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130-428: Music therapy , an allied health profession , "is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program." It is also a vocation, involving a deep commitment to music and the desire to use it as a medium to help others. Although music therapy has only been established as

260-406: A controlled study. The frequency of infection in preterm birth is inversely related to the gestational age. Mycoplasma genitalium infection is associated with increased risk of preterm birth, and spontaneous abortion. Infectious microorganisms can be ascending, hematogenous, iatrogenic by a procedure, or retrograde through the fallopian tubes. From the deciduae they may reach the space between

390-898: A country like Australia). Many allied health jobs are considered career ladder jobs because of the opportunities for advancement within specific fields. Allied health professions can include the use of many skills. Depending on the profession, these may include basic life support ; medical terminology , acronyms and spelling ; basics of medical law and ethics ; understanding of human relations; interpersonal communication skills; counseling skills; computer literacy; ability to document healthcare information; interviewing skills; and proficiency in word processing ; database management and electronic dictation. The explosion of scientific knowledge that followed World War II brought increasingly sophisticated and complex medical diagnostic and treatment procedures. Increasing public demand for medical services combined with higher health care costs provoked

520-517: A dynamic force of change toward rehabilitation. Assessment includes obtaining a full medical history, musical (ability to duplicate a melody or identify changes in rhythm, etc.) and non-musical functioning (social, physical/motor, emotional, etc.). Premature infants are those born at 37 weeks after conception or earlier. They are subject to numerous health risks, such as abnormal breathing patterns, decreased body fat and muscle tissue, as well as feeding issues. The coordination for sucking and breathing

650-403: A healthy pregnancy, medical induction of labor or cesarean section are not recommended before 39 weeks unless required for other medical reasons. There may be certain medical reasons for early delivery such as preeclampsia . Preterm birth may be prevented in those at risk if the hormone progesterone is taken during pregnancy . Evidence does not support the usefulness of bed rest . It

780-639: A heavier demand for professions that are employed outside of hospital settings — including allied health. In India, the National Commission for Allied and Healthcare Professions identifies and sets quality standards for 56 professions in diagnostics, therapeutics, community health, and biomedical technology (e.g., physiotherapists, radiologists). In the United Kingdom there are 12 distinct professions who are considered allied health professionals; in combination they account for about 6% of

910-421: A high concentration of air pollution is a major risk factor for preterm labor, including living near major roadways or highways where vehicle emissions are high from traffic congestion or are a route for diesel trucks that tend to emit more pollution. The use of fertility medication that stimulates the ovary to release multiple eggs and of IVF with embryo transfer of multiple embryos has been implicated as

1040-434: A large number of intervention techniques, some of the most commonly used interventions include improvisation, therapeutic singing, therapeutic instrumental music playing, music-facilitated reminiscence and life review, songwriting, music-facilitated relaxation, and lyric analysis. While there has been no conclusive research done on the comparison of interventions (Jones, 2005; Silverman, 2008; Silverman & Marcionetti, 2004),

1170-437: A low birth weight. Even though these results look promising, the review was only based on one study so more research is needed into routine screening for low genital tract infections. Also periodontal disease has been shown repeatedly to be linked to preterm birth. In contrast, viral infections, unless accompanied by a significant febrile response, are considered not to be a major factor in relation to preterm birth. There

1300-453: A physical rehabilitation goal relies on the child's existing motivation and feelings towards music and their commitment to engage in meaningful, rewarding efforts. Regaining full functioning also confides in the prognosis of recovery, the condition of the client, and the environmental resources available. Both techniques use systematic processes where the therapists assist the client by using musical experiences and connections that collaborate as

1430-469: A profession relatively recently, the connection between music and therapy is not new. Music therapy is a broad field. Music therapists use music-based experiences to address client needs in one or more domains of human functioning: cognitive, academic, emotional/psychological; behavioral; communication; social; physiological (sensory, motor, pain, neurological and other physical systems), spiritual, aesthetics. Music experiences are strategically designed to use

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1560-436: A range of technical and support staff they may deliver direct patient care, rehabilitation, treatment, diagnostics and health improvement interventions to restore and maintain optimal physical, sensory, psychological, cognitive and social functions. The allied health professions represent a large cluster of health and care service providers, which usually require specific training and/or certification, but which are distinct from

1690-404: A reduction in the risk of preterm birth in women with recurrent preterm birth by 40–55%. Progestogen supplementation also reduces the frequency of preterm birth in pregnancies where there is a short cervix. A short cervix is one that is less than 25mm, as detected during a transvaginal cervical length assessment in the midtrimester. However, progestogens are not effective in all populations, as

1820-421: A resulting decrease in preterm birth was not observed. Reduction in activity by the mother—pelvic rest, limited work, bed rest—may be recommended although there is no evidence it is useful with some concerns it is harmful. Increasing medical care by more frequent visits and more education has not been shown to reduce preterm birth rates. Use of nutritional supplements such as omega-3 polyunsaturated fatty acids

1950-442: A rhythm produced by the tapping of the left hand. At the same time, the therapist will introduce a visual stimuli of the written phrase to be learned. The therapist then sings the phrase with the patient, and ideally the patient is eventually able to sing the phrase on their own. With much repetition and through a process of "inner-rehearsal" (practicing internally hearing one's voice singing), a patient may eventually be able to produce

2080-410: A risk factor for preterm birth. Often labor has to be induced for medical reasons; such conditions include high blood pressure , pre-eclampsia , maternal diabetes, asthma, thyroid disease, and heart disease. Certain medical conditions in the pregnant mother may also increase the risk of preterm birth. Some women have anatomical problems that prevent the baby from being carried to term. These include

2210-426: A risk of preterm birth and send the findings to a smartphone. The notion that risk scoring systems are accurate in predicting preterm birth has been debated in multiple literature reviews. In humans, the usual definition of preterm birth is birth before a gestational age of 37 complete weeks. In the normal human fetus, several organ systems mature between 34 and 37 weeks, and the fetus reaches adequate maturity by

2340-407: A sense of community and can also be used as group ritual to structure a theme of the group or of treatment (Krout, 2005). Research that compares types of music therapy intervention has been inconclusive. Music Therapists use lyric analysis in a variety of ways, but typically lyric analysis is used to facilitate dialogue with clients based on the lyrics, which can then lead to discussion that addresses

