Therapy Literature Research Articles

Music and spirituality: Explanations and implications for music therapy

Previous literature in music therapy suggests a need for greater clarity and insight concerning correlations between music and spirituality for the modern clinician. The purpose of this article is to provide a clear explanation of these correlations and some possible implications for the practice of music therapy. My method is one of ‘reflective synthesis’ – combining theoretical knowledge from several disciplines with my own, practical experience with clients – to bring forward key working, concepts. This will include (1) presenting a rationale for the therapist’s study of spirituality; (2) clarifying some basic terms; (3) asking three important questions concerning a human life and viewing them through the lens of spirituality and music; (4) linking the first of these questions to awareness of transcendence; (5) answering the second question in light of purpose and meaning; (6) explaining how spirituality provides connection to the other; (7) illustrating the correlations in a clinical vignette, and as a conclusion; (8) suggesting implications this may have for the music therapist; and (9) offering some reasonable cautions for integrating spirituality into a music therapy practice.

The Utilization of Vital Signs During Physical Therapy Evaluation and Intervention After Elective Total Joint Replacement: A Mixed-Methods Pilot Study

Background: Previous literature in physical therapy has suggested that vital signs (VS) are not used as often as is recommended in clinical practice. However, this finding has not been established in the immediate postorthopedic surgery population, and physical therapy practitioners' views toward VS assessment in this population have not been previously examined. Therefore, the purpose of the current study was to (1) determine how often VS are measured via chart review, (2) describe attitudes, inclinations, and factors that may influence VS measurement by physical therapist practitioners, and (3) provide an explanation for the use or nonuse of VS in an immediate postorthopedic surgical population. Methods: This was a mixed-methods study with 2 phases. Phase 1 (quantitative) involved a retrospective chart review of 50 patients treated after total joint arthroplasty. Phase 2 (qualitative) involved interviewing 2 physical therapists and 1 physical therapist assistant who had treated patients in phase 1 to provide an explanation for phase 1 data. Quantitative analysis was performed on phase 1 data, and qualitative analyses were performed on phase 2 data. These data were subsequently corroborated. Results: Vital signs were documented on only 29 occasions over 134 therapy sessions. No correlation was found between comorbidities and VS assessment. Five major themes were induced from the qualitative data. Discussion: The results of this study suggest that physical therapy practitioners may practice in a manner that is inconsistent with their beliefs with respect to the assessment of VS for patients following total joint arthroplasty. Multiple explanatory mechanisms for VS utilization are suggested by physical therapy clinicians.

The Great Reveal: The Experiences of a Registered Music Therapist with a disability: an arts-based research project

Disability is a human phenomenon experienced not by a small minority but a large percentage of our global population. Disability is encountered by people of all ethnicities, religions, genders (and non-conforming), sexualities, socio-economic backgrounds, and ages. Recent music therapy literature has advocated for a diverse workforce and others describe the value in music therapists adopting an intersectional lens, which considers the interconnectedness of social and political identities. However, there is limited dialogue featuring lived experiences of music therapists of underrepresented identities, such as disability. This research sought to canvass the experiences of Australian Registered Music Therapists who identify as having a disability and to explore how their disability may impact or inform their practice. One Australian Registered Music Therapist (RMT) who identified as disabled was interviewed. The student-researcher engaged with arts-based research through music composition to allow an embodied analysis and to present results in an accessible format. Several themes were revealed, including; hidden disability, disclosure of disability, alliance, positive transference, visibility, and identity. These findings demonstrate the importance of lived experiences in the music therapy community and calls to amplify diverse voices of those with disabilities and other intersecting identities within our profession. Acknowledging the work of disabled music therapists may further challenge ableist attitudes in our society and provide options to participants who might prefer to work with therapists who have relevant lived experience.

