Aspects of Music Therapy Relating to Physical Disability

By Wigram, Tony | Australian Journal of Music Therapy, Annual 1992 | Go to article overview

Aspects of Music Therapy Relating to Physical Disability


Wigram, Tony, Australian Journal of Music Therapy


Keynote Address: Australian Music Therapy Association 17th Annual Conference, Sydney 27-28 September 1991

Introduction

Many years of working with people who have physical disabilities has convinced me that music therapy as a process of intervention has a great deal to offer. So many different approaches and techniques in music therapy with physically disabled people have already been developed and documented, it is difficult to review such a wealth of work. This paper will consider the role of music as a therapeutic intervention, and will consider the value of practical, movement and passive techniques which can be used to help people with these disabilities both to achieve measurable physiological improvement, and to fulfil emotional, communicative, social, physical and perceptual needs.

Dr. Derek Ricks, a Consultant Paediatrician and Psychiatrist working in the field of motor disability and communication impairment in Hertfordshire, England, stated that "anyone faced with the task of helping a profoundly physically handicapped and retarded child is usually so impressed with the magnitude of the child's disabilities that they do not know where to start. Later they may be so disheartened by the child's slow response that they do not see any point in persevering". (Ricks, 1979.) Bearing in mind this statement can equally apply to adults as to children, it perhaps encapsulates the feelings that can be shared by therapists and carers for the multiply handicapped, and although an atmosphere is often generated of enthusiasm and optimism, in moments of honesty one can share with fellow professionals a profound sense of helplessness and lack of direction.

For the music therapist, it is essential that they have a very clear understanding of and familiarity with the nature and pathology of the disability with which they are trying to work, and subsequently to have a range of therapeutic skills and techniques that can be used. Music can be both stimulating and relaxing, and above all it can have a physical effect on a person. Perhaps the first area to explore then is the techniques involved in making music with instruments. To date, this has been demonstrably the most successful application of music therapy with physically handicapped people, particularly through the medium of improvised music where the patient has tremendous possibilities for creating sounds within a musical framework which are for them both meaningful and physically satisfying.

Practical music making as a means of therapeutic change and development

Perhaps the most important lesson l have learnt over the years I have worked with this client group is the value of understanding and assessing the actual nature of their disability, and subsequently learning how to handle the patient. Before even presenting patients with instruments, it is vital to consider whether they are sitting in a secure and central position in order that they have the best chance of playing successfully. If they have scoliosis, which side of their wheelchair should one position the instruments? If they have extensor thrust, how much physical help does the therapist need to give in containing the patient in order for them to be able to successfully play the instrument? Can they grasp beaters, or will they need to play with their hands? How good is their gross and fine motor control, and what is their range of movement? What stimulates spasm, and should one avoid using that stimulus? What is their head control like, and in conjunction with that are they suffering any impairment of hearing or vision?

This may sound like a rather basic list of elements in the physical status of the patient, but the music therapist, in the same way as the physiotherapist, teacher, speech therapist, nurse or any other professional approaching somebody with physical disability must take all of these points into consideration before embarking on the process of music therapy. …

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