Music Therapy for Multisensory and Body Awareness in Children and Adults with Severe to Profound Multiple Disabilities

The MuSense Manual

Roberta S. Adler, Olga V. Samsonova-Jellison

• Publisher: Jessica Kingsley Publishers
• Year: 2017
• ISBN:
  9781784504472
• Topic: Psychologie
• Subtopic: Psychotherapie

This book offers the practical, ready-to-use MuSense program. Originally designed for music therapists working with individuals with profound multiple disabilities, the MuSense program provides comprehensive guidance to music therapists on how to effectively work with individuals whose needs can be extremely difficult to meet.

Containing a robust, structured, evidence-based protocol of music therapy, and supported by case studies throughout, this book is also an essential resource in treatment planning for other diverse populations needing to develop enhanced body and sensory awareness.

Part I

Sensory Development and
Detours on the Road of Life

Chapter 1

The Building Blocks of
Sensory Processing and Body
Awareness Development

The fundamental paradigm

American doctors know how to deal with emergencies better than anyone else because the healthcare system in the United States is based on the acute care model. The United States leads the world in providing acute medical care. However, this system disappoints and creates a burden of suffering when it comes to the treatment of chronic conditions (Hyman and Liponis, 2003). In conventional medicine, most treatments are geared towards relief of symptoms, providing comfort to a patient while the patient’s body heals itself (Schneck and Berger, 2006). When healing of the pathology is impossible in cases of incurable conditions, treatment is still symptomatically driven. It targets the enhancement of tolerance and activities of daily living rather than focusing on the biological causes of the illness or helping the patient to adapt to the reality in which he or she has been forced to live (Hyman and Liponis, 2003; Schneck and Berger, 2006).

People with severe to profound intellectual and developmental disabilities are one example of those with chronic conditions who do not fit into the acute care model system and do not respond to conventional medical treatment. Based on years of clinical practice, the authors have concluded that this clinical population has a unique set of needs and therefore requires a different approach in the planning and provision of their care. Furthermore, it requires a distinct and specific understanding of how the treatment may work and may be delivered. After careful consideration, the authors decided to subscribe to the following paradigm developed by Daniel Schneck and Dorita Berger.

1.Human bodies act only according to the information they receive from the external and internal environment through their sensory system.

2.The received information is evaluated through instinctive, emotional pathways concerned with maintaining the stability of the internal environment or homeostasis.

3.There is a finely tuned control mechanism in the human body that maintains the body’s functioning close to the predetermined set points of homeostasis.

4.Our bodies respond to continuous internal or external, environmental, non-life-threatening stimuli with a change in the body’s homeostatic set points. This process is called physiological entrainment.

5.Applied with intention and consistently, a structured stimulus (such as music and its various components) can lead to habituation. This, in turn, can result in alteration of the homeostatic set points.

6.The nature of dynamic interactions between musical elements, such as rhythm, melody, harmony, timbre, dynamics, and form may be used for creating clinical programs attending to populations with special adaptive needs.

(based on Schneck and Berger, 2006)

It is the authors’ belief that effective therapeutic interventions are based on the fundamental principles of human anatomy and physiological function. Thus they are designed to support human biological development, stimulate the body’s adaptive self-healing mechanisms, and help the body to transition from a less desired to a more effectual physiological and psychological state.

Sensory processing, integration, and awareness

Let us now take a close look at sensory processing from anatomo-physiological, neurological, developmental, and social perspectives.

Sensory processing

The term sensory processing describes the way in which bodily sensations are detected, transduced, and transmitted through the nervous system (Roley et al., 2007). The human body has various organs that are sensitive to specific forms of information emerging from internal and external environments. Schneck and Berger (2006) use a technical term, ceptors, for five well-known sensory organs—eyes, ears, nose, mouth, and skin. The ceptors’ job is to regularly check on how well the body is doing on satisfying its basic physiologic needs and to constantly keep the central nervous system (CNS) updated on what is going on inside (interoception) and outside the body (exteroception) in order to ensure that the body is functioning within its intended operating set points (homeostasis). The ceptors convert, or transduce, the outside energy into different, electrochemical energy because this is the coded language recognized by the central, peripheral, and autonomic nervous systems. Present-day anatomy and physiology offer a more complex schematic than a traditional five-sense formula. They divide the anatomical transducers into two types—special senses and general senses. The special senses have their respective transducers located entirely in the head and are associated with the 12 cranial nerves without passing through the spinal cord. Also, the senses of hearing and of balance and equilibrium are often combined into one because of the close anatomic and physiologic association. The following table permits a very brief excursion into the physiology of the sensory system.

