MT for Adults with TBI

The brain is made up of three main sections: the cerebrum, cerebellum, and brain stem. Together these sections make up the central nervous system that helps to transfer electric signals to the rest of the body. Within the cerebrum, there are four lobes that are responsible for different brain functions different jobs that are focused within the lobes. The frontal lobe is where Broca’s area is located, known to help control expressive speech and language. The frontal lobe also has an effect on music and the ability to sing. The temporal lobe is home to Wernicke’s area, which is responsible for the auditory processing and the comprehension of speech. This area of the brain is vital to language because impulses from the auditory system create an electrical signal-producing sound. Classic parietal lobe functions include sensory integration, memory retrieval, and mental rotation. In the domain of music, these mental functions translate to cognitive and perceptual manipulations with musical materials, such as learning and memory of sequences of pitches and rhythms. The supramarginal gyrus, near the temporal-parietal junction, is a region within the parietal lobe that has appeared in several studies on learning and memory. Activity in the supramarginal gyrus was significantly associated with memory performance, especially in musically trained subjects (Gabb, 2006). The occipital lobe is responsible for vision and visual perception.

 There is a theory that a person can be either “right-brain dominant” or “left-brain dominant.” The right side of the brain is connected with artistic expression and creativity, while the left brain is connected with logical and verbal skills. This has led people to assume that musical abilities and engagement are only connected to the right side of the brain. While there is no proof to back up this theory, there is robust evidence that music is involved with all parts of the brain because melody & rhythm—the elements of music—stimulate both sides of the brain at one time. The left hemisphere is involved with skills such as rhythmic sequences and identification from the premotor cortex, instrument play, and reading music. The right side focuses on pitch and timbre quality recognition, melodic representation, performance skills and the ability to track rhythm. While it is true that the right side of the brain is heavily involved in music-making or music-listening in regards to analyzing pitches and creative expression--music involves both sides of the brain as well as the cerebellum. This increases the ability for the sides to “communicate” with one another.

Because different aspects of music are located in many different spots (are process by different spots rather than “lcoated”) along both hemispheres of the brain, music can be used to help aid patients with traumatic brain injuries (TBI)  by creating new neural pathways in the brain to relearn skills lost due to damaged areas of the brain to create new ways of relearning where old neuron pathways are no longer functioning. (Thompson, 2014 does this citation belong to the prviosu sentence? ) Webster (1806) defines a traumatic brain injury as a “non-degenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness”. Period goes inside quotation. TBI arises when the mechanics within the frontal lobe are not able to regulate the controls it was designed to control. These injuries threaten the function of neurological, physiological, cognitive, psychological and social dysfunction (Vik, Skeie, Vikana, Specht, 2018).

Because of the drastic life change, depression is a common side effect for those working through the process of rehabilitation with a TBI. Patients become withdrawn and apathetic to the rehab process. These feelings prevent engagement in social relationships, meaningful interaction, and commitment to the rehab process. By adding music therapy into these patients’ rehab team opportunities can decrease agitation and increase relaxation by helping focus on eye contact and relearning language and daily activities. Patients are given multiple different types of therapy each supporting the client’s growth through different means of structure. 

Music Therapy is defined as “the therapeutic application of music to cognitive, sensory, and motor dysfunctions due to disease of the human nervous system” (Magee, 2005). Like other therapies, there are different techniques used to use music as a form of rehabilitation, but one therapy style continues to be utilized with those diagnosed with a TBI. Neurologic music therapy is defined as an advanced form of music therapy that utilizes evidence-based techniques to treat the brain. (Magee, 2005) These techniques emphasize the use of music and rhythm to achieve non-musical goals in the areas of cognition, physical movement, and speech (Gardiner & Horwitz, 2015). 

