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Case Study: Megan

14 June 2016

Megan, a beautiful, smiley little girl with complex needs, including intractable Epilepsy, limited movement, sight impairment and general developmental delay, has accessed music therapy since the age of two through Thomas’s Fund. Music therapy provides her with an outlet for self-expression, a space in which she is enabled and encouraged to use the instruments and her voice to engage in interaction, and to have her say using music as her medium instead of words. During the course of therapy, Megan has become increasingly able to engage in turn-taking vocal and instrumental conversations, to make choices through eye pointing, to track and sound a range of instruments and to take control, leading the music, as she might lead a conversation.

Through Thomas’s Fund she has accessed music therapy at home and whilst in hospital locally during frequent admissions. Even when very unwell, she is responsive to music, giving slight smiles on hearing the familiar hello song and often relaxing into sleep as the music soothes her.

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Case Study: Emily

21 August 2015

Emily was referred to Thomas’s Fund in 2014. She is 12 years old and has severe learning difficulties and visual impairment and spent weeks in intensive care due to sepsis and pneumonia. Her ill health and vulnerable state meant she continued to be isolated at home from her friends, teachers and activities at school. Emily was due to go back to school in the new term and yet due to further medical complications she needed further intensive treatment in hospital and periods of recuperation at home. Emily received weekly music therapy during these months and experienced a regular space in which to express herself freely and rebuild her physical strength and confidence in communication.

Emily spent the early sessions needing to sit on Mum’s lap on the sofa and often cuddling up to her and kissing her. She tentatively reached out to feel and sound different instruments such as the chimes and the shakers. She was intent on keeping gloves on her hands as she felt instruments. Over time she grew the confidence to vocalise more and to sing her own melodies as I accompanied. She often wriggled, danced, clapped and played the snare drum that had become her firm favourite instrument. She nodded her head to me to indicate she wanted me to continue playing and singing when I paused.

In one key turning point of independence, Emily chose to sit on the floor next to me for the whole session. From then on she sat independently of Mum and she engaged confidently and happily. She had by now no need of hand gloves and played steady beats on the snare drum and also the big gourd shaker and sung frequently, often playing and singing for a full 30 or 40 minutes. She continued to listen keenly, try new instruments and interact sociably, sometimes kissing instruments and blowing kisses to me. She continued to turn to Mum occasionally to acknowledge and appreciate her. After the sessions she was often more invigorated and happily went off to read some books, chatting away as she did so.

Emily is soon to return to school, fitter and stronger due to her treatment and convalescence and increasing in confidence and readiness to engage in school life. This is partly due to the consistent, affirming, creatively inspiring, encouraging, enabling and supportive role that Thomas’s Fund music therapy has provided. Emily’s mum has been an enduringly strong, devoted, comforting and essential presence for Emily throughout her ill health. Emily has both enjoyed this within the music therapy sessions and been able to gently become once again more independent over this period whilst keeping the special bond that they have.

Andy Stevens
Music Therapist, HCPC Reg: AS13775

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Logan's story

18 February 2015

Logan was referred to Thomas’s Fund at the age of 15 months. He suffers from a very rare chromosomal deletion and also has a very complex form of epilepsy. Logan is as yet unable to sit unaided or crawl. He can however roll over onto his tummy and desperately tries to push himself up when he is well. Logan has a beautiful smile and is very good at giving eye contact when engaged in interaction.

Logan’s needs are such that he is frequently hospitalised due to his seizures or associated ill health and he has to cope with a lot of medication, frequent medical appointments and is learning to cope with his standing frame, splints and other necessary equipment with the aim of giving him the best quality of life and independence. Despite all he endures, Logan is a cheerful little boy much of the time, who enjoys interaction with his devoted parents and big brother. Logan has attended all the sessions to date at home with his mummy and has had one session with his big brother.

Logan appears to be most comfortable lying on his back on the floor and this is how he was when I first met him. I sat beside him on the floor and sang hello to him, placing the guitar near to him. I gave him space in between the phrases of my greeting song and Logan, turning his head towards me, watched me intently then, in the silence, vocalised his soft, high pitched, happy sounding response. Logan continued to enjoy the guitar in these early sessions, rolling towards it and increasingly reaching out one of his hands to tap or to strum the strings. Logan was saying his hello. He was communicating spontaneously and had total control.

During our sessions Logan has been offered a variety of instruments. Initially he showed interest in the windchimes which he would occasionally reach out for, in the shiny radiant tambourine which he would track as I moved it above his head, and in the large gathering drum which his mummy would place him on. As Logan lay on his tummy across the drum, he would sense the vibrations of us sounding it and would increasingly pull himself up and try to roll over until there came a point where it was no longer so easy to keep him on it!

In these early sessions when Logan was not as active with the instruments, he would often vocalise and seemed increasingly aware of my responses to his sounds, engaging in brief turn taking exchanges.

Following our initial four-week assessment, the following aims were formulated for Logan:

• To offer Logan an outlet for his emotional self expression and development of his creativity.
• To support development of his pre-verbal skills, focusing on his ability to initiate and imitate within interaction, his turn taking, his increasing sense of anticipation and his awareness of cause and effect.
• To encourage Logan to increasingly make clear independent choices, giving him more control over his environment.
• To support Logan’s physical development, encouraging use of both his fine and gross motor movement to sound instruments.

As sessions progressed, Logan has had periods of inpatient hospital stays, surgery and changes to his medication and his diet. This has understandably had an effect on his responses in sessions. At times he has been very physically active, at other times he has been quite tired and less vocal but has continued to appear focused. During this period Logan has began however to access the instruments increasingly. In one session, whilst sitting up in front of Mummy, he reached out his hands to tap the tambourine as I sang a repetitive predictable melody. Logan’s tapping became increasingly confident as he developed a steady rhythm, filling the spaces I left in the song with his pulse. This was a special moment: Logan was clearly communicating very intentionally, music was giving him a voice where, as yet, words cannot. Logan’s mummy was overwhelmed.

Logan has continued to be increasingly proactive and intentional with his communicative play, initiating similar shared play on the large gathering drum for short periods. He has briefly explored the piano, whilst lying on his side and has reached out repeatedly to the windchimes. As he explores use of the instruments more, he is increasingly able to use them as an outlet for self expression.

In a recent session, he vocalised with open high pitched sounds as I sang hello to him, looking at me intently. As I strummed the strings close to him, he wriggled with apparent excitement and began to kick his legs. I improvised a song around his movements and, motivated, he initiated the phrases repeatedly by pausing then suddenly kicking his legs again. Later in the same session I hid behind the large gathering drum, turned on its side so that he could access it whilst lying on the floor. Logan tapped the drum, I followed, calling his name then rolled it away, calling “Boo!”, Logan grinned. Within minutes he reached over and began to tap a steady pulse.

These short but intense interactions show how Logan is developing an increasing awareness of those around him and of the impact he can have on others through communication. He does not as yet have the ability to use language to generate conversation, or express how he is feeling, but, through the non-verbal medium of music, he is beginning to do just that. Logan is still currently receiving weekly music therapy sessions with Thomas’s Fund as part of a 10-week block of sessions following assessment.

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