The
International Journal of Psychosocial Rehabilitation
Rehabilitation
for Children with Cerebral Palsy:
Seeing
Through the Looking Glass
--Enhancing Participation and
Restoring Self-Image through the Virtual Music Instrument
Heidi Ahonen-Eerikäinen[1], Ph.D., MTA,
Andrea Lamont[2], MMT, MTA,
Roger Knox[3], Ph.D.
Ahonen-Eerikäinen H, Lamont A & Knox R. (2008).
Rehabilitation for Children with Cerebral Palsy:Seeing Through the
Looking Glass
--Enhancing Participation and Restoring Self-Image through the Virtual
Music Instrument International
Journal of Psychosocial Rehabilitation. 12 (2), 41-66
Bloorview Research Institute has been at the
forefront in developing
and applying psychosocial rehabilitation technology. In
the music technology area, the Institute has developed four
original technologies, and tested a number of other devices and
software
programs that involve young people with disabilities in new and
different ways
(Knox, 2004). One of these developments was ListenUp! (Assistivex,
2003), a
music software program for remediation of attention deficits of clients
with
acquired brain injuries. Musical engagement has been encouraged through
active
participation, enabled by a variety of adaptive technologies such as
the
MIDImate switch access system (Assistivex, 2003), and automatic
movement
technologies that convert movement to music are used, such as the
Soundbeam
(Soundbeam Project, 2003; Swingler, 2003), and the Virtual Musical
Instrument
(VMI) developed at Bloorview Kid’s Rehab by Biomedical Engineer Tom
Chau
(Lamont et al., 2002). The
use of these adaptive technologies has
created a paradigm shift in which access to a musical instrument no
longer
requires physical strength, endurance and fine motor abilities (Ellis,
1995). As a result, participation in
musical tasks and the subsequent emotional, psychosocial and
therapeutic
rewards is no longer restricted by physical barriers (Schwellnus et
al., 2002).
Figure 1: The Virtual Musical Instrument
(VMI)

1.
Research
Methodology
The objectives of this
qualitative pilot study were to
identify music therapy interventions and techniques using the VMI that
are
suitable for young people with disabilities, to categorize areas of
benefit
over time that are made possible through enhanced participation using
the VMI,
to build theory on the role and significance of the VMI in music
therapy, and
to add to the existing literature and practice of music therapy, with
the
ultimate goal of client self-actualization through active participation.
1.
What interventions
and techniques are best used by the music therapist
to promote the therapeutic relationship in application of the VMI?[7]
2.
In which domains is there benefit, both during sessions and over
the time period of the study, from the use of this instrument within
music
therapy?
Research Design
The research was based
on the qualitative paradigm (Denzin & Lincoln, 2000; Coffey &
Atkinson,
1996) and its nature was abductive (Peirce,
1839-1914) and descriptive[8]
(Bruscia, 2005, p. 81). The
study employed a multiple case study paradigm, one of the five key
methods in qualitative research (Creswell, 1998), grounded theory[9]
(Corbin
& Strauss, 1998; Glaser & Strauss, 1967/1999;
Strauss & Corbin, 1990, 1997, 1998; Glaser, 1998), and narrative
inquiry (Ceglowski,
1997;
Glesne, 1997; Hollway
& Jefferson, 1997; Frank,
1995.)[10] The aim was to look deeply into
the characteristics and processes of six children in their music
therapy
sessions. The study was designed to characterise the individual;
however, cases
often show precedence and build up a body of evidence on which to build
theory.
In this study we also took a comparative approach to examining the six
children’s case data.
Qualitative Data Collection
During the research
process there was a cycle of observing-describing-interpreting
completed
several times; not always followed in a linear fashion (Ansdell &
Pavlicevic, 2001). Sometimes the different stages of the cycle
interacted and
circled back on each other. The task was to get the material into a
form where
closer analysis was possible, in view of the research questions. Once
field
notes of the therapist and videotape notes had been transcribed, the
two
researchers[14]
coded
data into themes for content analysis using QSR N6 software. The
aspects or
events that were relevant to the research questions were labelled,
while not
excluding the possibility of unveiling new questions. The material was
then
organized into categories and subcategories. The robustness of the
categories
was tested in addressing the research questions, and the researchers
firmed up
boundaries by looking for overlaps and discarding weak categories.
