Enfisiatria. Esta es nuestra. Mona, should I do it in Spanish or English? Let me do it in English first, just to be official with the AVNR. I'm Glenda Rizposquez. I'm the chair of Latinx Enfisiatry Community. And so this is our member May session. We wanted to mostly do a networking session, but we also wanted to give some potential members or other Latinx in rehab to have the opportunity to present a topic with a little bit of a Latin flavor. So we'll do that first. And then I'm going to present the survey results. I'll share with you after it, and then we can open it for networking. So this session is going to be recorded, so we would be able to access it later. And we just wanted the opportunity to connect and talk and feel and continue building this community slowly. So let's get started with Dr. Belen Rodriguez. I don't know if, Hector, if you want to introduce her, because you know her better than me. Well, yeah. I know Belen, but she's going to talk about her, because I actually know her better than me. OK. I prefer she talk. You can start, Belen. Belen, you can start. Well, first of all, thank you very much for the invitation and for accepting this invitation. I'm Belen Rodriguez. I'm a Music Therapy graduate. I live in Uruguay. I'm Uruguayan. And I wanted to tell you quickly that I've been a graduate since 2016. I had a Master's Degree in Mental Health since 2020, dictated by a Spanish university. I'm accredited as a Neuromusicotherapist, which is a training that is done in the United States, in Colorado, under the direction of Michael Taubt and Corinne Taubt. And I'm a postgraduate in Music Therapy in critical areas, hospital areas, by the Argentine Society of Intensive Therapy. And I'm currently studying an MBA, but I'll leave that for another chapter. I'm going to do the presentation and everything as quickly as possible to get to the most interesting part, which is the case. I am very grateful that Music Therapy is growing and the interest that the contribution of Music Therapy generates in other rehabilitation areas. So I'm going to get to the important part. But I want to tell you that I have been working since 2016 with children, girls and teenagers in a disability situation. Also with young people and adults with mental health disorders and with problematic substance use. I work with adults and older adults with neurological diagnoses and palliative care. I work as a teacher and I have worked as a teacher for the University of the Republic of Uruguay. And I have given classes and courses for different associations of Music Therapy. Before Latin American only. Now we can also add from other places. I coordinate the space Success, which is from where I meet Dr. Hector, who contacted me for a publication of some courses that we provide. And well, I have presented different works and seminars in different parts of the world. Here I leave you. I know this is recorded, so I'll leave it for a second so you can look if you want these publications that I have had over time. The last one was this year in e-book format, so I can take you through the space Success, which is Music Therapy and Dementia. There is a lot of talk about the contribution of Music Therapy in Alzheimer's and the techniques that are functional for this population. I apologize that I am a little hoarse, but biphonic. But I hope you understand the voice. And well, as I was saying, I am a co-coordinator of the space Success and a teacher. I work in a clinic called CRI, Center for Integral Rehabilitation, where I work with people who have neurological diagnoses. I work in the Martínez Vizca Center, which in Uruguay is a center that treats patients with schizophrenia. And I also treat patients with all these problems that I mentioned before. And I am also part of the editor team of the magazine of the Association of Music Therapists of Uruguay and also of the magazine Puentes, which is the Ibero-American magazine of Music Therapy in Critical Areas, which is already in its third edition and you can also look for it and it is free of charge. What is Music Therapy? This is the big question worldwide. Music Therapy is a health discipline. First of all, it uses music and all musical elements such as sound, rhythm, melody and harmony. By a qualified and qualified music therapist, with a patient or group, in a process designed to facilitate, promote and improve the quality of life of people in general, such as, for example, it can be at the level of communication, relationship, learning, expression. And other therapeutic objectives that are always looking to favor changes at the physical, emotional, mental, social and cognitive level. This is the definition of the World Federation of Music Therapy, I apologize for my very Latin English, but I'm sure that they will also know how to understand that this was the last definition that was consensual of a psychotherapy and I think it is quite complete in general. In my case, as I told you in my description of my work, I am a neuromusicotherapist and the difference that there is in the definition is that it is the application of music in the cognitive, sensory and motor dysfunctions caused by a disease or difficulty in the central nervous system or neurological system in general. The difference of this model compared to the other in music therapy, which is not that it is simply better, is that it emphasizes a more neuroscientific model where it is understood as the musical perception and musical production as part of the functions that the brain has and therefore they are generated as strategies that activate certain areas of the brain understanding, and a very important point of the NMTSS, that there is no music center in the brain. We use the brain for actions and music too, and it is not that there is something specific that is used for music, the same thing is used to speak than to sing, so