MUSIC THERAPY AND PAIN MANAGEMENT: COST EFFECTIVENESS
published February 2019
Living Unlimited had received a referral to assist with addressing pain management. Across medical facilities and human health service agencies, cost-effectiveness is a key role to providing individuals with options of services and the highest quality of life. During my internship, at a medical facility, I was provided the opportunity to read current literature on Music Therapy and cost-effectiveness. The paper addressed four symptoms, this article will address pain management.
Pain: “Pain is an unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons” (Medical Dictionary). Determining pain can be difficult considering patients are typically asked to rate their perception of pain on a scale from one to ten, ten being the highest degree of pain and one being the lowest degree of pain. Research has identified where low pain and high pain affect the brain using heat as a pain stimulus. According to Kong in 2010, 61 participants rated “low pain” at 4.9 and “high pain” at 14 on a scale from 1 to 20. After receiving baseline ratings, researchers used heat as a pain conductor and used a fMRI to view what areas of the brain are affected. Results showed that low pain produced more deactivations of the brain and high pain produced more activations of the brain. Deactivations meaning there is decreased activity of the brain, where activations indicate increased activity (Kong, 2010). This article reveals the parietal and temporal lobes are global areas that pain affects in the brain.
Medical literature suggests that patient and healthcare professional perspectives on pain are incongruent. Research shows that up to 82% of patients report experiencing pain from post-surgery until two weeks after discharge (Apfelbaum, 2003). These patients were administered pain prescriptions, and were not achieving lasting relief. Another article discusses how pain often leads to lack of sleep. When patients lose sleep, the body has a harder time healing (Honkus, 2003). The above articles show that pain can be difficult to manage, even with pharmacological interventions.
Music therapy literature dives into what pain means and how music is used to block pain receptors. A study by Wolfe in 1978 explains that pain starts with a stimulus, which leads to a trigger, and then treatment. Those experiencing pain often experience negative emotions, which can escalate the feeling of pain itself. Music therapists build a rapport with patients, and by understanding personality and preferences, interventions capitalize on strengths to manipulate negative thoughts and lead to positive verbal statements (Wolfe, 1978). This study breaks down how pain affects the body physically and mentally. A second study examined looked at a single music therapy intervention to decrease pain in palliative care patients. Results showed a significant decrease of pain through self-perceived rating in the music therapy group, as well as significant change of pain perception from the beginning of the session versus the end (Gutgsell, 2013).
There is minimal overlap research when it comes to music and pain in the medical setting. However, in 2003, Romo published a cost-benefit analysis of music therapy in home hospice. The findings suggest that there is a decrease in the use of opioids and other analgesics when patients receive music therapy. While qualitative, this study indicates that music therapy positively improves a patient’s perception of pain. Another study by Vaajoki suggests that music listening alone may enhance the quality of hospital stay. Researchers in this study did not use music therapy and did not find music listening alone to reduce length of stay after laparotomy surgery in adults. Also, researchers noted contradictions within previous studies. A quote to mention from Vaajoki, “It is important to distinguish music listening from music therapy, because nurses have no music therapy education and they are not present while the patient is listening to music.” This suggests that further research using live music therapy sessions may provide more consistent and effective results. Also, education for the staff may be beneficial for the patients as to what resources are available for treatment.
To learn more about Living Unlimited and music therapy services, contact us at 1-800-310-7776.
Published April 2018
Cognitive therapy is a goal-oriented therapy that seeks to change patterns of thinking or behaviors in a person. Cognitive therapy is individualized, meaning there is a focus on the needs of each individual to formulate strategies that are effective to support certain behaviors and thoughts. These strategies help individuals to learn patterns of behavior to improve their cognitive functions and to learn/utilize compensatory strategies so that they can become more independent in work skills or better access their community. At Living Unlimited, we utilize this approach to assist an individual, with a team approach, to meet the goals that they help set.
Goals set as part of our Cognitive Therapy can be accomplished in a variety of ways. Some examples of methods utilized are journaling, role play, reviewing coping skills, completing a progressive muscle relaxation, checklists, and maintaining schedules. These techniques are introduced to the client with encouragement and reminders to continue with their implementation to create a positive change in a person’s behavior or thought patterns. One example of such implementation is creating a daily checklist for morning tasks to help the individual prepare for work. Then the client collaborates with the specialist to place this checklist in a location where the client will see it each morning and be visually cued to complete the tasks in preparation for work. The specialist will then follow up with the client to make sure the checklist is being completed and to adjust the plan if it appears to not be working. Support and follow through are important factors to cognitive therapy. Individuals receiving cognitive therapy through Living Unlimited are part of the process and receive the necessary support and strategies to increase their everyday lives.
