Music therapy for children with severe and profound
multiple disabilities: a review of literature.
The purpose of this lit...
physical abilities also vary considerably, from well developed fine motor skills such as reaching or
grasping, to a comple...
The second goal found throughout the literature is developing the child's sense of self. Alvin (1976)
discussed this in te...
this goal area. Firstly, developing specific skills can be part of the therapy process concerned with
"developing the musi...
The sixth and final general goal is developing an awareness and sensitivity to the beauty of music
(Pfeifer, 1982). This i...
the child's behavior to meet an identified goal(s). As such, programs are developed with specific
goals in mind and struct...
overcome delays and accomplish tasks that meet their unique needs. Examples of this approach
include the work of Agrotou (...
Creation of music in real time. Improvisation usually involves some preparation beforehand,
particularly when there is mor...
children who are physically capable of using instruments, where the process centers around
developing ways to express feel...
shaking, striking and grasping (Pfeifer, 1982; Krout, 1987); imitative im?i?ta?tive??
1. Of or involving imitation.
an expressive vocal language, and developing music-related skills.
In developing an expressive vocal language, the music t...
1. ?movements, and perceptual motor activities (Boxill, 1985), where the music therapist plays or
example, fabrics can be gently rubbed over the child's arms, hands or feet, while textures can be
placed in the child's ha...
the sequence. For example, contingent listening has been used to reinforce imitative behavior
(Meltzer, 1974), reaching an...
Agrotou, A. (1993). Spontaneous ritualized play in music therapy: A technical and theoretical
analysis. In M. Heal & T. Wi...
developmentally challenged, retarded ?persons. Journal of Music Therapy, 23(4), 208-218.
Dorow, 1.G. (1975). Conditioning ...
Practice (pp. 223-284). Washington, DC.: National Association of Music Therapy.
Jellison, J.E., Brooks, B., & Huck, A.M. (...
Presti, G.M. (1984). A levels system approach to music therapy with severely handicapped children
in public school. Journa...
Wigram, A.L. (1988). Music therapy: Developments in mental handicap mental handicap
any intellectual disability resul...
Copyright 1997 Gale, Cengage Learning. All rights reserved.
Upcoming SlideShare
Loading in …5

Music therapy for children with severe and profound multiple disabilities: a review of literature.


Published on

The purpose of this literature review is to identify goals and methods of music therapy for children...

Published in: Health & Medicine, Education
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Music therapy for children with severe and profound multiple disabilities: a review of literature.

  1. 1. Music therapy for children with severe and profound multiple disabilities: a review of literature. The purpose of this literature review is to identify goals and methods of music therapy for children with severe and profound multiple disabilities, and to clarify the various orientations used by clinicians. The general goals described have been identified by different music therapists and chosen for their representativeness and breadth of application. The orientations which clinicians take in their work with these children are described according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. ?the practices outlined by Bruscia (1989). While many examples from the literature for adults with severe and profound multiple disabilities are also relevant for children, they have not been included in this review because of the school age focus (approximately 3 to 18 years). As such, this includes the work of Wigram (1988), Hughes (1995) and Schalkwijk (1994), among others. Further, while much of the music therapy literature for children with autism autism?(?`t?z?m), developmental disability resulting from a neurological disorder that affects the normal functioning of the brain. It is characterized by the abnormal development of communication skills, social skills, and reasoning. ?shares similarities in orientation, goal(s) and methods, it has also not been included unless there is a clear indication that the author is referring to work with children who are severely or profoundly multiply disabled. Identifying the Population Children who are severely and profoundly multiply disabled have a combination of physical and intellectual difficulties which, although caused by similar conditions, create unique qualities and characteristics. These disabilities generally lead to severe limitations of movement, communication and socialization socialization?/so?cial?iza?tion/ (so?shal-i-za?shun) the process by which society integrates the individual and the individual learns to behave in socially acceptable ways. so?cial?i?za?tion n. . Such children may require total care and be medically at risk. Epilepsy epilepsy,?a chronic disorder of cerebral function characterized by periodic convulsive seizures. There are many conditions that have epileptic seizures. Sudden discharge of excess electrical activity, which can be either generalized (involving many areas of cells in ?is common, and often not completely controlled by medication (Orelove and Sobsey, 1991). These children may have other impairments, such as hearing and vision loss. They vary considerably in their ability to understand and communicate information. Some use simple language or symbolic communication Symbolic communication is exchange of messages that change a priori expectation of events. Examples of this are modern communication technology as also exchange of information amongst animals. ?(such as gestures or picture symbols) while others may be unable to communicate needs or responses effectively. Their
  2. 2. physical abilities also vary considerably, from well developed fine motor skills such as reaching or grasping, to a complete lack of independent physical movement. Sometimes these children will be unable to comprehend or adapt to unfamiliar environments and events, and this may cause difficulty in transitions, particularly from familiar to unfamiliar environments. Similarly, these children may not show recognition of familiar people, including family, teachers and therapists. In educational settings, the needs of each child are generally outlined in an Individual Educational Program (I.E.P.) wherein where?in?? adv. In what way; how: Wherein have we sinned? conj. 1. In which location; where: the country wherein those people live. 2. ?goals are set by parents, educators, therapists and care staff. These goals are usually organized in areas such as auditory auditory?/au?di?to?ry/ (aw?di-tor?e) 1. aural or otic; pertaining to the ear. 2. pertaining to hearing. au?di?to?ry adj. , visual, tactile tactile?/tac?tile/ (tak?til) pertaining to touch. tac?tile adj. 1. Perceptible to the sense of touch; tangible. 2. Used for feeling. 3. , perceptual, sensori-motor, communication, cognitive, social and emotional development, and are then addressed by various disciplines (Boxill, 1989). Alley (1979), Codding (1988) and Jellison (1988) have reviewed various ways in which music therapy interventions have addressed the needs of people with disabilities, and this also includes children with severe and profound multiple disabilities. General Music Therapy Goals A number of interrelated in?ter?re?late?? tr. & intr.v. in?ter?re?lat?ed, in?ter?re?lat?ing, in?ter?re?lates To place in or come into mutual relationship. in ?goals have been identified by music therapists working with these children. These general goals may singularly, or in combination, provide the focus of a program. The first and most primary goal is fulfilling the child's basic needs. For Alvin (1976), this involved creating an emotionally stable and predictable environment that fostered feelings of security, love and acceptance along with finding ways of self expression. She felt that only then could the child relate and develop. For Nordoff and Robbins (1971, 1977, 1983), fulfilling the child's basic needs involves 'meeting the child musically', where the therapist matches the child's inner condition with the music. As Bruscia (1987 p.46) has indicated, this serves three main functions: to create an accepting, responsive environment; to make musical contact with the child; and to build trust and lessen resistiveness.
