Wednesday, September 30, 2015

Not Much Time Today for Blogging...

I typically like to arrive at my work about 30-45 minutes early, and I am running a bit late today, so there won't be much to this post. It's been an okay morning - the time crunch is coming from a task that I've not been able to do for my church job - the list of music for upcoming worship services. So, I started this project earlier and it's been a bit of a chore. I've got to get this finished, so just a bit of talk... I guess I'll be a bit later to work than I've been recently.

I am still waiting to find out if I will be having surgery next week or not. It's dependent upon two things - a clear chest x-ray and the surgeon's okay. I don't have either of those things right now.

My last group today is my most contentious group all of the time. I'm already dreading them. We'll see what happens this afternoon.

See you tomorrow!

Tuesday, September 29, 2015

It's Tuesday, Isn't It...

I know I've posted this before, but I'm going to do it again.

This is my process for writing TMEs...

The first thing that you do is to focus all of the TMEs that you write on the primary goal. Ask yourself the following questions when you are developing a TME:
  1. How does this TME address impulse control? (Do students have to raise their hands for attention or a turn? Do students have to listen for a musical cue to respond? Do students have to complete an entire pattern before progressing? These are just suggestions, there are many more ways to define impulse control that I cannot list here)
  2. What are the additional skills and goals that you are addressing? Does the TME work on any of the secondary or tertiary goals that are listed above? Does it address other skills or goals? WRITE them down!
  3. What are the expectations that you have of the clients? (These include: what level of functioning does the TME need for successful completion? Where will clients be in the music therapy room?
  4. What are the prerequisites for the clients to be able to participate in the TME? (What do they need to know before they will be able to complete the TME? Are they going to have to sit? Will they need to wiggle a while before they can concentrate on the TME?

How to write TMEs

This is not intended to replace any information that you have learned in your coursework, but it is intended to clarify some of the elements of TME design that you may either not be familiar with or that will make implementation a bit easier on you.

Components of Therapeutic Music Experiences (TMEs)
TMEs are comprised of several parts, all of which need to be planned prior to the session. These components include the purpose, the desired outcome, materials, the environment, the client, the therapist, the music, and the therapeutic relationship. Each component is as important as the others.

TME Plans: Plans define the process of the TME, provide a framework for the therapist, and illustrate the use of music and the influence of music on the client.

Purpose: This is the goal portion of the TME. Why would you use this TME in a session? Is it for a specific purpose? Does the TME serve to indicate the start of a session? How does this TME address impulse control? Does it also encourage motor development, communication, social interaction, emotional development? What domain does the TME address (motor, social, emotional, communication, academic, cognitive, behavioral, musical)?
  • List all of the domains that are addressed by the TME under the purpose statement
  • Goals are the big picture – umbrella topics
  • Be specific with your purpose statements – “To increase motor development” is not as complete as “To increase upper extremity range of motion” or “To increase fine motor pincer grasp.”

Desired Outcome: This is the objective portion of the TME. Why would you want to use this TME with a client? What skill will the client be able to demonstrate when this TME is completed? Why is this skill important for the client? Is this skill important for the client? If not, then why are you bothering using the TME in treatment? Goals are the large picture, while objectives are specific for each client and are designed to change over time.
  • Target behavior to determine when the client has completed the task – “Clients will demonstrate pincer grasp and release pattern four times during the TME.”
  • There may be several outcomes depending on the number of purposes that you have identified in the first section. This will allow you to use the same TME in groups allowing you to address many goals simultaneously.

Materials: What will you need to have to successfully run this TME? Do not forget electronic equipment, power sources, instruments, props, visual aids, and/or alternative materials.

Environment: Where do you want the clients to be? Do they need to be in specific places in the room? Do you need lights or darkness? Do you need clients sitting in chairs or on the floor? Are there any other environmental aspects that you will need to change?

Music: What music will be used during the TME? Is it original music? Is it prerecorded music? What CD, what track, and what performers? Where did you get the music? Where did you learn the music? If someone else composed it, include all the details – who, what, when, and where you can locate the original. If you composed the music, include all of the information located above with a copyright symbol © with the date of composition.

Therapeutic Function of Music: What function does the music serve in the TME? If the music would disappear, would the client still be able to complete the TME and reach the desired outcome? If so, is the presence of music necessary for the TME? If the presence of music is not necessary, then why would you use this TME in a music therapy session? (It may be appropriate to use the TME, but this is the time to think about why it is important to make music an integral part of every activity/intervention.)

The Client: What type of client will be able to complete this TME? Will many different clients be able to participate the way the TME is designed? Will some clients find this TME too difficult? Too easy? How can you change the TME to accommodate many different clients? How can you change the TME to accommodate different learning styles and interest levels? How much of the TME will be decided and directed by the client?

The Therapist: What do you need to do before you can run the TME? Where do you need to be located during the TME? Will you need to move around the room? Will you be able to remain in a chair? What music do you need to have memorized? Where will you need to place materials so you can access them during the TME? What alternative TMEs or materials do you need to have prepared just in case? What tasks do you have to do during the TME (data collection, preparation for the next TME, switching CDs)? Where is your focus? When will it be important for you to encourage the client to make decisions? When will it be important for you to make decisions for the client?

