Running head: NON-PROGRESSIVE ORTHOPEDIC IMPAIRED PRESCHOOLERS

Annamarie Dwozan
Dr. Keith
Music Therapy Principles with Children
10 December 14
Non-Progressive Orthopedic Impaired Preschoolers
There is a large range of non-progressive orthopedic impairments amongst all children,
including preschoolers that this essay will discuss in terms of the characteristics of the
disabilities and how music therapy strives to promote quality of life (Davis et al., 2009). To start,
it is important to take note that an orthopedic impairment is also referred to as a physical
disability or other health impairment (OHI). An orthopedic impairment, as defined by the IDEA,
is a bodily impairment that is severe enough to negatively affect a childs educational
performance (Logsdon, 2014). This disability category includes all progressive and nonprogressive orthopedic impairments, regardless if it is congenital or acquired. However, there is
very little research done on preschoolers with non-progressive orthopedic impairments, so this
essay will focus on generalizing the non-progressive orthopedic impairments of children of all
ages in order to get a better understanding of how children in preschool with impairments can
receive the best music therapy treatment (Perry, 2003).
A normally developed preschool child between the ages of three and five years old show
the following characteristics; attention span lasting five to ten minutes, play with others, literal
thinkers, curious, active, imitative, do not generalize, have a limited understanding of numbers,
time and space, growing in independence, talkative, developing small muscle control, expanding
vocabulary, tire easily, want to please, and formulate ideas through concrete experiences. What
they need at their developmental stage is; opportunity to change activity often, social interaction,
group games, no abstract concepts, imaginative activities, plenty of opportunities to move

NON-PROGRESSIVE ORTHOPEDIC IMPAIRED PRESCHOOLERS

around, setting that encourages learning by doing, opportunities to learn by specific actions,
routine and structure, opportunities to practice cutting, pasting, drawing and coloring,
opportunities to learn through language, periods of rest, tasks to perform, and encouragement
(Show Me Jesus, n.d.).
However, children with non-progressive orthopedic impairments face problems with
joints, bones, and muscles which can be onset as a result of congenital disease such as
Osteogenesis Imperfecta, or result from one of the two types nueromotor impairments; cerebral
palsy, and Spina bifida. Nueromotor impairments cause damage to or is considered to be an
abnormality of the childs spinal cord, brain, nervous system, and usually affects many body
systems at once (Weiss, 2014).
Cerebral Palsy is a general term that refers to a number of non-progressive disorders
which affect voluntary movement and posture that are caused by malfunctions or damages to the
childs brain and occur prior to or during birth, or within the first few years of the childs life.
People with cerebral palsy experience involuntary or uncoordinated movements (Weiss, 2014).
Four of the more common forms of cerebral palsy include Athetoid, Spastic, Ataxic, and Mixed.
Cerebral palsy may also be classified according to the persons limbs that are affected. These
classifications include: Diplegia (legs affected more than arms), Hemiplegia (left or right side),
and quadriplegia (all four limbs) (Keith, 2013).
The second type of nueromotor impairment is Spina Bifida, which is a form of
developmental disability involving a persons spinal column. Spina bifida is characterized by an
opening in the spinal column, often in combination with paralysis of portions of the persons
body. The disability may or may not involve some level of effect on the persons intellectual

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function. Forms of Spina bifida can include occulta or cystica; occulta is a milder form of spina
bifida while cystica is more serious (Weiss, 2014).
Onset of non-progressive orthopedic impairments may be a result of acquiring viral or
bacterial infections, such as bone tuberculosis or poliomyelitis which can cause paralysis (Weiss,
2014). Joint deformities can be acquired through surgery or injury like broken bones and burns,
which result in loss of bone or muscle tissue, and may lead to the amputation of a limb
(Reference.md, 2014).
Other examples of potential causes for non-progressive orthopedic impairment include a
number of genetic abnormalities, club foot, and birth trauma, to name a few (Weiss, 2014). It is
important to remember that not all chronic diseases are progressive; a chronic, non-progressive
disease is also referred to as a static condition which is applicable to the population of this essay
(Wikipedia, 2014 Progressive disease). It is important not to confuse this with a progressive

