Music Therapy, Research Proposal Example

Introduction 

Over the last several decades, neuroscientists and other researchers have made significant strides in furthering the collective understanding of Alzheimer’s disease. New technological advances and research modalities have made it possible for researchers to peer inside the brain as it functions, opening up new avenues of inquiry related to cause and treatment of Alzheimer’s and other forms and expressions of dementia. Despite such advances, however, a cure –or even a set of reliable treatments- for Alzheimer’s disease remains elusive (Ahn, 2013). Most treatment protocols, from medication to behavioral and cognitive therapy, are aimed to ameliorating symptomatic expression and modulating behavior (Ahn, 2012). One approach that has demonstrated significant promise for helping Alzheimer’s patients express some measure of relief from symptoms is music therapy.  While the term “music therapy” covers a wide range of treatment approaches for an equally wide variety of conditions, there are a number of specific ways in which music therapy can be helpful for dementia patients. The most basic music therapy programs simply provide listening opportunities for patients; more advance programs often involve more direct participation, such as the use of percussion and music instruments in a guided setting. The following paper provides a review of current literature related to music therapy for dementia patients, and proposes a qualitative study for use in a long-term care facility.

Background and Overview

A widely-circulated 2012 video clip of a dementia patient known as “Henry” has helped bring the concept of music therapy into the mainstream. In the clip –taken from a documentary film called Alive Inside– an elderly man is shown on camera, looking largely disengaged from his surroundings and demonstrating other outward symptoms of dementia (Alive Inside, 2014). After this introduction, one of Henry’s caregivers places a set of headphones on his ears; the headphones are connected to an iPod music player which is loaded with the music of Cab Callaway, a long-time favorite of Henry’s. Almost instantly Henry visibly perks up, and begins to nod and move (albeit slightly) to the music. After listening to the Cab Calloway song, an interviewer begins to ask Henry some simple questions. Henry, who had been entirely uncommunicative moments earlier, now looks directly at the interviewer and answers questions about his love of music, how he attended dances as a young man, and the names of some of his favorite musicians. It is an astonishing and emotionally evocative piece of film, and one that demonstrates the enormous implications that music therapy can have for patients with dementia.

Henry was a participant in a music therapy program that was fairly simple and straightforward: a group of patients in a long-term care facility were provided with iPods loaded with playlists of digital music files that were customized to suit the tastes of each subject. The results were monitored, and most participants demonstrated at least some measure of positive response. The Alive Inside documentary film focuses on several other patients besides Henry, including a woman who had not wailed without the aid of a walker in several months; after a few minutes of listening to some lively salsa music, the subject stood on her own, and even began to take a few tentative dance steps. Other featured patients also demonstrate marked improvements in symptoms and behavior, especially in the immediate aftermath of the therapy session.

Other forms of music therapy are more participatory. One approach to music therapy that is becoming fairly common is in the use of percussion instruments (hand drums, tambourines, wood blocks, etc.) that can be played by participants in conjunction with recorded or live musical performances. A variation on this approach is typically known as rhythm therapy, and typically involves a “guided drum circle” wherein the therapist or other facilitator plays a foundation rhythm on a drum or other instrument as participants join in on percussion, clapping, and even chanting or singing (Tomaino, 2013). These more participatory iterations of music therapy may not be appropriate for all patients, as those with more severe symptoms of dementia and other disabilities may simply lack the capacity to wield percussion instruments. In some instances, however, patients who could not participate at first did eventually develop some capacity to join in (Tomaino, 2013). To the extent that simply listening to music can be beneficial, these participatory approaches to music therapy are equally appropriate venues for subjects who are only involved as listeners (Kelleher, 2001). For long-term care facilities, family-member caregivers, and other private and professional caregivers, it may be helpful to explore the variety of forms that music therapy can take to determine the applicability and usefulness of such therapy for their patients.