One of the
chief characteristics
of this qualitative inquiry was the evolving nature of the design,
methods and
analytic procedures used. The theory
evolved as the data was being analyzed and the descriptive categories
were
formed. It was not straightforward to separate out description from
interpretation. The research process
included a series of dialogues; with the data, with the ideas, with
colleagues
and with oneself. All of those interactions led to reflections and
different
decisions. The results developed through these various transactions
(Coffey and
Atkinson, 1996).
Results: Therapeutic Benefits
The therapeutic
benefits of the VMI are introduced in the form of the following
descriptive
categories (Table 1). The core
category — the grounded
theory — is articulated as: “Enhancing
Participation and Restoring Self-Image Through the Virtual Musical
Instrument —
Seeing Through the Looking Glass.” The main category growing out of
the
core category is: “Knowing through
creative musical expression.” The four sub-categories include:”
To see and to be seen through
reflective mirroring,” “Learning and building concepts through a
musical
framework,” “Enhancing full body participation through multi-sensory
musical
expression,” and “Restoring self-image and expressing feelings through
containing musical experience.”(In
the following, participants’ names have been changed to maintain
confidentiality.)
|
1 Visual Awareness |
2 Auditory Awareness |
3 Kinesthetic Awareness |
4 Self Awareness |
|
I can see me I can see you I can see us I can see it |
I can hear it I can hear you I can hear myself I can hear us |
I can touch it I can play it I can control it I am good at it! |
I can understand I can feel it I know I like it I did it! I can cope I can choose I believe |
|
To see and to be
seen through reflective mirroring experience |
Learning
and building
concepts through musical framework |
Enhancing full body
participation through multi-sensory musical expression |
Restoring self-image and expressing
feelings through containing musical experience |
|
Knowing through
creative musical expression |
|||
|
Enhancing
Participation and Restoring Self- Image Through the Virtual Musical
Instrument —
Seeing Through the Looking Glass |
|||
Category 1 — “To see and to be seen
through reflective mirroring
experience”
I
can see me
I
can see you
I
can see us
I
can see it
According to Hobson, (1987) “The
face is
the mirror of the emotions and the eyes are the windows of the soul. In
a
simultaneous expression and communication, we give and receive, as our
eyes
convey and register the emotions of joy, interest, curiosity, anger,
fear, and
many complex combinations of these and other affects.” (p. 123).
We all need to belong. We need
a sense of self, other and belonging (Stern,
1985). “The sense of community and belonging can be related to empathy
itself”
(Shapiro, 1998, p. 52). “The earlier in life an individual experiences
that the
need for a relationship is not being
met, and the more consistent that experience is, the greater and more
disruptive its effects…” (Erskine, Moursund & Trautmann, 1999, p.
11).
There is only one thing that can cure isolation. “Contact… is the key.
Contact,
contact, and more contact” (Erskine,
Moursund, & Trautmann, 1999, p. 12). An infant can feel what her
mother is
feeling if she is imitating her mother’s facial expression (Lee and Martin, 1991). “Without
the dance that takes place between mother
and child, growth and development are constricted” (Shapiro, 1998, p. 51).
“The visual
feedback of her own image in the VMI allowed X to make eye
contact with herself and with the music therapist on a regular basis…
Also, the
visual feedback permitted X the opportunity to play “dress-up” as the
diva
(bowing in front of the camera and saying “thank you, thank you!”), or
as the
leapfrog. When the camera was not
focused on her face, X could become confused, occasionally moving to
the floor
to see her face in the television if working on a “dancing” screen.”
Category 2 — “Learning and building
concepts through musical framework”
I
can hear it
I
can hear you
I
can hear myself
I
can hear us
Cognitive behavioural
therapy focuses on correcting a vicious cycle of thought distortions,
negative
emotional responses to these thoughts, and the resultant maladaptive
behaviour
(Beck, 1975). In the context of this
study, challenges faced by children in previous music experiences, such
as
unsuccessful traditional music lessons or a lack of physical strength
and/or
dexterity, left a sense of failure. This
can leave the child with little motivation to embrace music-making and
distort
a sense of musicianship. The use
of VMI
seemed to motivate children:
“The
use of the pentatonic scale, specifically, appeared to be a motivator
for Bill to move his body.