A Qualitative Heuristic Inquiry into the Development of Therapeutic Presence as a Student Music Therapist

This first-person study investigates the role of cognitive and embodied forms of knowledge in relation to the development of therapeutic presence as a student music therapist. In this paper, I will provide an introduction to the topic reviewing its relevance to the practice of music therapy, and I will argue that the development of therapeutic presence is a fundamental part of becoming a music therapist. Although there are seminal articles in the music therapy literature that discuss the topic of therapeutic presence, I have not found any articles relating it to the development of being a student music therapist. Using heuristic methodology, I will describe the personal process of developing therapeutic presence as a student music therapist. To gain a broader perspective on the research topic, and to provide validation and transparency in relation to my personal heuristic process, three successive theoretical and experiential workshops were carried out with six student music therapists. Data, in the form of questionnaires, reflections and group musical improvisations were analysed systematically to validate my experience of the research topic, and also to discover and evaluate themes and practical methods. The research has culminated in the synthesis of data gathered during the study in relation to the main research question while also reviewing its relevance to music therapy practice and implications for further study.

Effect of exercise and physical activity on blood pressure in adults with resistant hypertension: a protocol for a systematic review

Background: Hypertension is highly prevalent globally but controlling hypertension with medication alone is challenging. Resistant hypertension, a special hypertension phenotype, is even more challenging to manage. Use of aerobic exercise is supported by high grade evidence as a therapeutic modality to reduce blood pressure in hypertension thereby reducing cardiovascular risk. Further, the new hypertension guidelines strongly recommend exercise to reduce blood pressure. However publications of trials investigating effectiveness of exercise in resistant hypertension are limited and no systematic review has been published to date.Objectives: To identify the level of evidence for the effectiveness of exercise and physical activity in managing blood pressure in adults with resistant hypertension.Methods: Studies published in Scopus, MEDLINE, CINHAL, Web of Science, Embase and SPORTDiscus databases; and unpublished studies in Open Grey, Current Control Trials, ClinicalTrials.gov, Cos Conference Papers Index and the WHO International Clinical Trials Registry Platform will be searched. Two reviewers will independently review the studies.Results: The following will be reported: methodological quality of the selected full texts assessed using Cochrane risk of bias tools (RoB-2 and ROBINS-I) for randomised and non-randomised trials; clinical heterogeneity and sensitivity analysed using Review Manager (RevMan) software; outcomes of detected and/orAQ2 correct reporting and publication bias described in Funnel plots and Begg’s rank correlation/Edgar’s regression tests; and results of quality of the evidence described using the Recommendation Assessment, Development and Evaluation (GRADE) tool. Types of exercise will be described in sub-groupings.Conclusions: Strength of the literature for exercise therapy for resistant hypertension will be identified.

Is the Neck Disability Index an Appropriate Measure for Changes in Physical Function After Surgery for Cervical Spondylotic Myelopathy?

The Neck Disability Index (NDI) is a 10-item questionnaire about symptoms relevant to cervical spine pathology, originally validated in the physical therapy literature. It is unclear if all of the items apply to spine surgery. The purpose of this study was to determine if improvements in the composite NDI score or specific NDI domains are appropriate measures for tracking changes in physical function after surgical intervention for cervical spondylotic myelopathy (CSM). A retrospective cohort review of patients treated at a major academic medical center was undertaken. Baseline and postoperative standardized outcome measurement scores, including composite NDI, NDI subdomain, and SF-12 physical component score (PCS), were collected. Wilcoxon signed-rank test was used to determine whether patients exhibited improvement in each of the outcome measures included. Multiple linear regression was performed to determine whether change in NDI composite or subdomain scores predicted change in physical function after surgery for CSM-compared with the well-validated PCS score-controlling for factors such as age, sex, etc. Baseline data were collected on 118 patients. All outcome measures exhibited significant improvement after surgery based on the Wilcoxon signed-rank test. On linear regression, work (β = -2.419 [-3.831, -1.006]; P = .001) and recreation (β = -1.354 [-2.640, -0.068]; P = .039), as well as the NDI composite score (β = -0.223 [-0.319, -0.127]; P < .001), were significant predictors of change in physical function over time. Although the NDI composite score did predict change in PCS over time, only 2 of the 10 NDI subdomains were found to be associated with change in physical function over time. Based on these results, the item bank and composite scoring of the NDI are inappropriate for evaluating quality of life in studies of surgically treated cervical spondylotic myelopathy patients. NDI may not be a valid tool in the determination of physical function changes after surgery for CSM. III.