Review of Literature

The state of New York has developed an educational DVD and instruction book on rhythm therapy that is available to private caregivers, long-term care facilities, and others whop have an interest in learning about or implementing a rhythm therapy program for a patient or group of patients. According to the protocols of this program, “rhythmic activities include any kind of activity that revolves around a steady and prominent beat. During rhythmic activities individuals participate in rhythmic body movement, drumming, auditory stimulation, playing musical instruments, singing, and chanting, to name a few, with a trained leader guiding the group toward a therapeutic purpose” (Dementia – EDGE Project – Therapeutic Drumming Intervention – New York State Department of Health, 2014). The informational materials for the program assert that the communal experience of rhythm therapy has been shown to have a strong positive effect on patients with dementia.

A number of studies have endeavored to determine what is behind the positive effects of music therapy and rhythm therapy. Adam Gazzaley, a University of California at San Francisco-based neuroscientist, has developed a proprietary system that utilizes a cap wired with sensors and transmitters; this cap is hooked up to a computer that displays a virtual, three-dimensional map of the human brain on a computer monitor. Subjects are monitored during various activities, including listening to music and participating in rhythmic activity. The resulting images show the areas of the brain that are activated by music and rhythm; according to Grazzaley, such activation often involves areas of the brain that are otherwise dormant as a result of dementia(Gazzaley, 2014) . Such research has enormous implications for the future of dementia research.

Similar research has also been conducted to determine the neurochemical effects of music and rhythm on the brains of dementia patients. Kumar et al (1999) conducted a series of experiments that measured the production of neurotransmitters and neurohormones, and determined that listening to music or playing rhythmic and musical instruments caused increases in melatonin, norepinephrine, prolactin, and other chemicals and hormones related to relaxation and communication between different areas of the brain (Kumar et al, 1999). Studies such as those conducted by Kumar and Grazzaley clearly demonstrate a quantifiable neurological basis for the reported positive effects of music therapy.

Vink et al (2013) provide a detailed and thorough systematic review of a number of different quantitative studies on music therapy, all of which focused on measurable behavioral effects on dementia patients in long-term care faculties. The researchers compared different therapeutic approaches (such as passive music listening and participatory rhythmic activity) and attempted to assess the effects of these therapies on specific behaviors, including attention span, wandering, and occurrences of agitated behavior. Unfortunately the researchers determined that the studies they used in their review demonstrated poor methodological quality, making it difficult to ascertain solid, valid conclusions (Vink et al, 2013).

The Institute for Music and Neurologic Function in New York has developed a wide range of music therapy programs and conducted research into both the practical and clinical implications of music and rhythm therapy. Like the research examined by Vink et al, the Institute is interested in determining whether positive quantitative outcomes can be gleaned from studies and research into music therapy programs. The Institute has had significantly more success in this endeavor, primarily because they develop their own methodological structures. The Institute hosts an informative website that includes photographs, video and audio recordings, and data related to their programs, and serves as an invaluable repository of educational and informational materials for individuals or organizations interested in implementing music therapy programs. According to the Institute, music and rhythm therapy have proven to be beneficial for patients suffering from stoke, Alzheimer’s disease, Parkinson’s disease, and even neurological damage from injury and accident (Institute for Music and Neurologic Function – Past Research Projects and Grants, 2014). The Institute provides program grants and supporting materials for eligible individuals and organizations.

Qualitative Research Proposal

While the preponderance of available evidence clearly supports the notion that music therapy can be a useful and beneficial tool for helping dementia patients deal with the challenges posed by their conditions, it is also clear that significant research remains to be done. There are few indications that any one approach to music therapy is of greater benefit that others; in fact, it appears that the benefits of different forms of music therapy are variable depending on a variety of factors, including the setting and context of the therapy, the severity of dementia or participants, and a range of other factors. With these considerations in mind, this proposal focuses on acquiring qualitative data from support staff at individual long-term care facilities for the purpose of determining whether each facility should adopt music therapy programs, and if so, what type or type of programs are best suited for a given facility. In sum, this is a practical research proposal designed to help long-term care facilities make informed choices about the development and implementation of music theory programs.

