Week 1: Introduction to Music Therapy
Music therapy: credentialed professionals (MTAs) using music purposefully within therapeutic
relationships to support development, health, and well-being
● use music safely and ethically to address human needs within cognitive, communicative,
emotional, musical, physical, social, and spiritual domains
● Use music to reach a health care goal
CAMT: federally incorporated non-profit association that regulates music therapists in Canada
● creates strong certified MTAs and bring awareness about professional music therapy services
● encourage practice of music therapy in clinical, educational, and community settings
○ Most provinces have a provincial body to support but do not regulate the profession
Requirements to become MTA (music therapist accredited):
● University undergrad or grad degree in music therapy
○ Nova Scotia - Acadia University (BMT)
○ Manitoba - Canadian Mennonite University (BMT)
○ British Columbia - Capilano University (BMT)
○ Ontario - Wilfrid Laurier University (BMT + MMT)
○ Quebec - Concordia University (GD + MMT)
● Education and training of a music therapist is multidisciplinary
○ Encompasses physiology, anatomy, biology, psychology, anthropology
● 1000 hours of MTA supervised internship to gain practical experience/clinical skills
● Certification Board of Music Therapists (CBMT) Examination
● Maintain credential every 5 years through CAMT continuing education process
● Personal qualifications
○ Musician (excellent musical skills, knowledge of music theory, creativity)
○ Therapist (interest in helping others, in good physical and emotional health, patient)
● Some MTAs use psychotherapy, regulated by CRPO (College of Registered Psychotherapists of
Ontario) → CRPO only applies to music therapists working in ON
○ Psychotherapy act of 2007 was proclaimed by ON gov in 2015, bringing the CRPO into
operation; only members of CRPO can use the title “registered psychotherapist” (RP)
● MTAs work with all ages and diagnoses, and can work in various places
What does a session look like?
● typical session consists of hello/greeting song → music therapy interventions → goodbye song
Music therapy interventions
● Precomposed music: certain songs evoke strong memories (music marks integral time points),
but are not always positive
● Listening - helps develop cognitive skills such as attention and memory
○ In early-mid stage dementia, music can provide sense of familiarity and increase
orientation to reality
● Singing - assists in development of articulation, rhythm, and breath control
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Group setting: improves social skills and awareness of others
Dementia patients: encourage reminiscence and discussion while reducing anxiety/fear
For individuals who have difficulty speaking following stroke/brain injury/cognitive
decline, music can stimulate language centers in brain to promote singing
Songwriting - facilitates sharing feelings, ideas, and experiences
○ Hospitalized children: means of expressing and understanding fears
○ Terminal illness: means for examining feelings about meaning in life
- opportunity to create a legacy or shared experience with caregiver, child, or
loved one prior to death
○ All ages (particularly for adolescents): expression of painful memories, trauma, abuse,
and socially unacceptable thoughts while fostering a sense of identification with a group
Lyric analysis - can find meaning and empowerment in song lyrics that represent what we feel
and want to express
Improvising - creative, nonverbal means of expressing thoughts and feelings
○ nonjudgmental, easily approached, requires no previous musical training
○ music helps express difficult emotions when words fail
○ safe opportunity for restoring meaningful interpersonal contact where trust has been
compromised due to abuse (no one can say if you’re right/wrong with improvisation)
○ opportunity for those with limited learning ability to try different instruments, sounds,
timbres, and mediums to master a new skill and increase life satisfaction
Why music?
1. Music is a universal phenomenon (not language as people can interpret it differently) that
people of all ages and cultural backgrounds can listen, perform, create, and enjoy
2. Music is a flexible therapeutic medium because it has many different styles and ways to be
involved (e.g. composing, performing, listening)
○ music is used as a tool within music therapy to achieve health goals
○ encompasses mood/emotions, acts as distraction, evokes memories, alters
mood, elicits relaxation responses
What is NOT music therapy?
x Client/patient does not need musical background (accessible to all)
x Not entertainment (engaging in music for leisure)
x Not musical lessons to hone musical ability
x Not special music education to teach special learners about music
To receive music therapy
1. Referral
○ Anybody can make a referral
○ Reasons for referral (must have a real healthcare based, no “music” prescription”)
○ Can be used for all ages and diagnosis, no experience needed
2. Assessment
○ 1 day, 6 weeks, ongoing, etc. to determine treatment plan (goals)
3. Goals
○ based on observations/assessments
○ e.g. client will increase vocabulary to include social interactions like hello/goodbye
4. Treatment plan (implementing interventions)
○ precomposed music, singing, listening (including client recordings), instrumental playing,
improvising, composing, lyric analysis
5. Reports and reassessments
Week 2: History of Music Therapy
Preliterate and ancient cultures (5000 BC)
● before reading existed - complex languages but no symbol system for reading
● believed music affected mental and physical wellbeing and is connected with supernatural forces
● “medicine-men” used music in healing rituals to appease gods and drive away evil spirits
○ important part of rational medicine
● music (drums, rattles, chants, songs) can be present in preliminary ritual and healing ceremony
● Ancient Egypt 5000 BC
○ Egyptian priest-physicians referred to music as medicine for the soul and used it in
medicine practice
○ magical, religious, and rational components of medicine existed side by side
- healer’s treatment philosophy would generally focus on only one
● Ancient Greece 600BC
○ music had force over thought, emotion, and physical health
○ healing shrines had hymn specialists that prescribed music to the mentally disturbed
- Emotional catharsis (Aristotle), medicine of soul (Plato)
- Rational medicine had almost replaced magical and religious rites
○ From the video: 9 muses governed topics that all “civilized” people had to learn, music
was the language that underlined all these topics.
- Harmonia = Harmony in music AND in the world
- Plato theorized that music directly impacts your ethos; the kind of music you
listen to impacts who you are
● Medicine of the soul
- Aristotle: emotional catharsis
- The idea that music is connected to many areas of our life is not new!
