Music Therapy with Alzheimer's Disease- An Intern Perspective By: Stephanie Schecter

Even though this internship is focused on kids being that it is a pediatric center, Perry and I have the wonderful opportunity to see one very special geriatric client. She has been diagnosed with Alzheimer’s disease and is in the early to middle stages. Though she likes to think she is already 90 years old, this sweet 89-year-old lady welcomes us each week and loves singing along to the familiar music we present to her. She may not remember who we are each week, or that she has repeated the same couple of sentences 3 times already, but she does remember the lyrics to old songs she grew up hearing. Why is that? 

This topic of music on the effects of Alzheimer’s disease has been and continues to be studied by researchers all around the world. Over recent years, stories have been hitting the news about the positive effects music has on elderly patients with dementia and Alzheimer’s. A story Atlanta Alive did on music therapy in memory units of nursing homes brought tears to a news anchor because, he describes, it’s an eye-opening experience seeing how beneficial music therapy is in bringing these patients momentarily out of their confusion and back into good times of the past.

Researchers in a 2014 study titled, The Role of Singing Familiar Songs in Encouraging Conversation Among People with Middle to Late Stage Alzheimer’s Disease report that this neurodegenerative disease causes the loss of more than just memory and cognition. It affects communication both expressively and receptively, making it troublesome for these patients to speak fluidly, spontaneously, or purposefully and thus can produce social isolation (Dassa & Amir, 2014).

While our client is still capable of producing speech, it is upon arriving to her house that we can usually hear her humming and making nonsensical vocalizations to herself, filling the silence. It seems that she craves music and dialogue, and we have the privilege of providing that for her!

Two weeks ago, I sang “Battle Hymn of the Republic” with the very catchy “Glory, glory, hallelujah” refrain. She kind of nodded along, but did not sing along much at all. Just last week, I presented the song again and she sang along every time that refrain came up, with enthusiasm! She even sang parts of the verses too. She seemed more present and moved her feet along to the beat. Did the repetition of the song spark an uplifting memory within her? Connie Tomaino, a well-renowned music therapist who works mainly with individuals who have suffered from stroke, other brain injury, and neurodegenerative diseases, states that the structural form of music (melody, lyrics) is not the only thing people remember about familiar songs, but that these songs also elicit memories and “rich associations” related to the song. Listening or singing along to these memorable tunes can bring to the forefront a sense of self that may have gotten lost through the progressive disease (Tomaino, 2002). Oliver Sacks, neurologist and author of Musicophilia: Tales of Music and the Brain, calls music a “memory aid that elicits long-forgotten emotions and associations, giving the patient access to moods, memories, and thoughts” (Sacks, 2008).  

It is well known that individuals with Alzheimer’s have difficulty staying focused and engaged in the topic at hand. Despite this, the researchers found in the aforementioned 2014 study that after singing familiar songs with a group of 65-83-year olds with middle to late stage Alzheimer’s disease twice a week for 4 weeks, the participants were more able to concentrate and take part in the following conversations than they were able to before without music (Dassa & Amir, 2014).  

               Using music therapy with individuals with Alzheimer’s disease is beneficial in a variety of ways. Participating in singing or playing along to familiar songs allows the client to feel a sense of belonging, a sense of accomplishment; engage in communication, gross and fine motor movements, breath control, relaxation; and of course recall memories associated with the music, which can bring back that sense of self, maintaining their dignity. Dassa & Amir reference a 2009 study concluding that, “in a disease that destroys memory, preserved musical memory could serve as an important tool to enhance the quality of life for people who have lost so many other abilities” (Dassa & Amir, 2014).

It is a joy to watch our client sing along and exercise gross and fine motor movements to the beat of the song. She always expresses her gratitude when we are leaving and asks us to come again! After researching more about music therapy with patients with Alzheimer’s, I now plan on integrating a little more dialogue and open-ended questions into the sessions after the songs to not only engage our client in conversation, but also to assess how much and what kinds of memories and associations the songs evoke in her.

