Eurhythmics for autism and other neurophysiologic diagnoses: A sensorimotor music-based treatment approach

Eurhythmics for autism and other neurophysiologic diagnoses: A sensorimotor music-based treatment... Eurhythmics for autism and other neurophysiologic diagnoses: A sensorimotor music-based treatment approach is a guide to using a Eurhythmics approach to address sensorimotor and fear-based reactivity in individuals with Autism Spectrum Disorder (ASD). The author quickly orients the reader in two premises: First, that autism is not a disorder, but rather a diagnosis describing numerous behavioral symptoms that have historically been addressed in terms of social deficits, yet have ties to differences in sensory processing that affect fear responses and sensorimotor control in individuals. Second, that the music therapist (referred to as the music-based clinician) has unique skills that when combined with a Eurhythmics approach to treatment may be optimal for addressing core needs in individuals with ASD. This book is composed of three sections. Part I contains three chapters focused on sensation and perception in typical neurological processing, with some information about differences in processing in individuals with ASD. Chapter 1 reviews the basic physiology of sensations, with particular focus on proprioception (position of body parts) and the vestibular sense (balance and spatial orientation). The chapter also reviews visual, tactile, and auditory senses. The information that is presented is accessible, with real-world examples that illustrate sensory processing. More information on the auditory sense would have strengthened this chapter, as the author states that audition must be fully understood by a music-based practitioner in order to apply music in treatment of individuals with sensory differences. Chapter 2 addresses cortical responses to sensory information, with particular emphasis on the role of emotion, stress, fear, and the hypothalamic–pituitary–adrenal axis (HPA Axis). One central idea is that sensory processing is a primary way to determine if there is a threat in the environment. When there are sensory processing differences, inaccurate processing may cause the system to respond in survival mode, putting the individual into a state of constant anxiety or fear. Berger provides some initial evidence that the HPA axis (involved in regulating homeostasis) response is atypical in individuals with ASD, leading to abnormal responses to their environment. Overall, this chapter provides a basic introduction to how sensory processing differences may impact behaviors in individuals with ASD. Chapter 3 is entitled “Interpreting Autism and Sensory Characteristics.” Berger posits that music-based interventions are not a cure for ASD; rather, they should focus on helping the individual develop functional ways to manage behaviors and maintain a state of COPING (which stands for Calm–Organized–Paced–Integrated–Growing). Berger continues by providing two hypotheses relating to Eurhythmics and behaviors in persons with ASD. Hypothesis 1 is: “Focused Eurhythmics-based music treatment can reduce pervasive survival-anxiety (HPA-driven fear factor) driven by sensory misinterpretation to yield functional coping skills” (p. 79). Hypothesis 2 is: “Movement, and motor planning timing deficits, often unaddressed in music-based treatment, can be improvised with Eurhythmics-based music and movement interventions” (p. 84). The descriptions of these hypotheses begin to illustrate where Berger will focus treatment within a Eurhythmics approach. Common behaviors exhibited in persons with ASD that may be explained by the proposed hypotheses are also presented; however, there appears to be a gap between current research on neurological or physiological findings in ASD and the direct relationship of these findings to the behaviors exhibited. Overall, Part I provides an explanation of sensory functioning and an initial evidence base for how individuals with ASD may have different processing. The reviewers felt that more information about different processing of sensory information in ASD that is based on recent research would provide a more thorough and evidence-based explanation of movement and sensory/fear-based processing differences. Although these views of ASD may be newer to many music therapists, there is a growing body of neuroscience and behavioral literature exploring sensory and motor differences in individuals with ASD (see reviews in Leary & Donnellan, 2012; Torres & Donnellan, 2015). However, it must be noted that the evidence base is conflicting, with different opinions and reports on how sensory, neurological, and hormonal differences impact individuals with ASD. Part II of the book focuses on the theory of Eurhythmics, the author’s approach using Eurhythmics, and clinical applications. The author expresses her thoughts about the application of music in therapy when she states that “music therapy is a form of training, using music interventions to teach the brain and body new options for responding and behaving” (p. 99). This section emphasizes the need for a music-based therapist to have knowledge of physiological function and competent musical skills (including piano improvisation). Eurhythmics, according to the Dalcroze philosophy, is described briefly to include the body’s “quick