- Although there are misconceptions about various genres of music in ancient and
modern society, the role of music therapy is not to judge, but to analyze what
kinds of music would be beneficial to the health goals of the client
○ Hippocratic oath: classic version of the hippocratic oath contains allusions to greek gods
(apollo) who was the god of healing, medicine, archery, music, poetry, and leader of
muses
Middle Ages (c. 476 - 1450 AD) - Europe
● Medicine influenced by 4 humors (blood, phlegm, yellow and black bile)
● Boethius thought music had the power to degrade/improve human morals
● Saint Basil believed it was a positive vehicle for sacred emotion
● hymns were considered effective against certain respiratory diseases
The Renaissance (1300 - 1600 AD)
● Beginning of scientific approach to medicine (still based on 4 humors)
● physicians prescribed music as a preventative medicine
○ Music was considered a powerful tool to improve emotional health during the time of
numerous epidemics (Zarlion the musician + Vesalius the physician)
Baroque Period (1580 - 1750 AD)
● Still based on 4 humours
● Kircher’s theory of temperaments and affections suggested certain personality characteristics
were associated with certain styles of music
○ e.g. depressed people responded to melancholy music
● Burton (anatomy of melancholy) → music to treat depression
● Louis Roger (physician in 1748) → published a book about the effects of music on human body
Modern Medicine (1800s+)
● First article published that held modern ideas was in 1789, called “music physically contributed”
in a columbian magazine
○ Talked about the importance of a trained practitioner
● 19C: scientific methodology (music in medicine, Big Pharma)
○ 1832: music programs in school for blind/disabilities
● reactive opposed to proactive
● shift towards more holistic approach - MT became accepted as treatment modality
○ received more research grants, many medical facilities recognized value of music therapy
for physical/mental rehabilitation of returning soldiers at the end of WWII
● USA was the founder of MT
○ First music therapy program was established in 1944 in Michigan
○ 1950 = national association of MT was established
● Europe: Juliette Alvin worked with children with autism and developmental differences, and
founded the society for MT and remedial therapy (1958)
○ 1976 = European music therapy association founded (BAMT)
Music therapy in Canada
● ~1955: music therapists working independently (e.g. Norma Sharpe, working as an MT but did
not have accreditation)
● 1960: Norma Sharpe conducted survey of music in hospitals
○ discovered many hospitals use music and staff have musical training/background
○ provided baseline measure for MTA and increased awareness about MT in hospitals
● 1970: Sharpe had regular contact with individuals/organizations with shared interest in MT
○ presided over first MT conference at St. Thomas Psychiatric Hospital, lots of enthusiasm
● 1974: conferences unified those working in MT throughout Canada
○ used to share techniques, programs, and assessment of rehabilitative effectiveness
○ lead to formation of a national association (Canadian Music Therapy Association)
Music therapy today
● CAMT (Canadian Association of Music Therapists)
● CRPO (College of Registered Psychotherapists of Ontario)
● first MT professional development academy in Canada in 2017
● 1985 was when the world federation of music therapy was developed
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Launched an int music therapy journal online called voices
World federation of MT: open access journal called “voices”
What is music therapy?
● Must be facilitated by an accredited music therapist
● Must have open dialogue between the patient and the provider; discussions about whether the
client enjoys the music/has trauma associated with music
● Other uses of music in medicine which do not follow these guidelines are NOT MT
Learning through music is innate and natural
● Examples: learning the ABCs through song
● Clear cognitive ties between music and knowledge acquisition
● Unfortunately, as we age in western culture, the “social acceptability” of singing and
participating in music causes people to feel uncomfortable singing publically
○ In music therapy, there are no musicality or technical goals. MT aims to encourage
patients to participate in music as humans with a natural rhythmic and musical capacity
Week 2: Evolution of Music Webinar
What is Music?
● Two major elements: Pitch and Rhythm
● Organized sound to convey emotion
How and When did music evolve?
● Rhythmic and vocal music are the oldest and most universal
● Instruments are prehistoric
● Written music is ancient (earliest writing systems have it)
Song and dance
● Modern human voice is 530,000 years old
● The location/shape of larynx is 1-1.8million years old
● Descended voice box makes voice more versatile - larger range and better control
● Human brains co-evolved with rest of anatomy including voice - neural mechanisms for vocal
chords were fine tuned 600-800k years ago
● Evidence of beating on cave walls and stalactites from 12k years ago
Prehistoric instruments
● Bone flute found in germany 42,000 years old (some say its 43-60k years old) a different and
older bone
● Made of hard material; very advanced suggesting years of practice and making
● Whistles were found 50, 000 years ago
● Bows can be tracked by existence of arrowheads
● Drums as early as skins could be dressed and dried
Why did Music Evolve?
● Religion, ritual, wooing, communication, enteriatiment, dance, catharsis, trance, healing
Why did musicality evolve?
● Descended voice box has an evolutionary trade off, increased chance of choking, increased
fatality
● Clapping hands and beating rocks takes energy and is painful
● Multiple theories on why song evolved
○ Most agree that it promotes social bonding
○ Alarm calls, motherease
○ Similar reasons for rhythmic music (rituals, war, dance ) all have cohesion
● Everyone was a musician and dancer
What did music evolve culturally?
● Controlled fire and hearths become common between 800 and 400 thousand years ago
● Firelit socializing would have arisen during this time
● Hominims had large and complex brains, were social, creative and innovative
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Lived in groups of up to 120 and required cohesion, cooperation, and coordination.
Used song for story telling
Why did music evolve culturally?
● Near the neolithic period, societies became larger and complex specialization of works and
hierarchy
● Signs of social status and competition became necessary
● Saw fancy beads and burial rites
● Ivory flutes, require production scale and are costly in terms of raw material and costly
maintenance so only high up people had them
Why did music evolve culturally?
● Music became specialized too
● At the end of the neolithic period (10-20 k years ago; agriculture revolution) music became
more sophisticated among educated and powerful
● Somewhere between 5k-2k years ago we see a divide between performers and audiences being
to form
● Music became an art
Ancient Egypt example
● Music is depicted in lives of elite class
● Rituals, religious, court, military , sexual
● Instruments and sheet music and descriptions of music activities have been found by
archeologists
Ancient Greece and Rome Example
● Existed both in elite class AND everyday life for everyone
● Greece had professional musicians, competitive musicians and everyone else
● Bards and court musicians had full time jobs
● The Pythian Games (before olympics) were about music and poetry
● Everyone was expected to have knowledge of folk songs
● Music appears in archaeological records of theater, festivals, private parties, domestic work,
manual labour, military activities, education, religious ceremonies, medicine
Still today
● Music exists in most of those realms today
● Cathartic properties of music continued to be recognized, but with the rise of rational medicine
and the theory of humours, it was generally used on an individual level
● Music has gone in and out of favour in medicine
● Utilization of the most important evolutionary aspect of music (its social bonding properties)
decreased as society grew more complex
Week 3: Music Therapy Approaches/Models
● many different approaches depending on setting, client group, and country/healthcare system
● Do all music therapists use the same approach? → no!
○ Many different music therapy programs, each uni has a different approach
○ Each MT has different strengths, client groups, interests, which influences their work
○ Different countries/healthcare systems, governments, economic demands, societal
pressures, and research also affects it
● All approaches have benefits, most important thing is that each therapist uses an approach that
best suits their strengths
What is the role of music?
