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Music Therapy Program Proposal Compacted

Pediatric Physical Medicine and Rehabilitation
by

Kaleigh Noel

on 20 February 2014

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Transcript of Music Therapy Program Proposal Compacted

Music Therapy Program Proposal

Prepared for Nationwide Children's Hospital - Physical Medicine & Rehabilitation Department
Prepared by Kaleigh Thomas, Music Therapy Intern
"Music can lift us out of depression or move us to tears - it is a remedy, a tonic, orange juice for the ear. But for many of my neurological patients, music is even more - it can provide access, even when no medication can, to movement, to speech, to life. For them, music is not a luxury, but a necessity."
-Oliver Sacks
What is Music Therapy?
Who are Music Therapists?

Music Therapy at
Nationwide Children's Hospital
Music Therapy in Rehabilitation
Commission on Accreditation of Rehabilitation Facilities (CARF)
Program Description
Schedule:





Plan of Care

Competency

Supervision
12 hours chart review, treatment planning, & documentation
3 hours panel, meetings, interdisciplinary consultation
20 hours individual or co-treat sessions
1 hour group session
4 hours procedural support in outpatient clinic
Program Goals
Provide meaningful, therapeutic experiences for each patient admitted
to the inpatient unit and increase patient and family satisfaction with treatment provided.

Increase the effectiveness of Physical Therapy, Occupational Therapy, Speech-Language Pathology, Therapeutic Recreation, and Massage Therapy interventions through collaboration and co-treatment of goals by helping to motivate the patients to achieve their respective functional goals more quickly, leading to greater cost-effectiveness of treatment.

Reduce patient’s anxiety before medical procedures, and if applicable, reduce the patient’s perception of pain during the procedure.

Educate rehabilitation staff on the effectiveness of music therapy interventions and how to maximize the potential of this position.
Future Goals
Conduct research studies to contribute to the body of medical music therapy research on the effectiveness of interventions with pediatric rehabilitation patients.

The Music Therapist will gain certification in Neurologic Music Therapy (NMT) to further advance their knowledge of music therapy techniques and increase effectiveness of treatment.

Conduct an hour-long drum circle once every six months for all Physical Medicine & Rehabilitation staff to promote stress relief, team bonding, and enhance physical and emotional well-being.
Description of Services
Consult
Assessment & Determination of Services
Music Therapy Goals & Techniques
Termination of Services
Program Budget
&
Reimbursement
Testimonials
Thank you!
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 therapy is an established health profession that addresses physical, emotional, cognitive, and social needs of individuals.
Required bachelor's degree or higher in Music Therapy from an AMTA-Approved University

1,200 required clinical training hours, including a 1,020 clinical internship at an approved facility

Required to obtain and maintain Board Certification (MT-BC credential) to practice music therapy in the US

Obtain 100 Continuing Education credits for recertification every 5 years
5 Music Therapists are employed by NCH and currently, music therapy services are provided to all inpatient units at NCH.

2 MT-BCs the NICU - 1.0 FTE
1 MT-BC on Heme/Onc - 0.5 FTE
2 MT-BCs covering the rest of the inpatient population - 1.1 FTE

Currently, the music therapist will receive referrals from either the Child Life Specialist or the Early Intervention Specialist/Early Childhood Teacher for select rehab patients.

The music therapist will then see the referred patient 1x/week for 30 minutes, with some additional time if the patient attends the music groups scheduled for the entire inpatient population. The time spent on the rehab unit equates to ~0.05-0.1 of the 1.0 FTE position.

Sessions currently consist of supporting other therapists' goals
during co-treatment sessions, or individual sessions
facilitating emotional expression, relaxation,
and calming, etc.
Funding a 1.0 FTE position would allow for more frequent intervention and the ability to focus on and facilitate functional rehabilitation goals.
Research has distinguished two critical findings regarding music and brain function:
“Brain areas activated by music are not exclusive to music; that is, the neural networks used for music are also used for many every day, non-musical functions” (Koelsch, 2009; Thaut & McIntosh, 2010).
“Learning music changes the brain” (Thaut & McIntosh, 2010) and “prolonged, intensive musical experience can modify the brain in significant ways” (Hummelsheim, 1999; Levitin & Tirovolas, 2009; Pascual-Leone, 2001; Pascual-Leone et al., 1993; Patel, 2011; Sergeant, 1993).
Rationale for music therapy interventions to support the significant areas of need commonly observed in rehabilitation patients:
Movement
Cognition
Communication
Emotional Functioning
Social Functioning
Behavior
The Joint Commission and the Commission on Accreditation of Rehabilitation Facilities (CARF) recognize Music Therapists as qualified individuals who may provide services within accredited facilities.
Music therapy would receive an automatic consult for patients when they are admitted to the Inpatient Rehabilitation Unit at NCH just as the other services currently provided (PT, OT, SP, TR, MT, School, EIS, etc.) are automatically consulted.
Reasons for consult include:
Psychosocial goals
___ Coping with hospitalization
___ Teach positive coping skills
___ Reduce anxiety/stress
___ Facilitate relaxation
___ Decrease perception of pain
___ Induce positive mood state
___ Provide opportunity for
positive social interaction
___ Develop new leisure skills
(provide adapted instrument
instruction)
Facilitate:
___ Motor skills
___ Speech skills
___ Cognitive skills
___ Developmental
milestones
___ Academic skills
___ Adjustment to
disability

