I came to this situation from a slightly different angle. I developed a repetitive strain injury and couldn’t play guitar (because it was too painful) for about a month or so (I’m still not 100%, as it’s still being treated). I have been conscious of my tendency to use the guitar much of the time (I travel around, and it’s just easier to move a guitar than a large keyboard), and it was, as you say, Krista, definitely an opportunity to stretch myself a bit more as a music therapist. I’ve been using my Native American flute of late, a recorder, and they keyboard. I tried our old autoharp, but it was- ahem- a bit horrible-sounding. It was illuminating in terms of my musical needs, and it was also helpful to see my clients’ responses.

Thanks for bringing up this important issue, and I do hope you’ll be in guitar peace again soon.

I too lost my guitar to an accident, last Fall. I thought it was in a safe space but two members of the group started playing around and managed to knock it over and step on it. I felt shock and took a second before I continued with the session. I managed to sing the
“Goodbye Song”, acknowledge concern from a staff member and get to my car before I started sobbing. I was really surprised – it was a true emotional loss. My husband had purchased the guitar for me in Maine after, on the first day there, I sprained my ankle. It held much sentimentality for that reason; and, it was my constant companion. It was not fixable so my husband gave me a sympathy card from he and our furry family before throwing it out. Fortunately, I did not have to see that part. Thanks for your story and for sharing your creativity after the fact. I now have a beautiful Guild – which is just the right size and, I keep it in its hard case always! Nancy

Asthma has a genetic origin and it is something that a person is born with, but you are correct that for most persons with asthma the symptoms begin to develop as a young child (http://www.aafa.org/display.cfm?id=8&cont=6). Just as with any Music Therapy session/client, always start with an assessment of the need and developmental stage in order to determine your instrument selection and type of musical structure needed.

Harmonicas can be used with younger clients so long as the musical structure you provide allows for the freedom to play without fear of a “wrong note”. For instance, if the harmonica is in the key of “C”, you as the MT-BC would play a song or improvisation in the key of “C” that allows for the client to play anything on the harmonica. If the goal is for increased diaphragmatic breathing or deeper respirations, the focus of the musical interaction will be on the length of the notes, not the notes themselves. For older clients who need more cognitive stimulation or motivation, you can change the structure so that they are engaged by playing specific notes or patterns. The benefit of the harmonica (musically) is that it naturally encourages longer notes and sustained breathing. Remember to consider that because a harmonica is more diffuse, especially for someone with less technical ability, it may not be ideal for a child who has ADHD and needs more structure in the form of less options for their playing. A kazoo could also work, but it has the potential to encourage more staccato notes; therefore the musical structure you add will need to provide the intention for playing both staccato and sustained notes with the instrument.

Always keep in mind that with these instruments you are monitoring the client’s breathing-is it from the diaphragm or the chest? Your initial assessment or subsequent evaluation may indicate that the client is not ready for a wind instrument because they first need to a concrete understanding of how they breathe. For instance, a song I wrote for this talks about breathing up “high” to the sky where they fill up their chest and life their arms above their heads “like a big balloon that’s flying by”, then they fill their “belly” (aka diaphragm) like a beach ball and breathe “low” keeping it “slow”. The musical structure echoes these concepts by ascending then descending both vocally and on the glockenspiel.

If you are familiar with the Neurologic Music Therapy techniques, these fit within the Speech and Language Technique of OM-REX (Oral Motor and Respiratory Exercises) to “enhance respiratory strength (Hass & Distenfeld, 1986). Although asthma is not specified as a diagnostic criteria (likely because it has not been sufficiently researched); OM-REX is still a viable option for children or adults with asthma or COPD whom you assess to have a need to improve their respiratory efficiency and strength.

Feel free to contact me if you’d like to chat further on this topic with your ideas from your practice or other questions. krista.winter@bcmh.net

Thank you!