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Recently, I was at a conference where a new term was introduced, at least the term, “empathic strain”, was new to me. The concept of compassion fatigue has long been acknowledged as a challenge for paid and unpaid caregivers. Recent discussions among researchers and experts have led to a significant shift in terminology, and our understanding of its impact and affects. The growing emphasis on the term empathic strain reflects a deeper understanding of the distinct neural processes involved in empathy and compassion and our understanding the difference between the two. Empathy , the ability to sense or share others' pain, and then compassion, the recognition of suffering accompanied by a desire to alleviate it, form the foundation of caregiving roles. Empathic strain refers to the toll taken on individuals regularly exposed to others' suffering without adequate support. The signs and symptoms of empathic strain are varied and profound, impacting both professional performance and personal well-being. The neural networks involved in empathy are the same as those connected to the experience of pain. Interacting on a regular basis with the suffering of others, compounded by an inability to effectively alleviate, causes our brain to react the same way it would to pain, with avoidance and self-protection. Those experiencing empathic strain often grapple with profound physical and emotional exhaustion, making even the simplest tasks seem daunting. This exhaustion is coupled with a notable decrease in empathy, rendering it challenging to connect with and understand the emotions of others. Heightened levels of anger and irritability become more frequent as emotional reserves are depleted, and some may turn to increased substance use or simply shutting down as a coping mechanism. Those affected may find their satisfaction at work greatly diminished, leading to a desire for isolation from colleagues and clients. Persistent worry and stress become constant companions, exacerbating emotional volatility, and impairing decision-making abilities. Absenteeism may also manifest as individuals struggle to muster the energy to fulfill their professional responsibilities, further blurring the boundaries between work and personal life. To address empathic strain, we need a comprehensive and multimodal approach. One of the most effective, and simple ways is to engage in mindful self-compassion practices, available through courses, online resources, and apps. It begins with training and mindfulness practices that fosters a compassionate attitude towards oneself amidst challenging circumstances. Room 217 offers musical self-care resources . It is critical to acknowledge and validate one's feelings, an essential first step while navigating emotional complexities effectively. This is significant because it helps us to develop awareness of environmental stressors and enables us to set up proactive management of triggers. Prioritizing self-care and establishing clear boundaries safeguard against emotional depletion, while cultivating mental calmness and equanimity through mindfulness practices enhances emotional resilience. Addressing past trauma and seeking professional help are crucial steps in healing and restoring emotional balance. From my perspective, empathic strain offers a nuanced perspective on the emotional toll experienced by caregivers. By acknowledging its signs and proactively implementing preventive strategies, such as fostering connections with music, we can effectively mitigate its impact and promote holistic well-being within caring professions. This approach not only safeguards individual mental and emotional health but also enhances the quality of care provided to those in need. “The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as being able to walk through water without getting wet.” - Rachel Naomi Remen, Kitchen Table Wisdom, 1996

This blog will include both person-first language (“a person with autism”) and identity-first language (“an autistic person”) to reflect the differences in preferred language in the autistic community. You should always directly ask a person’s preferred language. All references are hyperlinked. Neurodiversity is a term used to describe the differences in the way people’s brains work. It is the idea that there is no “right” or “wrong” way for the brain to function and that people perceive and respond to the world in different ways. It is often used in the context of autism spectrum disorder (ASD) but it also refers to ADHD, downs syndrome, dyspraxia (movement processing difficulties) and dyslexia (language processing difficulties) to name a few. The term was coined by Australian sociologist Judy Singer in the 1990s to promote equality and inclusion, as well as highlight the benefits of neurodiversity. The DSM-V describes autism spectrum disorder as a developmental disability characterized by difficulties with social communication and interaction, and restricted and repetitive behaviors. Historically autism research focuses on the social communication and interaction aspects of the disorder, often neglecting the sensory and motor needs of persons with autism. We have eight senses - sight, hearing, smell, taste, touch, vestibular, proprioceptive and interoceptive. The vestibular system senses balance and posture, while the proprioceptive system senses movement, action and location. The lesser-known interoceptive sense is responsible for understanding our body’s internal sensations, like whether we’re hungry, cold or tired. Autistic people often have difficulty interpreting sensory information which can result in difficulties with self-regulation. If you have trouble interpreting sensory information your body might feel uncomfortable but you don’t know why. This feeling of “not being in your body” can result in sensory seeking or sensory avoiding