As this scale was used in previous therapy,
it was easily recognizable to Bill evidenced
by the immediate use of his voice
and engagement with the VMI system... No
matter what icon was fired, Bill could
be assured that his music would sound correct and sonorous.”
Bill’s tune contained within
the pentatonic scale provided a secure base from which he could explore
musically in a safe manner. Success-oriented
client experiences in the music making can work to challenge thought
distortions. This is encouraged through
the music therapist’s ability to establish a therapeutic relationship
with the
client through the provision of an appropriate music aesthetic (Lee,
2003)
within communication accentuated music therapy practice
(Ahonen-Eerikäinen,
1999) in which child can then hear his or her successful communication
in the
music making.
The results show the VMI, as
a music therapy
tool, offers the potential for positive, reinforcing musical
experiences. The use of the VMI provides a
new learning
experience and one that focuses on the ability of the child versus the
child’s
inadequacy. The music therapist has the opportunity to design screens
that
focus on accessible modes such as the pentatonic. The
pentatonic offers a
developmentally-appropriate, comforting and stable aesthetic that
ensures no
harmonic mistakes can be made by the child, allowing the child a
success-oriented musical experience.
This resembles communication accentuated music therapy as an
upper level
of all music therapy approaches (Ahonen-Eerikäinen, 1999). Communication must be encouraged within a
safe musical atmosphere before an issue may be “worked through” (Ibid).
Once
this is achieved, learning a theoretically accentuated music therapy
approach
in which “music conditions and works on behaviour or stimulates
learning”
(Ibid, p.159) is possible. In this
approach, positive reinforcement through song lyrics and/or social
praise
confronts previous emotional responses.
Maladaptive behaviours in response to initial distorted musical
experiences can then be reshaped into more productive music making,
thereby
reinforcing the new thought process.
The
use of imitation is crucial to the process of reshaping associated
feelings and
behaviours. The child begins to
understand his/her music through the auditory recognition of his/her
movements
causing the effect of music (“I can hear it”), of his/her music played
on the
VMI or imitated by the therapist (“I can hear myself”), imitation of
the music
therapist’s music (“I can hear you”) and musical interplay (“I can hear
us”). This, of course, then feeds back
to reinforce the formerly distorted thought regarding musicianship and
leads to
potential success in other areas:
“…may develop
physical skills to access an augmentative communication
device. The VMI could be a motivating
method to practice physical and perceptual motor skills.”
Category 3— “Enhancing full body participation through
multi-sensory musical expression”
I
can touch it
I
can play it
I
can control it
I
am good at it!
Sensory integration refers to the body’s ability to receive input from the senses, integrate this information to what is already known by means of sorting and screening, and interpret this information with respect to the individual’s experiences and understanding of the world (Hatch-Rasmussen, 1995). It is known that sensory modulation, an aspect of sensory integrative dysfunction, is often a critical issue within developmental disability (Riesman, 1993). This refers to the nervous system’s over-efficiency or lack thereof when processing information from the senses resulting in hypo-reactivity or hyper-reactivity to the stimulus (Stephens, 1997). In the practice of sensory integration therapy, as developed by Ayrs (Spitzer et al. 1996), the occupational therapist strives to provide the client with a stimulating environment with physical activity (both gross and fine motor) that is reasonable in expectation (known as the “Just Right Challenge”), promotes adaptive behavioural responses to tasks presented, allows the child to be active in participation, and is client-directed or centered (Dabrowski, K., 1967).
In recent literature, it has
been suggested that there is a link
between the practice of sensory integration therapy and music therapy
(Hooper
et al., 2004). Music therapy provides a
context in which a client can interact with his/her environment in a
variety of
ways with purpose and success (Berger as cited in Hooper, 2004). Specific techniques involving the pairing of
movement with music (pre-composed and improvised) are of particular
interest
for the integration of the auditory sense to the vestibular
(information from
the head in relation to gravity and the inner ear) and proprioceptive
(as sense
of self in space) systems (Ibid). This
dovetails well with the idea of neuropsychologically accentuated music
therapy
in which “music serves as multisensory experience, contributes to the
automatisation of working, [and] initiates association and memory
functions and
stimulates verbalization” (Ahonen-Eerikäinen, 1999, p. 159).
“The
VMI provided the opportunity for full body musical expression. This emphasis on gross motor skills may have
better spoken to Bill’s abilities rather than his inability to
correctly grasp
or articulate his fine motor movement.