2470-524: A spontaneous conception have an adjusted odds ratio of 1.35 (95% confidence interval 1.22–1.50) of preterm birth. Pregnancies after IVF confers a greater risk of preterm birth than spontaneous conceptions after more than one year of trying, with an adjusted odds ratio of 1.55 (95% CI 1.30–1.85). Certain ethnicities may have a higher risk as well. For example, in the U.S. and the UK, Black women have preterm birth rates of 15–18%, more than double than that of

2600-467: A time when the world was much richer for them. He was a firm believer that music has the power to heal. Melodic intonation therapy (MIT), developed in 1973 by neurological researchers Sparks, Helm, and Albert, is a method used by music therapists and speech–language pathologists to help people with communication disorders caused by damage to the left hemisphere of the brain by engaging the singing abilities and possibly engaging language-capable regions in

2730-457: A trend toward expansion of service delivery from treating patients in hospitals to widespread provision of care in physician's private and group practices, ambulatory medical and emergency clinics, and mobile clinics and community-based care. Changes in the health industry and emphasis on cost-efficient solutions to health care delivery will continue to encourage expansion of the allied health workforce. The World Health Organization estimates there

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2860-584: A useful tool in the recovery of motor skills. Like many of the other disorders mentioned, some of the most common significant effects of the disorder can be seen in social behaviors, leading to improvements in interaction, conversation, and other such skills. A study of over 330 subjects showed that music therapy produces highly significant improvements in social behaviors, overt behaviors like wandering and restlessness, reductions in agitated behaviors, and improvements to cognitive defects, measured with reality orientation and face recognition tests. The effectiveness of

2990-458: A vessel through which to interact with others without requiring much cognitive load. Broca's aphasia, or non-fluent aphasia, is a language disorder caused by damage to Broca's area and surrounding regions in the left frontal lobe. Those with non-fluent aphasia are able to understand language fairly well, but they struggle with language production and syntax. Neurologist Oliver Sacks studied neurological oddities in people, trying to understand how

3120-706: A weak or short cervix (the strongest predictor of premature birth). Women with vaginal bleeding during pregnancy are at higher risk for preterm birth. While bleeding in the third trimester may be a sign of placenta previa or placental abruption —conditions that occur frequently preterm—even earlier bleeding that is not caused by these conditions is linked to a higher preterm birth rate. Women with abnormal amounts of amniotic fluid , whether too much ( polyhydramnios ) or too little ( oligohydramnios ), are also at risk. Anxiety and depression have been linked as risk factors for preterm birth. The use of tobacco , cocaine , and excessive alcohol during pregnancy increases

3250-724: Is a factor in the causality of preterm birth. Genetics has been a big factor into why Filipinos have a high risk of premature birth as the Filipinos have a large prevalence of mutations that help them be predisposed to premature births. An intra- and transgenerational increase in the risk of preterm delivery has been demonstrated. No single gene has been identified. Marital status has long been associated with risks for preterm birth. A 2005 study of 25,373 pregnancies in Finland revealed that unmarried mothers had more preterm deliveries than married mothers (P=0.001). Pregnancy outside of marriage

3380-473: Is a high risk of preterm birth. Selective reduction is used to reduce the number of fetuses to two or three. A number of agents have been studied for the secondary prevention of indicated preterm birth. Trials using low-dose aspirin , fish oil , vitamin C and E, and calcium to reduce preeclampsia demonstrated some reduction in preterm birth only when low-dose aspirin was used. Even if agents such as calcium or antioxidants were able to reduce preeclampsia,

3510-408: Is about 6%, while at 23 weeks it is 26%, 24 weeks 55% and 25 weeks about 72%. The chances of survival without any long-term difficulties are lower. Signs and symptoms of preterm labor include four or more uterine contractions in one hour. In contrast to false labour , true labor is accompanied by cervical dilation and effacement . Also, vaginal bleeding in the third trimester, heavy pressure in

3640-809: Is an effective method in helping people experiencing mental health issues, and more should be done to offer those in need this type of help. Music therapy may be suggested for adolescent populations to help manage disorders usually diagnosed in adolescence, such as mood/anxiety disorders and eating disorders, or inappropriate behaviors, including suicide attempts, withdrawal from family, social isolation from peers, aggression, running away, and substance abuse. Goals in treating adolescents with music therapy, especially for those at high risk, often include increased recognition and awareness of emotions and moods, improved decision-making skills, opportunities for creative self expression, decreased anxiety, increased self-confidence, improved self-esteem, and better listening skills. There

3770-460: Is associated with an increased risk preterm birth with an odds ratio of 1.9 and 95% confidence interval of 1.1–3.5. Intimate violence against the mother is another risk factor for preterm birth. Physical trauma may case a preterm birth. The Nigerian cultural method of abdominal massage has been shown to result in 19% preterm birth among women in Nigeria , plus many other adverse outcomes for

3900-548: Is available and the corticosteroids have a greater chance to work. Once the baby is born, care includes keeping the baby warm through skin-to-skin contact or incubation, supporting breastfeeding and/or formula feeding, treating infections , and supporting breathing. Preterm babies sometimes require intubation . Preterm birth is the most common cause of death among infants worldwide. About 15 million babies are preterm each year (5% to 18% of all deliveries). Late preterm birth accounts for 75% of all preterm births. This rate

4030-405: Is based on the observation that populations who have a high intake of such agents are at low risk for preterm birth, presumably as these agents inhibit production of proinflammatory cytokines. A randomized trial showed a significant decline in preterm birth rates, and further studies are in the making. While antibiotics can get rid of bacterial vaginosis in pregnancy, this does not appear to change

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4160-500: Is believed that nearly 11–15% of Filipinos born in the U.S. (compared to other Asians at 7.6% and whites at 7.8%) are premature. Filipinos being a big risk factor is evidenced with the Philippines being the eighth-highest ranking in the world for preterm births, the only non-African country in the top 10. This discrepancy is not seen in comparison to other Asian groups or Hispanic immigrants and remains unexplained. Genetic make-up

4290-444: Is believed to be a maternal genetic component in preterm birth. Estimated heritability of timing-of-birth in women was 34%. However, the occurrence of preterm birth in families does not follow a clear inheritance pattern, thus supporting the idea that preterm birth is a non-Mendelian trait with a polygenic nature. The absence of prenatal care has been associated with higher rates of preterm births. Analysis of 15,627,407 live births in

