MUSIC 2MT3 Lecture 6: Lecture 6
18 Jun 2018
School
Department
Course
Professor
Review Video
Developmental goal: encouraging speech
If he's drawn towards playing an instrument, she insists that he uses his
words to be able to obtain it (behavioural).
○
Fill in the blanks
○
-
Some music therapists will use a hand over hand model - we see this in the
video.
Some music therapists do not use this model and instead encourage the
client to move on their own.
○
Benefits of hand over hand for someone not initiating movements, it
provides muscle/motor memory so it enhances the chance that the child
will produce the behaviour on their own.
○
Depends on the client's needs, abilities and the therapists preferences.
○
-
Without knowing the background of the client, it's difficult to know how what
you're observing.
In the case of Anthony, his dad explained that he used to throw tantrums,
take his shoes off, etc. and now we can see where's he's at.
○
He's more engaged, his verbal skills have improved, he's concentrating
more.
○
-
Playing on a horn gives the individual the opportunity to work on their breath
and provides feedback via the sound produced and is used in a meaningful way.
-
Developmental goal: Self-regulation
For most people, self-regulation can be difficult.
E.g., when you're in something, it can be hard to change or stop.
§
○
For a child on the autism spectrum, it's even more difficult to self-
regulate.
In a music therapy session, common things like freeze dance are
done with intent to practice and develop self-regulation skills.
§
To practice that in the music is a safe way to learn about cues and
self-regulation.
§
○
Skill will transcend into different areas of life.
○
-
Teaching control over empowerment and choice, but there are also some forces
we need to comply to.
Yes, make choice. Yes, select the instrument you want to play. But you
cannot take 20 mins.
○
Transcends elsewhere (i.e., home, getting dressed, picking shoes)
○
Offers opportunities to make choices, feel self-empowered, but all in a
certain amount of time.
○
-
Long-term care; Sunnybrook Hospital Veteran's
Elders with various degrees of cognition.
○
Program includes music therapy and art therapy - different people can
collaborate on providing private or group sessions.
○
Goal was to improve quality of life for each group member in the
moment.
○
Even if an individual appears to not be engaging in the music, most of the
time their toe is tapping slightly and you can tell they're getting
something out of it.
○
Nothing that says "oh, they're in a music therapy session" at first glance.
But each song was carefully selected with intent to evoke a
response for the clients and each song comes with an introduction.
§
When you know how each response is significant, it does add a
different response to what's happening.
§
○
Gentleman with COPD.
Difficult for him to breathe without pain, but he would really sing
during the sessions.
§
○
-
What is Ageing?
To date there exists no normative established values of what cognitive
impairment or memory loss, or what neurochemical and neurophysiological
changes accompany normal aging.
For development from childhood into adulthood, there are normal
developmental trajectories.
○
But past adulthood, there are no normative values.
○
There's no windows of aging that describe how you're supposed to age.
○
There's a greater percentage of having less physical and mental abilities as
we get older, but there's no specific values of deficit and no idea of when
this will happen for each person.
○
-
Complex developmental process that involves the intersection of physical,
psychological and social factors.
Physical aging of the body, psychological aging and social factors
associated with aging.
○
-
Older adults: fastest growing population.
There are more older adults currently in Canada than any other age group
and it's a growing concern for healthcare and the government because it
will be a massive drain on resources and services.
○
-
Why are people living longer?
Increased longevity
E.g., smoking is less cool and okay to engage in - this definitely had a
massive impact on health and well-being. Now that we have the
knowledge of smoking's link to cancer and other health issues.
○
E.g., Wearing seatbelts. Cars used to be built without seatbelts,
specifically in the back.
○
E.g., More aware of healthy eating, healthier lifestyles, retiring later
because they can etc.
○
E.g., Less war in Western culture - as time has gone on we have less
deaths as a result of engaging in.
○
E.g., Healthcare - we have more available access to healthcare, therefore
there are increases in elder care.
○
-
We are continually becoming more educated as a society around safety and
health issues.
-
Chronological Age, Biological Age, Psychological Age, Psychosocial Age
RE: past lecture in regards to developmental age vs chronological age for people
with developmental/mental delays.