Chiropractic care for hypertension: Review of the literature and study of biological and genetic bases.

Background and aim:Hypertension is a multifactorial condition that is among the leading causes of mortality worldwide. Regulation of blood pressure greatly depends upon the activity of the autonomic nervous system. Alterations in the autonomic nervous system can lead to hypertension. In addition to nervous system control and individual physiologic state, various genes can directly influence autonomic responses. The complexity of blood pressure control is reflected in the 20-30% of individuals resistant to traditional pharmacological treatment, this indicates the need for alternative interventions. This article provides an integrative review and discussion of the key neurophysiologic and genetic factors that contribute to blood pressure regulation, the autonomic nervous system (ANS) and manual therapy literature, and the manual therapy and blood pressure literature.Methods:To assess the effects of chiropractic on the management of hypertension we searched articles published from 1980 to 2019 in PubMed, the Index to Chiropractic Literature and CINAHL, using the keywords: chiropractic, spinal manipulation, hypertension, and blood pressure.Results:We found 38 original studies that analyzed the effect of chiropractic therapy on hypertension. Of these studies, 10 were case reports and the statistical significance of the effects of chiropractic on blood pressure was not evaluated on these articles, so we focused on the remaining 28 articles.Conclusions:The results of the review relative to chiropractic care were promising, but often contradictory, suggesting more research should be done. In consideration of the complexity of ANS blood pressure control, an evaluation of patient presenting physiologic and genetic characteristics is recommended and could provide valuable insight relative to the likelihood of patient blood pressure related responsiveness to care (www.actabiomedica.it)

Nanotechnology approaches in the current therapy of skin cancer.

Skin cancer is a high burden disease with a high impact on global health. Conventional therapies have several drawbacks; thus, the development of effective therapies is required. In this context, nanotechnology approaches are an attractive strategy for cancer therapy because they enable the efficient delivery of drugs and other bioactive molecules to target tissues with low toxic effects. In this review, nanotechnological tools for skin cancer will be summarized and discussed. First, pathology and conventional therapies will be presented, followed by the challenges of skin cancer therapy. Then, the main features of developing efficient nanosystems will be discussed, and next, the most commonly used nanoparticles (NPs) described in the literature for skin cancer therapy will be presented. Subsequently, the use of NPs to deliver chemotherapeutics, immune and vaccine molecules and nucleic acids will be reviewed and discussed as will the combination of physical methods and NPs. Finally, multifunctional delivery systems to codeliver anticancer therapeutic agents containing or not surface functionalization will be summarized.

Unsettling trauma: from individual pathology to social pathology

Rather than assuming that psychological terms mirror natural categories in the world and that the task of the helping professions is to find ways to discover, diagnose and treat these categories, our goal is to inquire about the status of the categories as an aid to then focusing on therapeutic responses. To that end, we unsettle trauma by exploring its social ontology as a disorder as well as its grammar. Feminist and cultural critiques of PTSD illustrate the limitations of the dominant discourse of trauma, moving trauma from individual pathology to social pathology. We offer two illustrations from the family therapy literature that draw upon polyphony, inner dialogues and the creation of new narratives to expand beyond the pathologising potentials of the discourse of trauma.Practitioner points Understanding the concept of trauma as a socially embedded construction is a necessary first step towards recognising its different applications in therapeutic work The dialogic/constructionist stance taken here assumes that meaning and understanding are shaped by discourse and interaction The taken‐for‐granted meanings associated with trauma need to be questioned Practitioners may then assess when the use of a PTSD diagnosis might import individualising and objectifying assumptions that undermine the goals of systemic family therapy