4420-566: Is currently a worldwide shortage of about 2 million allied health professionals (considering all health workers aside from medical and nursing personnel) needed in order to meet global health goals. In recognition of the growth of the number and diversity of allied health professionals in recent years, the 2008 version of the International Standard Classification of Occupations increased the number of groups dedicated to allied health professions. Depending on

4550-401: Is estimated that at least 75% of preterm infants would survive with appropriate treatment, and the survival rate is highest among the infants born the latest in gestation. In women who might deliver between 24 and 37 weeks, corticosteroid treatment may improve outcomes. A number of medications, including nifedipine , may delay delivery so that a mother can be moved to where more medical care

4680-610: Is inconsistent across countries. In the United Kingdom 7.9% of babies are born pre-term and in the United States 12.3% of all births are before 37 weeks gestation. Approximately 0.5% of births are extremely early periviable births (20–25 weeks of gestation), and these account for most of the deaths. In many countries, rates of premature births have increased between the 1990s and 2010s. Complications from preterm births resulted globally in 0.81 million deaths in 2015, down from 1.57 million in 1990. The chance of survival at 22 weeks

4810-409: Is lateralized mostly to the left hemisphere (for right-handed and most left-handed individuals), some speech functionality is also distributed in the right hemisphere. MIT is thought to stimulate these right language areas through the activation of music processing areas also in the right hemisphere Similarly, the rhythmic tapping of the left hand stimulates the right sensorimotor cortex to further engage

4940-411: Is needed before the use of improvisation is conclusively proven to be effective in this application, but there were positive signs in this study of its use. Singing or playing an instrument is often used to help clients express their thoughts and feelings in a more structured manner than improvisation and can also allow participation with only limited knowledge of music. Singing in a group can facilitate

5070-516: Is not acted upon early on through the use of some kind of therapy, it can alter the entire course of an adolescent's life. In one particular study on the impact of music therapy on grief management within adolescents used songwriting to allow these adolescents to express what they were feeling through lyrics and instrumentals. In the article Development of the Grief Process Scale through music therapy songwriting with bereaved adolescents,

5200-484: Is not known. There is weak evidence to suggest that people with schizophrenia may benefit from the addition of music therapy along with their other standard treatment regieme. Potential improvements include decreased aggression, fewer hallucinations and delusions, social functioning, and quality of life of people with schizophrenia or schizophrenia-like disorders. In addition, moderate-to-low-quality evidence suggests that music therapy as an addition to standard care improves

5330-416: Is often not fully developed, making feeding a challenge. Offering musical therapy to premature infants while they are in the neonatal intensive care unit (NICU) aims to both mask unwanted auditory stimuli, stimulate infant development, and promote a calm environment for families. While there are no reported adverse effects from music therapy, the evidence supporting music therapy's beneficial effects for infants

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5460-487: Is opined that stressful conditions, hard labor, and long hours are probably linked to preterm birth. Obesity does not directly lead to preterm birth; however, it is associated with diabetes and hypertension which are risk factors by themselves. To some degree those individuals may have underlying conditions (i.e., uterine malformation, hypertension, diabetes) that persist. Couples who have tried more than one year versus those who have tried less than one year before achieving

5590-522: Is some evidence that, when combined with other types of rehabilitation, music therapy may contribute to the success rate of sensorimotor, cognitive, and communicative rehabilitation. For children and adolescents with major depressive or anxiety disorders, there is moderate to low quality evidence that music therapy added to the standard treatment may reduce internalizing symptoms and may be more effective than treatment as usual (without music therapy). Among adolescents, group meetings and individual sessions are

5720-461: Is some weak evidence to suggest that music therapy may help reduce symptoms and recreative music therapy and guided imagery and music being superior to other methods in reducing depressive symptoms. In the use of music therapy for adults, there is "music medicine" which is called for listening to prerecorded music as treated like a medicine. Music Therapy also uses "Receptive music therapy" using "music-assisted relaxation" and using images connecting to

5850-579: Is the birth of a baby at fewer than 37 weeks gestational age , as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 28 and 32 weeks, early preterm birth occurs between 32 and 34 weeks, late preterm birth is between 34 and 36 weeks' gestation. These babies are also known as premature babies or colloquially preemies (American English) or premmies (Australian English). Symptoms of preterm labor include uterine contractions which occur more often than every ten minutes and/or

5980-410: Is undesirable: A cervical length of less than 25 mm (0.98 in) at or before 24 weeks of gestational age is the most common definition of cervical incompetence . Technologies under research and development to facilitate earlier diagnosis of preterm births include sanitary pads that identify biomarkers such as fFN and PAMG-1 and others, when placed into the vagina. These devices then calculate

6110-976: Is used in medical hospitals, cancer centers, schools, alcohol and drug recovery programs, psychiatric hospitals, nursing homes, and correctional facilities. Music therapy is distinctive from Musopathy, which relies on a more generic and non-cultural approach based on neural, physical, and other responses to the fundamental aspects of sound. Music therapy might also be described as Sound Healing. Extensive studies have been made with this description Music therapy aims to provide physical and mental benefit. Music therapists use their techniques to help their patients in many areas, ranging from stress relief before and after surgeries to neuropathologies such as Alzheimer's disease . Studies on people diagnosed with mental health disorders such as anxiety, depression, and schizophrenia have associated some improvements in mental health after music therapy. The National Institute for Health and Care Excellence (NICE) have claimed that music therapy

6240-466: Is weak as many of the clinical trials that have been performed either had mixed results or were poorly designed. There is no strong evidence to suggest that music therapy improves an infant's oxygen therapy, improves sucking, or improves development when compared to usual care. There is some weaker evidence that music therapy may decrease an infants' heart rate. There is no evidence to indicate that music therapy reduces anxiety in parents of preterm infants in

6370-531: Is what it is often used for. Improvisation has several other clinical goals as well, which can also be found on the Improvisation in music therapy page, such as: facilitating verbal and nonverbal communication, self-exploration, creating intimacy, teamwork, developing creativity, and improving cognitive skills. Building on these goals, Botello and Krout designed a cognitive behavioral application to assess and improve communication in couples. Further research

6500-696: The Health Professions Council of South Africa (e.g., clinical technologists, dental therapists) or through the Allied Health Professions Council (e.g., massage therapists, chiropractors). Depending on the country and local health care system, the professions that are considered AHPs vary. For example, in some contexts optometrists are not considered AHPs, as the profession has a longer history of primary care practice independent of modern medicine, whereas in others optometrists are identified as falling under