what a neuromusicotherapist does is provide chord strategies for a difficulty in pursuit of a therapeutic goal. I don't know if I was clear on that. But as neuromusicotherapists we work on neurological rehabilitation, neurogeriatry, neurodevelopment and neuropediatry. And we always repeat this, that there is no music center, because it has to do with the fact that when we make music we don't use a specific part of the brain, we use what we use for other things in life. We use the same thing we use to walk, it's what we use to dance, the same thing we use to sing, we use to speak, so from that place we work with music. The NMT model, the NMT method, is based on the transformational design model, which I will explain later, but it consists of 20 techniques that are applied in 3 areas of operation, motor sensory on the one hand, communication language on the other, and cognitive. There are 20 techniques that are divided for these functions and they are developed from scientific evidence. The scientific evidence that was tested and re-tested, that they work at a certain time, that a technique that I am going to apply, if I apply it in a systematic way, will have an effect in the period that I have that technique. This training is given by this university in Colorado and it has the support of the Federation of Neurology and also of the International Society of Clinical Neuromusicotherapy, an area of music therapy, it is the only part of music therapy that is so endorsed, let's say, as internationally, which makes it more interesting. Here, as an example, I leave you the names of the techniques, in case at some point you would like to investigate or look, there are many videos on YouTube about these techniques. There are 3 techniques of motor sensory rehabilitation, there are about 8 of speech and communication rehabilitation and the rest are cognitive rehabilitation, all work wonderfully. And really, for real Latin America, let's say, those of us who are on this side of the equator, not because you are not real Latinos, but those of us who live on this side, the fact that it is based on evidence for inclusion in hospital, clinical and other work has been of great help. 10 minutes have passed, Hector, but I'm coming. Don't worry. And neuromusicotherapy is intended to work with all these difficulties and more, which I am not going to name so as not to waste time, but since this is recorded, it gives me a lot of peace of mind that you can pause and read with peace of mind in all the areas where we can be. The transformational design model is based on 6 steps and that has to do with making this evident, right? First, an assessment is made, which is generally pre and post test, and there is an initial assessment, it can be generic or not, goals and objectives are raised from that, non-musical stimuli and exercises are generated, then the person is provided with a psychotherapeutic activity and it is re-evaluated. For what? To generate a transformation, a generalization of what I want to achieve. I tell you this because I am going to develop a case for you, which was the case with which I did my fellowship in 2017 as a neuromusicotherapist, which I thought it was important to tell you in those steps because I am going to tell you what the pre and post was, show you a video of how it was before and how it was after, so that you can see a screenshot of what the effect of musicotherapy can be on a neurological patient. I want to tell you that all the videos that you are going to see have informed consent, signed by the relevant user and their family. I always recommend that you do this when you are going to show a video to a person because the person, apart from having to know that it is going to be shown in an example of learning, could also choose not to do it, so it is also good that we can legally cover ourselves with consent. This man is currently 53 years old, I forgot to update this, he is a doctor of medicine, he specializes in infectology, he had a traumatic brain hemorrhage with a serious diffuse axonal injury, he was riding a bicycle and was run over by a truck, that was his trauma. As a consequence, he generated a hypertonia generalized by spasticity and severe disorders in recent memory. Today we are going to see an example of spasticity and how his improvement was at the corporal level, it seemed to me that it was more interesting for you physiatrists to see this than perhaps the work with memory, but there are also advances in memory and hopefully in another opportunity we can also exchange about that. He begins treatment in April 2017 with one session per week and thanks to the advances from the following month we start with two sessions per week and until today, 2023, we have three sessions per week of music therapy. In addition to that, he goes to physiotherapy, he also does audiology and occupational therapy. The truth is that the substantial changes occurred from the beginning of the music therapy process and that is why until today he is sustained, I think that from that moment until now I am the only therapist who was sustained, although therapies are sustained, I mean with this that he has physiotherapy from that moment, the professionals who attend him are still rotating, but with music therapy it became constant because we achieved good improvements. He has a morbid consciousness, he is aware of what happened to him, a lot of awareness, and that is why he has a very big anger with his situation and he is also frontalized, which means that he has very little impulse control and you are going to see that in the videos because the music we use uses quite bad words, which is going to be a little funny to share with you, but it is part of putting this need that appears imperious sometimes, without filter, we apply it a little to music too, as to find a place where the person can also perhaps insult