MUSIC 2MT3 Lecture 11: Lecture 11 MT Research & MT in NICU's
18 Jun 2018
School
Department
Course
Professor
What is Research? Why is it Important?
Goal directed process to seek specific answers to specific questions in an
organized and reliable way (Payton, 1994).
-
Produces new knowledge, reaffirms or refutes knowledge.
-
Involves collection, analysis and interpretation of data.
-
Generalizability: extent to which the results are applicable.
Important that the research findings are translating into the subject'
everyday life.
○
-
In music therapy, research support is important because it can provide funding
for specific types of therapies and therefore it's important for access.
Lots of support, replication = validity
○
-
Comparison groups are important.
-
Music vs Music Therapy
When you are experiencing and emotion, it's a physiological event.
-
Majority of the research with music is surrounding listening to music rather than
engaging.
Just listening without a music therapist is not music therapy.
○
-
Music Therapy Research
Majority of the research in Canada
-
Music therapy research is found in health , mental health ,
physiotherapy/rehab , nursing , education, gerontology, neonatal, psychology,
kinesiology journals, etc.
Very diverse
○
-
Voices world forum -www.voices.no/index.php/voices/about
-
Qualitative vs quantitative research
Qualitative - data that tells the story, could have opinions or some
subjectivity.
E.g., surveys where they ask for written data, case studies
§
○
Quantitative - numerical data, values
E.g., asking for pain ratings before/after music therapy, brain
activity, cortisol levels, etc.
§
○
It's important to incorporate both types of research in music therapy for
the purpose of providing context to the numbers.
○
-
First American Music Therapy research symposium was held in 2015.
Its still a rather new field of research although there is a lot of research
out there.
○
-
Research Tools
It's been so difficult to look at the impact of music from an evidence-based
perspective because we haven't had the tools.
-
fMRI:
The development of fMRI in the 1990s, generally credited to Seiji Ogawa
and Ken Kwong, is the latest in long line of innovations, including positron
emission tomography (PET) and near infrared spectroscopy (NIRS), which
use blood flow and oxygen metabolism to infer brain activity.
○
As a brain imaging technique, fMRI has several significant advantages:
It is non-invasive and doesn't involve radiation.
§
It has excellent spatial and good temporal resolution.
§
It is easy for the experimenter to use.
§
Popular tool for imaging normal brain function - especially for
psychologists. Over the last decade, it has provided new insight to
the investigation of how memories are formed, language, pain,
learning and emotion to name but a few areas of research.
§
○
-
PET:
Angelo Morosso is responsible for the idea that brain function is related
to blood flow.
○
His claims were revalidated by Charles Roy and Charles Sherrington in
1890, where they concluded that blood flow would be directed to a
stimulated portion of the brain according to its function.
○
Autoradiography was used along with gas radiotracers in 1948, initializing
the beginning of brain imaging.
○
-
Back when the technology was first developed, it wasn't as accessible - today, it
is much more accessible .
-
Music and the Brain
Affective - emotions
-
Cognitive - distractions
-
Sensory - same pathway
-
Video: Music and the Brain
Oliver Sachs listens to two pieces while in an fMRI machine (1st Bach,
which he loves and 2nd Beethoven)
○
Even when he was told a Bach piece was made by Beethoven, his brain
recognized the difference and made its preference clear.
○
-
When more of the brain is engaged, the better - the more areas of the brain
that are lit up because of the music therapy, the more primed the brain is for
the access of other abilities.
-
Music Therapy and Pain (Pilot Project)
Long term care facilities were all being looked at in Ontario for their pain
management.
-
Sunnybrook unfortunately scored very poorly on the pain management section.
-
Rachel wrote her thesis on music therapy and pain perception.
-
Pain vs Nociception
Pain is a subjective experience impacted by cognition, memory,
experiences and emotions.
○
Nociception is the actual neurological response to harmful stimuli.
○
You can have completely different pain perceptions based on what's going
on in your life
○
-
Pain is an unpleasant sensory and emotional experience associated with actual
or potential tissue damage.
-
Pain is not just a physical sensation. It is influenced by attitudes, beliefs,
personality and social factors, and can affect emotional and mental well-being.
-
Although two people may have the same pain condition, their experience of
living with pain can be vastly different.
-
Neurological pathways identified support music's ability to produce an
endorphin response. (body's natural response to pain).
Research supporting the use of music listening to assist with pain
management.
○
Your body cannot process pain and music at the same time.
○
-
3 ways to modify pain perception.