Another effective approach that we utilize at Living Unlimited to support cognitive therapy is the use music intervention techniques. Our board certified music therapists use music therapy interventions because it is proven effective in improving attention/focus, memory, and sequencing. These skills are often ones that present as needs for individuals receiving cognitive therapy services. Music therapy in conjunction with cognitive therapy may take the form of song writing, lyric analysis, or the utilization of instruments to accomplish goals. An example of music therapy in this setting may look like completing a call-and-response experience to help increase focus. The therapist may start with one pattern the client has to repeat and change it in a variety of ways to elicit focus to task (the rhythm may change or the instruments may vary). The therapist provides immediate feedback to the client to reinforce positive behaviors such as remaining on task for ten consecutive minutes or completing the call-and-response with 100% accuracy.
Cognitive therapy can be approached in a multitude of ways to elicit a positive change in the individuals being supported. Whether using traditional techniques or those supported by a board-certified music therapist, the positive changes evoked within cognitive therapy are helpful in clients learning skills to obtain and maintain employment as well as accessing their community.
To learn more about Living Unlimited and cognitive therapy, contact us at 1-800-310-7776.
Available Resources for Individuals with Brain Injuries
Published May 2017
According to the Brain Injury Association of Pennsylvania, there are 10 million Americans are living with brain injury including stroke. Every 21 seconds, a person sustains Traumatic Brain Injury (TBI) in this country, resulting in 1.4 million new TBIs each year.
With these statistics, resources become a valuable tool to help individuals and families navigate services and develop a care plan.
Effects of Brain Injury (courtesy of the Northern Brain Injury Association)
Our brain controls virtually every function of our bodies. After a brain injury, many parts of the brain will work just as well as they always did, and other parts will not. The damage can vary from very mild to very severe. The result is that brain function can be somewhat patchy and inconsistent. No two people will have the same injury, although there are many effects that are typical among survivors.
So, what does a brain injury “look” like?
Brain Injury can be very difficult to identify simply by looking at a person. It is often called the “invisible injury” because most of the problems involve thinking and emotions. Family members, friends and professionals may not “see” your brain injury at all, which can lead to a lot of frustration for everyone.
What does a brain injury “feel” like? Survivors of brain injury say it feels like:
♦ Seizures – convulsions
Cognitive Effects – This includes changes in thinking abilities:
♦ Difficulty focusing – mind seems to wander, easily distracted
♦ Memory problems – forget things short term, and/or spotty long term memories◊
♦ Slowed thinking – world feels too fast, can’t keep up
♦ Flooding – brain gets overwhelmed and shuts down
♦ Trouble understanding – takes longer to learn
♦ Learning from experience – keeps doing the same things over and over
♦ Perseveration – excessive fixation on some thoughts, trouble letting go
♦ Rigid thinking – things are only “black & white”, there is no in-between
♦ Difficulty with executive functions such as:
o Sequencing – has trouble knowing what order to do things in
o Organizing – is easily mixed up, misses things,
o Planning – has trouble figuring out how to meet goals
o Reasoning – has trouble understanding what is appropriate
o Decision Making – has trouble looking at pros and cons of matters
o Problem solving – has trouble looking at options in order to find good solutions
o Serial-tasking – Has trouble trying to do more than one task at a time
Psychosocial Effects – changes in emotions and social behavior:
♦ Reduced self-awareness – not able to see them self or their problems honestly
♦ Increased self-focus – see only their own needs, finds it hard to see others’ point of view
♦ Emotional fluctuations – emotions are very intense, change rapidly, do not fit
♦ Depression – grieving over what is lost, sad, suicidal
♦ Anxiety and/or stress – feel stressed, jittery, restless, frightened
♦ Impatience and anger – has a quick temper, sometimes very threatening
♦ Impulsivity – acts without thinking first, with no thought to consequences
♦ Difficulty coping with change – can either be spur of the moment, or routine change
♦ Lower motivation and follow through – trouble getting started and finishing
♦ Changes in social skills – difficulties following socially acceptable behaviors
♦ Misperceptions – misunderstands people and things
♦ Changed sexual interest – has either decreased or increased interest
♦ Relationship problems – difficulty with family, friends and spouse
♦ Use of alcohol/ drugs – self-medication to cope with daily problems
♦ Reduced ability to work – cannot keep pace, cannot return to old job
♦ Changes in self-identity – changes in personality, does not know how to define self
The good news is that many of these challenges are easily dealt with using compensatory, or coping, strategies. For more information on Living Unlimited’s Head Injury services and to view our video, please visit this link on our website. If you are looking for more information or resources related to traumatic brain injury, please check out the following list:
What is music therapy? Published November 2016
You are walking down the hall of a school and you see a group of children, some able bodied and some with varying levels of disability, singing and playing instruments led by an adult playing guitar. In another room of the school, you might see a child playing different colored bells while the man with the child points to a chart of colors, indicating what the child should play. Or perhaps you are walking through a nursing home and see a group of older adults waving scarves as a woman singing and providing some instructions on how to play while music from the 1950’s plays in the background. You may think to yourself, “This looks like a lot of fun and everyone seems to be having a great time!” What you may not know, is that all of these people are involved in a Music Therapy session.