  3. 3. The second goal found throughout the literature is developing the child's sense of self. Alvin (1976) discussed this in terms of "relating self to objects" (Bruscia, 1987 p.91), where the main aim was to enable the child to develop relationships with instruments, music, and the therapist. "In order to form these relationships, developmental growth must take place in the physical, intellectual, and social-emotional domains" (Bruscia, 1987 p.91). For Nordoff and Robbins (1971; 1977; 1983), self- image is built by developing exploration and creativity. This is fostered by supporting the child's music making, acknowledging, and developing the inner "music child". Boxill (1985) discusses self image as built through a cycle or continuum of awareness, where the therapist approaches treatment with "a view to awakening, heightening height?en?? v. height?ened, height?en?ing, height?ens 1. To raise or increase the quantity or degree of; intensify. 2. To make high or higher; raise. v.intr. , and expanding [the child's] awareness" (Boxill, 1985, p. 75). Two main strategies are used: reflection, a mirroring technique; and identification, a musical representation of the client and therapist. The third general music therapy goal is establishing or re-establishing interpersonal relationships (1). For Boxill (1985; 1989), this meant developing the child's ability to understand and be understood by others through verbal and non-verbal means, where relationships may develop between the child, therapist or other person, or child's, therapist's or other person's music. Typically, this is developed through the contact song (Boxill, 1985, p.80), an improvised im?pro?vise?? v. im?pro?vised, im?pro?vis?ing, im?pro?vis?es 1. To invent, compose, or perform with little or no preparation. 2. ?or composed song which serves to affirm the therapeutic relationship, and enable interaction. Nordoff and Robbins (1983) felt that developing interpersonal relationships was achieved by developing expressive freedom, where musical options brought about increased possibilities for interaction and the realization that music can be "interresponsive". Alvin (1976) discussed this general goal as a two fold process: firstly, by establishing a relationship with the music therapist through self awareness and exploration, and secondly, by transferring the model of the therapeutic relationship to significant relationships in the child's life (for example, parents, siblings, peers) outside the immediate therapy environment. Agrotou (1993) felt that one way interpersonal relationships were established and developed was through ritualized play, the "creative rhythmical formalisation Noun 1. formalisation - the act of making formal (as by stating formal rules governing classes of expressions) formalization systematisation, systematization, rationalisation, rationalization - systematic organization; the act of organizing something ?of certain patterns of interaction" (Agrotou, 1993 p. 183). The basic qualities of this play are as follows: that each player's output is regular in length and falls into a predictable regularity of tempo; and that each player's contribution is called a turn and that a pair of turns constitutes a round, the building blocks of ritualized play. Developing specific skills is the fourth general goal. There are two distinct ways of thinking about
  4. 4. this goal area. Firstly, developing specific skills can be part of the therapy process concerned with "developing the music child" (Nordoff & Robbins, 1977) or developing "self awareness" (Boxill, 1985, 1989). In these orientations, skills are developed in order to increase expressive and interactive opportunities that foster the child's development and self esteem. Secondly, developing specific skills tan mean focusing on the acquisition or development of competencies which enable the child to function with greater independence. This may include physical, emotional, cognitive, social or communicative com?mu?ni?ca?tive?? adj. 1. Inclined to communicate readily; talkative. 2. Of or relating to communication. com?mu ?development such as increasing the quantity, quality or duration of a skill. When this orientation is taken, the acquisition of the skill often becomes the central focus of the therapeutic process. For example, skills may include increasing eye contact (Knout knout?? n. A leather scourge used for flogging. tr.v. knout?ed, knout?ing, knouts To flog with a knout. [French, from Russian knut, from Old Russian , 1987), using a switch toy (Holloway, 1980), or reaching for and touching objects (Saperston, Chan, Morphew & Carsrud, 1980), where musical activities provide a context, motivation or reinforcement for the development of the skill. The fifth general goal is dispelling pathological 1. pathological - [scientific computation] Used of a data set that is grossly atypical of normal expected input, especially one that exposes a weakness or bug in whatever algorithm one is using. ?behaviour. For Nordoff and Robbins (1971; 1983), dispelling pathological behaviour involves decreasing the incidence of maladjusted mal?ad?just?ed adj. Inadequately adjusted to the demands or stresses of daily living. ?or unhealthy behaviour and developing healthy ways of expressing needs, emotions and responses to both people and the environment. For Alvin (Bruscia, 1987), this involves developing a level of awareness that goes beyond sensorimotor sensorimotor?/sen?so?ri?mo?tor/ (sen?sor-e-mo?ter) both sensory and motor. sen?so?ri?mo?tor adj. Of, relating to, or combining the functions of the sensory and motor activities. ?experiences in order to resolve conflicts that lead to pathology and isolation. For Boxill (1985), this involves increasing the child's self awareness in order to free "misused, misdirected, unused [or] unoriented energy" (Boxill, 1985, p.73). Agrotou (1993) believes that fixated fix?ate?? v. fix?at?ed, fix?at?ing, fix?ates 1. To make fixed, stable, or stationary. 2. To focus one's eyes or attention on: fixate a faint object. ?and repetitive behavior(s) is a form of communication associated with grief or loss. Through the establishment of ritualized patterns of communication and intervention, she provides a reliable and predictable environment for working through these behaviors. Dispelling pathological behavior may also include decreasing self-stimulatory behaviour (Knout, 1987) or cueing other behaviours (Hanser, 1987).