  • Step-by-step instructions for leading the TME with clients
  • Remember to include the music when it enters
  • Remember to reinforce desired responses
  • Include a data element – what will you be evaluating? When will you evaluate? How will you evaluate? How will you record the data?
  • What will you do, as the therapist, to facilitate the TME?
  • What do you expect the client to do? What will happen if the client does not do what you expect? How will you get the client to complete the task or outcome of the TME?

I think of this procedure as a flow chart. This concept helped me understand exactly what the folks at KU wanted me to write. I was not able to complete this task until I stumbled upon this visual format. If the flow chart idea interests you. Ask me for an example. I have a couple of TMEs diagrammed in this manner. It takes a long time to diagram, but if you are a visual learner, it makes sense.
There you go! Happy Tuesday.

Sunday, September 27, 2015

Supplemental Sunday: Books for the Little Bits

I am constantly on the lookout for things that reinforce musical concepts, present songs, or engage my clients in musical expression. If I can find them for less money, GREAT!

Today's supplemental is a bunch of little books that I found at the Dollar Tree - 3 for $1.00! Can't beat that price! They are Sesame Street themed with Elmo, so I only use these with the Pre-K to K groups. They have wonderful illustrations and processing prompts on every page. I have lots of them - 15 different titles to be exact - and my young students enjoy them.

Now, these are not for group consumption. As you can see with the mini mouse for comparison, these books are palm-sized. They are great for children to read on their own or to share with one other person. Since the songs are pretty familiar, kids can sing them independently with a couple of repetitions. (Some of the songs have different words after the initial presentation.) The books are board books, so the pages are really thick and difficult to bend, though it can be done!

I use these for quiet interactions, relaxation sessions, and sharing songs with others. They lend themselves well to word recognition, sound production, and predictive verbalizations. The questions that are part of the story lend clients into vocabulary work and some expressive language skill development as well.

My recommendation? If you find something like this that can address client goals and objectives, snap it up! Get as many as you can because you never know when they will be gone. I'm glad that I buy these when I find them at the Dollar Tree - often they are gone when I go back to the store. 

Ta-da! Mini books for youngsters!

Saturday, September 26, 2015

Inspiration Needed...

I'm going to go on an inspiration odyssey today.

I'm in the need of something to spark some interest, some creativity, some thought process. It's been a struggle lately to think, but I know that thoughts and ideas that you come across at any given time can sprout and grow at the most inconvenient times. (That's why I always have Post-It Notes nearby, even when I'm driving!!)

I am going to avoid Pinterest. Pinterest tends to be more interesting for me when I just want to be entertained, not when I have a goal in mind. When I have a goal in mind, Pinterest just makes me feel inadequate. So, no Pinterest today!!

Music is always good for inspiration. I was watching the Teen Beach Movies yesterday (I know, but they are mindless and silly), and I remembered that I had the soundtrack from when I had a student who was obsessed with the music. I listened to the songs again, and found that I could probably adapt them and use them with clients (well, duh!). My computer is set up and ready to go for music listening.

My books are also great for inspiration. I have many books. (Somewhere my parents have just been overcome with giggles at the idea that "many" adequately describes my book hoarding problem.) I have poetry books, music therapy books, fiction books, craft books, nonfiction books, and music books of all genres. 

I also have toys, instruments, games, and many other things that I go to when I need inspiration. Brainstorming all of the sensory benefits to something is a good way to start creativity going.

In the next year (October 2015 to September 2016), I want to do the following music therapy things:
  • A new webinar series for Internship Supervisors
  • Development of the singabout song series
  • Donation of my materials to various music therapy organizations
For the moment, I am going to go out in this dark morning to grocery shop. I'm going to keep an eye out for things that inspire me to think differently or more deeply. You never know, while strolling through the cheese aisle, you may just have the next great song pop into your head. 

Friday, September 25, 2015

Favorite Things Friday: Introducing Mildred

I'd like you to meet Mildred. Mildred is the newest member of my personal circle, and she provides me with "gentle strength." This cage of bars, neoprene pads, hinges, and velcro has supported my knee for the past month, and has at least 10 more days to go before Mildred is set aside (for at least a short time) in favor of Arnold, my immobilizer.

Isn't it amazing that we have devices and things like this available to us when we need them?

I just marvel on this fact. In the old days, an injury like the one I have would have pretty much been a permanent thing. I would be limping and on crutches (at least) for the rest of my life. These days, I go in for a 6-hour surgery and voila! I start working that new ligament so it can work properly.

One of the interesting things about Mildred is that she is an attention-getter. When I'm not working, I go out in my shorts because pants are just too hot and skirts are too fluffy for Walmart. I am amazed at how many people have stopped me to discuss my injury all because they saw Mildred attached to my leg. I can't go anywhere without engaging in discussions with complete strangers about where I am in my treatment process. Everyone thinks I'm post-surgery, but I am not. Then, they often offer less than helpful information about recovery and physical therapy which makes me want to escape as quickly as I can...BUT, with my injury and Mildred attached to me, I can only go about 1/3 my regular speed these days. It makes escape difficult!

