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Music, Rhythm, and Their Potential Benefits for Childhood Apraxia of Speech - featured May 28, 2010

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Music, Rhythm, and Their Potential Benefits for Childhood Apraxia of Speech

By: Kimberly Sena Moore, MM, NMT-F, MT-BC

Children are little creative scientists. If you ever watch a child, they experiment, test, draw, sing, dance, imagine, and play their way to learning. This is true for almost any type of learning they need, from learning the alphabet to learning how to throw a ball, learning right from wrong, and learning first words.

Music is one of the ways through which children learn. In fact, music itself is such a powerful tool for learning and growing that there’s an entire profession dedicated to it: Music Therapy.

According to the American Music Therapy Association (2010), “Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.” Music therapists can target motor goals, learning goals, social goals, emotional goals, and, yes, even speech and communication goals through music-based interventions.

Music works as a therapeutic tool because our bodies like rhythm and our brains like music. A quick overview of some of the reasons why music as therapy works:

  1. Music is a core function in our brain. Our brain is primed early on to respond to and process music. Research has shown that day-old infants are able to detect differences in rhythmic patterns. Mothers across cultures and throughout time have used lullabies and rhythmic rocking to calm crying babies. From an evolutionary standpoint, music precedes language. We don’t yet know why, but our brains are wired to respond to music, even though it’s not “essential” for our survival.
  2. Our bodies entrain to rhythm. Our motor systems naturally entrain, or match, to a rhythmic beat. When a musical input enters our central nervous system via the auditory nerve, most of the input goes to the brain for processing. But some of it heads straight to motor nerves in our spinal cord. This allows our muscles to move to the rhythm without our having to think about it or “try.” It’s how we dance to music, tap our foot to a rhythm, and walk in time to a beat.
  3. Children (even infants) respond readily to music. Any parent knows that it’s natural for a child to begin dancing and singing at an early age. Both my kids started rocking to music before they turned one. Because children learn through music, art, and play, it’s important (even necessary) to use those mediums when working with children in therapy.
  4. Music uses shared neural circuits as speech. This is almost a no-brainer (no pun intended), but listening to or singing music with lyrics uses shared neural circuits as listening to and expressing speech. Music therapists can use this ability to help a child with autism learn to communicate or help someone who’s had a stroke that affected Broca’s area re-learn how to talk again.
  5. Music enhances learning. Do you remember how you learned your ABCs? Through a song! The inherent structure and emotional pull of music makes it an easy tool for teaching concepts, ideas, and information. Music is an effective mnemonic device and can “tag” information, not only making it easy to learn, but also easy to later recall.
  6. Music is predictable, structured, and organized--and our brain likes it! Music often has a predictable steady beat, organized phrases, and a structured form. If you think of most country/folk/pop/rock songs, they’re often organized using a verse-chorus structure. They’re organized in a way that we like and enjoy listening to over and over again. Even sound waves that make up a single tone or an entire chord are organized in mathematical ratios--and our brains really like this predictability and structure.
  7. Music helps improve our attention skills. From an early age, music can grab and hold our attention. This allows us music therapists to target attention and impulse control goals, both basic, fundamental skills we need to function and succeed.
  8. Music is non-invasive, safe and motivating. We can’t forget that most people really enjoy music. This is not the most important reason why music works in therapy, but it’s the icing on the cake.


So what does this mean when working with a child with Childhood Apraxia of Speech (CAS)?

Music is a natural fit for targeting speech, language, and communication goals. As mentioned above, there’s a lot of overlap and shared neural circuits involved in listening to music and singing songs as with listening to and producing speech.

Additionally, our motor systems entrain to a rhythmic pulse. Therefore, if we think about CAS as a disorder of the speech motor system, it makes sense to use rhythm as an external time-keeper to facilitate speech motor planning and coordination.

In fact, researchers started studying this possibility, albeit with acquired apraxia, in the mid-1970s. Keith and Aronson (1975) reported using a type of “singing therapy” to help expediate the speech re-learning process for a woman who had a stroke when more conventional treatments did not work.

Regarding CAS, studies investigating music-based treatment began appearing in the mid-1990s. Although there are few studies available, Square (1994) and Helfrich-Miller (1994) both report the effectiveness of using singing and rhythmic entrainment as a treatment tool for CAS. Jump 14 years later to 2008, a Beathard and Krout outlined a music therapy treatment approach that progressively moved a child with CAS from being nonverbal to producing words. Many more studies are needed, but the preliminary evidence is hopeful.

So what does this mean for you? Since there are only 5,000 board-certified music therapists in the country (compared with over 100,000 speech-language pathologists), chances are the children you work with won’t always have access to music therapy treatment (that said, if you’re interested in finding a board-certified music therapist in your area, visit the Certification Board for Music Therapists at http://www.cbmt.org).

