Our intern, Mary, will be diving into a variety of music therapy topics to increase her knowledge as her final project! She not only is gathering this information for herself, but also to share with you in the form of a blog post. Thanks for reading!

Overview

Augmentative and Alternative Forms of Communication (AAC): AAC refers to the various forms of communication besides speech. All forms of communication are valid. If your client communicates something to you in any way, listen and trust them. When working with all clients, it is important to take in various cues, including body language and facial expressions as possible signs of inner feelings and emotions. AAC options can includes, but is not limited to, the following:

AAC device, or Assistive Communication Device

An AAC device is an electronic communication tool that includes various options for words or phrases, such as a tablet with communication applications or an AAC-specific software such as Tobii Dynavox and LAMP. AAC devices are programmed to include client preferred topics and phrases in order to be most applicable to their conversations and encourage engagement.

Eye Gaze/Head Tacking Technology

For people who are not able to utilize a traditional tablet, there are other devices that can be controlled with one’s head and/or eye movements. A camera is used to track one’s eye movements, including actions such as blinking or prolonged staring to select a specific need, want, letter, phrase, etc. (Communication Matters). Similarly, a head tracking device can translate one’s head movements into mouse movements (Boundless).

Other Technology

Things like buttons, Boomcards, and other technology that can represent words / speech can be utilized to provide interaction options for clients. These can be overall limited, due to the restricted options for the user to choose from, but can be great on-the-fly communication tools. What we like about these are the ability to record a word or phrase on the button, such as “yes,” “no,” “sing a song,” “play instruments,” etc., and switch them up as needed!

Facial Expressions & Eye Contact

You can learn a great deal about someone by paying attention to their body language, facial expressions, and eye contact. This is also a way for AAC users to communicate their preferences, such as expressing a bright affect when an intervention seems appealing to them or displaying a frown if an activity is not enjoyable.

Gestures & Touch

Many of us utilize gestures and touch in everyday life. I have one client and have observed others who rely on these aspects of facial expressions, eye contact, gestures, and touch as their primary form of communication. Examples of gestures could include pointing, a halt hand, and nodding/shaking of the head. Touch can be used to signal when someone needs help or a hug to co-regulate.

Picture Exchange Communication System (PECS)

PECS are a paper-based form of communication that, similar to high-tech AAC devices, include the user’s wants, needs, and preferences, and can be edited to add new words or phrases (IU Bloomington). One client of mine utilizes PECs, and has his own PECs specifically for music therapy sessions, which has been a big factor in him reaching communication goals each week

Sign Language

Sign language is a widely used form of communication, and many non-speaking people use sign language as their primary form of communication! I believe it is beneficial to be familiar with basic sign language (i.e. signs for “eat,” “more,” “all done,” “thank you”) in the music therapy community. It can also be helpful to include sign language with songs in sessions. In college, I was part of the music department’s sign language choir, Hands in Harmony, which was such a great opportunity and truly aided my growth in sign language.

Writing & Drawing

I typically reserve coloring and drawing interventions as those that can aid in regulation, but they can also serve as communication. Similar to how music can be used to communicate (such as instrument play or song communication), art can too!

Upon researching AAC, I found information regarding Gestalt Language Processing (GLP). GLP refers to a process of language development that begins with memorizing phrases, or gestalts, then going back to understand the meaning of each word (Diaz). We all have gestalts that are part of our everyday vocabulary.

Aided Language Stimulation is defined as someone else, such as a caregiver or teacher, modeling how to use the AAC device for the AAC learner without expecting immediate action as a response (Diaz). Learning how to use an AAC device takes practice and time, and it is imperative for communication partners to remain patient.

The plus-one rule = if an AAC user is non-speaking, the modeler should begin with using one core word at a time. If the user utilizes 1-2 words at a time, the modeler can model 2-3 words at a time (Diaz) to encourage further development.

It is important to remember to always ask for permission before touching someone’s AAC device, as this is their voice that fully belongs to them. As a student and intern, I have found it helpful to obtain pictures of the client’s AAC device pages to further build experiences and educate myself on the device. With training and knowledge, a music therapist can learn how to program music-therapy specific terms and buttons onto a client’s device, if the client is willing!

Who could use AAC?

Anyone! Even those with multiple communication methods have different preferences from time to time, based on mood and situation. An AAC user does not have to have a specific diagnosis or skill to obtain a device, and the AAC device is not a last resort when it comes to communication techniques. AAC can aid and benefit all kinds of people.

Some of my current clients utilize an AAC device or application, and PECS. Each of these clients also have a music therapy goal of practicing communication skills in each session! In music therapy, it is important to provide a non-speaking client with opportunities to use their AAC device throughout each session. I’ve compiled a list of interventions, songs, visuals, and props that could be used with AAC users within music therapy. It is also important to remember that AAC users are similar to non-AAC users in that they are most likely to be engaged in music therapy interventions when their preferred music, artists, and leisure activities are included. Please recall this note while reading through these possible interventions!

Music Experience Ideas

Song Communication

Song communication is defined as utilizing a song to communicate how you feel, share a memory, or share a hope for the future. For example, if I’d like to share about my friendship with another person, I could choose the song, “if you got a problem” by Joy Oladokun to express these feelings. It can be helpful to provide highlighters or colored pens to mark lyrics or phrases that the client or therapist most resonates with!

Instrument Improvisation

One of my non-speaking clients and I strictly improvise for the duration of our sessions together. They love to explore the instruments and express themselves in this way. I also find it beneficial for them to be in control of their own music making. If you are not super comfortable with improvising, consider practicing on your own or with service-users to see what happens!