● Music AS therapy
○ Some approaches focus on music; music itself facilitates change (engagement, creation
listening supports the goal that creates change)
● Music IN therapy
○ Some approaches utilize music as a tool to facilitate change; but change doesn’t happen
in the music (more so in reflection, therapeutic relationship, images - music is only a
piece of the therapy)
Creative music therapy
● Nordoff-Robbins (1959-76), created creative music therapy (aka nordoff robbins therapy)
○ Paul Nordoff (American composer) + Clive Robbins (British special educator)
○ Must take NR training to become a music therapist that uses this method
● believed music did the therapy (music as therapy); music can reach an individual regardless of
diagnosis - symptoms of a diagnosis are not a barrier for reaching an individual’s full potential
● “Music-child” - worked mainly with children with disabilities and said that there is a “music
child” in everyone
● music-centered and not focused on verbal
● 2 therapists - 1 at the piano playing the music, 1 physically supporting client to engage
Guided imagery method (GIM)
● post MTA training (part time for 3 years) → must already have MT
● Built on therapeutic relationship and about listening to prerecorded music (traditionally
classical), then facilitating discussion about that music
○ it activates inner reflection (eg. what image does it provoke?)
● Helen Bonny (1970) → replaced clinical use of LSD with music, developed GIM
● GIM with cognitively able patients/musicians can help with performance anxiety (what visuals
come to mind when thinking about anxiety related to performing, and how can we change that?)
Behavioural Approach
● using music as reinforcement/stimulus cue to affect behaviour
● result-driven and therapist-led
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Eg. NICU infants using stimulus of music listening to suck for nutrition
○ Want to increase sucking behaviour in infants - sucking=music plays, stop sucking=music
stops (promotes sucking behaviour)
Cognitive behavioural model (aka CBT)
● When we have an extreme belief, it can become a fact in our mind and then can negatively
impact us
● CBT works on shifting the lens; providing new experiences or reframing experiences
● emotion, thought, and behaviour are interconnected
● Replace irrational thinking through the use of music therapy
○ Eg. trying improvisation to shift the idea that that patient always makes mistakes (as you
cannot make a mistake with improv - provide a positive experience to shift the lens)
Psychotherapy approach
● Psychodynamic therapy (Sigmund Freud, jung & adler) → unconscious thought/connections to
childhood/Free Association
○ Through free association, we can talk to unconscious
○ Use improv and song writing; GIM also uses a psychotherapy approach kind of
● Behavioural therapy → Classic (Watson) and Operant (Skinner) conditioning
● Humanistic Based Therapy (Carl Rogers) → positive abilities/aspirations, free will, wholeness
“self actualization”
Biomedical models - biopsychosocial
● About neurobiology - how does music impact the brain (Eg. how does it increase endorphins)
● MT collaborate with HCPs
● Mainly applied with pain management and with symptoms of mental illness
● 3 points on pp:
○ Focus on the neurobiological foundations of the nervous system
○ Emphasis on music perception and active music participation as a form of stimulation
that activates physiological and neurophysiological processes in the body (including
affect and cognition as a part of neural behaviour)
○ Belief that the unique structural and cultural properties of music can be harnessed to
access the brain and behavior functions to facilitate and promote healing/rehabilitation)
Neurologic music therapy
● Therapeutic application of music to cognitive, sensory, and motor dysfunctions due to neurologic
disease of the human nervous system
● Standardized evidence-based approach/interventions (no variability, all interventions are
implemented the same way regardless of therapist), and outcomes are measurable
● The domains are:
○ Sensorimotor rehabilitation
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Eg. at the start of a session to improve walking, patient’s pace was 65bpm, at the
end it was 125bpm
○ Speech and language rehabilitation
○ Cognitive rehabilitation
Post MT training required to be able to use this method
Eclectic model
● humanistic (client-centred)
● MTA uses whichever model(s) best benefit the client within the MTA’s training/ability/limitations
○ Can use multiple different approaches throughout the session
Week 4: Music therapy and ABI & Songwriting in MT
Acquired brain injury (ABI)
● Umbrella term for all brain injuries, classified as traumatic (TBI) or non-traumatic - concussions
are also a type of ABI
○ Not a developmental disability - ABI is damage to the brain that occurs after birth, 1 in
26 canadians live with brain injury
○ Can be visible or invisible
○ Affects cognitive, emotional, behavioural, and physical functioning
● An ABI patient often deals with: loss (of life, independence, identity), emotional crisis,
adjustment, rehabilitation, identity
● Ex. Sam had a brain injury and was struck by a train and lost insight. Couldn’t articulate with
words but can with music (song allows self expression and gives a tangible product to share
feelings)
ABI affecting speech
● Aphasia: client is aware of what they want to say but cannot find the words
● Dyspraxia: difficulty articulating speech (hard to understand the individual affected)
● Music therapist and speech pathology therapist can help with this - put together treatment that
will benefit the patient
○ Speech pathologist puts together the treatment plan, MT can contribute
○ Due to different brain regions being activated, clients with aphasia might still be able to
express themselves through singing
○ We can work to transition fluidity of speech in signing into normal speech
● NMT can manage speech symptoms of an ABI, can also help with physical rehab
● Technology can also be used to help facilitate music making for therapy
-------------------Introduction to songwriting
● Song writing provides a tangible product which can be shared with others (as well as experience
of writing the song)
● Can be used to communicate with loved ones in a way that might feel more safe than verbal
● Reflection - motivation and encouragement
● Safe self-exploration - identifying and externalizing emotions (share sense of emotions rather
than saying own feelings)
● Telling one’s story (create pride, self confidence)
● Feel self control and autonomy over the song and what it sounded like
Can anyone write a song?
- Music therapist facilitates song writing
- Think about intent (never for the product in MT), simple, repetitive, form
Songwriting as music therapy intervention
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Can be one to one sessions, or
Group settings - can collaborate on songwriting (eg creating lyrics from each one of them)
Important to see if client will be able to engage or benefit from it
○ Some clients may not have the cognitive abilities to write songs; depends on individual
Can be helpful for patients to represent feelings and change
Can be used for pt that are non-verbal, use of the cards to pick what the song can sound like
When to Introduce Song
Writing?
● When will song writing be helpful?
● Depends on the client, can be built overtime. May need other goals first (cognitive goals)
● Song Writing in Dementia Care?
- Likely not able to communicate through pictures or verbally, so songwriting is not possible
- Sometimes will do a new song every session in dementia patients b/c impaired short term
memory
Songwriting techniques
● Brainstorming: thinking about themes and words
○ Brainstorm ideas and find common themes then begin to find lyrics
● Fill in the blanks: using a pre-existing song and changing words
● Song parody: changing all the words but melody remains the same
● Song collage: using pieces of other songs and putting them together
● Rhyming: making brainstormed themes and words to rhyme in a song
○ Take words from brainstorm and then think of rhymes to expand
Summary Questions
● Why use song writing within a music therapy session? Express emotions.
● What are some examples of song writing techniques?
● Who can benefit from engaging in the music therapy intervention of song writing? Patient,
family, health care team
Week 5: Precomposed Music
● Why is it such a powerful tool? It is something we are always exposed to, something that is
already written. Helps us connect to others and stimulate dialogue. Can be secure, empowering,
reassurance, confidence (know when to come in and where the chorus is, allows pt to engage),
memory-evoking.
