Older Adults & Therapeutic Singing

We all experience aging, and according to the World Health Organization, “people everywhere are living longer” (World Health Statistics, paragraph 1). Currently, the older adult population has increased life expectancy by about 20 years (World Health Statistics, paragraph 2).  Older Adults may present with a variety of diagnoses, such as those with progressive neurodegenerative disorders, Parkinson’s or Alzheimer’s disease, and respiratory diseases, such as Chronic Obstructive Pulmonary Disease (COPD). However music therapists can use therapeutic techniques, like therapeutic singing, to address any health concerns, open communication, and improve overall well being with those diagnosed.

According to Dassa and Amir, music therapy and group singing creates new ways to increase communication, as therapeutic singing evokes memories, self-expression, and sense of comfort (2014). Groups, such as choir and other musical ensembles, provide an outlet where people can gather and discuss life experiences or struggles that others may encounter.  “Group singing sessions that focused on singing and reminiscing have been found to be significantly helpful in reducing symptoms of depression…” (Dassa & Amir, 2014, pg. 134) and can promote activities of daily living, such as swallowing and respiratory control (Stegmoller, 2017, pg. 408). 

Therapeutic singing displays the most benefits when it occurs in a large space that is familiar to those attending. The intervention of singing begins with breathing exercises, and is followed by “3 to 5 songs selected from a list of participant- chosen music selections” ( Elefant, 2012, pg. 285) Due to the educational training and certification a music therapist must receive to provide appropriate services, items such as client preferred music, tempo, therapeutic techniques for discussion,and musical cues for breathing become more effective, than someone who might sing recreationally to increase socialization between older adults.  

Group singing led by a music therapist, creates an environment where memories can be evoked through music familiar to each individual attending. Client preferred music, such as music from adolescence or early twenties, promotes “well-being and sense of self” (Dassa & Amir, 2014, pg. 145). Not only does listening and conversing about preferred music increase reminiscence, vocal warm ups allow for concentration to be placed on articulation and oral muscle movement. Vocal warm ups before singing, “target specific therapeutic needs of the Parkinson’s disease population” (Stegmoller, 2017, pg. 411).

  The repetition of familiar songs generates an “increase in participation and promotes security” (Lesta & Petocz, 2006, pg. 9), as well as “imitation and modeling to support” (pg. 9) responses provided in a group setting. Specifically singing has the ability to connect and provide power to those with Alzheimer’s and Parkinson’s disease. Singing familiar songs administers a group dynamic, even with those diagnosed in the middle stages of their progressive disorder (pg. 6) The ability to be within a group of individuals experiencing similar interactions, acknowledges the understanding of social support and connections through peer interactions (pg. 7)

Music therapists have used therapeutic singing with songs like “She'll Be Coming Around the Mountain” with older adults to create an environment where isolation dissipates. During this intervention, the music therapist may ask one client to name a place that they have visited and then the new lyrics will be filled into the song. Once the song has been sung, the music therapist will ask if anyone in the group has visited the place and items they remembered while visiting there. This technique of asking others attending the group, allows for a connection between patients to begin and conversations to continue following music therapy. 

In conclusion, group singing creates an environment that allows for music therapy techniques of reminiscence and self-expression to be evoked in most individuals through client preferred music. Music therapy and group singing allows for older adults to feel connected to the people around them.

-Michaela Shockcor, Music Therapy Intern

Resources

Alzheimer’s Association. (n.d.). What is Alzheimer’s? Retrieved from 

https://www.alz.org/alzheimers-dementia/what-is-alzheimers

COPD: Everything you need to know about chronic obstructive pulmonary disease: Everyday health. (2019, July 01). Retrieved from https://www.everydayhealth.com/copd/guide/

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

Elefant, C., Baker, F. A., Lotan, M., Lagesen, S. K., & Skeie, G. O. (2012). The effect of group music therapy on mood, speech, and singing in individuals with Parkinson’s disease- A feasibility study. Journal of Music Therapy, 49(3), 278-302. doi: 10.1093/jmt/49.3.278

Heyn, S. N.,& Davis, C. P. (n.d.). Parkinson’s Disease Early and Later Symptoms, 5 Stages, and Prognosis. Retrieved from https://www.medicinenet.com/parkinsons_disease/article.htm

Lesta, B., & Petocz, P. (2006). Familiar group singing: Addressing mood and social behavior of residents with dementia displaying sundowning. Australia Journal of Music Therapy, 17, 2-17. 

