There are several elements of music that Music Therapists employ in order to meet and accompany our clients in movement forward. This week, the element of rhythm and its importance in forward movement seemed to be a theme for my week. All of life happens in a rhythm, appropriate for the situation: night to day, season to season, and even in our own heartbeats and daily living patterns. When there is little consistency in rhythm or the rhythm is not appropriate for the situation, that is usually when healthy movement forward is stalled and stability is uncertain. Let me use the example of a crying baby. Usually, the first reaction when caring for a crying baby is when holding them, begin to rock. If the rocking was erratic, it would not be helping the infant very much. In fact, it could encourage more colicky, crying behavior. If the baby is rocked much too fast, the same result may ensure. If the baby is rocked too slow, that also will not help in satisfying the unhappy infant. A steady, appropriate tempo to a baby’s rocking is needed. Finding that tempo may mean trying rocking at different speeds before the infant lets us know what is working.
Sometimes in our earnest, sincere attempts to help, we can use tempos that are too slow. We need to watch carefully to find out if this is working. Sometimes I see individuals, in attempts to encourage success and respect for an individual, use slower tempos, and then continue to slow as they wait for a correct response. Sometimes this works and is what is needed. However, sometimes the client needs a steady grounding at an appropriate rate before they are able to respond. Sometimes, the tempo needs to encourage alertness, and although response may not immediately ensue, alertness and attentiveness is needed first .
I had two clients with speech difficulties this week, who each depended on a correct rhythm in order to move forward. One is an adult with traumatic brain injury. After being medicated this week, verbal response was not only very slow, but also very week . I had done a song with her that is familiar and brings success. It has several verses to encourage progress as the steady melody and rhythm carry the sing along. Initially, there were no attempts at vocal response; however, alertness was needed before vocal response, so I kept the tempo at an alert-needed rate and gave her a percussive instrument to use for participation. After a couple verses, some vocal response was displayed, and as we continued, the vocal responsiveness increased and her original whispering voice evolved to a normal volume and alertness continued to increase. Had I slowed the tempo to give time for response, I would have lost her attention totally.
Another little boy with fluency difficulties can speak in full sentences, but is not consistent with getting words needed out. He sometimes gets stuck on words and repeats the last word heard. His brain is much too accustomed to stopping and starting, stalling, waiting, and getting stuck. For him, backing up a bit is necessary. We have backed up to getting the 1 or 2 word response out in a timed matter the goal for now. It is okay when he does not vocally respond. He is demonstrating attentive thoughtful response through his attentive position and eye gaze. Often, he picks up the drumsticks himself and will beat away in time with the music until those responses roll out. Controlling the gross motor movement of the arms and matching them to the beat is easy for him now. That way he can first hear the vocal response in his head. We do familiar and interesting but easy tunes for him. There is very little pausing or stopping and his attention is at it’s prime. His typical prosody is often inaccurate and his typical verbal responses are clipped and abrupt. When he only needs to respond to 1 word at a time right now, he is also able to correct prosody by singing the correct tone and holding it appropriately in the tune. If we were to slow the tempo down for correct responses, he could get them, but in day to day speech, this would not correct the problem. For him, the key is to allow his brain to continue moving forward in a timed manner, accepting what he can do at the moment and continue to move.
When working with a group, watching attentive positions, eye contact, and erect posture are key to knowing where the tempo needs to go. If only a few are responding, where is everyone else? In working with kids with emotional difficulty, on chaotic days, tempos need to be adjusted to where the kids are. Energy spinning out of control? Slow down. Few responding and paying attention to other things? Speed up. Of course, other elements of music may need to be employed along with the rhythm, like dynamics.
Everyone has their own time. These need to be watched carefully to see where the client is and what the immediate need is. When working with groups, this focus remains true too. However, where the group is diverse, shoot for the middle and give it time, and then adjustments.
The important thing is not always what is on the paper. It may be what you need to strive for, but at the same time one must pay attention to where the client is, what their immediate need is, and what means they need at the moment to move forward.
Antoinette Morrison MT-BC
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