Neurological music therapy (give NMT acronym here after stating what it is the first time) focuses on research which has demonstrated that music and rhythm affect many different areas of the brain at the same time, and the brain that engages in music is actually changed by that engagement (Baker, 2007). Music can help build new neural connections in the brain through experience and exposure which improves rehabilitative potential and the ability to create new neural pathways after trauma or injury. This allows individuals to lead more productive and functional lives. “Research has shown rhythmic cues provide comprehensive optimization information to the brain for re-programming movement. This makes it important that patients enter the rhythmic period because the period template contains critical information to optimize motor planning and motor execution” (Thaut, Mcintosh, & Hoemberg, 2015). Introduce and fold the quote in--prepare the audience for what you are talking about like “in a 2015 essay about NMT research Thaut, Mcintosh, and Hoemberg explain the use of rhythm in motor planning: “

In 2005, Magee began to study case studies of patients of all ages with varying severity of TBI injuries and observe the effect music therapy had on the individuals. She found treatments that place “greater emphasis on relationship factors may be more likely to engage and or re engage patients with TBI who are resistant to behavior change.” (Magee, 2005 pp.5). For example, a music therapist worked with a forty-four-year-old man 14 months post-TBI. It was noted he had no regular visitors and no family for support. At the beginning of therapy, the music therapists could not stay longer than two minutes before J would become abusive and the therapist would need to leave for her safety. When the therapist noticed J's main habit of smoking, she used this as a way to communicate. The therapists and client began to write songs about what smoking made him feel and escape from. After 6 months of therapy, J went from a 2-minute session to a 45-minute session. Nurses confirmed J was calmer and had learned an outlet to channel frustration, songwriting (Magee, 2005). Comma doesn’t work after fruststration, Use an em dash “frustration--songwriting” 

Music therapy targets pragmatic communication skills such as turn-taking, listening, and eye contact. Evidence of music’s ability to increase attention, memory, and executive function, all are features of neurobehavioral disorders, have been tested with varying clients. M. is a 26-year-old man who sustained a severe TBI in a motor vehicle accident. Becoming agitated upon any movement or sound in his room, the music therapist focused on using music to reduce agitation. Music was tailored to match M’s behavior. M. did not react well to music in the beginning, but over the next five sessions, he improved becoming more alert and conscious of his surroundings and was beginning to make eye contact with the therapist. Two weeks later he began to sing and tap along to the music, attempting to communicate with the therapist. Music listening was found to enhance cognitive recovery and mood of individuals who have recently experienced a middle cerebral arterial stroke, and greater orientation and abilities to learn and retain new information. Separate those two sentences “Music listening was also show to lead to great orientation..” Patients can become more aware of and engage in strategies that increase their attention and tolerance levels. Music can be used as a way to recall information like creating a song to know how long to brush your teeth or how to get dressed in the morning. Rhythm and melody provide structure to organize, chunk and remember verbal information. (Magee, 2005)

Music’s ability to be used globally throughout the brain gives music therapy the power to be a successful source in the rehabilitation process. Studies have extensive research confirming the benefits of music-supported therapy in other areas of neurologic music therapy (Vik, Skeie, Vikana, Specht, 2018). Music therapy continues to recreate nerve pathways that have become blocked or destroyed by brain injury giving patients a new way to do old activities. Music gives structure to clients who need to be reminded how to brush their teeth, walk with proper gait, and need a positive outlet of expression. Depression and anxiety are common with TBI, but with music, clients are able to move past the difficult transition into a new way of living with coping activities and support groups. It is important that continual research is conducted in the field of neurological music therapy is needed to continue to make connections with music’s ability to be used as a new way to “rewire” pathways severed in the brain. Fix this last sentence--not sure what you were trying to say, but I think if you read it out loud, you will hear that it has some grammatical errors and doesn’t quite make sense. Also the NMT does conduct continual research--maybe here just suggest some resources/journals that people can read to be updated on current research.

-Macy Fehl, Music Therapy Intern

References

Baker, M., (2007). Music moves the brain to pay attention. In M. T. van Dijk, A. A. Fenton (Eds.), Neuron (pp. 832–845). Amsterdam, Netherlands: Elsevier Inc.

Gaab, N., Schulze, K., Ozdemir, E., & Schlaug, G. (2006). Neural correlates of absolute pitch differ between blind and sighted musicians. Neuroreport, 17(18), 1853–1857. 

Gardiner, J. C., & Horwitz, J. L. (2015). Neurologic music therapy and group psychotherapy for treatment of traumatic brain injury: Evaluation of a cognitive rehabilitation group. Music Therapy Perspectives, 33(2), 193-201. doi:10.1093/mtp/miu045

Magee, W., & Baker, M. (2009). The use of music therapy in neuro-rehabilitation of people with acquired brain injury. British Journal of Neuroscience Nursing, 5(4), 151-156.