response” to an auditory stimulus in regard to three key elements: 1) rhythmic movement, 2) improvisation, and 3) ear training. This chapter includes a description of musical elements (i.e., rhythm, melody, timbre, structure/form) and how the elements can be used in clinical work. Chapters 6 and 7 include five modules of clinical interventions with structured protocols that collectively work toward the goal of COPING. Module 1 includes breathing through instrument play for the objective of anxiety reduction. Module 2 involves rhythmic upper-body movements for eye-contact memory, task focus, and rhythmic embodiment. Module 3 involves full-body movements for objectives including control of movement energies, auditory focus, motor planning, and coordination. Module 4 involves improvisational experiences for sense of self, rhythmic internalization, creative self-expression, and task development. The final module is focused on relaxing and closing the session. Modules are to be repeated in each session, which can last 30 to 60 minutes. Water breaks are recommended frequently throughout the sessions. There are also several ideas in these modules for sensorimotor experiences (i.e., trampoline jumps) used during transitions, which coincided with the author’s explanation for movement and sensory regulation/exploration. The presented interventions have strength in repetition, use of music to calm, and structure. Protocols are clearly presented and easy to follow for the trained music-based clinician. Berger provides an explanation of the role of the therapist/music, for example, providing tempo markings for the exercises and ways for the therapist to facilitate. More information about generalization and expansion upon interventions would be helpful in order to help the music-based clinician avoid developing “splinter skills” (where individuals are able to complete the task only in a given structure and with specific supports) and to ensure translation to functional non-musical tasks that can impact the client’s daily life. Further, these highly structured experiences seem to be most appropriate for more independent and lower-need individuals with ASD, as many required sitting for an extended period of time, with direct and careful imitation, and involving complex cognitive processing. Clinicians may have different opinions of materials used in some of the interventions; for example, the pitch/timbre and ease of playing of a recorder (used in the warm-up exercise) may not be appropriate for auditory sensitivities and motor differences of some individuals. Furthermore, the use of abstract and imaginative interventions may be difficult or ineffective for some persons with ASD due to abstracting thinking differences. There is little information on adaptations for level of need/supports; however, Berger comments that the clinician must use their “clinical eye” to make adaptations within the modules (p. 178). It would also be helpful to have replicable systematic research of these modules (individually and collectively) to demonstrate that these protocols have been shown to facilitate their intended outcomes. In the conclusion of Section 2, the author provides case examples with opportunities to break down clinical observations into elements that would allow a therapist to better shape their assessment and define an appropriate approach for addressing the strengths and needs of a client. Examples of session-rating scales are provided within the appendices to help the reader conceptualize targeted observational data. Interventions described in the book serve, as the author states, as “treatment prescriptions” to prepare the brain/body for functional goals; however, a clearer idea of what functional tasks/generalizations would follow such interventions would be helpful. Part III of the book focuses on applications with other populations, including individuals with schizophrenia, ADHD, and other psychiatric disorders. This section is followed by a description of related movement theorists, including Laban and Alexander. In the “coda” of the text, Berger reviews the main points of the text and emphasizes being persistent within the modules in order to help the clients achieve the skills. She also includes some final thoughts for treatment with a Eurhythmics approach. Overall, Eurhythmics for autism and other neurophysiologic diagnoses: A sensorimotor music-based treatment approach provides the music-based therapy clinician with a basis for considering sensory and motor processing differences in their practice. Berger provides different modules or protocols that incorporate aspects of Eurhythmics, which may provide clinicians with some ideas for facilitating different goals. The text is a mix of emerging evidence in sensory and motor processing in autism and music therapy techniques based primarily on the author’s vast clinical experience. References Leary M. R. , & Donnellan A . ( 2012 ). Autism: Sensory-movement differences and diversity . Cambridge : Cambridge Book Review Press . Torres E. B. , & Donnellan A. M . ( 2015 ). Editorial for research topic “Autism: the movement perspective .” Frontiers in Integrative Neuroscience , 9 ( 12 ). doi: 10.3389/fnint.2015.00012 © the American Music Therapy Association 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Music Therapy Perspectives Oxford University Press