TABLE 1.1 THE SENSORY SYSTEM
The senses	Anatomical organs	Types of energy	Transmission pathways
The special senses (exteroception)
Olfaction/smell	Nose and rhinencephalon in the ancient archipallium (the oldest part of the brain, the first cranial nerve)	Chemical (molecular, thermodynamic)	An olfactory membrane with olfactory neuroepithelial receptor cells, olfactory vesicles, olfactory sensory neurons, the first cranial nerve, the olfactory bulb, the midbrain, the limbic system, the orbito-frontal cortex—conscious perception (almost instantaneous)
Gustation/taste	Mouth, tongue and cranial nerves V, VII, IX, and X	Chemical, solid, and/or liquid	Taste receptor cells, testant-receiving protein-binding sites and ionic channels, gustatory sensory neurons, medulla, cranial nerves V, VII, IX, and X, posterior thalamus, parietal lobe of the cerebral cortex—conscious perception (almost instantaneous)
Audition/hearing	Ears—outer, middle, and inner ear, the Organ of Corti, the eighth cranial vestibulocochlear nerve	Acoustic, in the frequency range from 20–20,000 cycles per second, kinetic molecular	Auditory canal, tympanic membrane, auditory ossicles of middle ear, basilar membrane and cochlea of the inner ear, neuroepithelial hair cell receptors, the Organ of Corti, auditory nerve endings on left and right cochlear branches decussate, the eighth cranial vestibulocochlear nerve, the auditory cortical area in the upper part of the temporal lobe, specialized receptive fields—conscious perception of the source and direction of a sound, basic frequency or pitch, timbre and intensity (awareness) is not instantaneous
Vision/sight	Eyes, retina, the second cranial nerve for vision, cranial nerves III, V, and VI for eye movement	Light, in the range of 390–790 terahertz range, electromagnetic atomic	Cornea, anterior chamber of the eye, the pupil, crystalline lens, focal point on the retina, highly specialized photoreceptor cells—rods and cones for brightness and color perception, optic nerves decussate carrying digitized bits of information to the visual cortex, decoding in specialized receptive fields—conscious perception of a seen picture (awareness) is not instantaneous
Balance and equilibrium/proprioception, kinesthesia, myesthesia	Muscle spindles, muscle tendon receptors (Golgi), joint receptors, and inner ear parts: semicircular canals, otolith organs, vestibule, eighth cranial nerve; connected with general tactile sense organs	Kinetic energy: gravity, inertia, angular motion, linear motion, stretching, bending, deformation	Semicircular canals, endolymph, cupula, hair-like sensory-receptor cells, sensory nerve fibers in crista acustica, vestibular branch of the eighth cranial nerve, vestibular nuclei, medulla and pons of the brainstem/the vestibular system signals help to maintain the tone of antigravity muscles by alternating activation of the monosynaptic reflex arc (MSR)—unnoticeable and imperceptible
The general senses (extero- and interoception)
Touch/taction pain/nociception	Skin—the largest organ in the body, sensory receptors responsive to different tactile sensations Mechanoreceptors, volume receptors, thermo receptors, chemoreceptors	Mechanical energy: compression, tension, pressure, torsion, vibration Thermodynamic energy: heat, cold, body core temperature Electromagnetic (atomic) energy: piezoelectricity, streaming potential Chemical (molecular) energy: osmotic pressure, acidity/alkalinity, lactic acid, water, glucose, sugar Pain	Skin receptors, dorsal roots of 31 spinal nerves, spinal cord, signal decus...