-
E.g., Betty White
Chronologically 96 years old
○
She is not 96 in the way her body moves and the way her mind works and
she speaks.
○
The reason we're shocked when she says certain things (i.e., current
events, sex, etc.) is because we've been brainwashed to look at her
chronological age instead of psychosocial age.
○
-
Just because someone's chart says they're 96 years old, doesn't mean we need
to go in and talk to them like they're little old people.
-
Go in and speak with them without any preconceived notions about who they
may be based on their age.
-
In Western societies, we tend to be ageist and have negative connotations
when we speak about the elderly.
-
Biological age: the ongoing process from birth to death; physiological changes.
E.g., hair loss, greys, wrinkles, loss of stamina, change in weight, change in
bone density, strength, organ function, molecular, cellular.
○
-
Psychological age: ability to respond to a changing environment and adapt to
new situations (learning/emotions).
When someone is the same biological and chronological age, it means
that they are not adapting to their environment/times.
○
When this is the case, the individual may say things to the clinician that
are offensive so you need to make sure you are mindful of where that is
coming from (psychological age).
As a clinician, you're not there to engage in different points of view,
just to support their healthcare goals.
§
Particularly as people are cognitively declining, they are cognitively
unable to develop new ways of thinking so when you correct them,
it cannot change.
§
Clinicians have the right to remove themselves from an offensive
client that makes them uncomfortable if needed.
§
○
-
Psychosocial age: cultural view and expectations.
How you culture views the elderly.
○
In Western cultures, this is reflected in the booming cosmetic industry
and overall negative portrayal of aging.
○
In non-Western cultures, people have a high regard for older people and
being older reflects wisdom.
○
-
Music Therapy and Ageing: all people age differently, we need to take into account all
influences.
The music therapist needs to be mindful.
-
Dementia
An umbrella term for any dementing/degrading) of the brain.
Overall, loss of cognition.
○
Not everyone gets dementia, it is not a direct result of getting older, but it
is associated with ageing.
○
Just because you're aging, doesn't mean you'll get dementia.
○
It tends to be a diagnosis that people 60+ receive - this age group has a
higher change of developing it.
○
-
Alzheimer's disease, frontotemporal dementia, vascular dementia.
-
Common Diagnosis Associated with Ageing (but not a result)
Depression
Lifestyle changes you cannot control could contribute (e.g., you used to
be busy, but now you don't have the same abilities, or your kids aren't
around, your partner has passed, etc.)
○
-
Dementia
-
Alzheimer's disease
-
Parkinson's
Motor control degenerative disease.
○
Fully cognitively aware, but slowly start to lose their motor abilities.
○
-
Reasons for Referral
To enhance speech and communication.
-
To improve or maintain strength and mobility.
-
To improve quality of life.
Need to break it down to see what specific things you need to work on in
order to enhance their quality of life.
○
E.g., developing relationships in a group therapy setting,
○
-
To evoke memories (ST and LT)
-
To stop exit-seeking behaviours.
-
To help cope with change overall, diagnoses, etc.
People new to long-term care facilities are usually in need of this.
○
-
To decrease pacing, agitation, vocalizations.
-
To increase eye contact, meaningful moments.
-
To increase alertness, movement.
-
To evoke positive memories, orientation to the here and now.
-
To transition to facility, lesson confusion, decreases anxiety.
-
Not reasons for referral:
Liking music,
○
Gifted at music,
○
Responds to music,
○
Was in a choir … etc.
○
-
Reminder: people are not referred because of their diagnoses, they are referred
because they have a healthcare goal.
-
Why Pre-composed Music?
Music therapists work predominantly in long term care facilities.
-
The individuals referred to music therapy in long term care facilities often have
some form of dementia.
-
The use of pre-composed music is what's used predominantly in long term care
with elders with dementia.
It seems to be the most effective in reaching the healthy part of the brain
of that person.
○
When an individual with dementia hears a song with meaning, they can
typically remember the lyrics or melody of the song, can remember
memories associated with that song.
○
Pre-composed music immediately evoked something.
○
It's a powerful tool.
○
It is not entertainment - music therapists are not entertainers.
○
Songs can help create a music time line where you can see certain points
in your life based on songs that were popular at the time.
