[Kathryn Costanza]

I work at a clinic for individuals with developmental disabilities that specializes in Neurologic Music Therapy and Applied Behavioral Analysis, so right now the individuals I work with have a variety of diagnoses and needs in both developmental delay and autism spectrum disorders. The age range of my clients is 3½ – 61 years old, although all but one person is 17 or under. We typically try to work with the family’s needs and the school goals to make sure that what we are working on can be generalized across settings. Academic goals, behavior, sensory needs, cognitive and attention tasks, gross motor coordination, speech/communication, and adapted lessons are all specific areas of need that our families have come to us to address. Because the needs of people with developmental delay are so unique to the individual and so broad, we end up addressing a little bit of everything.

[Kathryn Costanza]

Singing- Awareness: Uses pitch in vocalization. Trust: Make purposeful, pitched vocalizations. Independence: Vocalizes in response to music. Control: Engages in spontaneous singing and song-making. Responsibility: Maintains melodic intonation in familiar songs

Playing – Awareness: Recognizes changes in vocal timbre. Trust: Recognizes combinations of sounds. Independence: Explores a variety of instruments purposefully. Control: Retrieve instrument of choice. Responsibility: Accept a non-favored instrument

Moving – Awareness: Actions and movements are rhythmic in nature. Trust: Displays movement that is rhythmic but not synchronized to the music. Independence: Isolates body parts to move rhythmically. Control: Combine 2 movements in a repeated pattern. Responsibility: Uses sequences of movement patterns

Listening- Awareness: Prefers consonance over dissonance. Trust: Recognizes the relationship of notes in a triad. Independence: perceive changes in songs when melodic contour or rhythm is altered. Control: Anticipate the end of a familiar song. Responsibility: Maintain an attentive posture while listening

[Kathryn Costanza]

In general, I view the world of music therapy practice through the lens of Neurologic Music Therapy since I went to CSU, therefore, a lot of the ways that I use any one of these activities has to do specifically with a NMT technique directed towards a specific goal. Overall, the knowledge I’ve gained through these classes has encouraged me to really understand the developmental musical level where my client is before starting to implement said techniques. NMT techniques are specific to neurorehabilitation and when viewed through the lens of development, need to be adapted for the client’s abilities and states.

How I’ve used Singing: I’ve used singing to help prompt vocal output by leaving off the ends of familiar musical phrases and having the client fill them in (NMT technique: MUSTIM). When this skill is established, I then proceed to words or phrases they need to use more frequently in daily life by embedding them at the end of musical phrases in composed songs until they, too, become familiar. By having the client learn to fill in the end and then fading the music to rhythm and then to just speech, they are learning to say specific phrases at specific times. Developmentally, I may change my use of this progression depending on where the client is in the musical stages.

How I’ve used Playing: Instrument playing has been used primarily to encourage auditory discrimination and attention through start/stop games, matching timbre, and motor goals (reaching, grasping, etc.). What Sprouting Melodies has taught me is that simply playing the instrument is a sensory exploration in and of itself and doesn’t necessarily need to be paired to a task to be neurologically productive and engaging.

How I’ve used Moving: Any movement in my sessions has been done with a metronome or steady beat underlying the musical cues to provide a rhythmic feedback loop for the client to help them create the motor plan and get immediate feedback for whether that motor plan was successful. Sprouting Melodies opened up the knowledge that entrainment may not be possible for that child/client at that time (especially in Awareness and Trust stages), but that they have their own sense of rhythm and by matching their individual rhythm (instead of providing an external one), you can be more effective.

How I’ve used Listening: I’ve personally only ever used listening when embedding academic, safety, or other information into a song for the client to learn and remember and even then would give them an active part to play in the song itself. I’ve actually shied away from using listening experiences in music therapy sessions because I was taught that listening is passive and therefore not engaging the brain in a functional way. It’s been fascinating to think of listening as an active experience (especially for the very young ones!) and that has completely changed my opinion and views on listening experiences overall. I never realized how important just a simple listening task could be to joint attention, auditory discrimination, etc.

[Kathryn Costanza]

I work in Colorado Springs, CO which has some odd dichotomies. It is, for the most part, largely conservative and very christian. For that side of the city, worship music, country music, folk music, and bluegrass are all very popular here. There is also a part of town close to the clinic where I work that is more of a liberal reaction to the rest of the conservative city and classic rock, chillstep/dubstep, and heavy metal is more popular. I see quite a variety of preference in my caseload from Katy Perry to Fleetwood Mac to Queen to Tool to chillstep to Elvis to nursery rhymes and Disney.