Affectively - how does pain and/or music effect our emotions
○
Cognitively - distractions, how are we cognitively impacted by
music/pain?
○
Sensory - consider that pain and music are competing for the same
pathways.
○
** biopsychosocial
○
-
Note: Pain can be experienced even if the physical thing is not happening.
E.g., phantom limb
○
-
What was in the study?
Sunnybrook Hospital in the transition unit in general medicine.
Individuals who landed in the emergency unit and weren't able to
go home right away.
§
Undergo testing until a treatment plan is made, bed in a long term
care facility is ready or they're healed.
§
○
-
How was the information collected?
Quantitative - Likert scale of pain perceptions pre- and post-music
therapy.
○
Qualitative - observations (e.g., noting people's behaviours), noting
feedback/statements from patients and nurses involved.
○
-
What were the results?
All of the patients did have a decrease in pain perception after the music
therapy sessions with the exception of one person.
○
This person was there for a longer period of time and they had 5 sessions
together.
○
Why might there perception of pain have gone up after the first three
sessions gone up?
Maybe the music wasn't to their preference? - in this case, it was to
their preference.
§
Maybe the engagement and movement caused some pain? - not in
this case.
§
The reason was due to the emotional difficulties that the sessions
evoked for this patient.
Remember, pain perception is influenced by emotional well-
being.
□
So this enhanced the perception of pain. □
This particular client was a teacher and she loved her job, but
she actually fell on ice and damaged her back while at work
and was unable to go back to her job.
□
She felt a sense of loss when she remembered her good
memories because her pain was so severe that she could not
get back to the way things were.
□
But even though the emotional experience and pain was
difficult, she did want to continue and there was something
positive happening for her.
□
This highlights the importance of the qualitative data because
it provides context and the whole story.
□
§
○
-
Cost effectiveness?
Knowledge and information gained from research is obviously important,
but we need to consider the economic impacts (particularly in health
care).
○
Pain medication - pain medications cost hospitals billions of dollars per
year.
If you could reduce pills from 5 per day to 4 per day, it makes a
significant impact.
§
In the pilot project, they found that most of the individuals actually
skipped (with permission from doctors) one of their pain
medications.
§
Significant from a financial perspective.
§
○
-
Implications?
Music therapy program was improved and expanded (1 more day of
treatments added) based on these findings.
○
Wanted to make these programs more accessible.
○
-
"The body begins to look smarter and more soulful (flesh as 'spirit thickened') - Rchard
Selzer
"At the same time the mind incarnates itself as a biochemical event" - Jackson, 2002
Pain
Neurotransmitters that mediate pain (and emotions) are norepinephrine,
dopamine, melatonin, epinephrine, L-dopa, serotonin, prolactin and
Enkephalins
-
Studies based on blood samples show raised levels after music therapy.
-
Serotonin is involved in pain inhibition.
-
Dopamine (pleasure)
-
Listening to music enhances dopamine.
-
Limbic System
Involved in pain perception and emotions (and therefore, music)
-
Complex set of structures - largely responsible for emotional states.
-
Areas are activated during music listening and music therapy sessions.
-
Music/music therapy impacts breathing (hypothalamus)
-
Hippocampus - memories
-
Nucleus accumbens - pleasure
-
Orbitofrontal cortex - decision making
-
Ventral tegmental area - pleasure
-
Cingulated gyrus - process emotions
-
Other Approaches/Models: Medical Music Therapy
Takes place within a hospital with a healthcare team - focuses on healthcare
goals decided on by the team (e.g., pain perception)
-
Still needs to involve a music therapy in the team.
-
What Is NICU?
Falls under the medical music therapy model - working towards medical goal in
neonatal care.
-
When speaking about infants, prematurity includes:
"Preterm infants" - born before 37 gestational weeks
○
"Low birth weight infants" - premature by birth weight of less than 2500g
○
-
Many premature infants are fragile at birth and require medical care typically
provided in neonatal intensive care units for days, weeks or even months.
-
Some suggest that premature babies remember this traumatic experience and
they miss out of further development in the womb.
-
Video: University of Lousiville
Music is stimulating and soothing - it calms them and activates parts of
their brains.
○
Helps indicate that what is happening to them and around them is
positive.
○
Music activated sucking mechanism can help babies feed better - allows
them to gain weight faster and reach more goals.
○
Example of interventions: humming and massaging to prime the baby and
provide a soundscape.
○
-
MT's in NICU training settings may do further training in GIM, NMT, etc.