○
Engaging with familiar music is in the ABA format (verse chorus verse) so
it is predictable.
Being able to guess without too much risk is empowering and
provides security.
§
○
Reassurance, confidence and memory evoking.
Reminds people of their abilities
§
○
Stimulate dialogue and relationships.
○
-
In a music therapy session, we're not going to cure dementia, we cannot
document even whether we're slowing it down because there's no normal
progression of dementia.
But we can say that it provides moments to enhance quality of life,
engage with others and for people to be with their loved ones again.
○
Might create a pocket of time where you're cognitively more present and
free from the symptoms.
○
-
Bell-Choir
People in the group were individuals who were cognitively declined at different
levels.
-
Started with a hello song to warm up the communication systems and prime the
brain.
-
Then they would make a song choice together.
-
Then they would talk about relevant songs for the season.
-
Even those extremely cognitively declined were able to listen, know their part
and know how to play the bell.
-
Worked on self-expression, evoking memories, etc. - many different healthcare
goals.
-
Everyone needs to have some sort of focus in the group.
Needs to be listening, intrigued.
○
Really practicing a lot of cognitive and motor skills.
○
-
It's not a healthcare goal to do a performance, but doing a performance could
facilitate some health care goals:
Empowerment, confidence, self-esteem, etc.
○
-
Not uncommon for bell-choir's to perform.
There would be dialogues about what songs to perform.
○
Groups often work through creating an identity by selecting a group
name.
○
Different roles are given to different people.
○
Practices are therapy sessions, not to prepare for the performance.
Preparation comes with gaining the skills.
○
Typically, music therapists do not prepare people for performances.
○
-
iPod Project (Alive Inside Video)
Not music therapy, but important for understanding music as a tool in health
care.
It's not a music therapist involved.
○
-
Asking questions to evoke concrete, cognitive responses - not asking about how
people feel.
-
Example of how listening to pre-composed music evokes memory.
-
Define Dementia
Acquired decline of cognitive function (memory and language impairment)
-
Music abilities are preserved - uses both hemispheres of the brain.
There is an extremely small percentage of people who cannot engage in
music because their brains are damaged in a highly specific way.
○
-
Alzheimer's (Mini Mental State Exam and Music Therapy)
Music therapy can enhance the outcomes of the scores.
○
-
Listening to stories vs playing music
The music group could recall almost double the information the story
group did.
○
Attempting music playing can highlight deterioration.
○
-
Music and Changes in the Brain
Music changes the brain in various ways.
-
Recently, research looking at the brain of musicians vs non-musicians.
Significant difference in the make-up of the brain.
○
-
There's a good amount of support for how music can support cognition.
-
Lecture 6
Thursday, May 17, 2018
11:08 AM
Review Video
Developmental goal: encouraging speech
If he's drawn towards playing an instrument, she insists that he uses his
words to be able to obtain it (behavioural).
○
Fill in the blanks
○
-
Some music therapists will use a hand over hand model - we see this in the
video.
Some music therapists do not use this model and instead encourage the
client to move on their own.
○
Benefits of hand over hand for someone not initiating movements, it
provides muscle/motor memory so it enhances the chance that the child
will produce the behaviour on their own.
○
Depends on the client's needs, abilities and the therapists preferences.
○
-
Without knowing the background of the client, it's difficult to know how what
you're observing.
In the case of Anthony, his dad explained that he used to throw tantrums,
take his shoes off, etc. and now we can see where's he's at.
○
He's more engaged, his verbal skills have improved, he's concentrating
more.
○
-
Playing on a horn gives the individual the opportunity to work on their breath
and provides feedback via the sound produced and is used in a meaningful way.
-
Developmental goal: Self-regulation
For most people, self-regulation can be difficult.
E.g., when you're in something, it can be hard to change or stop.
§
○
For a child on the autism spectrum, it's even more difficult to self-
regulate.
In a music therapy session, common things like freeze dance are
done with intent to practice and develop self-regulation skills.
§
To practice that in the music is a safe way to learn about cues and
self-regulation.
§
○
Skill will transcend into different areas of life.
○
-
Teaching control over empowerment and choice, but there are also some forces
we need to comply to.