Additionally,
_ Provide positive auditory stimulation to reduce agitation and/or provide comfort for patients with altered mental status or otherwise compromised cognitive functioning
The Music Therapist would receive a separate consult for any procedures in which music therapy could provide support for the Inpatient Rehabilitation patients including Radiology procedures, equipment fittings, or even blood draws and other minor procedures for younger patients.
Care Plans:
The Music Therapist would plan to provide individual sessions (or co-treat with other Rehab Therapists) 1x a day, 3-5x a week for 30-60 minutes.

- Pt will utilize his LUE (weakened UE) at least 50% of the time in an alternating pattern during Therapeutic Instrumental Music Performance (drumming) intervention. (K)

- Pt will display decreased agitation AEB decreased movement and number of vocalizations during 30 minutes of passive music listening. (E)

-Pt will demonstrate improved gait and distance of ambulation when engaged in music therapy interventions throughout 30 minutes of physical therapy exercises. (A)
Physical
Cognitive
- Pt will demonstrate improved attention, requiring min-to-no redirections for engagement over a baseline of maximum redirections, during therapeutic music interventions throughout a 30 minute session. (T)

- Pt will demonstrate improved short-term memory AEB his ability to imitate back simple rhythms modeled by this intern with 100% accuracy over a baseline of 30% accuracy during TIMP (drumming) intervention. (T)

Communication
- Pt will verbalize or sing the correct word when prompted 6/6 times during “Man in the Mirror” therapeutic singing experience. (S)
Psychosocial
Emotional:



Social/Behavioral:
- Pt will demonstrate increased self-esteem AEB his ability to select at least four applicable positive affirmations of self during the Songwriting intervention. (T)
- Pt will demonstrate increased ability to interact positively and appropriately with staff (and/or peers) by discharge. (TR goal - T)
Techniques
Passive Music Listening, Interactive Instrument Playing, Interactive Singing, Improvisation (Vocal and Instrumental), Songwriting, Lyric Analysis, Song Composition, and Movement to Music.

These techniques can be designed, using the patient's preferences in musical songs and instruments, to facilitate the functional goals as set by the rehabilitation interdisciplinary team.
Music therapy services will be terminated when the patient is discharged from the hospital. Services also may be terminated at the patient or caregiver’s request. If the patient is re-admitted to Inpatient Rehabilitation, the Music Therapist would re-evaluate services at that time.
"I was able to utilize Kaleigh's services with one specific patient for increased tolerance with ambulation x1 per week. During each session I noted improved distance with ambulation, decreased anxiety, improved distractabilty from pain, and improved rhythmic movements and step patterns with ambulation after each session compared to sessions without music."
-Courtney Ebright, PTA
"The younger kids, who are at times difficult to engage in tasks that are more physically challenging, are motivated by the music and tend to work on standing or using a weaker hand to play an instrument more than they may have in a regular therapy session."
-Renee Harner, OT
"Music therapy has a way of entering a patient's world...it does not put demands on the patient to enter a "medical world." I have seen very reserved students change right before my very eyes when they have the opportunity to "dance"...even if is from their wheelchair."
-Jayne Derr, Rehabilitation
School Teacher
"I have personally seen the difference that music therapy can make in the life of a rehab patient. While much of the day on rehab is focused on motor strengthening to support mobility and a return to ADLs, music therapy helps a patient return to a familiar place where there are no boundaries. Music reaches into a traumatically injured brain and finds alternative pathways to bring back memories, language, and movement. The impact is dramatic and profound, often bringing that first sense of accomplishment to a frustrated patient."
-Susan Davis, EIS
Additionally, research has suggested that music therapy interventions....
Increase the patient's satisfaction of the quality of care provided (Yinger, O.S. & Standley, J., 2011)

Contribute to more cost-effective care (Standley, J. & Walworth, D.D., 2005; Walworth, D.D., 2005)
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