Music Therapy is defined by the American Music Therapy Association (AMTA) as “the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.” The service can be used to work on a variety of goal areas, including but not limited to: pain management, social interaction, self-expression, emotional management skills, memory enhancement, and physical/motor skills.
Music Therapists work in a variety of settings, such as those aforementioned. They may also work in prisons, clinics, hospitals, in-patient and out-patient psychiatric settings, drug and alcohol rehabilitation centers, and even in peoples’ homes. Music Therapists have received at least a bachelor’s degree and have completed 1200 hours of clinical training. In order to practice as a Music Therapist, they also must pass their board certification exam giving them the title of Board Certified Music Therapist and the credentials MT-BC. Music Therapists are also required to complete continuing education, gaining 100 hours every 5 years, in order to maintain this certification. A Music Therapist assesses individuals and groups, plans activities to promote specific non-musical skills, sets goals, and tracks progress.
At Living Unlimited, there are many examples of growth and progress in the lives of the individuals with whom we work. When I ask the therapists, some found it difficult to come up with just one example. Here are a few examples from our therapists: In working with an adult individual who has Intellectual Disability, therapy goals were focused on communication skills and managing perseverations and echolalia. Upon first meeting this individual, she did not greet the therapist with a hello or any verbal communication. During the initial assessment the client spoke only one or two sentences. When a familiar song was presented by the therapist, the client sang every word. It was also noted that the client matched pitch and kept the rhythm while singing. During those first sessions, the client also had several outbursts, especially when frustrated, presenting with perseveration and echolalia, due to not being able to find items in her home that she was looking for. The music therapist provided a “hide and seek” song to increase her resilience in not knowing where an item is. This song was a motivating way to participate in an otherwise anxiety producing task. Along with supporting her through these tasks, the therapist introduced breathing to music to encourage relaxation. This breathing is structured around a rhythm that is compatible to an appropriate breathing rate for the client’s current arousal state. In 5 months, this individual has grown to request songs using full sentences as well as use yes and no responses to questions. She also has demonstrated minimal frustration and has overcome perseveration and echolalia on some occasions.
Another example is a young man diagnosed with Autism. He presented with a high level of anxiety, rigidity in daily life, behavioral outbursts as well as limited functional communication skills. The music therapists presents music making, often using his preferred music and sometimes exploring new music. This may include singing, playing instruments and practicing coping strategies with music. Through these activities, the music therapist uses music functionally to allow for self-expression in an appropriate manner, to accept changes, and to change problem behavior. Over two years, he has grown and made progress as he works together with the therapist within the music. At this time, he is preparing for discharge from music therapy services to gain more age-appropriate educational and vocational experiences.
Some growth takes time and progress may be slow. For one child diagnosed with autism, coping with several changes in his life and routine was presenting as difficulty with transitions. Behaviors that were being seen included yelling, singing loudly (while okay here may not be okay at school), laughing, as well as some physical aggression. This happened at the beginning of every session for several months. Slowly, the behaviors decreased and after approximately 5 months, minimal behaviors were presented. Using the song Down by the Bay with visuals, the therapist engaged him to sing and make a choice about the next animal to sing about. As the behaviors decreased, the child increased using sentences and eye contact to request. As he has aged, preferences changed. Currently, they use songs about super heroes. The activity has changed but the positive behavior has sustained, as he still is using full sentences and eye contact as he makes a choice.
This same child has the strength of relative pitch. The therapist and his family have recognized this strength and used it to expand his attention to task. They have utilized songs that he likes singing and playing on the piano to grow his focus and ability to follow directions. Initially when starting with him he needed constant prompting and direction to sit for five minutes. Now he has grown to attend to playing his songs for ten minutes with fewer than 5 prompts.
Another child has challenges related to a traumatic brain injury. Her challenges relate to motor planning and communication. Music activities such as children’s songs, fingerplays and movement to music are being used to encompass all the functional skills she is developing through her many therapies. She is attending visually to her mother and the therapist as they sing Itsy Bitsy Spider. Memory skills and motor planning are a focus during this activity as well. She practices cognitive skills such as making choices and matching with instrument play all while extending her attention and focus for learning. During a movement to music activity, she follows verbal directives to move her body in a variety of ways. This not only works on auditory processing of directives, it works on attention to task, motor planning and coordination, body awareness, and bonding with her family. She also seems to be having a good time as evidenced by her smile and laughter.