Yes, make choice. Yes, select the instrument you want to play. But you
cannot take 20 mins.
○
Transcends elsewhere (i.e., home, getting dressed, picking shoes)
○
Offers opportunities to make choices, feel self-empowered, but all in a
certain amount of time.
○
-
Long-term care; Sunnybrook Hospital Veteran's
Elders with various degrees of cognition.
○
Program includes music therapy and art therapy - different people can
collaborate on providing private or group sessions.
○
Goal was to improve quality of life for each group member in the
moment.
○
Even if an individual appears to not be engaging in the music, most of the
time their toe is tapping slightly and you can tell they're getting
something out of it.
○
Nothing that says "oh, they're in a music therapy session" at first glance.
But each song was carefully selected with intent to evoke a
response for the clients and each song comes with an introduction.
§
When you know how each response is significant, it does add a
different response to what's happening.
§
○
Gentleman with COPD.
Difficult for him to breathe without pain, but he would really sing
during the sessions.
§
○
-
What is Ageing?
To date there exists no normative established values of what cognitive
impairment or memory loss, or what neurochemical and neurophysiological
changes accompany normal aging.
For development from childhood into adulthood, there are normal
developmental trajectories.
○
But past adulthood, there are no normative values.
○
There's no windows of aging that describe how you're supposed to age.
○
There's a greater percentage of having less physical and mental abilities as
we get older, but there's no specific values of deficit and no idea of when
this will happen for each person.
○
-
Complex developmental process that involves the intersection of physical,
psychological and social factors.
Physical aging of the body, psychological aging and social factors
associated with aging.
○
-
Older adults: fastest growing population.
There are more older adults currently in Canada than any other age group
and it's a growing concern for healthcare and the government because it
will be a massive drain on resources and services.
○
-
Why are people living longer?
Increased longevity
E.g., smoking is less cool and okay to engage in - this definitely had a
massive impact on health and well-being. Now that we have the
knowledge of smoking's link to cancer and other health issues.
○
E.g., Wearing seatbelts. Cars used to be built without seatbelts,
specifically in the back.
○
E.g., More aware of healthy eating, healthier lifestyles, retiring later
because they can etc.
○
E.g., Less war in Western culture - as time has gone on we have less
deaths as a result of engaging in.
○
E.g., Healthcare - we have more available access to healthcare, therefore
there are increases in elder care.
○
-
We are continually becoming more educated as a society around safety and
health issues.
-
Chronological Age, Biological Age, Psychological Age, Psychosocial Age
RE: past lecture in regards to developmental age vs chronological age for people
with developmental/mental delays.
-
E.g., Betty White
Chronologically 96 years old
○
She is not 96 in the way her body moves and the way her mind works and
she speaks.
○
The reason we're shocked when she says certain things (i.e., current
events, sex, etc.) is because we've been brainwashed to look at her
chronological age instead of psychosocial age.
○
-
Just because someone's chart says they're 96 years old, doesn't mean we need
to go in and talk to them like they're little old people.
-
Go in and speak with them without any preconceived notions about who they
may be based on their age.
-
In Western societies, we tend to be ageist and have negative connotations
when we speak about the elderly.
-
Biological age: the ongoing process from birth to death; physiological changes.
E.g., hair loss, greys, wrinkles, loss of stamina, change in weight, change in
bone density, strength, organ function, molecular, cellular.
○
-
Psychological age: ability to respond to a changing environment and adapt to
new situations (learning/emotions).
When someone is the same biological and chronological age, it means
that they are not adapting to their environment/times.
○
When this is the case, the individual may say things to the clinician that
are offensive so you need to make sure you are mindful of where that is
coming from (psychological age).
As a clinician, you're not there to engage in different points of view,
just to support their healthcare goals.
§
Particularly as people are cognitively declining, they are cognitively
unable to develop new ways of thinking so when you correct them,
it cannot change.
§
Clinicians have the right to remove themselves from an offensive
client that makes them uncomfortable if needed.
§
○
-
Psychosocial age: cultural view and expectations.
How you culture views the elderly.
○
In Western cultures, this is reflected in the booming cosmetic industry
and overall negative portrayal of aging.