Eurhythmics for autism and other neurophysiologic diagnoses: A sensorimotor music-based treatment approach

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Oxford University Press
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© the American Music Therapy Association 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
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0734-6875
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10.1093/mtp/miw022
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Abstract

Eurhythmics for autism and other neurophysiologic diagnoses: A sensorimotor music-based treatment approach is a guide to using a Eurhythmics approach to address sensorimotor and fear-based reactivity in individuals with Autism Spectrum Disorder (ASD). The author quickly orients the reader in two premises: First, that autism is not a disorder, but rather a diagnosis describing numerous behavioral symptoms that have historically been addressed in terms of social deficits, yet have ties to differences in sensory processing that affect fear responses and sensorimotor control in individuals. Second, that the music therapist (referred to as the music-based clinician) has unique skills that when combined with a Eurhythmics approach to treatment may be optimal for addressing core needs in individuals with ASD. This book is composed of three sections. Part I contains three chapters focused on sensation and perception in typical neurological processing, with some information about differences in processing in individuals with ASD. Chapter 1 reviews the basic physiology of sensations, with particular focus on proprioception (position of body parts) and the vestibular sense (balance and spatial orientation). The chapter also reviews visual, tactile, and auditory senses. The information that is presented is accessible, with real-world examples that illustrate sensory processing. More information on the auditory sense would have strengthened this chapter, as the author states that audition must be fully understood by a music-based practitioner in order to apply music in treatment of individuals with sensory differences. Chapter 2 addresses cortical responses to sensory information, with particular emphasis on the role of emotion, stress, fear, and the hypothalamic–pituitary–adrenal axis (HPA Axis). One central idea is that sensory processing is a primary way to determine if there is a threat in the environment. When there are sensory processing differences, inaccurate processing may cause the system to respond in survival mode, putting the individual into a state of constant anxiety or fear. Berger provides some initial evidence that the HPA axis (involved in regulating homeostasis) response is atypical in individuals with ASD, leading to abnormal responses to their environment. Overall, this chapter provides a basic introduction to how sensory processing differences may impact behaviors in individuals with ASD. Chapter 3 is entitled “Interpreting Autism and Sensory Characteristics.” Berger posits that music-based interventions are not a cure for ASD; rather, they should focus on helping the individual develop functional ways to manage behaviors and maintain a state of COPING (which stands for Calm–Organized–Paced–Integrated–Growing). Berger continues by providing two hypotheses relating to Eurhythmics and behaviors in persons with ASD. Hypothesis 1 is: “Focused Eurhythmics-based music treatment can reduce pervasive survival-anxiety (HPA-driven fear factor) driven by sensory misinterpretation to yield functional coping skills” (p. 79). Hypothesis 2 is: “Movement, and motor planning timing deficits, often unaddressed in music-based treatment, can be improvised with Eurhythmics-based music and movement interventions” (p. 84). The descriptions of these hypotheses begin to illustrate where Berger will focus treatment within a Eurhythmics approach. Common behaviors exhibited in persons with ASD that may be explained by the proposed hypotheses are also presented; however, there appears to be a gap between current research on neurological or physiological findings in ASD and the direct relationship of these findings to the behaviors exhibited. Overall, Part I provides an explanation of sensory functioning and an initial evidence base for how individuals with ASD may have different processing. The reviewers felt that more information about different processing of sensory information in ASD that is based on recent research would provide a more thorough and evidence-based explanation of movement and sensory/fear-based processing differences. Although these views of ASD may be newer to many music therapists, there is a growing body of neuroscience and behavioral literature exploring sensory and motor differences in individuals with ASD (see reviews in Leary & Donnellan, 2012; Torres & Donnellan, 2015). However, it must be noted that the evidence base is conflicting, with different opinions and reports on how sensory, neurological, and hormonal differences impact individuals with ASD. Part II of the book focuses on the theory of Eurhythmics, the author’s approach using Eurhythmics, and clinical applications. The author expresses her thoughts about the application of music in therapy when she states that “music therapy is a form of training, using music interventions to teach the brain and body new options for responding and behaving” (p. 99). This section emphasizes the need for a music-based therapist to have knowledge of physiological function and competent musical skills (including piano