disease or a progressive impairment in which tissues, organs, muscles, or bones deteriorate over
time (Wikipedia, 2014 Degenerative disease). As seen, the onset of non-progressive orthopedic
impairments vary, and children may experience trouble using their hands, arms, legs, or body.
Depending on the severity of the impairment, some of these children make use of assistive
devices and technologies in order to function as independently as they can (Weiss, 2014).
After reading the following, it is observable that small children with non-progressive
orthopedic impairments have a wide range of characteristics that are specific to the underlying
diagnosis. More characteristics include; limited limb movement, loss of fine motor skills, and
loss of appropriate alignment of the childs spine. If a child can sit up unaided at the age of 2,
they will eventually be able to walk. If they are unable to sit by the age of 4, they will be unable
to walk (Education.com, 2014). Children with these characteristics generally have more damage

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in the motor areas of their brain which disrupts the brains ability to adequately control
movement and posture (Weiss, 2014). Depending on the child and the case, muscle spasticity can
get better or worse over time. Medications can be used to reduce muscle spasms and surgical
treatment is usually the last resort for children with severe spasticity (Education.com, 2014)
Other examples of characteristics for non-progressive orthopedic impairments are;
disturbance in gait or mobility, difficulty swallowing and speaking. Abnormal sensation and
perception, impairment of sight, hearing or speech, seizures, or mental retardation may also
occur (Weiss, 2014). Difficulties such as feeding, bladder or bowl control, problems with
breathing because of postural difficulties, and skin disorders because of pressure sores
(Education.com, 2014).
The particular impact a disability will have on a childs cognition is dependent upon the
disability and its severity, as well as individual factors. Children with the same diagnosis can
have quite different abilities where learning is concerned, while others have more extreme
learning disabilities (Weiss, 2014). Children with these disabilities attend school if enough
assistance is provided and they generally receive special education or get placed in an inclusion
classroom, but this depends heavily on the severity of the disability and IQ (Sze & Yu, 2004).
This population utilizes various facilities and health specialists, such as; physical
therapists, occupational therapists, speech pathologists, music therapists, etc. Facilities include
schools and classrooms, rehabs, clinics, and hospitals. Although many of the individuals with
non-progressive orthopedic impairments do not experience cognitive disabilities, an educator
and/or health specialist should always collaborate with the child in relation to their
developmental level and curriculum as much as needed. Children may have pain and discomfort,
may sleep poorly, and may be on medications which lead to being fatigued in class. Impaired

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children may miss school more frequently than other students because of their medical
conditions (Education.com, 2014).
People with orthopedic impairments usually need physical accommodations or assistive
technology in work and life and have legal rights to this support under the Americans with
Disabilities Act (ADA) in Section 504 of the Rehabilitation Act of 1973 (Logsdon, 2014).
Devices used for both mobility and positioning include; canes, crutches, wheelchairs, specialized
exercise equipment, specialized desks, chairs, and tables (Weiss, 2014).
Music therapy goals with young children, ages three to five, are created after an
assessment is completed based on the severity of the clients impairments. Areas music therapists
focus on to create individual goals include these five domains; cognitive skills, communication
skills, motor skills, social skills, and expressive growth of the child (Ford, 1984). After an
assessment is completed and reviewed, goals, objectives, and effective methods are created to
best suit the clients priority needs. Some other music therapy purposes and goals include
addressing the needs of normalization and inclusion, positioning the clients to maximize
participation, reduction of perceived pain, and relaxation of muscles (Weiss, 2014).
Children with non-progressive orthopedic impairments can receive music therapy
treatment in rehab facilities, schools with inclusion and/or special education classrooms,
hospitals, and at private clinics. Music therapy is mostly done using individual session, but group
sessions are utilized depending on the needs of the child. The main principles of music therapy
include improvisation for making spontaneous music to encourage creativity and self-expression,
and re-creative experiences for acting out. The principles can be used for encouraging physical
activity through using music (Dieringer, Porretta, & Gumm, 2013).
For the children that have cognitive needs, such as; a learning disabilities, or mental
impairment, music is used to motivate, reinforce and reward the learning process. Music can