This instrument also addressed Bill’s energy and attention span. It did not require compliance to sit or
maintain
a specific posture, but could be adapted to Bill’s unique movement.”
The results of this study show how the use of
the VMI
provides a number of opportunities for sensory integration within the
music
therapy environment. Specifically, it
meets all criterion listed above for successful practice with an added
dimension of potentially positive visual feedback.
Adequate stimulation within the environment
is clear:
“The VMI may be a good way to promote
movement,
physical fitness and exercise. For
example,
it may help to increase strength, coordination and balance. Large movements of the body may help to
stimulate muscle tone of the trunk and increase her ability to sit in a
stable
position for activities that require more precise motor control of the
arms.”
“Most outstanding was motivation the VMI
provided X to
move both in novel ways and clearly outside of her normal ranges. She was rewarded both musically and visually
in the jumping tasks. With the success
of tasks such as jumping out the tune of “Twinkle, Twinkle Little
Star”, it
suggests that music education could be conceived as a full body
experience
promoting not only musical skills but also physical fitness and gross
motor
strength and agility.”
Physical activity was promoted:
“Used
right hand to access VMI icons most frequently and was observed to
cross
midline. Was able to target and activate
specific icons when asked.”
“The physical
nature of the VMI may improve joint range of motion,
muscle strength, eye-hand coordination and body awareness.
These skills may transfer to other activities
in her daily life such as participating in dressing, bathing, etc. It may make it easier to move her body and
rely less on caregivers to move/stretch her body parts”
“X demonstrated
twisting at his
waist and clapping to the side and overhead”
“For
the masking tape activity, he worked on directionality, front/back,
side to
side”
“The VMI could be
used to introduce new movements, therefore increasing
strength, coordination
and balance.”
As a result of
this study….“X increased the number of times he crossed
his midline with both arms…increased his ability to target specific
icons to
make musical sounds and phrases”
Activity was reasonable in its expectation,
fitting the “Just Right
Challenge”:
“X
could alternate hand movements on the drum.
Holding the drumsticks may give him a tactile, concrete clue to
improve
his accuracy to activating the icons (tactile feedback to his hand that
guides
movement).”
“X improved
bilateral hand skills.
He increased the use of a hand that he does not normally use.”
“X increased
ability to dissociate body movements i.e. he will be able
to move his arm without his whole trunk moving”
Adaptive behaviour was promoted:
“X
may develop physical skills to access an augmentative communication
device. The VMI could be a motivating
method to practice and develop physical and perceptual motor skills.”
“X demonstrated
the ability to separate movements i.e. he could play
the drum and VMI together and separately (demonstrated bilateral hand
skills)
“X created new
movements on his own such as twirling, walking on all
4’s, and taking little steps. Jumping
seemed challenging for him.”
Active participation was clear:
“X developed a
‘boxing’ move to activate icons and said it was like
getting exercise on a bike.”
“X appeared to increase her repertoire of
movements
from session 2. This could be used to
improve her balance, coordination, physical stamina and endurance, and
body and
spatial awareness. She was able to
explore different body movements to activate the VMI icons i.e. jump
like a
frog, flap like a bird.”
“X was able to
follow a simple beat.
Following the music beats may improve the fluidity & quality
of his
movements. He was able to respond to
increased speed of beats with increased speed of movements.”
“X demonstrated cause &
effect by crouching on the ground to stop the music, then popped up to
activate
the icons.”
Music making was client-directed:
”The
activation of his voice also appeared to be
influenced by the whole tone scale, although this could not be
confirmed with
so few sessions. It would suggest that
the stretching nature of the scale could be influencing the end points
of his
vocal range. In this case, there is very
much a safe base for the whole tone, but it is elongated vertically,
not
laterally which may encourage a smaller voice like Bills to slide
slightly
higher or lower than normally would be seen.”
“During the
dancing/making bird sounds activity, X initiated jumping,
flapping arms like a bird, moved right arm to hit icon”
Category 4 —“Restoring self-image and expressing
feelings through containing musical
experience”
I
can understand
I
can feel it
I
know
I
like it
I
did it!