behaviors. A sensory seeking behavior might look like stomping one’s feet or squeezing one’s hand and a sensory avoiding behavior might look like avoiding physical touch with others. As a result persons with autism have difficulty with arousal regulation. If you’re over- or under-stimulated, it is more difficult to interact with others and to regulate your emotions. Unfortunately these sensory seeking and avoiding behaviors are often mislabeled as difficult behaviors related to the socio-emotional aspects of the disorder. Music therapy is often used to support autistic individuals with arousal and sensory integration, interaction and communication, and emotion regulation. Here are some ways music might be used! Movement to music can aid in the integration of the senses, such as auditory perception and the integration of the visual, tactile and kinesthetic senses to improve body awareness. Music and deep pressure input, such as hand squeezes, can also provide functional sensory input and reduce sensory seeking behaviors. The rhythmic component of music helps to organize the motor system. Music can then be used to improve gait, as well as fine and gross motor skills. For example, playing the piano to improve finger dexterity or hitting a drum bilaterally to practice trunk rotation. A music therapist might use developmentally appropriate songs to enhance speech and language development in children with autism. Through singing, instrument playing and movement children can learn things like the days of the week or how to get dressed independently. Singing can also be used to help with vowel and consonant production or word learning to support speech and language development. Improvisational music playing can be used to mimic social situations in order to teach turn taking, listening and responding and joint attention. For autistic individuals who are non-verbal, music can be a form of communication and self-expression. Singing, songwriting, improvisational music playing and music listening can be used to help identify and express emotions. The different qualities of music can help us to convey emotions without using words. Music can also promote relaxation. A guided meditation or progressive muscle relaxation with music can help calm the body and mind, as well as improve body awareness. These are just some of the ways that music can support persons with autism.

I initially trained with MUSIC CARE to work with Seniors in Long Term Care who were experiencing dementia and Alzheimer’s Disease. This is the path I travelled with my mom. My training with Music Care and Room 217 supported capacity building in selecting music that was played on my harp or chosen recorded music. The music centered on the care of the individual and their specific needs. My job was to determine the individual’s specific and select music to address these needs. The music selected helped to build community, support sleep, talk about life experiences, create a background landscape of sound, support connection to decrease isolation and loneliness, as well as coming alongside people dying. My training with Music Care helped me understand how to support people “where they were” physically, emotionally, and spiritually. Through using beat, tempo, melody, and timbre, I could cater the music and desired support required for individuals or small groups. My profession is teaching. I am a special education teacher and use music in my primary teaching as a method for learning, practicing language skills, transmitting information about science studies or math equations, as well as having fun and creating our own songs. My teacher toolkit married exceptionally well with the knowledge and skills provided by the Music Care Certification training. Recently, my work with students has involved individual programming for the medically fragile children and the palliative children. I use music (repeating the chorus several times) to engage and connect with the kiddos. We use music to "talk" about feelings (our communication is through eye gaze, eye blinks, and squeezing hands), and content material. I use music to enjoy our relationship of being together. At times, due to medication for seizures, my little ones can be very sleepy. I increase the tempo, engaging in tapping the beat on her hands and using silly action songs. The giggles and wiggles make it magical. I also use music to tell stories (my students have CVI, cortical vision impairment, so visual perception is difficult). This helps the child to engage in the story arch and adventures. Music is my conduit for reaching out and being with the students. Recently, I had the sacred journey of visiting one of my children in ICU at Sick Kids. I was invited to come to say "goodbye". A dear friend who was an ICU nurse in a different department told me (AKA, insisted) that I bring my harp with me. I wasn't sure if this would be appropriate for the family. However, with the permission of the mom, I bravely packed my harp up and took it to the Unit. It was a beautiful evening of talking with their mom and dad about how special their child was in my life. I played the kiddo's favorite songs and then ended with "The More We Get Together". The little one opened their eyes and stared at me. We hugged, and I left. They passed the next morning. I consider this time to be a sacred gift. Music Care Certification has given me the confidence and toolset to work alongside people and to journey together. It is a time a beautiful, difficult, or sacred time that I have been honoured to participate in.  Thank You