Methodology and Participants

The structure of the research will include two primary components: first is a self-conducted survey to be administered to staff members at a given facility prior to conducting therapy sessions. The survey will be used to assess the attitudes of staff members related to music therapy, staff assessments of the impairment levels of participants, and other general questions.  The second component will utilize semi-structured interviews conducted after the therapy sessions are completed; these interviews will be used to determine how staff members responded to the different approaches to music therapy as well as their assessments about what, if any, positive effects the therapy had on patients. The data collected from these surveys and interviews will be analyzed using SPSS or other analysis to look for trend and areas of agreement.

Each facility or organization will nominate a therapy facilitator who will be responsible for setting up the sessions, administering surveys, and conducting interviews. Each facilitator will choose a group of participants; the numbers may vary, but should include equal numbers of patients with mild, moderate, and severe dementia. Two primary forms of music therapy will be used: passive and active. Passive therapy will involve patients listening to music, while active therapy will give patients an opportunity to play rhythmic instruments (small hand drums, rattles, and other similar instruments) in time with the same recorded music used in the passive therapy. The length of these sessions can be structured according to the determinations of individual facilitators, but the passive and active sessions should be of approximately equal length.  Sessions should be observed by participating staff members, with surveys and interviews administered at appropriate times before and after the sessions take place.

Facilitators who have access to formal data-analysis systems should utilize such systems to reach conclusions about the results gathered from their sessions. When such formal analysis is unavailable, less formal analysis can be conducted in the form of discussions among the facilitator and facility administrators and supervisors. The primary purpose of the analysis is to determine what, if any, forms of music therapy seemed the most beneficial to patients and the most feasible and practical to implement in the facility. As such, the analysis of the qualitative data will likely include subjective, personal responses; this is both expected and appropriate for research of this nature.

Conclusion

While the potential positive benefits of music therapy are clearly demonstrable, there are still many things to be learned about the various iterations of such therapy.  An informal qualitative study of this nature provides a simple, practical set of guidelines and criteria for use by long-term care facilities and other organizations to help in making decisions about if and how to implement music therapy programs for their patients. While organizations such as the Institute for Music and Neurologic Function and the University of California are engaged in rigorous, detailed, quantitative studies about brain function and other aspects of neurology and dementia, long-term care facilities need to make practical, real-world decisions based on the current and future needs and symptoms of their patients. This requires an individualized approach to choosing and implementing one or more types of music therapy that best meet patients’ needs. This informal qualitative research study can be administered by facilitators with a variety of academic and professional backgrounds, and can be tailored to suit the specific conditions of any given facility. The primary purpose and goal of this study is to help individual facilities see the benefits of music therapy and to implement music therapy programs that will best help their residents with dementia.

References

Ahn, S., 2012. Music Therapy for Dementia. Maturitas, 71(1).

Dementia – EDGE Project – Therapeutic Drumming Intervention – New York State Department of Health. 2014. [online] Health.ny.gov. Available at: <http://www.health.ny.gov/diseases/conditions/dementia/edge/interventions/bethabraham/> [Accessed 20 Apr. 2014].

Gazzaley, A., 2014. Home < The Gazzaley Lab. [online] Gazzaleylab.ucsf.edu. Available at: <http://gazzaleylab.ucsf.edu/> [Accessed 20 Apr. 2014].

Harrison, L., 2011. Music therapy beneficial for dementia patients: expert analysis from the annual, conference of the American society on aging. Clinical Psychiatry News, 39(6).

Institute for Music and Neurologic Function – Past Research Projects and Grants. 2014. [online] Musictherapy.imnf.org. Available at: <http://musictherapy.imnf.org/research-education/category/past-research-projects> [Accessed 20 Apr. 2014].

Kelleher, A., 2001. The beat of a different drummer: music therapy’s role in dementia respite care. Activities, Adaptation \& Aging, 25(2), pp.75–84.

Kumar, A., 1999. Music therapy increases serum melatonin levels in patients with Alzheimer’s disease.Alternative Therapies in Health and Medicine, 5(6).

Tomaino, C., 2013. Meeting the Complex Needs of Individuals With Dementia Through Music Therapy.Music and Medicine, 5(4), pp.234–241.

Vink, A., Bruinsma, M. and Scholten, R., 2014. Music therapy for people with dementia (Review). The Cochrane Library, (9).