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serve as a memory aid for academic information, for example the ABCs song. Educational songs
with visual aids can be arranged to meet the needs of the individual and should be practiced in
the home or preschool (Guy & Neve, 2005).
School grade children experience difficulties in communication, such as; using objects as
a focus of joint attention, interpreting the interactive environment, being sufficiently motivated to
communicate, have severely limited means of interaction, and lack interest in interaction and the
outside environment (Perry, 2003). Communication areas of need for all children include
stuttering, speech fluency, cluttering issues or other disorders with the voice (Guy & Neve,
2005).
Music therapy has proved that rhythm-based techniques are successful at treating speech
fluency and rate of speech by providing structured and predictable foundation for verbal
responses. Vocal exercises with singing can help to remediate unusual loudness, breathing and
pitch of the speaking voice (Guy & Neve, 2005). Music therapy can also address receptive
speech skills as described in the Part II of this project. Music therapists can co-treat with speech
therapists to enhance the effectiveness of the treatment (Guy & Neve, 2005).
Motor and other physical areas of need include difficulty with fine motor tasks, such as
writing, turning pages, using scissors, difficulty maintaining balance or walking, involuntary
movements, and exploring typical classroom activities (Weiss, 2014). Music can be used to
structure and guide stretching to increase the range of motion, and other motor exercises. Playing
musical instruments can exercise muscles and help improve fine and gross motor skills (Guy &
Neve, 2005). Another method used in the case study by Corra are colored cards with graphic
symbols that replace the music keyboard. Unlike the keyboard, composed of unchangeable and
fixed keys, in this system the therapist can print cards of different sizes and place them in various
ways, according to the desired motor exercise. Each card represents a different musical note in
the timbre of a given instrument. A colored virtual cube is attached to each card. Results showed

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the potential of this software (Corra, Ficheman, Nascimento, & Deus Lopes, 2009). Music
therapists can also co-treat with occupational and physical therapists to enhance the effectiveness
of the therapy (Guy & Neve, 2005).
Social areas of need with children with non-progressive orthopedic impairments can
include the lack of ability that the individual has to participate on their own, depending on the
severity and prognosis of the impairment. Some children may be more limited than others in
which the music therapy has to be accommodated depending on the specific individual. Social
song stories can teach appropriate social interaction, eye gaze, facial expression, turn-taking, and
other important social skills for this the developmental level. In addition, group-based music
therapy sessions can provide a successful, normalized outlet for individuals with impairments to
engage in social experiences through music (Guy & Neve, 2005).
Modern music therapy methods involve the use of assistive devices in order to increase
cognitive, communication, and motor skills such as, screen reading software, speech recognition
software, augmentative and alternative communication devices, and other academic software,
and movement-to-music (MTM) system (Tam et al, 2007). Adaptive instruments are widely
utilized amongst the practice of music therapy in order to accommodate an impaired patients
participation, such as mallets with straps. This allows them to strike with more ease. Percussion
instruments include; large and medium circular knobbed gongs; bronze plates and varying
pitches; all arranged in a pentatonic scale sequence; and suspended over a trough-like resonator.
These instruments can be easily handled and do not require fine motor skills (Nasuruddin, 2003).
As previously stated, there has been very little research on preschoolers and on nonprogressive orthopedic impairment. This may be because preschoolers are generally still under
their parents care, meaning they spend a lot of their time at home, which doesnt exactly allow a
time for a researcher to come in and observe. Preschoolers sleep a lot and are still figuring out
how to act and socialize in the world they live in. Having a researcher come and observe a child