6630-737: The North American Industry Classification System (NAICS), the health care industry consists of four main sub-sectors, divided by the types of services provided at each facility: In the US, a larger proportion of the allied health care workforce is already employed in ambulatory settings. In California, nearly half (49.4 percent) of the allied health workforce is employed in ambulatory health care settings, compared with 28.7 percent and 21.9 percent employed in hospital and nursing care, respectively. One source reported allied health professionals making up 60 percent of

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6760-451: The amnion and chorion , the amniotic fluid , and the fetus. A chorioamnionitis also may lead to sepsis of the mother. Fetal infection is linked to preterm birth and to significant long-term disability including cerebral palsy . It has been reported that asymptomatic colonization of the decidua occurs in up to 70% of women at term using a DNA probe suggesting that the presence of micro-organism alone may be insufficient to initiate

6890-599: The medicine , nursing and dentistry professions. There is a large demand for allied health professionals, especially in rural and medically underserved areas. AHPs are generally considered distinct from other healthcare service providers on the basis of several factors. These factors may include AHPs offering services in ways which support treatments provided by other healthcare professionals (working either in independent autonomous practice or under direct supervision), or by offering services which other healthcare professionals require but do not provide themselves (for example in

7020-950: The AHP umbrella. Similarly, in some health care jurisdictions physiotherapists are not considered AHPs, as they tend to have more autonomy in private practice without the need for medical referral , whereas in other jurisdictions physiotherapists are identified and regulated as AHPs. A limited subset of the following professional areas may be represented, and may be regulated: Some allied health professions are more specialized, and so must adhere to national training and education standards and their professional scope of practice. Often they must prove their skills through degrees, diplomas , certified credentials, and continuing education. Other allied health professions require no special training or credentials and are trained for their work by their employer through on-the-job training (which would then exclude them from consideration as an allied health profession in

7150-500: The Act from the list of AHPs, although they may possess degrees or diplomas in health sciences, include the following: Projections in the United States and many other countries have shown an expected long-term shortage of qualified workers to fill many allied health positions. This is primarily due to expansion of the health industry due to demographic changes (a growing and aging population), large numbers of health workers nearing retirement,

7280-494: The Behavior Rating Index for Children and the bereavement Group Questionnaire for Parents and Guardians as measurement tools, it was found that children who were in the music therapy group showed significant improvement in grief symptoms and also showed some improvement in behaviors compared to the control group, whereas the social work group also showed significant improvement in both grief and behaviors compared to

7410-673: The Bonny Method of Guided Imagery and Music (GIM), community music therapy, Nordoff-Robbins music therapy (creative music therapy), neurologic music therapy, and vocal psychotherapy. Allied health profession In providing care to patients with certain illnesses, AHPs may work in the public or private sector, in hospitals or in other types of facilities, and often in clinical collaboration with other providers having complementary scopes of practice . Allied health professions are usually of smaller size proportional to physicians and nurses. It has been estimated that approximately 30% of

7540-673: The NHS workforce. In 2013 the annual expenditure on services provided by allied health professionals amounted to around £2 billion, although there is a lack of evidence around the extent to which these services improve the quality of care. In the United States, the Association of Schools of Allied Health Professionals uses wording from the Public Health Service Act to list those who are considered to be allied health professionals. Professionals who are excluded under

7670-559: The NICU or information to understand what type of music therapy may be more beneficial or how for how long. Music may both motivate and provide a sense of distraction. Rhythmic stimuli has been found to help balance training for those with a brain injury. Singing is a form of rehabilitation for neurological impairments. Neurological impairments following a brain injury can be in the form of apraxia – loss to perform purposeful movements, dysarthria , muscle control disturbances (due to damage of

7800-585: The United States in 1995–1998 concluded that the absence of prenatal care carried a 2.9 (95%CI 2.8, 3.0) times higher risk of preterm births. This same study found statistically significant relative risks of maternal anemia, intrapartum fever, unknown bleeding, renal disease, placental previa, hydramnios, placenta abruption, and pregnancy-induced hypertension with the absence of prenatal care. All these prenatal risks were controlled for other high-risk conditions, maternal age, gravidity, marital status, and maternal education. The absence of prenatal care prior to and during

7930-681: The United States, music therapists do not diagnose, therefore diagnosing a bereavement-related disorder would not be within their scope of practice. Grief treatment is very valuable within the adolescent age group. Just as adults and the elderly struggle with grief from loss, relationship issues, job-related stress, and financial issues, so do adolescents also experience grief from disappointments that occur early on in life, however different these disappointing life events may be. For example, many people of adolescent age experience life-altering events such as parental divorce, trauma from emotional or physical abuse, struggles within school, and loss. If this grief

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8060-522: The ability to listen to their preferred music genre. It can improve mood, decrease stress, decrease pain, enhance relaxation, and decrease anxiety; this can help with coping skills. There is also evidence of biochemical changes (e.g., lowered cortisol levels). In active music therapy, patients engage in some form of music-making (e.g., vocalizing, rapping, chanting, singing, playing instruments, improvising, song writing, composing, or conducting). Researchers at Baylor, Scott, and White Universities are studying

8190-538: The basis of their past obstetrical history or the presence of known risk factors. Preconception intervention can be helpful in selected patients in a number of ways. Patients with certain uterine anomalies may have a surgical correction (i.e. removal of a uterine septum ), and those with certain medical problems can be helped by optimizing medical therapies prior to conception, be it for asthma, diabetes, hypertension, and others. In multiple pregnancies , which often result from use of assisted reproductive technology , there

8320-454: The border between the chorion and decidua has been disrupted. A positive test indicates an increased risk of preterm birth, and a negative test has a high predictive value. It has been shown that only 1% of women in questionable cases of preterm labor delivered within the next week when the test was negative. Obstetric ultrasound has become useful in the assessment of the cervix in women at risk for premature delivery. A short cervix preterm

8450-751: The brain works. He concluded that people with some type of frontal lobe damage often "produced not only severe difficulties with expressive language (aphasia) but a strange access of musicality with incessant whistling, singing and a passionate interest in music. For him, this was an example of normally suppressed brain functions being released by damage to others". Sacks had a genuine interest in trying to help people affected with neurological disorders and other phenomena associated with music, and how it can provide access to otherwise unreachable emotional states, revivify neurological avenues that have been frozen, evoke memories of earlier, lost events or states of being and attempts to bring those with neurological disorders back to

