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Notes week 2/21

by: Jacqueline Vilca

Notes week 2/21 MED 545 Music in Rehabilitation

Jacqueline Vilca
GPA 3.9
Music in Rehabilitation

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Music in Rehabilitation
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This 9 page Class Notes was uploaded by Jacqueline Vilca on Saturday February 28, 2015. The Class Notes belongs to MED 545 Music in Rehabilitation at University of Miami taught by in Spring2015. Since its upload, it has received 32 views. For similar materials see Music in Rehabilitation in Music at University of Miami.

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Date Created: 02/28/15
Music in Rehab 1 1152015 OVERVIEW OF THE CNS THE CNS Purposes to perceive sensations coordinate behaviors TERMINOLOGY COLORS OF THE CNS Study the pictures to know when the colors are super cial or deepen OCCIPITAL LOBE Receives information from the retina and the visual cortex TEMPORAL LOBE We look most at Wernicke39s and primary auditory cortex functions Superior temporal gyrus primary auditory cortex The yellow piece of the green is the primary auditory cortex Posterior superior temporal gyrus Wernicke39s area Functions of temporal lobe recognition learning and memory and emotional reactions More involved in emotional processing areas than other parts of the brain PARIETAL LOBE houses the somatosensory cortex In the picture the somatosensory cortex is the bright magenta strip FRONTAL LOBE Orbitofrontal cortex meaning behind your eyeballs Prefrontal cortex deals with executive functions Broca39s area is for speech production right next to the primary motor cortex Orbitofrontal cortex it39s decision making and planning especially as it relates to rewards and punishments DEEP STRUCTURES Amygdala emotional salience what is important right now Hippocampus memory Hypothalamus Situated under the thalamus Creates and sends out chemicals speci cally those related to the stress response ght ight or freeze Thalamus secretary The relay center All the information going to the brain stops by the thalamus and the thalamus tells it where to go Cingulate cortex It serves as a go between the neocortex and the deep structures for regulatory functions such as emotional lt calms down your amygdala when you realize the quotintruderquot is just your cat BRAINSTEM the regulatory lifesustaining functions NEUROANATOMY MOTOR DIVISION SPINAL CORD Re exes bypass cortical processing Afferent sensory information Efferent motor information As soon as it leaves the spinal cord it is the peripheral nervous system Divisions the numbers are the number of pairs of spinal nerves in that area Spinal quotnervesquot is what they are called when they leave the spinal cord There are 31 total one coxical A spinal nerve is called a mixed nerve because it carries sensory motor and autonomic information therefore it is afferent and efferent Each division corresponds to where in the area of the body their nerves exit from see picture CEREBELLUM quotLittle brainquot It sits on the back underneath the big brain It stores information to a movement sequence and is stored Usually movement patterns that you39ve learned really well Motor memory is implicit memory you don39t realize you39re learning it procedural memory and you don39t have to think about it BASAL GANGLIA Was originally thought to be a structure but is now known as a group of connected nuclei Some people add more nuclei than others depending on the author and scientist It39s a deep structure woven into the others They receive connections to and from the primary motor cortex and the substantia nigra They get inputs from those areas and send outputs Substantia nigra makes dopamine and involved in motor planning Talked about a lot with Parkinson s In general though it39s still being explored Basal ganglia is involved in the intensity of your movements learning complex movement patterns cerebellum is patterns with a sequence while basal ganglia movements don39t necessarily happen over and over again such as gripping a pen and movement initiation PRIMARY MOTOR CORTEX houses instructions for movements in speci c parts of the body Homonculus it is proportionate to the area size of the brain that is involved in sending the information to the body Location is the same for everyone but perhaps the sizes will be different based on experiences PREMOTOR CORTEX AND SMA SMA medial Premotor cortex lateral They are both involved in motor planning Premotor cortex selecting movement pattern involving muscle groups in performing speci c tasks For example lifting your leg typing chewing etc SMA is for movement patterns that less precise or a larger muscle muscles are physically larger group For example muscle marches versus lifting your knees while marching to lift your hand Premotor motor cortex initiates movements to external stimuli Things like environmental factors such as someone coming towards you and you moving away SMA is more for internal movement initiation Such as our thoughts initiating what movement we39ll do quotThat chair looks nice I39ll go sit over therequot COMMUNICATION Corticospinal tract begins in the cortex and ends in the spinal cord Depending on what it39s doing will determine what tract the information goes to Ventral corticospinal tract sends movement information to trunk muscles on the ipsilateral side Such as telling it to bend over It39s sending information to more proximal muscle groups In the brain stem the motor information