Did you know that ADHD is one of the most common neurodevelopmental disorders in Canada? According to the Centre for ADHD Awareness, it affects 4-6% of adults and 5-7% of children or approximately 1.8 million Canadians. This means 1 in every 21 Canadians has the disorder. So what is ADHD? ADHD stands for Attention-Deficit/Hyperactivity Disorder. The DSM-V defines symptoms of ADHD as inattention, hyperactivity and impulsivity. Inattention might include failure to pay attention to detail and difficulty focusing and following through tasks. Hyperactivity might include excessive fidgeting and movement not appropriate to the situation, while impulsivity may include difficulty with turn taking or blurting something out. ADHD can be defined as a predominantly inattentive, hyperactive/impulsive or combined presentation, and often persists into adulthood. However sometimes the diagnosis is missed in childhood leading to a diagnosis later in life. Persons with ADHD have lower levels of the neurotransmitter dopamine. Dopamine is involved in attention and memory, movement, reward and motivation. A study from Lyon University found that listening to the music you like will increase the release of dopamine from your brain. Curious to know more about how music can support persons with ADHD? Well, music is often used to practice attention skills. Attention can be broken down into four types: sustained, selective/focused, alternating and divided. Did you know that learning to play an instrument can help develop different memory and attention skills? For example, while playing piano you have to sustain your attention on the task, alternate your attention between the music and your hands, as well as divide your attention between the treble and bass clef. If you catch yourself playing a wrong note, you might also pause to practice the passage. Other examples of attention exercises might include responding to different musical cues with music and movement. For example, to practice selective/focused attention a music therapist might have the client drum along to a beat with distractions in the background and a distinct musical cue that indicates stop and start. Another example of an alternating attention exercise might look like clapping if you hear the drum and swaying if you hear the guitar - this requires you to switch your focus between two different sources! Overall, attention exercises are important for improving focus on tasks, filtering out distractions and multitasking. Persons with ADHD often struggle with executive function. Executive function is our ability to plan, organize and make decisions etc. Research suggests that music therapy can improve executive functioning. Improvisational music playing and musical composition can help a client work on these skills in a pleasurable and motivating environment! In order to create a musical composition you have to plan and organize the structure, making decisions about your creation along the way. Finally music can also help with stress management and emotion regulation. Music and progressive muscle relaxation or movement can help calm the body and mind, as well as get rid of excess fidgeting. Improvisational music playing, listening and creating can also provide a means of self-expression in order to regulate one’s emotions. No matter your age - music can help improve attention, reduce hyperactivity and create pleasurable experiences for persons with ADHD. 

Developmental Coordination Disorder (DCD), also called dyspraxia, is a chronic condition affecting fine and gross motor coordination. Impacting nearly 6% of school-aged children, risk factors include being born prematurely or with a low birth weight, as well as a family history of the disorder. In kids with dyspraxia the issue is not with their muscles, but rather the communication between their brain and their muscles. Coordination problems happen because the brain has a hard time telling the body what to do. Symptoms of DCD include difficulty with fine motor skills such as using a pencil, eating with a spoon, making hand gestures or getting dressed, as well as gross motor skills such as walking, running, kicking and throwing. As a result children with DCD often avoid activities like drawing and writing or playing sports. While there is no cure for DCD, therapy can help children improve their coordination by being taught how to do an activity by breaking it into smaller parts and practicing them regularly. Activities can also be adapted to make them easier, such as using special grips for utensils. How does music come into play? Music activates different regions of the brain, creating alternative routes for the transfer of information. In fact, research shows that music activates the motor cortex. The structure and predictability of music helps the brain to time our movements - this is called priming. Moving rhythmically is important for full body regulation and allows the brain and the muscles to communicate more efficiently. For example, crossing the midline activates both sides of the brain. When we execute this movement to music we are strengthening the connection between our right and left hemispheres, as well as practicing reaching and trunk rotation. A music therapist might set up an instrument target, such as the drums or chimes, for the child to hit to practice this function. To target fine motor skills, a child can learn an instrument such as the piano to practice finger dexterity exercises that will make tasks like tying their shoes or fastening buttons easier. Improvisational instrument playing that involves the use of a mallet or drumstick can also improve grasping and reaching movements which can help with self-feeding or drawing and writing. To target gross motor skills, a music therapist can create different musical patterns that reflect a desired movement to provide spatial, temporal and force cues. For example, if you want a child to practice reaching you might play high on the piano versus low for touching the ground. Music and movement is an effective way to target coordination. Not only does the rhythm provide structure and timing, but the music can create a safe and motivating space to practice movements that a child with DCD might be struggling with.