and contextualize that a little and leave the spaces of family and others a little more relieved, but that at an emotional level, so I'm not going to go into much there. For the initial assessment, I used this scale that says there and I used it pre and post each session, it is a subjective scale of spasticity, the person is asked how spastic, I mean, I used one that is visual, which is the first, and the second, which is a subjective scale, this means that I asked the person every time I saw her for a period of time, how spastic she felt being 10, very spastic and being 0, nothing. This is the scale that is visual, you can look for it later, that is something that I marked, but I set myself as a goal to reduce spasticity in four months and support the work of phonobiology, because apart from spasticity it also cost language and work on motivation and recent memory of work. As non-musical exercises and stimuli, movements were specifically asked for, now you will see it in the videos, relaxations were made with verbal indication, where the amplitude and speed of movement were measured, and they were also used as non-musical exercises, conversations about general questions of culture, this in relation to memory and others, and also to the skills of everyday life. As therapeutic musical activities, these four techniques of NMT were used, then it was re-evaluated and this was seen, that when I arrived, there are two, the blue color is the measure of spasticity, before I started applying the techniques, and the one below in red is when I left the session, that is, it always reduced spasticity in music therapy sessions, at least subjectively, which is quite important for patients, because feeling better, already makes it, for me it is already a win, we are talking about this patient being a doctor, when I told him how spastic you feel, he understood perfectly what I was referring to, that for me it is not less, and well, transformation, generalization, I show you the videos, and I'm going to ask you at a first moment, to observe how he was, I ask you a minute less, a moment, Can you hear me? No. I think I shared without sound. I think you have to share with sound, exactly. Yes, that's it. Let's see there. Now you can see. I apologize for the words. This is just so you can see a little bit of how I met him, even that day was a good day of spasticity, let's say. I'm going to show you the specific case with the exercises and I'm going to show you how it is now. So short. Ok. The movement is to lift the heel and go down, lift the heel and go down. Do you remember? Perfect. You have an impressive memory, I tell you. Up to there you already saw the difference in the range of motion at the beginning when I put the metronome, which has already changed. And then what I do is ... This is as an example, but so that you can see how the range of motion and speed changes and changes from adding a pattern, in this case rhythmic, for this movement. Well, after many years, as I told you, working with him, things don't always work out overnight. We managed to stop it with work with physiotherapy too. And currently we are like this. I don't know if it's because of the song Macho Man, but quickly to show you a screenshot of when you work from the motivation, which was part of the objectives, in addition to reducing spasticity and favoring that he can, for example, stop, something that he could not achieve when I met him, we also work on the addition to the treatments, adherence to the treatments, and the desire to live, right? That many times in patients with trauma or with different neurological difficulties, we find a lot of death drive, right? Many more desire not to be alive, or that the resolution would have been another, than having to rehabilitate. Beyond the spirituality and others that each one transits, the patients after such a serious accident as the one that this person had, for example, sometimes they would have preferred to die than to stay as they were. So, being able to work from the motivational and connect them with life, from joy, is also a benefit that musicotherapy can provide as a discipline in all areas of health. But well, without a doubt, accompanying the rehabilitation, I think we have a double check, as in this win-win. And well, without stealing your time Hector, because I already saw that I am very tight with time, but I will pass you. Actually, well, I put a little of what I told you, but I will leave you marked there as a consultation bibliography for those who are watching it recorded, of all this that we work and the contact in case at some point they want to communicate with us, exchange, get the e-books, whatever, there are the contact emails and thank you of course for this time to share a little bit of the experience of music therapy in Uruguay. And well, I leave you Hector. Well, excellent, thank you, thank you for this participation and I also want to thank Dr. Glendalís Bosque for letting us participate and show this passionate work of music therapy. Let me share my presentation, let's see if I can share it. Okay, perfect. Well, first, this is what we had to talk about first, which are the objectives we had for this presentation. What you already talked about, the contributions of music therapy in acquired neurological patients and also the presentation of the clinical case. I'm going to talk about music therapy in people with visual impairment, a job I did at the Victorino Santaella Hospital in Venice in 2009. So, music therapy in visual impairment. I am an officer doctor, graduated from the Caracas Military Hospital in 2009. I am also a superior technician in audio. I graduated from the sound art workshop in Caracas in 1995. I studied contemporary piano and musical theory at the Conservatory of Music of the State of Uruguay in Venezuela in 1994. Among other things, I have also studied