-
Video: Music Therapy for Preemies (NYT)
Provides stability.
○
Creates environment that may be better for their development.
○
Can help lower/increase heart rate, improve oxygenation, improve
sucking behaviour and help with sleeping.
○
Premature infants have nothing to acclimate themselves to because they
were supposed to be in the womb.
○
Studies have shown that live music is optimal because it can be changed
in the moment.
○
Examples of interventions: playing gato drum while looking at the heart
rate of the baby to match them and connect them directly; ocean disc
helps create a steady soundscape to mimic being in the womb; singing
lullabies that have a connection with the mother.
○
Also helps the parents - the challenges of seeing your baby in the
incubator, having it early, being unprepared, feeling helpless - this can
help give the parents a role in improving their child's health.
○
-
Entrainment - What is it? Where else have we seen it?
When your physiological responses line up with your environment.
○
E.g., how music is played can entrain to impart change on the
physiological responses.
○
Important in NICU care.
○
-
Can it help these babies?
Developmentally, premature infants often suffer from impairment with
respect to several abilities including: the ability to suck or swallow,
difficulty with nutrient processing/absorption (which may lead to
cognitive impairment), smaller brain volume and challenges to regulate
body temperature.
○
There are several health conditions that premature infants are at risk for
By keeping their heart rate, oxygen, etc, up we are reducing these
risks.
§
○
-
Training
NICU environment poses a challenge to premature infants as they
navigate their development in a setting quite different than that of the
mother's womb.
○
Premature infants receive care from multiple caregivers and as a result
may be subjected to overstimulation from the sounds, sights and
interactions.
○
Pre-recorded music can be used, but live music is preferable due to the
ability to change and modify the music.
○
-
Be a critical viewer/researcher
Video shows a doctor and labels it as "medical music therapy" - unfortunately,
we know that this is not in fact music therapy if the doctor is not a music
therapist.
-
Lecture 11: MT Research & MT in NICU's
Thursday, June 7, 2018
1:11 PM
What is Research? Why is it Important?
Goal directed process to seek specific answers to specific questions in an
organized and reliable way (Payton, 1994).
-
Produces new knowledge, reaffirms or refutes knowledge.
-
Involves collection, analysis and interpretation of data.
-
Generalizability: extent to which the results are applicable.
Important that the research findings are translating into the subject'
everyday life.
○
-
In music therapy, research support is important because it can provide funding
for specific types of therapies and therefore it's important for access.
Lots of support, replication = validity
○
-
Comparison groups are important.
-
Music vs Music Therapy
When you are experiencing and emotion, it's a physiological event.
-
Majority of the research with music is surrounding listening to music rather than
engaging.
Just listening without a music therapist is not music therapy.
○
-
Music Therapy Research
Majority of the research in Canada
-
Music therapy research is found in health , mental health ,
physiotherapy/rehab , nursing , education, gerontology, neonatal, psychology,
kinesiology journals, etc.
Very diverse
○
-
Voices world forum -www.voices.no/index.php/voices/about
-
Qualitative vs quantitative research
Qualitative - data that tells the story, could have opinions or some
subjectivity.
E.g., surveys where they ask for written data, case studies
§
○
Quantitative - numerical data, values
E.g., asking for pain ratings before/after music therapy, brain
activity, cortisol levels, etc.
§
○
It's important to incorporate both types of research in music therapy for
the purpose of providing context to the numbers.
○
-
First American Music Therapy research symposium was held in 2015.
Its still a rather new field of research although there is a lot of research
out there.
○
-
Research Tools
It's been so difficult to look at the impact of music from an evidence-based
perspective because we haven't had the tools.
-
fMRI:
The development of fMRI in the 1990s, generally credited to Seiji Ogawa
and Ken Kwong, is the latest in long line of innovations, including positron
emission tomography (PET) and near infrared spectroscopy (NIRS), which
use blood flow and oxygen metabolism to infer brain activity.
○
As a brain imaging technique, fMRI has several significant advantages:
It is non-invasive and doesn't involve radiation.
§
It has excellent spatial and good temporal resolution.
§
It is easy for the experimenter to use.
§
Popular tool for imaging normal brain function - especially for
psychologists. Over the last decade, it has provided new insight to
the investigation of how memories are formed, language, pain,
learning and emotion to name but a few areas of research.
§
○
-
PET:
Angelo Morosso is responsible for the idea that brain function is related
to blood flow.
○
His claims were revalidated by Charles Roy and Charles Sherrington in
1890, where they concluded that blood flow would be directed to a
stimulated portion of the brain according to its function.
