things that children experience related to pain are anxiety/fear and depression.

There are various scales used to rate the amount of pain a child is feeling. Some examples include The Visual Analogue scale (VAS), Graphic rating scales and multidimensional pain scales. The VAS is “a 100-mm line, the length of which represents the continuum of an experience such as pain” (26). Graphic ratings scales involve the use of numeric ratings, word graphics, pain thermometers, and/or facial scales. Multidimensional pain scales are geared at mearing various dimensions of the pain experience. A music therapy assessment of pain will often assess more than the pain itself. It will also assess the patient's emotional state, developmental level, cognitive understanding, musical preferences, etc. “The assessment should also include information about the musical qualities of the pain. Many attributes of pain can be easily translated into musical parameters”  two examples of this would be pulse (how fast is the pain) and timbre (instruments that have a sharp sound/dull sound). 

There are various different types of music therapy methods that are designed to help with pain management. Those methods include Receptive music therapy, improvisational music therapy, Re-creative music therapy, and compositional music therapy. Some examples of interventions within each of these methods are as follows (31):

• Receptive MT

  • Music Guided Imagery: Use of imagery supported by music to help children relax, find refuge from pain, escape hospital environments, and be empowered in the healing process.

  • Vibroacoustic Therapy: Use of sound in the audible range to produce mechanical vibrations that are applied directly to the body, resulting in relaxation and analgesic effects. 

• Improvisational MT

  • Tonal Intervallic Synthesis: The purposeful use of tones and timbres that resolve dissonance into consonance to influence circulation, release, integration, pain, and physical perception.

  • Improvised music for Integration: The use of drumming, toning, and chanting in an improvisatory style to help the child integrate the hurt.

• Re-creative MT

  • Singing songs: Singing favorite songs to shift the child's focus away from the pain, improve perceived level of control, normalize sterile hospital environment and encourage interaction with others. 

• Compositional MT

  • Songwriting: the use of songwriting to give the child the opportunity to articulate their feelings and direct them into a creative form, provide cognitive reframing, and to enhance the child's understanding of pain and/or procedure. 

Bradt states that inadequate treatment of pain in the hospital can have a severely negative impact on a child and create long-term negative effects, “Music therapists play an important role in assuring that children's pain management needs are adequately addressed” (53). Music Therapy can be an amazing tool for children to help contextualize and deal with their pain. 

-Sara Demlow, MT Intern

Sources:

Bradt, J. (2013). Guidelines for music therapy practice in pediatric care. Gilsum, NH: Barcelona.

Music Therapy & Hearing Impaired

Researchers, clinicians, and cochlear implant (CI) manufacturers are engaged in ongoing work to understand what makes music sound like music to a person with a CI. The nature of music experiences and the skill set achievable by children using CIs are debated, but after researching the effects of music on auditory learning and the positive effects music therapy can have on those with cochlear implants. Reifinger conducted a study to determine whether a treatment program using music notation would improve the verbal rhythmic and intonational accuracy of hearing impaired children, and to determine the degree of transfer to other reading and verbal skills. Thirty-five children with hearing impairment, ages 3 through 12 years, participated in a treatment program for 40 consecutive days. The study was initiated to investigate the use of music notation training in facilitating non-linguistic elements of speech with children with hearing impairment. This study also sought to determine the degree of improvement and transfer in speech rhythm and inflection in these children when music notation was paired with spoken and written language. The study found positive results were obtained in speech prosody, stimulation, generalization, and music learning, all areas which enhance the personal esteem of the children with hearing impairment (Reifinger, 2018). 

Auditory stimulation is essential during infancy and early childhood for the normal development and maturation of the central auditory neural pathways. Neural responses in the auditory pathways of most children receiving a cochlear implant after age three and a half reportedly do not typically reach normal levels, even after years of experience with the implant. Darrow (1989) and her colleagues began to focus research on children who had received a cochlear implanted between thirteen and twenty-four months because they had significant language delay. One of the most consequential topics within their research is to develop post-implant auditory training programs that use music to help optimize the hearing acuity attained by cochlear implant recipients. Darrows research study analyzed the results of eighteen experimental studies involving children ranging in age from four to nine years and concluded that students who received music training experienced significantly greater gains in phonological skills compared to peers who did not participate in music. 