popular music and other types of instruments. As a professor, I am also recognized worldwide. And well, I am a musician, I am a doctor, but I am also a musician. So, that's why I got excited when I saw the work, when we did the patient in visual disability, in rehabilitation in visual disability. And then I told him, I told Dr. Yadira Pino to do a job in terms of musical teaching in patients with visual impairment in her service. Not only did I do it, with other colleagues, and well, this was left. The visual disability is nothing more than the decrease or defect in vision. Blindness and low vision are sensory deficiencies that produce visual disability. Here we have more or less the scale that is used to classify the patient with visual disability. In our case, we work with patients who had a disability between 20,500 and 20,000. And there are even patients who had total blindness, as is the case of one of the boys who participated with us. And well, it is more or less the causes that produce disability or blindness in patients with diabetes, cataracts, trauma, glaucoma, etc. There are thousands of causes. Music therapy, well, I'm not going to talk about it here because Belén already told us about music therapy. But I do want to touch on the physiological effects of music therapy in patients with visual impairment. In this case, we saw that rhythmic movement, as Belén also showed, helps patients with visual impairment to overcome two obstacles. One is the limitation of movement in space, and the other is the dependence on other people for this limitation. When a person has visual impairment, they obviously use other senses to be able to locate themselves in space. And one of these things is the sounds that are generated around them. It is very interesting when you do this walk, because at the beginning they do an empathy exercise so that we put ourselves in their shoes and one of them guides us around the hospital. In this exercise, we realize other things that they use, such as the temperature of the environment, the air, the sounds. And in that sense, music can help them develop these skills. Stimulation, lack of vision, tends to delay motor development, and music provides a basis for psychomotor stimulation, which stimulates the use of long and short music. And it is important to use musical toys from childhood to regulate activity. In this case, one can use, for example, maracas. I brought some examples, a bell, a flag, and some keys. We also use some drums to work on the rhythmic part at that time. Here I am with them, and we also work on relaxation, which was one of the most serious problems that they face in patients with visual impairment. It tends to be very intense, precisely because as they lose their vision, they have that hypertonicity as a defense mechanism. Achieving relaxation through music was something very interesting in them, and we were able to see it. The universal power of music as a human expression in people with or without visual impairment is indisputable, and the understanding of the aspect of human emotion, which cannot be observed either. That is why music can do many things so that they can express their emotions. In this case, they can even get to musical improvisation, they can even create songs and stimulate their creativity, which is extremely important. And it also leads them to develop or relate to other people. One of the particular cases in which we saw this social importance when we did this work was the boy I told you about at the beginning. I don't know if you can see him, this boy who is here with a cap. He was born, unfortunately, with total blindness. And he had a greater ability to distinguish sounds than the rest, because normally patients who are born with blindness develop a much greater hearing. And when we started the work, he was very introverted, he didn't talk to anyone. When we started working, and he started to participate, of course, he was the one who had the most musical skills. So he felt like he belonged more to this project. And well, he participated in an incredible way. The change was like from heaven to earth, and we were all amazed. The justification of the work is that the contribution of music has to do with personal development, social interaction, increase of manual skills and creativity, in conjunction with the fact that music is the only artistic form that can be completely developed by people with visual disabilities. Well, this also forced us, it told us, well, we are going to apply music therapy in these patients to see what happens. Well, here are some examples, Andrea Bocelli and José Feliciano, Puerto Rican, very well known here in the United States, who even in one of his songs, look at what creativity is in these patients. He developed his creativity, he composed the song Feliz Navidad, which here in the United States is among the 15 songs that are most heard in December. The materials and methods that we used were simply the Physical Medicine and Rehabilitation Service of the Hospital Victorino de Santaella, an electric piano, two fours, two drums and a harmonica. We used nine participants with visual disabilities and a control group of nine participants without this disability, and a short-term perspective team study was done. What I did with them at the beginning was to teach them what the diatonic scale is, the chromatic scale, more or less so that they have an idea of the diatonic scale. I don't know if you can hear the piano, I put my piano here. This would be C, D, E, F, G, A, B, E. Well, I taught them that scale, to play it and listen to it. And also the chromatic scale, which would be C with C sharp, D, D sharp, and so on. And then I played them and told them that I am playing the diatonic or chromatic. They knew how to identify it just by listening, which the control group did not do, or very few succeeded. Also, the