A couple months ago there was a big buzz about a video circulating widely on the Internet. The video, called "Alive Inside," showed a social worker giving an iPod filled with music to a nursing home resident. What ensued allowed viewers to witness the amazing power of music: Henry, the gentleman featured in the story, does indeed come alive while listening to music of his era, and after doing so he lifts up his head, he opens his eyes, his face lights up and he talks about the music, he reminisces, and he shares what music means to him.
This is just a short clip from a documentary by Michael Rossato-Bennett that follows Dan Cohen, social worker and executive director of Music & Memory, whose mission is to improve the quality of life for people who are elderly and infirm through the use of personalized music and digital technology. His iPod Project brings iPods loaded with patients' favorite music to long-term care facilities. The project's aims "are to support the initiation of iPod-based personalized music programs regardless of one's location (e.g., at home, in a nursing home, assisted living facility, hospital, or hospice) and raise public awareness about the benefits of keeping engaged with a rich personal music environment regardless of physical, cognitive, or social condition."
What Cohen observed and viewers can observe in the film is that individuals with memory loss seem to "awaken" when they experience music to which they have an emotional attachment. Neurologist Oliver Sacks has explained, "Music imprints itself on the brain deeper than any other human experience. Music evokes emotion and emotion can bring with it memory."
Furthermore, according to Connie Tomaino, executive director and co-founder of the Institute for Music and Neurologic Function and senior vice president for music therapy at CenterLight Health System, formerly Beth Abraham Family of Health Services, "Music is an essential bridge to connecting people with dementia and Alzheimer's Disease to themselves, their loved ones and their personal history."
Using music in nursing homes and health care facilities is nothing new. It's been happening since the 1940s. Music therapy, "the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program" has specifically been occurring since then as well. According to the Certification Board for Music Therapists (CBMT), "over 5,300 music therapists currently maintain the MT-BC credential and participate in a program of recertification designed to measure or enhance competence in the profession of music therapy."
What is new, however, is how readily accessible music can be because of the iPod and other technology. The power of music and its inherent abilities to animate, enliven, stimulate and more are the very basis of the profession of music therapy. The combination of readily accessible music and a qualified, trained professional music therapist is a very strong mixture. Suzanne Hanser writes that patients who are "the most withdrawn and confused" due to Alzheimer's disease or other dementias "are able to participate actively in music therapy sessions." [4] In addition, "as music demands reality-oriented behavior in the present without risk of failure, even the most cognitively impaired older adults master musical tasks with enhanced self-respect." [2] [5] And many music therapists now work with patients and their family caregivers. [3]
Connie Tomaino comments that Henry's profound response in the film shows how dramatic the right music can be -- but it is not until someone speaks to Henry that we hear his response about what the music means to him. Since we know that music can be positive as well as negative, input from a music therapist would maximize the music's therapeutic benefits. If a person can be awakened simply by listening to his favorite music, imagine what would happen if he participated in sessions with a professional music therapist on a regular basis... Music therapy can take these "in the moment" responses to a different level of improved attention, awareness, social interaction, connection to others, even improved memory, whereas the iPod is only tapping into the possibilities.
Take, for example, a music therapy session with Molly. [6] Molly was a quiet woman who was pleasantly observant during group programs but otherwise nonverbal. She had been diagnosed with advanced dementia, and she no longer recognized family or time and place. Sometimes she was tearful and withdrawn.
Molly's family had mentioned that she enjoyed old but popular Irish American tunes, like "When Irish Eyes Are Smiling," and James Cagney movies. Her records mentioned that she grew up in England and then came to the U.S. in her early adolescence. The music therapist worked with Molly in a group program on her unit but found that Molly was mostly responsive to two songs: "It's a Long Way to Tipperary" and "An Irish Lullaby." Seeing these positive responses informed the music therapist that Molly had a particular connection to these songs compared to others of the same genre.
Working with Molly in individual sessions, the music therapist played these songs -- both live on the accordion and on recordings to further engage Molly's responses. Remember, up to now she had been nonverbal. With each session Molly started opening her mouth as if trying to sing the song -- sometimes random words would be spoken. The music therapist was able to make pauses in the song when these words were spoken to see if Molly was trying to communicate something about the song. As the therapist analyzed the verbalizations she realized that Molly was speaking about an apartment, a house number and her family. Some of the images were of towns in Ireland rather than England. When the music therapist asked Molly's family about this, they noted that Molly spent her early childhood in Ireland. This information had been forgotten by family as it was so long ago they didn't think it mattered. Fleeting images were being verbally expressed as the music therapist continued to play, pause and allow Molly to respond to the music in real time. Without this ongoing and regular engagement between the music therapist and Molly, the meaning of these verbalizations would have been missed.
A response in the moment is only "scratching the surface." It is a fleeting reaction to something familiar. But with the music therapist engaging the client in those responses there becomes a potential for maximizing therapeutic benefit or treatment. The therapist may learn to understand where the responses are coming from and why.
It is the hope of Michael Rossato-Bennett, the filmmaker, "that this film awakens people's hearts and helps make it possible to bring music to those in nursing homes, people who don't even know how deeply they need music's gifts." And I'd like to add, when the music arrives, it is my fervent hope that there will be music therapists around to guide the process, ready to accept referrals of individuals into the program, develop rapport with them, assess their strengths and needs, set goals and objectives for their therapy, observe, develop music therapy strategies, plan and implement music therapy interventions, evaluate progress on an ongoing basis, and readjust and reassess as needed.
So, the more music the better! Ensuring that residents in nursing homes and others have access to music of their choice is a fabulous goal to strive toward. In addition, with the mission of "advancing public awareness of the benefits of music therapy and increasing access to quality music therapy services in a rapidly changing world," provision of music therapy services to aid in the recovery of illness or lessen the impact of a disabling condition is also a goal to which we in the American Music Therapy Association are striving.
For more resources, fact sheets, or a bibliography on music therapy with individuals with dementia or to purchase helpful references, such as Music Therapy with Geriatric Populations (Belgrave, Walworth, Darrow & Wlodarczyk, 2011), visit www.musictherapy.org.
Selected References
1. Belgrave, M., Darrow, A-A, Walworth, D. & Wlodarczyk, N. (2011) Music therapy and geriatric populations. Silver Spring, MD: The American Music Therapy Association.
2. Brotons, M., Koger, S. M., & Pickett-Cooper, P. (1997) Music and dementias: A review of literature. Journal of Music Therapy, 34, 204-245.
3. Brotons, M. & Marti, P. (2003). Music therapy with Alzheimer's patients and their family caregivers: A pilot project. Journal of Music Therapy, 40(2), 138-150.
4. Hanser, S. B. (1999). The new music therapist's handbook, 2nd edition. Boston, MA: Berklee Press.
5. Koger, S.M., Chapin, K., & Brotons, M. (1999). Is music therapy an effective intervention for dementia? A meta-analytic review of literature. Journal of Music Therapy, 36 (1), 2-15.
6. Tomaino, C.M. (1998) Music on their minds: A qualitative study of the effects of using familiar music to stimulate preserved memory function in persons with dementia. Unpublished Doctoral Dissertation. New York University: UMI.
7. Tomaino, C. (2000). Working with Images and Recollection with Elderly Patients. In, D.
Aldridge (Ed.) Music therapy in dementia. London: Jessica Kingsley.
For more by Ronna Kaplan, M.A., click here.
For more on Alzheimer's disease, click here.