Stegmoller, E. L., Hurt, T. R., O’Connor, M. C., Camp, R. D., Green, C. W., Pattee, J. C., & Williams, E. K. (2017). Experiences of persons with parkinson’s disease engaged in group therapeutic singing. Journal of Music Therapy, 54(4), 405-431. Doi: 10. 1093/jmt/thx012

World Health Statistics 2014. (2014, May 15). Retrieved from https://www.who.int/mediacentre/news/releases/2014/world-health-statistics-2014/en/

social stories

The term Autism Spectrum Disorder “refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication” that affects approximately 1 in 59 children in the United States (Autism Speaks, n.d.). Signs of the disorder begin to appear around the age of 3 but may be present as early as 18 months.  As a spectrum disorder, Autism presents itself in many ways. The two most common symptoms of Autism are: 1. interpersonal challenges such as difficulty recognizing/interpreting emotions and eye contact and 2. restricted and repetitive behaviors like hand flapping and rocking (Autism Speaks, n.d.). The cause of Autism is unknown. Environmental factors such as birth related complications may increase risk but research shows that there are both genetic and environmental components that factor into the Autism diagnosis. (Autism Speaks, n.d.). 

In 2015, the National Autism Center named music therapy as an “emerging intervention” for Autism treatment (AMTA Strategic Priority Group). Common goals include improvement of language/communication, behavioral/psychosocial, cognitive, perceptual, and motor skills (Autism Spectrum Disorders, 2010). Music therapy goals are based on an assessment that measures a client’s strengths, weaknesses, and preferences while considering the family’s priorities. The assessment is used to measure a client’s baseline through musical interventions and then develop a treatment plan (AMTA Strategic Priority Group, 2015). 

Music interventions like instrument play help to improve social skills and interpersonal interactions. Other common interventions include songwriting and lyric analysis. These interventions help with idea development and creativity (Autism Spectrum Disorders, 2010). Research shows that music therapy helps improve communication, attention span, fine and gross motor skills, interpersonal skills, responsibility, emotional expression, and play.

Musical social stories can also help change behaviors and teach new skills (AMTA Strategic Priority Group, 2015). A social story is a short story that plainly states the steps of an activity or a target behavior. It may also tell relevant information such as who, what, when, or where an activity takes place (Brownell, 2002, p.121). Social stories may be a task analysis of a specific activity like brushing teeth or an activity schedule that goes through the steps of a morning routine (Schwartzberg & Silverman 2013, p. 331). The first step to creating a social story is identifying a goal or target behavior and measuring the baseline. Once a goal is established and data has been collected, a story can be written using “descriptive, directive, perspective, and control” sentences (Brownell, 2002, p. 122). Social stories can then be implemented in music therapy sessions to address target behaviors.

The following is an example of a musical social story:

Music therapy is able to use social stories and can “lead to improved comprehension and generalization of targeted social skills (Schwartzberg & Silverman, 2013, p. 334).When a story is presented to a client it is best to have between one and three sentences on each page with a picture. As the story is read to the client, demonstrate the appropriate behaviors and prompt the client to follow along (Brownell, 2002, p.123). Social stories can be read like a book or sung like a song. When creating a new social story, the lyrics and tune can be original or they can be written “piggyback” style where the therapist selects a familiar, memorable tune and creates new words. Brownell’s research found that when read, social stories increased target behaviors such as appropriate greetings and parallel play and decreased undesirable behaviors such as aggression. This research found that when sung, social stories increased target behaviors at an even higher rate (2002, p.121). Schwartzberg and Silverman’s study found anecdotal evidence that music based social stories were “enjoyable,” “catchy,” and transferable to daily life (2013, p. 334). 

In closing, music therapy uses social stories to address goals such as communication, behavior, and cognitive skills. Social stories teach behaviors or new skills that can be used at home or school to prompt desired behaviors. Musical social stories are set to an easily singable tune. This musical quality makes the social story memorable and transferable to other settings which helps the client be successful in and out of music therapy.


-Rachel Buchheit, Music Therapy Intern

References

AMTA Strategic Priority Group. (2015, August 26). Fact sheet: music therapy and Autism Spectrum Disorder (ASD). American Music Therapy Association. Retrieved from https://www.musictherapy.org/assets/1/7/Fact_Sheet_ASD_and_MT__8-26-15.pdf

Autism Speaks. (n.d.).What is Autism? Retrieved June 26, 2019, from https://www.autismspeaks.org/

Autism Spectrum Disorders: Music therapy research and evidence based practice support. (2010). American Music Therapy Association. Retrieved from

https://www.musictherapy.org/assets/1/7/bib_autism10.pdf

Brownell, M. (2002). Musically Adapted Social Stories to Modify Behaviors in Students with Autism: Four Case Studies. Journal of Music Therapy, 39(2), 117-144.

Schwartzberg, & Silverman. (2013). Effects of music-based social stories on comprehension and generalization of social skills in children with autism spectrum disorders: A randomized effectiveness study. The Arts in Psychotherapy,40(3), 331-337.

Meet Ms. Michaela!

