Presentation given at The First Music & Medicine Conference of the Cincinnati Music & Wellness Coalition. Defines music therapy, reviews recent research in Music Medicine, and describes music therapy program at general hospital.
Activate auditory system, respiratory system. Activate motor functions and tactile sense. Activate vestibular system.
Difference between MT and RMM are significant. Some MTs are trained in RMM. MT requires higher level of training, broader scope of practice.
After assessing the strengths and needs of each client, the qualified music therapist provides the indicated treatment including creating, singing, moving to, and/or listening to music. Through musical involvement in the therapeutic context, clients' abilities are strengthened and transferred to other areas of their lives. Music therapy also provides avenues for communication that can be helpful to those who find it difficult to express themselves in words.
Reviewed the last couple years of MT journals to find some interesting studies that will help define the practice of music therapy in medical settings.
Patients experience elevated psychological distress, leads to immune dysregulation and adverse health behaviors. Emotional expression and processing may function as an approach-oriented strategy (vs. avoidance-oriented strategy). Use emotional expression, awareness, and understanding to facilitate coping with significant life stressor. Subjects N=29, ages 32-73, post-op.
Coping self-efficacy and satisfaction with hospitalization trended toward improvements, results not significant. No significant change in ambulation willingness or length.
Studies have shown music and rhythmic stimulation effective in gait-training, movement training, engagement and enjoyment. Subjects N=35, average age 79. Stroke, Parkinsons, hip/knee surgery.
Demonstration of TIMP
Patients who experience problems with ventilation describe it as one of worst experiences in their lives. Stress and anxiety play major role in preventing patients from weaning. Standard treatment in pharmacological sedation which may complicate process. Subjects N=51, age 32-96. 126 nurses surveyed.
45-60 minute sessions, 3x per week. Live patient-preferred music used. Two-part intervention includes playing/improv to engage, music assisted relaxation/guided imagery. MT adjusted music to match/influence pt. respiration/heart rates.
Compared preferred recorded music with live music therapy. Many patients have difficulty undergoing MRI due to discomfort, anxiety, claustrophobia. Can cause pt. movement requiring repeated scans, early termination of scan, resulting in significant loss of $$ and vital healthcare information.
88 patients age 15-93 years. Both groups consulted with music therapist to choose music. Critical to decrease in anxiety for both groups.
Play from 17:00:00-20:00:00
Data demonstrated that MT alone is sufficient for these tests and precludes need for sedation and its subsequent need for RN supervision. Subjects were pediatric patients.
From Medical Music Therapy: A Model Program for Clinical Practice, Education, Training and Research. Standley, et. al. AMTA monograph series.
Every Time I Feelthe Spirit
Music therapy is sound medicine
Mimi Sinclair, MM, MT-BCFirst Music and Medicine ConferenceCincinnati, OHSeptember 21, 2012
I’m Gonna Sing When the Spirit Says SingI’m Gonna Sing When the Spirit Says SingI’m Gonna Sing When the Spirit Says SingAnd obey the Spirit of the Lord.
Define music therapyIdentify treatment goals for music therapyDescribe difference between RMM and MTIdentify research-based outcomes for variedpopulations
Masters in Music, CCM Violin PerformanceMusic-Therapist- Board CertifiedOwner & Director, Music Therapy Services, LLCFaculty, CCM Preparatory Dept.Faculty, University of Dayton Music Dept.
Completion of an American Music TherapyAssociation (AMTA) approved academic andclinical training program.Completion of a written objective examinationdemonstrating current skills in the profession ofmusic therapy.Recertification every five years through re-examination or successful completion anddocumentation of 100 recertification credits
Clinical and evidence-based use of musicinterventionsto accomplish individualized goalswithin a therapeutic relationshipby a credentialed professional who hascompleted an approved music therapy program
supports its effectiveness in many areas such as: overall physical rehabilitation and facilitating movement increasing peoples motivation to become engaged in their treatment providing emotional support for clients and their families providing an outlet for expression of feelings.
Ghetti, C.M. (2011). Active music engagementwith emotional-approach coping to improvewell-being in liver and kidney transplantrecipients. Journal of Music Therapy, 48(4), 463-485.
Active Musical Engagement group experiencedsignificant decrease in pain.Emotional-Approach Coping groupdemonstrated significant increase in positiveaffect.Both groups showed significant decrease innegative affect.
Lim, H.A., Miller, K., Fabian, C. (2011). Theeffects of therapeutic instrumental musicperformance on endurance level, self-perceivedfatigue level, and self-perceived exertion ofinpatients in physical rehabilitation. Journal ofMusic Therapy, 48(2), 124-148.
Compared TIMP to Traditional OccupationalTherapy treatment outcomesNo significant difference in enduranceSignificant difference in perception of fatigueand exertionPossible long-term effects include greatermotivation to take on more demanding andmore frequent tasks, and increased generalsense of well-being
Hunter, B.C., Oliva, R., Sahler, O.J.Z., Gaisser, D.,Salipante, D.M., & Arezina, C.H. (2010). Musictherapy as an adjunctive treatment in themanagement of stress for patients beingweaned from mechanical ventilation. Journal ofMusic Therapy, 47(3), 198-219.
