Pediatric

*In accordance with HIPAA, and out of respect for our client’s privacy, the initial A. will be used as an alias throughout this blog post.*
*Photo used with parent’s permission*

In the world of Private Practice, it’s not uncommon to spend the majority of a given week – professionally – alone. Of course, I am seeing clients, their families, and facility staff members as I drive from one location to the next. But most of these folks don’t know much about Music Therapy, apart from what I present to them. As for the sessions themselves, it’s usually just me and the client, and perhaps a parent stationed nearby. And sure, there are my wonderful colleagues at Metro Music Therapy, for whom I am immensely grateful. But we unfortunately only get to see one another in person about once or twice a week, for staff meetings and the like. Outside of those happy moments, they’re all off doing fantastic work with their own clients.

Suffice to say, I rarely have a chance to collaborate with another health professional in the midst of a session. Which is why those rare occasions are so much fun!

I recently had the privilege of working side by side with a Physical Therapist in a session with one of our mutual clients – we’ll call him A. The first thing worth mentioning is that this merging of sessions was suggested and arranged by none other than A’s parents! How cool is that? It’s always exciting when the benefits of interdisciplinary co-treatment are recognized and sought out by the client or his/her family. Let’s take a look at some of those benefits in A’s case:

1. It’s Practical – Time Efficient, Decreased Duplication of Services, More Hands!
I honestly believe that I would be a more effective therapist if I had four arms. Imagine the possibilities! Playing guitar with two hands, helping the client play another instrument with a third, and taking real-time data with a fourth – sounds like a sweet deal, right? Alas, even on my best days, I’m no Dr. Octopus. Which brings us to benefit #1: more professionals means more hands! It’s a simple, obvious benefit, but a benefit nonetheless. Live music is often preferred in a music therapy session, but that can be difficult if I need my hands to assist the client. With an extra set of hands, I’m able to incorporate all the good things that come with playing guitar (rather than a recording), such as easy fluctuation of tempo, while the client still receives physical assistance. And then there’s the time efficiency – in A’s case, his Physical Therapist and Music Therapist were able to see him simultaneously, so I imagine he was less worn out afterward!

When professionals work together, there’s less chance of the client “double-dipping” with a given service on the same day. For example, let’s say A’s Physical Therapist visits him to work on head posturing for 30 minutes, and then I show up to work on head posturing for 10 minutes, but in a different way. Sure, it’s not a bad thing to get more practice in on a given skill, but why not combine methods for a more concentrated practice session, with the combined knowledge and skills of two very different therapists? That brings us to our next major set of benefits.

2. Teamwork Makes the Dream Work – Combining Knowledge, Skills, and Experience
While I can address some physical goals through musical interventions, I am no Physical Therapist. There’s a significant difference between my knowledge and training regarding physical development and the knowledge and experience of A’s Physical Therapist. And similarly, there are skills that I possess as a Music Therapist that she does not, having never gone through my training. She may incorporate singing and music into some of her interventions, but not in the same way or with the same knowledge. Which is, again, why it’s so cool to work together! I had heard from A’s parents that he’d been working on holding his head up independently during Physical Therapy, but I did not entirely know what that looked like (or how the intervention was implemented in the safest, most beneficial way for A.) until seeing it with my own eyes.

Meanwhile, I recalled reading a research study in the Journal of Music Therapy, titled: “The Effect of Automated Interrupted Music on Head Posturing of Cerebral Palsied Individuals” (Wolfe, 1980). Participants in the study each wore a special head device, utilizing mercury switches which activated recorded music when the subject’s head was held erect, and paused the music when the subject’s head became improperly postured. Results of the study indicated that, for four of twelve participants, head control improved during the treatment condition. This essentially means that music can be a helpful contingency when it’s used to alert a client that they are holding their head properly.

We did not have a fancy head device, but with A’s Physical Therapist assisting him in initial head positioning and standing by to support him should he begin to fall, I was able to simulate the function of the device by playing guitar and singing while A. held his head upright. Whenever his head began to droop, the music would stop!
And there you have it: interdisciplinary co-treatment in action!

3. New Ideas – Next Time in Music Therapy…
What’s neat about co-treatment, even when it only happens rarely, is that it can inform individual treatment moving forward. Since that first co-treatment session, A.’s mother and I have replicated the intervention – using music as a contingency for head posturing, while she supports his head, should he start to fall – several times. And A. has been able to hold his head in place for up to about 45 seconds! I’m thankful that A’s mother brought me and his Physical Therapist together that day, for his benefit and for mine. Because, have I mentioned?
Co-treatment is just really fun!

4. It’s Fun!
Can’t really over-state this one. Other therapeutic disciplines are the coolest. There is so much we can learn from each other, and it’s such an honor to have a chance to work with another of my client’s therapists. I wish it could happen more often! In addition to the mixing of knowledge and experience, you’re mixing rapport and relationships too. My clients are awesome, and here’s someone else (namely, his Physical Therapist) who gets to work with A. and see how awesome he is every week!
And now we’re here with him together, working side by side?
That’s just… man, it’s a good time.

To quote Rob Base and DJ EZ Rock, sometimes,
“It takes two to make a thing go right.
It takes two to make it outta sight.”

– Written by Kevin Middlebrooks, LPMT, MT-BC

Resources:
Co-treating: What Is It and What Are the Benefits For Your Child?
Lauren Weichman – https://nspt4kids.com/therapy/co-treating-what-is-it-and-what-are-the-benefits-for-your-child/

The Effect of Automated Interrupted Music on Head Posturing of Cerebral Palsied Individuals
D. Wolfe – Journal of Music Therapy – 1980

Benefits of an Interdisciplinary Approach: A Case of Collaboration
Dana Howell-Kimberly Cleary – Physical & Occupational Therapy In Geriatrics – 2001