A patient with early-onset Dementia had been referred for music therapy. This patient was a wife and grandmother. As the patient began a steady decline including memory loss, the inability to interact, significant weight loss, and loss of ability to care for self, her family was no longer able to care for her and the disease was taking an emotional toll.
Traditional family roles had been changed and the patient continued to decline to the point where she was no longer verbal, staring at the floor, and needed full assistance with all ADL’s. A referral for music therapy was made based upon the patient’s reaction to music being played in her room on a CD player. The patient’s nurse stated that as soon as the music began, the patient started to hum and tap her feet.
Information was gathered from the family regarding what kind of music this patient might respond to. On the initial and follow-up visits, this patient, who had little to no communication skills, smiled, laughed, started vocally responding to her name being called and simple questions about the music being asked. I would sing her favorite songs and also sing and play music from when she would have been a very young woman.
This patient had an immediate response to music that was unlike any other type of interaction. She would imitate certain pitches in the music and would always be swinging her feet and legs to the beat. The patient even started tapping the rhythm of the music on her back and I was able to adapt the rhythm of the song to match this pattern. This very simple use of the music opened up communication between me and the patient. As the sessions continued, the patient began using her voice more and even spoke a few simple phrases from time to time. At one point, the patient refused to sit down because she wanted to stand so that she could move her whole body to the music. During that session, the patient also reached, for the first time, to press a key on the piano. Sound and music was providing a very simple mode of communication for her: cause and effect. Through the music, the patient was finding different ways of expressing herself.
Music, no matter how structured or predictable, can be instantly changed to meet the expression of the patient and in doing so allows the therapist to begin to create a relationship that ultimately says, “I’m here and I’m listening.”
Of the many music therapy techniques taught, through my own work, improvising and changing the music to meet the patient where they are currently functioning seems to be the approach that I adopt the most. I approach sessions with the information I gather from the referral and case history. And although the reason for referral gives me some indication of what this patient might need, it is not until I am sitting at the bedside of that patient, assessing where they are currently, that I begin to make my plan.
When a patient is particularly agitated, restless, trying to crawl out of bed, etc., it would be a waste of time to start playing and singing something very calming and slow and relaxing. This patient is not going to respond simply because the therapist is not meeting them where they currently are. At this most anxious time, when words are of no use or comfort, the music is what can be used to meet the patient’s emotional state and help to bring about change.
For more information about Gilchrist Hospice Care’s Music Therapy program, visit our website: gilchristhospice.org/music