Relationship to the client: Mother Client’s name: Eric
Eric was 2 years and 9 months when I first visited him with the VDNT. Eric’s mother, Janet, was involved in a car accident whilst he was still in utero. Janet was immediately taken to the hospital for emergency Caesarean. Eric was later diagnosed with cerebral palsy with very limited control of voluntary movements; he was blind and suffered from various types of seizures. Eric’s parents were told by the doctor that he would never walk or talk. Eric lives with his parents and his seven-year-old sister Cathy. At the time of the interview Janet was about to give birth to a baby girl.
Eric was referred to music therapy because his parents thought it was beneficial and he seemed to enjoy previous sessions with another music therapy student. At the time of the interview, Eric had already had about 9 months of individual music therapy with me. Eric’s parents were both very supportive of him having music therapy and would take turns to join in the sessions. The initial sessions involved integrating music into neurodevelopmental therapy and later the sessions focused solely on music therapy activities. The sessions were held once a week and lasted for approximately one and a half hours. It was felt that long sessions were needed as it took time for Eric to initiate a movement or a vocal sound, therefore, giving sufficient time for responses was necessary. After the initial visit to Eric, long-term goals and short-term objectives were formulated. Two main goals underpinned his music therapy sessions: to promote gross and fine motor skills and to facilitate communication skills. Specific objectives generated from the sessions over time included:
• Participate in action songs involving various bodily movements
• Explore different motor motions and increasing motor strength by playing various instruments with hands or legs
• Increase vocalisation / Vocalising targeted sounds • Develop oral-motor skills – blowing
• Take turns to play an instrument A.2 Observation from clinical notes9
The clinical notes were reviewed and summarised to find out what occurred during the music therapy sessions. This information would be used to compare the researcher’s observations to the participant’s perspective of their child’s music therapy experience. Themes drawn out from the clinical notes are presented below:
Music therapy promoted vocalisation and communication skills
Eric was non-verbal and had very limited range of vocal sounds. The sessions gradually included activities that encouraged vocalisation and communication skills particularly in the last three months. Eric was encouraged to vocalise the targeted sound ‘o’, using the nursery rhymes ‘Old McDonald’ and ‘BINGO’. Eric was able to make distinct sound of ‘o’ several times. Improvised songs using the sounds Eric initiated were also employed in the session to provoke awareness and more vocalisation. Eric also participated in activities promoting communicative behaviour such as choosing his preferred instrument by reaching for, or turning his head towards it; playing wind chimes for the word ‘star’ during ‘Twinkle, Twinkle Little Star’; taking turns to strum the guitar with musical cues. Janet suggested working on his oral-motor skills at one stage hence songs involving blowing/breathing exercises were included in the sessions.
Music therapy helped develop motor skills
The initial music therapy goals focused on physical movements and body awareness as Eric had very limited motor skills and could not see what was around him. Young children learn through sensory input (e.g. touching, looking and listening) by being in contact with their immediate environment. This is particularly important for children with visual impairment like Eric. However, Eric’s restricted motor movements prevented him from receiving same level of sensory stimulation as his same-aged peers. Therefore, the music therapy sessions involved many music-making activities to create opportunities for intentional motor movements. These in turn increased his tangible sensory stimulation both in an auditory and a tactile way. Eric was encouraged to play various instruments using either his hands or legs. Instruments such as guitar, keyboard, shaker eggs, cymbals (small pairs/large one with beaters),
wind chimes, drums, ocean drum and tambourines were used to to explore motor motions, improving motor control and strength. Eric became very good at moving his legs after he realised he could make sounds on tambourines when we placed one under each foot.
The sessions changed with more hand-oriented activities during music-making after Janet expressed her concerns about Eric not practicing hand movements adequately outside music therapy sessions. The family also tried to encourage more hand movements outside the sessions. For example, they would often place the wind chimes by his hands rather than his feet. The practice of leg movements was with the physiotherapist who involved exercises such as getting up to stand. To help increase Eric’s awareness of his own movements, action songs were used as well as the adaptation of Music and Attuned Movement Therapy (Fearn & O’Conner, 2004). I would place the end of my flute in Eric’s lap whilst I improvised tunes that mirrored and reflected his body movements, breathing or vocal sounds. Whilst Eric’s breathing and body movements were reflected by the flute playing, his facial expressions would also change in response to the music. For example, when the music varied in duration – he would make long and/or short sounds.
It was noted that Eric was often tight-fisted. Strumming the guitar encouraged him to try to open his hands. Initially, Eric would often need support from us to open his hands by stretching out his fingers or rubbing the back of his hands (as suggested by the VDNT). Slowly, Eric’s hands would become more relaxed and stay open for longer periods of time. I noticed that he would also use different fingers to pluck or strum the strings. Instrument playing also helped increase hand grasping strength. Contrary to what is described above about Eric relaxing his hands from tight-fists, Eric’s hands would on occasion be quite floppy. Encouraging him to hold beaters or small instruments such as egg shakers appeared to be useful in promoting fine motor skills.
Home-based music therapy offered opportunities for family involvement
The clinical notes indicate that Eric’s parents were actively involved in the sessions. When either of them was present in the sessions, they often joined in the activities, brainstormed ideas and made suggestions. For example, on one occasion Janet asked if we could try to encourage Eric to blow. She explained that they tried to do it before but unsuccessfully, therefore, she wondered if I had any music activities or techniques that might help Eric understand how to blow. Eric’s father, Kevin, was
usually very enthusiastic when he joined in the sessions. He commented on some occasions that he would ‘practice’ making animal sounds (e.g. elephant sound) so he could do it properly for Eric.
Music therapy supported parental learning
The sessions attempted to involve the parents as much as possible which created opportunities for them to observe how I worked and interacted with Eric. It was noted in one clinical report that Kevin picked up a technique I used in the previous session himself and tried to carry it on. As Eric was blind, when I introduced a new instrument the first time I would let him touch different parts of that instrument along with a verbal description before he tried to play it. Kevin then used this technique when he encouraged Eric to play an instrument in the following sessions. On one occasion, Kevin said at the end of the session that it was great to have music therapy because they were running out of ideas of what else they could do with Eric.