8580-817: The central nervous system), aphasia (defect in expression causing distorted speech), or language comprehension. Singing training has been found to improve lung, speech clarity, and coordination of speech muscles, thus, accelerating rehabilitation of such neurological impairments. For example, melodic intonation therapy is the practice of communicating with others by singing to enhance speech or increase speech production by promoting socialization, and emotional expression. Music may help people with autism hone their motor and attention skills as well as healthy neurodevelopment of socio-communication and interaction skills. Music therapy may also contribute to improved selective attention, speech production, and language processing and acquisition in people with autism. Music therapy may benefit

8710-584: The certification of a physician . Allied health professionals are different from alternative medicine practitioners, also sometimes called natural healers, who work outside the conventions of modern biomedicine. The organization of International Chief Health Professions Officers (ICHPO) developed a widely-used definition of the allied health professions: Allied Health Professions are a distinct group of health professionals who apply their expertise to prevent disease transmission, diagnose, treat and rehabilitate people of all ages and all specialties. Together with

8840-407: The cervix and therefore is limited in discerning what is or is not normal. Four different pathways have been identified that can result in preterm birth and have considerable evidence: precocious fetal endocrine activation, uterine overdistension ( placental abruption ), decidual bleeding, and intrauterine inflammation or infection . Identifying women at high risk of giving birth early would enable

8970-496: The chance of preterm delivery. Tobacco is the most commonly used drug during pregnancy and contributes significantly to low birth weight delivery. Babies with birth defects are at higher risk of being born preterm. Passive smoking and/or smoking before the pregnancy influences the probability of a preterm birth. The World Health Organization published an international study in March 2014. Presence of anti-thyroid antibodies

9100-509: The characteristic use of certain procedural sequences and techniques." In the literature, the terms model, orientation, or approach might be encountered and may have slightly different meanings. Regardless, music therapists use both psychology models and models specific to music therapy. The theories these models are based on include beliefs about human needs, causes of distress, and how humans grow or heal. Models developed specifically for music therapy include analytical music therapy, Benenzon,

9230-446: The chorus of a song and by repeating phrases back to the music therapist when the therapist sang a phrase of a song to them. Drumming led to increased socialization of the group, as it allowed the patients collaborate to create particular rhythms. Improvisation allowed the patients to get out of their comfort zone and taught them how to better deal with anxiety. Lastly, movement with either one arm or two increased social interaction between

9360-416: The control group. The study concludes with support for music therapy as a medium from bereavement groups for children (Hilliard, 2007). Though there has been research done on music therapy, and though the use of it has been evaluated, there remain a number of limitations in these studies and further research should be completed before absolute conclusions are made, though the results of using music therapy in

9490-472: The control of preterm birth risk factors (e.g. working long hours while standing on feet, carbon monoxide exposure, domestic abuse, and other factors). Reducing physical activity during pregnancy has not been shown to reduce the risk of a preterm birth. Healthy eating can be instituted at any stage of the pregnancy including nutritional adjustments and consuming suggested vitamin supplements. Calcium supplementation in women who have low dietary calcium may reduce

9620-453: The difference between aerobic vaginitis and bacterial vaginosis, which may explain some of the contradiction in the results. Untreated yeast infections are associated with preterm birth. A review into prophylactic antibiotics (given to prevent infection) in the second and third trimester of pregnancy (13–42 weeks of pregnancy) found a reduction in the number of preterm births in women with bacterial vaginosis. These antibiotics also reduced

9750-604: The effect of harmonica playing on patients with COPD to determine if it helps improve lung function. Another example of active music therapy takes place in a nursing home in Japan: therapists teach the elderly how to play easy-to-use instruments so they can overcome physical difficulties. Music therapist Kenneth Bruscia stated "A model is a comprehensive approach to assessment, treatment, and evaluation that includes theoretical principles, clinical indications and contraindications, goals, methodological guidelines and specifications, and

9880-475: The effects of different forms of health care, the potential for harm from exposure to particular agents, the accuracy of diagnostic tests, and the predictive power of prognostic factors". Both qualitative and quantitative studies have been completed and both have provided evidence to support music therapy in the use of bereavement treatment. One study that evaluated a number of treatment approaches found that only music therapy had significant positive outcomes where

10010-506: The elements of music for therapeutic effects, including melody, harmony, key, mode, meter, rhythm, pitch/range, duration, timbre, form, texture, and instrumentation. Some common music therapy practices include developmental work (communication, motor skills, etc.) with individuals with special needs, songwriting and listening in reminiscence, orientation work with the elderly, processing and relaxation work, and rhythmic entrainment for physical rehabilitation in stroke survivors. Music therapy

10140-553: The end of this period. One of the main organs greatly affected by premature birth is the lungs. The lungs are one of the last organs to mature in the womb; because of this, many premature babies spend the first days and weeks of their lives on ventilators . Therefore, a significant overlap exists between preterm birth and prematurity. Generally, preterm babies are premature and term babies are mature. Preterm babies born near 37 weeks often have no problems relating to prematurity if their lungs have developed adequate surfactant , which allows

10270-608: The experience in assisted reproduction has shown when the number of embryos during embryo transfer was limited. Many countries have established specific programs to protect pregnant women from hazardous or night-shift work and to provide them with time for prenatal visits and paid pregnancy-leave. The EUROPOP study showed that preterm birth is not related to type of employment, but to prolonged work (over 42 hours per week) or prolonged standing (over 6 hours per day). Also, night work has been linked to preterm birth. Health policies that take these findings into account can be expected to reduce

10400-528: The family as a whole. Some family members of children with autism claim that music therapy sessions have allowed their child to interact more with the family and the world. Music therapy is also beneficial in that it gives children an outlet to use outside of the sessions. Some children after participating in music therapy may want to keep making music long after the sessions end. Listening to music may improve heart rate, respiratory rate, and blood pressure in those with coronary heart disease (CHD). Music may be

10530-456: The global state, mental state (including negative and general symptoms). Further research using standardized music therapy programs and consistent monitoring protocols are necessary to understand the effectiveness of this approach for adults with schizophrenia. Music therapy may be a useful tool for helping treat people with post-traumatic stress disorder however more rigorous empirical study is required. For adults with depressive symptoms, there