Magee, W. (2005). Music therapy methods with children, adolescents, and adults with severe neurobehavioral disorders due to brain injury. Music Therapy Perspectives, 29(1), 5-13.

Vik, B., Skeie, G., Vikana, E., Specht, K. (2018). Effects of music production on cortical plasticity within cognitive rehabilitation of patients with mild traumatic brain injury. Brain Injury, 32(5), 634-643. doi:10.1080/02699052.2018.1431842

Thaut, M. H., Mcintosh, G. C., Hoemberg, V. (2015). Neurobiological foundations of neurologic music therapy: Rhythmic entrainment and the motor system. Frontiers in Psychology, 5(1) doi:  10.3389/fpsyg.2014.01185

Thompson, W.F. (2014). Music, thought, and feeling: Understanding the psychology of music (2nd ed.). New York: Oxford University Press.

This is Your Brain on Music: The Science of Human Obsession by Daniel J. Levitin

MT in the NICU

Music Therapy for Premature Infants in the NICU

Every year, approximately 9.6% of infants in the United States, and 15 million worldwide are born prematurely (Scott et al., 2018). For those born prematurely, many are diagnosed with illnesses or disabilities that hinder physiological and mental development. Several studies have been conducted to gather data in an attempt to improve the well-being of parents who have an infant in a neonatal intensive care unit, as well as increase the premature infant’s health (Ettenberger et al., 2017). By using several approaches, music therapy is proven to have positive effects not only on the health and development of these infants but on the parents and the parent-child relationships as well (Haslbeck, 2012).

         The neonatal intensive care unit, also commonly referred to as the NICU, is home to many infants born prematurely, or before 37 weeks (O’Toole et al., 2017). Premature infants have a lower survival rate since they are not able to fully mature during the remainder of the third trimester, a vital time for organ maturity (Haslbeck, 2012; O’Toole et al., 2017). Unfortunately, there are several stressors in the NICU that can harm infant growth. Besides having difficulties feeding and motor abilities, infants are often overstimulated by sound. This is putting infants in situations of sensory overstimulation that can overstress their bodies. Infant overstimulation can have detrimental effects on their health and should be further considered during interactions with family and doctors, as well as therapies and techniques for premature infants. Besides potentially harmful NICU environments, premature infants often develop neurological disabilities, developmental disabilities, and behavioral problems (Scott et al., 2018). Since they are more susceptible to neonatal illnesses such as intraventricular hemorrhage or sepsis, they are at a higher risk for these long-term effects. Along with these risks, individuals born prematurely were found to have behavioral problems involving internalizing, externalizing, and attention which increased social withdrawal and depression, lower academic performance, increased attention deficit hyperactivity disorder, and aggression compared to those born non-prematurely (Scott et al., 2018). According to Aylward (2005), over 50% of low birth weight infants will need special education, up to 20% will repeat grades, and 16% to 47% will experience symptoms of attention deficit hyperactivity disorder. Even though the odds of these problems increase for these infants, the cause-effect relationship between birth weight and cognitive disorders can be confounded by other factors related to those conditions.

         Music has potential to drastically affect the body in psychological and physiological ways, especially for infants. Through methods of reporting and physiological measurements, music has been proven to lower the perception of pain, positively affect heart rate, increase learning and behavior, lower stress levels, and produce more desirable states (Haslbeck, 2012; O’Toole et al., 2017). These positive aspects of music stimuli affect the development of infants by reducing physical stressors on their bodies and increasing brain maturity. One important effect is an increase in oxygen saturation level. Cevasco and Grant (2005) conducted a two year study of 188 infants that investigated several factors regarding music, specifically lullabies, and premature weight gain. Although weight gain prior to post intervention in the hospital was not statistically significant, their results found that music provided positive sucking patterns for infants, increasing oxygen saturation level. Increased levels of oxygen saturation lead to better eyesight, calmer states, faster times to fall asleep, increased initiation of nutritive sucking, and faster weight gain. Furthermore, the researchers found infants who listened to lullabies had lower weight loss, lower behaviors of stress, and a short length of stays in isolettes, NICU, and hospital overall due to the positive impacts on oxygen saturation rate, as well as heart and respiratory rates.