NON-PROGRESSIVE ORTHOPEDIC IMPAIRED PRESCHOOLERS

so young, could be intrusive and make a child feel uncomfortable or awkward. The lack of
research could also be due to lack of experience with this population. Both go hand in hand.
On the other hand, there are numerous cases studies, quantitative researches, randomized
and controlled trials of evaluation on children with CP, which is the most severe type of nonprogressive orthopedic impairment. Music therapy research topics include; quality of life (QOL),
acupuncture in combination with osteopathic manipulation and music listening in order to reduce
perceived pain, dyadic relationship between a CP child and her mother, synchronized metronome
training (SMT) with children with hemiplegic CP, vibration therapy on spasticity and motor
function in children with CP, rhythmic auditory stimulation (RAS) on gait performance in
children with spastic CP, improvisational MT with severely and multiply disabled children,
music interventions and group participation skills of preschool children with visual impairments,
and the effect of automated interrupted music on head posturing in children with CP (Davis et al.,
2009; Duncan et al., 2004; Gilboa et al., 2010; Johansson et al., 2012; Katusic et al., 2013;
Kwak, 2007; Perry, 2003; Robb, 2003; Wolfe, 1980; Yu et al., 2009). To know more about these
research articles, see the annotated sections of the Bibliography part of this project.
While many of these research articles have been proved successful, others did not have
enough statistical data to show an important difference. Almost all the articles concluded with the
fact the further investigation is needed in order to get more clear results. Generalizing children
with non-progressive orthopedic impairments still gives lots of information about how music
therapists could approach preschool aged children.
Even though this essay outlined the most severe cases of non-progressive orthopedic
impairments, music therapy strategies can be accommodated and transferred to preschool
children. By combining the ideas of this essay we can conclude that music therapy could be very
beneficial for preschoolers. Methods like; play time, song stories, games, movement with
visuals, arts and crafts, singing, taking turns can help develop a preschoolers developmental level

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even with while having physical restrictions. Communication, cognitive, motor, and social skills
are crucial domains for an overall healthy QOL. All in all, as music therapy progresses as a
health profession, further investigation will be developed in order to understand the response a
preschool child could have to a music therapy treatment.

References
Corra, A. G. D., Ficheman, I. K., do Nascimento, M., & de Deus Lopes, R. (2009, July).
Computer assisted music therapy: A case study of an augmented reality musical system
for children with cerebral palsy rehabilitation. In Advanced Learning Technologies, 2009.
ICALT 2009. Ninth IEEE International Conference on (pp. 218-220).
This article presents an experiment conducted with an Augmented Reality musical system
for music therapy. In this system, colored cards with graphic symbols replace the music
keyboard. Unlike the keyboard, composed of unchangeable and fixed keys, in this system
the therapist can print cards of different sizes and place them in various ways, according
to the desired motor exercise. Each card represents a different musical note in the timbre
of a given instrument. A colored virtual cube is attached to each card. A music therapist
initially evaluated the system and later an experiment was conducted with a child with
cerebral palsy. Results showed the potential of this software in the rehabilitation process.
Davis, E., Shelly, A., Waters, E., Mackinnon, A., Reddihough, D., Boyd, R., & Graham, H. K.
(2009). Quality of life of adolescents with cerebral palsy: perspectives of adolescents and
parents. Developmental medicine & child neurology, 51(3), 193-199.
Quality of life (QOL) has emerged over the past 20 years as an outcome for measuring
the effectiveness of health-improvement interventions. The Cerebral Palsy Quality of Life
Questionnaire for Children (CPQOL-Child) is well regarded and now integrated into
research internationally. We describe the results of qualitative research, using grounded

