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Melanie Burton, two case studies. Case Studies “The benefit of music therapy to those with late-stage dementia” Queen Margaret University MSc Music Therapy.

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Presentation on theme: "Melanie Burton, two case studies. Case Studies “The benefit of music therapy to those with late-stage dementia” Queen Margaret University MSc Music Therapy."— Presentation transcript:

1 Melanie Burton, two case studies. Case Studies “The benefit of music therapy to those with late-stage dementia” Queen Margaret University MSc 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.

2 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.

3 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.

4 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

5 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

6 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?

7 'HOW THE CLIENT IS...' SCALE 1 RATING SHEET: HOW THE CLIENT IS THE RELATIONSHIP CONTINUUM NAME OF CLIENT DATE OF SESSION NUMBER OF SESSION EVENTS FIRST EVENT (__________) PREDOMINANTLY ____ SECOND EVENT (_________) PREDOMINANTLY ____ THIRD EVENT (___________) PREDOMINANTLY ____ FOURTH EVENT(_________) PREDOMINANTLY ____ TOTAL: DIVIDED BY NUMBER OF EVENTS (__), _________ ACQUIRED AN OVERALL SCORE OF ___

8 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

9 '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”

10 The trouble with Carers.... Participant Observer (carer) LUCY From the outset she was very skeptical

11 The trouble with carers At the outset she was very sceptical  She was incredibly observant!

12 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.

13 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?

14 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

15 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

16 CASE STUDY - MARY Goodbye song – 'So Long, Farewell' Mary reaches to pluck ukulele string

17 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.

18 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

19 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

20 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

21 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

22 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

23 GERALDINE Case 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!

24 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.

25 CLIP 1 – HELLO SONG Use of hello song Geraldine claps, then sits back Music is repetitive

26 CLIP 1 – 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

27 CLIP 1 – 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

28 CLIP 1 – 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 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

29 CLIP 2 – IMPROVISATION In this next clip Geraldine is responding in her usual pattern  Stillness / movement Lucy's surprise at Geraldine's responses

30 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!'

31 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

32 MAOIRI'S WEDDING Use of known songs Frequent movement of hands – putting on wedding ring?

33 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 7 th chord As my playing is a little amateur I have included markers for each bar on the video BAR 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

34 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

35 CLIP 3 – BLUES Geraldine interacting on a structural level 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

36 OUTCOMES LINKED TO GERALDINES CASE STUDY Geraldine remained 'in the moment during music therapy'  Similar to Magee (2007)

37 OUTCOMES LINKED TO GERALDINES CASE STUDY Geraldine retained structural information Geraldine remained 'in the moment during music therapy' Magee (2007)

38 OUTCOMES LINKED TO GERALDINES CASE STUDY Geraldine recalled members of her family Geraldine remained 'in the moment during music therapy' Magee (2007) Geraldine retained structural information

39 OUTCOMES LINKED TO GERALDINES CASE STUDY Music therapy enable Geraldine to interact with me, and others in the room Similar to Powell (2006; Brotons and Koger (2000); Knaefsey (1997) Geraldine remained 'in the moment during music therapy' Magee (2007) Geraldine retained structural information Geraldine recalled members of her family

40 OUTCOMES LINKED TO GERALDINES CASE STUDY 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) Geraldine remained 'in the moment during music therapy' Magee (2007) Geraldine retained structural information Geraldine recalled members of her family Music therapy enable Geraldine to interact with me, and others in the room Powell (2006; Brotons and Koger (2000); Knaefsey (1997)

41 OUTCOMES LINKED TO GERALDINES CASE STUDY Geraldine received less anti-psychotic medication during the trial Geraldine remained 'in the moment during music therapy'Magee (2007) Geraldine retained structural information 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) Geraldine's staff team use music at night to aid transition to bed time

42 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

43 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?

44 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?

45 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?

46 That's all folks THANKS FOR LISTENING Melanie Burton MSc Music Therapy Case study of the dissertation “What is the benefit of music therapy to those with late-stage dementia”

47 REFERENCES Aldridge, A Music Therapy In Dementia Care. London and Philadelphia: Jessica Kinglsey Publishers. Belgrave, M 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 The Impact of Music Therapy on Language Functioning in Dementia. Journal of music therapy XXXVII (3) Gro ß W., Linden. U, and Ostermann T 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 The therapeutic use of music in a care of the elderly setting: a literature review. Journal of nursing care 6 Ledger and Baker, 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) Magee, W 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 Mahoney. J. F Interrater Agreement on the Nordoff-Robbins Evaluation Scale 1: Client-Therapist Relationsip in Musical Activity. Sage Publications NHS National Dementia and Antipsychotic Prescribing Audit. NHS Information Centre 2012 Nordoff, P. and Robbins, C Creative music therapy: a guide to fostering clinical musicianship. 2 nd ed. USA: Barcelona Publishers. Pavlicevic, M Music therapy in context: music, meaning and relationship. London: Jessica Kingsley Publishers. Powell, H 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 Suzuki, M., Kanamori, M., Nagasawa, S., Tokiko, I. and Takayuki, S 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. Svansdottir, H. B. and Snaedal, J Music therapy in moderate and severe dementia of Alzheimer’s type: a case-control study. International Psychogeriatrics, 18 (4). Pp Robertson, J How The Client Is.. adapted rating scale. QMU. Vink, A. C., Bruinsma, M. S. and Scholten, R. J. P. M Music therapy for people with dementia. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD DOI: / CD pub2.


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