         With music being a universal healing method, techniques in the field of music therapy became popularly used for premature infants in the NICU as well as in various other settings. Due to the challenges that can arise while being in a NICU setting, such as overstimulation, music therapists’ have to be NICU-MT certified to practice in the NICU. In the neonate setting, music therapy is used “as an intervention based on music and auditory stimulation that incorporates musical elements such as rhythm and melody or sounds based on the acoustic intrauterine environment...used by either music therapists or other healthcare professionals in neonatal care” (Haslbeck, 2012, p. 205)

(Miami Herald, 2019)

One big challenge that families can face while their baby is in the NICU is feeding. In order to go home from the NICU, babies need to be able to receive their nutrients by not fully relying on gavage feedings (forced feedings). Jayne Standley, a music therapy professor at Florida State University, knew that feeding in the NICU could be a long and difficult process, and she decided that she was going to find a way that music could help the baby progress. The Pacifier-Activated-Lullaby (PAL) is a music therapy method developed by Jayne Standley to promote non-nutritive sucking (sucking when there is no fluid being produced) for infants, therefore leading to better nutritive feeding abilities and self-regulation (Haslbeck, 2012; Standley et al., 2010). The PAL uses electrical signals to an attached cassette and provides music only when an infant sucks, growing the suck-swallow-breathe reflex that is essential to weight gain and growth (Haslbeck, 2012). The original researcher conducted a randomized study that included three trials with 68 premature infants, and the results showed a shorter length of gavage feedings as well as female infants learning how to nipple feed faster than male infants (Standley et al., 2010). Additionally, Cevasco and Grant (2005) studied the PAL music therapy method in their two year study. By placing speakers in the corners of infants’ isolettes or cribs, infants were assigned to four groups corresponding to the number of trials, and each used the PAL for fifteen minutes per trial. The researchers studied their suckling in an attempt to see if it went along with the music, specifically how many times they stopped, and for how long. Despite not reaching statistical significance and having music played at 65 dB, which is above the recommended level, infants increased their sucking time, showed improvement in learning, coordination, and endurance. Furthermore, Cevasco and Grant (2005) found infants using the PAL stayed awake and alert, but still calm, after feedings instead of agitated or sleepy like those not using PAL.

         In recent studies of music therapy in the NICU, researchers have begun to focus on the effects of using the mother’s voice and its comparison to recorded singing. Cevasco and Grant (2005) conducted a study with the PAL and found that infants, even as young as one day old, increased their sucking rate when hearing their mother’s voice compared to another female's voice. Similarly, Haslbeck (2012) found live music of female voices to be more beneficial than recorded, engaging the infant to enjoy an activity with the mother and initiate a bond between them. 

         Parents with premature infants in the NICU can have several concerns that impact their mentality as well as their relationship with their infant. After observing hospitalized children separated from their parents in the 1930s, John Bowlby and Mary Ainsworth developed attachment theory which showed infant-parent bonding as essential to healthy development (Bretherton, 1992). Despite often being focused on the child’s relationship with the mothers, there have been other studies suggesting alternate figures such as fathers, siblings, and daycare providers can provide the satisfaction of an intimate relationship that an infant needs in its first year of life (Bretherton, 1992). Infant-parent bonding is difficult for premature infants in the NICU since parents are often physically separated from their infants through isolettes or rooms. This physical separation along with parent’s trauma and emotional struggles due to the end of pregnancy, survival uncertainty, and feelings of fear and guilt can cause negative parental stress, affecting their attachment process (Haslbeck, 2012).

         Two common methods - kangaroo care and kinesthetic stimulation - are often used in the NICU to help with the attachment process. Kangaroo care provides premature infants with skin-to-skin contact with parents, often lying on their chests. Haslbeck (2012) also stated if an infant is too fragile to be touched, kinesthetic stimulation allows for rocker-beds to sway infants’ mattresses back and forth, often timed with music that is played through the crib. This added element of music can provide additional development and growth that would not be achieved with the methods alone. In addition to standard care such as kangaroo care and kinesthetic stimulation, music therapy benefitted infants’ feeding habits overall (O’Toole et al., 2017). Having positive feeding habits helps babies in the NICU go home sooner, and being well enough to go home is what you want to help with bonding. In Ettenberger et al. (2017), a treatment group using music therapy along with kangaroo care was compared to a control group of standard care alone. Although the study with thirty-six infants was not statistically significant, the infants in the music therapy group went home approximately 60 days sooner and reported 50% re-hospitalizations four months after discharge than the group without music therapy.