○ Music can create a timeline. Different eras of your life have different music prevalent.
● Music timeline: can be useful for mental health or cognitive goals
● How it’s implemented
○ Live music: a MT can slow down, invite client, repeat sections → depends on the goal.
○ Pre-recorded: client hears the music in the form they’re used to hearing - might be
more powerful. The patient can sign with it.
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Isn’t this a sign-a-long? No, the MT is facilitating healthcare goals. Ex. engaging
in convo, sharing memories, eye contact. If entertainer it would not be for
healthcare goals.
○ Singing
○ Listening
○ Playing instruments
○ Moving
● Need to consider cognitive ability. If the patient cannot process negative memories, try to only
use music that evokes positive memories.
● Precomposed music and cognitive goals
○ Memory: they can remember the songs
○ Speech: singing, can be used to help communication and speech. It may feel
safe/motivating for pts because music is familiar.
● Precomposed music and developmental goals (can help with action, vocab)
○ Head & Shoulders: learning body parts, proprioception
○ Wheels on the bus: coordination, vocab, motion
○ Alphabet Song
○ 5 little ducks: help with counting
● Precomposed music and physical rehabilitation
○ Strong beat – familiar piece of music: help with movement, motor cortex fires
○ Walking, improving gait (balance/coordination) improving stride
○ Motivating movement – increase range of motion
○ Hand bells ( shake or push button ) – gross/fine motor dexterity
■ MT: meaningful discussions, elevating mood, fine motor skills, building
connections, achieving a goal that is meaningful
■ Entertainment: learning and performing.
○ Age appropriate
● iPod project (not music therapy)
○ Not music therapy, but important for understanding music as a tool in health care
○ Unresponsive dementia patient lights up when given ipod with familiar music → provide
personalized playlist in Alzheimers
■ Music could also evoke a negative response, so it is important to observe the
individual’s response when playing them music
○ Not music therapy because it's not done by a music therapist
● In Summary - Key Points
○ Precomposed music can evoke meaningful memories
○ Precomposed music can evoke movement
○ Precomposed music can facilitate speech
○ Precomposed music can facilitate developmental goals
○ Singing / playing of instruments / listening to music
Week 5: Improvisation
What is Improvisation?
● Playing freely and with no rules/context.
● Free improvisation approach, nordoff robbins approach (creating music in the moment, free
expression), psychotherapeutic approach can all be used during improvisation
○ Not neurologic (standardized)
● Healthcare goals: building confidence, self exploration, taking risks
● Improvising can be done in turn taking, which may facilitate social skills/communication
● Goal: musically express as a means of self expression, self reflection, communication
○ Not necessarily to make aesthetic music
Clients
● All ages ( not infants )
● What is the intent of the improvisation? Managing anxiety, giving pt a voice.
● How will it be processed? A tool for self-reflection or discussion? It has to relate to the pt and their
goals.
● Could choose to record and listen back to the creation
Free Improvisation & Playing Rules
● Free improvisation can feel intimidating/overwhelming, right here and right now not thinking to
be replicated
● MT can suggest playing rules to ease improvising experience
○ Eg. only explore the black keys on the piano
● **rules are in place to facilitate improvisation; meant to help the client to explore/be creative not meant to constrain the client
○ Good thing if rules are broken!! Means the client is more comfortable
MT Improvisation Technique
- Interplay between all these techniques can occur in a session
→ Mirroring
● Empathic; MT is trying to put themselves in emotional space of the client
● MT does what the client is doing at the same time
○ This shows the client that the MT is listening to them, and allows client to see
themselves in the therapist and forms a connection.
→ Matching
● Empathic (therapist puts themselves in shoes of client), validates client
● Therapist creates music that is compatible with the client (matches what the client is playing)
○ Same style and quality
○ Says “we’re doing different things but we’re in this together” (concept of together yet
separate)
→ Grounding
● When client is expressing themselves freely and music becomes chaotic, MT can use grounding
to provide the client’s improvisation some form (feeling of being grounded/anchor)
○ Eg. repetitive octaves supporting the client's improvisation
→ Holding/Containing
● Providing a musical anchor to contain improvisation
○ Eg. create a strong pattern which provides structure for client’s improvised musical
chaos (rather than the octaves in grounding)
→ Dialoguing
● MT and client take turns improvising back and forth as a means to have a musical conversation
○ Opportunity to communicate, express
● Effective technique for those who are struggling with language (eg. developmental delay, after
stroke)
Week 5: Music Therapy with the Elderly
● no normative established values of cognitive impairments or memory loss, or what
neurophysiological/neurochemical changes accompany normal aging
● Complex developmental process that involves physical, psychological, and social factors
● Increased longevity
○ We now understand danger of smoking, we are making lifestyle changes, and healthcare
is improving - therefore there is increased elder care
● Definitions of age:
○ chronological age = # of years
○ biological age = ongoing physical process from birth → death (eg. wrinkles, muscle
strength, organ function - different depending on the individual)
○ psychological age = ability to adapt to new situations (eg. someone may refuse to use
internet or insist on writing everything on paper)
- Especially with dementia, it is difficult to shift pov
○ psychosocial age = cultural views and expectations
● In western culture, there is often a negative connotation with the elderly/aging
○ In non western cultures, being older is revered and they have high regard/wisdom
Dementia
● Definition: acquired decline of cognitive function represented by memory and language
impairment; is an umbrella term
○ Alzheimer’s, vascular disease, dementia with Lewy’s body, Parkinson’s, progressive
supranuclear palsy (and more) all fall within the definition of dementia
● Difficult to diagnose (normal degeneration vs. dementia)
● Masked by depression, which can also cause cognitive and behavioural disorders
○ 20-30% of older adults will have accompanying depression
● Mini-mental state examination (MMSE): brief cognitive test for dementia, gold standard in
determining cognitive ability
● Music abilities preserved in dementia because music uses both hemispheres of the brain (not
part of cognitive deterioration)
○ Music and singing are rarely tested as features of cognitive deterioration
● No cure for dementia, only symptom management; also is very costly
Reasons for referral
● “Liking music, good at music” are not healthcare goals, therefore it is not a valid referral for MT
● Having dementia is not a reason for referral - what is the specific healthcare goal?
○ Healthcare goals can include: decrease pacing, reduce agitation, reduce vocalizing
increase eye contact, alertness, decrease anxiety
Research into outcomes of MT
● Enhances socialization and communication (reduces isolation) - also better bc it can be done in
groups, so it saves money
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Muscle stimulation for fine and gross motor skills through playing instruments
○ Hard for people with dementia to remember lyrics - humming and repetitive lyrics!! (eg.
I know that it's now time to sing the chorus because we are humming the part before!)