  5. 5. The sixth and final general goal is developing an awareness and sensitivity to the beauty of music (Pfeifer, 1982). This involves "cultivating an awareness of, appreciation for, and satisfaction from beauty through experiential ex?pe?ri?en?tial?? adj. Relating to or derived from experience. ex?pe ri?en ?involvement with music" (Pfeifer, 1982, p.5). As Salas (1990, p.5) discussed, this experience may lie in intramusical structures and relationships, or in music's ability to connect with human emotion, "giving voice to currents of feelings far beyond what is expressible in language". Orientations to Practice When addressing these goals, music therapists take a number of orientations to practice. An orientation is defined by a therapist's stance or theoretical approach to clinical work. This includes their beliefs about music, their role, and their relationship to the child. It is represented by the type of goals and methods used in working with these children and the meaning given to the therapy experience. Bruscia (1989) describes a number of areas of practice, and the following orientations are based on his categorization. These examples are meant to be illustrative il?lus?tra?tive?? adj. Acting or serving as an illustration. il?lus tra?tive?ly adv. Adj. 1. ?and not a comprehensive categorization of all music therapists working with this client group. Further, there is no intention to imply that the examples given are the therapist's only orientation to practice. Recreational Orientation When music therapists take a recreational orientation, they are concerned with providing musical experiences for entertainment, recreation, diversion and leisure (Bruscia, 1989). These experiences can include concerts, plays, or special events where children perform music, perform with music (for example dancing), or where music performance is a shared experience that unites all members of the event (for example singing hymns at a church service). In these situations, the music therapist usually acts as coordinator, either of the musical portions or the entire event. Sometimes this requires writing or arranging music, creating a play, or preparing taped music to be used at the event For example, Shoemark (1988) and Coull and Meadows (1990) created and produced plays with music as special events in a school setting. In doing so, they focused on the following: providing performance oriented opportunities for children to demonstrate skills that they had developed (Coull & Meadows, 1990; Shoemark, 1988); providing an opportunity for a school to join together in community (Coull & Meadows, 1990); providing enjoyment for family and friends (Shoemark, 1988) ; and, maintaining the dignity of children by involving them appropriately by age and ability (Shoemark, 1988). Behavioral Orientation When music therapists take a behavioral orientation, they are concerned with "the influence of music (on children] to increase, decrease, modify, or reinforce carefully designed targeted behaviors" (Bruscia, 1989 p.114). From the literature reviewed, music therapists typically place less emphasis on the dynamics of the therapeutic relationship and are more concerned with changes in
  6. 6. the child's behavior to meet an identified goal(s). As such, programs are developed with specific goals in mind and structured interventions formulated to meet these goals. For example, Wolfe (1980) used selected recorded music recorded music?n -> m?sica grabada??attached to a mercury switch A mercury switch is a switch whose purpose is to allow or interrupt the flow of electric current in an electrical circuit in a manner that is dependent on the switch's physical position or alignment relative to the direction of the "pull" of earth's gravity. ?to increase the head control of children with cerebral palsy cerebral palsy?(s?r?`br?l p?l`z?), disability caused by brain damage before or during birth or in the first years, resulting in a loss of voluntary muscular control and coordination. . Music acted as a reward for these children, which they were able to hear when keeping their heads in an upright position. In another study designed to reinforce behavior, Holloway (1980) used both passive (contingent music listening) and active (instrument playing) music reinforcers to increase the pre-academic and motor skills of children in an institutional setting. Other examples of behavioral interventions include programs designed to elicit responses such as reaching for and touching objects (Saperston, Chan, Morphew & Carsrud, 1980), following directions (Dorow, 1975), and changing activity level (Dorow & Horton, 1982; Kaufman & Sheckart, 1985; Reardon & Bell, 1970). Educational Orientation In adopting an educational orientation, the music therapist "places an emphasis on curricular or developmental goals ..." (Bruscia, 1989 p. 70). In the literature reviewed in this discussion, two distinct orientations can be found. This first, described by Bruscia (1989) as music therapy in special education, focuses on the use of music to gain nonmusical skills and knowledge. The second, described as developmental music therapy, focuses on a broader range of goals that address delays or obstacles to developmental growth in all areas of the child's life (e.g. sensory, cognitive, communicative, social, emotional, affective affective?/af?fec?tive/ (ah-fek?tiv) pertaining to affect. af?fec?tive adj. 1. Concerned with or arousing feelings or emotions; emotional. 2. ). Each will be briefly discussed. When music therapists focus on the use of music to develop non-musical skills and knowledge, they are typically concerned with reinforcing and maximizing the educational goals of a child's I.E.P.. For example, Alley (1977, 1979), Jellison (1977, 1979), Krout (1987) and Presti (1984) describe the role of the music therapist in an educational setting as one who provides a systematically structured program of activities to meet educational/ curricula goals. In meeting these goals, Jellison (1979) describes how the music therapist should derive a sequence of short term objectives or behavioral tasks, determine an acceptable performance criteria for their achievement, and then implement a series of activities to meet these criteria. As such, the music therapist takes on an instructional role in the child's development, focusing on overt behavior and functional adaptation. Some music therapists take a broader approach to the child's development, incorporating sensorimotor, communicative, cognitive, affective, intrapersonal in?tra?per?son?al?? adj. Existing or occurring within the individual self or mind. in tra?per ?and interpersonal needs in an integrated way. This approach, which Bruscia (1989) calls developmental music therapy, "is concerned with autobiographical material, family background, private emotions, and personality development" (Bruscia, 1989 p.74) in ways that help children