A little girl with autism has been coming here to us for several years and has been working on emotional identification and appropriate expression of emotions. Regularly, she would identify feeling happy or excited, and denied experiencing other emotions, even if she was visibly upset, mad or sad. This child gradually increased her understanding and ability to appropriately express her emotions through a variety of experiences, including singing songs about emotions and emotional triggers, instrumental improvisations where emotions were musically expressed, and writing songs about emotions. Over time, she began to identify emotional triggers for a wide variety of emotions, and is now able to identify when she feels upset, mad, or frustrated and is able to express why she feels that way. The pairing of emotions, which was a non-preferred topic, with music, which is she finds enjoyable and motivating, greatly helped her to increase her emotional understanding and appropriate expression of emotions.
We measure the success, growth and progress in many ways including direct observation, tracking, documenting after each session and parent report. When a child uses the strategies during their everyday activities or practices an appropriate social skill that has been a focus in our therapy services, we celebrate! When the parents and caregivers see the progress that we make in other environments, we share in that success.
In the community, there is music everywhere being used in many different ways. Some of it may be music therapy and some of it may not. If a college student is playing piano and singing at a nursing home for an audience of older adults or a nurse is playing music in the background for one of her patients, this may be a great benefit for those involved, but it is not music therapy. If a celebrity plays music for a local children’s hospital, it is a wonderful experience for everyone involved, but it is not music therapy. If a staff person at a nursing home puts music on an iPod, placing the headphones on an individual while making sure they are comfortable before walking away, they are giving the person a musical experience, but it is not music therapy. Walking by these experiences, it may be hard to tell the difference between an enjoyable music experience and a music therapy session. It may be hard to see the difference while music is being made and the experience is happening. The difference is in the preparation and planning, the individualized experiences, the knowledge and assessment of strengths and needs, the tracking of goals, the celebration of progress, the problem solving during challenges, the therapeutic relationship, and the specific use of our tool, music!
American Music Therapy Association, www.musictherapy.org
Research in music therapy supports its effectiveness in a wide variety of healthcare and educational settings. For further information, please explore the rest of this site including the Frequently Asked Questions (FAQ) page and the 2014 press release, "Setting the Record Straight: What Music Therapy Is... and Is Not."
Social Skills – Why We Need Them in the Workplace
Published July 2016
It is likely that anyone who has ever worked before can share a story about someone who they worked with who had poor social skills. It could be that the person never had eye contact when speaking, often staring off into space; stood too close causing you to continually back up; had a tendency to continually start talking even though you were in mid-sentence or shared stories that clearly were personal and made for an awkward encounter.
This person likely had little awareness that they had virtually no social skills and could not understand why co-workers avoided them at all costs. Demonstrating social skills at work is generally something that we do not think about – it just happens for many of us. Social skills are considered “skills that allow people to communicate, relate and socialize with others. They include both verbal and nonverbal forms of communication.” These skills are often “hidden” and really help mold others’ impression of us. For employment, the way we act or behave can help land jobs or promotions or just the opposite, resulting in no job offers or even termination.
Social or soft skills in the workplace can include communication abilities, ability to work with a team and problem solving abilities. For example, communication skills include being able to determine what is appropriate to say and when, as well as, demonstrating a clear voice that is appropriate in tone and volume when speaking while remaining on topic during conversations. It can also be eye contact, standing up straight, smiling appropriately, and demonstrating open postures. Communication is generally not positive when speaking to someone who is looking at everything but you while crossing their arms and turning away. This leads to short conversations and the tendency to avoid you.
Listening abilities fall within non-verbal social skills and can be demonstrated by the occasional nodding or shaking of the head, the occasional quick comment, and clearly taking in someone else’s communications is valuable. To ensure effective communication, each person should have equal parts in a conversation.
For those with a disability, demonstrating effective social and soft skills can be even more challenging. Particular disabilities that preclude effective communication such as Autism can lead to significant challenges for workplace integration for those diagnosed. The National Collaborative on Workforce and Disability (NCWD, 2011) identifies the following skills as necessary social skills for job success: communication skills, interpersonal skills, decision making skills, and lifelong learning skills. Within these areas are specific skills, which may be developed through individual or group skills training. These include active listening, cooperating with others, problem solving, planning, and using technology.
There is debate about whether good social skills are learned or innate. In working in vocational rehabilitation for many years, I have understood the need to help individuals who have challenges with social skills learn how to develop and demonstrate effective strategies to minimize those challenges. Living Unlimited has understood the impact behaviors have on employment potential and have provided interventions since our inception in 1986 to help individuals demonstrate behaviors that employer’s value. Current trends have finally understood that employment opportunities for those with disabilities goes beyond teaching how to master a task but how to best integrate into a work environment.