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10

research in which we aimed to identify domains of QOL for adolescents with cerebral
palsy (CP) from adolescent and parent perspectives to guide the development of an
adolescent version. Seventeen adolescents (nine males, eight females) aged 13 to 18 years
(mean=15.53 SD=1.74), with varying levels of impairment (Gross Motor Function
Classification System levels I n=5, II n=2, III n=6, IV n=4, and V n=6) and their parents
(n=23) participated in semi-structured interviews. Questions included: What do you
think is important to your (childs) QOL? and How does CP impact on your (childs)
life? Fifteen themes were identified, including domains related to health issues in
adolescence, participation, education, specific CP-related issues (pain and discomfort,
communication), family issues, practical issues (financial resources), and changes
associated with adolescence (sexuality, independence). The composition of these QOL
domains reflects the developmental concerns of adolescents with CP, adding to the views
of children, and strongly supports adolescent participation in the development of selfreported well-being and QOL measures. Many of the domains are consistent with child
reports of QOL and thus it appears feasible and valid to develop a measure that will be
transferable across childhood and adolescence.
Dieringer, S. T., Porretta, D., & Gumm, E. (2013). Using music therapy principles to enhance
physical activity participation in children and adolescents with disabilities. Palaestra,
27(3), 42-46.
The article discusses the application of music therapy principles in enabling physical
activity involvement of disabled children and teenagers. The main principles of music
therapy include improvisation for making spontaneous music, creative for selfexpression, and re-creative for acting out experiences. The principles can be used for
encouraging physical activity through using music from sources like Kids in Motion Greg
and Steve, iTunes, and PE Central.
Duncan, B., Barton, L., Edmonds, D., & Blashill, B. M. (2004). Parental perceptions of the
therapeutic effect from osteopathic manipulation or acupuncture in children with spastic
cerebral palsy. Clinical pediatrics, 43(4), 349-353.
Fifty children were involved in a randomized, controlled trial to evaluate the
effectiveness of either osteopathic manipulation or acupuncture as a 6-month therapeutic
adjunct for children with spastic cerebral palsy. Exit interviews were used to obtain
parental perceptions and form the basis of this report. Only 2 of 17 parents reported
positive gains while their child was in a wait-list control period but all 17 reported gains
while in the treatment phase of the study. Ninety-six percent (48 of 50) of the parents
reported some improvement while their child was receiving treatments but the gains
varied from child to child. The most frequent gains were seen in improvement in the use
of arms or legs (61% and 68%) and more restful sleep (39% and 68%) in the osteopathic

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and the acupuncture groups, respectively. Improvement in mood and improved bowel
function were also very common benefits noted by the parents in both groups.
Education.com, (2014). Orthopedic Impairments | Education.com. [online] Available at:
http://www.education.com/reference/article/orthopedic-impairments/ [Accessed 10 Dec.
2014].
Ford, S. C. (1984). Music therapy for cerebral palsied children. Music Therapy Perspectives,
1(3), 8-13.
This paper presents the uses of music in the therapeutic approach to children with
cerebral palsy. The basic characteristics of the disorder, including associated difficulties,
are presented. In the author's view, music can be considered as an aid to the cognitive,
physical, emotional, social, and expressive growth of the children. Literature supporting
this view is presented. Specific music experiences designed to meet the needs of cerebral
palsied children are offered.
Gilboa, A., & Roginsky, E. (2010). Examining the dyadic music therapy treatment (DUET): the
case of a CP child and his mother. Nordic Journal Of Music Therapy, 19(2), 103-132.
Children with cerebral palsy (CP) experience not only motor disabilities but other,
emotional, communicative, and social impairments. The relationship between caregivers
(usually mothers) and CPs as well as their communication patterns might also be
impaired. Music therapy was found to be effective with CPs and dyadic treatment has
been found to be effective in facilitating mother-child relationships. However, music
therapy and dyadic treatment were never combined to address CPs and their mothers. We
present the dyadic music therapy treatment (DUET) and report of a preliminary study that
examined if it was effective. The DUET of one dyad was videotaped and subsequently
analyzed according to the mixed methods approach. Qualitative analysis resulted in 10
types of communication patterns, seven being non-verbal, two musical, and one verbal.
Twenty-two types of relationship were found, 17 being coordinated relationships and five
uncoordinated ones. Analyzing the frequencies of these types across the DUET sessions
showed that dyadic communication increased significantly, especially in the second half
of the treatment. It was also found that relationship types became more coordinated as the
treatment progressed. The functions of music in the DUET are discussed and
recommendations for future research are provided.
Guy, J. and Neve, A. (2005). Music Therapy & Cerebral Palsy Fact Sheet. 1st ed. [ebook] San
Diego, CA: PDF, pp.1-4. Available at:
http://www.themusictherapycenter.com/sites/default/files/images/factsheets/mtcca_cerebr

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alpalsy.pdf [Accessed 10 Dec. 2014].

