Articles for 2014

Health Notes: Officials Recognize Healing Properties of Music Therapy

Photo courtesy of Amy Rodgers Smith: Founder and Executive Director of On A Better Note Music Therapy LLC, Amy Rodgers Smith is one of only 15 board-certified music therapists in West Virginia.

Photo courtesy of Amy Rodgers Smith: Founder and Executive Director of On A Better Note Music Therapy LLC, Amy Rodgers Smith is one of only 15 board-certified music therapists in West Virginia.

Posted: Oct 03, 2014 1:41 PM MST

Updated: Oct 04, 2014 7:00 AM MST

By Erin Timony

For some, childhood memories include an attempt at mastering some sort of musical instrument — whether by choice or because a parent thought it an important life skill to master.  For some, it stuck.

For others … it takes years and countless hours of sitting down to practice before it becomes clear that no amount of lessons or sitting down to practice will change the feeling of torture that may accompany the attempt of creating music.  Despite any grudges that may linger from learning or trying to learn how to play an instrument, evidence shows merely listening to music may have health benefits, and music therapy is a small, but growing field in West Virginia.

Healing properties.  Simple sounds can be a powerful force in the human body.

Music therapy can be used as a tool for treating individuals suffering from a wide range of ailments, including abuse issues, cancer, chronic pain, post traumatic stress disorder and substance abuse, according to Amy Rodgers Smith, chairwoman of the West Virginia State Task Force for Music Therapy West Virginia.

Smith is a board-certified music therapist as well as the founder and executive director of On A Better Note Music Therapy LLC. She is one of only 15 board-certified music therapists in West Virginia.

Results from music therapy include but are not limited to: reduction of pain, anxiety and stress as well as improvement in symptom management, communication skills, social skills and developmental skills.

So what, exactly, is music therapy?

Like any therapeutic program, Smith said music therapy entails an individualized treatment plan and data tracking. Progress reports give indications of strides gained through the program.  As stated by the American Music Therapy Association, “music therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional, or MT-BC, who has completed an approved college degree program and additional clinical training hours.”

Since the Music Therapist-Board Certified credential is a national certification granted and monitored by the Certification Board for Music Therapists, anyone from any state who has completed at least a four-year undergraduate degree program in music therapy and 1,200 hours of clinical internship under the supervision of a current MT-BC can sit for the board examination and become certified.

Music therapists use both instrumental and vocal musical activities that can include performing, composing, listening and improvisational experiences to implement a vast continuum of results.

However, Smith said that because the Mountain State does not currently have any undergraduate or graduate programs in music therapy, those in the Mountain State today still have to leave the state to pursue a degree in music therapy.  With West Virginia University in the process of developing an undergraduate degree program that is scheduled to open in fall 2015, Smith said the unavoidable exodus of students may change.

The appeal

Because of music’s role in many peoples’ everyday lives, Smith said individuals are usually highly motivated by therapy interventions that involve music therapy and are able to better engage in the therap

She explained that music functions differently in the brain than other types of therapy because of neuroplasticity — an umbrella term that refers to changes in neural pathways and synapses which are due to changes in behavior, environment, neural processes, thinking and emotions, as well as changes resulting in bodily injury.

Due to the neurological intricacies tying the brain and music together and how it relates to neuroplasticity, Smith said using music as therapy is “a unique resource.”

In 2013, the WVU School of Medicine highlighted Cindy Lewellen, a certified music practitioner who volunteers her time to play the harp for patients at Ruby Memorial Hospital in Morgantown.

“There have been studies about pain and how much pain medication people need and that, you know, a half hour of music can reduce the need for pain meds and there are many fewer side effects from harp music,” Lewellen said in the WVU Health Report. “Sometimes I’m playing for people who are in pain, and I’ll play very quiet, slow music, simple music. Sometimes if it’s somebody who has had a heart problem, I’ll play very rhythmic music.

“If I’m playing in the (Intensive Care Unit) and I know somebody who has had a heart attack, I don’t want to mess with that. My music is going to be nice, steady heartbeat music. At least when I started, it seemed like every other patient I played for went to sleep. And that was the biggest gift I could give them because a hospital is a very noisy place.”

