Music Therapy and Acute care rehab

Part 2 of Collaboration in Medical Music Therapy

One of the more recognizable aspects of music therapy is the ease in which it connects with rehab therapies. This is likely because rehab therapies exist in a number of settings outside of the inpatient, medical world and because music therapy can adapt rehab goals within music. For many music therapists, MT is a part of the rehab team because it is a natural fit. Music therapists consistently mold ourselves to fit existing healthcare teams and structures. We can do this because music therapy is adaptable. This adaptability gives us opportunity to exercise special skills that coincide with whatever team we are on, whether it is behavioral health, family support services, spiritual care, rehab therapy, or whomever.

Regardless of the team you are on, its important to determine what makes your work similar and what makes your work unique from your teammates. I have found it incredibly rewarding to build relationships with different disciplines by simply addressing their humanness first. In a fast-paced hospital setting, it can be challenging to get to know people outside of your team because most disciplines are running from patient to patient to provide care. Rehab therapists are no different. It can take time to get to know rehab therapists as people first because they are often have hefty caseloads each day and not ample amounts of time to spend getting to know you.

It can also require a lot of confidence as a music therapist to stop a rehab therapist in the middle of their schedule to have a quick chat or advocate for a co-treatment session. I have found myself to be incredibly intimidated by a number of rehab therapists because I’ve found their knowledge, expertise, and understanding of their specialized skillset to be inspiring. I’ve also been nervous that very confident rehab therapists would be unwilling to take my own expertise seriously. What I have personally found to be the most effective has been to ask questions. Communicate an interest in learning more about their skillset as it relates to your shared patients. Share what you have assessed about a patient and ask what they think. Do they have advice of things you could incorporate into your sessions that help work towards their rehab goals?

I specifically recall a situation with a PT in our NICU who has amazing insight and skill. I was very intimated by them and nervous to co-treat. One day, I was working with an infant we share and was struggling to provide them with appropriate positioning. Our PT was nearby and saw me struggling and came in to assist. I was very nervous that they would tell me I was doing something wrong and subsequently ask me to leave. But I immediately spoke up and said, “I know that this infant is arching and having difficulty regulating right now – what should I do?” The PT then gave me a condensed lesson in positioning and we had a wonderful conversation. I felt empowered with new knowledge and, I believe, the PT felt more comfortable knowing that I was going to listen to their suggestions and honor their expertise.

With increased confidence and knowledge of how MT can support these disciplines and their specialized goals, the easier it can be to begin to build relationships and ultimately create very collaborative networks across the hospital setting. Below are just a few examples of ways MT can collaborate with each discipline.

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Music Therapy and Physical Therapy

One of the more obvious ways to co-treat with Physical Therapy is through a neurologic music therapy approach. Many of these interventions can be planned ahead of time for patients and in conjunction with a physical therapist. But sometimes the best interactions and collaborations happen when it is unplanned, and MT and PT simply arrive at a patient’s room at the same time. When this happens, check in with PT regarding their goals and quickly assess the situation to see how you might support them. The rehab goals become the current patient need. The rehab goals are the music therapy goals. Pack your cart each day to ensure that you have enough adaptable items to be prepared for moments like these!

PT is often focused on the big picture. They might say – I just want him to stand for 15 minutes with assistance – which gives you tons of freedom of how you will spend those 15 minutes. What songs can you play to hold this patient’s attention and engagement so that they are not aware of how long they’re standing? Or perhaps the big goal is to increase range of motion with the patient’s legs, in which case you can utilize an NMT intervention – therapeutic instrument playing – to engage flexion and extension of both legs.

Maybe a patient is preparing to take a walk around the unit and you can support a number of functional movements, least of which is the walking itself. The complexity of your support can range from a fully executed Rhythmic Auditory Stimulation (RAS) intervention to smaller components of the intervention to support the situation; clinical details pending. It is not unfamiliar to find yourself needing to walk backwards around a unit, playing the guitar, and encouraging/supporting gross motor movements. As you prepare for increased opportunities with PT, make sure you have practiced your flexibility – both physically and musically! Supporting gross motor movements requires a music therapist to have mobility, adaptability, and physical preparation.

Music Therapy and Speech and Language Pathology

Speech and Language Pathologists have a wealth of knowledge that extends past working on obvious speech/communication goals. Because speech and language are neurologically complex functions, and because music can address those neurologic components, collaborative efforts between MT and SLP can be incredibly fulfilling for both parties.

One of my favorite calls to receive from an SLP is to assist with a patient’s tolerance of a speaking valve on their tracheotomy – most often a Passy-muir valve. Using a speaking valve requires a different functionality of speaking, which might take a different period of adjustment for a patient. Often older patients have a more difficult time and can benefit from distraction of the length of time they are wearing the valve, or provides them with a specific length of note to hold while singing, or cues them to breathe and vocalize.

Other opportunities to engage with SLP relate to feeding, especially within the NICU. MT can support infants’ feeding by assisting with reinforcing non-nutritive sucking (often supported by the Pacifier Activated Lullaby Device) or even by providing live music during breastfeeding. Even if you cannot be present during feeding times, looking to your SLPs to gain more information about an infant’s suck-swallow-breathe coordination and self-regulation can be great objectives to incorporate into your MT session and later be able to report back your observations for how the infant responded.

Whether you are supporting speech, language, feeding, or any other motor function that is related, look to your SLPs for their expertise in this area and remain confident in your own expertise. Ask questions, seek information, and offer ideas. These therapists will likely take advantage of what you have to offer.

Music Therapy and Occupational Therapy

Whereas PT might look at the larger picture of functionality, and SLP might look at a specific challenging area, Occupational Therapy brings the whole picture together. I appreciate the ways in which these disciplines balance each other out and support one another to address the whole person. When I think about the rehab therapy team, I see music therapy as threading itself between all three disciplines to support however necessary.

OT is a great collaborative partner to have as a medical music therapist. OT is familiar with looking at the big picture with PT and zeroing in on the smaller details to assist with the overall functionality of the patient. OT can easily see how and where music therapy can assist and can be excellent advocates for your work. MT and OT co-treatments can be incredibly fun because many OTs are often very creative! OTs are not afraid to get into the nitty gritty of the music therapy session and are usually over the moon when you provide special equipment like adaptive mallets.

Co-treatment sessions with OT are some of my most favorite sessions because you can take a step back and allow the OT to provide much of the physical assistance that you might give a kiddo during a session. MT can focus entirely on the music during the session and be very aware of planning how the music can drive cues, prompts, or movement. When OT is present, everyone can more easily get down on a play mat, or be up in a supported upright position to increase success. In these sessions, patients have greater accessibility towards the activities within the session. OTs benefit from these sessions by often having less to plan or prepare for therapeutic activities and often increased success towards their rehab goals.

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I could write many more anecdotes and examples of the collaborative opportunities that exist between music therapy and the rehab team, but the essence of these brief snippets are that the opportunities are limitless! If it seems overwhelming to start, choose one discipline to learn more about and focus on getting to know one or two of those therapists. Just like with nursing, getting to know the person as best as you can (while adhering to a fast-paced schedule) is first and foremost the best way to connect with another professional.

As you build a relationship with that first or second therapist, they will likely share their experiences with their team members, who in turn might reach out to you to collaborate. The rehab team values the recommendations they receive from one another and once they are able to experience the potential of these collaborations with music therapy, you have it made.

Be open to flexibility, adaptations, and creativity. Once the rehab team learns of your willingness to support their goals and then witnesses the power of that teamwork, they will always be open to the collaboration, whether it is planned or unplanned. Be the extra support they can rely on when they need it most.