                                                                References

Dassa, A., & Amir, D. (2014). The role of singing familiar songs in encouraging conversation among people with middle to late stage Alzheimer’s disease.                Journal of Music Therapy, 51(2), 131-153. doi: 10.1093/jmt/thu007.

Sacks, O. (2008). Musicophilia – Tales of music and the brain. New York: Alfred A. Knopf.

Tomaino, C. (2002). The role of music in the rehabilitation of persons with neurologic diseases. Music Therapy Today (online). Retrieved from  http://www.wfmt.info/Musictherapyworld

WHAT'S IT LIKE BEING A HARMONY KIDS MUSIC TEACHER?

What’s it like being a Harmony Kids music teacher?

 I have worked for Therabeat Inc. since March 2012. My first job as a Therabeat Inc. employee was a Kindermusik educator. I was so excited to begin this part of my job as I had completed my Kindermusik educator training the previous summer. I was so anxious to teach my first class. I had so many notes and had written out exactly what I wanted to say. I was so nervous because I wanted each family to know just how important music is to the development of their child. I am so passionate about music therapy and the benefits of music for the brain. I prayed that I could be that vessel for each parent to learn how to best help their child develop a love for music. Music has always been my saving grace. I have been apart of music for as long as I can remember. It was always apart of me. It was what I turned to when I felt alone and when I felt joyful. I long each and every day to share just a glimpse of that passion with the families and children I serve.

 In June 2014, Therabeat Inc. moved to teaching Harmony Kids music classes. This seemed like a perfect fit, because as a music therapist we understand how to develop curriculum. We know how to design each session to fit the needs of the children, socially, emotionally, and physically. The sessions are developed to incorporate the levels of play and to target the age appropriate development for each child. It has been an incredible blessing and the highlight of my week to see kids return each week to class. They run down the hall, bursting with energy and relationships have formed. Families have become friends and the children have become friends. There is a routine and sense of predictability in the sessions. I love when families show me videos of their child singing the songs at home and in their daily life. Children are forming lasting memories and they are doing it with music!

 I highly recommend Harmony Kids music classes! Music is a wonderful medium to promote joy, relationships, and physical well-being. I hope to see you in a class this semester!

 Chelsea Kinsler LPMT, MT-BC 

Incorporating Music Therapy research with Cerebral Palsy into Physical Therapy/Music Therapy co-treats.

Incorporating Music Therapy research with Cerebral Palsy into Physical Therapy/Music Therapy co-treats.

               Over the past few weeks, I’ve had the amazing opportunity to work with and get to know this awesome guy with cerebral palsy at the clinic. I look forward to these sessions with him, because they are co-treats—physical therapy and music therapy working together to help him reach his goal of walking independently. When it came time for me to start treating in this setting, I was a bit apprehensive, because I didn’t know what to look for or how to plan to incorporate physical therapy into a session. So, that meant it was time for me to do some research in the good ol’ Journal of Music Therapy (and also go back and read some of my Anatomy text book J).

               This proved to be very helpful in acclimating myself to the type of therapy being done in the co-treat, and to some helpful tips that I could use in planning effective interventions. The first article I found was “Music and Rhythmic Stimuli in the Rehabilitation of Gait Disorders.” This article helped me understand the types of interventions being done to facilitate walking from a neurological standpoint. The researchers find in their experiment that significant improvements were made in the participants’ walking with an even and steady gait when they walked to rhythmic stimuli. By matching the tempo of the music with their steps, their brains were able to internalize and entrain the beat of the music to each step, facilitating an even gait. The participants were even able to keep their improved steady gait when the music was taken away by hearing the beat in their head (Staum, 1983). This is exactly what we are working on with our client in the co-treat. I strum the guitar at a steady walking tempo while singing (we always use the same song to ensure that the beat is “stuck in his head”) and the PT facilitates him and steadies him while he is walking. This is an awesome thing to be a part of! I can tell when our client is really hearing the music in his head—he gets such a focused and grounded look and his steps fall with steadiness and ease. I can also see whenever he loses focus, which brings me to the next helpful article I found to incorporate into the co-treat.