  7. 7. overcome delays and accomplish tasks that meet their unique needs. Examples of this approach include the work of Agrotou (1993), Alvin (1976), Boxill (1985, 1989), Howat (1995), Nordoff and Robbins (1971, 1977, 1983), Shoemark (1991) and Warwick (1995). For Nordoff and Robbins (1971, 1977, 1983), therapy involves three interrelated stages: meeting the child musically, where the therapist's music creates an accepting environment; evoking musical responses, where the therapist stimulates the child to explore and create music, both instrumentally and vocally; and developing musical skills, expressive freedom and interresponsiveness. In this approach, both recreative rec?re?ate?? v. rec?re?at?ed, rec?re?at?ing, rec?re?ates To impart fresh life to; refresh mentally or physically. v.intr. To take recreation. ?and improvisational techniques are used. An increased emphasis is placed on the dynamics of the therapeutic relationship, and while sessions may have a structure or plan prior to each session, the therapist is likely to spontaneously respond to the child, altering the content of the session accordingly. Further, the therapist places an emphasis on self inquiry as a way of understanding the therapy process. Healing Orientation Music therapists that adopt a healing orientation use "musical experiences and the relationships that develop through them to heal the mind, body, spirit, to induce self-healing, or to promote wellness" (Bruscia, 1989 p.93). In this orientation, primary value is placed on the music therapist's experiences of the child(ren) as part of understanding the therapy process, and self inquiry is central to this. The work of Nordoff and Robbins (1971, 1977, 1983) falls into this category because the therapeutic experience allows the child to heal and change from within, activating the child's 'inner resources'. As Bruscia (1989 p. 94) discusses, Nordoff and Robbins give the music therapist as healer healer?Mainstream medicine A romantic synonym for physician. See Traditional healing. ?four main functions: "1) to accept the [child] with respect and reverence, 2) to work through various relationships that develop through the music, 3) to create music that will activate the [child's] inner resources, and 4) to continually develop one's own musical life". Major Treatment Methods When these orientations are taken to meeting the general goals previously described, music therapists use both active and receptive treatment methods in individual and group settings. Both of these methods will be discussed separately. Active methods refers to the therapy that "takes place within and through the [child's] efforts to perform, improvise im?pro?vise?? v. im?pro?vised, im?pro?vis?ing, im?pro?vis?es 1. To invent, compose, or perform with little or no preparation. 2. , or create music, either alone or with others. Here the active experience either provides therapeutic benefits directly, as the main stimulus for change, or it leads to a response process that parallels or triggers a therapeutic change experience" (Bruscia, 1991, p. 65). Active methods include instrumental activities, improvisation improvisation
  8. 8. Creation of music in real time. Improvisation usually involves some preparation beforehand, particularly when there is more than one performer. Despite the central place of notated music in the Western tradition, improvisation has often played a role, from the , vocal activities and movement. Instrumental Activities An instrumental activity involves the child manipulating an instrument in order to produce some kind of sound. Typically, instruments that are used include hand held percussion percussion?/per?cus?sion/ (per-kush?un) the act of striking a part with short, sharp blows as an aid in diagnosing the condition of the underlying parts by the sound obtained. , drums, cymbals cymbals?(s?m`b?lz), percussion instruments of ancient Asian origin. They consist of a pair of slightly concave metal plates which produce a vibrant sound of indeterminate pitch. ?and xylophones. Sounds can be "organized or unorganized, consist of random groups of sounds, short series of pulses, intermittent or prolonged beating, or rhythmic patterns of varying length and complexity" (Bruscia, 1987, p.48). Instruments are typically selected according to the child's ability and interest, and may be adapted to maximize success and independence. In adapting instruments, the music therapist may position them for the child's easy access and provide splints splints inflammation of the interosseous ligament between the small and large metacarpal bones of horses and an accompanying periostitis and exostosis production on the small metacarpal bone. The metatarsal bones are similarly but less frequently involved. ?and grips in order to grasp smaller instruments and mallets. Instruments may be physically altered or other devices, such as levers or frames may be built. For example, Clark and Chadwick (1980) and Elliott, Macks, Dea and Matsko (1982) describe a range of adaptations to instruments designed to maximize the child's access and independence. Music technology, such as computers and synthesizers, has also been adapted to utilize the synthesizer's touch sensitivity and potential to produce a wide variety of sounds using similar movements (Meadows, 1991). Evoking Instrumental Sounds There are several reasons why music therapists use instrumental activities. The first of these is to evoke sound or music making responses from the child. Here, the music therapist helps the child to produce sounds through the exploration of instrument timbre timbre Quality of sound that distinguishes one instrument, voice, or other sound source from another. Timbre largely results from a characteristic combination of overtones produced by different instruments. , texture and shape (Pfeifer, 1989). Sometimes adapting the instrument or providing physical assistance is necessary. When the child explores an instrument, it is a way of stimulating them, making contact, establishing intent and engaging them in the therapy process. This goal is particularly important for the child with a physical disability because such activities physically stimulate them and assist them in understanding and controlling their bodies. Nordoff and Robbins.(1971, 1977) evoke musical responses by engaging the child in music making on instruments through modeling, verbal encouragement or instruction, and/or physical assistance. Once the child begins to play, the therapist concentrates on the way the sound is produced, responding to the dynamics, timbre, melody and level of organization the child shows. In this way, the therapist begins from the child's music, and engages the child by imitating, contrasting, pausing or structuring the musical experience in certain ways. These techniques apply more readily to
  9. 9. children who are physically capable of using instruments, where the process centers around developing ways to express feelings, explore, or participate in instrumental activities. Developing Instrumental Skills The second goal is to develop instrumental skills. Two types of skills are emphasized, the first of which is to develop an expressive musical language. Here the music therapist fosters the child's ability to express personal feelings, explore and create sounds, and interact with others through the playing of an instrument(s) (Alvin, 1976; Boxill, 1985, 1989; Nordoff & Robbins, 1971, 1977). In developing expressive music skills, a common intervention is improvisation, where the therapist and child spontaneously make music together. This may comprise the child and/or therapist improvising with piano, voice, guitar, melodic me?lod?ic?? adj. Of, relating to, or containing melody. me?lod i?cal?ly adv. ?or percussive per?cus?sive?? adj. Of, relating to, or characterized by percussion. per?cus sive?ly adv. ?instruments, either alone or in combination. Improvisations can vary in their complexity from simple sound forms to multi-dimensional compositions. For example, Nordoff and Robbins (1971; 1977) discuss developing expressive musical skills through improvisation in terms of 'expressive freedom' and 'inter-responsiveness', where developing a musical language gives the child new or improved expressive options and choices. Other examples include the work of Alvin (1971), Boxill (1985), Howat (1995), Nordoff & Robbins (1971, 1977, 1983), Shoemark (1991) and Wigram (1992). The second area is developing specific music skills, and involves the child learning and playing an instrumental part in a composition. Typically, this is structured