Safety Dance

Until this internship (and I bet this is the same for other MT majors), I had not been in a situation where I needed to worry about a pt's. safety. The closest to that was with the babies in the NICU, but the only thing I had to do was not drop them. Not too hard.

Here... it's a lot different.

In our textbooks, there is a little bit about kids with lots of lines and tubes, but what happens when you are working with a 2 year old who wants to run around & twists those cords all around himself or presses buttons on his IV pole? We talk about impulse control in a verbal sense all the time (saying the first thing that pops into your head, no filter, etc.), but what happens when that impulse control translates to a 16 year old (who absolutely towers over you in the height department), who walks with someone holding onto his gait belt because of balance problems, decides to stand up and walk to the CD player with no warning whatsoever. I'll tell you what happens: this intern jumps up like someone lit a fire under her.

Situations like these call for some "creative positioning". For the first friend I mentioned, sometimes distracting him while throwing a blanket over the pole works. Out of sight=out of mind. For my other friend, I had to stay pretty close to him at all times so that I could jump up and grab that gait belt, and there were a lot of verbal reminders to this kid to get him to remember to say something before he stands up.

Now both of these kiddos had one-on-one supervision at all times so that they didn't hurt themselves, but that can be a lot to handle for just one person! I can assure you that my reflexes have never been sharper. Above all, when working with someone where safety can be an issue, proximity is KEY to keeping those kids from inadvertently hurting themselves. These issues are just another thing that my brain is learning to make room for in addition to the Music Therapy portion of the session. Like, if you are playing the guitar and singing and dancing with your little friend, how are you going to move it out of the way quickly enough if your pt. decides to pull out his PICC line?

Just some food for thought on this lovely Monday.

The Best Purchase Ever

This post is all about one of my most treasured possessions and best purchases outside of my instruments! It's my "Musician's Notebook". 

I got this from Barnes & Noble about 2 years ago. This lovely little journal where I write down all the little songs I make up for my Music Therapy sessions. There are 40 pages that look like this:

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There is a place for the title, a staff for the melody, 3 lines for words in multiple verses, guitar chords, guitar tab, and piano accompaniment. I don't use the last two things very much, but they are an option if you want to! Also, at the back of this book there are about 6 lined pages where I write the words to all of my "piggy-backed" songs.

At the bottom of every other page, there is a music quote by some of the most prolific musicians and songwriters of our time, talking a bit about their process or beliefs. These are some of my favorites:

~"Those first five or six songs I wrote, I was just taking notes at a rock concert that was going on inside my head. And once I had written the songs, I had to sing them."- Jim Morrison

~"A great song is more than just words and music. It's like a thumb pressing against the pulse of living that relates a simple truth about a very complicated process."- Jimmy Buffett

~"I don't want audiences to feel a specific thing- I just want audiences to feel."- Paul Simon

~"I wish it would last forever, but as long as I am able to sit with a guitar on me lap, not even to sing to people but just sing to myself, then I'll be alright."- Noel Gallagher

I love this notebook. It is pretty thin, so you can take it anywhere, and it is PERFECT for all of my Music Therapy friends. I am pretty close to filling mine, and I will definitely be getting another one! Also, it cost $5.95. That's it. Less than 6 bucks and you have a notebook that is designed to hold a bunch of short little songs and compositions! And it's on recycled paper. Write music and save the earth? This is a no brainer, people.

"My music will go on forever. Maybe it's a fool to say that, but when me know me facts me can say me facts. My music go on forever."- Bob Marley

the Middle

Hello Friends! Now I am on my third rotation, yes third, and I am working with a lot of little ones and babies. "Hi, friend!" is how I start a lot of my sessions.

