The purpose of this literature review is to identify goals and methods of music therapy for children with severe and profound multiple disabilities, and to clarify the various orientations used by clinicians. The general goals described have been identified by different music therapists and chosen for their representativeness and breadth of application. The orientations which clinicians take in their work with these children are described according to the practices outlined by Bruscia (1989).
While many examples from the literature for adults with severe and profound multiple disabilities are also relevant for children, they have not been included in this review because of the school age focus (approximately 3 to 18 years). As such, this includes the work of Wigram (1988), Hughes (1995) and Schalkwijk (1994), among others. Further, while much of the music therapy literature for children with autism shares similarities in orientation, goal(s) and methods, it has also not been included unless there is a clear indication that the author is referring to work with children who are severely or profoundly multiply disabled.
Identifying the Population
Children who are severely and profoundly multiply disabled have a combination of physical and intellectual difficulties which, although caused by similar conditions, create unique qualities and characteristics. These disabilities generally lead to severe limitations of movement, communication and socialization. Such children may require total care and be medically at risk. Epilepsy is common, and often not completely controlled by medication (Orelove and Sobsey, 1991). These children may have other impairments, such as hearing and vision loss. They vary considerably in their ability to understand and communicate information. Some use simple language or symbolic communication (such as gestures or picture symbols) while others may be unable to communicate needs or responses effectively. Their physical abilities also vary considerably, from well developed fine motor skills such as reaching or grasping, to a complete lack of independent physical movement. Sometimes these children will be unable to comprehend or adapt to unfamiliar environments and events, and this may cause difficulty in transitions, particularly from familiar to unfamiliar environments. Similarly, these children may not show recognition of familiar people, including family, teachers and therapists.
In educational settings, the needs of each child are generally outlined in an Individual Educational Program (I.E.P.) wherein goals are set by parents, educators, therapists and care staff. These goals are usually organized in areas such as auditory, visual, tactile, perceptual, sensori-motor, communication, cognitive, social and emotional development, and are then addressed by various disciplines (Boxill, 1989). Alley (1979), Codding (1988) and Jellison (1988) have reviewed various ways in which music therapy interventions have addressed the needs of people with disabilities, and this also includes children with severe and profound multiple disabilities.
General Music Therapy Goals
A number of interrelated goals have been identified by music therapists working with these children. These general goals may singularly, or in combination, provide the focus of a program.
The first and most primary goal is fulfilling the child's basic needs. For Alvin (1976), this involved creating an emotionally stable and predictable environment that fostered feelings of security, love and acceptance along with finding ways of self expression. She felt that only then could the child relate and develop. For Nordoff and Robbins (1971, 1977, 1983), fulfilling the child's basic needs involves 'meeting the child musically', where the therapist matches the child's inner condition with the music. As Bruscia (1987 p.46) has indicated, this serves three main functions: to create an …