Neurologic Music Therapy (NMT) has had an important role in our son’s progress, helping him to acquire skills he was not able to gain with the other therapy modalities. Tony has been receiving services at NMTSA since July of 2015. In that time, he’s worked with 5 therapists, many of whom moved on to higher paying opportunities. Our current fantastic habilitative therapist, Emily, was the NMT therapist Tony had worked with the longest. When she left NMTSA and took over as his habilitative therapist, our little man (like many families receiving therapy there) experienced a six month gap in music therapy services while their team worked hard to find another qualified therapist willing to work for the lower level of pay necessitated by the DDD reimbursement rates. As we have previously discussed, most music therapy clinics in the metro area no longer accept DDD benefits as the reimbursement rates have been too far below the cost of providing services.
For seven months now we have been working with Jessi, his new NMT. I was thrilled when I found out she would be his new NMT therapist because Tony had worked some with her during her music therapy internship. I knew he would recognize her and that this would increase his willingness to work with her during earlier sessions, which are often a fairly difficult period of transition when he is unfamiliar with a therapist. Jessi has been doing a fabulous job working with Tony and our family, and I love how she speaks to Tony in a way that expresses her confidence in his ability to learn.
In our first session, she told me that because of the length of the gap in services, she had made a decision to base her current treatment goals on her observations of the first few sessions and Tony’s current needs. I am going to use many of her own words from her October 2019 treatment plan and progress report that was submitted to our little man’s support services coordinator. I will also share some of what we are doing in our sessions to advance Tony’s progress in these goals.
“Neurologic Music Therapy (NMT) is an evidence-based, therapeutic application of music to address cognitive, sensory, and motor dysfunction. It is based on a neuroscience model and its techniques have been developed via data from scientific and clinical research. Its effectiveness is based strongly on the biological mechanisms of rhythm. Rhythm has been clinically shown to prime and organize the motor system, facilitating greater fluidity and control of movement. Within individuals with sensory difficulties, rhythm has also been shown to provide a temporal structure for more effective processing and integration of sensory stimulation. This allows Neurologic Music Therapy to facilitate change at a neuronal level in the areas of cognition, language, and motor learning.” (Jessi, NMTSA therapist)
Currently, the two main NMT interventions being used for our son are Auditory Perception Training (APT) and Developmental Speech and Language Training Through Music (DSLM). “APT includes auditory perception and sensory integration. It is composed of musical exercises to discriminate and identify different components of sound (e.g., time, tempo, duration, pitch, timbre, rhythmic patterns as well as speech sounds). It involves integration of different sensory modalities (visual, tactile, kinesthetic) during active musical exercises…or integrating movement to music…DSLM is designed to utilize musical, as well as related, materials (e.g., singing, chanting, playing musical instruments, and combining music, speech, and movement) to enhance and facilitate speech and language development in children with developmental speech and language delays.” (Tony’s quarterly Treatment Plan, October 2019, completed by Jessi, referencing Medical Coding and Records Manual for NMT; Oliver, S.E., Thaut, M.H., Sena, K.M., 2005)
Tony’s current NMT treatment goals are as follows:
#1) “Tony will demonstrate increased emotional flexibility and increased adaptability while engaging in activities directed by others for 75% of opportunities…During this quarter, Tony presented with similar behaviors as last quarter that included darting, hitting himself, banging his head against the wall or floor, crying yelling, and pushing his head into his mother’s knees when challenged with switching up his previous routine of activities during sessions. This occurred when he was told ‘no’ or ‘yes, but not yet’ to various activities that he had requested. His mother expressed a desire for Tony to be more flexible…in order to strengthen his overall flexibility throughout daily life at home and in the community…When Tony was engaged in the evidence-based practice of Auditory Perception Training (APT), his self-regulation increased significantly and he was able to engage in activities directed by others.” (Jessi)
#2) “Tony will demonstrate spontaneous use of communication device and/or speech sounds to communicate with others for 70% of opportunities…During this quarter, it was observed that Tony’s communication increased dramatically…His spontaneous communication was mostly executed using his communication device, yet there were many times he would access his voice to indicate what he wanted or how he was feeling, especially when paired with vestibular input. Sometimes when giving a response Tony still had trouble formulating certain phenomes as well as full words…When Tony was engaged in the evidence based intervention of Developmental Speech and Language through Music (DSLM), he used more effort on successfully formulating his phenomes. He also accessed different buttons on his communication device.” (Jessi)
Shortly before this treatment plan and progress report was written in October, Jessi let me know that NMTSA had a volunteer (Paulina) who might be able to join in on some of our sessions. The therapeutic goal for this is to decrease my involvement in some of the sessions so that Tony could further practice generalizing cooperation to others. I asked for a picture of Paulina so that I could help adjust Tony to the idea, and she worked with all of us together for a few weeks. Our next step will be to remove me from the session for about 15 minutes and have our little man work exclusively with Jessi and Paulina.
Tony actually met his communication goal last quarter, but Jessi decided it would be a good idea to maintain it as-is for the time being as he was experiencing aggression secondary to the brief period of time he was taking Sertraline. This made him more agitated and less cooperative across every therapy setting for several weeks.
This is the part of the power of Neurologic Music Therapy. NMT has helped my son to move from being unable to maintain a stable walking gait and falling dozens of times a day to fluidly maintaining sustained movements in even the most stressful of environments for him (from the sensory perspective). NMT has helped dramatically improve our little man’s emotional regulation and ability to tolerate public spaces. And, NMT is helping to improve his ability to communicate.
This is why, in my opinion, failure to adequately fund this therapy modality (thereby decreasing the number of providers able to make it available to anyone who can’t afford to pay the cash value out-of-pocket) is doing more long-therm budgetary harm than good when it comes to funding services for the developmentally disabled. Every skill individuals like my son gain not only increases the quality of life for everybody involved, but also decreases the cost of providing care over the course of many years of what can be a very long life.
I am given to understand that while DDD was able to raise the music therapy pay rate some this past October, the rates being offered still aren’t sufficient to cover the costs of providing these services. As I write this, families of loved ones receiving services through NMTSA still remain uncertain how long they will be able to use DDD benefits to obtain these life-improving services. The board of directors at NMTSA will have to consider many factors, including if fundraising will be enough to offset the difference in what is needed and what is being reimbursed.
Because NMT has brought our family so much hope in the past few years, we wait- and we hope for better news about funding concerns. We honor Jessi and Paulina for their patience, and for helping move our little man forward. And as always, we honor Suzanne for her commitment to do everything within her power to advocate for continuing access to NMT therapy for individuals receiving Arizona DDD benefits.
