After reading Wendy Magee’s article regarding her perspective of music therapy (MT) in rehabilitation from the UK, I felt compelled to make known the position of a music therapist working in a rehabilitation hospital in Ireland, as they are one of the very few therapists practicing in this area in the republic. One must be aware that Magee’s voices article was submitted in 2006 and I suspect that there have been great advances in establishing music therapy’s role in rehabilitation in the UK since then. However, when Magee describes rehabilitative MT in the UK at the time as “struggling to make its mark”, one can see a strong similarity to the present role of MT in rehabilitation as a profession in Ireland. Whilst I cannot comment on an overall view of MT in rehabilitation in Ireland, I can give a detailed synopsis from a trainee’s perspective of a recently established permanent music therapy post in a rehabilitation hospital in Ireland.
An Overview of a Music Therapy Position in Rehabilitation from Ireland: A Perspective from a Trainee Music Therapist
This rehabilitation hospital provides a comprehensive range of specialist rehabilitation services to patients who, as a result of accidents or illness have acquired a physical or cognitive disability and require professional medical rehabilitation. Three categories of patients are referred to this hospital, which includes people who have brain injuries, spinal injuries and patients who require prosthetic, orthotic and limb absence rehabilitation. The facility also has a small paediatric rehabilitation department which takes referrals of patients under the same diagnosis.
The music therapy position was initially set-up at this hospital as a pilot program in 2009 with the costs of running the program being covered by fundraising and charity donations. When comparing this article to Magee’s, it is noteworthy to see the similarity in funding sources for MT between Ireland and the UK, as Magee states when talking of how music therapy is funded in the UK that, “sources for funding are predominately from charitable trusts and organizations”.
As the pilot program came to a close in 2011, and the music therapist was set to leave the facility, feedback from service users, their families and the staff indicated that there was overwhelming support of an appeal for a music therapy post to be established on a permanent basis. In 2012, a permanent senior music therapy position was set up at the hospital employed under the health service executive (HSE) of Ireland. Magee states how in 2006, there were very few MT posts in neuro-rehabilitation funded by the National Health Service (NHS) in the UK. Comparing this to the position in Ireland six years later in 2012, this newly established post at this hospital became the only MT post working in neuro-rehabilitation employed by the HSE in Ireland. This comparison between the UK and Ireland displays how music therapy in rehabilitation is an innovative service in this area.
Team Working
An inter-disciplinary team forms the basis for the programs available at this hospital. Within the paediatric department, the music therapist works as part of a team of occupational therapists, physiotherapists, speech and language therapists, teachers, social workers, psychologists, nurses, doctors and others which contribute and work together on each child’s rehabilitation goals. A main feature of the paediatric program at this hospital is a transdisciplinary approach, where therapists for example will run joint occupational therapy (OT) and speech and language therapy (SLT) sessions with a patient. Music therapy is fully involved in this joint approach where the music therapist will regularly run sessions alongside an OT, a physiotherapist or an SLT where each professional will assist each other in achieving similar or identical goals. In addition to this collaborative working approach other members of the team may observe music therapy sessions in order make assessments of patients. (Twyford & Watson 2008).
Magee’s describes in her article sources of referrals to music therapy across three rehabilitation units in the UK, where referrals came from multidisciplinary groupings such as case reviews, joint therapist referrals such as a combined referral by an OT and an SLT, and single therapist referrals from an SLT or a physiotherapist. The source of referrals to music therapy at this facility in Ireland are comparable to Magee’s account, as referrals at this facility come from similar professional team groupings and therapists.
The music therapist at this rehabilitation hospital also works using a method of clinical practice which they developed alongside another music therapist over a 13 year period working in a day center in London prior to their move to this Irish hospital in 2009. They called this approach collaborative approach music and attuned movement therapy. At this hospital the music therapist employs this method with certain patients where they will work closely with another professional, (usually a therapist such as those mentioned above) who acts as a movement facilitator for the child. During the therapy communication is on a pre-verbal level where patterns of breathing, vocal sounds and bodily movements are acknowledged by reflective improvised music and attuned movements. (Fearn & O’Connor 2008).
Expansion and Moving Forward
Since the MT pilot program was started in 2009 and a permanent music therapy position was founded in 2012, the service has moved from strength to strength and is continuing to expand. At first the music therapist solely worked with the paediatric patients which could range from birth to eighteen years of age. However, the prompt expansion of the music therapy service is evident as the music therapist now receives referrals from across the hospital. Along with their paediatric work the therapist now sees a number of adults in the hospital and they have also been integrated into the team, working with adult patients who have neurological damage, mainly with patients who are in altered states of consciousness.
From a trainee’s perspective it is clear that music therapy services are in high demand at this hospital and as knowledge of MT’s contribution and benefits to patients grows among the hospital staff, the service can only continue to expand in the future. However, as only a single music therapist is currently employed at this hospital, there is a definite limit to the amount referrals and workload this single therapist can manage with the hours available to them.
