The key ideas that emerged can be categorised according to three main areas:
§ Communicative Interaction
§ Integrating voice and movement
§ Interacting with familiar adults
Zaizai Social Area Change
36.0% 31.8% 59.1% 20.0% 20.0% 11.1% 16.7% 22.0% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% Pre Post Fa milia r Adults Envi ronme nt Pe ers Overall
i. Communicative Interaction
Although Zaizai’s progress fluctuated in the middle of the research period, and was certainly affected by his physical and health difficulties, it was found that his communication appeared to increase during the eleven weeks. Studies suggest that when working with children with CP who are experiencing communication difficulties, it is best to modify the music therapy model to one inspired by the ideas from parent-child interaction while working with the child (Colle, 2003; Gilboa & Roginsky, 2010; Pennington, 2008). In the studies cited, this particular technique was adapted to encourage initiation of communication, and it gradually led to more purposeful communicative interaction. Through gentle humming, Zaizai became more aware of his participation, imitating the particular pitches and vocal sounds I made and anticipating responses from me. Zaizai was showing an increase in the length of his spontaneous musical interactions which increased from two minutes to eight minutes. The vocalisation may have given him confidence in his ability to cope with interacting, and a willingness to communicate. This links with the statement that Coulson made on the effectiveness of vocalisation (Coulson, 2004). It also signified that the relationship between Zaizai and the therapist was established through the process.
During the research period Zaizai’s communication not only became more spontaneous, but he developed some other skills as well. He managed to join me in singing a long, and he attempted to form the vowel shapes that I was making. The speech therapist working on site believed that the way Zaizai formed his mouth as demonstrated in the video extract was purposeful and intentional (Trass, 2010). Each single approach or technique I used in the music sessions seemed to be beneficial, because Zaizai was becoming more aware of his responses, showing the potential of imitating and learning new skills. Results from the assessment also indicated that Zaizai was showing an improvement in prelinguistic communicative interactions: his engagement in vocal exchange and his ability to turn to the person who was initiating conversation with him had become consistent. Thus, it seems that through music therapy, Zaizai’s ability to communicate was enhanced, and music is certainly embedded in non-verbal communication.
ii. Integrating Voice and Movement
The clinical notes and interviews data found that Zaizai was not only displaying his ability to reach towards the instruments; he was also able, when stimulated and motivated to interact by approaches from me, to lift his head, turn to me and make a vocal response all at the same time. As well as this, he also demonstrated the ability to multitask by vocalising and playing on musical instruments, which is a big challenge for a boy who has severe physical disability. The three data sources from the findings provide evidence that music is not only able to enhance communication; it might also help children who have involuntary movement to take control of their body movement in some way and integrate it with the use of their voice.
According to Coulson (2004), body movement can be an important purposeful interaction from non-verbal children thus it is not necessary always to seek for vocal responset when working with non-verbal children with CP. The findings indicated that Zaizai was not only responding through vocal sound but also integrating his body movement by straightening both his upper and lower limbs when he was stimulated by the musical intervention. Bean has stated that through the musical therapeutic process, a child’s inner attitude to his/her body can be enhanced and the realisation awakened of some self-control being a possibility (Bean, 1995): and all this would certainly seem to be true in Zaizai’s case.
iii. Interacting with Familiar Adults
As mentioned in Chapter Three it seems that regardless of the approaches taken by the therapist, the most important consideration was to establish a therapeutic relationship with clients. By working consistently with Zaizai for a period of time, he became familiar with my approaches and knew what I was expecting from him: as the interviewee said, “…he gained… some function, some reason to be… to be there…”. The connection between Zaizai and I was established naturally through our music- making: he became comfortable about sharing his music with me as a result of our singing, playing and making music together.
Significantly, it emerged from the AEPS assessment that Zaizai appeared to interact more with familiar adults than with his environment generally, or with peers. As was strongly in evidence during his sessions, he demonstrated consistently appropriate
responses to a familiar adult’s affective tone, smiled in response to a familiar adult and responded to communication from him/her. As one of the interviewees stated: “not many of them [have] seen him in this type of really… [optimum] really responsive…,… I don’t think they guess, or they think Zaizai can respond the way he responded in there…”; which showed that Zaizai was comfortable interacting with me in the music room. This indicates that regular sessions and consistent approaches by the therapist are essential, especially when working with a child like Zaizai; as they can contribute significantly to building the therapeutic relationship. According to the triangulated data, music appeared to motivate and stimulate a lot on Zaizai as music therapy provides a secure and comfortable environment for him to express himself within his abilities. Besides, he was able to predict what would happen during the music therapy sessions and be aware of what was taking place with the musical interaction.