         Different music therapy techniques can not only benefit the infant, but also benefit parents and the relationship with their infant. Whipple (2000) used observation of interaction through stress behaviors and parent self-reports of twenty sets of parents and premature, low birth weight infants, to see if training parents with an hour of music instruction and techniques would affect interaction. The study found parents with the instruction reported spending more time with their infants as well as shorter hospitalization stay and greater weight gain. However, the results were not statistically significant due to the small sample size and a follow-up one month after discharge showed little difference between the control and experimental groups. Without knowing what the home environment was after discharge, further research with longitudinal studies could show how increased parent training could provide long term benefits.  Promoting parental presence through music therapy can encourage bonding and lower anxiety and fear that comes with being in a hospital environment (Ettenberger et al., 2017; O’Toole et al., 2017). Translating those skills to the home setting is essential for continuing the benefits of music therapy after being discharged from the hospital.

Many babies in the NICU are diagnosed with illnesses or disabilities that hinder physiological and mental development. The NICU environment can be very stressful for the babies and their families. There are many positive aspects of music stimuli, such as increased learning and behavior and lower stress levels, that affect the development of infants by reducing physical stressors on their bodies and increasing brain maturity. Music therapy can be an essential part of the growth and development for a baby in the NICU.

-Amanda Brennen, MT Intern

References

Aylward, G. (2005). Neurodevelopmental outcomes of infants born prematurely. Journal of

Developmental and Behavioral Pediatric, 26(6). 427-440.

https://doi.org/10.1097/00004703-200512000-00008

Barfield, D. (May 2, 2019) Music Therapy In NICUs Can Help Babies Get Home Sooner. [Photograph]. Miami Herald.

Bretherton, U. (1992). The origins of attachment theory: John Bowlby and Mary

Ainsworth. Developmental Psychology, 28(5), 759-775.

https://doi.org/10.1037/0012-1649.28.5.759

Cevasco, A. M. & Grant, R. E. (2005). Effects of the pacifier activated lullaby on weight gain of

premature infants. Journal of Music Therapy, 42(2), 123-139. https://doi.org/10.1093/jmt/42.2.123

Ettenberger, M., Cárdenas, C. R., Parker, M., & Odell-Miller, H. (2017). Family-centred music

therapy with preterm infants and their parents in the neonatal intensive care unit

(NICU) in Colombia – A mixed-methods study. Nordic Journal of Music Therapy, 26(3),

207-234. https://doi.org/10.1080/08098131.2016.1205650

Haslbeck, F. B. (2012). Music therapy for premature infants and their parents: An integrative

review. Nordic Journal of Music Therapy, 21(3), 203-226.

https://doi.org/10.1080/08098131.2011.648653

O’Toole, A., Francis, K., & Pugsley, L. (2017). Does music positively impact preterm infant

outcomes? Advances in Neonatal Care, 17(3), 192-202. https://doi.org/10.1097/ANC.0000000000000394

Scott, A., Winchester, S. B., & Sullivan, M. C. (2018). Trajectories of problem behaviors from 4

to 23 years in former preterm infants. International Journal of Behavioral Development,

42(2), 237-247. https://doi.org/10.1177/0165025417692899

Standley, J .M., Cassidy, J., Grant, R., Cevasco, A., Szuch, C., Nguyen, J., Walworth, D.,

Whipple, J. (2000). The effect of parent training in music and multimodal stimulation on

parent-neonate interactions in the neonatal intensive care unit. Journal of Music Therapy, 37(4), 250-268. https://doi.org/10.1093/jmt/37.4.250

Music Therapy & Sexual Abuse/Domestic Violence

  Research has shown that music can be a powerful tool for growth and healing. Music therapists reach a broad range of people with varying needs and disabilities. One population that often falls through the cracks are women and children that suffer through sexual abuse and domestic violence. The National Domestic Violence Hotline (2019) cites statistics that show that IPV affects more than 12 million people each year, and females 18 to 34 experience the highest rates of IPV. They also state that “30 to 60% of perpetrators of intimate partner violence also abuse children in the household” (National Domestic Violence Hotline 2019).  Numerous studies, such as “Exploring Negative Emotion In Women Experiencing Intimate Partner Violence: Shame, Guilt, And PTSD” and “Intimate Partner Violence Exposure In Early Childhood: An Ecobiodevelopmental Perspective,” have suggested the negative effects IPV can have on a person and the lifelong trauma it can cause. Many of these women and children end up in shelters after leaving their partners. This presents a dire need of services to help meet the needs of their daily lives, as well as cope with the trauma they have faced. Studies have been done on various music therapy methods, “The Bonny method of guided imagery and music with intimate partner violence” (Hahna 2004)  and “Supportive Music And Imagery With Sandplay For Child Witnesses Of Domestic Violence: A Pilot Study Report” (Kang, 2017) suggests that music therapy is an effective tool and way for people to deal and recover from trauma. 