identification of the tone within the diatonic scale by ear. At first, I randomly grabbed and played a tone and told them that I was playing. At first it was difficult, but after a few months, the patients with visual disabilities, especially the boy with the cap, I played the tone and he said it was a G. It was a sustained G and it was incredible. You can see how they have that sharpness. And here is a research work that demonstrates this, how people who are born with disabilities tend to discriminate the tone of the notes more. They were also taught the execution of melodies within the diatonic and chromatic scales with a musical instrument on the 4 and also on the piano. I also taught them to tune the 4 and play the 4. This is the 4, a Venezuelan musical instrument, which I am also talking about with Belén, because when we work in our areas, it is difficult to find a piano. On the other hand, at least in my country, the 4 is something that is almost in all cases. So I started with them, I taught them how to tune the 4, and I told them, well, let's go to the piano. And they did it, which my sister, who plays the 4, still has to tune the 4. On the other hand, they were incredible. After two months, they already tuned the 4. I also taught them the basic principles of rhythm and time, the duration of the notes, the round, the white, the black. And in the end, we managed to form a vocal interpretation group to interpret typical musical pieces from our country, and we participated in several cultural events from the hospital. Well, the conclusion was that with just two months of musical teaching, participants with visual disabilities managed to complete the objectives of this research, obtaining basic knowledge of musical theory, taking this knowledge to practice, and in this way create a musical organization that allows the participation in cultural and scientific events of the community, expanding their circle of friendships, thus improving their interpersonal relationships, and offering personal growth, greater self-confidence, and better control of their emotions. That was the conclusion of our work, and another conclusion that I make as a physiotherapist is that a physiotherapist must include and coordinate music therapy within the therapeutic strategies offered by the Department of Physical Medicine and Rehabilitation. This is my personal opinion, but I think that physiatry, as the entity in charge of coordinating therapeutic treatments for patients, must include music therapy. Here are the music references that I used at that time, the bibliographic references, sorry, that I used at that time, one of which was the book by Dr. Matthew Lee, I have it here, I had the honor of meeting him and he gave me the book. He is a physiotherapist here in New York, I met him when he was quite older, and he had developed this book because he loves music, his wife was a musician, and it was very interesting to meet him there. But here there are also other bibliographies, such as Music Therapy, Methods, and Neurorehabilitation. There is also a handbook of Neurologic Music Therapy, and there are the books in Spanish of our licensee, we have the book on dementia, Music Therapy in Patients with Dementia, here is her website, and also the contacts for you to contact her. To talk a little about how music therapy is located right now here in the United States, because the licensee already spoke to us in Latin America, here in the United States there is the Association of Music Therapy, and to be a music therapist you study four years of career, and after this they have to present a board, which the academy is the one that follows it, just like the doctors. Then they graduate and after that they do their specialties, or as the licensee did, in Neurorehabilitation or in another area of rehabilitation. And there are also some master's degrees that can be done, for example, musicians who are not music therapists and want to get a master's degree in music therapy, here in the United States there are more than 25 master's degrees that they can do, the only thing is that they are very expensive, but there is that possibility. And for those who are not music therapists, but we have the interest, for example, physiotherapists, doctors, therapists and other health personnel who want to study, there is the Academy of Neurology and Music Therapy, where the licensee studied. They take courses in the year, some even via Zoom, and they are short courses of four or five months. Of course, it is important that whoever is going to participate has some musical knowledge, they evaluate if they can interpret an instrument or not, but it is a matter of communicating with them and telling them if they can or cannot participate. They evaluate you, here are the contacts for those who want to participate, there they are. And well, questions and answers, this is me with my rock and roll band, with my gringos, as I say, playing in a place, and I am a musician, a doctor, but also a musician from the heart. Well, thank you very much, doctor, for allowing us to be here. Thank you, Hector, thank you for sharing this topic. I am one who always advocates for music therapy, I am a pediatric physiotherapist, and I like that my patients have exposure to music therapy from intensive care, to try to stimulate and wake up specifically with patients with brain disorders, whether they are traumatic or non-traumatic, severe. So here they have a lawyer. Okay, excellent, thank you, doctor. Does anyone have any questions? Anybody has any questions for Dr. Parada or Belen? Okay, thank you for the presentation, for sharing your experiences. I've always been very interested. I know that children that are born blind in the U.S., they also have training for echolocation, kind of like the dolphins, kind of like making sounds in order for the sound to bounce from, but that would