One of the biggest challenges someone with a disability may have when it comes to social skills is that the rules often change depending on the environment. When with friends or family, it is okay to be less formal – many people hug their friends or family when leaving an event but that is not something that we would do at work. Understanding why there is a difference is at the forefront when teaching social skills to people. Additionally certain topics such as religion, politics, and sex are generally not acceptable at any workplace. Personal topics and questions related to race, ethnicity, sexual orientation, disability or other personal characteristics/topics are also not acceptable. Nevertheless, to someone with a disability, these topics may occur nightly at the dinner table and it is important to help them understand workplace expectations.
Living Unlimited’s Vocational and Community Adjustment Program, established in 1986, was developed to undertake the task of social skills development for effective workplace integration. Through a comprehensive curriculum based service, individuals are taught skills related to team work, self-advocacy, problem solving, initiation, focusing and concentration, stress management and many others. Effective and functional workplace strategies are learned and practiced as individuals recognize, accept and adapt to challenges and achieve vocational goals related to social and soft skill development. Cooperative learning, role-playing, and participation in social adjustment groups during the VCAP day will foster the acquisition of soft skills.
Another effective manner for teaching workplace social skills is related to job coaching efforts where immediate feedback is given to the person. This feedback is intended to convey what is and is not acceptable and why. The development of natural supports on a job site is a job coach’s most important task and one that should begin on day one. In addition to teaching job tasks, the job coach is tasked with teaching the individual how to act for the specific environment as well as providing support to co-workers and supervisors who will continually assist the person as the job coach decreases time on the job.
Our community is now understanding the need for effective social skills in all facets of life. Programs to teach these skills to individuals with disabilities are “popping up” everywhere and while this can be beneficial, it is important to ensure that services are focused on what employers value to fully prepare individuals for a work life. Each workplace is different as is each person – we cannot lose sight of individuality and need to ensure that this is always at the forefront of any program. Preparing for employment can be daunting to anyone, let alone someone with a disability. Nevertheless, there are many resources and programs like Living Unlimited that are trained in making sure each person has the skills needed to succeed in transitioning into a work environment and learning job tasks.
THE IMPORTANCE OF TRANSITION
Simply put, “transition” is an opportunity to help students with disabilities and their families discuss life after high school. Throughout high school, transition meetings are held to help identify short and long term goals that the student wants to achieve by identifying resources, supports, and guidance needed to achieve each goal. Transition in the state of Pennsylvania starts an early at 14 years old and occasionally younger. The purpose for starting the process of transition at an early age is to start educating the student and their families of the resources available to them. An IEP (Individual Education Plan) is the guide that teachers use to help each student who needs specific support in and out of the classroom. Examples can include extra test time, a quite area to take a test, extra time with their homework, reading assistance. Supports can also include community options and one of the goals of the transition team is to assist in identifying resources in the student’s own community that are available. Resources can be available while the student remains in high school or can be available once they graduate. In all cases, the resources are beneficial in assisting the students with their identified goals based on their strengths, preferences, and interests. Transition can be thought of as a bridge between school programs and the opportunities of adult life, including employment, independent living, and community participation.
Living Unlimited is very active in transition meetings for all of their covered counties in the state of PA. Staff attend transition meetings to help “brainstorm” ideas for each student in attendance or presented at the transition clinic. The purpose of this is to “bridge” the gap from high school graduation to the “real world”. Often situations exist where students go from highly structured environments to little or no activity , often remaining at home with no movement toward work or independent living. Transition meetings are held to avoid this. Topics discussed are often centered on postsecondary education or vocational training, employment, independent living, and community participation. Students need to be fully incorporated into each transition meeting with providing information to questions related to future goal, including post-graduation work/school objectives, residential plans, community access, etc. This information guides discussion by the transition team to identify resources and options available to each student as they “bridge” the gap from high school to the adult world.
Transition is designed to help facilitate a student’s successful transition from high school into the adult world by illuminating the way for students and families. Community based service providers such as Living Unlimited are consulted with and connected with the student to prepare them for crossing the “bridge” into adult life. Living Unlimited is holistic and has a menu of services available to assist students with their transition goals. Please take some time to view our services, view our videos, and read about our talented staff. Living Unlimited Specialists are the front line staff who support students in reaching their goals. Below is a check list used in high schools across the state of PA to help teachers, students, families, support systems ensure that they are on the right path for success after high school. Success is on the horizon and we are just the program to help achieve your success.