               Whenever this awesome guy loses focus, his head will drop or his posture will droop. I decided to incorporate the use of music as reinforcement for this behavior—this idea is found in “The Effect of Automated Interrupted Music on Head Posturing of Cerebral Palsied Individuals.” It is simple—whenever undesirable posture is observed, the music is stopped, then the music resumes whenever posture is corrected (Wolfe, 1980). I’ve found that this works really nicely! By stopping the music, our client can immediately correct his posture, and refocus himself on the walking to the beat of the music.

               These interventions have made a huge difference in walking independently for this amazing dude!! It is so amazing how rhythm works to synchronize our movements with our brains. He is gaining so much confidence and walking with so much “swagger” J J

Staum, M.J. (1983). Music and Rhythmic Stimuli in the Rehabilitation of Gait

               Disorders. Journal of Music Therapy, 20(2), 69-87. doi: 10.1093/jmt/20.2.69.

 Wolfe, D.E. (1980). The Effect of Automated Interrupted Music on Head Posturing of

               Cerebral Palsied Individuals. Journal of Music Therapy, 17(4), 184-206.

               doi: 10.1093/jmt/17.4.184.

-Posted by Perry Wright (Music Therapy Intern) on 7/13/15

I Have Begun Implementing Interventions! June 15th-June 19th- By Stephanie Schecter

I have begun! And it’s so much fun! It’s amazing to think that just a few weeks ago, I had no idea who my clients would be at this internship, what they would be like, and how the music therapists would interact with them. I had the usual first day jitters (or first week jitters, in my case), but now at the end of the 3rd week I feel really good. I am even more excited than before. Let me tell you why!

This past week, I started implementing interventions with a lot of different clients! In each of these sessions, I learned something new. Here are a few highlights from it!

During the Tots class on Monday and Tuesday, I had the opportunity to sing the Baby Beluga story. After I led the activity on Monday, I learned that I sang through the story without many pauses or questions for the children to interact with. They had been engaged for about half of the story song, but then most of them lost attention and some wandered away. In Tuesday’s class, I took more time singing the story and asking questions. I had the toddlers touch the pages and identify the different sea animals on the pages and redirected children to sit down. It worked and by doing this, the children were all engaged longer, listening and interacting with the whole story.

I observed that with a 10-year-old client, the music therapist works on reading notes on the staff and then playing it on piano. The activity I made for him was a game where I had written out 4 familiar melodies in the treble clef. The melodies were to “Row Your Boat”, “Happy Birthday”, “You Are My Sunshine”, and “In the Jungle”. My plan was to have him read the music, play it on the piano, and then guess the name of the song once he recognized the tune. He started in on the first melody and it took him longer than I had anticipated for him to transfer from reading the music to playing it. I realized that I made this activity too difficult for where he was at with his skill of reading music. I learned that it was a very new skill for him to read the notes on the staff, and that he is most comfortable with the notes on the lines and the spaces instead of below and above the staff as well. He did really well staying focused and kept on trying, but we ran out of time. So for this coming week, I have modified the activity. I will have him guess what song it is after I play the melodies on the piano. I will also write the note names underneath the notes for now and after he guesses, I will ask him to play the last phrase of the familiar tune. This way he will still work on transferring from reading to playing while also working on maintaining attention and listening skills. I learned that adapting and modifying are huge components when implementing an intervention so that you, as the music therapist, are setting up the client for success!

My favorite intervention I did this week was with the Family Class. The theme for June is The Beach! So I made up an activity to go along with the theme and work on things like following directions, identifying animals seen at the beach, utilizing gross and fine motor skills, sensory stimulation and counting. At first, I brought out a little sandbox full of seashells and I had it covered and off to the corner. Jennifer advised me that leaving it outside the room would be better. She was right. Setting up the room is so important because I discovered that no matter what the object is, if it is in the room with babies and toddlers, they will find it and play with it. Though I did not put the sandbox in the room until I used it, I did accidentally leave a small empty container, which one baby began exploring during other activities in the session. Good thing it was not the sandbox!