around recreative activities, where the child rehearses and performs their part (3). While a number of therapeutic objectives, such as attending to the task and behaving appropriately, are implied in this activity, the emphasis remains on music making. The therapist may write music for specific goals (Levin, Levin & Safer, 1974; Purvis & Samet, 1976), adapt it from existing literature (Boxill, 1985, 1989), or write it specifically for the child, type of activity or goal (Boxill, 1985, 1989; Nordoff & Robbins, 1971, 1977). Developing Music-Related Skills The third goal area is developing music-related skills. Typically, goals focus on either those non- music skills developed in the process of music-making, or the non-music skills developed where music is used to motivate or reinforce specific skills. Bruscia (1991) has outlined a number of general objectives, which include "developing sensorimotor skills, learning adaptive behaviours, maintaining reality orientation, mastering different roles, identifying with the feelings of others, and working co-operatively toward a common goal" (Bruscia, 1991, p.7). This goal area shares many similarities with the previous goal (developing instrumental skills). The main difference is in the emphasis placed by the music therapist. In this particular goal area, the emphasis is placed on the skills (for example behavior, motor skills or attention) associated with the instrumental activity. In the previous goal area, the emphasis was placed on the process of music making. A wide range of music-related goals have been addressed in the literature (Alley. 1977; Hanser, 1987; Pfeifer, 1982). These include developing eye-hand coordination and motor skills such as
  10. 10. shaking, striking and grasping (Pfeifer, 1982; Krout, 1987); imitative im?i?ta?tive?? adj. 1. Of or involving imitation. 2. Not original; derivative. 3. Tending to imitate. 4. Onomatopoeic. ?behaviour and turn taking (Boxill, 1985): and following directions (Lathom & Eagle, 1982). Typically, these goals share a close relationship with the child's I.E.P., where the music therapist specifically addresses one or more of these goals in the child's music therapy program. Vocal Activities A vocal activity is one which, is focused on the child producing any sound that can be made orally. Vocal sounds can be "sustained or unsustained, pitched or unpitched, verbal or non-verbal. They may be unrelated single tones, short motifs, melodic patterns Melodic patterns are repetitive patterns that can be used with any scale. It is used primarily for use in solos because, when practiced enough, it can be extremely useful when improvising. , or short phrases" (Bruscia, 1987 p.47). Nordoff and Robbins (1983) and Boxill (1985) discuss singing as a direct and intimate self extension, with the potential to integrate perceptual, cognitive and expressive capacities As with instrumental activities, goals for vocal activities can be divided into three main areas: evoking vocal responses, developing vocal skills, and developing music-related skills. Evoking Vocal Responses In evoking vocal responses, the music therapist helps the child to produce any vocal sound in a musical context. This goal is usually most relevant in three specific situations. Firstly, for children who have profound disabilities as a way of stimulating a response or fostering interaction (Boxill, 1985; Cunningham, 1975; Johnson, 1975; Nordoff & Robbins, 1971, 1977). Secondly, for children with physical disabilities which impede im?pede?? tr.v. im?ped?ed, im?ped?ing, im?pedes To retard or obstruct the progress of. See Synonyms at hinder1. [Latin imped ?their ability to produce vocal sounds. And thirdly, for children who are withdrawn or lack self confidence and need specific vocal support and encouragement (Nordoff & Robbins, 1971, 1983). Nordoff and Robbins (1977, 1983) use a number of techniques to elicit vocal responses. These include improvisational techniques such as a) making vocal sounds while musically reflecting the child's emotional state, b) singing phrases that describe what the child is doing, feeling or experiencing, and c) imitating the child's vocal sounds or words, matching the musical and emotional qualities. Recreative techniques include a) presenting material the child is able to copy, add to or develop, b) introducing a familiar song or tune and encourage the child to sing along, and c) varying the instruments used in accompaniment. Techniques that can use either method include a) providing opportunities to complete phrases, add sounds, syllables or words, and b) combining vocalizing with movement or instrument playing. Developing Vocal Skills Developing vocal skills involves the therapist increasing the range, length, type, accuracy and/or quality of the child's vocal sounds. Two types of goals are emphasized in the literature: developing
  11. 11. an expressive vocal language, and developing music-related skills. In developing an expressive vocal language, the music therapist is primarily concerned with stimulating, supporting and developing the child's vocal expression(s). These include both verbal and non-verbal expressions of the child's here-and-now experience with the therapist, either in group or individual sessions. Boxill (1985) gives the example of an agitated ag?i?tate?? v. ag?i?tat?ed, ag?i?tat?ing, ag?i?tates 1. To cause to move with violence or sudden force. 2. , hyperactive person, "when encouraged to hum a melody, may create his or her own sense of calm through the vibratory vibratory?/vi?bra?to?ry/ (vi?brah-tor?e) vibrating or causing vibration. vibratory vibrating or causing vibration; vibritile. ?effect of the music, as well as the emotional gratification GRATIFICATION. A reward given voluntarily for some service or benefit rendered, without being requested so to do, either expressly or by implication. ?it affords" (Boxill, 1985, p. 101). For Nordoff and Robbins (1983), developing an expressive vocal language involves presenting a variety of songs with different emotional qualities that gives the child a range of emotional experiences. In so doing, the child's personality can become integrated in the act of singing and is functionally organized by the musical structure and content of the song itself. "Such a variety of emotional experience is vital to music therapy for it enhances responsiveness ... and simultaneously fosters the personal development of (the child)" (Nordoff & Robbins, 1983, p. 32). Music-related Skills Developing vocal skills comprises many music-related skills. Typically, these are either the non- music skills developed in the process of singing and music making, or the non-music skills developed where singing is used to motivate or reinforce specific skills. These include the broad categories of receptive language, expressive language and academic skills (Pfeifer, 1982). For example, vocal activities can address the child's ability to attend (Wylie, 1983), turn take, listen, and make eye contact (Krout, 1987). Songs can reflect a skill or knowledge that is learnt in the classroom. For example, songs can describe colours and seasons (Purvis & Samet, 1976), providing a learning context for the child. Movement Movement activities focus on the physical well-being and development of the child. As an active method, movement activities are those where the child moves their body independently in a musical context. This includes gross motor activities, basic locomotor lo?co?mo?tor?or lo?co?mo?tive adj. Of or relating to movement from one place to another. locomotor of or pertaining to locomotion. ?activities, structured and free psychomotor psychomotor?/psy?cho?mo?tor/ (si?ko-mo?ter) pertaining to motor effects of cerebral or psychic activity.