Examining the Occupational Therapy Definition of Self-Care: A Scoping Review

Self-care practices such as exercise and meditation are commonly identified as strategies to address stress and chronic disease. However, in occupational therapy, the term self-care has traditionally referred to basic activities of daily living (ADL), potentially limiting the profession’s ability to promote wellness among clients. This scoping review aimed to clarify how the term self-care has been used in select occupational therapy literature. We found that of 1,254 included articles, 54.9% use the term self-care ambiguously and that authors primarily apply the term to basic ADL. This understanding contrasts with the evidence from the wellness literature and the concept’s use by the general population and other health professions. Findings serve as a call to redefine the term self-care to articulate clearly the profession’s value in promoting population health and well-being.

Music Therapists’ Goal and Objective Writing Practices

Abstract Maintaining current curricular materials for teaching goal and objective writing can be challenging. The purpose of the present study was to investigate the goal and objective writing practices of music therapists and compare them to the related music therapy literature. A survey was emailed to 6,643 board-certified music therapists asking them to describe their goal and objective writing and to share examples of such statements. Four hundred fifty-seven music therapists responded. Quantitative analysis of the results revealed that the majority of respondents participated in writing goals and objectives as well as nine other types of related statements. Qualitative analysis of the statement examples revealed that the statements were constructed using 15 different components. Comparison of study results and published literature demonstrate alignment with current practice in the descriptions it provides of the basic qualities of goal and objective statements. Data analysis also indicates that current practice encompasses a larger scope and complexity of ideas than those presented in the literature. Clinical and educational implications are discussed.

Music therapy and spiritual care: Music as spiritual support in a hospital environment

This paper is a personal essay that offers reflection on professional experiences of music therapy practice with a focus on emotional and spiritual care in the hospital context in Australia. There is a growing need to map the terrain of music therapy in relation to spirituality. Music can deepen spiritual experiences and holds broad potential for addressing ‘the spiritual’ across contexts. Music therapy within a pastoral care context is considered, with spiritual and emotional support as the primary focus. After a brief discussion of spirituality in the music therapy literature, a context and background is provided for the establishment of a music therapy program within the pastoral care department of a regional hospital. Examples of ‘the spiritual’ in patient responses to music therapy are discussed. Professional challenges surrounding a more direct recognition of a spiritual aspect to music therapy are explored. Vignettes from clinical experiences across two different hospital settings are shared with reflection on the place of spirituality in the author’s practice. Practice-based experiences are considered against existing notions of spirituality in the music therapy literature, to see what they may offer in mapping this field. The relationship between body, mind and spirit is briefly explored, with a reflection on the position of spirituality in relation to health and culture.

Facial Pain and Temporomandibular Joint Dysfunction Secondary to Acromegaly: Treatment with Manual Therapy, Neuromuscular Re-education - A Case Report.

Acromegaly is a disorder typically caused by a benign pituitary adenoma resulting in hypersecretion of growth hormone. Common sequelae, including musculoskeletal changes and arthropathies can result in facial pain and temporomandibular disorder (TMD) that persist beyond primary treatment. Due to the unique etiology of facial pain and TMD in cases of acromegaly, the generalizability of established physical therapy (PT) literature for treatment of TMD cannot be assumed. The purpose of this case report was to illustrate an example of multimodal PT as a treatment strategy for facial pain and TMD secondary to acromegaly following treatment for benign pituitary macroadenoma. 48-year-old male patient with history significant for benign pituitary macroadenoma, presented with facial pain and TMD secondary to acromegaly. Patient-reported outcomes of pain, function, and quality of life were assessed utilizing the Gothenburg Trismus Questionnaire (GTQ) at baseline, eighth PT visit, and eight weeks following course of PT. Quantity and quality of jaw mobility were assessed at baseline and post-intervention using standard goniometric measurements and observation. A total of nine PT sessions were delivered over three months consisting of manual therapy, relaxation techniques, neuromuscular re-education, and therapeutic exercise. After eight PT visits, patient's GTQ score improved from 81% to 67.6%, with a corresponding decrease in pain and improved symmetry of jaw mobility. Eight weeks following last PT visit, patient's GTQ score further decreased from 67.6% to 61.3%. Conservative management through multimodal PT may be effective in managing facial pain and TMD secondary to acromegaly following treatment for benign pituitary macroadenoma.

