Example Activities

Goals, Objectives, and Musical Tasks:

Goal: Increase purposeful motor movement

Select objectives and musical tasks based on the client’s areas of strength and support:

Objective 1: Client will touch their pointer finger to three successive points at least one inch away from each other several times throughout the duration of a song (eg. C, E, and G).

Musical Task 1a: Client will be prompted to use their pointer finger to play three notes of a triad in a row

Objective 2: Client will touch their left hand pointer finger and thumb and right hand pointer finger to three successive points at least one inch away from each other several times throughout the duration of a song

Musical Task 2a: Client will touch their left hand pointer finger to the chord root, left hand thumb to the third, and right hand pointer finger to the fifth of each chord.

Objective 3: Client will switch between movement patterns at least four times throughout the duration of a song 

Musical Task 3a: Client will be prompted to switch between 2 four chord progressions

Musical Task 3b: Client will be prompted to switch between 4 chord shapes

Music Method: Recreative

Music Delivery Method: Music will be delivered live by the client playing piano and MT-BC singing. Recorded music can also be added for the client to play along to a preferred song.

Materials Needed: 

• Keyboard or piano, preferably with note names marked on the keys

• Speaker (in the case of playing along to recorded music)

Procedures 

Step 1: Choose a preferred song with the client.

• Ask the client and their communication partner (if applicable), “What song would you like to play along to today?" The MT-BC has several options on how to facilitate this. Always use that client’s preferred and most reliable communication method for them individually.

  • The MT-BC can ask the question to the client and give them time to spell out their answer on their spelling board with assistance from their communication partner.

  • The MT-BC can present four choices of songs by preferred artists by drawing fourths on a markerboard and assigning each a song choice. Read aloud the choices to the client while they look at the board. Then remove the board from their view and place it in front of the client’s dominant hand so the client can point to their preferred choice.

  • Another option is to associate one song with each of the MT-BC’s hands in a fist shape. Extend both fists towards the client. Point to one fist while saying one song name and repeat with the other hand for the opposite choice. Then ask the client to touch the hand that is associated with their song choice.

  • To double check that the communication was reliable, ask the question again and swap the order of the options. Another way to confirm a choice is to ask the client to point to one hand if the choice they indicated was their “true choice” or if they meant something different.

Step 2: Look at the chords in the preferred song to make sure the song is a fit.

• Depending on the client’s current progression in music therapy, modify the chord structure of the song to include only two to four chords or keep the chord structure as is. Consider transposing the song if the chords include black keys, since reaching forward to play a black key is another step in the motor sequence.

Step 3: Teach the client the triad shapes or review them with the client. 

• Start with the first chord, using C as an example. Instruct the client to play the first note of that chord by saying “start on C” as an initiation prompt then “to” or “and” as a continuation prompt before saying the next note name “E.” Continue by saying “to” or “and” then the third note of the triad “G.”

  • Additional prompting: Verbal instructions might include “eyes on C,” “straight to C,” or “pointer finger touches C” (to link a specific body part with the movement). Visual prompts include pointing to the correct key using the same finger as a visual prompt. Musical prompts include playing the next note in the sequence or singing the pitch of the note while giving its verbal cue (singing the note E while saying “E” out loud) so the client hears the pitch.

•  Move on to the other chords in the progression, using the same cueing strategies. Before moving to another chord, use a verbal cue like “now switch to” to indicate to the client’s body that the movement pattern is changing.

• After reviewing the entire chord progression, practice the chord progression several times, adding or removing layers of verbal, visual, and/or musical prompting as needed based on the client’s behavior. Provide cues to let the client know when the practice is coming to an end by counting down. For example, when there are four chords left to play say, “four,” and count down from there until the last chord has been played.

• As the client completes this process, provide continuation prompts like “keep going” or other positive reinforcement.

Step 4: Add in MT-BC singing or a recording of the song.

• Once the client becomes more familiar with the movement patterns to play the song’s chord structure, add another musical element. If the song has been transposed from its original key, do not play along to recorded music and sing along, following the natural pace of the client’s movements. If the song has not been transposed, play the recorded version of the song over a speaker. Depending on the original song’s speed and client preference, reduce the speed to .75.

• ​Play through the song, guiding the client using the above visual, verbal, and musical cues and layering them in and out as necessary. Provide additional cueing during switches between movement patterns or large jumps between keys.

Therapeutic Role of Music:

The form of a song with a repetitive chord structure provides a natural structure for the client to switch between new movement patterns associated with different chord progressions, which is a valuable skill (Goh, 2024). For example, many songs have a four chord structure that is largely repetitive, creating a predictable pattern that switches between four different chord shapes. Some songs that use the same four chords in the verses and choruses but switch the order also promote purposeful movement and switching between chords in a different order. Saying “C and E and G” on beats 1 + 2 + 3 to subdivide the measure promotes the continuation of movement from one note to the next without stopping between each note.

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When cueing a movement, subdividing the beats to cue each stage of the movement in rhythm provides a point of reference at each point of the movement and promotes the continuation of the movement over time. For example, giving the verbal cue “C and E and G” (on counts one, and, two, and, three, and) when moving to each note of the C chord emphasizes each stage of the movement (pressing down on the key and lifting the finger to move to the next key).

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Asking the client what song they would prefer to use while working on purposeful motor activities is important because not all client-preferred music as listed in intake information or communicated by the client's family may be beneficial during these activities. This is because certain preferred music may elicit undesired and uncontrollable bodily reactions in the client, which may make it more difficult to achieve their personal goals and complete the musical task. Asking the client ensures they choose a song they enjoy but can successfully use to work on purposeful motor skills; the client knows themselves and their bodily reactions best.

Additionally, individuals with apraxia are capable of complex thought and should be spoken to using age-appropriate and respectful language, yet many face assumptions that they prefer music from a younger developmental age (Tino, 2020). This means acknowledging client preference and taste is especially important. For example, some clients at MTSP prefer music from artists and composers like PINK, Hozier, and Tchaikovsky, and their music therapist incorporates their preferred styles into musical activities.

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Therapeutic Strategies, Accommodations, and Adaptations

• Adapt this activity to work on other purposeful movement goals using the xylophone (bending and straightening the wrist and/or elbow), boomwhackers (bending and straightening the wrist and/or elbow), bells (tapping their pointer finger on three successive points), or any other pitched instrument with enough notes to play the chords in the chosen song.

• Scaffold up to a three note chord by beginning with only the root note of each chord. Over time, add the third, then the fifth of the chord as the client's purposeful motor capabilities increase.

• Use similar prompting styles to teach the client a melody line on piano rather than chords.