How it’s done

A visit to On A Better Note Music Therapy LLC’s Facebook page shows examples of the personal stories of music therapy beneficiaries, like Keeley Drabish.  While watching a video of Drabish and Smith interacting, Smith sings while Drabish plays along with an instrument. Smith said the focus of the session was to work on Drabish’s “social skills” by targeting “turn-taking” and “waiting skills.”

Smith said she works with children and adults with special needs or who are recovering from some neurological event that has happened in their lives. One client is an older patient who survived a stroke and, with Smith’s help, is working on some neurological music therapy rehabilitation.

“Ultimately, the goal is to work on nonmusical skills such as communication, behavior or academic learning concepts,” Smith said in one video. “The purpose is not necessarily to teach the instrument, but to use music as a tool in treatment.

“In a normal session we use a variety of interventions — singing, playing instruments, sometimes song writing or lyric analysis, depending on what the nonmusical goals are for that client or that patient.”

Drabish’s parents, Anissa and Scott, discuss in one video the ways they’ve witnessed the therapy’s benefits firsthand.  At first, they said it was hard for their daughter to sit still due to a short attention span. Now, they say they’ve seen “enormous progress” as far as her ability to sit still and follow the directions and instructions that Smith gives, “It’s just been a very good program,” they said.

Because Keeley Drabish “was singing since she was two,” the parents said they thought using music as a therapy technique would be something she would enjoy, while building social skills and interaction skills. Drabish stays very engaged with Smith, keeping eye contact and staying attentive, they said.  “We are very, very happy with the progress,” they said.

Not a new idea

According to Smith, using music as therapy has been happening in the United States for more than 60 years with the governing body of the American Music Therapy Association overseeing educational programs in 33 states.  “Probably more states than not have been using (music therapy),” Smith said.\

In order to be credentialed as a music therapist, one must sit for the National Board and become board certified while meeting continuing education and recertification requirements every five years.

Under the Individuals with Disabilities Education Act, or IDEA, signed into law in 1990, music therapy is considered a related service. A related service is a service that falls into certain categories and guidelines. When that service is deemed necessary for a child’s education, it must be put into IDEA’s Individualized Education Plan, with its costs covered by the school.  However, the “deemed necessary” stipulation often becomes a sort of a barrier because many schools don’t understand the potential benefits of music therapy, Smith said. In order to rectify that, Smith advocates educating school personnel and the public just what the benefits of music therapy are by introducing it to the school environment.

According to Smith, some school districts in the Mountain State provide music therapy for their Pre-K-12 special education students.  “It is my understanding that these schools are in the Martinsburg, Wheeling and Huntington areas,” she said.

Coming back home

Over the last two to three years, Smith said more young, professional music therapists have moved back home to their native Mountain State.  Raised in Parkersburg, Smith took a long and winding road before ending up back “home.”  She received her bachelor’s degree in music therapy with a minor in psychology from Ohio University. She completed her music therapy internship at Palmetto Health Baptist Hospital in Columbia, South Carolina, and after her internship, Smith founded On A Better Note Music Therapy in Houston, Texas. Smith became the director of music therapy at Alvin Independent School District and began earning a master’s degree in early childhood special education at the University of Houston-Clear Lake.  Smith followed her husband to Alexandria, Virginia, and taught preschool there, but the couple recently returned “home” to Morgantown.  Not only is Smith excited to be home but also to have the opportunity to provide access to music therapy. She’s also optimistic about the jobs the music therapy niche could create.

Long-term goals

One of the goals of the Task Force is to request the music therapy profession and the Music Therapy-Board Certified credential receive state recognition. Another Task Force objective is to have music therapy added to all West Virginia Medicaid waivers so all clients can access musical therapy.  Under the three different West Virginia Medicaid waivers, music therapy is currently reimbursed at a rate of $1,000 per year under the “Goods and Services” section only available under the “Self-Directed” waiver participants. For West Virginians on the traditional form of waiver, music therapy is not recognized or paid for in any way.  By seeking full inclusion, music therapy would be listed as a therapy service option on all types of waivers, both self-directed and traditional — the same as occupational, physical and speech therapies are currently listed.

