Monday, June 27, 2011

Thoughts About Future Directions In Therapy

Pondering the meaning of life, for sure.Image via WikipediaI have been pondering what to do after I finish Interactive Metronome and a course of Captain's Log.  It's really hard to say as getting my brain and body together is a multidisciplinary problem.  I still haven't found a really good captain that can set a direction for a bunch of therapists and help me organize what needs to be done when.  Each person thinks their specialty is Number One!

I do need to work on my hearing.  I definitely don't hear consonants properly.  Maybe this will be addressed through a course of FastForward or maybe it just needs a hearing aid.  There was a study done of gifted and talented children with auditory processing problems but otherwise normal hearing who were given a hearing aid to amplify sounds that showed marked improvement in children.  But I will investigate this after, IM.  Interactive Metronome helps improve hearing. After I finish IM, I will be doing an audiological assessment focused on teasing out my auditory processing problems.  I imagine some of this will focus on decoding consonants.  Some of these tests will look to see if working memory problems are coming from auditory processing or from cognition.

My balance isn't 100% and does interfere a bit with Interactive Metronome.   I am having problems balancing on one foot as I do some toe tapping.  But when to schedule more balance work?

Interactive Metronome helps with a lot of ADHD symptoms but it doesn't help with my core problems with slow response time and response time variability.   The treatments that adresss these two areas  in the medical literature seem to be either using a stimulant or neurofeedback. 


Another problem that rears its little head is Social Anxiety.  One strategy is Social Skills Training.  Another is music therapy.  A friend had sent me an interesting article about the use of music therapy to treat trauma.

social engagement, mobilization, and immobilization

 It is interesting to note that the neural pathways regulating the orbicularis oculi, a sphincter muscle around the eye involved in expressive displays, also are involved in the dynamic regulation of the stapedius muscle in the middle ear (Djupesland, 1976). Thus, the neural mechanisms for emotional cueing via eye contact are shared with those needed to listen to human voice.



The human nervous system evolved efficiently to shift between conditions of safety and danger. We easily adjust and calm following situations requiring fight or flight maneuvers. We use social interactions with attuned and contingent facial expressions, intonation of our voice (i.e. prosody), and gaze to calm and be calmed. However, in contrast to challenges of danger, reactions to life threat are not easily remediated. Attempts to socially engage a traumatized individual, rather than calming, may result in defensive strategies of rage and anger. Life threat triggers a very ancient neural circuit that severely limits social engagement behaviors and may distort neuroception resulting in a false detection of risk. Thus, treatment of trauma requires a new model distinct from the traditional psychotherapeutic strategies of face-to-face dialog in order to trigger the calm states associated with the Social Engagement System. Music and music therapy strategies may provide this portal to the Social Engagement System and avoid the initial face-to-face interactions that may be misinterpreted as threat by a traumatized individual.

The evolution of the human middle ear enabled low amplitude, relatively high-frequency airborne sounds matching the frequency of the human voice to be heard, even when the acoustic environment was dominated by low frequency sounds, such as sounds made by large predators. Detached middle ear bones were a phylogenetic innovation that enabled mammals to communicate in a frequency band that could not be detected by reptiles. Reptiles have difficulties in hearing higher frequencies, since their hearing is dependent on bone conduction.
Studies have demonstrated that this critical neural regulation of middle ear muscles, a necessary mechanism to extract the soft sounds of human voice from the loud sounds of low-frequency background noise, is defective in individuals with language delays, learning disabilities and autistic spectrum disorders (Thomas, McMurry, & Pillsbury, 1985). 

The observed difficulties that individuals with a variety of physical and mental disorders have in extracting human voice from background sounds may be dependent on the same neural system that regulates facial expression. Thus, deficits in the Social Engagement System would compromise the expression of emotion, as well as social awareness and language development.
Music Therapy & Trauma: Insights from the Polyvagal Theory
http://insightcenter.org/kathykain/Articles/Porges_Music_Therapy_Paper.pdf


This theory seems to explain a number of my problems with vision, hearing and anxiety.

Furthermore, Music therapy has been used successfully to treat autism and is one of the therapies that has got an A level recommendation by the environmental scan done for the Interagency Autism Committee.   However, the environmental scan didn't say which music therapy works best.  So I am left with the equivalent of psychological treatment is a good thing.

But, the devil is in the details.  Which music therapy will work best for me?  There are all kinds of music therapies.  There are therapies that work with rhythm.  There are therapies that are designed to work with the nonverbal to help them communicate-- definitely not me.  There are music therapies that are integrated with neurofeedback.  There are other music therapies that involve creating music directly from your brain waves. 

So what to do next? And in which order?  I wonder.

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