[Kathryn Costanza]

I only recently started working with children younger than 11, so it has been very interesting pairing this new knowledge with my client’s abilities of all ages. For example, a 17 year old on my caseload with spastic CP is in the Trust phase. He responds very strongly to preferred music, will visually track instruments, sounds, and people, and attend differently when the rhythmic, melodic, or dynamic content of the music is altered. There’s also a 3 year old with an unspecified neurologic condition on my caseload, and she is moving into the Independence phase, minus most vocalizations which is one of her areas of delay. She loves musical surprises and is highly motivated by glissando and dynamics, will rock and bounce rhythmically, inspects and transfers instruments from hand to hand, and is showing and expressing preferences in instruments, songs, and activities. It has been very fascinating to me to see the areas in which some of my older clients are still in the early phases of musical development and how understanding this knowledge has helped me to better address their needs.

[Kathryn Costanza]

These songs have such great underlying structure and functional, musical thought to them! It has been such a joy to use and adapt them for sessions. I recently started working with a 3 year old with an unspecified neurologic condition who is just starting a lot of different therapies and being assessed for expressive and receptive language skills. The songbook has been my go-to for finding appropriate, functional music to facilitate the goals we’re working on. To gauge receptive language, I adapted the “Open, Shut, Cut” song for a small cloth box (I took out the “cut, cut, cut” line and then repeated the instructions of “this is how we open, shut”). After modeling the “open” and “shut” motions with the lyrics, melody, and rhythm of the song, I presented her with the box and started singing. Independently, she opened and shut the lid of the box at the appropriate times and in perfect rhythm. Her mom started tearing up while watching her. I also used the “In the Ring” song for the concept of in vs. out with stuffed animals, but found that more structural adaptation was needed to immediately bookend the cognitive concept of in vs. out instead of singing about one and then switching to the other. All in all, the songs are an incredibly helpful tool and are very easily adapted (or not!) to fit the specific needs of people with delays.

[Kathryn Costanza]

I was so glad to read that some of the other therapists in this forum are not parents either. As a professional working with children, it can be difficult to be taken seriously if you don’t already have children (and it clearly gives professional parents the advantage of more experience and understanding!). However, I believe in educating myself to provide the best therapy services possible and currently work in a clinic where client-centered care and evidence-based practice are strongly emphasized. The material for this week really focused my attention on using developmental knowledge for two different, yet equally important tasks:

1. To further develop an environment of unconditional positive regard through understanding of where the child is (i.e. biting at a developmental age of 9-12 months is not necessarily behavioral or aggressive, but sensory)

2. To incorporate evidence and track data more efficiently in my sessions by using the template of appropriate development. (i.e. If I’m working with a 3 year old who can follow 1 step directions but not more, an appropriate objective may be the completion of 2 step directions, before progressing to the developmentally typical 3 step direction.) Being able to track progress through appropriate stages of development are an excellent indicator of progress in therapy, if such things are being addressed through specific objectives and are taking place on an atypical developmental timeline (as is often the case with our clients).

Plus, the reminder to see the world through the eyes of a child and to experience things from the client’s perspective is always helpful and makes for more effective therapy.

[Kathryn Costanza]

I hate to echo what everyone else has already said, but I definitely agree that reminding myself of the typical milestones of development was incredibly helpful. Without that template to refer back to, it can be difficult to know what I’m seeing within a session or what would be the most helpful to both the child and parent to work towards. In addition to that, what really struck me was how so many of the atypically developing children I’ve seen are at several different developmental stages depending on the domain. For example, a client may be at 3-6 months in terms of language, but developmentally appropriate for their age group in terms of physical or motor development. Knowing a client’s current developmental status as it relates to specific domains is going to be incredibly helpful in creating appropriate goals and interventions, especially since it relates to utilizing areas of strength to help bolster areas of weakness. I also appreciated the “red flag” tips.

[Kathryn Costanza]

Hello everyone! My name is Kathryn and I recently worked a couple of weeks up at Adam’s Camp (where the internet was incredibly spotty), so I apologize for my latecomer status. Looking forward to reading through all the posts and catching up this week and next on all of the work. I’m currently an employee at a music therapy clinic in Colorado Springs, CO called NeuroRhythm Music Therapy Services and am pursuing this training as part of my work there. However, this training means so much more to me than that. My background is in Neurologic Music Therapy through CSU (my alma mater: Go Rams! I graduated from CSU in 2011), but a gaping hole in their evidence=based-program is development as opposed to rehabilitation. Since the majority of my clients are either young or developmentally delayed, it can be difficult to apply the techniques of NMT to their needs, since habilitation and rehabilitation address different needs. This training appears to be a perfect opportunity to integrate the neuro knowledge with developmental knowledge to best address the needs of my clients and have some great fun with little ones in the process. Looking forward to the process and to getting to know all of you!

Kathryn Costanza

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