Precomposed music
● Powerful tool due to familiarity and predictability (ABA structure - verse, chorus, verse)
● Secure, empowering, reassurance, confidence, memory evoking (often positive)
● Stimulates dialogue/relationships - MT engages individuals to sing with them
● Reduce isolation and muscular stimulation
MT interventions in dementia care
● Singing
● Improvising
● Playing instruments - bell choir (gives a sense of normalcy and community; the bells will give
them a successful experience because they are very easy to play - together they create music
that the dementia patients might recognize)
● Song writing - can express one’s life story (cause otherwise dementia patients forget)
Dementia video
● Worse over time, affects our thinking, not a normal part of aging, due to disease that changes
our brain (neuronal damage - area where damage occurs determines what is affected)
○ Back of brain = vision issues
○ Side of brain = communication and speaking issues
● 4 main diseases that cause dementia:
○ Alzheimers: often affects the hippocampus first, therefore we experience forgetfulness
- Due to age, genetics, poor heart health
○ Dementia with lewy bodies: changes in attention, sleep problems, hallucinations
- Can develop parkinson like symptoms
○ Frontotemporal dementia: symptoms get worse over time
○ Parkinson’s disease
○ Vascular dementia: occurs after stroke (BV in brain are in poor health); progresses in
distinct steps
● No cures for diseases that cause dementia
Week 6: Neurologic Music Therapy
• Neuroscience approach to Music Therapy based on scientific knowledge in music perception, music
production and the effects of nonmusical brain and behaviour functions.
• Research –based system of 20 standardized clinical techniques for
• Sensorimotor training
• Speech and language training
• Cognitive training
Neurologic Music Therapy training is issued by the Robert F.Unkefer Academy for Neurologic Music
Therapy.
• Completion of the NMT training allows the board-certified music therapist to practice and use the
designation of NeurologicMusic Therapist (NMT) for three years, then you become a fellow.
- Fellow: review and update of current technique. Participants are required to present video
examples demonstrating their current clinical work using three different NMT techniques.
- • Participants are evaluated and will pass with a 70% majority vote.
• The NMT Academy training is endorsed by the World Federation of Neurorehabilitation (WFNR), the
European Federation ofNeurorehabilitation Societies (EFNS), and by the InternationalSociety for Clinical
Neuromusicology (CNM).
• Formally established in 1999/2000.
• In the late 1990s researchers and clinicians in music therapy, neurology, rehabilitation and brain
sciences classified evidence into a system of standardized therapeutic techniques for sensorimotor,
speech/language and cognitive rehabilitation. → collaborate with different disciplines.
• NMT is medically recognized as evidence based therapy [e.g., by the World Federation of
Neurorehabilitation], is represented in over 60 countries by certified NMT-Therapists, and one prominent
NMT technique [Rhythmic Auditory Stimulation for gait rehabilitation] has been included in the official
clinical stroke care guidelines in the US [Departments of Veteran Affairs and Defense] and Canada
[Heart Stroke Foundation], Similar efforts are underway in several other countries.
- Dr. Michael Thaut: the founder of NMT. Works collaboratively
- There is a diverse connections and collaboration to inform approach. Widely recognized
in neuroscience.
Common conditions
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ALS, Alzheimer’s, Acquired Brain Injury, Cerebral Palsy, Concussion, Epilepsy, Multiple Sclerosis,
Muscular Dystrophy, Neuropathy, Parkinson’s Disease, Stroke
Common symptoms
- Weakened muscles, Loss of coordination, Loss of sensation, Seizures, Confusion, Pain, Altered
cognition, Paralysis, Altered speech patterns
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Music activates many parts of the brain, so music can be a tool to engage other parts of the
brain. NMT is developed with the interplay of the brain areas for rehab of speech, movement,
and cognition.
Entrainment
- A temporal locking process in which one system's motion entrains the frequency of another system.
This process is a universal phenomenon that can be observed in physical (e.g., pendulum clocks) and
biological systems (e.g., fire flies). → natural reaction of motor cortex
• Temporal rhythmic entrainment has been successfully extended into applications in cognitive
rehabilitation and speech and language rehabilitation, and thus become one of the major neurological
mechanisms linking music and rhythm to brain rehabilitation.
• These findings provided a scientific basis for the development of neurologic music therapy.
SENSORIMOTOR IE) TIMP
• Therapeutic Instrumental Music Performance (TIMP)
• Sensorimotor skills technique
• Combines physiotherapy exercises with instrumental playing
• Rhythm is the driving force to facilitate interventions
- Ex. tambourines and the legs, to use for rehab
SENSORY MOTOR IE)RAS
• Rhythmic Auditory Stimulation
• Specifically for gait training
• Aims to improve balance and posture
- Strong beat for gait training. Can measure results in an objective way (bpm).
COGNITION IE) MUSICAL NEGLECT TRAINING
• Visual Spatial Skills
• Executive Functioning Skills
- Began to use the neglected side, motivation to continue the melody.
SPEECH & LANGUAGE IE) MIT &THERAPEUTIC SINGING
• Melodic Intonation Therapy
• Primary Tools (Rhythm, Melody, Pitch)
- Practicing speech phrases in melody and rhythm.
Week 7: Improvising as MT Intervention & MT in ASD Support
---------What is Autism Spectrum Disorder?
