~ Effects of Music Therapy ~

Overview

This term, I researched the effect of MT on patients who are suffering from various illnesses and conditions. I also got the wonderful opportunity of observing Music Therapy at the Huntington Hospital.

Background

There are a number of methods used to improve patient's well being. These include: drugs, as well as interdisciplinary measures, such as physical exercise, occupational and speech therapy, music therapy and psychological, nutritional, and social counseling.

Music has been used as a form of therapy for many diseases. It is effective when normal communication is absent or broken down and can be experienced and appreciated by even the most severely physically or cognitively handicapped children. Music Therapy (MT) has been used widely in the rehabilitation of handicapped children, providing one of the few channels in which they can attain self-expression.

Observing Music Therapy

I visited the Huntington Hospital twice to observe music therapy. The music therapist goes there once a week and conducts half- hour sessions with different groups. The patients she sees are divided into two main groups: those in the 'closed-unit' (they are locked in for their safety) and those in the 'open-unit'. Examples of patients in the closed unit would be those suffering from Alzheimer's disease or Schizophernia, psychotic or bipolar patients. Those in the open unit would be patients who are under stress or suffering from depression and are non violent.

What the music therapy consisted of was the therapist asking the patients to pick a track that they would like to listen to from a set of CDs. Once the track was done playing, the therapist would go around asking the patients what they felt about the music and what it reminded them of. Sometimes, the patients would get so excited by the music, that they would dance with each other. It really brightened up the atmosphere. Other times when a old song was played, some patients would tell interesting stories of what they were doing while the song came out, and so on. It was interesting to see Alzheimer.s patients whose short term memory was poor tell these stories while they couldn.t even remember what day or month it was. Another benefit that I observed of the MT was that it got the patients to be more friendly to each other and improve their social skills, while they reminisced about some time or tried to remember a certain singer's name.

The music therapist would move the arms and feet of those patients who were unable to move on their own trying to improve their motor skills. Apparently, they did not have physical therapy for some patients even though they would benefit from them.

In addition to working at the hospital, the music therapist I met also made private visits to autistic children's homes to work with them. She said that she had successfully used MT to improve eye contact, language and social skills, attending and expressiveness in these children.

Effect of MT on patients with leg injuries

Oliver Sacks book, "A Leg to Stand On" describes his experiences after he sustains a serious leg injury while running away from a raging bull on a desolate mountain. In this book, the author, a physician, is forced into role-reversal and learns what it is like to be a patient. At various stages after his injury, he uses music to improve his situation. For example, right after his injury, he uses inner music to get down the mountain he was on "..There came to my aid now melody, rhythm and music. Before crossing the stream, I had muscled myself along --moving by main force...Now, so to speak, I musicked along...I fell into a rhythm, guided by a sort of marching or rowing song..."(5)

After his operation, he feels like he has lost his leg although it is intact and attached to his body. He develops both a "perceptual deficit"--a loss of feeling of the leg--and a "sympathetic deficit"--a loss of feeling for the leg. "I had lost," he explains, "the inner image, or representation, of the leg. There was a disturbance, an obliteration, of its representation in the brain--of this part of the body-image as neurologists say. Part of the 'inner photography' of me was missing." (5). The book describes his journey to learn how to use his leg again - he tries various methods to bring back full use of his leg. The only one that works is music therapy. With the assistance of Mendelssohn's music (Mendelssohn was a German composer in the 19th century), he remembers the "tune" of walking without needing conscious intervention.

Effect of MT on patients with Parkinson's Disease

Current research indicates that active MT does have many positive effects on patients suffering from PD. Experiment done in this area show that MT has a beneficial effect on emotional wellbeing of the patients, helped improve patients' quality of life (patients were more active) and improved patients' performance of daily activities. In addition to these, it appears that MT improved rhythmic limb movements and gait in patients with PD. However, the changes were no longer evident 2 months after completion of MT.

Effect of MT on patients with Alzheimer's Disease

For people in the middle stages of AD, familiar music employed in a range of different music therapy interventions, was found to improve orientation to time, place and person. It is possible that music achieves this response for people with AD because people's memory for music may remain intact following neurological damage or degenerative neurological diseases (7). For example, AD patients may experience language deterioration but they retain the ability to recognise and recall familiar musical material. Production and improvisation of music, however, seem to fail the same way language does. It may be because the fundamentals of language itself are musical, and are prior to semantic and lexical functions in language development(7). Music's potential to create a structured, safe and more familiar environment has been argued as one possibility for understanding why music is able to enhance orientation of people with AD.

In addition to improvements in the orienting process, it has been shown that MT reduces agitation in patients with AD. The inclusion of familiar music that has been implicated as the primary reason for the reduction of agitation in the patients with AD.

MT has been to shown to significantly improve the quality of life of AD patients along with overall social benefits of acceptance and sense of belonging that are gained by communicating with others.

Effect of MT on coma patients

MT has also been shown to have a positive effect on coma patients. The form of MT used with coma patients relies on the principle that we are organized as human beings in "a musical form and not in a mechanical way; that is a harmonic complex of interacting rhythms and melodic contours" (1). Scientists working in this therapy argue that we are better served by "a non-mechanistic concept of musical organization rather than search for a master clock that coordinates us chronologically"(1).

Each MT session lasted 8-12 min and the therapist improvised her wordless singing based on the patient's pulse and breathing pattern. The character of the patient's breathing determined the nature of the singing.

A range of reactions were noticed: changes in breathing (it became slower and deeper), fine motor movements, grabbing movements of the hand, turning of the head, eye opening, and the regaining of consciousness. When the therapist first started singing, a slowing down of the heart rate was observed. Then the heart rate rose rapidly and sustained a high level till the end of contact. It is suggested that this shows an attempt at orientation and cognitive processing within the communication context.

A direct benefit of the MT was that the staff were made aware of the quality and intensity of human contact on coma patients. The staff were used to shouting commands at these patients and few attempts were made at normal human communication. Upon observing the effects of quiet singing, the staff came to realize the importance of treating these patients as normal human beings rather than as some vegetable hooked up to a machine.

References

1.Aldridge, D, Gustorff, D, Hannich, H-J. "Where am I? Music Therapy applied to coma patients", JRSM, 1990;83.

2.Aldridge, D. "A phenomenological comparison of the organization of music and the self". Arts in Psychotherapy. 1989;16.

3.Nordoff P, Robbins, C. "Creative music therapy". New York, John Day, 1997.

4.Pacchetti et al., "Active Music Therapy in Parkinson's Disease: An Integrative Method for Motor and Emotional Rehabilitation". Psychosomatic Medicine, 2000;62.

5.Sacks, Oliver. "A Leg to Stand On". Touchstone Books, 1998.

6. Aldridge, D. "Music and Alzheirmer's disease - assessment and therapy: discussion paper". JRSM, 1993:86.

7.Aldridge, D. "Alzheimer's disease: rhythm, timing and music therapy. BioMed Pharmacother, 1994;48.