Chimeric Antigen Receptor T Cells in Chronic Lymphocytic Leukemia: Are We Any Closer to a Cure?

Recent advances in the treatment of chronic lymphocytic leukemia (CLL) have dramatically changed outcomes for patients. Despite these improvements, CLL is still considered incurable. Chimeric antigen receptor-modified T cells have demonstrated the ability to produce long-term remissions in subsets of heavily pretreated patients with B-cell malignancies, including CLL. Unfortunately, the majority of patients with CLL do not attain durable responses. Recent studies have focused on understanding the mechanisms and predictors of response in these patients. In this review, we will discuss the literature for chimeric antigen receptor-modified T-cell therapy in CLL and highlight mechanisms of response and resistance as currently understood.

House as a mirror of self: A case study of a twenty-one-year-old female in an inpatient psychiatric hospital

The concept of house has been universally significant since its development some 8500 years ago. Its mythic and metaphoric meaning permeates the language, art, poetry, and music of virtually all cultures. Yet, contemporary art therapy literature has focused little on the significance and meaning of house imagery when it emerges as a choice of subject matter in the image making process. I present this case study in the hope that it will inspire the reader to think further and more deeply about the house should it emerge as an impromptu theme in art therapy. I provide a brief introduction of a 21-year-old African American female followed by a discussion of her artwork - the construction of what she described as her dream home made in art therapy sessions over a three-week period during an inpatient psychiatric stay. I employed a fairly traditional interpretive style to illustrate how the client’s house and its various elements presented as a symbol of her ego-self and reflected how she viewed herself both as an individual and in relation to the outside world.

How We Talk when We Talk About Disabled Children and Their Families: An Invitation to Queer the Discourse

Despite contemporary perspectives in resource-oriented music therapy, community music therapy, and anti-oppressive practice, there seems still to be a tendency to describe disabled children and their families in a pathologizing, problem-focused way. Disability is often located within the child and not in the societal structures that sustain and support the concept of disability as tragedy and burden for the families. Queer theories challenge the concepts of normality and fixed identities, reject pathologization, and politicize access. In this paper, I attempt to explore how queertheories offer a critical perspective on normativity, identity, and power. I will do this by exploring the concept of normality and normativity and discourse current representations of disabled children in the music therapy literature and by reflecting upon an ongoing participatory action research project where I aim to co-create knowledge on musicking, its accessibility, and meaning together with disabled children and their families. I argue that we need to change the way we talk and write about our practice as well as to challenge the concepts and attitudes toward diversity in order to contribute to inclusive environments that appreciate and celebrate diversity.

It's all about the process: Examining the convergent validity, conceptual coverage, unique predictive validity, and clinical utility of ACT process measures

The Acceptance and Commitment Therapy (ACT) literature now offers a range of process measures, including: the Acceptance and Action Questionnaire-II (AAQ-II), the Open and Engaged State Questionnaire (OESQ), the Comprehensive Assessment of ACT Processes (CompACT), and the Multidimensional Psychological Flexibility Inventory (MPFI). The current study sought to directly compare and contrast the information provided by those scales: (1) in a sample of 2,385 online respondents (67% female, 85% Caucasian, M = 33yo) and (2) in a case study of a client receiving ACT for a depressive disorder. Quantitative results revealed that all of the flexibility scales were strongly linked to wellbeing whereas the inflexibility scales were strongly linked to psychological distress. The results further highlighted that newer multidimensional scales (the 3-dimension CompACT, the 12-dimension MPFI) offered greater insights into current functioning, often doubling the amount of variance explained by the AAQ-II alone. Both the quantitative analyses and the clinical case study demonstrate the more nuanced and clinically meaningful patterns that emerge when multiple dimensions of flexibility and inflexibility are tracked. In particular, the results suggested the MPFI (and the online MindFlex Assessment System that makes the MPFI easy to administer and interpret) offers researchers and clinicians the most conceptually comprehensive scale to assess the dimensions of the Hexaflex model. Implications for clinical research and practice are discussed.