Songwriting/Song Transformation/Mad-Libs

Songwriting templates have been extremely helpful for me as a facilitator but also for my clients to share how they feel and possibly relate to the message of a song. Aspire has many songwriting templates available for free! I can’t recommend them enough. Join the email list to receive new templates free, delivered right to your inbox.

Duet Sheets

Duet sheets are an intervention I started using consistently throughout my internship. It is simple to print song lyrics to an iPad app or physical paper and highlight sections for each person to sing. A couple popular (already structured as a duet) songs I use most often are “A Whole New World,” and “Love Is An Open Door,” but duet sheets can be adapted and edited for client preferred songs/artists.

Song Re-creation

Re-creation can also be facilitated with non-speaking clients through prompting them with specific lyrics, which is a helpful way to practice communication skills. For example, in the song “Can’t Stop the Feeling,” prompted words could include “stop,” “on,” “high,” “sunshine,” “feet,” “hot,” “body,” etc. In addition to lyric-sheet prompting, visuals such as “Old McDonald” can also be used to target client communication skills.

Boom Cards

Boom Cards are a fun, interactive intervention that anyone can create with a free online account. My co-intern introduced me to boom cards and has created multiple sets that she utilizes with non-speaking clients, not only as lyric selection in re-creation, but also as choice cards and lyric scrambles to read along while singing. Boom cards are a fun tool to play around with!

Art-To-Music

Art-to-music is an inclusive way to bring art and music together in therapy sessions. Some examples of art-to-music include coloring, drawing, painting, creating projects, and crafting. I have found that pinterest is a helpful site to browse art project ideas if you’re looking for more of a craft-based activity. Preferred or instrumental music can be played during the art-to-music activity too.

Journaling To Music

I started utilizing journaling with one of my clients who works towards processing thoughts. It can be helpful to create prompts for the journaling, as these can focus on client-specific goals. Similar to art-to-music, journaling can also be facilitated with receptive music, which can possibly relate to the journaling prompt (i.e. playing Thanksgiving-themed music with the prompt “What are some things you’re grateful for in your life?”).

Song Ideas

While these are not necessarily specific songs that are best to use with non-speaking clients, I included a few songs that I have experienced or used with clients with communication goals.

Greeting Song - a hello song can be a useful and simple way to check-in with the client at the beginning of each session. One of my clients utilizes their AAC device to select an adjective for the hello song which is used to describe their day. This can also be used to practice communicating greetings, such as “hello” or asking questions like “how are you?”

Who Took the Cookie from the Cookie Jar - this song is a simple one that can be adapted to each client’s needs and communication style.

We’re Going on a Bear Hunt - this song can be integrated in sessions by prompting clients with specific nouns such as “bear” and “grass,” verbs such as “go” and “swim,” and feeling “scared.”

For clients who would benefit from speech goals, it’s an important distinction to make that we cannot teach articulations (it’s out of our scope of practice!). It CAN be helpful though to provide opportunities for clients to practice verbalizing. Even better if we can co-treat with a speech therapist! Here are some of my favorite songs that use specific verbalization opportunities or lots of repetition to encourage participation:

“If All the Raindrops” targets various vowel sounds (i.e. “ah”) and can be adjusted to include space for client suggestions
“Apples and Bananas” by Raffi also targets various vowel sounds!
Nursery Rhymes such as “Old McDonald,” “Five Little Monkeys,” “Row Row Row Your Boat,” “If You’re Happy and You Know It” are familiar songs that include repetition!

Musical Books

Listed below are some musical books that I have found to be beneficial for clients practicing communication skills. Specific words in each book can be used as a prompt for the client to communicate in their preferred way.

There Was An Old Lady Who Swallowed …
Little Blue Truck
Brown Bear, Brown Bear What Do You See?
Pete the Cat

Visuals

Visuals can be a helpful aid when working with clients with communication goals. As a student and intern, I am able to find a decent amount of free resources online and have really benefitted from the visuals our Aspire team has made over the years.

Check-In

A visual check-in is something I use with multiple clients, speaking and non-speaking to aid them in sharing their current emotions. A check-in is a visual that can be independently created, even if it just includes feeling words, but I like to use a check-in visual that includes facial expressions as well.

Movement Cards

I personally have trouble creating new movements in therapy sessions and have found movement cards to be a helpful, unique addition. These cards can also be used to prompt clients or encourage them to choose movements.

Intervention Selection Choice Cards

Some AAC users may not have access to music therapy specific choices through their primary form of communication, so it is helpful to have choice cards for their preferred activities or songs. These can be created for free on Canva, then printed, and laminated. I typically edit a Canva template that is already accessible. If a client really enjoys “Old Mcdonald,” songwriting, and instrument play, I would create cards with these choices for them to choose from!

Old McDonald

This visual can be used to assess client’s knowledge of animals, as well as practice speech skills with each animal’s sound. I use an “Old McDonald” velcro visual as an encouraging way for clients to select each animal as it is prompted, or select them themselves. The animals can also be printed on cards for clients to select/identify!

5 Little Pumpkins

Similar to “Old McDonald,” this fall season I have been using a 5 Little Pumpkins visual for clients to select each pumpkin based on their facial expressions. This is also a great way to assess emotional skills! Additionally, AAC users can utilize choice cards and/or their preferred method of communication to select specific emotions. This visual can be created on Canva, or I use the Music For Kiddos version found in their Fall Bundle Packet.

Itsy Bitsy Spider

This can be utilized with AAC users as sequencing cards, encouraging them to place the cards in the order of the song. The cards can also be mixed up to create a silly version of the song.