Another area of study is the effect music can have on improving one’s ability to distinguish background noise after receiving a cochlear implant. Hearing background noise is accomplished by following the particular pitch range and timbre of a target voice, such as that of the teacher’s voice in a noisy classroom. It is also accomplished by focusing on the direction of the sound, which can be aided by bilateral implants. Music therapy can focus on improving pitch and timbre perception with musical sounds and therefore may improve pitch and timbre perception of speech sounds. Interventions included exploring vocal and instrumental timbres, moving to musical sounds, remembering and producing rhythmic patterns and timbres, determining emotional content of pieces, and writing and performing simple rhythm pieces are exercises used in Reifinger’s studies. Results indicated that compared with peers having similar hearing impairments who received no music instruction, the group of students that participated in music education showed significantly greater ability to discriminate between two similar vowel or consonant speech sounds, which is particularly important because it suggests that a sharpening of the language perception skills of children with hearing impairment may be achieved with music training.

Barton and Robbins (2015) working as clinicians with young children with CIs  see the potential that music has to jumpstart the mechanisms required to process and produce spoken language, as well as other important developmental skills. The Oxford dictionary defines ‘jumpstart’ as: ‘to give an added impetus to something that is proceeding slowly’. They view music as valuable, not just at the initial stages of CI use, but across the lifespan of the listener. Barton and Robbins broke down the effects music can have on increasing hearing capabilities after a cochlear implants into core values music therapists aim to achieve. 

The first value Barton mentions is attention. The assumption is that music as an auditory stimulus has the ability to attract attention. Music training provides a mechanism for education in the auditory domain, enhancing the ability to direct “spotlight.” This is a critical skill, because what we hear is determined by how well we listen and by our capacity to direct our attention to the input of highest interest while monitoring our surroundings for changes that require immediate attention. The second assumption is that music can modulate and regulate emotion. The ability to identify and understand emotion is the very essence of communication. Unfortunately, children with CIs often have difficulty extracting the subtle emotional cues that are present in spoken language. Because music embodies a wide range of emotions and has the capacity to evoke moods and feelings, explored the notion that music could provide more salient emotional cues than spoken language for CI children (Barton, 2015). 

Growing evidence indicates that experience with sound may provide a sort of scaffolding for the development of general cognitive skills that depend on the representation of temporal or sequential patterns. Hearing is the primary gateway for perceiving sequential patterns of input that change over time (rather than over space, as in vision). 

The image above (Staum, 1987) shows an example of music interventions that can be used to build or “scaffold” language into rhythmic interventions. By beginning with simple rhythmic patterns therapists can help patients to hear and feel this rhythm. Therapist will help patients by adding simple syllables to the rhythmic patterns. As patients begin to feel more comfortable with identifying and pronouncing sounds like “pah” “mah” or “tah”, the therapists can start to add simple words to the rhythmic pattern. As the patients vocabulary grows, the music therapists can begin to add different simple rhythms together to create sentences. Even though it is a process starting with clapping simple rhythms, the outcome can help patients with CI speaking in full sentences. 

There is also the assumption that music has the potential to condition and prompt behavior without requiring conscious will. Perception, the assumption is that music training can affect the perceptual mechanisms necessary for language comprehension. This is especially relevant for children with receptive and expressive language impairments. CIs are designed to provide sufficient information for the user to attain high levels of speech recognition and production (Crain, et al 2017). However, music requires more fine structure timing and pitch cues than speech. Thus, for children using CIs, pitch discrimination and production can be difficult because of spectral limitations of the device. Some studies have shown that music training can improve pitch perception in children with CIs. Even though we are in the beginnings of learning more and more about the effect music can have on improving those with hearing impairments, research continues to back up to significant success music therapy can have on discerning background noise, increasing discernment in emotional tone, and rhythmic patterns and timbres. 

-Macy Fehl, Music Therapy Intern

References

Barton, C., & Robbins, A. M. (2015). Jumpstarting auditory learning in children with cochlear implants through music experiences. Cochlear Implants International: An Interdisciplinary Journal, 16, S51–S62. https://doi.org/10.1179/1467010015Z.000000000267

Crain, K. L., LaSasso, C., & Leybaert, J. (2010). Cued Speech and Cued Language for Deaf and Hard of Hearing Children. Plural Publishing, Inc.

Darrow, A. A. (1989). RMT-BC, Music Therapy in the Treatment of the Hearing-Impaired, Music Therapy Perspectives, (6)1, 61–70 https://doi.org/10.1093/mtp/6.1.61

Reifinger, J. L. (2018). Music Education to Train Hearing Abilities in Children with Cochlear Implants. Music Educators Journal, 105(2), 57–63. https://doi.org/10.1177/0027432118809404

Staum, M. J. (1987). Music Notation to Improve the Speech Prosody of Hearing Impaired Children. Journal of Music Therapy, 24(3), 146–159.