is crossed over and is sent contra laterally An example is when you39re writing something From the corticospinal tract it goes to a motor neuron of the spinal nervemixed nerves 90f the Peripheral nervous system Extensor neurons and exor neurons are a motor neuron 1202015 Physical quotBiosocialquot EARLY ADULTHOOD In general there are signi cant life transitions and new experiences Bills partners kids marriage commitment jobrelated stuff etc Physically overall still fairly healthy There is an optimal level of functioning Muscle strength increases until your thirties Physical changes in women who have kids Cognitively Take on the responsibilities and commitments of being an adult Being organized creative problem solving where to live look for a job how to pay the bills There is also the moral side what are our values What39s right and wrong Solidify spiritual beliefs We are coming into one39s own Psychosocially development of intimate relationships and friendship nature and also the need for sense of achievement Achievement looks different for everyone money living alone and pregnancy doing what you love MIDDLE ADULTHOOD Noticeable effects of aging Primary aging Systematic and genetically determined decline Declines are in the ef ciency of the body s organs Effects are seen across all domains Secondary effects related to stress trauma disease and health practices diet exercise sleep Causes are often preventable and immediate the effects of primary aging Mediation when it changes the effects either delaying them or having them come sooner Physically grey hair body shape and composition changes wrinkles sunspots vision or hearing loss menopause etc Cognitively differences in uid vs crystallized intelligence Fluid decreases skills that make learning quick and thorough Crystallized increases re ects accumulated learning iPhones vs tax forms Fluidshort term memory abstract thought processing speed Crystallized vocabulary general information Development of expertise happens around these years when the person has been in a eld for a while Psychosocially there can be stability or change There is a trend for adults to divorce around this time Or stability because your kids have moved out and you know who you guys are as people Generally there are adult relationships with adult children and no stress of childrearing There may be nancial support though being given to young adult children and aging parents Work tends to be a very important source of stress and status LATE ADULTHOOD This has been increasing because life expectancy is now increasing gerontology 3 stages 1 Youold 2 Oldold 3 Oldestold This stage has the most individual variability than any other stage in this life span Youngold 6075 oldold 7585 oldestold 85 Oldestold is fastest increasing population Physically primary aging affects are pretty noticeable XD General Decline in immune system and overall muscle strength Greater risk for chronic and acute diseases ex cancer which is mediated by health habits and health care Cognitively memory fades shortterm and working memory mostly but longterm memory stays more durable More common to see dementia Alzheimer39s is a form of dementia progressive impairment of cognitive functioning There is also the storyteller grandparent Psychosocially most will retire Many keep active and healthy by spending time with family volunteering traveling etc Flip side many may need assistance with ADL39s Older adults may be caregivers or cared for Both can be stressful Ageism prejudice against aging This is experienced by adults really in middle adulthood as well as in late adulthood Late adulthood may feel held back from being happy and really ful lled Pete Seager EFFECTS OF AGING PHYSICAL A lot of musculoskeletal changes In the head a decreased movement of the mandibularjoint jaw loss of teeth this affects eating and speaking Spinal column A deterioration of disks the bones in the spinal column They start getting smaller and going away They are connected by ligaments and there may be calci cation of ligaments Calci cation hardening of ligaments See stiffness pain stooped posture getting shorter Body Bones become thin and brittle Loss of calcium A decrease in cartilage around joints decrease in body tissue decrease in muscle bers replaced by fat cells Osteoporosis the loss of bone mass Bones become easily fractured speci cally in wrists hips and your femur thigh done It can impact posture and it affects mostly postmenopausal women Arthritis in ammation of the joints In ammation of the cartilage the bone but the joints in general Stiffness swelling pain is caused and it makes movement dif cult Typically goes to hands rst Followed are hips knees spine and shoulders You can delay the progression but the changes are irreversible once they happen Body overall loss of exibility and elasticity Beginning in middle adulthood stretching is VERY important Increased stiffness and pain Dif culty standing sitting and walking Bones become more vulnerable Falls then become very dangerous Changes in patterns of physical activity walking instead of running May need help with ADLs Slower movement overall Re exes are slowed Increased reaction time increased accidents while driving increased endurance increased postural sway arched posture side to side front back harder to maintain balance There is also decreased coordination COGNITIVE SENSORY Cognitive Fluid intelligence skils prefrontal cortex The process of aging is basically backwards from the development so the rst thing to go is the prefrontal cortex