The intervention itself was a success! When prompted through the song, the children pretended to splash in the ocean, flap their arms like seagulls flying, wave and say “Hi dolphins!” and held up 10 fingers to count. Then with only a little bit of redirection, each child waited their turn to pick out a seashell and put in a line until we counted 10 seashells. Once we sang through the song and began counting the seashells again, one child who had skipped his second turn of picking a seashell came up and began throwing them all back into the box. I rolled with it and sped up the counting to match his rhythm. Most of the children counted with me, singing up the octave plus the extra two notes for 9 and 10. I was worried that ending on 10 (the 2nd scale degree) would be weird, but I did not want to have them associate the sound of an octave with 10, so we went all the way up past the octave and after distinctly reaching 10, I slid the melody down to end satisfyingly on the octave. Another thing I learned, which I had not thought about, was to set up counting activities from the clients’ left to right. This reinforces reading skills, which some in this class are starting to develop. Overall, it was a successful intervention. The children followed directions pretty well during this activity and seemed to have fun singing, moving, counting and digging for shells in the sand!

A session with another client supported the idea that adapting during the session or in the midst of an activity is a necessary skill for music therapists. This client is an 11-year-old girl who is nonverbal, but has a system of expressing herself through short sounds or using the iPad. One of her goals is to attend to a given task for 10 consecutive minutes with no more than 3 verbal prompts and 2 physical assists for the entire duration. My plan was to do a sequencing activity on the bells and have her repeat it until we play a song. I discovered that she needed hand-over-hand assistance to complete this task. At first I helped her from my position across the bells from her, but eventually sat next to her to better help. To my surprise, she let me help her press the bells and stayed very attentive throughout the entire activity. At one point she even looked up at the music therapist to make sure she was watching. Then, at the end of the session as we were leaving, the client decided to hold my hand as we walked out. This made me feel like I established more rapport with this client, which will be a necessary basis in order to continue having successful interventions.

The other three interventions I led went well not only because the clients dove right in with me and stayed engaged, but also because I learned to set them up in a way geared for their success. I love getting to know each individual client here. And that is something really cool about this site…there are so many 1:1 sessions that I can really focus on each person and how I can help them achieve their goals. I think I’m finding that the best way to get to know the clients is by starting to implement interventions with each one on my own!   

This week I saw the importance of planning a detailed session, setting up the room, adapting during a session or in the midst of an activity, meeting the clients where they are, getting to know each one and building a rapport, understanding their strengths and needs, and that there is a difference between knowing these things and putting them to practice!

-Stephanie Schecter 

First Week Of Interventions By Perry Wright

As last Monday was approaching, I was buzzing with excitement to start doing music therapy interventions with clients I had the joy of getting to know over the past two weeks. Throughout my first two weeks of observation, I had learned so much from all the music therapists, the therapists of other disciplines, and from new reading material—so I was really anticipating getting my feet wet. Monday came, and it was pretty wonderful! There is something really special about facilitating these kiddos in reaching their potential. All in one day, I witnessed some pretty neat things—memorizing new Bible verses, learning to play a chord on the ukulele, being courageous enough to try playing a new instrument—all of these occurrences because these kids shine in music therapy, and bring their unique talents to the table.

               After my first day of treating, things got a little topsy-turvy. Somewhere in between laryngitis and a ruptured eardrum, I was incapacitated for the rest of the week. As I spoke to family and friends about the situation, they pointed out that the bright side of everything was that I would be able to stay at home. I realized that as much as I love a good lazy day, I was bummed that I couldn’t keep working. When I told my aunt the way I felt, she responded, “Wow, you are so lucky to be in a field that you actually miss when you’re sick.” When I stopped to think about that comment, I realized how true it was—I feel so thankful that The Lord showed me a path to get into the field of music therapy, and that He led me to a place for internship that is a dynamic and challenging experience to grow into a better therapist. Most of all, I am thankful for the kids I get to see and share music with—it says a lot to their character that when I had to stay, I genuinely missed them after knowing them for only two weeks.

               With that said, I’m beyond ready to really start interventions next week, and get some more helpful feedback from the other therapists!!

-Perry Wright