Smiles, tears, and -- of course-- music

Earlier this year, four-year-old twin brothers with epilepsy were admitted into Children's neuroscience unit for their routine evaluation of their treatment plan. During their stay, they had frequent severe seizure episodes which extended their stay to a total of 44 days and moved them back and forth between the  neuroscience unit and the pediatric intensive care unit (PICU) when needing more emergent care. Mom, Dad, and older brother stayed with the twins during their extended admission.

Along with medical needs, extensive neurologic impact to both of the boys was apparent after the initial severe seizures. Previously, the boys did have some speech and language delays but were observed to socially play with each other, use functional language, and actively ambulate around their rooms and the unit.  After their severe seizures all of their developmental abilities were impaired. Music therapy was referred to this family to support rehabilitation of developmental skills.

Initially, music therapy facilitated sessions individually, as the boys couldn't leave their separate rooms. During the assessment sessions, one of the twins, John, demonstrated limited visual tracking, the ability to grasp larger instruments with only his right hand, and tolerated a supported neck and seated position.  John's mom was present during the session and informed the music therapist about John's favorite/preferred songs. She also reported she could tell he was motivated by the therapeutic music interventions because he attended for a longer duration and that he grasped the instruments for a longer duration than previously seen since his seizure.

Jeremy, the other twin, was more limited in his response to the therapeutic music interventions during his assessment.  He intermittently opened and closed his eyes to the auditory stimulus but was unable to sit up or grasp any instruments. Jeremy's dad was present for the session and reported Jeremy's favorite songs and activities.  The music therapist played Jeremy's favorite songs to provide low auditory stimulus and incorporated his name and family member's names to naturalize the environment and increase attention.

During the following six weeks, music therapy facilitated weekly individual and family group sessions for John and Jeremy. Singing familiar and preferred songs were used to support speech and language rehabilitation. Instrument play was used to support strengthening of grasp, increasing coordination in both hands, and broadening their range of movement.  Repetitive sequential songs were used to support sequential relearning of daily living tasks (i.e. steps of eating or brushing teeth). The twins wrote a songs about members of their families and made songbooks about favorite activites for visual vocabulary support.

The most motivating music therapy times were the family sessions where John, Jeremy, Mom, Dad, and older brother were in the room together.  The twins made choices about which family member could play what instrument and directed the instrumental play by starting and stopping their instruments. The family members wrote affirmation songs about each child and worked together during the parachute exercises.

The music therapy sessions provided the boys an avenue for expression when their language and movement was impaired. It provided a way for the boys to be interactive and playful with each other as well as their family members in a developmentally supportive way. John and Jeremy successfully made  many developmental rehabilitation gains in a supportive and nurturing environment.

On John and Jeremy's discharge day, music therapy collaborated with child life specialists and the family's unit nurses to put on a good bye parade to celebrate the gains they made.  Smiles, tears, and -- of course-- music was shared.