Hello! My name is Michaela Shockcor and I am thrilled to be joining the Therabeat team as a music therapy intern. I am from Columbus, OH and recently finished my academic course work at Ohio University. Some of you may be wondering why a new college graduate packed up and moved her life 10 hours away, and here’s the reason why. While at Ohio University, I worked with multiple populations, but always felt my heart belonged working with children and adolescents. For the past few summers, I have been a teacher's aid to a transition classroom and enjoyed every minute of my experience there. When an intensive search began for various music therapy internships, a professor recommended that I contact the Therabeat team. So, I did and thoroughly enjoyed everything this program had to offer. From advocacy to music recitals, Therabeat will allow me to form my personal music therapy style and voice, as well as become a well rounded individual with all of the lessons I will learn

Amid my first week here, I have felt welcomed by everyone I have met and it’s just the beginning! From observing occupational, physical, and speech therapy to meeting everyone during music therapy, I am forming new relationships and learning so much. The various teaching styles each therapist bring to their sessions has allowed for new techniques and a greater understanding of why we do what we do. To learn from a teacher is wonderful, but to learn things from a child is even better. During internship, I hope to gain a greater love for music and working with children and adolescents, as well as immense growth in my music therapy skills and techniques. I am someone who is always willing to push myself in new opportunities, in order to become better than I was before.

I can tell that Therabeat and In Harmony Pediatric Therapy will keep my on my toes with new adventures and opportunities each and every day!

-Michaela Shockcor, Music Therapy Intern

Meet Ms. Rachel!

Hello! My name is Rachel Buchheit and I recently finished my course work at Belmont University in Nashville, TN. During my time at Belmont, I had the opportunity to work with various populations including older adults, inpatient psych, and kids with special needs. Also, as a double major in church music I have spent the last two years working in a church where I worked with children, youth, and adult handbell choirs and vocal ensembles. 

One of the reasons I was drawn to Therabeat as an internship site was the amazing team. I am so excited to be able to observe and work with the eight music therapists and learn from their different styles. I can’t wait to see each therapist in action and learn more about the different aspects of running a private practice. Another reason I was drawn to Therabeat was because of the variety of services offered. Therabeat offers both individual and group sessions as well as adaptive music lessons for various ages.

My first day at Therabeat was the recital last Saturday. It was awesome to see all of the kids sing, dance, and play. They were amazing! During my first week at Therabeat I have been able to observe individual music therapy sessions as well as the Little Beats group, the Marietta Enrichment Center group, and the Tots class. I also had the chance to observe a few co-treats of music therapy and physical therapy. Outside of this, I have been observing in the physical and occupational therapy gyms and will be observing speech therapy in the coming weeks. 

I look forward to meeting all of the kids and their families and getting to see them grow over the next six months. I am thrilled to be working with the team at Therabeat!

-Rachel Buchheit, Music Therapy Intern

The Role of Music Therapy for Adolescents in School

High school can be difficult, but for a teenager with special needs, there are many more obstacles that can affect his/her success in a classroom. A person with special needs may have trouble processing academic concepts, processing directions, working well in a group setting, or staying on-task. Research suggests that music therapy is indicated to promote skills needed for success in the classroom.

In an article on the effectiveness of a music therapy social skills program in a private school, music therapists focused on integrating peer-relations and self-management skills into the classroom (Gooding, 2011, p. 440). Just as it takes time to establish a new habit, it takes time to learn social skills. Research shows us that learned social skills are more likely to grow with evidence-based programs such as music therapy. When desired skills are rehearsed and reinforced, they are likely to occur more often. Music therapy interventions such as movement to music, improvisation, or problem solving provide students opportunities to interact with peers and reinforce appropriate social skills (p. 444). Results from this study indicate that there were improvements in social competence in adolescents with social deficits (p. 440).

In this particular article, the students attended a school designed to meet their specific needs, but there is also research on the use of music therapy in public schools. The benefits of music therapy have been documented to reduce severely inappropriate behaviors, increase on-task behaviors, and teach social skills (Presti, 1984, p. 118). Music therapy interventions were used to provide opportunities for successful achievement of both behavioral and musical goals. For example, group cooperation skills may be targeted through playing a tone bar song together. Each student has a tone that corresponds to different parts of the song. On their own, it may seem like just one note, but together, they each contribute an equal part to the ensemble. If a music therapist was working on improving turn-taking skills in a group at a high school, he/she may use an intervention such as instrument soloing. Music can structure a turn-taking task by aloting turns for each student to play individually. Music is naturally rhythmic, so there is consistency to both waiting and playing. The structure becomes expected, which can decrease negative behaviors while increasing cooperative behaviors.

Whether it be in private or public schools, already existing music therapy programs are providing musical experiences to work toward a common goal: success! Music adds motivation, structure, and consistency to tasks. Wanted behaviors increase when they are reinforced over the course of time. When group cohesion and on-task behavior become consistent in the music therapy setting, these skills inherently become more consistent in the classroom setting. In this way, school music therapy programs are indicated to make the tough high school years less of a stress and more of a success!

-Anna Carter, Music Therapy Intern

Gooding, L. F. (2011). The Effect of a Music Therapy Social Skills Training Program on Improving Social Competence in Children and Adolescents with Social Skills Deficits. Journal of Music Therapy, 48(4), 440-462.

Presti, G. M. (1984). A Levels System Approach to Music Therapy with Severely Behaviorally Handicapped Children in the Public School System. Journal of Music Therapy,21(3), 117-125.