ASU Research E-Magazine: Song of Sensation

Lots of 18-month-old babies love to pound on pianos. But when Sara Romero started pounding, everyone knew it was something special. Born blind and developmentally delayed, Sara was not the average tot. Her instrument of choice was an organ, not a piano; and little Sara did not bang, she played television theme songs by ear.

“I’d never seen this with any child I’d worked with—and I’d seen a lot of children—Sara is just very incredible,” says Suzanne Oliver.

Oliver has been Sara’s music therapist for the past 14 years. She is a graduate of the Music Therapy Program at Arizona State University’s School of Music.

As a child, Sara found it difficult to communicate with others. After years of therapy sessions with Oliver, and lots of hard work, Sara has grown into a 16-year old who has established herself in local circles as an accomplished musician and composer.

Sara has trouble processing information in every way, from organizing information to analyzing and responding to it. Her lack of visual input compounds the problem. She also has difficulty comprehending concepts such as time and the sequencing of events. The music therapy process helps Sara work through her developmental delays and deficiencies in her neurological programming.

“Music profoundly affects Sara neurologically. She’s motivated by it and sometimes that motivation is the key factor,” Oliver says.

Therapists like Oliver use music to help their clients make connections outside of the music itself. Music itself becomes an instrument that helps treat individuals with challenges ranging from blindness to autism to Alzheimer’s disease. Music entices interaction and compels movement.

At ASU, the Music Therapy Program has trained people for this field of mental health and special education for decades. The program teaches students how to assess a client’s needs and problem areas, and then create therapeutic activities, called “interventions.” Specifically designed interventions help clients to improve motor skills or enhance their cognitive, emotional, or social development.

“Music therapy is the application of music and various music therapy interventions to achieve specified educational and treatment goals,” says Barbara Crowe, director of ASU’s program. “Music is the tool through which the therapist involves the client in an interaction to treat or remediate a problem in some aspect of his or her functioning.”

Interventions are applied within highly structured environments as well as in sessions with virtually no structure at all, except for that provided inherently within the music itself. All music therapy settings use a variety of activities to elicit and improve cognitive, communication, motor, social, and emotional skills.

These activities may be passive or active, Crowe explains. They include song, movement, and instrumental tasks that concentrate on a variety of skill areas. In the case of children with visual impairments, music therapy interventions provide information through singing and language-based tasks.

“Sighted children are stimulated by what they see, but children with vision problems don’t tend to reach out and actively explore their environment,” Oliver says. “The music therapy process may provide them with increased amounts of information about their world—they become aurally in touch with their surroundings.”

Children with vision problems learn to actively integrate sound, touch, and movement information. This can speed up their learning and promote social and language skill development.

“When the auditory, tactile, and kinesthetic components of music are applied within the music therapy process, blind children are able to overcome difficulties with movement, communication and cognitive ability, attention to task, and learning, such as in the area of self-help skills,” Oliver explains.

Sara was blinded by retinopathy of prematurity, a condition resulting from premature birth. She weighed just one pound, six ounces. She also suffered from hydrocephaly, a condition that causes fluid to accumulate around the brain. The disorders interfered with her information processing skills.

Oliver learned about Sara through Music Therapy Services of Arizona, an organization she founded shortly after graduating from the ASU program. Oliver’s agency provided services to The Foundation for Blind Children. Sara enrolled in group music therapy sessions through that group.

“Sara was quiet and had difficulty communicating,” Oliver recalls. “But there was an organ in the classroom. Sara would reach up to the keyboard and play television theme songs. The therapists knew she had an affinity for music.”

To assess Sara’s musical ability, Oliver decided to perform a composition she had written, one she was certain Sara would not know.

“I asked Sara to play the tune on piano. As she did, I played the bass accompaniment. When we were finished, she played both parts in their entirety,” Oliver says. “She was only two-and-a-half years old! I knew music therapy would help her cognitive development.”

Oliver and Sara worked in a highly structured setting to improve her language and communication skills. Children’s songs such as “Itsy Bitsy Spider” and “Twinkle, Twinkle Little Star,” helped Sara learn by hearing. By the time she was 7- or 8-years old, Sara had studied piano through the Suzuki Method and learned classical music.

“Music therapy interventions helped the active integration of Sara’s neuropathways, increasing her ability to organize and process information,” Oliver explains. “This promotes her ability to learn and more readily output the information she learns.”

Sara’s musical and communication skills continued to develop over the years. But she continued to struggle with cognitive abilities such as time and the sequence of events. Oliver responded with new interventions. They sang songs about daily activities, from getting dressed in the morning and going to school, to events at home in the evening.

Oliver also reduced the structure of the interventions. This encouraged Sara to develop her own self-imposed structure and incorporate the use of her own music. In the process, Sara expressed her personality while elevating her self-help and organizational skills.

Sara was motivated to prepare for her music therapy sessions. Today, she decides what music to play, which instruments to use, and what she and Oliver will perform.

“Sara still struggles with information processing, particularly with spontaneity and emotion. However, the music motivates her to work through her difficulties,” Oliver says. “Although her music is very visual and emotional, she has trouble understanding and expressing emotion verbally.”

To help Sara make the emotional connection, Oliver has her create music that expresses a variety of feelings, such as happiness or sadness.

“I use her music to see where she has holes in understanding,” Oliver says. “If the assignment is to play something that sounds sad, and it isn’t, then we discuss and explore the feeling further.”

Oliver uses improvisational exercises to improve spontaneity. Sara will choose a key, tell Oliver what chords she’ll use, and then improvise on those chords.

“This is a way to get her to work through the sequencing of events, from the key to the chords. It’s all a function of the timing and framework of music,” Oliver explains.

Oliver designed a separate intervention to work on Sara’s ability to read Braille. Sara read individual Braille letters rather than scanning the page to pick up words and sentences.

Sara’s songs and stories were converted to Braille and put to music; a series of chords Sara had identified. As Oliver played the chord progression, Sara read and sang what she had written. This forced her to read the Braille at a faster pace in order to keep up with the music.

“Sara’s reading speed picked up quickly because she was so motivated,” Oliver says.

Sara’s understanding of the structure and organization of music also improved dramatically during the summer of 1996.

“It all began to make sense to her,” Oliver says. “She had created music before, but now she understood that music had a beginning, middle, and an end.”

During previous improvisations, Sara would create for 30 minutes at a time, with little formal structure to her music. The realization that songs she listened to on the radio lasted only two to four minutes had a huge impact on her.

“She began to comprehend the structure of time within music,” says Oliver. “Music moves through time and Sara began to realize that you can’t always wait to process information and think—you have to put information back out quickly.

“She began to convey her ideas and musical thoughts in a more organized and comprehensive manner,” Oliver explains. “As this began to improve, Sara’s spontaneity and organization in social conversation improved as well.”

Music’s effect on Sara is profound.

“Due to her developmental delays and unique neurological programming, Sara still is subdued at times,” Oliver says. “Yet after we get going with the music, her personality comes out. Sara becomes more spontaneous and organized and displays improvement in her processing of information.”

After years of music therapy, Sara is now able to process her thoughts quicker than before. Her thought and communication patterns are clearer and more organized.

“I can still see differences each day during every new session,” Oliver says. “There is such a risk of people with conditions similar to Sara’s using music to withdraw into their own world. The music therapist’s job is to use the music to bring them out and connect them to our world. That’s where Sara is right now. She is being her whole self and sharing that with others. She is actively sharing the gift of herself and her music with the world.”—Vickie Hamilton-Smith