10660-424: The goals of therapy. Two fundamental types of music therapy are receptive music therapy and active music therapy (also known as expressive music therapy). Active music therapy engages clients or patients in the act of making music, whereas receptive music therapy guides patients or clients in listening or responding to live or recorded music. Either or both can lead to verbal discussions, depending on client needs and

10790-459: The health problems of premature infants and children. Smoking bans are effective in decreasing preterm births. Different strategies are used in the administration of prenatal care, and future studies need to determine if the focus can be on screening for high-risk women, or widened support for low-risk women, or to what degree these approaches can be merged. Adoption of specific professional policies can immediately reduce risk of preterm birth as

10920-408: The health services to provide specialized care for these women and their babies, for example a hospital with a special care baby unit such as a neonatal intensive care unit (NICU). In some instances, it may be possible to delay the birth. Risk scoring systems have been suggested as an approach to identify those at higher risk, however, there is no strong research in this area so it is unclear whether

11050-461: The industry's need to be cost efficient, and a lack of sufficient investment in training programs to keep pace with these trends. Studies have also pointed to the need for increased diversity in the allied health workforce to realize a culturally competent health system. Workforce and health care experts anticipate that health services will increasingly be delivered via ambulatory and nursing care settings rather than in hospitals. According to

11180-480: The infectious response. As the condition is more prevalent in black women in the U.S. and the UK, it has been suggested to be an explanation for the higher rate of preterm birth in these populations. It is opined that bacterial vaginosis before or during pregnancy may affect the decidual inflammatory response that leads to preterm birth. The condition known as aerobic vaginitis can be a serious risk factor for preterm labor; several previous studies failed to acknowledge

11310-580: The leaking of fluid from the vagina before 37 weeks. Premature infants are at greater risk for cerebral palsy , delays in development , hearing problems and problems with their vision . The earlier a baby is born, the greater these risks will be. The cause of spontaneous preterm birth is often not known. Risk factors include diabetes , high blood pressure , multiple gestation (being pregnant with more than one baby), being either obese or underweight , vaginal infections , air pollution exposure, tobacco smoking , and psychological stress . For

11440-565: The left hemisphere. There is debate, however, as to whether changes in right hemispheric activation are part of the therapeutic process during/after MIT, or are simply a side effect of non-fluent aphasia. In hopes of making MIT more effective, researchers are continually studying the mechanisms of MIT and non-fluent aphasia. There is tentative evidence that music interventions led by a trained music therapist may have positive effects on psychological and physical outcomes in adults with cancer. The effectiveness of music therapy for children with cancer

11570-474: The length of the cervix may identify women at risk of preterm labour and tentative evidence suggests ultrasound measurement of the length of the cervix in those with preterm labor can help adjust management and results in the extension of pregnancy by about four days. Screening for the presence of fibronectin in vaginal secretions is not recommended at this time in women at low risk of preterm birth. Women are identified to be at increased risk for preterm birth on

11700-487: The long-term effects of the antibiotics on mothers or babies. More research in this area is needed to find the full effects of giving antibiotics throughout the second and third trimesters of pregnancy. A number of maternal bacterial infections are associated with preterm birth including pyelonephritis , asymptomatic bacteriuria , pneumonia , and appendicitis . A review into giving antibiotics in pregnancy for asymptomatic bacteriuria (urine infection with no symptoms) found

11830-607: The lungs to remain expanded between breaths. Sequelae of prematurity can be reduced to a small extent by using drugs to accelerate maturation of the fetus, and to a greater extent by preventing preterm birth. Historically efforts have been primarily aimed to improve survival and health of preterm infants (tertiary intervention). Such efforts, however, have not reduced the incidence of preterm birth. Increasingly primary interventions that are directed at all women, and secondary intervention that reduce existing risks are looked upon as measures that need to be developed and implemented to prevent

11960-477: The main methods for music therapy. Both methods may include listening to music, discussing concerning moods and emotions in or toward music, analyzing the meanings of specific songs, writing lyrics, composing or performing music, and musical improvisation. Private individual sessions can provide personal attention and are most effective when using music preferred by the patient. Using music that adolescents can relate to or connect with can help adolescent patients view

12090-506: The mother and baby. This ought not be confused with massage therapy conducted by a fully trained and certified/licensed massage therapist or by significant others trained to provide massage during pregnancy, which—in a study involving pregnant females with prenatal depression—has been shown to have numerous positive results during pregnancy, including the reduction of preterm birth, less depression, lower cortisol, and reduced anxiety. In healthy women, however, no effects have been demonstrated in

12220-407: The mother may not have warning signs until very late in the birthing process. The main categories of causes of preterm birth are preterm labor induction and spontaneous preterm labor. The exact cause of spontaneous preterm birth is difficult to determine and it may be caused by many different factors at the same time as labor is a complex process. The research available is limited with regard to

12350-434: The music. There is some discussion on the process of change facilitated by musical activities on mental wellness. Scholars proposed a six-dimensional framework, which contains emotional, psychological, social, cognitive, behavioral and spiritual aspects. Through conducting interview sessions with mental health service users (with mood disorders, anxiety disorders, schizophrenia and other psychotic disorders), their study showed

12480-558: The number of negative outcomes including preterm birth, pre-eclampsia, and maternal death. The World Health Organization (WHO) suggests 1.5–2 g of calcium supplements daily, for pregnant women who have low levels of calcium in their diet. Supplemental intake of C and E vitamins have not been found to reduce preterm birth rates. While periodontal infection has been linked with preterm birth, randomized trials have not shown that periodontal care during pregnancy reduces preterm birth rates. Smoking cessation has also been shown to reduce

12610-418: The number of waters breaking before labor in full-term pregnancies, reduced the risk of infection of the lining of the womb after delivery (endometritis), and rates of gonococcal infection. However, the women without bacterial vaginosis did not have any reduction in preterm births or pre-labor preterm waters breaking. Much of the research included in this review lost participants during follow-up so did not report

12740-420: The others showed little improvement in participants (Rosner, Kruse & Hagl, 2010). Furthermore, a pilot study, which consisted of an experimental and control group, examined the effects of music therapy on mood and behaviors in the home and school communities. It was found that there was a significant change in grief symptoms and behaviors with the experimental group in the home, but conversely found that there

