Brain Injury & Trauma
When seventy-year-old Judy came to her first session, she anxiously responded to the therapist with exaggerated and animated facial expression ,and the vocals of a repeated “wow, wow, wow”. She responded this way but could not sustain interaction beyond this. Although she had played piano since childhood, she had appeared to have no idea of what to do at the piano.Judy could mechnaically play with sheet music in front of her, however.
Playing at the piano with no music gave Judy too many choices. The therapist began where Judy was at with her banging response. The therapist began Judy on the drum. Judy understood when the therapist spoke to her that she should respond ,but knowing that was the expectation and not being able to access the language, the expectation created anxiety.Judy’s golbal response was the exaggerated repeated exclamations of “wow” or “yes” along with banging on the drum. Again, the therapist developed the thematic music around Judy’s actions, sounds, and expressions.
As Judy became more responsive to the play on the drum and less hesitant to play, the Therapist moved her on to a five-note xylophone. She transitioned well from the drum with only one choice, to the xylophone with five choices. Judy was still playing in a very chaotic, banging manner. Judy now, however, was not afraid to play. As the therapist used the thematic tune, the therapist altered it to pull Judy into a more parallel play situation. Still not playing “with” the therapist, but alongside and now expanding her banging to exploring the notes on the xylophone – playing independently to the therapist’s rhythm. The fear and anxiety to engage melted away and Judy was now playing with the therapist, instead of the one-way, repetitive banging.
The therapist decided eventually to move Judy to the piano. Judy went back to her place of safety asking “what do I do?”. The therapist used visual supports of playing a repeated black note in front of Judy, to get her started at the piano. Once again, the therapist modeled only the 5 black note possibilities, knowing that this classically trained pianist did not know, at this time, what to do with the overwhelm of to many choices.
The therapist switched to the familiar five-note mode that Judy was comfortable with on the xylophone. The therapist used the visual support of tapping on the set of two or a set of three black notes with her whole hand. This Judy could imitate and play with ease. Now only using two choices, a set of two or a set of three helped Judy to develop the play that was moving from parallel play to more of an interactive, creative play.
Judy listened, watched and responded with her simplistic banging. She began to play variations with the set of two and the set of three up and down on the piano. Using her language was difficult, finding either a symbolic thought or recalling it was out of the question at the moment. The ability was being rebuilt in the musical play. Judy couldn’t produce or reach the abstract, symbolic language that she needed. She demonstrated this by using the same repeated unregulated response every time she was brought something new and unfamiliar.
Judy was now starting to focus her attention most of the time on the play, but the ability to demonstrate an affective emotional response was limited to only exaggerated excitement. Her ability to join the interaction was beginning to expand from a one-note response to a combination of a set of two or a set of three located anywhere on the piano. At the next step, the therapist began to use both black notes and white notes that would fit with Judy’s two-note pattern response. This was a more visual modeled support than anything.
The therapist continued to support Judy’s play. Judy would often attempt to copy the therapist, now using black and white notes. Therefore, the therapist was provided some visual support in the play, and groundedness that Judy needed to explore . The rhythm and theme provided the musical structure and boundaries for her.
Now that Judy was utilizing both black and white notes, she was moving from playing a single repeated unregulated punctuated rhythm ,to beginning play a melody. As the therapist took the theme and began to alter it, Judy began to give a more playful melodic response to what the therapist was doing. Judy however, could only do this in a fast tempo not yet able to regulate, slow down and play softly or delicately. But now Judy was hearing the therapist’s melody and responding to it with a linked, yet new thought.
Outside the Music Therapy room, Judy was beginning to add her own thoughts and opinions, versus the repetitive plastic response of “wow” or “yes”. It was now time to build more creative response and regulate by working towards refining tempo and dynamics – (slow and soft play). Judy could now, not only share attention and engage, but was now also demonstrating two way communication. This was important for Judy, in order to regain the ability to be able to hold abstract thought in her head.The ultimate aim, was to aid Judy in moving from the constant, overly exciteable, verbal response of “wow”, to a more regulated, intentional response.