○
In non-Western cultures, people have a high regard for older people and
being older reflects wisdom.
○
-
Music Therapy and Ageing: all people age differently, we need to take into account all
influences.
The music therapist needs to be mindful.
-
Dementia
An umbrella term for any dementing/degrading) of the brain.
Overall, loss of cognition.
○
Not everyone gets dementia, it is not a direct result of getting older, but it
is associated with ageing.
○
Just because you're aging, doesn't mean you'll get dementia.
○
It tends to be a diagnosis that people 60+ receive - this age group has a
higher change of developing it.
○
-
Alzheimer's disease, frontotemporal dementia, vascular dementia.
-
Common Diagnosis Associated with Ageing (but not a result)
Depression
Lifestyle changes you cannot control could contribute (e.g., you used to
be busy, but now you don't have the same abilities, or your kids aren't
around, your partner has passed, etc.)
○
-
Dementia
-
Alzheimer's disease
-
Parkinson's
Motor control degenerative disease.
○
Fully cognitively aware, but slowly start to lose their motor abilities.
○
-
Reasons for Referral
To enhance speech and communication.
-
To improve or maintain strength and mobility.
-
To improve quality of life.
Need to break it down to see what specific things you need to work on in
order to enhance their quality of life.
○
E.g., developing relationships in a group therapy setting,
○
-
To evoke memories (ST and LT)
-
To stop exit-seeking behaviours.
-
To help cope with change overall, diagnoses, etc.
People new to long-term care facilities are usually in need of this.
○
-
To decrease pacing, agitation, vocalizations.
-
To increase eye contact, meaningful moments.
-
To increase alertness, movement.
-
To evoke positive memories, orientation to the here and now.
-
To transition to facility, lesson confusion, decreases anxiety.
-
Not reasons for referral:
Liking music,
○
Gifted at music,
○
Responds to music,
○
Was in a choir … etc.
○
-
Reminder: people are not referred because of their diagnoses, they are referred
because they have a healthcare goal.
-
Why Pre-composed Music?
Music therapists work predominantly in long term care facilities.
-
The individuals referred to music therapy in long term care facilities often have
some form of dementia.
-
The use of pre-composed music is what's used predominantly in long term care
with elders with dementia.
It seems to be the most effective in reaching the healthy part of the brain
of that person.
○
When an individual with dementia hears a song with meaning, they can
typically remember the lyrics or melody of the song, can remember
memories associated with that song.
○
Pre-composed music immediately evoked something.
○
It's a powerful tool.
○
It is not entertainment - music therapists are not entertainers.
○
Songs can help create a music time line where you can see certain points
in your life based on songs that were popular at the time.
○
Engaging with familiar music is in the ABA format (verse chorus verse) so
it is predictable.
Being able to guess without too much risk is empowering and
provides security.
§
○
Reassurance, confidence and memory evoking.
Reminds people of their abilities
§
○
Stimulate dialogue and relationships.
○
-
In a music therapy session, we're not going to cure dementia, we cannot
document even whether we're slowing it down because there's no normal
progression of dementia.
But we can say that it provides moments to enhance quality of life,
engage with others and for people to be with their loved ones again.
○
Might create a pocket of time where you're cognitively more present and
free from the symptoms.
○
-
Bell-Choir
People in the group were individuals who were cognitively declined at different
levels.
-
Started with a hello song to warm up the communication systems and prime the
brain.
-
Then they would make a song choice together.
-
Then they would talk about relevant songs for the season.
-
Even those extremely cognitively declined were able to listen, know their part
and know how to play the bell.
-
Worked on self-expression, evoking memories, etc. - many different healthcare
goals.
-
Everyone needs to have some sort of focus in the group.
Needs to be listening, intrigued.
○
Really practicing a lot of cognitive and motor skills.
○
-
It's not a healthcare goal to do a performance, but doing a performance could
facilitate some health care goals:
Empowerment, confidence, self-esteem, etc.
○
-
Not uncommon for bell-choir's to perform.
There would be dialogues about what songs to perform.
○
Groups often work through creating an identity by selecting a group
name.
○
Different roles are given to different people.
○
Practices are therapy sessions, not to prepare for the performance.
Preparation comes with gaining the skills.