Johansson, A., Domellf, E., & Rnnqvist, L. (2012). Short- and long-term effects of
synchronized metronome training in children with hemiplegic cerebral palsy: A two case
study. Developmental Neuro-rehabilitation, 15(2), 160-169.
Background: Children with cerebral palsy (CP) require individualized long-term
management to maintain and improve motor functions. The objective of this study was to
explore potential effects of synchronized metronome training (SMT) on movement
kinematics in two children diagnosed with spastic hemiplegic CP (HCP). Method: Both
children underwent 4-weeks/12 sessions of SMT by means of the Interactive Metronome
(IM). Optoelectronic registrations of goal-directed uni- and bimanual upper-limb
movements were made at three occasions; pre-training, post completed training and at 6months post completed training. Results: Significant changes in kinematic outcomes
following IM training were found for both cases. Findings included smoother and shorter
movement trajectories in the bimanual condition, especially for the affected side. In the
unimanual condition, Case I also showed increased smoothness of the non-affected side.
Conclusions: The observed short- and long-term effects on the spatio-temporal
organization of upper-limb movements need to be corroborated and extended by further
case-control studies.
Katusic, A., Alimovic, S., & Mejaski-Bosnjak, V. (2013). The effect of vibration therapy on
spasticity and motor function in children with cerebral palsy: A randomized controlled
trial. Neurorehabilitation, 32(1), 1-8.
As the motor system relies heavily on deep sensory stimulation, recent studies have
investigated the effect of vibration stimuli. Although research suggests a positive
influence of vibration on motor performance in individuals with neurological disorders,
there are very limited numbers of studies in children with cerebral palsy (CP). The
objective of the present study was to evaluate the effects of sound wave vibration therapy
on spasticity and motor function in children with CP. In this 3-month trial, 89 children
with spastic CP were randomized to either continue their physiotherapy treatment (PT) or
to receive vibration therapy twice a week in addition to their PT program. The
randomization was stratified according to the Gross Motor Function Classification
System (GMFCS) level to ensure similar functional ability. Children were assessed at
baseline and after the 12-week intervention period. The outcomes measured were
spasticity level as assessed by Modified Ashworth Scale (MMAS) and gross motor
function as assessed by Gross Motor Function Measurement (GMFM-88). Subgroup
analysis was performed for the GMFCS. Significant differences between groups were
detected for changes in spasticity level and gross motor function after the three months
intervention. In conclusion, vibration therapy may decrease spasticity and improve motor

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performance in children with CP. The results of the present trial serve as valuable input
for evidence-based treatments in pediatric neuro-rehabilitation.
Keith, D. (2013). Music therapy with orthopedic impairments.
Kwak, E. E. (2007). Effect of rhythmic auditory stimulation on gait performance in children with
spastic cerebral palsy. Journal of music therapy, 44(3), 198-216.
The purpose of this study was to use Rhythmic Auditory Stimulation (RAS) for children
with spastic cerebral palsy in a clinical setting in order to determine its effectiveness in
gait training for ambulation. RAS has been shown to improve gait performance in
patients with significant gait deficits. All 25 participants (6 to 20 years old) has spastic
CP and were ambulatory, but needed to stabilize and gain more coordinated movement.
Participants were placed in three groups: the control group, the therapist-guided training
(TGT) group, and the self-guided training (SGT) group. The TGT group showed a
statistically significant difference in stride length, velocity, and symmetry. The analysis of
the results in SGT group suggests that the self-guided training might not be as effective as
therapist-guided depending on motivation level. The results of this study support three
conclusions: (a) RAS does influence gait performance of people with CP; (b) individual
characteristics, such as cognitive functioning, support of parents, and physical ability play
an important role in designing a training application, the effectiveness of RAS, and
expected benefits from the training; and (c) velocity and stride length can be improved by
enhancing balance, trajectory, and kinematic stability without increasing cadence.
Logsdon, A. (2014). Orthopedic Impairment - What Is an Orthopedic Impairment?. [online]
About. Available at: http://learningdisabilities.about.com/od/mo/g/Orthopedic_Impa.htm
[Accessed 10 Dec. 2014].
Nasuruddin, M. G. (2010). The confluence between arts and medical science -- music and
movement therapy for children with cerebral palsy. Malaysian Journal Of Medical
Sciences, 17(3), 1-4.
Perry, M. M. R. (2003). Relating improvisational music therapy with severely and multiply
disabled children to communication development. Journal of Music Therapy, 40(3), 227246.
The effect of different levels of pre-intentional and intentional communication
development on musical interaction with children with severe and multiple disabilities
has not been explored in the music therapy literature. Aside from stage of communication

