Melanie Burton, two case studies. Case Studies “The benefit of music therapy to those with...

Melanie Burton, two case studies.

Case Studies“The benefit of music therapy to those with

late-stage dementia”

Queen Margaret UniversityMSc Music Therapy

2012

If you have experience using music therapy with those with dementia and would like to be included in a Ph.D. aimed at reducing the use of anti psychotic medication for those with dementia please add your name to my list.

THE PROJECT

Prior to my Music Therapy course I had experience as a care assistant in homes in Oxon, CAMBS and Scotland

Gave me ideas for future study

As part of my dissertation in my second year approached a nursing home with my project idea.

Began with 3 clients, once a week for 8 weeks.

THE PROJECT

Experience as a care assistant prior to the project Gave me ideas for future study

Approached a nursing home with my project idea.

Began with 3 clients, once a week for 8 weeks.

LITERATURE OVERVIEW

Music Therapy for those with early to mid stage dementia Belgrave 2009

Suzuki et al 2007

Ledger and Baker 2007

Svansdottir and Snaedal 2006

Belgrave, M. 2009. The effect of expressive and instrumental touch on the behaviour states of older adults with Late-stage dementia of the Alzheimer's Type and on Music Therapist's Perceived Rapport. Journal of music therapy XLVI (2)

Suzuki, M., Kanamori, M., Nagasawa, S., Tokiko, I. and Takayuki, S. 2007. Music therapy-induced changes in behavioural evaluations, and saliva chromogranin A and immunoglobulin A concentrations in elderly patients with senile dementia. Geriatric and Gerontology International 7(1). Pp. 61–71.

Ledger and Baker, 2007. An Investigation of Long Term Effects of group music therapy on agitation levels ofpeople with Alzheimer's disease. Ageing and Mental Health 11 (3)

Svansdottir, H. B. and Snaedal, J. 2006. Music therapy in moderate and severe dementia of Alzheimer’s type: a case-control study. International Psychogeriatrics, 18 (4). Pp. 613-621

LITERATURE OVERVIEW

Music Therapy for those with early – mid stage dementia Belgrave 2009 Suzuki et al 2007 Ledger and Baker 2007 Svansdottir and Snaedal 2006

ALL highlight symptoms of the syndrome as limitations to the research

Report

PROJECT AIMS

Is music therapy of benefit to those with late-stage dementia?

Is the rating scale 'How the client is...' relevant for use with those in late-stage dementia?

What are the perceived benefits of the intervention of music therapy by an observer?

'HOW THE CLIENT IS...'

SCALE 1 RATING SHEET: HOW THE CLIENT ISTHE RELATIONSHIP CONTINUUM

NAME OF CLIENTDATE OF SESSIONNUMBER OF SESSIONEVENTSFIRST EVENT (__________)

PREDOMINANTLY ____SECOND EVENT (_________)

PREDOMINANTLY ____THIRD EVENT (___________)

PREDOMINANTLY ____FOURTH EVENT(_________)

PREDOMINANTLY ____

TOTAL: DIVIDED BY NUMBER OF EVENTS (__), _________ ACQUIRED AN OVERALL SCORE OF ___

EVALUATIONS

LEVELS OF PARTICIPATION

1 Unresponsive 2 Ambivalence 3 Limited response 4 Relationship

develop 5 Co-activity 6 Mutuality 7 Stability

QUALITIES OF RESISTIVENESS

1 Oblivious 2 Uncertainty 3 Defensive 4 Perversity 5 Perseverative 6 Crisis toward

resolution 7 Sense of

accomplishment

'HOW THE CLIENT IS....' Scale was evaluated by Mahoney (2009)

Found 74% interrator congruence, even in non-Nordoff Robbins trianed music therapists

As used by Groß, Linden and Ostermann (2010) “Effects of music therapy in the treatment of children with delayed speech development – results of a pilot study”

The trouble with Carers....

Participant Observer (carer)

LUCY

From the outset she was very skeptical

The trouble with carers

At the outset she was very sceptical

She was incredibly observant!

The trouble with carers

At the outset she was very sceptical

She was incredibly observant!

By the end of the eight sessions she was championing music therapy and it's use for clients with dementia.

Report

PROJECT AIMS




CASE STUDY 1 - MARY

MARY was unable to walk. She could have moments of lucidity.

Mary had parkinsons disease and dementia.