As of over a week ago, I am halfway through with my internship! It is absolutely crazy to think that I have been living and working in Kansas City for over 3 months. In honor of reaching my midway point, I thought it would be fun to come up with a list of things all future interns should do or have BEFORE they start. Some of these I had, some I didn't. Here it goes:

1.  Practice guitar regularly, and for more than 15 minutes at a time: I feel like everyone says that, but it's true. Especially when doing procedural support, I play a ton of guitar. It's important to build up those callouses on your fingers so they don't feel like they are going to fall off by lunchtime!
2. Have lots of layers: Super important when you are working anywhere that has multiple units, different classrooms, etc.
3. Have comfortable, sturdy, washable work pants: So far I have been drooled on (a lot) and had IV fluid leak onto me, so washable and not super expensive/nice pants are ideal! Having to get those suckers dry cleaned would have been no fun.
4. Comfortable shoes or insoles.
5. An open mind about everything, especially music. No matter where you are in your internship, you are going to have to know a number of different genres! I have had kids request everything from Justin Bieber to Johnny Cash. And Patsy Cline.
6. A big, fat notebook: You need a place to write down songs, tasks, interventions, ideas, etc that you might come up with off the top of your head, and things you will learn from your supervisors or other interns.
7. A journal or some way to record the awesome moments you are going to have in your internship
8. A way to de-stress. Sometimes your day is not going to be perfect and bright and shiny, and being a music therapist full time is way different than only having one or two practicums a week. It is important to have something to do to unwind that is positive. Or make a book of things that make you happy, like positive quotes, memories, and Music Therapy moments!

I know, they are pretty much what you hear from everyone, but they are important things to have. I wonder if my other intern friends have any tips they would like to add...

Happy preparing!!

Blame it on the goose...

I have a kid who I love to pieces. A teenager, I love working with this pt. My friend has made such tremendous steps since I first saw a session, it is incredible. Today... started off a little rough.

The session began a little late because pt. was upset (understandably so and totally normal) about being in the hospital. It sucks having a TBI and being stuck in the hospital away from you friends and you can't convey what you want to say because of this pesky little thing called aphasia. The PT I was working with kinda led the first interaction with this pt, so she gave him some time to calm down before therapy. We started with him selecting a song from the ipod to listen to while he walked on the treadmill. Slowly he started bobbing his head to a Lil Wayne song (very slightly). Soon he was ready for another tune, and selected one that he picks a lot: "Blame It" by Jamie Foxx. You could tell as he was walking that he started singing it in his head a little. His hands started moving to the beat, and that carried through his whole body and demeanor. THEN we hear from someone working with another pt in the gym, who had not been a fan of therapy today, to turn it up so this kid could sing along. No more talking about the pain this pt was in, it was all about this song for a few minutes. One of my other friends in the gym stated singing along too, and it was just a little jam session.

From there, my pt. was in a better mood (not all bright and smiley) and decided he would like to do some drumming. Now we know he has access to a CD player, and naturally I put this song on the CD I burned for him.

So this is my "thank you" to Jamie Foxx for releasing such a ridiculously catchy song that it got one of my pts. to feel a little better and want to do some therapy AND got all the other kids in the gym to sing along. From all of us in the MT department at my hospital, thank you Jamie Foxx, thank you.

iPad Nation

I promised to post about this lovely piece of new technology a while ago. Sorry it has taken so long!

 Our MT department now has an iPad to share between all of us for use in sessions. We live in an era obsessed with technology, and many of the kids we see have seen an iPad before, or love computer and video games. What I really love about the iPad is that you can do everything by just touching the screen, which is great for kids with limited UE use, or the use of just one hand, etc. And, since many kids are so used to computer games and the like, it makes for a GREAT distraction tool during Botox treatments and dressing changes, especially because the kids want to know what comes next, and what that pig is going to do if you tap on it. But, what does this have to do with Music Therapy?

Well.... there are a ton of awesome music-related apps for the ipad that are great for working with kids and teens alike. Some of my favorites (and a bunch are free!) are:

• Songify- Record yourself saying something, and the program puts in autotune and turns it into a song! This is especially great with computer-minded kids who are working towards articulation and speech volume goals in ST.
• Falling Stars- You click on different icons and drag to make different vines across the screen, then click on stars. The stars fall, hit the vines you made, and make music!
• Rhythm Racer- You move a spaceship around to catch different colored balls of light to get points. There are 2 different ways to move the spaceship. One way is to drag your finger across the screen (fine motor) and the other is to tilt the whole iPad (gross motor). Both are pretty tricky!
• Garage Band- On the iPad it's a tad different than on the computer. They have some pre-made loops, but it's more about you making your own beats, tunes on guitar, piano, or bass, and recording your own stuff. I especially like using it with teens.
• "Old MacDonald", "Itsy Bitsy Spider", and "Wheels on the Bus"- all interactive song books. I absolutely love them. Kids (and adults) can touch the different animals, people, and buses, and they move, make noises, etc.
• Tap Tap Revenge (and all its incarnations)- tap on the different colored balls when they hit the right spot. With three different lanes, it requires a lot of concentration and fast finger movements to get it right!
  