○
Typically, music therapists do not prepare people for performances.
○
-
iPod Project (Alive Inside Video)
Not music therapy, but important for understanding music as a tool in health
care.
It's not a music therapist involved.
○
-
Asking questions to evoke concrete, cognitive responses - not asking about how
people feel.
-
Example of how listening to pre-composed music evokes memory.
-
Define Dementia
Acquired decline of cognitive function (memory and language impairment)
-
Music abilities are preserved - uses both hemispheres of the brain.
There is an extremely small percentage of people who cannot engage in
music because their brains are damaged in a highly specific way.
○
-
Alzheimer's (Mini Mental State Exam and Music Therapy)
Music therapy can enhance the outcomes of the scores.
○
-
Listening to stories vs playing music
The music group could recall almost double the information the story
group did.
○
Attempting music playing can highlight deterioration.
○
-
Music and Changes in the Brain
Music changes the brain in various ways.
-
Recently, research looking at the brain of musicians vs non-musicians.
Significant difference in the make-up of the brain.
○
-
There's a good amount of support for how music can support cognition.
-
Lecture 6
Thursday, May 17, 2018 11:08 AM
Review Video
Developmental goal: encouraging speech
If he's drawn towards playing an instrument, she insists that he uses his
words to be able to obtain it (behavioural).
○
Fill in the blanks
○
-
Some music therapists will use a hand over hand model - we see this in the
video.
Some music therapists do not use this model and instead encourage the
client to move on their own.
○
Benefits of hand over hand for someone not initiating movements, it
provides muscle/motor memory so it enhances the chance that the child
will produce the behaviour on their own.
○
Depends on the client's needs, abilities and the therapists preferences.
○
-
Without knowing the background of the client, it's difficult to know how what
you're observing.
In the case of Anthony, his dad explained that he used to throw tantrums,
take his shoes off, etc. and now we can see where's he's at.
○
He's more engaged, his verbal skills have improved, he's concentrating
more.
○
-
Playing on a horn gives the individual the opportunity to work on their breath
and provides feedback via the sound produced and is used in a meaningful way.
-
Developmental goal: Self-regulation
For most people, self-regulation can be difficult.
E.g., when you're in something, it can be hard to change or stop.
§
○
For a child on the autism spectrum, it's even more difficult to self-
regulate.
In a music therapy session, common things like freeze dance are
done with intent to practice and develop self-regulation skills.
§
To practice that in the music is a safe way to learn about cues and
self-regulation.
§
○
Skill will transcend into different areas of life.
○
-
Teaching control over empowerment and choice, but there are also some forces
we need to comply to.
Yes, make choice. Yes, select the instrument you want to play. But you
cannot take 20 mins.
○
Transcends elsewhere (i.e., home, getting dressed, picking shoes)
○
Offers opportunities to make choices, feel self-empowered, but all in a
certain amount of time.
○
-
Long-term care; Sunnybrook Hospital Veteran's
Elders with various degrees of cognition.
○
Program includes music therapy and art therapy - different people can
collaborate on providing private or group sessions.
○
Goal was to improve quality of life for each group member in the
moment.
○
Even if an individual appears to not be engaging in the music, most of the
time their toe is tapping slightly and you can tell they're getting
something out of it.
○
Nothing that says "oh, they're in a music therapy session" at first glance.
But each song was carefully selected with intent to evoke a
response for the clients and each song comes with an introduction.
§
When you know how each response is significant, it does add a
different response to what's happening.
§
○
Gentleman with COPD.
Difficult for him to breathe without pain, but he would really sing
during the sessions.
§
○
-
What is Ageing?
To date there exists no normative established values of what cognitive
impairment or memory loss, or what neurochemical and neurophysiological
changes accompany normal aging.
For development from childhood into adulthood, there are normal
developmental trajectories.
○
But past adulthood, there are no normative values.
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There's no windows of aging that describe how you're supposed to age.
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There's a greater percentage of having less physical and mental abilities as
we get older, but there's no specific values of deficit and no idea of when
this will happen for each person.
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Complex developmental process that involves the intersection of physical,
psychological and social factors.
Physical aging of the body, psychological aging and social factors
associated with aging.