  12. 12. psy?cho?mo?tor adj. 1. ?movements, and perceptual motor activities (Boxill, 1985), where the music therapist plays or selects music which supports and stimulates the child's movements. In movement activities, two main goals are emphasized: maintaining or increasing gross and fine motor skills (Robbins & Robbins, 1988); and educating the child to physically interact with the environment in ways that help them to learn about themselves, the environment and others around them (Boxill, 1989). More specific goals include increasing body awareness body awareness, n the felt sense of embodiment; consciousness of our somatic feelings. alternative medicine... ?(Boxill, 1985), identifying body parts (Levin, Levin & Safer, 1984), increasing muscle control (Lathom & Eagle, 1982; Robbins, 1988), maintaining range of movement (Robbins & Robbins, 1988) and integrating movements (Krout, 1987; Levin, Levin & Safer, 1984). Typically, movement programs are designed for groups, where children have similar needs, and may be coordinated with physiotherapists (Robbins & Robbins, 1988). Live or recorded music may to used, chosen specifically for the type of activity or experience undertaken. Live music can be improvised from an established song repertoire (Robbins & Robbins, 1988; Wigram, 1992). For example, improvised music can support or imitate im?i?tate?? tr.v. im?i?tat?ed, im?i?tat?ing, im?i?tates 1. To use or follow as a model. 2. a. ?the movement(s) undertaken. Songs can describe the movement (for example stretching), the context of the movement (for example, identifying body parts), or be a medium by which the movement occurs (for example, the child spontaneously responding to the music). Receptive Methods The second major area of interventions for children with severe and profound multiple disabilities are receptive methods. As Bruscia (1989 p.43) describes, receptive methods refer to "the therapy that takes place when the child listens to, takes in, or receives the music itself"_ Three main receptive methods can be identified in the music therapy literature These are sensory stimulation sensory stimulation, n in acupuncture, the practice of inserting needles into skin and tissue to coax the body into using its energy to heal itself. , movement, and contingent listening. Sensory Stimulation Sensory stimulation refers to the therapist's use of musical and other media to arouse, excite and activate the child: In all interventions, the emphasis is on engaging the child in any type of response that will foster activity and awareness of themselves, objects and others. For example, this can include singing or playing to the child in order to change affect (e.g. eye contact) or manipulating the child's arms and hands to explore an instrument, watching for changes in awareness and activity. Typically, there are three elements to this type of intervention, and they can be used separately or' together when working with a child. The first element is auditory stimulation, or the therapist's efforts to stimulate the child by improvising (Johnson, 1975), singing songs (Dorow & Horton, 1982; Kaufman & Sheckart, 1985) or playing pre-recorded music (Wigram, 1981). Secondly, this can involve the use of textures, fabrics and other materials to physically stimulate the child. For
  13. 13. example, fabrics can be gently rubbed over the child's arms, hands or feet, while textures can be placed in the child's hand(s) or between fingers. Thirdly, the therapist can physically stimulate and manipulate the child's body by touching, massaging or carefully moving body parts. For example, the therapist may massage the child's arm and hand as a way of making contact or building trust. Alternatively, the same technique may be used as a preparation for instrument playing, stimulating the child's body and then placing the instrument so that the child can explore it, either independently, or with assistance. Movement As a receptive method, movement activities refer to the therapist's caring and purposeful pur?pose?ful?? adj. 1. Having a purpose; intentional: a purposeful musician. 2. Having or manifesting purpose; determined: entered the room with a purposeful look. ?manipulation of the child's body in a musical context to meet his/her physical well-being and development. These activities are specifically designed for children who have little or no voluntary control over their bodies, or lack the understanding to move in purposeful or controlled ways (Weigall & Meadows, 1995). These programs are usually designed and run with physiotherapists because of the high level of expertise required in understanding the physical makeup of children and limitations to their movements. Programs are usually run for groups, and there is generally a very high student staff ratio as children require individualized in?di?vid?u?al?ize?? tr.v. in?di?vid?u?al?ized, in?di?vid?u?al?iz?ing, in?di?vid?u?al?iz?es 1. To give individuality to. 2. To consider or treat individually; particularize. 3. ?attention. The music therapist has two main functions in these programs. Firstly, to provide the structure of the sessions, or secondly to work with a child providing physical intervention. Providing the structure to sessions includes both musical and verbal elements. Musically this involves selecting songs (both live and recorded) and improvising to connect, support, and facilitate the child's movement experience. Verbally, it means acting as a guide to staff members throughout the session. Providing physical intervention means working with a child while recorded music is played. These movement programs have three related elements. The first of these is to focus on maintaining the child's physical functioning, including range of movement, muscle tone, and body symmetry (for example, maintaining posture). Secondly, an emphasis is placed on the quality of the interactions between therapist and child. As these children usually receive constant physical handling, care is taken to make the interaction as positive and sensitive as possible. Thirdly, while the adult moves the child's body, independent movement is encouraged and supported at all times. Contingent Listening Contingent music listening refers to the therapist's application of live or recorded music to reinforce or reward appropriate non-musical behavior. Typically, the music therapist will identify, shape, reinforce and reward a desired behavior(s), with the music functioning in the last two elements of
  14. 14. the sequence. For example, contingent listening has been used to reinforce imitative behavior (Meltzer, 1974), reaching and touching objects (Saperston, Chan, Morphew, & Carsrud, 1980), head positioning (Wolfe, 1980), motor skills (Dorow, 1975; Holloway, 1980) and foster positive interactions and acceptance among students in a mainstream music classroom (Jellison, Brooks & Huck huck?? n. Huckaback. Noun 1. huck - toweling consisting of coarse absorbent cotton or linen fabric huckaback toweling, towelling - any of various fabrics (linen or cotton) used to make towels , 1984). Summary One way of presenting the music therapy literature for children with severe and profound multiple disabilities is by goal, orientation and method. This gives an indication of the ways music therapists work with these children, showing both the diversity and similarities in overall approach. Given the diverse goals of music therapists, there seems to be many similarities in the methods used. For example, instrumental and vocal activities were used to meet all the general goals identified in this review. It appears, therefore, that it is not so much the methods that are different as the meaning given to the therapy experience. For example, when a child first plays an instrument independently, it can be framed in two entirely different ways. From a behavioral orientation, it may be an example of following directions and playing attention to the task. From a broader educational perspective (developmental music therapy) on the other hand, it may be the child's first communication of intent or interaction. It follows that the general goals identified earlier in this review are not really 'general' at all. They reflect an orientation or orientations to practice by music therapists that value certain types of goal(s) for these children. For example, the first goal of fulfilling the child's basic needs reflects a developmental music therapy or healing orientation that places an emphasis on the quality of the therapeutic environment and the relationship with the therapist. It has not been identified as a goal when working from other orientations. Taking another perspective, the general goal of developing specific skills means different things in different orientations. From a behavioral orientation, developing skill; means targeting and systematically working toward the mastery of a specific skill, task or behavior that was identified by the therapist to meet adaptive or educational needs. Typically, music listening is used to reward or reinforce the child and the music therapist takes on an instructional role. From a healing orientation, developing skills means fostering, allowing and encouraging the child to develop his/her own unique ways of communicating and interacting to become whole. As such, sessions take place spontaneously and develop in unique and unpredictable ways. A central focus is placed on the music as a representation of the process, perhaps without necessity for interpretation or explanation. Further, the therapist uses his/her own experiences to further understand this process. In closing, while music therapist's goals and methods give an indication of the ways in which therapy is approached with these children, it is the therapist's orientation to practice which gives meaning to the experience. References