Several states have created licensure and registries including: Rhode Island, Wisconsin, North Dakota, Nevada, Georgia, New York State and Utah.

 

Snowboarding accident robs a Virginia man of his voice. Music helps bring it back.

By Susan Svrluga August 2  

Screen Shot 2014-08-08 at 6.09.57 PM

Friends draped arms across one another’s shoulders and swayed as they listened to Forrest Allen sing. Some joined in softly, not wanting to drown him out. Some blinked back tears.

They never expected him to survive the accident. They knew the effort it took that afternoon for Forrest to sing each note — just audible, even with a microphone — as his music therapist played keyboard next to him. His brother steadied Forrest with a hand to his back; with so much of his skull missing, a fall could be deadly.

Forrest stopped in the middle of “Lean on Me.” He grinned at the graduation-party guests gathered on the lawn of his family’s home in Virginia horse country. “You guys aren’t singing!” he teased. They laughed, and raised their voices along with his.

Forrest is 21. He was supposed to graduate from high school three years ago. Then he caught an edge snowboarding and fell, hard. For two years Forrest couldn’t say a word.

When he was finally able to type, he tapped out a message to his childhood music teacher: “Mr. Sweitzer, please help me get my voice back.”

Music therapist Tom Sweitzer and Forrest Stone Allen rehearse their songs at A Place to Be in Middleburg. (Nikki Kahn/The Washington Post)
Life changes in an instant for millions of people each year who, like Forrest, suffer traumatic brain injuries. Such injuries — whether from an IED in Afghanistan, a tackle on the football field, a fall off a ladder or a car accident — kill and disable more young people in the United States than anything else. More than 5 million people are trying to recover from them, at a staggering emotional and financial cost.

For Forrest, help came from places both expected — family, friends, teams of medical professionals — and unexpected. Tom Sweitzer used rhythm and melody to motivate him through the endless repetitions of neural recovery, coaxing out breathing and movement and laughter and, finally, Forrest’s own words. Cheering him on was a team of supporters — all of Middleburg, it seemed: old classmates, nurses and teachers, and thousands of strangers who followed online updates.

Those who came to the party in June had been waiting for this moment: graduation, celebration, a chance to hear Forrest sing. It was something to hold onto, a moment to savor before the next hit.

This month, Forrest will undergo the first of a groundbreaking series of surgeries to try, once again, to close up his skull.

It could save his life. It could wipe out everything he has so painfully earned back.

Ponies and dolphins

Forrest grew up riding ponies on his family’s farm in The Plains, Va., just outside Middleburg, and climbing in tree forts with his older brother, Austin. He spent summers scuba diving wherever his mom’s career as a marine mammal veterinarian took them, swimming with dolphins.

He was fun-loving, polite, silly, charismatic — and could talk his way out of anything, said Sweitzer, who has known him since kindergarten.

He spoke up for underdogs. There were tight cliques at the Hill School, but Forrest was always the one to bring everyone together, with sleepovers, parties and paintball fights. “He just had a lot of empathy for everyone,” said former classmate David Marshall.

He wanted to be a veterinarian, like his parents, and had been accepted into the president’s leadership program at Christopher Newport University in Newport News.

Soon after his 18th birthday and a family trip to Aspen, Colo., where he and Austin rode some of the toughest slopes, Forrest went snowboarding at a little ski area in Virginia.

This time, he didn’t wear his helmet.

He fell so hard that he shattered a wooden fence.

Doctors in Charlottesville, where Forrest was airlifted, told his family to prepare for the likelihood that he would never emerge from the coma, recalled his mother, Rae Stone. Surgeons cut out the front third of his skull to relieve pressure on his swelling brain.

But after 10 days, Forrest opened his eyes and squeezed Stone’s hand.

As Forrest began to recover, there were small signs that his personality, though silenced, wasn’t completely lost. On a medevac flight to a rehab hospital, a nurse handed him a stress ball. Forrest made his family laugh by playfully dropping the ball back in the nurse’s pocket.