improvisation). Eurhythmics, according to the Dalcroze philosophy, is described briefly to include the body’s “quick response” to an auditory stimulus in regard to three key elements: 1) rhythmic movement, 2) improvisation, and 3) ear training. This chapter includes a description of musical elements (i.e., rhythm, melody, timbre, structure/form) and how the elements can be used in clinical work. Chapters 6 and 7 include five modules of clinical interventions with structured protocols that collectively work toward the goal of COPING. Module 1 includes breathing through instrument play for the objective of anxiety reduction. Module 2 involves rhythmic upper-body movements for eye-contact memory, task focus, and rhythmic embodiment. Module 3 involves full-body movements for objectives including control of movement energies, auditory focus, motor planning, and coordination. Module 4 involves improvisational experiences for sense of self, rhythmic internalization, creative self-expression, and task development. The final module is focused on relaxing and closing the session. Modules are to be repeated in each session, which can last 30 to 60 minutes. Water breaks are recommended frequently throughout the sessions. There are also several ideas in these modules for sensorimotor experiences (i.e., trampoline jumps) used during transitions, which coincided with the author’s explanation for movement and sensory regulation/exploration. The presented interventions have strength in repetition, use of music to calm, and structure. Protocols are clearly presented and easy to follow for the trained music-based clinician. Berger provides an explanation of the role of the therapist/music, for example, providing tempo markings for the exercises and ways for the therapist to facilitate. More information about generalization and expansion upon interventions would be helpful in order to help the music-based clinician avoid developing “splinter skills” (where individuals are able to complete the task only in a given structure and with specific supports) and to ensure translation to functional non-musical tasks that can impact the client’s daily life. Further, these highly structured experiences seem to be most appropriate for more independent and lower-need individuals with ASD, as many required sitting for an extended period of time, with direct and careful imitation, and involving complex cognitive processing. Clinicians may have different opinions of materials used in some of the interventions; for example, the pitch/timbre and ease of playing of a recorder (used in the warm-up exercise) may not be appropriate for auditory sensitivities and motor differences of some individuals. Furthermore, the use of abstract and imaginative interventions may be difficult or ineffective for some persons with ASD due to abstracting thinking differences. There is little information on adaptations for level of need/supports; however, Berger comments that the clinician must use their “clinical eye” to make adaptations within the modules (p. 178). It would also be helpful to have replicable systematic research of these modules (individually and collectively) to demonstrate that these protocols have been shown to facilitate their intended outcomes. In the conclusion of Section 2, the author provides case examples with opportunities to break down clinical observations into elements that would allow a therapist to better shape their assessment and define an appropriate approach for addressing the strengths and needs of a client. Examples of session-rating scales are provided within the appendices to help the reader conceptualize targeted observational data. Interventions described in the book serve, as the author states, as “treatment prescriptions” to prepare the brain/body for functional goals; however, a clearer idea of what functional tasks/generalizations would follow such interventions would be helpful. Part III of the book focuses on applications with other populations, including individuals with schizophrenia, ADHD, and other psychiatric disorders. This section is followed by a description of related movement theorists, including Laban and Alexander. In the “coda” of the text, Berger reviews the main points of the text and emphasizes being persistent within the modules in order to help the clients achieve the skills. She also includes some final thoughts for treatment with a Eurhythmics approach. Overall, Eurhythmics for autism and other neurophysiologic diagnoses: A sensorimotor music-based treatment approach provides the music-based therapy clinician with a basis for considering sensory and motor processing differences in their practice. Berger provides different modules or protocols that incorporate aspects of Eurhythmics, which may provide clinicians with some ideas for facilitating different goals. The text is a mix of emerging evidence in sensory and motor processing in autism and music therapy techniques based primarily on the author’s vast clinical experience. References Leary M. R. , & Donnellan A . ( 2012 ). Autism: Sensory-movement differences and diversity . Cambridge : Cambridge Book Review Press . Torres E. B. , & Donnellan A. M . ( 2015 ). Editorial for research topic “Autism: the movement perspective .” Frontiers in Integrative Neuroscience , 9 ( 12 ). doi: 10.3389/fnint.2015.00012 © the American Music Therapy Association 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Journal

Music Therapy PerspectivesOxford University Press

Published: Aug 20, 2016

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