  15. 15. Agrotou, A. (1993). Spontaneous ritualized play in music therapy: A technical and theoretical analysis. In M. Heal & T. Wigram.(Eds.), Music Therapy in Health and Education. London: Jessica Kingsley Publishers. Alley, J.M. (1977). Education for the severely handicapped: The role of music therapy. Journal of Music Therapy, 14(2), 50-69. Alley, J.M. (1979). Music in the I.E.P.: Therapy/education. Journal of Music Therapy, 16(3), 111-127. Alvin, J. (1976). Music for the Handicapped Child (second edition). London: Oxford University Press. Boxill, E.H. (1985). Music Therapy for the Developmentally Disabled. Aspen aspen, in botany aspen:?see willow. Aspen, city, United States Aspen?(?s`p?n), city (1990 pop. 5,049), alt. 7,850 ft (2,390 m), seat of Pitkin co., S central Colo. ?System Corporation. Boxill, E. H. (1989). Music Therapy for Living. The Principle of Normalization In relational database management, a process that breaks down data into record groups for efficient processing. There are six stages. By the third stage (third normal form), data are identified only by the key field in their record. ?Embodied in Music Therapy. St Louis, MO: Magna Music Baton. Bruscia, K. E. (1987). Improvisational Models of Music Therapy Springfield, II.: Charles C. Thomas. Bruscia, K.E. (1989). Defining Music Therapy. Phoenixville, PA: Barcelona Publishers. Bruscia, K.E. (Ed.), (1991). Case Studies in Music Therapy. Phoenixville: Barcelona Publishers. Bruscia, K. E. (1992). Receptive methods of music therapy. Unpublished lecture series. Temple University. Clark & Chadwick, D. (1980). Clinically Adapted Instruments for the Multiply Handicapped. St Louis, MO: Magna Music Baton. Codding, P.A. (1988). Music in the education /rehabilitation of visually disabled and multihandicapped persons: A review of literature. In C.E. Furman (Ed.), Effectiveness of Music Therapy Procedures: Documentation of Research and Clinical Practice (pp. 107-136). Washington, DC : National Association of Music Therapy. Coull, S.E. & Meadows, A.N. (1990). Creating a play with music for children with moderate to profound multiple disabilities. A paper presented at the annual conference of the Australian Music Therapy Association Inc., Sydney. Cunningham, T.D. Jr., (1975). The effect of music volume on the frequency of vocalizations of institutionalized in?sti?tu?tion?al?ize?? tr.v. in?sti?tu?tion?al?ized, in?sti?tu?tion?al?iz?ing, in?sti?tu?tion?al?iz?es 1. a. To make into, treat as, or give the character of an institution to. b. ?mentally retarded Noun 1. mentally retarded - people collectively who are mentally retarded; "he started a school for the retarded"
  16. 16. developmentally challenged, retarded ?persons. Journal of Music Therapy, 23(4), 208-218. Dorow, 1.G. (1975). Conditioning music and approval as new reinforcers for imitative behavior with the severely retarded re?tard?ed?? adj. 1. Often Offensive Affected with mental retardation. 2. Occurring or developing later than desired or expected; delayed. . Journal of Music Therapy, 12, 30-39. Dorow, I.G. & Horton, J.J. (1982). Effect of the proximity of auditory stimuli auditory stimuli, in dentistry, the irregularities or deposits on the surface of a tooth that may be detected by ear of both patient and clinician during examination and probing. ?and sung versus spoken stimuli on activity levels of severely/profoundly mentally retarded females. Journal of Music Therapy, 19(2), 114-124. Elliot, B., Macks, P., Dea, A., & Matsko, T. (1982). A Guide to the Selection of Musical Instruments with Respect to Physical Ability and Disability. St Louis, MO.: Magna Music Baton. Gaston, E.T. (1968). Music in Therapy. New York New York, state, United States New York,?Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of : The Macmillan Company. Greenway, M.A. (1978). The effectiveness of distorted versus interrupted music to decrease self- stimulatory behavior in profoundly retarded adolescents. Journal of Music Therapy, 15, 58-66. Hanser, S.B. (1987). Music Therapist's Handbook. St Louis, MO.: Warren H. Green, Inc. Holloway, M.S. (1980). A comparison of passive and active music reinforcement to increase preacademic and motor skills in severely retarded children and adolescents. Journal of Music Therapy, 17, 58-69. Howat, R. (1995). Elizabeth: A case study of an autistic autistic?/au?tis?tic/ (aw-tis?tik) characterized by or pertaining to autism. ?child in individual music therapy. In T. Wigram, B. Saperston & R. West (Eds.), The Art and Science of Music Therapy: A Handbook. Switzerland: Harwood Academic Publishers. Hughes, M.H. (1995). A comparison of mother-infant interactions and the client-therapist relationship in music therapy sessions. In T. Wigram, B. Saperston & R. West (Eds.), The Art and Science of Music Therapy: A Handbook. Switzerland: Harwood Academic Publishers. Jellison, J.E. (1977). Music instructional programs for the severely handicapped. In E. Sontag (Ed.), Educational Programming for the Severely Profoundly Handicapped. Reston, VA.: The Council for Exceptional Children. Jellison, J.A. (1979). The music therapist in the educational setting: Developing and implementing curriculum for the handicapped. Journal of Music Therapy, 16(3), 128-137. Jellison, J.E. (1988). A content analysis of research with handicapped children (1975-1986). In C.E. Furman (Ed.), Effectiveness of Music Therapy Procedures: Documentation of Research and Clinical
  17. 17. Practice (pp. 223-284). Washington, DC.: National Association of Music Therapy. Jellison, J.E., Brooks, B., & Huck, A.M. (1984). Structuring small groups and reinforcement to facilitate positive interactions and acceptance of severely handicapped students in the music classroom. Journal of Research in Music Education The Journal of Research in Music Education (JRME) publishes research reports "that enhance knowledge regarding the teaching and learning of music." It is published by the National Association for Music Education. , 32, 243-264. Johnson, M. (1975). Music in the education of profoundly multiply handicapped children. In Nature and Scope of Music Therapy with Handicapped Children (pp. 9-14). British Society for Music Therapy. Jorgenson, H. (1971). The use of contingent preferred music in reducing two stereotyped behaviors of a profoundly retarded child. Journal of Music Therapy, 8(4), 139-145. Kaufman, F.M. & Sheckart, G.R. (1985). The effect of tempo variation and white noise on the general activity level of profoundly retarded adults. Journal of Music Therapy, 22(4), 207-217. Krout, R. (1987). Music therapy with multihandicapped students: Individualizing treatment in a group setting. Journal of Music Therapy, 24(1), 2-13. Lathom, W. & Eagle, C.T. (1982). Music for the severely handicapped. Music Educators Journal, 68(6), 30-31. Levin, G.M.; Levin, H.D., & Safer, N.D. (1984). Learning Through Music. Boston, MS.: -teaching Resource Corporation. Meadows, AX (1991). Using computer based music programs as an educational aide for students who are intellectually disabled. Australian Journal of Remedial Education, 22(1&2), 35-36. Meltzer, R.K. (1974). The use of music as a reinforcer reinforcer?/re?in?forc?er/ (-in-for?ser) any stimulus that produces reinforcement, a positive r. being a desirable event strengthening responses preceding its occurrence and a negative r. ?to increase imitative behavior in severely and profoundly retarded female residents. Journal of Music Therapy, 11(2), 97-110, Nordoff, P. & Robbins, C. (1971). Therapy in Music for Handicapped Children. New York: St Martin's Press. Nordoff, P. & Robbins, C. (1977). Creative Music Therapy, New York: Harper and Row Publishers. Nordoff, P. & Robbins, C. (1983). Music Therapy in Special Education (second edition). New York: John Day Co.. Orelove, F.P. & Sobsey, D. (1991). Educating Children with Multiple Disabilities: A Transdisciplinary Approach. Baltimore, MD.: Paul H. Brooks. Pfeifer, Sr. M. (1982). Music Therapy for Handicapped Children: Multi-Handicapped. National Association for Music Therapy, Inc. Pfeifer, Sr. M. (1989). A step in the right direction: Strategies for implementing music therapy with multihandicapped children. Music Therapy Perspectives, 6, 57-60.