● A condition related to brain development that impacts how a person perceives and socializes
with others, causing issues in social interaction and communication
○ Disorder also includes limited and repetitive patterns of behaviour
○ Wide range of symptoms and severity, hence “spectrum”
● Outdated terms: autism, asperger’s, childhood disintegrative disorder, unspecified form of
pervasive developmental disorder (PDD-NOS)
● Use person first terminology!! Autistic vs person on the autism spectrum
○ But ask person first what they prefer
● ASD is complex!! Different from person to person; cannot generalize
○ Non specific to socio-economic or cultural factors
→ Symptoms
● Cannot really be diagnosed pre birth; typically diagnosed by age 3 (eg. can be seen if
developmental milestones are not reached)
● Diagnosis includes: impairment of reciprocal social interaction, verbal communication, restricted
interests (may include stereotypical/repetitive movements)
→ History
● 1943: Leo Kanner (psychiatrist at Johns Hopkins) first noticed autism and assigned particular
characteristics to describe it
○ Often misunderstood (Eg. ppl think it only occurs in children)
○ Kanner thought that the lack of a mother’s love (refrigerator mother) contributed to the
“psychiatric illness”
● Due to misunderstanding the disorder up until the 1980s, it was often misdiagnosed as
schizophrenia and treated as a psychiatric disorder
○ Until 1980s, autism was considered a disease/illness in the DSM (was differentiated in
DSM3 in 1980s)
→ Causes
● Unknown, could be genetic/environmental
○ But no genetic markers have been found yet
● Not a result of the “refrigerator mother” (mother that does not show enough love)
Rethinking ASD
● Research is helping to gain better understanding of ASD (including how to support people and
how to recognize abilities within a diagnosis)
● Music can often highlight such abilities!! Lots of people on the spectrum have heightened
abilities in regard to music
● Also there are many support and awareness groups advocating for people with ASD
ASD and MT Interventions
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Goals: communication, social interactions, sensory processing, behavioural issues (eg. stopping
nail picking - fix behaviour that impacts quality of life)
MTs often collaborate with a speech language pathologist (SLP), and use shared tools like the
PECS (picture exchange communication system)
○ These are pictures where patient can point to communicate
Music is flexible, so MT can change the use of music to best fit the client
○ Music is also expressive and receptive (eg. call and response songs, repetitive lyrics)
○ Use music to prompt/motivate interactions - facilitate meaningful interactions (build
social skills)
Summary: live music provides opportunities for interactions, is freeing, allows client to feel
heard (no barriers in expression)
○ Even if person with ASD has sensory issues/finds sounds overwhelming, it is rare that
they find music overwhelming
○ Many ASD patients have heightened abilities in music (eg. perfect pitch)
Predicting Change and Transition in a MT Setting
● For some individuals, transition/predicting what comes next may be difficult
● MT can have a white board with a schedule, visual cues of what's coming next
○ Basically just trying to make a predictable space
○ Eg. hello / movement song / singing / playing drums / *surprise or choice / dice / closing
○ A way of practicing how to manage the unknown/unpredictable and managing the stress
that may come with not knowing
● Additional learning goals can also be included (eg. memorizing stuff from school, physical/motor
skills, whatever is related to enhancing quality of life)
Week 9: Music Therapy and Mental Health
● There is no health without mental health
● Health: state of complete physical, mental, and social well-being, not just the absence of disease
● Mental health vs mental illness
○ Mental health: continually manage and work on (by managing stressors, engaging in
therapy, engaging in mindfulness)
○ Mental illness: criteria is met to provide a diagnosis (like depression)
Mental health
● Is the well-being in which the individual:
○ Realizes their own abilities
○ Can cope with normal life stressors
○ Can work productively and fruitfully
○ Is able to make a contribution to their community
● Mental health is not a “normalized” priority - we tend to prioritize physical health
○ We tend to support people with their physical health, but not mental health
○ Don’t make time for mental health (not prioritizing it)
○ In 2016, 40% of individuals unger 24 accessed mental health care through emergency
department, indicating they reached out for support only in crisis
○ Canadian mental health association reports that ½ of canadians over 15 claim their
mental health needs are unmet (shows that it is not prioritized/people do not know how
to access support)
● Suicide is second leading cause of death for those 15-24
● Proactive opposed to reactive measures are key to promoting mental health
● Music can affect autonomic systems such as heart and respiration rate
● BUT music is normalized!! Seen as healthy, no negative stigma with music
Music therapy and mental health
● In order to gain results, one must commit to the experience (compare to gym - 1 visit will not
yield results)
● Client must be able to reflect and articulate goals; must be able to work with therapist to create
goals and treatment plan
● Client must have a desire to enter an alliance to reach goals - responsibility falls on both client
and therapist (working together to meet goals)
● Music therapy approaches: is one better?
○ It depends on client and their goals; if they want to build tools to manage symptoms
(e.g., tools to destress), then a CBT approach may work better
○ Also depends on if it is a group or individual - in a group setting, it may be beneficial as it
allows patient to realize that other people also have that experience/feeling, will
validate them and help them recognize that they are not alone
Music therapy interventions
● Any intervention may be appropriate, depending on the music therapy approach
● Songwriting: beneficial in externalizing thoughts and emotions, for self expression, and a way to
self examine
● Lyric analysis: can articulate how one is feeling, explore experiences through lyrics, validating
feelings (recognizing that others also feel the same way from the lyrics)
● Singing: improve mood (enhances endorphins and dopamine)
● Improvising: provides a judgement free zone to fully explore and create; means to connect to
oneself
● Music listening: passively affect the ANS (heart rate, breathing, O2 sat) - physiological response
can help to regulate the individual and impact the mood; can also be used as a reflective exercise
Music and the ANS
● Music can affect ANS (affect heart rate, respiration rate); many people use music to achieve
physical and psychological balance
● Many studies show that msci can be used to manage pain and anxiety in pre-op patients
○ Music can then also manage stress and anxiety
● Social factors play a big role in health; group music therapy activities like singing and drumming
have been shown to improve mood, decrease stress, and iis cost effective
Article: Individual music therapy for mental health care clients with low therapy motivation: multi-centre
randomised controlled trial
● Purpose: is MT effective compared to treatment as usual (TAU) in supporting clients to express
themselves emotionally, build relationships, and improve general motivation?
● Summary of study:
○ 144 participants - all adults in mental health care with low motivation for therapy
○ Randomly assigned MT or TAU; 71 participants receiving MT bi weekly for 3 months, 71
patients receiving TAU for 3 months
○ Data was collected at 1,3,9 months ; study was conducted in australia, austria, and
norway
● MT sessions: 45 mins, 2x/week, for 3 months
○ 10 music therapists provided sessions (study controlled for therapist effect!! Results are
not specifically due to the MT), and a flexible MT manual was developed for the study
(that the therapists drew from for the sessions)
○ MT approach used: resource-oriented MT
- Defined as: “Using the client’s resources, strengths, and potentials in meeting
the healthcare goals, opposed to focusing on problems and symptoms; emphasis
on collaboration as equals in the MT relationship”
● Music therapy manual: created specifically for this research, highlighted the main aspects of
resource-oriented MT, and highlighted which interventions could be used in sessions
○ Includes improvising, songwriting, use of pre-composed music, music listening, verbal
reflection
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**within MT, there is no manual that MTs can access; a manual was made for the study
to ensure consistency in the deliver of MT across MTs
TAU: included medication therapy (antipsychotic, antidepressants, mood stabilizers, psychotropic
drugs), psychotherapy or psychological treatment, electroconvulsive therapy, counselling,
physiotherapist, gardening, working with social worker
Outcomes:
○ Assessed primarily with the scale for the assessment of negative symptoms (SANS)
- more negative symptoms=less effective treatment
○ Secondarily assessed with: general symptoms, anxiety, depression, somatic complaints,
interest in music, motivation for change, vitality, social relationships
Results:
○ MT effective for mental health care clients with low motivation
○ Most primary and secondary measures indicate a significant difference
○ Drop out rate is less for MT compared to TAU
Support on McMaster campus
● Lots, like Good2Talk, Student Assistance Plan
● SACHA, Bounceback, Assaulted Women’s Helpline
Stigma and mental health
● Stigma can be a barrier to maintaining mental health
● MT can feel less stigmatized than normal verbal therapy
Proactive wellness - study
● Goal: provide evidence of efficacy of online group MT to proactively manage stress
● No negative stigma
● Collect psychometric data, cortisol from hair clippings, and heart rate and stuff to measure
changes in stress and anxiety
Week 10: Music Therapy and Palliative Care
Hospice and palliative care
● Individuals diagnosed with a terminal illness
● Philosophy of care implemented at the end of life; directed by patient (eg. if patient does not
want bloodwork, then blood does not need to be drawn)
○ Is person-centered, not illness-centered
● Team oriented approach with the aim of enhancing comfort and quality of life
● Priority is to prevent suffering and relieve pain
● Bereavement: MT may continue to work with family after the patient has passed
MT in palliative care
● Palliative care is about living life to the fullest in the moment, not about “dying”
● Sounds may be the last sense that we have, so music can help a lot in palliative care
● Music can help with pain - those listening to music experience complain about pain less
● Not all palliative care patients are bedridden/dying; many people in palliative care are very
functional (living in own home, can verbally communicate), they just have a terminal illness
○ Can engage in music therapy sessions a lot
● Music therapy is non-intrusive; by engaging in music, the MT can share with the healthcare team
stuff about the patient (eg. able to play instrument, expressed emotions, was not showing SoB
and was able to sing)
○ Instead of asking patient about all this in questions, which can be tiresome for patient
● MT is not only music, but also building relationships and bringing a human element to care
● MT can also provide reflective moments, especially in a time (end of life) where it is important to
have closure and reflection on aspects/relationships throughout their lives
● Songwriting, playing instruments, singing, reminiscing (were MT strategies used in videos)
Who benefits?