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Older adults: fastest growing population.
There are more older adults currently in Canada than any other age group
and it's a growing concern for healthcare and the government because it
will be a massive drain on resources and services.
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Why are people living longer?
Increased longevity
E.g., smoking is less cool and okay to engage in - this definitely had a
massive impact on health and well-being. Now that we have the
knowledge of smoking's link to cancer and other health issues.
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E.g., Wearing seatbelts. Cars used to be built without seatbelts,
specifically in the back.
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E.g., More aware of healthy eating, healthier lifestyles, retiring later
because they can etc.
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E.g., Less war in Western culture - as time has gone on we have less
deaths as a result of engaging in.
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E.g., Healthcare - we have more available access to healthcare, therefore
there are increases in elder care.
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We are continually becoming more educated as a society around safety and
health issues.
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Chronological Age, Biological Age, Psychological Age, Psychosocial Age
RE: past lecture in regards to developmental age vs chronological age for people
with developmental/mental delays.
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E.g., Betty White
Chronologically 96 years old
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She is not 96 in the way her body moves and the way her mind works and
she speaks.
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The reason we're shocked when she says certain things (i.e., current
events, sex, etc.) is because we've been brainwashed to look at her
chronological age instead of psychosocial age.
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Just because someone's chart says they're 96 years old, doesn't mean we need
to go in and talk to them like they're little old people.
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Go in and speak with them without any preconceived notions about who they
may be based on their age.
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In Western societies, we tend to be ageist and have negative connotations
when we speak about the elderly.
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Biological age: the ongoing process from birth to death; physiological changes.
E.g., hair loss, greys, wrinkles, loss of stamina, change in weight, change in
bone density, strength, organ function, molecular, cellular.
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Psychological age: ability to respond to a changing environment and adapt to
new situations (learning/emotions).
When someone is the same biological and chronological age, it means
that they are not adapting to their environment/times.
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When this is the case, the individual may say things to the clinician that
are offensive so you need to make sure you are mindful of where that is
coming from (psychological age).
As a clinician, you're not there to engage in different points of view,
just to support their healthcare goals.
§
Particularly as people are cognitively declining, they are cognitively
unable to develop new ways of thinking so when you correct them,
it cannot change.
§
Clinicians have the right to remove themselves from an offensive
client that makes them uncomfortable if needed.
§
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Psychosocial age: cultural view and expectations.
How you culture views the elderly.
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In Western cultures, this is reflected in the booming cosmetic industry
and overall negative portrayal of aging.
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In non-Western cultures, people have a high regard for older people and
being older reflects wisdom.
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Music Therapy and Ageing: all people age differently, we need to take into account all
influences.
The music therapist needs to be mindful.
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Dementia
An umbrella term for any dementing/degrading) of the brain.
Overall, loss of cognition.
○
Not everyone gets dementia, it is not a direct result of getting older, but it
is associated with ageing.
○
Just because you're aging, doesn't mean you'll get dementia.
○
It tends to be a diagnosis that people 60+ receive - this age group has a
higher change of developing it.
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Alzheimer's disease, frontotemporal dementia, vascular dementia.
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Common Diagnosis Associated with Ageing (but not a result)
Depression
Lifestyle changes you cannot control could contribute (e.g., you used to
be busy, but now you don't have the same abilities, or your kids aren't
around, your partner has passed, etc.)
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Dementia
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Alzheimer's disease
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Parkinson's
Motor control degenerative disease.
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Fully cognitively aware, but slowly start to lose their motor abilities.
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Reasons for Referral
To enhance speech and communication.
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To improve or maintain strength and mobility.
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To improve quality of life.
Need to break it down to see what specific things you need to work on in
order to enhance their quality of life.
○
E.g., developing relationships in a group therapy setting,
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To evoke memories (ST and LT)
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To stop exit-seeking behaviours.
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To help cope with change overall, diagnoses, etc.
People new to long-term care facilities are usually in need of this.
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To decrease pacing, agitation, vocalizations.
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To increase eye contact, meaningful moments.
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To increase alertness, movement.
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To evoke positive memories, orientation to the here and now.
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To transition to facility, lesson confusion, decreases anxiety.