After hours of a drill where a physical therapist asked him to hold up two of his fingers, he tired of doing it. So when she said, again, “Show me two fingers, Forrest,” he pointed at her fingers, and smiled.

But after doctors closed up his skull with a prosthetic plate, he went back into a coma. Racked with seizures and hallucinations, unable to breathe on his own, his 6-foot-3 frame dropped to 118 pounds.

Finding his voice

His condition was so precarious that Team 44 — as his loved ones called themselves, after his childhood nickname and lacrosse jersey number — didn’t look ahead very far. They focused on 12-hour plans. His family stayed with him in shifts around the clock, reading cards aloud and watching silly movies, despite his silence. Friends told funny stories over Skype.

Stone asked Sweitzer to come, hoping a familiar voice might trigger some response. Sweitzer played guitar and felt like a failure; Forrest seemed catatonic, he said. But Stone saw Forrest’s pinkie move to the music.

Over time, there were other glimpses of Forrest’s personality — a reassuring thumbs-up, a flash of his dimpled smile. When he came home from the hospital shortly before Christmas 2011, he required 24-hour nursing care and was still on oxygen and a feeding tube. But Sweitzer was able to visit more regularly.

 

They spent months working on breathing, or hitting a drum. Sweitzer used music, often the silliest of songs from cartoons, or pirate fights, to motivate his patient.

“I’m worried about the same thing the physical therapist is worried about,” Sweitzer said. “How many times can you cross the midline of your body to hit a drum?”

Forrest had both physical and cognitive gaps, typical of brain injuries. After two years of intensive therapy, he could understand a 12th-grade government class, but struggled with short-term memory. He was learning to use a keyboard, but was unable to speak and was unsteady on his feet.

As the 2012-2013 school year began, Forrest’s parents met with specialists at Fauquier County Public Schools, who laid out an education plan for a non-verbal person. Stone told them no — her son was going to talk again. They thought she was crazy.

In October, after months of effort, he was able to blow into a whistle enough to emit a tiny noise.

Later that fall, Forrest typed the message to Sweitzer asking for his voice back. After leaving the house, the music therapist broke down. “I knew Forrest was trapped in there,” he said.

The signs kept coming: same warmth, same playfulness. In his first typed message to a longtime aide, Forrest wrote, “You are a — ”

The aide waited breathlessly. What was it he wanted to say?

“ — nincompoop,” Forrest typed. They both cracked up.

Sweitzer kept trying to get Forrest to say words, to greet him when he arrived. In December 2012, he saw Forrest’s mouth forming, then heard the slightest sound, half an exhale, half a hum: “Good morning.”

It was afternoon but, Sweitzer said, they all laughed, elated. It was morning somewhere.

For the many months his son was silent, Kent Allen said, he kept thinking, “I’ll give anything in the world if you’ll just say yes or no.”

Once the words started to return, “you want more,” Allen said. “You want him to live a normal life.”

A starring role

“Eeeeeee,” Forrest said on a recent afternoon, trying to hold a note as long as he could at Sweitzer’s music therapy center in Middleburg. Sweitzer held up his phone to time the seconds.

“That was 21,” Sweitzer said. “Can you make it to 30?”

Forrest pounded out an ominous little crescendo on the piano keys with one hand. His mouth twitched into his ready smile. His “bucket,” a big white helmet signed by friends, and his service dog, Toliver, were at his side. He had tied a bandana around his head. It dropped starkly in front where his skull is missing.

“Eeeeeeeeeeeee,” he said.

For the past six months — since Forrest got out of the hospital after a third failed attempt to close his skull — he and Sweitzer have been working on a musical about Forrest’s life. It is by turns serious (information about brain injuries), goofy (“Dolphins, flying through the sky. Dolphins, eating pies.”) and heartfelt.

In the musical, titled “44,” Forrest thanks his brother for putting his life on hold for years to be there for him. He sings about the trapped feeling of wanting so badly to talk. He says he sure wishes he had worn a helmet that day.

His voice is weaker than it was last year, before the last, terrifying setback. But he can still talk trash during a ping-pong match, or sing along when friends play guitar.