I
can cope
I
can choose
I
believe
It was Donald Winnicott (1971)
who first
asked “What does the new born baby see when he or she looks
at the mother’s face?” Mother is looking
at the baby, and how she looks at the baby is somehow
related to
what the baby sees in her. If the mother “looks with love and with
tenderness,
the baby experiences him or herself as joyfully alive. If, however, she
is
depressed and unsmiling, even more so if she does not look back and
cannot
maintain the reciprocity of looking, the baby experiences him-or
herself as
joyless, unlikely, even absent” (Pines,
1998, p. 47). Winnicott (1947/1964) discovered how the baby begins to
see him-
or herself in the mother’s look, and how babies begin their lifetime
search of
“creating a sense of self. That sense of self could, for example be: ‘I
am good
or bad to see and/or to hold.’ Or the response could be empty of
feeling”
(Pines, 1998, p. 144–145). Can the cerebral palsy experience be an
“empty
mirror” for the baby or toddler, who may adopt a non-reflective image
and
incompetence and bad self-esteem through to the core of the self?
VMI could be compared to a hall
of mirrors where each client is confronted with aspects of his or her
psychological, social or body image (Foulkes and Anthony, 1990, p.
150–51).
Children discover themselves, seeing who they are in a new light
through their
experiences in the VMI screen. For many children with CP this is
crucial as
their environments may not have provided that “magical” or good mirror
all
human beings need to see themselves in a healthy light. These children
may have
been seeing themselves only through distorting mirrors that have been
reflecting only ugly images or freezing images (Behr, 2000, p. 175–76).
“Period 3 is a
time in which X is able to process many of his feelings
around strong emotions such as violence and sadness.
It is in the acknowledgement of sadness that X
opens up emotions forbidden in the past.
Like other children with disabilities, X is not denying his own
capacity
or understanding of sadness, but is sensitive to exposing others to
what might
be additional sadness or worry; especially his parents.”
“Creating music and
incorporating emotional content may help him to express his own
feelings and
explore emotional expression…”
“X was able to explore
emotions by matching sounds to the emotions.
He
followed the verbal cue of
‘sad’ in the song to change instruments.”
“Repetition of key words such
as yes or no allowed the song to be
accessible to X.
These were words that were well practiced and
easily understood in his
vocabulary allowing to express some of
these feelings, in some ways,
to the “empty chair” containing different
family members.”
Main Category —“Mastery of knowing through creative musical expression”
“X demonstrated
increased competence in making
something happen (making musical sounds)…He seemed to have increased
confidence
that he could produce/create music. He
was doing something that made him feel good.”
“A smile on his
face indicated enjoyment of
making music. He appeared to be proud of
himself in completing the whole song and said “I may have a little
party when I
come home.”
Core
Category: Seeing Through the Looking Glass
—Enhancing participation and
Restoring Self-Image through the Virtual Musical Instrument
MATTHEW—The Boxer
Matthew is looking through the glass
but he can’t
see himself —he only sees his
disability. He feels sadness and anger but locks the forbidden emotions
inside.
He doesn’t want to upset anybody as they’ve been through enough… Gradually, music opens the door for Matthew
to reach out and explore an extreme character. He becomes a boxer,
rapper, a
crocodile hunter… He expresses anger, sadness, frustration, violence…
Multi-sensory combination of music and the physical manipulation of the
mirroring experience make the self-process and new identity possible.
He
declares he will have a little party for himself!
There
was a boxer - there was
a boxer
There
was a boxer who wasn’t
in the ring
So
he boxed - and he boxed
And
he boxed the television
in
BOXING
ACTIONS &
INSTRUMENTAL CHORUS
First
he gave it the left
hook
Then
he gave it the right
hook
And
then he gave it the
noggin
And
the TV fell down
BOXING
ACTIONS &
INSTRUMENTAL CHORUS
There
was a boxer – there was
a boxer
There
was a boxer who wasn’t
in the ring
So
one day he boxed the TV
And
his parents came in
BOXING
ACTIONS &
INSTRUMENTAL CHORUS
The Long
Way Home
Song
composed
by Matthew
There were
two crocks that
liked to eat humans
[3x
djembe, tom drum right hand then left]
But I’m
already too far into
the story. Let me go back
[chime]
One day a
man goes for a
walkabout and becomes very, very hot
[bongos]
So he
decides to go for a
swim in the lake
[2
black, one red, one green icon on VMI]
But he
doesn’t know that
there are 2 crocks in the lake.