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development, what are the particular influences of disability on musical interaction with
children who have pre-intentional and early intentional communication? A qualitative
research project explored these issues. Ten school-aged children with severe and multiple
disabilities participated in the project. The most common medical diagnosis was cerebral
palsy. Analysis of video recordings and other data confirmed that the children's level of
communication development was reflected in individual music therapy. Specifically,
children at different levels of communication development varied in their abilities to
initiate, anticipate, and sustain participation in turn taking, and to maintain attention to
and engagement in the interaction. Both turn taking and playing and singing together
were found to be important forms of communication during music therapy.
Communication problems related to disability included: difficulties in using objects as a
focus of joint attention, difficulties in interpreting the interactive environment, being
sufficiently motivated to communicate, severely limited means of interaction, attaining
and maintaining an appropriate level of arousal, and lack of interest in interaction and the
outside environment. Further study of how music therapy can be related to general issues
in communication for individuals with severe and multiple disabilities is recommended.
Reference.md, (2014). Joint Deformities (definition). [online] Available at:
http://www.reference.md/files/D016/mD016916.html [Accessed 10 Dec. 2014].
Robb, S. L. (2003). Music interventions and group participation skills of preschoolers with visual
impairments: Raising questions about music, arousal, and attention. Journal of Music
Therapy, 40(4), 266-282.
The purposes of this pilot study were two-fold: First, to document and compare attentive
behavior during music and play-based group instructional sessions and second, to
document and compare 4 group participation behaviors during music and play-based
sessions. The 4 group participation behaviors included facing a central speaker, following
one-step directions, manipulating objects according to their function, and remaining
seated. Six of the 12 children enrolled completed the study, with all participants enrolled
in an early intervention program due to visual impairments. Study participants were
between the ages of 4 and 6 years inclusively. Children participated in 4, 30-minute
instructional sessions. Two instructional sessions were music-based and two were playbased with the 4 sessions equally distributed across a 2-week period. An ABBA design
was used to control for possible order effects. Each session was videotaped to facilitate
collection of behavioral data. Statistical analysis of these data revealed that attentive
behavior was significantly higher during music based-sessions (t(5) = 5.81; p = .002).
Mean scores for the remaining group participation behaviors were higher in the music
condition, but these differences were not statistically significant. Discussion regarding
differential outcomes among participants, as well as an exploration of theories related to
music, arousal, and attention are discussed in an effort to guide future research.
Show Me Jesus. (n.d.). 1st ed. [PDF] Suwanee, Ga 30024: Great Commission Publications Inc.,

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pp.1-5. Available at: http://resources.coths.org/DevelopmentalCharacteristics.pdf