Trauma can look different for everyone but many women will often suffer from issues of self-esteem, anxiety, identity crisis and high levels of depression (Juan, 2016). A 2016 study discussed the use of music therapy for 17 women who had survived IPV from a cultural perspective. Music Therapy techniques used included group music presentation, improvisation, etc. Data was collected based on client self-report following music therapy interventions. Participants in this study expressed increased self-discovery, and ideas to improve upon those insights. The stimulation of images and sensations through sound (SISS) is one of the music therapy interventions used in this study and “This article highlights the results of working with songs, instruments and with the SISS technique as an aid for bringing about indirect catharsis” (Juan, 2016, p. 22). SISS “Involves listening to a sequence of recorded musical fragments of varying durations designed by the music therapist for a given patient’s or group’s unique situation” (Juan, 2016, p. 22). The idea of this technique is that each sequenced musical stimuli will stimulate memories that the patient may have repressed unconsciously. 

Researcher Huan-Jun Kang conducted a pilot study to examine the use of supportive music and imagery with sandplay as a technique to improve emotional and behavioral adaptability for children who had witnessed IPV(2017). The Participants were three children living in a domestic violence shelter. Kang conducted research on how supportive music and imagery with sandplay is an effective technique to use with children. The results found that self expression increased with this therapeutic technique. Kang’s research states that “the findings demonstrated that the intervention of Music and Imagery with sandplay could have a positive effect on the improvement of children’s self expression” (Kang, 2017, p. 77). A case study in 2013 conducted by Pasiali on family based therapy with children who have been exposed to IPV or experienced domestic violence stated that progress was slow but this could be due to time constraints and the length of time it may take to re-establish bonds between children and parents after they have had such negative experiences (Pasiali, 2013, p. 261). Healing can take time, but the end result is worth it.

Based on this research found, it is evident that music therapy is a need for this population and should be more readily available to those in shelters. Given that these studies have a small sample size and are qualitative, there is a need for more research in order to build a strong body of evidence-based clinical techniques. More quantitative research should be done so that the argument for music with this population can be backed up. However, from the small research found, it is clear the profound effect music can have for survivors of IPV. Having it available in shelters would greatly affect the IPV cycle and help these survivors get on their feet again. 

-Sara Demlow, Music Therapy Intern

References/Sources 

Beck, J., Mcniff, J., Olsen, S., Avery, M., Hagewood, J., (2011). Exploring negative emotion in women experiencing intimate partner violence: Shame, guilt, and PTSD. Behavior Therapy, 42, 740-750. http://dx.doi.org10.1016/j.beth.2011.04.001

Hahna, N. & Borling, J. (2004). The Bonny method of guided imagery and music with intimate    partner violence. Journal of the Association for Music Imagery, 9, 41-57. 

De Juan, T. F. (2016). Music therapy for women survivors of intimate partner violence: An intercultural experience from a feminist perspective. The Arts in Psychotherapy, 48, 19-27.

Kang, H. J. (2017). Supportive music and imagery with sandplay for child witnesses of domestic violence: A pilot study report. The Arts in Psychotherapy, 53, 72-79. 

Pasiali, V., (2013). A clinical case study of family-based music therapy. Journal of Creativity in Mental Health, 8, 249-264. http://dx.doi.org10.1080/15401383.2013.821925 

Smith, R., (2012). Intimate partner violence exposure in early childhood: An ecobiodevelopmental perspective. Health and Social Work, 38, Issue #4, p.231-239.  http://dx.doi.org10.1093/hsw/hlt018

National Domestic Violence Hotline (2019). Statistics. (n.d.). Retrieved from       https://www.thehotline.org/resources/statistics/

Pediatric Music Therapy

The Pediatric population deals with children and their different diagnoses. Normally the considered age range for pediatric patients is 0-18, but that does not mean those above the age of 18 could not fall in the category. Pediatric caretakers are specially trained to take care of the physical, mental, and behavioral needs of your child. The more facilities begin to see the effects that music can have on growth in children of all ages and diagnoses, the more music therapy is being offered in pediatric settings. Over the past 10 years, there has been a tremendous growth of research being reported showing statistically sound studies showing the benefits of music therapy in pediatric settings.