I also really like using the iPad with teens. Remember my "less-than-enthusiastic" friend? The iPad is a great reward tool for him, and garage band on the iPad gets teens to be a little more creative than just regular garage band, because they can compose their own beats to add to their songs.

As wonderful as it is, I want to be clear that it doesn't work in every situation, and it is JUST a tool that we can use. I love it, but in this day and age, it's hard to keep it from being your "go-to" item, so I often use it as my back-up plan, rather than my number one tool. Unless of course, it has worked well in the past, or is a good reward tool for a teen. Music Therapy is really so much more than taking out an iPad during procedural support, but it sure can be awesome!

Struggles...

Power struggles, that is. This post is mainly for everyone who thinks that music therapy is nothing but rainbows and sunshine. It is much, much more than butterflies and flowers, even at a children's hospital!

Most kids who get music therapy really enjoy it, but what happens when you get a patient who gets MT as part of his or her therapy who is... less than enthusiastic about doing things that may be more difficult than he or she wants to do? I'm not saying that MT is the problem here, rather doing things that make this kid work a little harder so he or she can go home is. How do you work with kids who literally stalemate and shut you out in therapy when they need to have it?

Story: Met with this kid for a session (and not the first) and we were doing an UE movement task. Things were a little slow and full of complaints, and then out of nowhere, this kid stops. For about ten minutes pt. just sat there not wanting to finish the number of reps. Eventually, the pt. completed task, but it was... quite a power struggle between us for a little while.

So my latest project (and things have been slowly getting better) has been to find new interventions that this kid will like and will work toward our goals, as well as providing the right reinforcers. But for everyone else out there, How do you help someone who doesn't seem to want to help themselves?

this is not kim kardashian's botox...

.... okay, actually it is the same thing BUT these kids need it (and not in their faces)!

Botox paralyzes muscles. That's what it does! The way muscles work (for those who don't know) is that each muscle has an opposing one that allows us to move our bodies. With each movement, muscles oppose one another. In many people with cerebral palsy or other illnesses that effect their muscles, they experience contracture with some of those, where one (or many) muscles in a limb are too tight to stretch. Botox is injected into those muscles, which relaxes them and allows for stretching and physical therapy to take place. It takes about 7 days to take full effect. In our rehab clinic at the hospital, kids come in every 4 months or so to get those injections.

Our body is full of TONS of muscles, so the kids who come in usually need multiple shots. Even though the needle is tiny, it still hurts, and the muscles that need the injections are so specific that the kids have to be entirely still during the procedure. Why am I telling you all this? Because today I spent the entire day doing procedural support in this clinic, and it was fantastic!

The kids who come in typically get EMLA cream where the injections will be, which helps to numb the skin. The only thing about that is that it takes 30+ minutes to really take effect, during which the kids are sitting and waiting. in anticipation. of shots. That's where the Music Therapists (and interns) come in! We start by building rapport and playing/doing music tasks before the procedure to help calm the kids and provide some fun distraction, and then we stay through the needle sticks to help that calm environment and provide more distraction during it. As someone who had lots of scary needle sticks growing up, I can say that music helped distract me, but being held down was the WORST part.

It was a little strange being on the other side of those shots, and being there when the kids are crying and screaming (because really, needles hurt and nothing we do is going to keep a kid in pain completely calm), but it was wonderful being there and seeing those kids look up at me and reach toward the guitar or ipad (more on that later) and just have that moment where even though they are NOT happy, they have something they can focus on that they like. As my first kid (a 5-year-old veteran of botox) said when I walked in, "yeah! and you stay here the WHOLE TIME!" with a huge smile on his face.

That's why I love procedural support in this unit. I get to be the "music lady". I'm fun and they trust me, and that little bit of extra support during those needle sticks helps!