Jazz Walia is a third-year undergraduate student in the Bachelor of Health Sciences (BHSc) program at McMaster University. During the 2023 winter academic semester, she participated in the Room 217 Research Practicum course generously funded by FAVDTR and wrote this blog post as part of her coursework. When I was in my first year of university, just before my first undergraduate assessment, our professor’s only piece of advice was: “Just put on some Mozart 30 minutes before and you’ll be grand.” I initially thought the advice was completely random, but I was convinced it was a hint for a question or even bonus points. Not so shockingly, there were no Mozart questions on the test, but I did end up typing “Mozart” on Spotify 30 minutes before our test and listening to the first classical music playlist I saw. Two years later, my Spotify and YouTube recommendations are filled with playlists called “Calming Music for 12 Hours” or “Classical Test Music.” Music has always provided me with great comfort; however, it is the soft melodic tones of classical music that have transformed my "pre-test ritual." For me, this type of music has always had a calming effect on me whenever I feel stressed, but especially when it comes to mitigating performance anxiety. A quick search on the internet will yield you thousands of results of people searching for the same thing—"calming music"—on various streaming services. Millions of people listen to the likes of Mozart , Bach , Chopin , etc., on platforms such as YouTube and Spotify, begging the question: why exactly does it work? Over the past couple of decades, research into music listening has inspired further exploration into the use of music as an intervention for reducing anxiety. In a recent survey by the Centre for Addiction and Mental Health (CAMH), 25.1% of survey participants expressed feeling moderate to severe anxiety. In addition, 24.0% of Canadians indicated needing some sort of mental health services but were unable to access them, highlighting the need for accessible services and systems. It’s estimated that only 20% of people experiencing anxiety receive formal interventions , illustrating the need for evidence-based resources. Previous research suggests that music can have a significant effect on endocrine function and autonomic activity, enhancing parasympathetic activities—your body’s "rest and relaxation" state—and reducing respiratory rate and heart rate. In a study by Ubmrello et al ., featuring about 960 critically ill patients, 15 to 60 minutes of music therapy were shown to have a significant effect on reducing anxiety and stress. In a recent review of 21 studies conducted by Harney et al., it was discovered that listening to music had an overall large effect on reducing anxiety. This study was the first of its kind and highlights that while we can see a link between music listening and anxiety, more research needs to be done into important aspects such as music selection, length, setting, and dosage when looking into this relationship. Even if you’re not a fan of the classics, both "fast" and "slow" music have been shown to improve mood. In a study by Darki et al. , 98% of fast music listeners and 99% of slow music listeners reported that music helped manage stress. The study also showed that listening to slow music decreased heart rate and both systolic and diastolic blood pressure . Fast music, on the other hand, increases heart rate and both systolic and diastolic blood pressure. Fast music was seen as "uplifting," while slow music was seen as "calming." These feelings of calmness when listening to slow music help showcase why it might be helpful to listen to music in an anxious state. Of course, "slow" music isn’t restricted to just the classics, which arguably can be "fast" at times, but rather music that often features a relaxed pace, a slower tempo, and a simple, repetitive rhythm and melody. Our relationship with music is extremely subjective and unique to our own experiences. It has been shown that music has profound effects on both our physical and mental health; it can serve as a significant non-pharmacological resource to help mitigate anxiety and stress. The internet—most notably YouTube, Spotify, and Apple Music—is filled with playlists specifically for mood. Music and video streaming websites are a great place to start when selecting music that works for you and exploring different genres and playlists! Author’s note: Spotify , YouTube , and Apple Music are audio streaming services that can be accessed through the internet or through cellular devices. Creating an account is free and on YouTube, an account is not needed to listen to music.