be beyond music therapy, that's a very specific training, basically, right? Right. All right, so I wanted to, so we did a survey, because I've been, we've been trying to basically gauge the, let me see, there we go, kind of like what people from our community are looking in terms of the supports from the APMR, with COVID in the middle, and what we're expecting the APMR to support us as a community. Is this a community just mainly for networking, kind of like feeling that we are part of a community, sharing similar life experiences, collaborating as physicians, et cetera? Or, you know, are there other potential supports that we can also, that we're expecting from the APMR or from each other as a community? So I just wanted to present the survey results. I think from my understanding, this morning I checked, and the Latinx emphysiatry community actually has 154 members, which is nice to kind of like know that there's 154 of us out there. Part of my, you know, issue has been social engagement or just community engagement. And actually, this survey, we only had 17 respondents, which is similar to how many people registered for this session. So at the end of the presentation, I'm going to open up to the podium or to networking and see if there's additional interest or sharing of ideas in terms of how to improve engagement. So in terms of the survey, the first question was, what is your current professional status? And most people were physiatrists in training, though there is still 30% of the responders were residents. What do you expect from the Latinx emphysiatry community through the APMR? And the majority of responders actually wanted mentoring or professional supports, followed by networking, connecting with other people, collaboration, opportunities to present or to do research. With maybe some educational topics, either for, I don't know, that pertains to being a physiatrist as a Latinx or having or the whole concept of health care disparities in Latinx population. Or, yes, I think that was it. Which topics interest you the most? Again, most people, again, pick professional development or leadership skills, followed by advocacy in physiatry, either local, regional, state or national. And then intersectionalism in medicine, and then clinical topics in Spanish. So in terms of other topics, specifically clinical topics that interest the respondents, again, the whole perspective of underserved, socioeconomically disadvantaged populations, educationally disadvantaged population and how to advocate toward this population really interests one of the respondents, international health and APMR. And someone is really interested in spinal cord injury and plant-based nutrition. How often would you prefer community-related activities to occur? I think the majority, actually, maybe twice a year. I think every month would be very onerous on people. I think that this is something very doable, either quarterly, like every three or four months, or at least twice a year to connect. We typically will connect in the APMR meeting at least once a year, but adding something around this time in order to maintain that communication or that contact. Are you interested in having a journal or a book club? I think the majority was not sure, probably maybe pertaining of what book club or journal article or what would be the topics to be presented. When I posed this question, I was thinking that if people are interested in mentoring and advocacy, maybe instead of like clinical journal clubs or book clubs, actually kind of like thinking of resources specifically for like leadership skills or advocacy skills or something that we could share with each other as a community could be an opportunity to explore. Other comments or suggestions on how our community and the APMR may support you all? I think some people mentioned salary information to help with negotiations, and I actually think that the APMR puts on a report about salary every couple of years, so that's something that has been done in the past. In networking meeting at the APMR, that's something that we've done since the inception of this community. Would you like to be an active volunteer with the Latinx in Society? I'm happy that 40% may be interested and that 47% may be interested as well because we would need really help in order to improve engagement and to connect with other people. I like this representation because from the 17 respondents, there is like a wide array of people that are doing different specialties, including general. I also forgot cancer rehab and sports medicine, but there were respondents in the other category that are also practicing or training in this area. So those are the responses. And I wanted to open up to the floor to see if anybody has ideas on how to engage or if we can stay for a little bit for networking as well. One thing that I wanted to share, especially in terms of collaboration, is that both through this forum and our unofficial Facebook group, I typically, if there is our opportunity for collaborating for a clinical topic or for research, I would share those resources through there. Actually, we collaborated with the African American community, and we actually got accepted two sessions for the APMNR for the annual meeting. One in terms of pain in diverse populations and ethnical and cultural considerations. And then there's also going to be one about climate and how it affects populations with disabilities, especially in underserved areas and socioeconomically disadvantaged populations. So these are just examples of, you know, opportunities out there. So kind of like be active in this forum, be active in the Facebook group in order to put this clinical topics together. Julio, Cesar, anything for us? It's just us. No, no, I just wanted to say that, unfortunately, the thing is that Monday night is a tough day for us to have a meeting. And