In 2014, a hospital began to keep records of families' responses to their experience with inpatient music therapy on Pediatric Oncology. A 15-question survey (5-point Likert scale) was developed and distributed to all patients who received music therapy during their inpatient hospitalization from 2008 to 2010 totaling 53 surveys. The questionnaire focuses on patients' improved mood, a decrease of depression and anxiety, an increase in socialization in hospital settings, and overall coping of inpatient stay through music therapy. In the patient/family feedback survey, parents highlighted family bonding as the most important component in relation to clinical outcomes, followed by assisting with their child’s coping abilities and providing an avenue for self-expression. I firsthand have seen the effect music therapy can have while on patients who are coming in for chemotherapy and radiation treatments. Music is used to help families and patients process and cope with a new diagnosis and the different procedures and difficult journeys ahead. Music is used to help patients express how they are feeling and create a new way to process that information. Patients enjoy learning instruments and gaining skills that they can take with them outside the hospital. Some patients use music as a tool for relaxation and to decrease anxiety over different procedures and tests re-recording music patients have created or learned to have available to them when they need it. 

Photo is from Arkansas Children's Hospital's MT Program

Another hospital in Australia created a study with the results gathered from music therapy in their inpatient settings. The hospital staff wanted to address the ongoing difficulties of long-term patients struggling with anxiety, depression, stress and increased pain patients experience while undergoing extensive medical treatments impacting the quality of life. The hypotheses for this study are: Music Therapy enhances the mood of patients in inpatient settings. Music Therapy reduces pain, stress, depression, and anxiety of patients in inpatient settings. While running the experiment researchers found when music is introduced as one form of distraction, the neural gates regulating pain can be partially closed, causing a decrease in the transmission of sensory signals of pain to the brain which results in an overall decrease in pain perception. 

Results showed this experiment has provided evidence that mood level can be elevated, and pain levels can be reduced by the application of receptive music therapy.

Integrating music therapy in palliative care has continued to increase within interdisciplinary teams helping to encourage positive coping, as well as to reduce stress and anxiety during hospitalization. Palliative care teams are made up of the patient, family, medical staff, and other multidisciplinary team members to create a care plan for the patient with realistic goals, hopes, and wishes for the patient. Their goal is to help patients and families, and they begin to process and walk through disorders with uncertain prognosis helping to create an environment where the families and patients still feel they have control of the situation.  

Songwriting, lyrical analysis, and memory-making during end of life situations are beneficial for creating a healthy environment. Legacy building activities are tangible representations of memory with the patient through poetry, journaling, and scrapbooking. Using prerecorded or live music during procedures and medical interventions to help reduce stress and help patients with pain management. Focusing on ability rather than disability, promote success, and encourage self-expression. Palliative care teams will also have co-treatment sessions with physical, occupational, speech, or recreational therapists giving new creative means to working toward treatment goals and help patients tolerate exercises designed to increase physical abilities or range of motion. 

Reference

Duda, L. J. (2013). Integrating music therapy into pediatric palliative care. Progress in Palliative Care, 21(2), 65–77. 

Hanser SB, Larson S., O'Connell A.: The effect of music on relaxation of expectant mothers during labor. J Music Ther 20:50-58, 1983

Tan, P., Lester, L. H., & Lin, A. M. (2020). Music therapy treatments in an inpatient setting—A randomized pilot study. The Arts in Psychotherapy, 69. https://doi.org/10.1016/j.aip.2020.101660

Tucquet, B., & Leung, M. (2014). Music therapy services in pediatric oncology: A national clinical practice review. Journal of Pediatric Oncology Nursing, 31(6), 327–338. https://doi.org/10.1177/1043454214533424

Wylie ME, Blom RC: Guided imagery and music with hospice patients. Music Ther Perspec 3:25-28, 1986

Music Therapy & Older Adults

Aging is a universal phenomenon, present in all ages and cultures. It is a continuous process that depends on several factors that are not the same in every human being. Many factors contribute to the type of aging process people have like lifestyles and social and environmental surroundings. 

