I was speaking with one of my son’s speech therapists the other day about what I do in music therapy. After giving her a case example, she said, “you should publish that!” Well, I have heard that many times over the years. Unfortunately, when I sold my practice, my records went with it and I no longer have the hard data. However, I can still tell the story and I think it’s an important one. So, here you go:
I was working with a pre-teen who had generalized dyspraxia and severe sensory integration dysfunction. He was really bright, but had difficulty communicating. When he did speak, his voice was nearly non-existent and he spoke with as few words as possible. However, when he was in a state of high self-stimulation such as bouncing on a ball or spinning, or when he was really upset, you could hear his voice plain as day. So, we knew he had a voice and could use it. Multiple speech therapists had been working with him for years and years, but were not successful in getting increased volume. I had some success with having him sing, but it was not generalizing to speech. He really wanted to fully participate in his bar mitzvah which meant that he would have to say/sing pages of prayers in front of people.
My major instrument is my voice and I have taken and taught voice lessons for years. I was becoming frustrated at not being able to help him gain his voice. One day, it dawned on me that his voice might actually be painful for him in the way that people lightly touching him was painful due to his sensory integration dysfunction. I asked him what his voice felt like, if it was comfortable, if it felt funny, etc. He said, “ouch”.
I want to take a moment and explain what was causing this pain for my client. When one creates vocal sound, the bones, cartilage, and sinus cavities of the face and head vibrate. Most of us learn from the time that we are infants to incorporate those vibrations into the sensory experience of vocalizing. Vocalists can alter their voice to vibrate more or less in certain parts of their face, neck, and chest to influence their tone. It was with this, and sensory integration, knowledge that I started the real work on this boy’s voice.
Through collaboration with his speech therapist and occupational therapist, I developed a desentization program for this client. We started with a very small vibrator and I had him vibrate key areas of his face as he counted outloud. We then systematically increased the intensity and number of seconds that he could tolerate the vibration. We got to the point where he could tolerate an electric back massager for 20 seconds on each of the 7 targeted areas on his face. That’s a lot of vibration! After about 2 months, people who knew him for years were commenting on how much better they were able to understand him. After 6 months, he was able to perform his Bar Mitzvah in full without assistance. When he had times that using his voice was important, such as giving a speech for class or participating in his IEP meeting, he would vibrate his face ahead of time so that he could better tolerate the use of his voice.
Working with this particular client provided me with many a-ha moments that have since shaped my career, this instance definitely being one of them. Since then I have noticed similar vocal issues in other children who have autism and even traumatic brain injury. For instance, while working in a children’s hospital, I noticed that many children with traumatic brain injury almost forget how to use their voice. Through the use of sensory integration and auditory feedback techniques I was successful in helping them gain their voices.
Having a voice is one of the greatest gifts that we have and something that we often take for granted. It is one of the human being’s primary methods to convey meaning in communication. I hope that by sharing this story you and those you work with are able to benefit. As always, I love your feedback!
Thanks for reading! Lillieth