Mary was able to express her emotions through vocalisations

CASE STUDY 1 – MARY

Use of various musical idioms Known songs Ledger and Baker (2007)

Improvisation Magee (2007) Listening activities

Showed a preference for modal music

Magee, W. 2007. A Comparison Between the Use of Songs and Improvisation in Music Therapy with Adults Living with Acquired and Chronic Illness. Australian Journal of Music Therapy 18

Ledger and Baker, 2007. An Investigation of Long Term Effects of group music therapy on agitation levels ofpeople with Alzheimer's disease. Ageing and Mental Health 11 (3)

CASE STUDY - MARY

Goodbye song – 'So Long, Farewell' Mary reaches to pluck ukulele string

CASE STUDY 1 – MARY Clip 1 – Goodbye song

Mary sitting in an armchair, music therapist next to her with a ukulele.

Music therapist plays 'So long, farwell, a known song to Mary.

After many repeats Mary reaches out to touch a string. She let's out a deep sigh. This is one of the only times she plays an instrument.

CASE STUDY - MARY

Mary seemed to concentrate on making the movement necessary to pluck the string.

Mary was in subsequent sessions more vocal

Mary used her voice to communicate

CLIP 2 – MARY

Next clip is by Mary's bedside

On this occasion Mary could be heard from three floors away, she sounded restless

Mary had responded well to improvisations around her vocalisations

Mary showed signs of responding to musics structure, I used this to encourage Mary to interact

After this session Mary was quiet and was able to rest

CLIP 2 - Bedside

Mary is in bed, sighing deeply. Music Therapist is opposite with a violin Mary sighs loud and long, therapist matches with violin Mary pauses Music therapist allows a melody around the note Mary sang

Mary continues to sigh, becoming less frequent, quieter, face becomes relaxed

Therapist uses C# to draw Mary into interacting

ENDS – Mary face looks more relaxed, seems more peaceful

MARYS' TONIC

THE IMPORTANCE OF STRUCTURE

Taking Mary's D as the tonic

Consciously using the C# to encourage interaction Encouraging continued interaction by never resolving

the melody Aspects of atonal/ modal playing to avoid implication

of mood, and resolution

D E F G A B C D

OUTCOMES RELATED TO MARYS CASE STUDY

Mary responded to structure – this maybe an important area for more research

Mary was able to respond to music

Mary was aware of the therapist and her music

Mary grew familiar with the therapist

GERALDINECase Study 2.

Geraldine “Don't take her, we haven’t found a way of

interacting with her...” (Carer)

“don't take it for granted that they can't hear or understand us”

The very reason I started this project!

GERALDINE

Geraldine was confused, very introverted and isolated with periods of agitation and anxiety.

Use of 'Hello Song'.

Geraldine showed a preference for blues

I used a variety of playing songs and improvising with Geraldine.

CLIP 1 – HELLO SONG

Use of hello song Geraldine claps, then sits back Music is repetitive


Moments of interaction / moments of still attentiveness

Getting to know one another

Notice how the other clients are in the room?

As Geraldine became more used to the sessions she began to anticipate the Hello Song


Moments of interaction / moments of still attentiveness

Getting to know one another

Notice how the other clients are in the room?

As Geraldine became more used to the sessions she began to anticipate the Hello Song

Geraldine noticed the Ukulele falling off the piano – she responded to her environment.

In line with Magee (2007)

Magee, W. 2007. A Comparison Between the Use of Songs and Improvisation in Music Therapy with Adults Living with Acquired and Chronic

Illness. Australian Journal of Music Therapy 18

CLIP 2 – IMPROVISATION

In this next clip Geraldine is responding in her usual pattern Stillness / movement

Lucy's surprise at Geraldine's responses

CLIP 2 - IMPROVISATION

Geraldine suddenly sways her shoulders during an improvisation!

Observer says 'That's nice!' Therapist laughs Geraldine touches therapist on the shoulder looks her in the

eye and says 'I knew you would laugh, I knew you would laugh!'

CLIP 2 - IMPROVISATION

Greater sense of knowing each other.

Sense of fun emerging

She spoke directly to me for the first time – Outcome, aiding in maintaining lucidity and

remaining in the here and now

Interruptions into the music therapy room

MAOIRI'S WEDDING

Use of known songs

Frequent movement of hands – putting on wedding ring?

CLIP 3 – BLUES... ISH

Use of a blues style to encourage interaction

Using this table a pattern of behaviour can be seen – in time with each repetition of the 7th chord

As my playing is a little amateur I have included markers for each bar on the video

BAR 1 2 3 4 5 6 7 8

REPETITION 1

BEGINS clapping

REACHES therapist + QUICKER clapping

SLOWS clapping

STOPS Clapping

2 STOPS clapping

(pause)

3 STOPS clapping

QUICKER clapping

REACHES Lucy

STOPS clapping

REACHES Lucy

4 BEGINS clapping

SLOWS clapping

STOPS clapping

1 2 3 4 5 6 7 8

1 BEGINS clapping


SLOWS clapping

STOPS Clapping

2 STOPS clapping

(pause)

