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Author: 
Peter Mutch, MT, Alzheimer Society of Prince Edward

Music therapy is an incredible tool for increasing the quality of life of people diagnosed with Alzheimer’s disease and related disorders (ADRD). The most common needs addressed through music therapy for this population include anxiety, depression, aggression, memory stimulation, physical stimulation, pain management, communication, and emotional expression. It can be implemented using both receptive and active approaches.  In receptive music therapy, the client will listen to either pre-recorded music or live music played by the Music Therapist.  In active Music Therapy, the client participates in making music through experiences such as keeping rhythm with shakers, singing, and playing a melodic instrument. The choice of whether to use receptive or active Music Therapy techniques is based on the assessed individual and/or group needs.  In many cases, especially in the early to middle stages of the disease process, both are used. Often, in the late stages, receptive music therapy is the primary approach.  This article will focus on techniques employed in memory stimulation.

Our identity is significantly linked to our past and the memories created by those experiences. I can't imagine the devastation of loosing ones memory, one’s past, and one’s identity because of ADRD. As a Music Therapist, it is so rewarding to be able to unlock these memories from the shackles of the disease by singing a familiar song.  These familiar songs may be sung with the traditional words or new words can be substituted instead, based again on the client’s needs. For example, I've Been Working in the Garden instead of I've Been Working on the Railroad. These words were written as a therapeutic activity with an individual who, before placement in the nursing home, loved gardening with her husband. The verse Someone's in the garden with Joyce (instead of  Someone's in the kitchen with Dinah) was used to recall memories of home. At times, after we sang that verse, Joyce and I would have a long conversation about memories of her garden and her family.

It has been shown in numerous studies that familiar music triggers memories more then any other type of sensory stimulation including verbal reminiscing, visual reminiscing or familiar smells (Lord and Garner, 1993; Smith, 1986; and Tomaino, 1996). Another study by Prickett and Moore (1991) found that patients were able to recall words to songs they were singing more often than spoken words. A very interesting example is of a past client of mine who has a difficult time communicating and forming a sentence that is comprehensible. However, often after singing a song with me, he would repeat a verse or the entire song with an even flow and very clear words.

When using music for enhancing memory recall and face recognition, there is no such thing as a recipe book of songs that work for everyone. It is true that certain melodies tend to provide comfort or stimulation, but to reach someone with a dementia effectively is to use songs that had significant meaning that person's life (Aldridge, 2000).  In addition, only a small section of the music is needed to stimulate the memories. This is because of the connection of the auditory nerve to the key limbic structures of the brain. According to Aldridge (2000) the limbic area of the mid-brain has been indicated in long term memory storage and emotional processing. This link makes it possible for sound to be processed almost immediately by the parts of the brain that are associated with long term memory and emotions (Tomaino, 1993). Familiar music is able to unlock this area of the brain and facilitate, for a person with dementia, memory recall. This 'musical memory' is demonstrated each time a person with dementia sings all the words to a song even though he is no longer speaking in coherent sentences.

A previous client, whom I would see once a week for 30 minutes, was a gentleman in

his late 80's and in the middle stages of the disease process. We would sing together a group of songs that were familiar to him and had meaning for him. We would usually start the session by looking at the pictures of his wife and family. He would generally refer to his wife as his mother, and his children were unfamiliar to him. We would sing a few songs that he would have danced to as a young man, and then we would go through the pictures again. He would be able to point out his wife and at times would be able to recall her name. After some more singing, he would then talk about how wonderful she was, that she had died, and how he missed her. By the end of the session he would be able to go through the pictures and say, “Those are my two daughters”.  Sometimes, he was able to say their names. He was also able to say, “That is my son”, and usually give his name and where he lives, or say that he just lives up the road.

Noberg et al. (1986) found that in the final stages of Alzheimer’s, familiar music was the only stimulus to get a response. This was measured by heart rate, breathing, eye movement, and mouth movement.  During my internship, I was working with an elderly woman in the late stages of her dementia who had a love for music throughout her life. However, she was no longer able to communicate through words. She would normally keep her eyes shut and was considered non-responsive. She also had an involuntary hum that was constant. I decided to match the pitch and tempo of her hum on my cello and then improvise around it (the pitch of her hum was D). That was the building block to her communicating with me. She opened her eyes and stared at the cello during that session while continuing her hum. I moved forward from there with her and would start each session by matching her pitch. I would then play some Aria's from some of her favorite operas. By the end of my internship, she was making strong eye contact and reaching out for my cello. She was being brought to groups again and generally showing interest in the music. In the end, her quality of life had improved. She was brought out of the isolation of her room and into a reawakening of something that was very important to her life, music.

Music Therapy is so versatile and beneficial for people with ADRD. Its use for memory

stimulation can help to slow down the progression of the disease. It's use for agitation, aggression, depression and pain management can help make it possible for the person with ADRD to live in the community longer, decrease medications and restraints and provide quality of life. This being said, Music Therapy needs to be considered an essential service and should be available for this population starting from the ADRD diagnosis, as community outreach. This would make it possible to live in the community longer; thus, keeping loved ones together and also making it more cost effective for government. As a Music Therapist for the day program at the Alzheimer Society of Prince Edward Island, I see first hand how this service can delay the move from home care to nursing care. Music therapy needs to be a standard service in all nursing care facilities to provide the many benefits of stimulation, relaxation and quality of life.

References

Robbins, C.M. and Robbins, C. (1991).  Music Therapy for a Severely Regressed Person with a          Probable Diagnosis of Alzheimer’s Disease. In K. Bruscia (Ed.), Case Studies in Music      Therapy.  Philadelphia: Barcelona Publishers. 

Cassity Michael D. and Cassity Julia E. (2006) Multimodal Psychiatric Music Therapy for Adults, Adolescents and Children, A Clinical Manual 3rd Edition. Philadelphia: Jessica Kingsley Publishers. 

Aldridge David (2000) Music Therapy in Dementia Care. Philadelphia: Jessica Kingsley Publishers.

Tomaino Concetta M. (1999) Active Music Therapy Approaches for Neurologically Impaired Patients. In Cheryl Dileo (Ed.), Music Therapy and Medicine: Theoretical and Clinical Applications. United States: The American Music Therapy Association, Inc.

The Author:   After finishing his education in Music Therapy at Acadia University Peter Mutch moved back to Prince Edward Island where he opened his private practice working with children, adults and seniors with a wide range of needs. Peter was also given the opportunity to work for the Alzheimer Society of Prince Edward. The Alzheimer Society has a day program that is a social, home-like setting which gives participants with varying degrees of memory impairment the chance to optimize their intellectual and social capabilities. By using various techniques and activities music therapy has become an essential part of this program in memory stimulation, relaxation and for stimulation. Peter is so pleased to be a part of this program and to be able to reach out and assist this population.

For more information on Music Therapy visit:

Canadian Association for Music Therapy

American Music Therapy Association