○
Autoradiography was used along with gas radiotracers in 1948, initializing
the beginning of brain imaging.
○
-
Back when the technology was first developed, it wasn't as accessible - today, it
is much more accessible .
-
Music and the Brain
Affective - emotions
-
Cognitive - distractions
-
Sensory - same pathway
-
Video: Music and the Brain
Oliver Sachs listens to two pieces while in an fMRI machine (1st Bach,
which he loves and 2nd Beethoven)
○
Even when he was told a Bach piece was made by Beethoven, his brain
recognized the difference and made its preference clear.
○
-
When more of the brain is engaged, the better - the more areas of the brain
that are lit up because of the music therapy, the more primed the brain is for
the access of other abilities.
-
Music Therapy and Pain (Pilot Project)
Long term care facilities were all being looked at in Ontario for their pain
management.
-
Sunnybrook unfortunately scored very poorly on the pain management section.
-
Rachel wrote her thesis on music therapy and pain perception.
-
Pain vs Nociception
Pain is a subjective experience impacted by cognition, memory,
experiences and emotions.
○
Nociception is the actual neurological response to harmful stimuli.
○
You can have completely different pain perceptions based on what's going
on in your life
○
-
Pain is an unpleasant sensory and emotional experience associated with actual
or potential tissue damage.
-
Pain is not just a physical sensation. It is influenced by attitudes, beliefs,
personality and social factors, and can affect emotional and mental well-being.
-
Although two people may have the same pain condition, their experience of
living with pain can be vastly different.
-
Neurological pathways identified support music's ability to produce an
endorphin response. (body's natural response to pain).
Research supporting the use of music listening to assist with pain
management.
○
Your body cannot process pain and music at the same time.
○
-
3 ways to modify pain perception.
Affectively - how does pain and/or music effect our emotions
○
Cognitively - distractions, how are we cognitively impacted by
music/pain?
○
Sensory - consider that pain and music are competing for the same
pathways.
○
** biopsychosocial
○
-
Note: Pain can be experienced even if the physical thing is not happening.
E.g., phantom limb
○
-
What was in the study?
Sunnybrook Hospital in the transition unit in general medicine.
Individuals who landed in the emergency unit and weren't able to
go home right away.
§
Undergo testing until a treatment plan is made, bed in a long term
care facility is ready or they're healed.
§
○
-
How was the information collected?
Quantitative - Likert scale of pain perceptions pre- and post-music
therapy.
○
Qualitative - observations (e.g., noting people's behaviours), noting
feedback/statements from patients and nurses involved.
○
-
What were the results?
All of the patients did have a decrease in pain perception after the music
therapy sessions with the exception of one person.
○
This person was there for a longer period of time and they had 5 sessions
together.
○
Why might there perception of pain have gone up after the first three
sessions gone up?
Maybe the music wasn't to their preference? - in this case, it was to
their preference.
§
Maybe the engagement and movement caused some pain? - not in
this case.
§
The reason was due to the emotional difficulties that the sessions
evoked for this patient.
Remember, pain perception is influenced by emotional well-
being.
□
So this enhanced the perception of pain. □
This particular client was a teacher and she loved her job, but
she actually fell on ice and damaged her back while at work
and was unable to go back to her job.
□
She felt a sense of loss when she remembered her good
memories because her pain was so severe that she could not
get back to the way things were.
□
But even though the emotional experience and pain was
difficult, she did want to continue and there was something
positive happening for her.
□
This highlights the importance of the qualitative data because
it provides context and the whole story.
□
§
○
-
Cost effectiveness?
Knowledge and information gained from research is obviously important,
but we need to consider the economic impacts (particularly in health
care).
○
Pain medication - pain medications cost hospitals billions of dollars per
year.
If you could reduce pills from 5 per day to 4 per day, it makes a
significant impact.
§
In the pilot project, they found that most of the individuals actually
skipped (with permission from doctors) one of their pain
medications.
§
Significant from a financial perspective.
§
○
-
Implications?
Music therapy program was improved and expanded (1 more day of
treatments added) based on these findings.
○
Wanted to make these programs more accessible.
○
-
"The body begins to look smarter and more soulful (flesh as 'spirit thickened') - Rchard
Selzer
"At the same time the mind incarnates itself as a biochemical event" - Jackson, 2002
Pain
Neurotransmitters that mediate pain (and emotions) are norepinephrine,
dopamine, melatonin, epinephrine, L-dopa, serotonin, prolactin and
Enkephalins
-
Studies based on blood samples show raised levels after music therapy.