I am grateful for this device which helps me move around the world. I am ready to get fixed, however.

I'm taking yet another sick day off from work because my leg hurts, and I'm tired - absolutely exhausted - so, I'm off to nap!

See you tomorrow.

Thursday, September 24, 2015

I Just Hit the Wall

I hit the fatigue wall today.

I overextended yesterday and actually went to both of my jobs. I didn't get into bed until late (for me), and then had to call my parents and my sister. My sister was in a bit of a tizzy about a decision that someone made about her role at her school, so I stayed awake until she had something figured out what to say and an idea of how to approach the people involved. Once she found her way, we hung up, and I fell asleep immediately.

This morning I awoke right before my "alarm" light turned on. I flipped over and went back to sleep for another hour - again, not at all like me. I had to force myself to actually get up and get my morning routine started. I really want to stay at home, but I am running out of sick time and don't know for sure if my worker's comp claim will kick in to pay me while I am considered "Temporarily Totally Disabled." I certainly don't want to owe my school district part of my salary due to an injury that happened at work.

Tonight is my webinar for interns on self-care. We'll be talking, as we always do, about the importance of taking care of ourselves in ways that will help up avoid situations like compassion fatigue and professional burnout. Unfortunately, I am finding it all too easy to talk about the patterns of behavior that lead us into these situations. I am having some difficulty finding my way back into health, but my current situation is not completely due to my lack of self-care - I've been helped in my decline. I just have to be more cognizant of listening to my body as well as to what others suggest.

Tomorrow I have nothing to do while I am at school (other than get my documentation finished, plan next week's sessions, and try to figure out how to organize my messy clinical space) and then talk to parents and sister before going to bed. I can also spend most of the day on Saturday napping in between running the dishwasher and laundry loads.

Time to peel myself off the wall I just splatted on and get going. I'm not stressing (too much) about the fact that I'm not getting much done with my time these days. It's about all I can do to keep myself awake. 

Music therapy sessions have been comprised of drumming to Planet Drum (love Mickey Hart's world music compilations), brushing and scarf play, and playing Instrument Memory games. All things we can do with a limited amount of breath support and interference from the therapist. 

Things have gone pretty well, but yesterday's afternoon session was a mess - less of a mess than in other sessions, but not as good as the last several sessions. Seven kids aggressed on someone else. Only two were able to keep their hands to themselves. Sigh. That's probably contributing to my fatigue - you think?

Take care of yourselves, and I'll try to take care of myself. See you tomorrow!

Wednesday, September 23, 2015

Currently, I'm...

Reading... Imitation in Death by J.D. Robb. I'm also looking at starting Learning & Memory: The Brain in Action by Marilee Sprenger
Playing... not much. Candy Crush Saga every so often.
Watching... Miss Fisher's Murder Mysteries
Listening To... Miss Fisher's Murder Mysteries
Working On... finding motivation and energy to get things finished on this day
Eating... nothing yet
Drinking... water. Always water.
Wanting... energy to get things done
Needing... a spark
Loving... the fact that my clients missed me while I was sick
Thinking... that two weeks is a short period of time
Feeling... nervous, scared, apprehensive, excited, and ready to be fixed!
Celebrating... being able to breathe without coughing every single time!
Grateful For... all of the things easily available to me since I am this person, in this place, at this time!

Tuesday, September 22, 2015

TME Tuesday: Oh No!

Today's TME is one that I composed several years ago for a bunch of students who loved it when things went wrong! They would engage if there was some sort of calamity happening! My drama skills came in handy as well!

Therapeutic Music Experience
Oh No!
 Mary Jane Landaker, MME, MT-BC

Purpose: To increase object recognition; to address directive-following

Source: Original song. © July 8, 2008 by Mary Jane Landaker, MME, MT-BC

Materials: Instruments to hide around the room; containers to hide things

Environment: Variable


Oh no, oh no, oh no, oh no!
Where did it/they go, it/they go, it/they go, it/they go?
Help me find the egg shaker(s). Look in the box.

Replace underlined words with other objects and directives.

Procedure: R = Reinforcement opportunities; C = Redirection/Cue opportunities; A = Assessment
  1. Start singing song, using objects in the music room
  2. C=Using song lyrics, direct clients to objects
  3. A=Expect clients to move around the room to find and indicate specified objects
  4. R=Reinforce correct responses through eye contact, facial expressions, and brief verbal reinforcement
  5. R=Redirect incorrect responses through changing the lyrics or adding nonverbal emphases to indicate locations
  6. Change object and location to repeat the verses
  7. Ask clients to take over the leadership and sing the song
  8. Repeat steps 1-6 until clients show signs/symptoms of disinterest or time runs out

Therapeutic Function of Music:

  • Use song for Instrument Hunt TME
  • Use song as alternative to I Spy TME
  • Use song as format for Hot and Cold TME
  • Use as a closing/transition song (see below)

Oh no, oh no, oh no, oh no!
It’s time to go, to go, to go, to go.
Time to walk to Room One.
Help me get to Room One.