Diaz Abrahan discusses the psycho-gerontological approach to aging being split into three types of aging: normal, pathological, and active aging. The first one refers to the natural changes occurring as a result of the constant modifications along an individual’s course of life. This can be characterized by the degree of natural decline of cognitive functions like memory, information processing speed, and visual decline. Pathological aging has to do with changes produced by illnesses or bad habits that are not part of normal aging. Sometimes, it can be prevented or controlled, but in some it is irreversible. This can be the case for those diagnosed with dementia, neurodegenerative disorders, Alzheimer’s disease, and Parkinson’s disease, among others. Finally, active aging takes place in the best possible physical, psychological and social conditions, with little loss of the psychosocial, physical, and/or cognitive abilities, resulting in a better quality of life and life expectancy. 

 Diaz wanted to evaluate the effectiveness of music therapy in improving the quality of life of older adults. A program proposal was made by the day center aiming to deal with the psychosocial problems of older persons, encouraging integration among peers, self-management, and social participation with 15 patients for eight months at an average age of 80 years old. The care center used the inventory of quality of life (IQoL) as their pre/post documentation to help validate the need for music therapy with older adults in their facility. By the end of the eight months, the results showed that the benefits of music therapy were reflected in the total quality of life scores, encompassing the final average of all the inventory areas of life. 

Similar to the proposal Diaz conducted, the staff at Cottonwood Retirement wanted to begin to include music therapy sessions into the residents’ schedule. After implementing a music therapy session twice a week the staff found music therapy effective in changing social, physical, emotional, and cognitive functioning. All participants shared observations of the effectiveness of music therapy for older adult consumers at Cottonwood Retirement and reported that consumers were more animated and more likely to participate in movement exercises while engaging in music therapy versus being prompted. More socialization throughout the week if music sessions were held on Mondays. 

Music acts as a complex stimulus, exerting neurophysiological signals that activate brain structures associated with cognition, motor skills, and the regulation of emotions. Evidence of a music therapy intervention has shown an increase in cerebral blood flow and prefrontal cortex activity in older adults with cognitive decline. This suggested the development of new neural networks working to improve executive function. This suggests improvements in the person's ability to concentrate and retain and remember information in both the short and long-term, as well as the ability to organize, plan, and execute actions.

Evidence has shown that music therapy has been effective in reducing symptoms of depression in older adults with different neuropathological states. The nursing staff at Cottonwood Retirement recorded their patients writing songs with music therapists for family members, creating scrapbooks to help process past memories, and use lyric analysis to assist residents remembering experiences from their past and relating them to words from their favorite songs. 

Some music therapy interventions used with older adults focus on body movements generating a positive effect on the motor system. Rhythmic auditory stimulation (RAS) is also used to become a rhythmic signal that is translated into a motor response. Gait parameter improvements are not often reported as outcomes in music therapy interventions in older adults with cognitive decline. The study published in Music Therapy Perspectives found preliminary effects in two gait parameters, gait velocity, and stride length, with higher scores at the end of the music therapy intervention. The effects in terms of cognition, gait parameters, depression symptoms, and flexibility can be attributed to the fact that music acts as a stimulus for cognitive, affective and sensorimotor processes by acting on the brain structures associated with cognitive, emotional, and motor responses (Wells, 2019 pp.52).

References 

Diaz Abrahan, V., Lemos Jaramillo, A., & Justel, N. (2019). Benefits of Music Therapy in the Quality of Life of Older Adults. Revista Ciencias de La Salud, 17(3), 9–19. https://doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.8349

Domínguez-Chávez, C. J., Murrock, C. J., Guerrero, P. I. C., & Salazar-González, B. C. (2019). Music therapy intervention in community-dwelling older adults with mild cognitive impairment: A pilot study. Geriatric Nursing, 40(6), 614–619. https://doi.org/10.1016/j.gerinurse.2019.06.004

Wells Staab, K., & Dvorak, A. L. (2019). Perception of music therapy by direct care staff of older adults with intellectual disabilities. Music Therapy Perspectives, 37(1), 45–54. https://doi.org/10.1093/mtp/miy021