Strengths The accumulated learning and expertise from long term memory are shown De cits slower thought process or response time Dif culty making decisions and decreased ability to learn new information Dementia can lead to a broad range of impairments speech writing engrossed in ne motor skills personal hygiene social skills and recognition of familiar objects and faces lmplications ageism feelings of frustration especially if you know that you39re not like you used to be lower selfesteem and depression Sensory Auditory impairments in almost 60 percent of adults Distortion limited hearing range presbycusis agerelated hearing loss More common in men A decreased perception of high pitched sounds mostly lmplications communication problems which then leads to feelings of isolation and depression social paranoia limiting certain activities Visual impairments not as prevalent as hearing loss In general as you age there is a thickening and hardening of the lenses The lenses lter and direct the light on the retina It can lead to decreased color perception increased perception of glare harder to see in sunlight poorer peripheral vision poor visual acuity and a slower adaptation to light changes the pupil won39t adjust as well because the muscles are not as strong anymore lmplications loss of mobility and independence decreased response to visual cues dif culty reading PSYCHOSOCIAL Emotionally motivation to try new experience decreases lack of effective coping skills this is a time where socially it is common to have a loss of loved ones who were once a source of support leading to feelings of loneliness deprived of cognitive stimulation overall lead to depression 2045 percent over 65 can experience depression Symptoms of depression sleep disturbance either extreme loss of selfesteem chronic fatigue dif culty concentrating social withdrawal and irritability Depression can be exacerbated from situational factors loss of loved one feeling ageism Socially loss of loved ones retirement change in residence assisted living facility downsizing leading to feelings of loneliness and loss of sense of belonging deterioration of communication skills and lack of cognitive stimulation Developmental tasks of aging 1 To determine that one39s life has been meaningful musical life review 2 To maintain some sense of control letting them make their own choices 3 To cope with their losses 1222015 USES OF MUSIC quotThe situation in which music is employed in human actionquot Usually involves listening creating music moving to music etc FUNCTIONS OF MUSIC quotThe reason for the use of music and in particular the broader purpose it servesquot The uses vs functions goals and objectives Merriam anthropology of music The starred ones can be combined But also it39s hard to understand the de nitions of all ten and therefore hard to study them C LAYTO N First bullet Most people will listen to music because it makes them feel better Or to redirect their attention to something else Listening to it playing instruments etc Most people will think of calming down and relaxing but regulation also applies to get yourself excited Mediation between self and others Social communication using music as a tool to interact with individuals or interact as a group This function has had a very religious component in rituals and infantdirected singing Performing communicates something to the audiences The playlists of communicating emotions to somebody Symbolic representation musical sounds and actions that specify aspects of affect and movements Like Disney39s Fantasia Peter and the Wolf Tom and Jerry Operas minor keys vs happy keys duple vs triple meter etc This is very literal movements of a river falling down NOT with cultural identity That39s not literal enough Coordination of action the entrainment of physical and physiologic responses or of emotional states Group or individual entrainment physical Emotional tends to be more group because of quotsetting the moodquot in a lot of places It can be used to facilitate identity as a social group Dancing weddings Macarena tribal dances marching band etc It could also be used in the intentional ways of maintaining revising or creating a sense of tradition Born in the USA singing the prayer before we eat National anthem A lot of the starred ones from Merriam fall under coordination of action The Protestant church quotrevisingquot and using pop music in serVIces There is a continuum for functions ranging from individual level to a group level It can help facilitate a larger group as well as just for us individually Function importance vary from culture to culture For example aesthetic enjoyment and entertainment was said to have been very speci c to Western culture39s balance A single use of music can serve multiple functions But singing to a baby can have multiple functions regulation and communication Same as in a religious setting coordination communication regulation etc DEVELOPMENTAL FUNCTION OF MUSIC This involves having a very good understanding of the appropriateness of music and knowing what to keep in mindconsiderations what to use with certain age groups Then why use music for a speci c therapeutic need and how One reason is because its evidence based practice This research separates us from our work and the nurse who plays guitar Intervention recording involves being very clear about what you are doing and how you are structuring everything Music resourcesimulation assignment Theoretical framework quotHow is musical element processed by the target age