I imagine that there was not many choices. But I can relate. I wanted to do it on a Thursday, but it was like everybody else wanted to do it on a Thursday. Right, Mona? It was something like that. This is also a difficult, you know, I actually had to leave work early. So I understand this. Yeah, I think I think that may be the main reason. It's really it's really tough for you to do a Monday night meeting unless it's something kind of work related or an emergency or something like that. If it's something optional. So I'm not really surprised that you got six cats to come over one drop off already. It does make a lot of noise. I know. So, but I'm happy that I know that we're talking on Facebook to maybe make something. And again, the time came up and we couldn't make it work. Maybe, maybe on the AAPMR meeting, we should try to maybe spend some time to try to organize something a little bit more concrete and follow up on it to see if we can make it work. Maybe something better for for the next meeting coming in 2024. No, thank you for for putting this together. I got interested by seeing the posts on the member community forum and pretty much see what are your experiences on on the rehab world here in the US and also having the information from, for example, from Uruguay, from Venezuela and all those places. And those perspectives are really interesting to me to see what's available there. I'm originally from Guayaquil, Ecuador. So it's very, it's interesting. It's still interesting to me to see what's available. I got when I was in medical school over there. That's how I got interested in in Pete's Rehab. Pete's Rehab! Sorry. Yes. Pete's Rehab in Dallas. Yes. You're looking for a job. There you go. So, so yeah, that's that's how I got interested in Pete's Rehab by watching mission teams going coming to the Children's Hospital in my hometown and seeing their their work and and there's a lot of work to be done. Not a lot of us, especially in the Pete's Rehab world, especially in my home country and in my hometown. So, so yeah, I'm looking forward to what the community can bring in ideas and hopefully I can join one of those mission teams and go back either to my home country or other countries that Spanish speaking. I feel that every time I have a Spanish speaking patient or family member in the unit in consult or an inpatient, I enjoy it so, so much and they like the interaction because I can clear some things up for them that probably will get lost in translation. So it's just just so much fun for me to to do that. And and yeah, I know in regards to music therapy, we use it all the time. They're there in our unit all the time and I do see a change as soon as music therapy walks in the door the next day. I talk to the patient about it and it's a completely different person from what I remember from boards. It helps with improving gait, improving cognition, improving communication. There's a nice story in Netflix about one of my favorite artists, Natalia Lafourcade from Mexico. She had a TBI, I think moderate to severe TBI when she was a young lady, a kid, actually, and her interaction with music therapy is what got her into music and now she's like a awesome artist right now. So it's, it's, yeah, it's interesting that that's why I'm here. That's, you know, to see the experience that everybody has and and what else is there, especially in Latin American and see how we can help. Yeah, awesome. Thank you so much. I appreciate it. Well, this is not the only opportunity for interactions, even though these are kind of like the, you know, Zoom options, there's always a space for discussions in this forum. And if you all want, you know, some more informal way to connect, we always have the Facebook group as well. And I know Julio is in our Facebook group, but you know, this goes for anybody that is watching the video, you guys can always connect with me and I'll be glad to include you in our group as well. Okay, well, Mona, I think that we are done then. Yes. Do you have any final, anybody has any final things for us today? We're good? Yeah, I think we're good. Thank you. Yeah, thank you, everyone. I think we can move the survey and kind of plan some more as the, you know, as the year progresses, you are welcome to do a Community Connect any time of the month, you know, any, any month really outside of May and November. So hopefully we can put a link to this recording and people can see it and find value in it and, you know, it'll be like something to plan off of for next time. Yeah, probably might be a good idea to present the responses or to redo the survey closer to the AAPMinar to kind of like assess the needs closer to that as well and see if there's more people engaged because we kind of like put this last minute. Anyway. And we want everyone to start thinking about, you know, the next chair, whoever's interested, you know, the self nomination process will begin at the end of the month. Yeah, so we want members to start thinking about it who would like to be the chair for the next two years and, you know, work with you to kind of have that transition. Yeah, so anybody has new ideas and anybody that is interested can talk with me about time, you know, commitment and all that stuff. It's actually something not that, you know, complex, and you can put a little bit more flavor into things. I think a person that can put a little bit more time, or do a little bit more social engagements, that me probably would be the best candidate. My administrative duties have really like increased in the last two or three years so, and it was kind of like around the time that we opened the community so, but I'm more than happy to continue helping whomever kind of like comes along as well. Wonderful. Thank you all have a good evening. But I'm not just a little grassy. Ciao.

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