Heart rate and respiratory lowered. Staffassessment strongly agreed patient appearedless anxious. 98% patients reported feeling lessanxious.No significant difference in days to wean.Patient and nurse satisfaction high. Nursesreported reduced stress in caring for patient.100% of patients indicated they wouldparticipate in MT again.
Walworth, D. D. (2010). Effect of live musictherapy for patients undergoing MagneticResonance Imaging. Journal of MusicTherapy, 47(4), 335-350.
26% of patients receiving live music requiredrepeat scans. 73% of recorded music patientsrepeated.2% of live music patients requested breaks.17.6% of recorded music patients requestedbreaks.Less time required to complete scans with livemusic.Patient perception of MRI significantly betterwith live MT.
Andrew Rossetti with Ira Flatow, Talk of the Nation“Treating Stress, Speech Disorders with Music”December 16, 2011 www.npr.org
Cost analysis for Echocardiograms (Walworth, 2002)Without MT Staff time per Cost per Total Cost per Procedure Procedure PatientRN 2 hours $55.00Sonographer 1 hour $23.00Medication $9.45 $87.45With MTSonographer 1/3 hour $7.66Music Therapist 1/3 hour $5.55 $13.21
Cost analysis for Echocardiograms (Walworth, 2002)Savings per patient = $74.24Total savings for 92 patients = $6830.00Total RN hours saved = 184 hours @27.50/hr = $5060 saved in staff cost now available for other dutiesTotal Sonographer hours saved = 62 hours @ $23/hr = $1426
Kaplan, R.S., & Steele, A.L. (2005). An analysis ofmusic therapy program goals and outcomes forclients with diagnoses on the autism spectrum.Journal of Music Therapy, 42(1), 2-19.
Goal areas typically addressed by music therapistsinclude: language/communication behavioral/psychosocial cognitive, musical perceptual/motor.
Goal attainment was found to be high withinone yearParents and caregivers surveyed indicatedsubjects generalized skills/responses acquired inmusic therapy to non-music therapyenvironments.
Hilliard, R. E. (2003) The effects of music therapyon the quality of life and length of life of peoplediagnosed with terminal cancer. Journal of MusicTherapy, 40(2), 113-137.
Quality of life was higher for those subjectsreceiving music therapy and quality of lifeincreased over time as they received moremusic therapy sessions.No significant differences on length of life
Gold, C., Heldal, T.O., Dahle, T., Wigram, T.(2005). Music Therapy for Schizophrenia orSchizophrenia-like Illnesses. The CochraneDatabase of Systematic Reviews, 3. Accession:00075320-100000000-03007 PMID: 15846692
Music therapy as an addition to standard carehelps people with schizophrenia to improvetheir global state and may also improve mentalstate and functioning if a sufficient number ofmusic therapy sessions are provided.
Tallahassee Memorial Healthcareas described in Medical Music Therapy: A Model Program forClinical Practice, Education, Training and Research. American MusicTherapy Association (2005).
Multimodal stimulation for neurologicaldevelopmentMusic reinforcement of non-nutritive suckingfor feeding enhancementCounseling for parents to reduce stressLullabies in incubator to mask aversive soundsParent training
To reduce anxiety, decrease need for sedation duringCT scans/echocardiograms, IV sticks, pre-operativepreparationsFamily assistance in dealing with special needsTraining in pain management, relaxationCounseling for coping skillsNormalization of physical and emotional environmentTo elevate mood, improve quality of lifeIncrease fine and gross motor skills
Counseling for coping skillsPain managementMT during chemotherapyFor outpatient surgery to reduce use of post-operative medicine, relieve side effects ofanesthesia
Stress reduction and life managementCounseling for anxiety reductionPain management
Reduce agitationPain managementImprove quality of lifeCounseling for coping skillsFamily assistance with special needsReality orientation for confusion
Preoperative anxiety reductionReduced length of stayPost-operative pain reductionElevate mood, improve quality of life
Reality orientation for those with confusionEnvironmental stimulationIncrease range of motionMemory enhancementCounseling for anxiety reduction/lifemanagement issuesIncrease motor skills pairing music therapy withphysical activity
Cognitive stimulationIncrease communication skillsIncrease physical activity, gait-trainingIncrease or stabilize respirationMemory enhancementPain managementAnxiety reduction
To facilitate difficult or extended laborFor childbirth educationFor relaxation and coping with extendedhospitalization
To calm agitated mental health patientsTo reduce anxietyTo facilitate services to children
Parkinsons Voice ProgramSupport GroupsPediatric RehabilitationAdult Day Services
I’ve got peace like a river.I’ve got joy like a fountain.I’ve got love like the ocean.