The Client Centered Approach
Consider this: You are on an uphill climb and you want to get to the top of the mountain so badly. It is hard. You have so many emotions as you approach this challenge: excitement, anxiety, doubt, fear, but you have hope and a passion to get to the top. This climb seems impossible to do on your own, but you know what you want and you are going to try your best to get to the top! Now imagine you come upon a group of people who ask you what you are doing and you share your dream of climbing to the top of the mountain. These people get to talking and ask you how you are going to get there and listen to you in a supportive way. You learn a little bit about each of them and realize some have tools, some have food and water, some have a tent for rest, some have positive energy, and all of them cheer you on and say they will walk with you and make sure you get to the top. As you travel, you will have good days and bad. You will need flashlights to travel in the dark, ropes to get up the steep parts of the path, a tent to rest and regroup, and people to talk to and listen to what you have to say. The team works together and gets you to the top of the mountain as the sun rises and you have reached your goal.
In this scenario, the person with the goal is the center of the activity. This individual has chosen their own goal and is moving toward that goal with the assistance of others. They are in the center of the service, making decisions and acting as an integral part of the team. In treatment, the client is the center and the team surrounds that individual with support and assistance.
Client Centered Therapy, also called Person Centered Therapy, was introduced by Carl Rogers in the 1930’s. The British Association for Person Centered Therapy describes the approach in the following way, “this therapy moved away from the idea that the therapist was the expert and towards a theory that trusted the innate tendency (known as the actualizing tendency) of human beings to find fulfilment of their personal potentials. “ It was first used in psychotherapy but the theory has adapted itself for other settings such as classrooms, community habilitation, and skills training and with various individuals. The British Association for Person Centered Therapy states, “the approach does not use techniques but relies on the personal qualities of the therapist/person to build a non-judgemental and empathic relationship” which allows for the person and their therapist, or treatment team, to work toward the goal set by the individual in a safe and supportive structure.
In treatment, the therapist or team does not always focus on particular techniques but the therapeutic relationship built upon support, authenticity, empathy, and understanding in order for change to occur. The concept of Self-actualization is an important feature and is defined by Shamekia Thomas in the following way, “Self-actualization refers to the tendency of all human beings to move forward, grow, and reach their full potential.”
Why is it important to be client centered in therapy? In the field of human services, the individual participating in an intervention should be the main focus and should help lead the direction of therapy.
At Living Unlimited, our mission is to encourage individuals to gain the maximum level of independence across a variety of settings. This can be achieved by participating in the many services we offer which may include life skills training, prevocational activities, vocational support programming and music therapy. To maximize independence, a person must be invested in the process to make progress.
No matter what the service, Living Unlimited focuses on the person right from the beginning. At intake, it is important for the individual and their support system to participate fully by offering thought, ideas, and helping set goals for the future. Consider this: Do you want someone else to set goals for you? What if every decision about your life was made by someone else? How would that feel? Would you like someone else to tell you that you should be working at clothing store when you are passionate about food? Each person knows themselves the best which is why each person needs to be a part of their services right from the start!
Our next step at Living Unlimited is to consider each individual’s strengths and the areas that need to improve in order to plan for success. Each individual must share their passions and preferences in order to guide the process. The team will offer suggestions, however the individual has to be an active part of planning in order for the services to be successful.
Services at Living Unlimited will be based around each individual’s goals. If that is to work, we will support and challenge an individual to prepare them to be successful in the work of their choosing. If that is to better access their community and maximize independence, we will support an individual in their community, challenge them to extend their comfort zone, and support the individual to practice skills to be successful and fade support over time. If that is music therapy, the music and music activities that each individual prefers will be used to work toward goals of socialization, communication, emotional management, quality of life and beyond. We work together to determine a course of action and what services will best help challenge a person to get them to their goals. This means the individual must be an active part of the process with the team offering suggestions, ideas and assisting the individual as they walk the path toward their goals.
At Living Unlimited, we want you to gain success no matter what that means to you. We want to be your team that offers you the tools, the rest, the listening ear, and the positive support . Ultimately, you need to lead the way and have the drive to meet your goals. You are the center of the service and success is on the horizon.
LIFE AFTER BRAIN INJURY
published September 2018
Living Unlimited helped me find my “new normal” after brain injury.
Imagine for a moment feeling as if you were 8 and 88 years old at the same time. That’s how I felt at age 59 after a 2011 car accident left me with brain and spinal injuries. My 8 year old self read at a simple level, set hot pads on fire when cooking, lacked social graces and impulse control, and didn’t remember to look both ways when crossing a street. My 88 year old self had head and back pain, memory problems, needed rest, couldn’t see well, and no longer felt safe driving a car. Every night, when acute pain kept me from sleeping, I thought of suicide.