groupquot Look into music theory music neuroscience or cognition literature on music with older adults music and wellness we may have your own experiences and knowledge things we39ve learned in this class practicum experiences etc When citing yourself there can be a separate sectionsomething informal as long as it39s clear quotselfquot Transfers from your own learning maybe such as knowing what happens when you heave hearing loss and what frequencies are rst to go Description of musical element how do you structure that musical element based on what39s listed in the previous column Do you need a large dynamic range or small Focus on certain octaves Quantity of element To what extent Synthesis summary of this third column what to search quotperception of element in musicquot quotmusic cognitionquot quotagingquot quotelderly and pitch perceptionquot put in CAPITAL AND to put things together in searches CONSIDER music development 1272015 The majority of our interaction with music is music listening We do it even more than we used to now Research indicates the 6 nonmusical activities when we listen to music traveling driving metro or walking physical work chores brain work reading writing body work exercise or relaxation or pain management and meditation emotional work regulation reminisce and attending a live music performance event Four reasons why distraction energizing spinning class entrainment and meaning enhancement enhances relaxation or reminiscence WHAT TO LISTEN TO We prefer music from our late teens and early twenties young adulthood We39re guring out who we are Also very tied to social groups Personal favorite DO CHANGE over time of course There is a difference of what we like on a given day and what we like long term Long term is more connected to personal life history Daily favorites are context dependent There is also research in musical culture and the effect it has on our preferences It is largely determined by the culture of our childhood This is why we could have very similar music ways with each other It can be ethnic religious or geographical Family too Differences evidenced in 3 ways in culture 1 the music itself comparing America and Appalachia 2 Through behaviors associated with making teaching and listening to music what are the rules of improvisation How is notation used Aurally or reading Composition and performance Who is charge with performing and who is charged with composing How is it learned or taught Formally or informally 3 Ideas about music and music39s place in society OTHER WAYS MUSIC IS CONSUMED In general there are 3 outside of listening lessons community making New Horizons Parkinson39s choirs and intergenerational programming involves music making of two or more generations together preschool and school age older adult as an example The capacity to learn music remains viable throughout adulthood into older adults but it will take longer to learn because 1 The uid intelligence has decreased 2 Not the same dexterity BENEFITS OF MUSIC MAKING Cognitive attention working memory increased ability to selectively attend Socially making new friends increased opportunities for social interactions community involvement Motor improvements in ne motor skills breath supportrespiration oral motor skills improvement Emotionally increased opportunities to selfexpress motivation may experience pride and joy to be involved in these experiences Other being involved in some sort of formal process can provide structure to their day an increased cultural awareness and sensitivity MUSIC AND AGING Changes in vocal range pitch range decreases A below middle C to a above middle C tend to be the most comfortable Changes in hearing loss ability to hear high frequency pitches lower frequencies are easier to hear and clearer music may need to be louder Tempo Preference prefer to hear music at a slower tempo Musical Accompaniment 1 A simpler accompaniment is preferred not necessarily all down strums But an engaging and pleasing pattern just not too fancy live is preferred over recorded Motor Changes reduced dexterity and instrument control Motivation very highly motivated 1 It s a personal desire for leisure recreation expression etc 2 Musical they just love music 3 Social they get to to be with people with friends and a sense of belonging Why to consider these 1 In uences treatment planning 2 Affects efficacy of treatment how well it works quotModeratorsquot they moderate the effects of the treatment ex hearing loss 1292015 MT PRACTICE ASD MILITARY AGING The 3 main populations we now work for because of the prevalence increasing A lot of us are working on the wellness side of aging Hospice palliative care nursing homes assisted living facility memory care units Alzheimer39s and Dementia community centers and adult types of day programs hospitals and medical facilities surgical orthopedic oncology rehabilitation facility in or out patient VA hospital Clinical populations in these settings 1 neurological stroke tbi parkinson39s huntington s2 medical cancer care oncology surgery cardiac care stress reduction relaxation management 3welness 4 Psychiatric Alzheimer39s and dementia Clinical needs we pretty much hit all of the domains One difference is that you have to navigate an illness and also navigate agerelated changes Clinical considerations 1 We are working with the family the children It39s important for us to maintain a professional boundary and balance that into the therapeutic relationship


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