MT Co-Treat Intervention Guide

Goal: Improve balance & ambulation
Equipment Needed: Tap Bells, Guitar, Gait Belt, Mobility equipment (walker, cane), footwear (shoes, grippy socks)
Musical Design

Client preferred music in key of tap bells
Select tap bells that fit into tonic dominant chords (Ex. Key of C, C & G)
Assign each lower extremity a bell color. Bonus points if you challenge the weaker side with the bell that is activated most often!
Place bells on the ground. The client will utilize their lower extremities to activate the bells.

Give instructions to PT about how you will communicate when the client should activate bells. Discuss what spacial cues you will give, like standing in front of the desired bell, or using guitar neck to direct to desired bell.

You can give this information in front of a client!
If a client has a cognitive deficit where multi-step instructions will be challenging, you should have this conversation with PT prior to entering the client’s room.

Reiterate to PT that they have full ability to provide physical assistance and verbal cues.

Physical assistance may look like holding a gait belt, contact guarding, or intervening to prevent a fall.
Verbal cues may include observations about posture, timing and activation of movements, or reminders of what bell to activate.
PT may also reposition the client or tap bells to increase success to task.

If the balancing task is difficult for the client, shorten the musical structure to the chorus. Incorporate breaks as you see fit with music or non-musical structure.
If the balancing task moves to an endurance phase, lengthen the song by adding more verses. You can also lengthen the activity by moving into another song in the same key.

Goal: Improve ability to complete activities of daily living (ADLs) through functional movement exercises

Equipment Needed: Percussive instruments (drums or tambourine), Mallet, Adaptive Grip for Mallets
Musical Design

Client preferred song with strong anticipatory beats for structure
Select drum that is easy to position by either MT or OT (discuss prior to session)
Select grip that will be successful for client to utilize (discuss adaptations prior to session)
Position drum and mallet to simulate functional movement contact point

Dressing: placing tambourine on one side of the body and adjusting height to simulate dressing patterns

Play music with predictable rhythmic patterns to reinforce the physical contact points of the desired movement. For example, grasping a mallet can be beat one, bringing the mallet to drum by head can be beat two. Beat three is moving the mallet back to the tray table. Beat 4 is releasing the mallet.

If a client has difficulty with motor planning, increase the rhythmic time needed to complete a task. Use musical phrases to lengthen time rather than slowing tempo. (Ex. Grasping a mallet may take four counts. Next downbeat (count 5) would cue the second part of the movement. Contact point with the drum would be beat 9. Moving the mallet back to the tray table would be beat 13.)

Communicate with OT about the level of assistance the client may require for functional movement exercises. Be open to input on adjusting grip, positioning of instruments, and repetition needed to reinforce movements & neural pathways.

Occupational Therapists may also use parts of the session to work on sequencing and education needs for transfer of skills to the home environment! Be ready for musical breaks should OT need this time to reinforce strategies & education.

For the dressing activity, this movement pattern can be completed standing or seated. Collaborate with OT to provide physical assistance support if the dressing task challenges the client's balance!

Goal: Improve communication of activities of daily living (ADLs) phrases to increase autonomy & connection with caregiver
Equipment Needed: Guitar or keyboard, notation system for melodies
Musical Design
- Identify phrases with 4-8 words
- Avoid use of melodies that are familiar, as familiar songs may impact the retainment of phrases
- Have steady beat/musical accompaniment ready in keys for additional structure to assist with success of activity (ex. all phrases are in key of G)
Treatment Design

Have conversation with the Speech Language Pathologist to identify critical communication phrases and meaningful phrases for client (restroom, lights on or off, blanket, “I Love You,” Wanting water, etc.)
Have phrases written and preliminary melodies created.
Put phrases into memorable melodies/rhythmic phrases for repetition.
The music therapist can compose phrases and provide musical structure for practice of phrases. The speech language pathologist can give anticipatory cues and give direction for fading cues.

As the client is successful with recall, you can transition into a higher-level communication/cognition activity through structured songwriting with a functional purpose. Examples include writing a dressing song or making a song that has the steps for how to pour a cup of coffee or fold your clothes.