Music Therapy and Apraxia: An Online Resource
Check out this blog to read about a new online resource on music therapy and apraxia created by Amaya Stamm, one of our MT-BCs!
During the early part of my internship, I met and worked with a client with apraxia, a disconnect between the mind and the body which caused his body to move out of his control. I wanted to support him and guide his body back to regulation but felt unequipped to help him, not knowing which step to take to bring his body under control and in alignment with his desires. Over the next few months, I received guidance from my supervisor, Whitney Perry, and I read resources about apraxia, learned about different methods of communication to try with clients, observed several interventions, practiced using effective motor prompts and cues, and gained personal experience while working with and learning from individuals with apraxia. During the last week of my internship, I sat on the floor looking toward this same client, completely relaxed and feeling capable of guiding this client’s body to play a piano chord progression while my co-intern and I sang this client’s original song together. The right resources, tools, and mindset changes caused a helpful and noticeable shift in my facilitation skills, and I was motivated to share this information with others who might benefit.
Music Therapy and Apraxia is an online resource I created as I navigated my internship, compiling resources and information from supervisors, families, and other professionals along with my personal experiences. I aimed to fashion an easy-to-read and evidence-based resource to equip music therapy students, interns, professionals, and any other people who care for and advocate for individuals with apraxia with some of the same tools that helped me.
Apraxia is underdiagnosed and prevalent, yet not frequently mentioned throughout music therapy literature. Although apraxia does not always occur alongside an autism diagnosis, Jeong and Darroch (2021) report that about 60% of people with autism have apraxia. This means that apraxia occurs more commonly than one might initially assume and may not be given as much attention as other diagnoses. Music Therapy: An Introduction to the Profession, a respected textbook for music therapy students covering various populations relevant to the field, presents limited information on apraxia of speech outside of a rehabilitative environment, and no information on working with clients with ocular, oral, or limb-kinetic apraxia to music therapy students. With increased awareness, education, and resources, music therapists can better support individuals with apraxia, improving their purposeful movements and supporting regulation and emotional exploration.
Below, find a brief description of each section of the resource available, starting with the definitions section which follows the home and about page:
Definitions
Beginning with a few quotes from advocates, including clients and authors, this section describes apraxia in detail. As stated above, apraxia is a mind-body disconnect, and individuals with apraxia understand the world around them but are unable to fully control their bodily movements. Some may use Augmentative and Alternative Communication, or AAC, to communicate or supplement their spoken communication with others. The four types of apraxia are described, and families share their personal experiences with obtaining an apraxia diagnosis. This page also outlines various forms of Augmentative and Alternative Communication available for families, therapists, or others to use when communicating with an individual with apraxia; divided into low tech, mid tech, and high tech options. At the bottom of the page, several links lead to helpful outside resources on apraxia, including but not limited to the Communication for Education website and the Meraki Spelling Collective’s website.
Example Interventions
This page provides three in-depth descriptions of music therapy interventions appropriate for increasing purposeful motor movement with individuals with apraxia, including instruments like piano, boomwhackers, and guitar. Embedded in each are motor prompting and coaching tools and contributions from relevant music therapy research that are helpful with this population. Each intervention includes goals and objectives, the music method, music delivery method, materials, procedures or individual steps, the therapeutic role of music or how music is adapted to best serve the client’s goals, and adaptations to consider.
Songwriting
In a survey sent to several individuals with apraxia, respondents shared that songwriting in music therapy was “incredibly enriching” and “meant the world.” This page contains a sample process for songwriting with individuals with apraxia and considerations. This process includes determining the direction of the song as a whole, discussing song structure, finding the client’s musical “voice” and personal style, and dissemination of the finished product. The end of the page lists additional considerations as well as a collection of original songs by spellers, including works by songwriters Nicolas Segrera, Forging Friendships, and Joel Nyland.
Example Check-Ins
Every person benefits from learning how to process and express their emotions, and individuals with apraxia are no different. Because their body movements may be unreliable, their bodies might not be representing what they truly feel on the inside, and some have experienced others misinterpreting their body’s actions and incorrectly assuming their feelings. Several individuals with apraxia share what is helpful to consider when asking them questions or exploring emotions with them during sessions, and their feedback is reflected in the example check-in questions provided, relating to mood and emotions. Most are in a two-question format, with an initial question and a clarifying question. These check-in questions are not unlike other standard check-ins regarding mood and emotions, the biggest difference is accommodating response time in your session planning.
Reflection and Mindset
This final section highlights a perspective shift I found helpful when working with this population. At first, I doubted my ability to provide the care these people wanted and needed. However, by asking these individuals what they personally valued in a care provider and music therapist, their answers surprised me. Answers included “relationship,” “patience, presuming competence,” and “understanding,” and others shared that they enjoy that their music therapist “believes in me” and “makes her sessions more didactic” or educational in nature. In other words, the attitude of the music therapist matters significantly more than how many things they say or do “right” in a session, because their perspective and care is aligned with the client. When asked what music therapists should know about working with clients with apraxia, individuals and parents had much to say. One piece of advice shared by Nicolas Segrera is “We have a lot to give, but our bodies are hard on us. Please be patient with us and don't be misled by the dysregulation you might see.”
Final Words
I encourage you to access this resource linked here and explore it for yourself, taking time to find what may be useful to you and sharing this resource with your colleagues, students, clients, and circle of influence. Also be sure to locate the resources at the bottom of the definitions page, research the ones that are most interesting to you, and watch Jordyn Zimmerman’s interview to see text-based AAC in action.
Thank you all for taking the time to read through this blog and for exploring this resource. As my experiences expand and I discover new resources, I plan to add content, most specifically about working with younger clients with apraxia, as this resource was created from my internship experience with older teens and young adults. Please reach out to me at [email protected] with any questions, constructive feedback, and thoughts about this website; I am seeking to continue learning and growing from others as I develop this resource!
