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Ronna Kaplan, M.A.

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Music Therapy Intervention in Medical Settings

Posted: 03/15/2012 7:00 am

Music therapy services in medical settings such as hospitals take many forms. Patient outcomes are individualized and specific. They are related to diagnoses, symptoms, "course of treatment," and discharge timelines. Although benefits are often described in medical terms, music therapy is clearly for the "whole person." Examples of the possible benefits of music therapy interventions in medical settings include: reduction of anxiety, agitation, stress, blood pressure, heart rate, and/or muscle tension, improved respiration and/or cardiac output, decreased length of stay, improved mood, management of pain and discomfort without or with reduced doses of medication, active, positive participation in treatment, and positive, meaningful time spent with families and caregivers. Music therapy also provides opportunities to enhance socialization, communication/language skills, self-expression, motor skills such as gait and range of motion, and general developmental and cognitive skills including reality orientation, attention, memory, and/or executive functioning, as appropriate to each individual.

Our first stop is a neurological unit. Celia (not her real name) is a 45-year-old woman who recently had a stroke. Her doctor referred her for music therapy because of her expressive aphasia, which resulted from damage to anterior regions of her brain, including (but not limited to) the left inferior frontal region known as Broca's area. Celia, like others with this form of aphasia, now found it very difficult to initiate speech. Patients with this diagnosis typically know what they want to say but cannot express themselves effectively. Celia recognized her name and knew she was in the hospital and why she had been admitted.

During her first music therapy session, she and the music therapist sang "Happy Birthday," with Celia singing approximately 25 percent of the words accurately. Her face brightened as she sang. Then the music therapist began a modified version of a protocol called melodic intonation therapy, where he held Celia's left hand in his right, while gently tapping the rhythm of his carefully-chosen sung words on top of her left hand. He practiced a very functional phrase, "I want a drink of water," singing it with a melody that resembled how one might speak the phrase: Do-faa-do-ree-mi-re-dooo. The therapist noted that Celia picked up the tune quickly, began singing "I want" and "water" consistently, but didn't articulate the other words. After approximately five minutes Celia pulled her hand away from the therapist. When asked if they were done, she replied "mm-hmmm." That had been her only intelligible speech in her first music therapy session.

The music therapist followed up four days later. Celia immediately smiled and extended her hand, anticipating the session and showing she was ready to work. Again attempting the phrase "I want a drink of water," Celia was only able to sing "I want" correctly at first. The music therapist sang, "I want a drink of" and then paused for her to fill in "water." As she was able to complete the phrase by filling in the blank five times consecutively, the therapist returned to the previous protocol. Celia was able to sing the phrase in its entirety with the exception of one word, "drink," correctly and consistently. Celia had made progress, concentrating for at least 10 minutes and moving from only one intelligible response the first session to three, adding the words "okay" and "what."

The next day was Celia's third and final music therapy session, as she was being discharged from the acute hospital to a rehabilitation facility. She was immediately ready to work. First they reviewed the phrase, "I want a drink of water," practicing the whole phrase and filling in the word "water." Celia always repeated the rhythm accurately but still displayed difficulties with the word "drink."

Because Celia was being discharged, the music therapist introduced a second phrase, stating, "If you leave here, you gotta tell people your name." This new phrase was "My name is Celia Johnson." The melody and rhythm of this phrase again mirrored the prosody of speech: Mi-ree-mi-faa-mi-re-dooo. Together they rehearsed the notes, which she learned easily, and then added words. The fill-in-the-blank procedure was used to help her say her last name at the end of the phrase. Celia was then able to sing the complete phrase twice.

In addition to her feeling and expressing the rhythm with her voice, Celia tapped her foot in the same rhythm the music therapist tapped on her hand. She displayed great eye contact with the therapist for the entire 15 minutes. Today not only did she utter intelligible one-word responses, such as "What?" and "Okay," as she had previously, but she was able to spontaneously produce two- and three-word phrases, including "Thank you," "There you go," and "Oh, my God." The therapist commented on this increase and then had to bid Celia farewell.

Next let's visit a comprehensive burn unit. As dressing changes for patients with burns have been noted to be some of the most painful medical procedures imaginable, burn patients typically dread each day's procedures and display considerable anxiety leading up to them.