The usefulness of aggression as explored by becoming-teenagers in group music therapy

ABSTRACTIntroduction: Music therapy literature infrequently acknowledges the adaptive functions of aggression for teenagers. This article uses the thinking tools of Deleuze and Guattari to examine how “becoming-teenagers” at a school in Eersterust, South Africa used group music therapy to explore the ways they use aggression. The term “becoming-teenagers” highlights continuous transformation, rather than static identity.Method: The author conducted rhizomatic analysis of video excerpts, session notes and art works created during 12 group music therapy sessions. Analysis entailed a non-linear and non-hierarchical approach that sought connections between concepts in the data.Results: For these participants, aggression was useful for reinforcing “rules for good living” in the context of seeking justice; for understanding and changing territories; for creating a sense of belonging; for becoming worthy and powerful; for becoming dynamic (as opposed to feeling “stuck”); in creating an end to destructive relational dynamics; and for affording a sense of pleasure (while aggression simultaneously evoked regret).Discussion: A meaning-making space can be created in music therapy where the functions of aggression may be explored in multiplicity and intersection, allowing us to more fully encounter those we work with and to invite new lines of becoming.

A person-centred approach to psychosexual therapy: theorizing practice

There is little explicit referencing of the Person-Centred Approach in the psychosexual therapy literature and clients who experience sexual difficulties seem seldom to be discussed in publications on person-centred therapy. These ‘silences’ might suggest that there is little interest in establishing a greater dialogue between these two therapeutic approaches, yet there is, we would suggest, considerable value in doing so. Drawing on developments in person-centred theory and practice, we outline and extend in this article the ‘theorization of practice’ that has supported the development of a more person-centred approach to time-limited psychosexual therapy. While acknowledging the tensions that exist between the philosophical tenets underpinning the Person-Centred Approach and the practices that constitute psychosexual therapy, we suggest that the experiential therapies of Gendlin and Rennie provide useful meeting points between the Person-Centred Approach and psychosexual therapy. We argue that in addition to facilitating a more idiographic approach to psychosexual therapy, the Person-Centred Approach helps to widen the scope of practice within psychosexual therapy by placing greater emphasis on the promotion of sexual potential.

O uso da análise funcional na literatura brasileira de terapia comportamental: uma revisão teórico-conceitual

&#x0D; A Análise do Comportamento investiga, tanto de modo experimental quanto interpretativo, as relações estabelecidas entre indivíduo e ambiente, o que é chamado de análise funcional. Ainda que a análise funcional seja central na pesquisa e na prática do analista do comportamento, existem inconsistências tanto em sua caracterização conceitual quanto em seu uso na prática clínica brasileira. Em vista disso, esta pesquisa teve por objetivo investigar as características das análises funcionais na literatura brasileira de terapia comportamental. Foram identificados no procedimento de coleta de dados 13 casos de clientes típicos atendidos no ambiente de consultório nos quais análises funcionais foram desenhadas ou organizadas em forma de tabela. Tais análises funcionais foram sistematizadas e analisadas em diferentes categorias relativas aos antecedentes, respostas e consequências, quantos e quais eram os termos empregados e como eram descritos. Os resultados encontrados ilustram as principais características do uso da análise funcional. Revelam tanto dificuldade na transposição do conhecimento teórico para a prática, quanto dificuldades conceituais, indicando em que é necessário investir mais esforços para expansão do conhecimento teórico e para formação prática de terapeutas comportamentais brasileiros.