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Not reasons for referral:
Liking music,
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Gifted at music,
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Responds to music,
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Was in a choir … etc.
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Reminder: people are not referred because of their diagnoses, they are referred
because they have a healthcare goal.
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Why Pre-composed Music?
Music therapists work predominantly in long term care facilities.
-
The individuals referred to music therapy in long term care facilities often have
some form of dementia.
-
The use of pre-composed music is what's used predominantly in long term care
with elders with dementia.
It seems to be the most effective in reaching the healthy part of the brain
of that person.
○
When an individual with dementia hears a song with meaning, they can
typically remember the lyrics or melody of the song, can remember
memories associated with that song.
○
Pre-composed music immediately evoked something.
○
It's a powerful tool.
○
It is not entertainment - music therapists are not entertainers.
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Songs can help create a music time line where you can see certain points
in your life based on songs that were popular at the time.
○
Engaging with familiar music is in the ABA format (verse chorus verse) so
it is predictable.
Being able to guess without too much risk is empowering and
provides security.
§
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Reassurance, confidence and memory evoking.
Reminds people of their abilities
§
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Stimulate dialogue and relationships.
○
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In a music therapy session, we're not going to cure dementia, we cannot
document even whether we're slowing it down because there's no normal
progression of dementia.
But we can say that it provides moments to enhance quality of life,
engage with others and for people to be with their loved ones again.
○
Might create a pocket of time where you're cognitively more present and
free from the symptoms.
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Bell-Choir
People in the group were individuals who were cognitively declined at different
levels.
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Started with a hello song to warm up the communication systems and prime the
brain.
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Then they would make a song choice together.
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Then they would talk about relevant songs for the season.
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Even those extremely cognitively declined were able to listen, know their part
and know how to play the bell.
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Worked on self-expression, evoking memories, etc. - many different healthcare
goals.
-
Everyone needs to have some sort of focus in the group.
Needs to be listening, intrigued.
○
Really practicing a lot of cognitive and motor skills.
○
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It's not a healthcare goal to do a performance, but doing a performance could
facilitate some health care goals:
Empowerment, confidence, self-esteem, etc.
○
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Not uncommon for bell-choir's to perform.
There would be dialogues about what songs to perform.
○
Groups often work through creating an identity by selecting a group
name.
○
Different roles are given to different people.
○
Practices are therapy sessions, not to prepare for the performance.
Preparation comes with gaining the skills.
○
Typically, music therapists do not prepare people for performances.
○
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iPod Project (Alive Inside Video)
Not music therapy, but important for understanding music as a tool in health
care.
It's not a music therapist involved.
○
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Asking questions to evoke concrete, cognitive responses - not asking about how
people feel.
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Example of how listening to pre-composed music evokes memory.
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Define Dementia
Acquired decline of cognitive function (memory and language impairment)
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Music abilities are preserved - uses both hemispheres of the brain.
There is an extremely small percentage of people who cannot engage in
music because their brains are damaged in a highly specific way.
○
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Alzheimer's (Mini Mental State Exam and Music Therapy)
Music therapy can enhance the outcomes of the scores.
○
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Listening to stories vs playing music
The music group could recall almost double the information the story
group did.
○
Attempting music playing can highlight deterioration.
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Music and Changes in the Brain
Music changes the brain in various ways.
-
Recently, research looking at the brain of musicians vs non-musicians.
Significant difference in the make-up of the brain.
○
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There's a good amount of support for how music can support cognition.
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Lecture 6
Thursday, May 17, 2018 11:08 AM
Document Summary
If he"s drawn towards playing an instrument, she insists that he uses his words to be able to obtain it (behavioural). Some music therapists will use a hand over hand model - we see this in the video. Some music therapists do not use this model and instead encourage the client to move on their own. Benefits of hand over hand for someone not initiating movements, it provides muscle/motor memory so it enhances the chance that the child will produce the behaviour on their own. Depends on the client"s needs, abilities and the therapists preferences. Without knowing the background of the client, it"s difficult to know how what you"re observing. In the case of anthony, his dad explained that he used to throw tantrums, take his shoes off, etc. and now we can see where"s he"s at. He"s more engaged, his verbal skills have improved, he"s concentrating more.