● All ages of people who are terminally ill
● Family an friends also benefit if participating in the sesion
● Health care team (hearing the music often elevates their mood/helps them feel relaxed)
Hospice team and MT
● MT focuses on interventions for physical, emotional, spiritual, cognitive, and social needs
● MT focuses on the whole person
● It is non-invasive and cost effective (having a MT on the team is less than pharmaceutical costs MT can often lower amount of pharmaceuticals used)
● Can be passive (receives music) or active (patient engages/participates in music)
Goals
● Psychosocial: managing anxiety, managing feelings of loss, supporting spirituality, providing
patient with a sense of control, managing isolation, helping with family cohesion
● Pain management: most common symptom of palliative care
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Manage dyspnea (SoB): through signing/humming, SoB can be managed
Manage sleep difficulties: eg. music can help manage stress/anxiety, which may help patient to
sleep better
Biomedical theory of MT
● Pain is number 1 symptom in palliative care
● Biomedical theory recognizes that music has analgesic effects
● Distraction hypothesis: when we’re engaged in music, it’s more difficult for brain to process pain
○ Study found that pain was lessened the most when patient was listening to music that
they chose themselves
● Pain is subjective!! Our mood can impact how we experience pain (eg. good mood = less pain;
pain is also different from person to person)
● Also, increases in endorphin levels = pain perception reduction
○ Music enhances endorphin production, which supports previous observations
Treating “total pain”
● In order to lessel pain in palliative care, we must treat “total pain”
● Includes psychosocial, emotional, social, spiritual, physical, biopsychosocial approach
(incorporating biological, psychological, and social)
● MT is very rounded and can touch on many different aspect of this “total pain”
● Psychosocial support: can be achieved by engaging in MT; supporting symptoms of anxiety,
depression, isolation, confusion, fried, impaired communication, ineffective coping, self-esteem,
relationship issues, life review
Interventions
● Music listening, improvisation, singing, song writing, music playing, lyric analysis
○ Singing example: patient could not speak/communicate, yet could sing
● GIM
● Iso-principle - matching patient’s mood with music
● MAR (music assisted relaxation)
● MT’s must be flexible and adapt in the moment
● MT may be used to keep patient awake - this can improve quality of life (positively keep
individual awake until nighttime, so then they can get back to a normal sleep schedule which will
increase overall quality of life)
Jean
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Has dementia and severe arthritis, living in LTC
Nails dig into palm so she must constantly put new dressings; main priority is pain management
MT distracts Jean from pain and provide a positive experience while changing the dressings
MT matched client’s pain vocalizations with voice and guitar, and slowly started to change
vocalizations to encourage deep breathing
○ Also started improvising about Jean’s past where she was on a farm (reminiscing)
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This music created calming effect for Jean, which also helped caregiver who was changing the
bandage to feel less stressed
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Diagnosed with ALS: was weak, had dysphagia
Became anxious due to laboured breathing
Upon working with the MT, he would vocalize and also help the MT with guitar (as he used to
play guitar) - provided Bud with independence and control
Outcomes for Bud: distraction, anxiety reduction, positive reminiscence, spiritual support,
control, improve social interactions, finding meaning and purpose
○ Became comfortable enough to allow friends and family to join, where he previously did
not want to see them as he felt self-conscious
Bud
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Dan
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Non-responsive, was at end-of-life
MT provided positive memories in a situation where family felt helpless and distressed due to
end of life
MT would play songs that were meaningful for the family and they would all join in
○ Family was able to engage with Dan, even though he could not communicate with them
Even if Dan is unresponsive, he can probably hear the music and his family
Emily - Children in Hospice
● 6 yr old, inoperable tumour
● She wanted the whole family to sing her favourite songs over and over again - this gave her a
sense of autonomy and control
● Recordings were made for her family so that they would have positive memories
Week 11: Community Music Therapy
Community music therapy
● Way of working that challenges traditional boundaries and definitions of MT
● Does not require a referral or treatment plan, no clinical format
● Considers the ways how culture informs our ways of perceiving therapeutic needs
● Seeks to develop new perspectives, role identities, and ways of doing music therapy
● This approach is growing and evolving in field of MT
○ Historically, engaging in music was a way of building community (music was not specific
to certain people); idea of engaging in music to build community is not new
● Is a way of doing and thinking about music therapy where the larger cultural, institutional, and
social context is taken into consideration
● Approach involves awareness of the system the MT is working within; MT is often aimed at
changing the system that is sometimes part of the client’s situation
● Often, leadership is shared and clients all have autonomy in leading their MT sessions; also is
often in a team environment
System theory
● Community MT has its roots in system theory
● This theory suggests an alternative to the traditional cause and effect model; it looks at all the
layers to a client’s situation, outside of just looking at diagnosis and symptoms
○ circular model of understanding how phenomena are interacting
PhD research example
● Community MT - effective for managing stress and anxiety in undergraduate students?