-
Serotonin is involved in pain inhibition.
-
Dopamine (pleasure)
-
Listening to music enhances dopamine.
-
Limbic System
Involved in pain perception and emotions (and therefore, music)
-
Complex set of structures - largely responsible for emotional states.
-
Areas are activated during music listening and music therapy sessions.
-
Music/music therapy impacts breathing (hypothalamus)
-
Hippocampus - memories
-
Nucleus accumbens - pleasure
-
Orbitofrontal cortex - decision making
-
Ventral tegmental area - pleasure
-
Cingulated gyrus - process emotions
-
Other Approaches/Models: Medical Music Therapy
Takes place within a hospital with a healthcare team - focuses on healthcare
goals decided on by the team (e.g., pain perception)
-
Still needs to involve a music therapy in the team.
-
What Is NICU?
Falls under the medical music therapy model - working towards medical goal in
neonatal care.
-
When speaking about infants, prematurity includes:
"Preterm infants" - born before 37 gestational weeks
○
"Low birth weight infants" - premature by birth weight of less than 2500g
○
-
Many premature infants are fragile at birth and require medical care typically
provided in neonatal intensive care units for days, weeks or even months.
-
Some suggest that premature babies remember this traumatic experience and
they miss out of further development in the womb.
-
Video: University of Lousiville
Music is stimulating and soothing - it calms them and activates parts of
their brains.
○
Helps indicate that what is happening to them and around them is
positive.
○
Music activated sucking mechanism can help babies feed better - allows
them to gain weight faster and reach more goals.
○
Example of interventions: humming and massaging to prime the baby and
provide a soundscape.
○
-
MT's in NICU training settings may do further training in GIM, NMT, etc.
-
Video: Music Therapy for Preemies (NYT)
Provides stability.
○
Creates environment that may be better for their development.
○
Can help lower/increase heart rate, improve oxygenation, improve
sucking behaviour and help with sleeping.
○
Premature infants have nothing to acclimate themselves to because they
were supposed to be in the womb.
○
Studies have shown that live music is optimal because it can be changed
in the moment.
○
Examples of interventions: playing gato drum while looking at the heart
rate of the baby to match them and connect them directly; ocean disc
helps create a steady soundscape to mimic being in the womb; singing
lullabies that have a connection with the mother.
○
Also helps the parents - the challenges of seeing your baby in the
incubator, having it early, being unprepared, feeling helpless - this can
help give the parents a role in improving their child's health.
○
-
Entrainment - What is it? Where else have we seen it?
When your physiological responses line up with your environment.
○
E.g., how music is played can entrain to impart change on the
physiological responses.
○
Important in NICU care.
○
-
Can it help these babies?
Developmentally, premature infants often suffer from impairment with
respect to several abilities including: the ability to suck or swallow,
difficulty with nutrient processing/absorption (which may lead to
cognitive impairment), smaller brain volume and challenges to regulate
body temperature.
○
There are several health conditions that premature infants are at risk for
By keeping their heart rate, oxygen, etc, up we are reducing these
risks.
§
○
-
Training
NICU environment poses a challenge to premature infants as they
navigate their development in a setting quite different than that of the
mother's womb.
○
Premature infants receive care from multiple caregivers and as a result
may be subjected to overstimulation from the sounds, sights and
interactions.
○
Pre-recorded music can be used, but live music is preferable due to the
ability to change and modify the music.
○
-
Be a critical viewer/researcher
Video shows a doctor and labels it as "medical music therapy" - unfortunately,
we know that this is not in fact music therapy if the doctor is not a music
therapist.
-
Lecture 11: MT Research & MT in NICU's
Thursday, June 7, 2018 1:11 PM
Document Summary
Lecture 11: mt research & mt in nicu"s. Goal directed process to seek specific answers to specific questions in an organized and reliable way (payton, 1994). Generalizability: extent to which the results are applicable. Important that the research findings are translating into the subject" everyday life. In music therapy, research support is important because it can provide funding for specific types of therapies and therefore it"s important for access. When you are experiencing and emotion, it"s a physiological event. Majority of the research with music is surrounding listening to music rather than engaging. Just listening without a music therapist is not music therapy. Music therapy research is found in health , mental health , physiotherapy/rehab , nursing , education, gerontology, neonatal, psychology, kinesiology journals, etc. Qualitative - data that tells the story, could have opinions or some subjectivity. E. g. , surveys where they ask for written data, case studies.