[2 black
VMI icons and cymbal]
So he tries
to throw a fish
to trick them
[VMI
icon arch]
But then
they fought
[VMI/piano
fighting music with arch ending in an
accelerando]
And fought
– but then the
man died
[bell tree
music with Aeolian scale on piano]
There was a
funeral for the
man. Everyone was sad, but especially
his cousin. His cousin was very sad
[improvisation
con’t]
He went
from being sad to
being mad
[Improvisation
with snare drum and piano in dual
tonality]
To being
angry
[improvisation
con’t]
And he went
from angry back
to being sad again
[Snare
changes to bell tree, piano changes to Aeolian
mode]
He couldn’t
get over
it. He began to have feeling about the
crocks. He started to think about how he
wanted to shoot them
[black
square VMI icon]
Then he
thought no, he wanted
to poison them
[blue
circle icon]
Then he
thought he wanted to
club them
[black
circle icon]
Then he
thought, “That’s
even too good – I’m going to leave them in the water.”
[silence]
One day the
cousin discovers
that music helps to fill the hole in his heart.
While he was playing, he realized something about life. He began to sing: “Live Your Life”
and he
lived happily ever
after
[Guitar
with vocal line “live your life”]
JENNIFER—The Performer
Jennifer is looking through the glass and
only sees
herself. Me, me, ME!!!! MY MUSIC! She’s
afraid of the mist because she can’t see anyone else… she can’t find
them. She’s there by herself.
It’s a lonely place to be, filled with
anxiety. It’s like she’s desperately
trying to control her environment but she can never see very far ahead.
New
sound, new person, new demands would break down her safety. Music
clears the
mist. Jennifer first recognizes
connections in music and gradually with another human being. She integrates the “we-ness”, dance between
two people. She learns to dialogue. She
becomes brave—exploring novel movements, crossing her physical comfort
level.

Level of
independence: 5=Independent
4=verbal prompting required
3=gestural prompting required
2=physical prompting required 1=no performance

BILL—The Conductor
Bill is looking through the glass and
only sees
the glass, its beauty, its colours, its shapes, its music…its chaos. He
does
not see himself. He does not see another person. He’s thrilled,
however, like
being inside a kaleidoscope. Every turn produces beautiful sounds. He controls them. He owns them. There’s
empowerment but music stretches him …
his body, his voice, his abilities.
Music helps him to differentiate himself from the chaos and have
intentional communication with another person. And certainly the chaos was beginning to melt away, just like
a bright silvery mist.
MADDIE—The Scout
Maddie is looking through the glass but
doesn’t
like what she sees. She turns away.
She’s resistant. She tries to control but there’s too many things going
on… She tries to trust but why bother as
she may not come back next week. [16] Music gave her a glimpse of an old Megan, the
playful one, without so many worries…
Although she has explored before through the looking glass her
footing
was no longer secure. It’s like she’s
looking at the frame and not the mirror… and taking glimpses of herself
when
she can. Let's pretend there's a way of
getting through into it, somehow, Kitty…
STEVEN—The Acrobat
Steven is looking through the glass and
is looking
for something particular…to be excited.
There are many fascinating things in the glass but he only plays
with
his favourites. You can just see a little peep
of him in Looking-glass House, even if you leave the door
wide open and offer him all the possible opportunities.
He’s caught and knows only a few ways to get
out. Music helps him to expand his
musical expression. Enticing music
brought him to life.
LUKE—The Rebel
Luke is looking through the glass and
sees
everything taking away from him. He sees an angry boy! He’s blaming his
disability. He’s blaming his family. He feels his life is unfair. He
feels
nobody’s listening. He’s beating himself on a glass. Music allows
constructive
expression and control over the feelings.
The song is empowering. It validates his opinions and feelings
about his
life. Music gives him a voice. It allows him to be articulate,
respected. It gives
permission to rebel. Music restores his self-image, re-constructs his
identity.
YA, YA, YA, YA! I want TV!
YA, YA, YA, YA! I want TV!
NO, NO, NO, NO! I don’t want
to go!
NO, NO, NO, NO! I don’t want
to go!
NO, NO, NO, NO! I don’t want
to go!
NO, NO, NO, NO! I don’t want
to go!
4.
NO, NO, NO, NO! I don’t want
to go!
NO, NO, NO, NO! I don’t want
to go!
&n