○ Is community MT as it is not clinical, it is open to all undergraduate students, no referral
needed, coming together to work on health goals
- Also is looking to make changes in the system (university) - wants to remove
negative stigma about reaching out for support - promoting proactive stress
management!! Can prevent crisis
○ Physiological, psychological, and biomarkers are used to assess stress
○ Seeing efficacy compared to treatment as usual (verbal therapy)
● Results are not only to support the students in the moment, but also aims to impact change to
the system and shift it from a reactive model to proactive; also has a goal to change how we
think about therapy (normally, there is negative stigma; BUT music has no stigma)
Community MT goals
● Bigger picture goals in addition to specific healthcare goals
● Typical community MT goals:
○ Provider of vitality, ie emotional stimulation and expression
○ Tool for developing agency and empowerment
○ Recourse in building social networks
○ Way of providing meaning and coherence in life
●
Local musicians can also be brought into community MT in order to be authentic to the client (eg
if MT only knows western music and client knows a different type of music, then MT must
recognise their own limitations and cultural difference)
Case Study of a Coffee House (at mental health treatment facility)
● Bi-annual musical performance event at an adolescent mental health treatment
● Youth and staff can perform musically, and would be supported by MT and multidisciplinary
team(help prepare for performances)
○ Perform individually or with groups
● Purpose: build skills to overcome anxiety, engage in risk taking, enhance self-efficacy and
confidence, provide a leveling of institutional dynamics (staff and patients both should be
performing and taking risks)
● Participatory ethos:
○ Success = the act of participating (doesn’t matter what you did, as long as you
participated)
○ No judgement, safe-environment for people to take risks
○ All people participate as performer and audience member (sequential)
○ Also listening and supporting and contributing to safe environment is still considered
participating in the coffee house
● This type of thing is unusual in Western society - much more used to an expert/audience
dynamic (performer, listener)
● Outcomes:
○ Increased agency outside the coffee house
○ New lens for client and staff to see each other (sees new, vulnerable side)
○ Buzz of excitement in a setting often void of excitement and positivity
○ An opportunity for creativity and normalcy
○ Coffee house challenges the system (new way for staff to engage with clients)
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MT interventions implemented in CMT: music listening, playing, improvising, song writing, lyric
analysis; basically all MT interventions
CMT can have performance, but does not always need to have it
○ Most approaches do not work towards a performance, but CMT does
CMT typically does not follow a typical clinical framework; but it can happen in a clinical context
and has healthcare/wellness outcomes
CMT can also have clinical outcomes and benefits (eg. increased agency, increased confidence)
CMT is music therapy, as a MT facilitates the process
Paradox: MT is often not seen as a “treatment”(as it is not illness-centered), but it is helpful in
working towards healthcare goals, which makes it a treatment
○ MT focuses on abilities/strength of individual rather than illness
Week 12: MT in NICU
What is NICU?
● Specialization of care for ill/premature infants
● Neonatal = first 28 days of life
● Premature = born more than 3 weeks before due date, before 37 weeks gestation
Development of MT in NICU
● Began over 25 years ago; medical staff resisted that the idea of music could be part of the
medical model/impact medical outcomes
● today, NICU-MT is well known in the US (but not so much in canada)
● Requires specialty training - over 300 specially trained board certified music therapists (MT-BC)
have done the specialty training on how to use MT in NICU setting
● Over 50 research studies in journals provide evidence-based methodology for NICU-MT and
document important and unique infant benefits from music
○ Outcomes are objectively measured
How can babies engage in MT
● MTs can sing, hold babies and sing, singing while mother holds baby, create special lullabies for
babies, use pre recorded music to evoke sucking behaviours, using music can entrain breathing,
music can be used to mask noise of machines that surround the baby
● Listening (sucking to turn on music)
● Entraining (breathing/heart rate)
● Making noise
Family centered care
● A survey in US demonstrated that 68% of NICU nurses wanted music included in NICU treatment
● Family centered care is individualized treatment to support the family
○ Just as important to support to parent/caregiver of the infant
Training to work as a MT in NICU
● Working with infants is very different than all other lenient group
● In canada, specialty training is not required
● In states, there is formalized training; hundreds of MTs around the world take this training to
effectively work with infants in the NICU
○ This training is approved by the certification board for music therapy; program is
conducted through four universities and five medical centers
○ Training is in three phases and consists of a minimum 8 hours of lecture, 16 hours of
hands-on training in an affiliated NICU, and completion of online tests
● Can music be dangerous (for untrained MTs)?
○ Problems occur when music is used in NICU setting without expertise
- Problems with overstimulation of infants and volume; can do more harm than
good in the development of premature infants
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Volunteer musicians often want to perform in the NICU without knowing the
consequences of overstimulation or how to use music to the greatest benefit
Parents of other professionals sometimes bring toys or mobile into the NICU
environment with auditory components (lullabies, heartbeats) without understanding
the consequences for the infants
Healthcare goals
● Physiological measures: regulating HR, RR, weight gain, O2 sat, apnea, days in hospital,
bradycardia
● Developmental/behavioural milestones: behaviour state, ability to transition from state to state,
self-soothe, feeding skill (eg. the sucking thing), caregiver/infant attachment
● Important that the way the music is used is fully described with careful attentions to content,
complexity, duration, and decibel level
Live or recorded music?
● Research shows that music is effective in multiple ways, both live and recorded
● What’s important is that how it is used so as to not harm the infant
● Live music is the preference of the profession (allows MT to be flexible), BUT there are too many
premature infants for their needs to be full met by the limited number of MTs available
○ Recorded music = able to help more premature infants
3 stages of developmental care
1. Survival/pacification
○ No touching, no interacting or disturbance of sleep
○ Used live or recorded music, with fewest alerting stimuli possible (consistent and calm)
○ Guidelines for where the MT should situate themselves (MT’s face should be more than
10 inches from infant to not overstimulate)
○ Quiet consistent music (less than 65 dB, should be in C major) soothes, masks adverse
auditory stimuli, and enhances medical indicators of infant wellbeing (eg. O2 sat)
○ Use of lullabies in child’s native language simultaneously promotes language
development while pacifying an are specifically designed to soothe and quiet inants
2. Cautious stimulation
○ Touch and interaction are permitted; mom can remove infant from incubator and put
into kangaroo care - highly beneficial and can only be provided by the primary caregiver
○ Methods like this where parent can interact with infant are contraindicated until infant
can tolerate minimal stimulation
○ Gender differences in response to this technique:
- Show that males respond better to a capella voice (no background) if touch is
applied while females respond better to greater complexity (such as guitar)
accompaniment for voice combined with touch
3. Transition to interactive stimulation
○ Music listening after distressing medical procedures to return the infant to sleep
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Infant must coordinate suck/swallow/breathe ability and build endurance for feeding, as
indicated by weight gain to be able to go home
- Music can reinforce sucking and facilitate oral feeding abilities
Systematic multi-mocal stimulation is highly effective in promoting neurological
maturation that is evidenced by tolerance to the combined stimuli of touch, signaling,
and movement
Infant must orient to and track visual and auditory stimuli; music is a good cue for
initiating tracking ability
Conclusion
● What are premature infants needs and how is MT implemented in NICU
○ Also important to think of needs of the family
● What is the landscape of MT in NICU in canada?
○ Not a part of NICU team
○ US is driving research, advocacy, and training regarding MT in NICU