Instead, let’s explore ways you can incorporate music into your treatment. Not all of these will work for every child, but they are additional intervention “tools” worth exploring:
  • Simply Sing. Sing at least one familiar children’s tune at each session. Old McDonald, Twinkle Twinkle, ABCs, Mary Had a Little Lamb, Wheels on the Bus-- there are dozens of songs you can use that most children know. Depending on the child, this may be helpful at the beginning of the session (to “warm-up”), in the middle of a session (for a mental and physical “break”), or at the end of a session (to bring it all together again). The best part is that you don’t have to be a “good” singer--the child won’t care.
  • Fill-in-the-Blank Singing. What happens when you sing “Twinkle twinkle little...”? You naturally want to fill in “star.” Another option is to do this type of “fill-in-the-blank” with your client. Choose a familiar song. You’ll notice that the music to almost every children’s song has natural breaks (for example “A B C D E F G” or “Mary had a little lamb”). These natural breaks are called phrases. Sing a phrase to one of the songs, but leave off the last word. The child’s “job” is to complete the phrase (and likely he or she will want to do this anyway!).
  • Use a Metronome. Musicians are very good at maintaining a steady beat. This can be hard, or at least uncomfortable, for non-musicians. A metronome is your “cheat sheet.” A metronome is an external time keeper. You can purchase one for as little as $15 at your local music store (or download a metronome app on your iPhone for a couple bucks). The tempo, or speed, is listed as “beats per minute,” or “bpm.” The higher the bpm, the faster the beat. Find a speed that fits the child. You may err on the side of picking a slower speed (maybe start with 120 bpm?). Then have the child speak a word or sentence to the beat, with each syllable matching a single beat. The timing won’t match natural speech prosody, but it may help coordinate the child’s speech-motor system.
  • Walk and Talk. Walking is an inherently rhythmic task. In this case, do the same thing as you would with a metronome, but use the natural walking patterns as an external timekeeping. You may have to slow the child’s walking, or try a different style of walking (e.g. stomping) so you can match each syllable to a step. Again, this won’t match natural speech prosody, but it will help coordinate the child’s speech motor system.

We still have a lot to learn and a lot to study about the best ways to use music and rhythm to facilitate speech and language goals. But we know enough to know that music is a safe medium to implement and it’s one that our brains and bodies respond to. So dust off your vocal cords and have fun with it!

NOTE: Music therapy cannot replace speech therapy and any person using music to target speech goals should first consult with the child’s Speech-Language Pathologist. Conversely, SLPs who use music in their work are not doing “music therapy” unless they hold the national music therapy board certification credential (MT-BC).

References


American Music Therapy Association (2010, May 13). What is the profession of music therapy? Retrieved from http://www.musictherapy.org/

Beathard, B. & Krout, R.E. (2008). A music therapy clinical case study of a girl with childhood apraxia of speech: Finding Lily’s voice. The Arts in Psychotherapy, 2, 107-116.

Helfrich-Miller, K.R. (1994). A clinical perspective: Melodic Intonation Therapy for developmental apraxia. Clinics in Communication Disorders, 4 (3), 175-182.

Keith, R.L. & Aronson, A.E. (1975). Singing as therapy for apraxia of speech and aphasia: Report of a case. Brain and Language, 2, 483-488.

Square, P.A. (1994). Treatment approaches for developmental apraxia of speech. Clinics in Communication Disorders, 4 (3), 151-161.

This Month's Featured Author: Kimberly Sena Moore, MM, NMT-F, MT-BC

Many thanks To Kimberly Sena Moore for providing us with article for our newsletter.

Kimberly Sena Moore, MM, NMT-F, MT-BC is a board-certified music therapist and neurologic music therapist in private practice. She works with children, teenagers, and adults, using music and rhythm to improve their quality of life. Kimberly manages the blog Music Therapy Maven (http://www.musictherapymaven.com), an educational resource for music therapists, students, and consumers, and she writes a blog for Psychology Today called “Your Musical Self” (http://www.psychologytoday.com/blog/your-musical-self). She’s also been published by PositScience (http://www.positscience.com/blog/) and PediaStaff, Inc. (http://www.pediastaff.com/).

Kimberly lives with her husband and two children in northern Colorado, where she enjoys reading, running, Pilates, cooking, wine, and making music.

You can connect with Kimberly on Twitter (http://www.twitter.com/kimberlysmoore), Facebook (http://www.facebook.com/neurosong), or through her blog (http://www.musictherapymaven.com).

Tags: Article SLP Newsletter 28 May 2010 Childhood Apraxia of Speech Music Therapy