However, the music therapist at this hospital recently achieved a major step forward in the expansion of the music therapy department. They submitted a proposal to the ethics review board of the hospital to carry out a research study to assess the new music therapy assessment tool for awareness in disorders of consciousness (MATADOC),(Daveson et al, 2007). They proposed to identify its benefits in assessing patients level of response which would contribute to diagnosis and treatment planning as well as monitoring change in disorder of consciousness patients. Ethical approval was awarded in early 2013 and the research study is now in the final stages of preparation before the work can finally commence. If the study begins it will run for a period of two years and will result in the expansion of the music therapy department by an increase of employment hours for the senior music therapist and the addition of a second music therapist to the department to work on the research study.
In Conclusion
In Magee’s conclusions she considers findings from two different hospitals about MT’s role within the medical rehabilitation environment and its benefits to a rehab and neuro-rehabilitation programs. However she suggests as part of a future study that the findings “would be of greater value if we could collect these types of statistics on music therapy services from international units”. (Magee, 2006, para. 6).
From a trainee’s perspective the similarity between Magee’s findings in her conclusion and the music therapy program at this rehabilitation hospital in Ireland is unmistakable in terms of the process of establishing an MT post in this area, sources of referrals, music therapy’s relationship with other therapists and the contribution and role of MT within a rehabilitation team. A future evaluation or an audit of the music therapy service at this Irish rehabilitation hospital would be of great value to Magee’s proposal to collect data from international MT departments in rehabilitation and as she suggests, “would make an interesting and invaluable study in terms of examining the role of MT in the rehabilitation setting”. (Magee, 2006, para. 6).
References
Daveson, B. A., Magee, W. L., Crewe, L., Beaumont, G., Kenealy, P., (2007) The Music Therapy Assessment Tool for Low Awareness States. International Journal of Therapy and Rehabilitation. 14(12) (pp. 544-549)
Fearn, M. C., & O’Connor, R., (2008) Collaborative Working at the Cheyne Day Centre London. In Twyford, T., & Watson, T. (Eds), Integrated Team Working: Music Therapy as part of Transdisciplinary and Collaborative Approaches. (pp. 55-61) London: Jessica Kingsley Publishers
Twyford, T., & Watson, T. (2008) Integrated Team Working: Music Therapy as part of Transdisciplinary and Collaborative Approaches. London: Jessica Kingsley Publishers.
About Kevin Draper
Biography
Kevin Draper, Music Therapy Trainee, University of Limerick, Ireland
After reading Wendy Magee’s article regarding her perspective of music therapy (MT) in rehabilitation from the UK, I felt compelled to make known the position of a music therapist working in a rehabilitation hospital in Ireland, as they are one of the very few therapists practicing in this area in the republic. One must be aware that Magee’s voices article was submitted in 2006 and I suspect that there have been great advances in establishing music therapy’s role in rehabilitation in the UK since then. However, when Magee describes rehabilitative MT in the UK at the time as “struggling to make its mark”, one can see a strong similarity to the present role of MT in rehabilitation as a profession in Ireland. Whilst I cannot comment on an overall view of MT in rehabilitation in Ireland, I can give a detailed synopsis from a trainee’s perspective of a recently established permanent music therapy post in a rehabilitation hospital in Ireland.
An Overview of a Music Therapy Position in Rehabilitation from Ireland: A Perspective from a Trainee Music Therapist
This rehabilitation hospital provides a comprehensive range of specialist rehabilitation services to patients who, as a result of accidents or illness have acquired a physical or cognitive disability and require professional medical rehabilitation. Three categories of patients are referred to this hospital, which includes people who have brain injuries, spinal injuries and patients who require prosthetic, orthotic and limb absence rehabilitation. The facility also has a small paediatric rehabilitation department which takes referrals of patients under the same diagnosis.
The music therapy position was initially set-up at this hospital as a pilot program in 2009 with the costs of running the program being covered by fundraising and charity donations. When comparing this article to Magee’s, it is noteworthy to see the similarity in funding sources for MT between Ireland and the UK, as Magee states when talking of how music therapy is funded in the UK that, “sources for funding are predominately from charitable trusts and organizations”.
As the pilot program came to a close in 2011, and the music therapist was set to leave the facility, feedback from service users, their families and the staff indicated that there was overwhelming support of an appeal for a music therapy post to be established on a permanent basis. In 2012, a permanent senior music therapy position was set up at the hospital employed under the health service executive (HSE) of Ireland. Magee states how in 2006, there were very few MT posts in neuro-rehabilitation funded by the National Health Service (NHS) in the UK. Comparing this to the position in Ireland six years later in 2012, this newly established post at this hospital became the only MT post working in neuro-rehabilitation employed by the HSE in Ireland. This comparison between the UK and Ireland displays how music therapy in rehabilitation is an innovative service in this area.