3 STOPS clapping

QUICKER clapping

REACHES Lucy

STOPS clapping

REACHES Lucy

4 BEGINS clapping

SLOWS clapping

STOPS clapping

CLIP 3 – BLUES

Geraldine interacting on a structural level

1 2 3 4 5 6 7 8

1 BEGINS clapping


SLOWS clapping

STOPS Clapping

2 STOPS clapping

(pause)

3 STOPS clapping

QUICKER clapping

REACHES Lucy

STOPS clapping

REACHES Lucy

4 BEGINS clapping

SLOWS clapping

STOPS clapping

OUTCOMES LINKED TO GERALDINES CASE STUDY

Geraldine remained 'in the moment during music therapy'

Similar to Magee (2007)



Geraldine retained structural information

Geraldine remained 'in the moment during music therapy' Magee (2007)


Geraldine recalled members of her family




Music therapy enable Geraldine to interact with me, and others in the room

Similar to Powell (2006; Brotons and Koger (2000); Knaefsey (1997)




Powell, H. 2006. The voice of experience: evaluation of music therapy with older people, including those withdementia, in community locations. British Journal of Music Therapy, 20 (2). Pp.109-120.

Brotons, M and Koger, S, M. 2000. The Impact of Music Therapy on Language Functioning in Dementia. Journal of music therapy XXXVII (3)

Knaefsey, R. 1997. The therapeutic use of music in a care of the elderly setting: a literature review. of nursing care 6


Resulting from Geraldine's responses to music therapy staff now use music to settle down at night

Similar to Svansdottir and Snaedal (2006) and Suzuki et al (2007)




Music therapy enable Geraldine to interact with me, and others in the room Powell (2006; Brotons and Koger (2000); Knaefsey (1997)




Geraldine received less anti-psychotic medication during the trial

Geraldine remained 'in the moment during music therapy'Magee (2007)



Music therapy enable Geraldine to interact with me, and others in the roomSimilar to Powell (2006); Brotons and Koger (2000); Knaefsey (1997)

Geraldine's staff team use music at night to aid transition to bed time

REDUCING ANTI-PSYCHOTIC MEDICATION

NHS audit on use of anti-psychotics says 80% are inappropriately prescribed

Anti psychotics can lead to reduced mobility, increasing fall risk, lack of attention, makes people tired

In fact, anti psychotics increase the risk of many of the adverse symptoms associated with dementias.

Nursing homes urged to reduce Anti psychotic use At present, there are little alternatives

New research on psychotherapy

Report

PROJECT AIMS




That's all folks

THANKS FOR LISTENING

Melanie BurtonMSc Music Therapy

Case study of the dissertation“What is the benefit of music therapy to those with late-stage

dementia”

REFERENCES

Aldridge, A. 2000. Music Therapy In Dementia Care. London and Philadelphia: Jessica Kinglsey Publishers.

Belgrave, M. 2009. The effect of expressive and instrumental touch on the behaviour states of older adults with Late-stage dementia of the Alzheimer's Type and on Music Therapist's Perceived Rapport. Journal of music therapy XLVI (2)

Brotons, M and Koger, S, M. 2000. The Impact of Music Therapy on Language Functioning in Dementia. Journal of music therapy XXXVII (3)

Groß W., Linden. U, and Ostermann T. 2010. Effects of music therapy in the treatment of children with delayed speech development – results of a pilot study. BMC Complementary and Alternative Medicine 1-:39.

Knaefsey, R. 1997. The therapeutic use of music in a care of the elderly setting: a literature review. Journal of nursing care 6

Ledger and Baker, 2007. An Investigation of Long Term Effects of group music therapy on agitation levels of people with Alzheimer's disease. Ageing and Mental Health 11 (3)


Mahoney. J. F. 2009. Interrater Agreement on the Nordoff-Robbins Evaluation Scale 1: Client-Therapist Relationsip in Musical Activity. Sage Publications

NHS. 2012. National Dementia and Antipsychotic Prescribing Audit. NHS Information Centre 2012

Nordoff, P. and Robbins, C. 2007. Creative music therapy: a guide to fostering clinical musicianship. 2nd ed. USA: Barcelona Publishers.

Pavlicevic, M. 1997. Music therapy in context: music, meaning and relationship. London: Jessica Kingsley Publishers.

Powell, H. 2006. The voice of experience: evaluation of music therapy with older people, including those with dementia, in community locations. British Journal of Music Therapy, 20 (2). Pp.109-120.



Robertson, J. 2012. How The Client Is.. adapted rating scale. QMU.

Vink, A. C., Bruinsma, M. S. and Scholten, R. J. P. M. 2003. Music therapy for people with dementia. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD003477. DOI: 10.1002/14651858.CD003477.pub2.

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