  18. 18. Presti, G.M. (1984). A levels system approach to music therapy with severely handicapped children in public school. Journal of Music Therapy, 21(3), 117-125. Purvis, J. & Samet, S. (1976). Music in Developmental Therapy: A Curriculum Guide. Baltimore, MD.: University Park Press. Reardon, D.M. & Bell, G. (1970). Effects of sedative sedative,?any of a variety of drugs that relieve anxiety. Most sedatives act as mild depressants of the nervous system, lessening general nervous activity or reducing the irritability or activity of a specific organ. ?and stimulative music stimulative music?Music therapy Assertive or buoyant music that may prompt the body into joining the rhythm, evoking hand clapping, dancing, etc. Cf Sedative music. ?on activity levels of severely retarded boys. American Journal of Mental Deficiency mental deficiency n. See mental retardation. , 75(2), 156-159. Robbins, C. & Robbins, C. (1988). Teamwork in clinical improvisation: Music therapy and physiotherapy physiotherapy:?see physical therapy. ?combined. Proceedings of the Fourteenth National Conference of the Australian Music Therapy Association, Inc. Saperston, B., Chan, R., Morphew, C, & Carsrud, K. (1980). Music listening versus juice as a reinforcement for learning in profoundly mentally retarded individuals. Journal of Music Therapy, 17(4), 184-183. Schalkwijk, F.W. (1994). Music and People with Developmental Disabilities. London: Jessica Kingsley Publishers. Shoemark, H. (1988). Creating a Christmas play event for profoundly multiply handicapped children. Journal of Visual Impairment Visual Impairment?Definition Total blindness is the inability to tell light from dark, or the total inability to see. Visual impairment or low vision is a severe reduction in vision that cannot be corrected with standard glasses or contact lenses and ?and Blindness, $2(10), 405-409. Shoemark, H. (1991). The use of piano improvisation in developing interaction and participation in a blind boy with behavioral disturbances. In K.E. Bruscia (Ed.), Case studies in music therapy. Phoenixville, PA.: Barcelona Publishers. Stevens, E.A. (1971). Some effects of tempo change on stereotyped rocking movements of low level mentally retarded subjects. American Journal for Mental Deficiency, 76(1), 76-81. Warwick, A. (1995). Music therapy in the educational service: research with autistic children and their mothers. In T. Wigram, B. Saperston & R. West (Eds.), The Art and Science of Music Therapy: A Handbook. Switzerland: Harwood Academic Publishers. Weigall, P. & Meadows, A.N. (1995). Music-movement for children with profound multiple disabilities. Unpublished Inservice Presentation. Wigram, A.L. (1981) . The value of recorded music for the severely handicapped. In 1981 International Year of Disabled People. The Role of Music Therapy. London: British Society for Music Therapy.
  19. 19. Wigram, A.L. (1988). Music therapy: Developments in mental handicap mental handicap Noun any intellectual disability resulting from injury to or abnormal development of the brain mentally handicapped adj . Psychology of Music, 16(1), 42-51. Wigram, A.L. (1992). Music therapy and physical disability. Australian Journal of Music Therapy, 3, 3-15. Wolfe, D.E. (1980). The effect of automated interrupted music on head posturing of cerebral palsied pal?sied?? adj. 1. Affected with palsy. 2. Trembling or shaking. Adj. 1. palsied - affected with palsy or uncontrollable tremor; "palsied hands" ?individuals. Journal of Music Therapy, 17(4), 184-206. Wylie, M.E. (1983). Eliciting vocal responses in severely and profoundly mentally retarded handicapped subjects. Journal of Music Therapy, 2D(4), 190-200. Tony Meadows *, MMT MMT Million Metric Tons MMT M?decins Ma?tres-Toile MMT Methadone Maintenance Treatment MMT Multiple Mirror Telescope MMT Mission Management Team (International Space Station) MMT Military Training Technology , RMT RMT?right mentotransverse (position of the fetus). RMT?1. Registered Massage Therapist 2. Renal mesenchymal tumor ? * Tony Meadows is an Australian-trained music therapist currently enrolled in a doctoral program at Temple University, Philadelphia, USA. Notes (1) This goal was originally identified by Gaston (1968). (2) Pfeifer cited Eagle (1978) as the primary source for this goal. However, as this is acknowledged as a personal communication (Pfeifer, 1982 p.32), Pfeifer is used as the source. (3) Performance can take place either within the therapy session or to peers, family and/or others. COPYRIGHT 1997 Australian Music Therapy Association, Inc. No portion of this article can be reproduced without the express written permission from the copyright holder.
  20. 20. Copyright 1997 Gale, Cengage Learning. All rights reserved.