Of all the many types of therapies he has to do, including speech therapy, music feels different, Forrest said. Sweitzer “makes it fun. I like going to it.”

At the beginning of summer, Forrest and several students read “44” to a packed auditorium at the Hill School. They plan to perform the play in October, but wanted to stage it early, just in case.

After three failed attempts, surgeons are trying a more extreme way to reconstruct Forrest’s skull and protect his brain. The protocol was designed by U.S. doctors serving in Iraq and Afghanistan to help brain-injured soldiers.

A team of doctors at Johns Hopkins will work to create a layer of living tissue on Forrest’s head by moving a flap of muscle there during an initial 10-hour surgery later this month. Eventually they plan to remove part of the healthy bone from the back of his skull, split it, and implant a piece on the front, behind his forehead.

“It kind of makes me sick to think about it,” Stone said. The risk. The hospital time. She’s most afraid of a return to silence.

Forrest says he’s ready. He told Sweitzer he would either wake up happy, “or, pfff.” He made a funny noise, like air coming out of a balloon.

When Kettle Run High School’s class of 2014 marched into the football stadium on graduation day, Forrest walked with it, mortarboard shimmied onto his helmet. He grinned and gave a thumbs-up when he saw Team 44 waving a giant photo of his head.

After the ceremony, his mom told him: You did it! You’re done!

No, Forrest said. I’m not done.

For a moment she thought he was confused. Her heart clenched. “ ‘Have we got a bleed?” she wondered. “Is there a setback situation here?’ ”

It was neither. Forrest wasn’t confused. He just had something to say. “There’s still college.”

Susan Svrluga is a Virginia rover for the Washington Post, covering anything and everything that’s happening in the Commonwealth.

Babies Soothed with Music Therapy in NIC Unit

By Allyson Kraemer

Updated: 02/19/2014 9:26 pm MST

An emerging therapy is bringing hope and nourishment to babies in the Neonatal Intensive Care Unit. 

“When live music is provided, by a music therapist in conjunction with a family, baby’s tend to gain weight faster. It improves their oxygen saturation rate, and in some studies, they’ve been released from the NICU earlier than babies who have not had music therapist working with them,” said Dr. Kathleen Murphy.  Cash Michael Stephens is soothed in St. Mary’s NIC Unit. “He was born January 8. I was 26 weeks pregnant,” says Tracie Stephens, Cash’s mom. “He was not due until April 15th. He was only one pound, 15 ounces. Now he’s up to three pounds, two ounces.” All thanks to a music therapist. “Amazing Grace is what we sang to all of our kids. I think all of our kids. That’s the first song they could sing. We plan to keep that tradition with him,” Stephens says. Murphy, an Associate Professor of Music Therapy at the University of Evansville, sings and then hums his favorite lullaby. “Parents who sing to their babies, there’s a better bond. They feel closer to their babies,” Murphy shares. But for Tracie and Michael Stephens, who think they can’t carry a note, Murphy says, ” Your baby has heard your voice for a long time while they were in the womb, they think you’re the MET opera star. They think you’re the best singer in the world. It’s really all they know and they want to hear that voice because it’s a comfort.” Two music therapy students begin the session by assessing the room. “We’re trying to get a pulse on the stress levels, the tension levels and then we’re trying to create music to sort of bring everything down,” Murphy says. Doctors say the lub-dub of a heartbeat and the woosh of the ocean drum create a sense of safety. “It’s just interested to watch him see how he reacts. He always seems to know when I need that smile and I need my spirits lifted,” Stephens says. St. Mary’s also partners with the University of Evansville Music Therapy Program in the Oncology Unit, Pediatric Feeding Clinic, and Rehabilitation Institute.

Copyright 2014 WFIE. All rights reserved.

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Music Therapy in the Hospital/Hospice Setting

Music Therapist Trisha Garvin has worked with hundreds of patients and their families. She bases the therapy sessions on patients’ needs and their music tastes. Sometimes she even makes CDs of a client’s favorite musical selections to play on the days between music therapy sessions and to keep as a treasure after a loved one has passed.