My primary care doctor didn’t know how to help me with my recovery, so I searched out resources on my own. Physical therapy, chiropractic care, and exercise diminished my pain. Vision therapy took away vertigo and motion sensitivity. Hyperbaric oxygen and neurofeedback normalized my speech, took away my sensitivity to light and noise, and returned lost brain functions. Cognitive therapy and neuropsychological counseling helped me accept limitations, pace myself, and learn compensatory strategies.
Over seven years, 1400 therapy sessions, and with the help of many kind, skilled therapists, I came back to life. Even so, everyday life was hard and few people understood. Meeting other people with brain injuries and attending an adult concussion support group helped me.
Support group members inspired me to attend the Brain Injury Association of Pennsylvania annual conference. Brain injury survivors and providers spoke about the Pennsylvania Head Injury Program (HIP), a one-year intensive program where a rehabilitation specialist comes to your home. I decided to apply and was happy to discover that the HIP application process included receiving help filling out the forms.
Once I was approved for the program, supportive Living Unlimited rehab specialists came to my home twelve hours a week. From the beginning I felt as if Living Unlimited staff understood brain injury. They helped me set goals I wanted to reach during my year of services: to exercise regularly; improve my social skills; make decisions more easily; continue to develop compensatory strategies; and re-integrate myself socially.
As a result of Living Unlimited services, I exercise regularly, speak more clearly and succinctly, make decisions readily, enjoy new hobbies, and have a well-organized home. Working intensely with rehab specialists increased my cognitive stamina and flexibility so I am more socially active. I have new friends and new goals for the future.
The improved awareness I gained through HIP and Living Unlimited helped me move on in a positive new direction in my life. I began the year seeking volunteer work as a precursor to paid employment. Over the course of the year, I decided that at age 66 it was time for a joyful retirement. This is a huge change. Everyone has to find a “new normal” after brain injury and I have found mine — seven years post-injury. I have a feeling of momentum in my life with many new joyful activities and I thank Living Unlimited for serving as a catalyst to my growth and healing.
To learn more about Living Unlimited and head injury services, contact us at 1-800-310-7776.
Music Therapy in Early Intervention
Published November 2017
For many people, music is an integral part of life, and is an important part of our culture. We listen to music on the radio or watch music videos online, hear music on TV shows and commercials, hear the national anthem at sporting events, attend concerts, and hear music in places of worship. Just as music is an integral part of our life and culture, music is also an integral part of early childhood. Parents sing lullabies or play music for their infants to help them fall asleep. Children learn their alphabet by learning to sing their ABCs, and learn animals and animal sounds by singing songs like “Old MacDonald Had a Farm.” Most children’s shows incorporate songs and music, and children will often be seen singing and dancing along. Music assists with language development, coordination, gross and fine motor skills, and can provide opportunities for social interaction, among many other benefits. Since music is already a significant factor in early childhood, it is only natural that music be used to facilitate growth and development in children experiencing delays in development or disabilities, and who may be involved in Early Intervention programs.
What is Early Intervention? Early intervention programs are run through the county, and provide support and services to families of children from birth to age 3 who experience a variety of challenges, delays in development or disabilities. Early Intervention services can benefit children who need support in learning basic developmental skills in order to better prepare for successful integration into home, school, and the community. Needs may include physical or cognitive development, communication, social and emotional challenges, decreasing tantrums, etc. Services may include Physical Therapy, Occupational Therapy, Speech Therapy, Special Instruction, Hearing Services, Vision Therapy, Nutrition, etc. and are provided at no cost to the family. Early Intervention builds upon the natural learning opportunities that occur within the daily routines of a child and their family, by providing the family with ideas, strategies and resources that they can use at home and in the community to help their children learn new skills and develop to their fullest potential. Activities are individualized to facilitate treatment goals as determined through assessment and in collaboration with the family and Early Intervention team members.
Music Therapy is one of the many services that Living Unlimited provides. Currently, Living Unlimited provides Music Therapy services within the Early Intervention programs in Dauphin, Cumberland, Perry, York and Adams counties. Music Therapy services provided through Early Intervention is classified as a Special Instruction service. Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program. Through working within Early Intervention programs, our music therapists work with children and their families to address a wide variety of areas of need, which may include cognitive skills including attention, direction following, and learning basic concepts; communication, social skills, physical development, decreasing tantrums, etc. The music therapists collaborate with families and caregivers to develop music-based strategies that they can use during their daily routines, and coach them on how to use music both in the home and community, to support their child’s development. A few examples of music strategies may include the following: songs to support routines, i.e. a song about dressing or a song to help a child calm down when they are upset; songs that incorporate choice-making, vocalizing or filling in words for communication development; instrument playing activities can assist with coordination and direction following, and action songs or other movement activities can assist with physical development. These are only a few examples of how music strategies may be used to support routines and promote positive development. The interventions that our music therapists develop with caregivers are individualized to meet the needs of each child, and to support the family’s routines. Our music therapists utilize resources that the family has access to in their home environment, rather than bringing in outside instruments or resources, that way the family has access to these resources to use throughout the week rather than having them removed at the end of each session. Resources that may be utilized may include musical and non-musical toys, books, musical instruments the family may own, or they may get creative assist the family in making homemade instruments, or find other objects to substitute for instruments, for example, using boxes or containers for drums. When families make music together, they can engage together and support their child’s growth and development in positive and impactful ways.