12870-439: The patients. Another meta-study examined the proposed neurological mechanisms behind music therapy's effects on these patients. Many authors suspect that music has a soothing effect on the patient by affecting how noise is perceived: music renders noise familiar, or buffers the patient from overwhelming or extraneous noise in their environment. Others suggest that music serves as a sort of mediator for social interactions, providing

13000-475: The pelvis, or abdominal or back pain could be indicators that a preterm birth is about to occur. A watery discharge from the vagina may indicate premature rupture of the membranes that surround the baby. While the rupture of the membranes may not be followed by labor, usually delivery is indicated as infection ( chorioamnionitis ) is a serious threat to both fetus and mother. In some cases, the cervix dilates prematurely without pain or perceived contractions, so that

13130-419: The phrase verbally without singing. As the patient advances in therapy, the procedure can be adapted to give them more autonomy and to teach them more complex phrases. Through the use of MIT, a non-fluent aphasic patient can be taught numerous phrases which aid them to communicate and function during daily life. The mechanisms of this success are yet to be fully understood. It is commonly agreed that while speech

13260-478: The pregnancy is primarily a function of socioeconomic factors (low family income and education), access to medical consultations (large distance from the place of residence to the healthcare unit and transportation costs), quality of healthcare, and social support. Efforts to decrease rates of preterm birth should aim to increase the deficits posed by the aforementioned barriers and to increase access to prenatal care. Placental alpha microglobulin-1 (PAMG-1) has been

13390-942: The presumed skill level, they may either be identified as "health professionals" or "health associate professionals". For example, new categories have been created for delineating "paramedical practitioners"—grouping professions such as clinical officers , clinical associates , physician assistants , Feldshers , and assistant medical officers —as well as for community health workers ; dietitians and nutritionists ; audiologists and speech therapists; and others. In developing countries, many national human resources for health strategic plans and international development initiatives are focusing on scaling up training of allied health professions, such as HIV/AIDS counsellors, clinical officers and community health workers , in providing essential preventive and treatment services in ambulatory and community-based care settings. With growing demand for ambulatory health care , researchers expect to witness

13520-472: The rate of preterm birth. Preconceptional intake of folic acid is recommended to reduce birth defects. There is also some evidence that folic acid supplement preconceptionally (before becoming pregnant) may reduce premature birth. Reducing smoking is expected to benefit pregnant women and their offspring. Self-care methods to reduce the risk of preterm birth include proper nutrition, avoiding stress, seeking appropriate medical care, avoiding infections, and

13650-898: The relevance of the six-dimensional framework. Music therapy has been used to help bring improvements to mental health among people of all age groups. It has been used as far back as the 1830s. One example of a mental hospital that used music therapy to aid in the healing process of their patients includes the Hanwell Lunatic Asylum. This mental hospital provided "music and movement sessions and musical performances" as well as "group and individual music therapy for patients with serious mental illness or emotional problems." Two main categories of music therapy were used in this study; analytic music therapy and Nordoff-Robbins music therapy. Analytic music therapy involves both words and music, while Nordoff-Robbins music therapy places great emphasis on assessing how clients react to music therapy and how

13780-734: The research was of very low quality but that it did suggest that taking antibiotics reduced the numbers of preterm births and babies with low birth weight. Another review found that one dose of antibiotics did not seem as effective as a course of antibiotics but fewer women reported side effects from one dose. This review recommended that more research is needed to discover the best way of treating asymptomatic bacteriuria. A different review found that preterm births happened less for pregnant women who had routine testing for low genital tract infections than for women who only had testing when they showed symptoms of low genital tract infections. The women being routinely tested also gave birth to fewer babies with

13910-416: The result of a study conducted in the US showed that between 1989 and 2006, marriage became less protective of preterm births which was attributed to the changing social norms and behaviors surrounding marriage. Medications during pregnancy, living conditions, air pollution, smoking, illicit drugs or alcohol, infection, or physical trauma may also cause a preterm birth. Air pollution: Living in an area with

14040-724: The results of the study demonstrate that in all of the treatment groups combined, the mean GPS (grief process scale) score decreased by 43%. The use of music therapy songwriting allowed these adolescents to become less overwhelmed with grief and better able to process it as demonstrated by the decrease in mean GPS score. Since 2017, providing evidence-based practice is becoming more and more important and music therapy has been continuously critiqued and regulated to provide that desired evidence-based practice. A number of research studies and meta-analyses have been conducted on, or included, music therapy and all have found that music therapy has at least some promising effects, especially when used for

14170-437: The right hemisphere in language production. Overall, by stimulating the right hemisphere during language tasks, therapists hope to decrease dependence on the left hemisphere for language production. While results are somewhat contradictory, studies have in fact found increased right hemispheric activation in non-fluent aphasic patients after MIT. This change in activation has been interpreted as evidence of decreased dependence on

14300-399: The risk of preterm birth. Extensive studies have been carried out to determine if other forms of screening in low-risk women followed by appropriate intervention are beneficial, including screening for and treatment of Ureaplasma urealyticum , group B streptococcus, Trichomonas vaginalis , and bacterial vaginosis did not reduce the rate of preterm birth. Routine ultrasound examination of

14430-561: The risk of preterm birth. It has been suggested that chronic chorioamnionitis is not sufficiently treated by antibiotics alone (and therefore they cannot ameliorate the need for preterm delivery in this condition). Progestogens —often given in the form of vaginal progesterone or hydroxyprogesterone caproate —relax the uterine musculature, maintain cervical length, and possess anti-inflammatory properties; all of which invoke physiological and anatomical changes considered to be beneficial in reducing preterm birth. Two meta-analyses demonstrated

14560-800: The risk. The use of personal at home uterine monitoring devices to detect contractions and possible preterm births in women at higher risk of having a preterm baby have been suggested. These home monitors may not reduce the number of preterm births, however, using these devices may increase the number of unplanned antenatal visits and may reduce the number of babies admitted to special care when compared with women receiving normal antenatal care . Support from medical professionals, friends, and family during pregnancy may be beneficial at reducing caesarean birth and may reduce prenatal hospital admissions, however, these social supports alone may not prevent preterm birth. Screening for asymptomatic bacteriuria followed by appropriate treatment reduces pyelonephritis and reduces

14690-492: The single best predictor of imminent spontaneous delivery within 7 days of a patient presenting with signs, symptoms, or complaints of preterm labor. Specifically, the PPV, or positive predictive value , of the tests were 76%, 29%, and 30% for PAMG-1, fFN and CL, respectively (P < 0.01). Fetal fibronectin (fFN) has become an important biomarker—the presence of this glycoprotein in the cervical or vaginal secretions indicates that