Team Working
An inter-disciplinary team forms the basis for the programs available at this hospital. Within the paediatric department, the music therapist works as part of a team of occupational therapists, physiotherapists, speech and language therapists, teachers, social workers, psychologists, nurses, doctors and others which contribute and work together on each child’s rehabilitation goals. A main feature of the paediatric program at this hospital is a transdisciplinary approach, where therapists for example will run joint occupational therapy (OT) and speech and language therapy (SLT) sessions with a patient. Music therapy is fully involved in this joint approach where the music therapist will regularly run sessions alongside an OT, a physiotherapist or an SLT where each professional will assist each other in achieving similar or identical goals. In addition to this collaborative working approach other members of the team may observe music therapy sessions in order make assessments of patients. (Twyford & Watson 2008).
Magee’s describes in her article sources of referrals to music therapy across three rehabilitation units in the UK, where referrals came from multidisciplinary groupings such as case reviews, joint therapist referrals such as a combined referral by an OT and an SLT, and single therapist referrals from an SLT or a physiotherapist. The source of referrals to music therapy at this facility in Ireland are comparable to Magee’s account, as referrals at this facility come from similar professional team groupings and therapists.
The music therapist at this rehabilitation hospital also works using a method of clinical practice which they developed alongside another music therapist over a 13 year period working in a day center in London prior to their move to this Irish hospital in 2009. They called this approach collaborative approach music and attuned movement therapy. At this hospital the music therapist employs this method with certain patients where they will work closely with another professional, (usually a therapist such as those mentioned above) who acts as a movement facilitator for the child. During the therapy communication is on a pre-verbal level where patterns of breathing, vocal sounds and bodily movements are acknowledged by reflective improvised music and attuned movements. (Fearn & O’Connor 2008).
Expansion and Moving Forward
Since the MT pilot program was started in 2009 and a permanent music therapy position was founded in 2012, the service has moved from strength to strength and is continuing to expand. At first the music therapist solely worked with the paediatric patients which could range from birth to eighteen years of age. However, the prompt expansion of the music therapy service is evident as the music therapist now receives referrals from across the hospital. Along with their paediatric work the therapist now sees a number of adults in the hospital and they have also been integrated into the team, working with adult patients who have neurological damage, mainly with patients who are in altered states of consciousness.
From a trainee’s perspective it is clear that music therapy services are in high demand at this hospital and as knowledge of MT’s contribution and benefits to patients grows among the hospital staff, the service can only continue to expand in the future. However, as only a single music therapist is currently employed at this hospital, there is a definite limit to the amount referrals and workload this single therapist can manage with the hours available to them.
However, the music therapist at this hospital recently achieved a major step forward in the expansion of the music therapy department. They submitted a proposal to the ethics review board of the hospital to carry out a research study to assess the new music therapy assessment tool for awareness in disorders of consciousness (MATADOC),(Daveson et al, 2007). They proposed to identify its benefits in assessing patients level of response which would contribute to diagnosis and treatment planning as well as monitoring change in disorder of consciousness patients. Ethical approval was awarded in early 2013 and the research study is now in the final stages of preparation before the work can finally commence. If the study begins it will run for a period of two years and will result in the expansion of the music therapy department by an increase of employment hours for the senior music therapist and the addition of a second music therapist to the department to work on the research study.
In Conclusion
In Magee’s conclusions she considers findings from two different hospitals about MT’s role within the medical rehabilitation environment and its benefits to a rehab and neuro-rehabilitation programs. However she suggests as part of a future study that the findings “would be of greater value if we could collect these types of statistics on music therapy services from international units”. (Magee, 2006, para. 6).
From a trainee’s perspective the similarity between Magee’s findings in her conclusion and the music therapy program at this rehabilitation hospital in Ireland is unmistakable in terms of the process of establishing an MT post in this area, sources of referrals, music therapy’s relationship with other therapists and the contribution and role of MT within a rehabilitation team. A future evaluation or an audit of the music therapy service at this Irish rehabilitation hospital would be of great value to Magee’s proposal to collect data from international MT departments in rehabilitation and as she suggests, “would make an interesting and invaluable study in terms of examining the role of MT in the rehabilitation setting”. (Magee, 2006, para. 6).
References
Daveson, B. A., Magee, W. L., Crewe, L., Beaumont, G., Kenealy, P., (2007) The Music Therapy Assessment Tool for Low Awareness States. International Journal of Therapy and Rehabilitation. 14(12) (pp. 544-549)
Fearn, M. C., & O’Connor, R., (2008) Collaborative Working at the Cheyne Day Centre London. In Twyford, T., & Watson, T. (Eds), Integrated Team Working: Music Therapy as part of Transdisciplinary and Collaborative Approaches. (pp. 55-61) London: Jessica Kingsley Publishers
Magee, W. L., (2006) Music Therapy in Rehabilitation: A perspective from the UK. Voices: A world forum for music therapy. Retrieved from http://voices.no/?q=content/music-therapy-rehabilitation-perspective-uk
Twyford, T., & Watson, T. (2008) Integrated Team Working: Music Therapy as part of Transdisciplinary and Collaborative Approaches. London: Jessica Kingsley Publishers.