More information on Early Intervention can be found at:
For more information on Music Therapy services, please contact Living Unlimited at 717-526-2111.
Work Based Learning and What it Means to You
published January 2017
Hi, my name is Tiffany and I want to get a job…
This is something we hear a lot at Living Unlimited. Since we are a job coaching agency and provide interventions to many individuals regardless of disability type, area and funder, we are able to provide assistance in most cases. As regulations change and more services become available to school aged individuals, we are contacted more often by students asking the same question and expressing interest in employment.. We can start programming by asking a few simple questions including …
Do you have an IEP or a 504 plan?
Do you have updated psychological testing?
Do you have a diagnosed disability?
Do you have a case open with MH/ID?
Do you have a case open with OVR?
Are you eligible for the autism wavier?
Do you get SSI or SSDI?
Do you have your driver’s license?
Do you have a PA photo ID?
Are you over the age of 18?
Do any of these questions sound familiar? Do any of the acronyms sound familiar? What is OVR, what is MH/ID, what is a disability, what is psychological testing? The questions go on and on.
If you are a high school student with a disability or a parent of a high school student with a disability who is between the ages of 14-22, the chances of being asked the questions above are very likely and probably very confusing. High school is a time when students who are between the ages of 14-22 are preparing for life after graduation. Disability or not, high school ends at some point and we want our students to be prepared for the “real world.” High school transition teachers in the state of PA start to schedule appointments called clinics or transition meetings with their students to prepare them for “adult life”. The questions above are typical questions asked during any transition meeting and the answers guide the path each student is presented. The transition meeting involves community providers who present different services to prepare each student for life after high school.
One type of service that is discussed and offered for students who are eligible for the Office of Vocational Rehabilitation (OVR) is the Work Based Learning Experience (WBLE). Here are a few fun facts about WBLE’s completed by Living Unlimited and how each student can benefit from this service:
If these services sound like something you are interested in learning more about, please contact us and we will be happy to provide you with additional information. Living Unlimited is experienced vocational provider and will assist you and your family manage the very confusing transition process from high school to the “real world.”
TRAUMA INFORMED CARE - POSTED FEBRUARY 2015
Traumatic Brain Injury and Trauma Informed Care
Anyone who has experienced a brain injury (TBI), or is the family member of someone with a TBI can share how traumatic that is for them. In an instant, one’s world can be changed in a devastating way. Trauma informed care is an integral part of the therapeutic process for this reason. Trauma informed care can teach skills such as breathing techniques or how an individual’s body reacts to anxiety as well as discussing related feelings. Individuals can then process the memories from the traumatic events with less anxiety. Each person can process the event at their own pace and explore how the trauma has affected their life and work on reducing anxiety.
When anyone experiences a trauma of any kind the brain is literally re-wired. Chemicals are released which are meant to protect the person in the event but can have long lasting effects. Coupled with a TBI, this process has even more significant of an impact on the ability to process what has happened. It is common for anyone who has experienced a trauma to have challenges with remembering the event or it may feel like fractured pieces in the memory. If there is a TBI short term memory deficits can make this even more difficult to process.
There are some important Trauma Informed Care therapies that have been researched and shown to have significant impacts on improving the outcomes for those individuals struggling with trauma and TBI. Prolonged Exposure is an important component of this process. If there is a place or environmental factors that cause extreme anxiety after a trauma; it can be helpful, in a safe environment and in increments, to actually experience that trigger over and over until the feelings of anxiety diminish. If someone is nervous about being in an automobile after an accident, simply sitting in a car that is turned off may be the first step to Prolonged Exposure Therapy. Another step may include not moving the car but turning on the engine with the emergency brake firmly in place. The more the individual is exposed to the trigger the less power it has in their life.
Anxiety can make our lives much smaller. The more we allow the anxiety to make our decisions for us, the less control we have over our lives. By using Trauma Informed Care through Living Unlimited, Inc, individuals can take control of their own destinies. They can make the decisions about what kind of life they would like to make. Their horizons can be unlimited!