[Accessed 10 Dec. 2014].
Sze, S., & Yu, S. (2004). Effects of music therapy on children with disabilities. In International
Conference on Music Perception and Cognition.
The purpose of this study is to highlight literature concerning the effects of music therapy
on children with disabilities. The paper discusses the following topics: background of
music and children with disabilities, the aims of music therapy, main contributions to
cognitive, biopsychosocial development of children with disabilities, implications of
learning, and implications for using music to accommodate children with disabilities in
an inclusive classroom.
Tam, C., Schwellnus, H., Eaton, C., Hamdani, Y., Lamont, A., & Chau, T. (2007). Movement-tomusic computer technology: a developmental play experience for children with severe
physical disabilities. Occupational Therapy International, 14(2), 99-112.
Children with severe physical disabilities often lack the physical skills to explore their
environment independently, and to play with toys or musical instruments. The movementto-music (MTM) system is an affordable computer system that allows children with
limited movements to play and create music. The present study explored parents'
experiences of using the MTM system with their children. A qualitative methodology
employing in-depth interview techniques was used with six mothers and their children.
The themes extracted from the data were organized under two main concepts of the
International Classification of Functioning, Disability, and Health (ICF) (WHO, 2001)
framework. The results showed that the MTM expanded horizons for the child along the
ICF health dimensions and the MTM had a positive impact on ICF environmental
determinants of health. The small sample size should be noted as a limitation of this
study. Further research should be carried out with a larger sample of children with
restricted mobility to obtain a better understanding of the impact of MTM technology on
children's psychosocial development.
Weiss, T. and Impairments, C. (2014). Children and Orthopedic Impairments. [online] Disabled
World. Available at: http://www.disabled-world.com/disability/children/orthopedicimpairments.php [Accessed 10 Dec. 2014].
Wikipedia, (2014). Degenerative disease. [online] Available at:
http://en.wikipedia.org/wiki/Degenerative_disease [Accessed 10 Dec. 2014].

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Wikipedia, (2014). Progressive disease. [online] Available at:

http://en.wikipedia.org/wiki/Progressive_disease [Accessed 10 Dec. 2014].
Wolfe, D. E. (1980). The effect of automated interrupted music on head posturing of cerebral
palsied individuals. Journal of Music Therapy, 17(4), 184-206.
The study investigated the effect of interrupted music/silence and interrupted music/tone
on the head posturing of persons having cerebral palsy. Twelve subjects clinically
diagnosed as spastic cerebral palsied and ranging in age from 3 to 37 years participated in
the study. An individual subject design (ABAC) consisted of two baseline conditions and
two treatment conditions: (a) interrupted music/silence; and (b) interrupted music/tone.
Each subject wore a special head device containing a series of mercury switches which
activated the music/tone contingencies. This apparatus also monitored erect head
position, the number of seconds during which the head was improperly postured, and the
number of times the head changed position. During the interrupted music/silence
condition, recorded music was contingent upon erect head position. When the head
became tilted 20 or more, the music ceased and was replaced with silence. When the
head was improperly positioned during the music/tone condition, a 493 Hz tone
automatically sounded until the head again was erected; at this time, the music stimulus
resumed. Results indicated that head control improved during the treatment conditions for
four subjects. One subject seemed to respond only to the music/tone condition, and the
remaining subjects showed minimal improvement in head posturing throughout the
experimental conditions. Individual results and recommendations for clinical applications
are included.
Yu, H., Liu, Y., Li, S., & Ma, X. (2009). Effects of music on anxiety and pain in children with
cerebral palsy receiving acupuncture: a randomized controlled trial. International journal
of nursing studies, 46(11), 1423-1430.
The objectives of this study is to find the effects of music on anxiety and pain in children
with cerebral palsy receiving acupuncture daily in a clinical setting. The design used was
a randomized controlled trial. The setting of the study was at Acupuncture Unit at
Shenzhen Hospital of Traditional Chinese Medicine in Shenzhen City of China. The
participants: sixty children with cerebral palsy undergoing acupuncture. Intervention
used: Children listened to their favorite music or a blank disc for 30 min. Measurements:
(1) the modified Yale preoperative anxiety scale for children's anxiety (mYPAS); (2)
children's hospital of eastern Ontario pain scale (CHEOPS) and Wong-Baker faces pain
rating scale (FACES) for pain intensity; (3) vital signs including mean arterial blood
pressure (MAP), heart rate (HR) and respiratory rate (RR). In conclusion, this study
demonstrates that listening to music while receiving acupuncture can relieve anxiety
among children with cerebral palsy; however, no effect was observed in terms of pain
reduction. Further research is needed to explore the types of music which best impact an

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individual's treatment. Whether music results in fewer accidents and side effects of
acupuncture should be investigated. Music can be considered as adjunctive therapy in
clinical situations that may be anxiety-provoking for children.

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