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  • Sarah Cowan

Mily's Story

Mily has been a client of mine here at NMTSA for over 4 years. She is 11 now and has a list of diagnoses including epilepsy and cerebral palsy. In neurologic music therapy, the therapist can focus on motor skills, speech and language, or cognition, all of which are things which Mily works on as a part of her therapy schedule. So, therapy with Mily has always been an effort to use music in the most efficient possible way. With just one hour a week together, we want to focus on the skills that will have the biggest impact on her life outside therapy.

Mily began therapy with goals to improve her gait parameters and sustained attention. I used Rhythmic Auditory Stimulation (RAS) to even out Mily's gait. When she walked, she used to spend more time on one foot than the other due to her right-sided weakness. In therapy, we worked to find a metronome cadence that would best facilitate even steps on both sides. Due to Mily's hard work here and in her physical and occupational therapies, her steps are now much more even. This goes a long way toward preventing injury as she gets older, as well as increasing her ease in walking. Even steps mean easier steps, which means more time to play before she gets tired!

One of my favorite parts about working with Mily is the amazing communication I have with her family and her therapy team. Her great-grandmother, Ginger, sends me every bit of paperwork she can on Mily, from her IEP updates to her speech therapy reports to the results of any recent testing.

The best example of this was our decision in 2018 to focus on cognitive treatment only. Mily had a neuropsychiatric evaluation that changed our focus. It was found that Mily's frustration tolerance was the main barrier to assessment of her needs, and her progress in other therapies. Some of the assessment measures could not even be administered because Mily got frustrated, got emotional, and stopped participating. This happened when a task became too cognitively difficult or required too much attention or memory. The physical therapist could provide the best exercises in the world, but it wouldn't matter if Mily wouldn't do them or couldn't remember the directions.

So we stopped working on motor skills and really focused on cognitive skills such as attention, memory, and executive functions. We played games with instruments in which Mily had to listen to a partner and change her playing to match. We had her remember rules such as "play the drum, but then play the bell if you hear this special sound". We listened to songs and counted how many times she heard certain sounds or words. We tried new instruments and noticed which ones she played the longest. We memorized new songs. She played music games at home. And as we worked, Mily became more flexible, more easygoing, and more teachable. She took in new information more quickly and became distracted less often. She let others be "in charge" without becoming overwhelmed. Mily was developing naturally, helped along by a cognitive focus in her weekly NMT sessions.

Mily still loves coming to music therapy. Her favorite thing to do right now is to invite others into the clinic to take turns being the leader in attention exercises. She doesn't forget the rules mid-exercise anymore, and she loves passing the leadership to her great-grandmother (or another client parent she has convinced to come in from the waiting room!). She's come a long way from "Is it my turn yet?!" and "I want to do something else!!", all because her treatment team was able to choose the best use of our weekly sessions.

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