A "50-something" man who had burned more than one-third of his body had already experienced a few painful dressing changes when he consented to participate in a study to determine whether music therapy is an effective non-pharmacological intervention in the treatment of pain and anxiety in burn patients. He was "looking for anything that might help." The music therapist used music-based imagery, a relaxation intervention where the patient gives descriptive input regarding his own "special place" and the music therapist puts these details into a song individualized for him. As the therapist played the guitar, this gentleman imagined himself in his "special place," a beach in Hawaii watching the ocean. He later reported that visually focusing on Hawaii and listening to the music took his mind off the pain. He further stated he "could see the skin, blood and scars they were scrubbing off" but didn't focus on this. Instead he was "concentrating on the music."

Another patient, a 12-year-old boy, preferred more active involvement in music-making during dressing changes. After telling the nurse that on a scale of 0-10, with zero being no pain and 10 being the highest, he rated his pain a "5" on his right leg and a "7" for his left, and he imitated the deep breathing the music therapist modeled. Next he spontaneously requested "The Lion Sleeps Tonight." The music therapist, in her gown and cap, sat next to him as he immersed himself in the tub. She handed him two silver choir chimes from her cart of musical instruments. He intently alternated playing each chime on cue as they sang the song. When this song was done, the nurse observed that his facial expression had been transformed from crying to a slight smile and then to a large grin. His muscle tension level had also changed. When asked what his pain level was now, he replied that it was better. He was even able, with encouragement from his music therapist, to peel the layer of gauze off his wounds himself. As his nurse scrubbed and cleaned the burned area, whereas the previous patient had focused on listening to the guitar, he focused on playing the chimes and singing. He requested another song, "I'm a Believer." This was quite fitting, as his music therapist, doctors and nurses are definitely believers: They believe and have demonstrated that music therapy is making a difference for him and other patients.

Finally, a personal perspective: In addition to being a clinical music therapist practicing for 37 years, I have been a patient experiencing music therapy twice, both in out-patient surgery situations. In the first instance another music therapist, a comforting, familiar face, was with me in pre-op and stayed for the entire surgery. She made sure that the music I had specifically selected to effectively help distract me from my pain or decrease my perception of it was playing on my iPod when I awoke in recovery. Three weeks ago I had surgery to repair a broken fibula. I chose to listen to certain recorded music to help me relax prior to surgery. In post-op and at home I again listened to music as I had with the prior surgery to help me cope with my pain. Some of my personal favorites for this use are Craig Chaquico and Russ Freeman's "From the Redwoods to the Rockies," Hiro Fujikake and James Galway's "The Enchanted Forest," and Regina Carter's "Paganini: After a Dream." Each patient might choose something different. I particularly look for familiar, slow pieces with simple instrumentation and no lyrics. A Board Certified Music Therapist might assist patients in selection and access of music for their use in other similar situations.

Research reported in journals such as the Journal of Music Therapy substantiates the use of live and recorded music therapy interventions to reduce physiological and psychological indicators of distress as well as to decrease anxiety for surgical patients. Music therapy can also affect quality of life, medications administered, and length of stay. To learn more about how music therapy makes a difference for patients in medical and other settings, visit www.musictherapy.org, the website of the American Music Therapy Association.

Selected References

Effective Clinical Practice in Music Therapy: Medical Music Therapy for Adults in Hospital Settings (D. Hanson-Abromeit & C. Colwell, Eds.) (2010). Silver Spring, MD: American Music Therapy Association.

http://www.musictherapy.org/assets/1/7/MT_Pain_2010.pdf

Keough, D. (June 20, 2005). Music Works Its Magic, Soothes Burn Patients, "The Plain Dealer," Cleveland, Ohio.

Miluk-Kolasa, B., Matejek, M. & Stupnicki R. (1996). The effects of music listening on changes in selected physiological parameters in adult pre-surgical patients. Journal of Music Therapy, 33, 208-218.

Prensner, J. D, Yowler, C. J., Smith, L. L., Steele, A. L & Fratianne, R. B. (2001). Music therapy for assistance with pain and anxiety management in burn treatment. Journal of Burn Care and Rehabilitation, 22 (1), 83-88.

Robb, S.L., Nichols R.J., Rutan R.L. & Bishop B.L. (1995). The effects of music assisted relaxation on preoperative anxiety. Journal of Music Therapy, 32, 2-21.

Thaut, M. H. (2008). "Rhythm, Music and the Brain: Scientific Foundations and Clinical Applications." New York, New York: Routledge.

Walworth, D., Rumana, C.S., Nguyen, J. & Jarred, J. (2008). Effects of live music therapy sessions on quality of life indicators, medications administered and hospital length of stay for patients undergoing elective surgical procedures for brain. Journal of Music Therapy, 45(3), 349-59.