Parkinson’s disease is a progressive disorder that is caused by degeneration of nerve cells in a part of the brain called the substantia nigra, which is responsible for controlling movement. It’s the most common movement-related brain disease, affecting approximately 1% of people 60 years and over worldwide (AANS, 2023). When you hear Parkinson’s disease, what comes to mind? Most people will think of slowed movements (bradykinesia), tremors and rigidity, a stooped posture and shuffling (or festinating) walking pattern. But did you know that Parkinson’s disease heavily impacts the voice? Approximately 90% of people with Parkinson’s disease experience something called dysarthria (Moya-Galé, 2019). Dysarthria refers to a group of motor speech disorders characterized by weakness, slowness or poor coordination of the speech muscles. It is referred to as an execution disorder because the weakened speech muscles result in consistent speech errors. Signs of dysarthria might include an inability to speak loudly, abnormal speech rhythm, a strained, raspy or nasal sound voice, monotonous speech, difficulty moving the tongue and facial muscles, slow and/or slurred speech and rapid speech that is difficult to understand. While there are seven types of dysarthria, hypokinetic and hyperkinetic dysarthria are most commonly associated with Parkinson’s Disease. Hypokinetic dysarthria is marked by difficulty initiating speech, rigidity, short rushes of speech, a harsh of breathy sound, monopitch and monoloudness. In contrast, hyperkinetic dysarthria is marked by difficulty inhibiting speech, irregular articulation, emotions and facial expressions, as well as tremor, dystonia (involuntary muscle contraction) and tics. With all dysarthrias, the main concern is intelligibility of speech. Did you know that music therapy can be used to treat symptoms of dysarthria? In Neurologic Music Therapy, there are two main techniques I have used when working with client’s with Parkinson’s Disease. The first technique is Rhythmic Speech Cueing (RSC). In RSC, the rate of speech is controlled via auditory rhythm (Thaut & Hoemberg, 2016, p. 151). By practicing speech to a metronome the temporal characteristics of speech, such as fluency, rate of speech and intelligibility improve. The beat of the metronome is determined by assessing the client’s fluency and rate of speech. From here, functional sentences can be practiced. For example, if working on metric cueing, each syllable would be matched to one beat of the metronome (“I – want – a – glass – of – wa – ter”). The second technique is Vocal Intonation Therapy (VIT). In VIT, vocal exercises are used to maintain and rehabilitate aspects of voice control such as inflection, pitch, breath control, timbre and dynamics (Thaut & Hoemberg, 2016, p. 179). These exercises are similar to those used in vocal warm up. Another concern among those with Parkinson’s disease is monoloudness and reduced loudness because it can be difficult to communicate with others if they cannot hear you. A music therapist might use an exercise that has the client crescendo their voice to practice singing more loudly, and then transfer this skill to speaking. With the prevalence of Parkinson’s disease it is important to think about all aspects of the disorder – especially the voice – because it allows us to communicate with one another. In persons with Parkinson’s disease, singing can then be used as an effective tool for maintaining vocal function in an engaging and motivating way.

According to the Heart and Stroke Foundation, stroke is the leading cause of disability in adults in Canada. The annual occurrence rate has increased to 108,707 which equates to approximately one stroke every five minutes. With the rapidly aging population in Canada, the prevalence of stroke is only expected to increase. And with that, a growing need for strong stroke care. With stroke, one of the most common side effects is impaired speech. Some stroke survivors may experience dysarthria (muscle control difficulties), apraxia (muscle coordination difficulties) or aphasia. Aphasia is a language disorder that can result in difficulties with speaking, reading, writing and understanding speech, depending on the type of aphasia. Research indicates that aphasia occurs in 25-50% of individuals post-stroke. While there are several types of aphasia, we’re going to focus on Broca’s aphasia. Sometimes referred to as an expressive or non-fluent aphasia, Broca’s aphasia is characterized by diminished speech output. Persons with Broca’s aphasia may be able to comprehend speech but have difficulty producing speech. So how does music come into play? Melodic Intonation Therapy (MIT) uses the melodic and rhythmic elements of singing words and phrases to aid in speech recovery. This technique is used with patients who have aphasia. Several studies have indicated that the Neurologic Music Therapy technique MIT can help reroute speech pathways from the damaged left hemisphere to the language-capable regions of the right hemisphere (Thaut & Hoemberg, 2016, p. 141). In MIT the therapist begins with humming, then singing and gradually moves into speaking. The therapist may employ a vocal technique called sprechgesang. In sprechgesang, the therapist uses their voice in an expressive manner, halfway between singing and speaking. Throughout the exercise, the therapist also taps the client’s left hand. Why the left hand? MIT can help reroute speech from the left to the right hemisphere. This is because our brain is organized contralaterally. This means when we tap our left hand we are activating the right side of our brain! Research by Gentilucci and Dalla Volta (2008) also indicates that left hand tapping activates right hemispheric language networks. You may have even heard of MIT in the news before. Congresswoman Gabby Giffords suffered a traumatic brain injury, and was diagnosed with aphasia. MIT was part of her journey to recovering her ability to speak. This is just one way music can be used in speech rehabilitation. It can be difficult to watch a loved one experience the loss of their ability to speak. The beauty of music is that it can aid in rehabilitating the voice while encouraging meaningful moments of connection with others.