14820-467: The subject of several investigations evaluating its ability to predict imminent spontaneous preterm birth in women with signs, symptoms, or complaints suggestive of preterm labor . In one investigation comparing this test to fetal fibronectin testing and cervical length measurement via transvaginal ultrasound , the test for PAMG-1 (commercially known as the PartoSure test) has been reported to be

14950-538: The therapist as safe and trustworthy, and to engage in therapy with less resistance. Music therapy conducted in groups allows adolescent individuals to feel a sense of belonging, express their opinions, learn how to socialize and verbalize appropriately with peers, improve compromising skills, and develop tolerance and empathy. Group sessions that emphasize cooperation and cohesion can be effective in working with adolescents. Music therapy intervention programs typically include about 18 sessions of treatment. The achievement of

15080-432: The therapist's orientation. Receptive music therapy involves listening to recorded or live genres of music such as classical, rock, jazz, and/or country music. In Receptive music therapy, patients are the recipient of the music experience, meaning that they are actively listening and responding to the music rather than creating it. During music sessions, patients participate in song discussion, music relaxation, and are given

15210-656: The total US health workforce . Advancements in medical technology also allow for more services that formerly required expensive hospital stays to be delivered via ambulatory care. For example, in California, research has predicted the total consumption of hospital days per person will decline from 4 days in 2010 to 3.2 days in 2020 to 2.5 days in 2030. In contrast, the number of ambulatory visits per person will increase from 3.2 visits per person in 2010 to 3.6 visits per person in 2020 to 4.2 visits in 2030. Preterm birth Preterm birth , also known as premature birth ,

15340-458: The total health workforce worldwide are AHPs. In most jurisdictions, AHPs are subject to health professional requisites including minimum standards for education, regulation and licensing. They must work based on scientific principles and within an evidence based practice model. They may sometimes be considered to perform the role of mid-level practitioners , when having an advanced education and training to diagnose and treat patients, but not

15470-448: The treatment have consistently shown to be positive. Music therapy practice is working together with clients, through music, to promote healthy change (Bruscia, 1998). The American Music Therapy Association (AMTA) has defined the practice of music therapy as "a behavioral science concerned with changing unhealthy behaviors and replacing them with more adaptive ones through the use of musical stimuli". Though music therapy practice employs

15600-446: The treatment of grief and bereavement. The AMTA has largely supported the advancement of music therapy through research that would promote evidenced-based practice. With the definition of evidence-based health care as "the conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services, current best evidence is up-to-date information from relevant, valid research about

15730-431: The treatment seems to be strongly dependent on the patient and the quality and length of treatment. A group of adults with dementia participated in group music therapy. In the group, these adults engaged in singing, drumming, improvisation, and movement. Each of these activities engaged the adults in different ways. The singing aided with memory, as these adults improved memorization skills in by taking out specific words in

15860-426: The undamaged right hemisphere. While unable to speak fluently, patients with non-fluent aphasia are often able to sing words, phrases, and even sentences they cannot express otherwise. MIT harnesses the singing ability of patients with non-fluent aphasia as a means to improve their communication. Although its exact nature depends on the therapist, in general MIT relies on the use of intonation (the rising and falling of

15990-501: The use of medical technologies). The precise titles, roles and requisites of AHPs vary considerably from country to country. For the United States, a generic definition is in the Public Health Service Act , including those with "training, in a science relating to health care, [and] who shares in the responsibility for the delivery of health care services or related services" (other than a registered nurse or physician assistant). In South Africa, AHPs are identified and regulated through

16120-421: The use of particular interventions is individualized to each client based upon thorough assessment of needs, and the effectiveness of treatment may not rely on the type of intervention (Silverman, 2009). Improvisation in music therapy allows for clients to make up, or alter, music as they see fit. While improvisation is an intervention in a methodical practice, it does allow for some freedom of expression, which

16250-664: The use of risk scoring systems for identifying mothers would prolong pregnancy and reduce the numbers of preterm births or not. Risk factors in the mother have been identified that are linked to a higher risk of a preterm birth. These include age (either very young or older ), high or low body mass index (BMI), length of time between pregnancies, endometriosis , previous spontaneous (i.e., miscarriage ) or surgical abortions , unintended pregnancies, untreated or undiagnosed celiac disease, fertility difficulties, heat exposure, and genetic variables. Studies on type of work and physical activity have given conflicting results, but it

16380-540: The use of this type of therapy can be constantly altered and shifted to allow it to benefit the client the most. The DSM-IV TR (Diagnostic and Statistical Manual of Mental Disorders) lists bereavement as a mental health diagnosis when the focus of clinical attention is related to the loss of a loved one and when symptoms of Major Depressive Disorder are present for up to two months. Music therapy models have been found to be successful in treating grief and bereavement (Rosner, Kruse & Hagl, 2010).In many countries, including

16510-405: The voice) and rhythm (beat/speed) to train patients to produce phrases verbally. In MIT, common words and phrases are turned into melodic phrases, generally starting with two step sing-song patterns and eventually emulating typical speech intonation and rhythmic patterns. A therapist will usually begin by introducing an intonation to their patient through humming. They will accompany this humming with

16640-464: The white population. Many Black women have higher preterm birth rates due to multiple factors but the most common is high amounts of chronic stress, which can eventually lead to premature birth. Adult chronic disease is not always the case with premature birth in Black women, which makes the main factor of premature birth challenging to identify. Filipinos are also at high risk of premature birth, and it

16770-570: Was associated overall with a 20% increase in total adverse outcomes, even at a time when Finland provided free maternity care. A study in Quebec of 720,586 births from 1990 to 1997 revealed less risk of preterm birth for infants with legally married mothers compared with those with common-law wed or unwed parents. A study conducted in Malaysia in 2015 showed a similar trend, with marital status being significantly associated with preterm birth. However,

16900-535: Was no significant change in the experimental group in the school community, despite the fact that mean scores on the Depression Self-Rating Index and the Behavior Rating Index decreased (Hilliard, 2001). Yet another study completed by Russel Hilliard (2007), looked at the effects of Orff-based music therapy and social work groups on childhood grief symptoms and behaviors. Using a control group that consisted of wait-listed clients, and employing

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