Immediate Effects of Music Therapy on Fatigue in Hospitalized Patients Recovering from a Bone Marrow Transplant
Dan Andersen, Sarah E. Pitts & Michael J. Silverman (University of Minnesota)
Background: Cancer remains one of the leading causes of death for adults in the United States. While many patients complete chemotherapy and radiation as part of cancer treatment, some patients also undergo a bone marrow transplant. Due to the invasiveness of this procedure, physiological and psychological symptoms and side effects can be intense and often result in extreme fatigue.
Purpose: The purpose of this study was to evaluate the immediate effects of music therapy on fatigue in patients recovering from a bone marrow transplant during a single-session randomized and wait-list controlled trial utilizing an established psychometric instrument.
Methods: Patients on a bone marrow transplant unit were randomly assigned to two groups. Patients in the experimental group received music therapy prior to completing the Lee Fatigue Scale (Lee, Hicks, & Nino-Murcia, 1991) while patients in the wait-list control condition received music therapy services after they completed the instrument.
Results: There was a significant between-group difference, with experimental participants having less fatigue than control participants. Although not significant, experimental participants tended to have higher mean energy scores than control participants.
Conclusions: Music therapy can immediately decrease levels of fatigue for patients undergoing bone marrow transplants. A reduction in fatigue may temporarily assist a more active lifestyle that can facilitate recovery and quality of life. Limitations, implications for clinical practice, and suggestions for future research are provided.
The Effects of Music Interaction on Joint Attention Skills of Preschool Children with Autism Spectrum Disorders
Clare Arezina (University of Kansas)
The purpose of this study was to investigate the effect of interactive music sessions on joint attention behaviors in preschool children with Autism Spectrum Disorders (ASD). Joint attention, the ability to share attention to a stimulus with another person, is a key deficit in children with ASD. Lack of joint attention behaviors lead to the limited social and verbal skills that characterize ASD. Participants (N=6; 5 male, 1 female) were between 36 and 64 months old at the time of the study, and were recruited from the child development program at a large Midwestern university. All children were enrolled in classrooms with curriculum designed specifically for children with ASD. A multiple treatment (single-subject) design was used, with three treatment conditions: music interaction, non-music interaction, and independent play. In the music interaction condition, the researcher greeted children with a song, offered a choice of instruments, and engaged children with musical instrument play, songs, and music books. Turn-taking through instrument play, start-stop cues with music, and songs with repetition and multiple opportunities to respond were frequently used. In the non-music interaction condition, the researcher greeted children verbally, offered a choice of non-musical toys, and engaged children with non-music toys and books. Repetitive games, such as peek-a-boo, and turn-taking games, such as "catch", were frequently used. In the independent play condition, the researcher did not actively attempt to engage children; participants had access to the same non-music toys and books as in the non-music interaction condition. In this condition, the researcher would respond if a child initiated interaction, but would not attempt to elicit engagement. Participants experienced each condition six times for a total of 18 ten-minute individual sessions over a five-week period. Session order was randomized to control for order effect. Behavioral observation of videotaped sessions was used to determine both interaction (responding to a bid for joint attention) and requesting behavior (initiating joint attention). Visual analysis of data graphs was used to determine treatment effect. Interaction behaviors were generally most frequent in the music interaction condition, although the difference was less significant among the children with the best interaction skills. Requesting behavior was highly variable across sessions, regardless of treatment condition. Implications, limitations, and opportunities for further research are discussed.
Music Therapists’ Musical Decision Making: A report of two Studies using Process Tracing Methods
Mi Hyun Bae (Michigan State University)
A music therapist’s decision making regarding the music used or created in a music therapy session is an idiosyncratic sort of professional decision making, which is distinguished from the decision making of other health-related or music professionals. Decision making has been a burning research topic in many other fields such as politics, industry, medicine, education, and so on; however, research on it has rarely appeared in music therapy despite the importance of clinical decision making in practice. With a focus on clinical music listening, the presenter has developed an analytical model that encapsulates what music therapists listen to in practice and explains how they make judgments or decisions about what they listened to. In order to inquire into a music therapist’s decision making regarding the music used or created in a music therapy session is an idiosyncratic sort of professional decision making, which is distinguished from the decision making of other health-related or music professionals. Decision making has been a burning research topic in many other fields such as politics, industry, medicine, education, and so on; however, research on it has rarely appeared in music therapy despite the importance of clinical decision making in practice. With a focus on clinical music listening, the presenter has developed an analytical model that encapsulates what music therapists listen to in practice and explains how they make judgments or decisions about what they listened to. In order to inquire into music therapists’ perception about their musical decision making and to examine their decision-making strategies, she conducted two studies using the process tracing methods of verbal protocol and the information display board. Her multiple case study using verbal protocol, namely Think Aloud Protocol, investigated the musical decision-making process of seasoned music therapists who have different music therapy backgrounds (e.g., receptive, improvisational, and cognitive behavioral). Right after their music therapy sessions or while watching their videotaped sessions, she interviewed the therapists with the question of why they made such decisions in the situations. The other decision-making research employed a computerized version of the information display board. By choosing from a pre-fabricated list of words, music therapists identified the possible contributors to their musical decision making in clinical situations and listed them in a sequence according to their relative importance. In this way, the music therapists demonstrated their decision-making strategies for the research.
A Replication of a Concise Emotional Inventory for an Adolescent Population
Christopher D. Bailey (Southwestern State Hospital)
Adolescent emotions are constantly changing as new life experiences and freedoms begin to emerge from daily life activity. This study investigated the emotional attribution patterns of adolescents using a concise emotional inventory. The concise emotional inventory used in this study was replicated from an original study conducted by Madsen, Madsen, and Madsen (2009) which assessed the emotional attribution patterns of college-aged students. The present study modified the concise emotional inventory to better suit the adolescent population. This scale was used as an appropriate device with adolescents to assess their emotional state across a variety of life’s content areas. The scale consisted of twenty three questions and each question was answered using an 11 point Likert scale. The scale covered a range from negative attribution (-5 to -1), to neutral attribution (0), to positive emotional attribution (1-5). The inventory concluded with a section that allowed the participant to organize the highest and lowest scores, analyze them, and determine if any further improvements were necessary. In the present study, comparisons were made with sixth- through twelfth-grade students at a large school in Northern Florida (n = 250). Comparisons from the results of the present study and results from the original study (Madsen, Madsen, and Madsen, 2009), indicated that there were similarities and differences between the emotional states of adolescents and college-age students. Results indicated that when participants were asked to rate their current emotional state in the morning, participants displayed the lowest mean. Results also indicated that when participants were asked to rate their current emotional state regarding future schooling, participants displayed the highest mean. Adolescent participants were able to recognize and analyze emotional attribution as well as determine if the results were trivial or consequential. Suggestions for beneficial uses of the instrument by educators and mental health professionals were also discussed.
Using Music Technology to Foster Lifelong Learning for Older Adults within an Urban Community
Melita Belgrave (University of Missouri-Kansas City)
The purpose of this study was to create a lifelong learning experience for older adults through music. The lifelong learning experience was implemented through teaching piano lessons to older adults. Piano lessons were taught using the teaching method Piano Wizard, a technology-based instructional method that utilizes sensory learning. Piano Wizard instruction was provided to older adult participants by the researcher through a laptop computer and midi keyboard. Eleven older adults, who attended an urban senior center in a large Midwestern city, volunteered to participate in the lifelong learning music program. Eight 30-minute piano lessons occurred in which the researcher taught older adults piano lessons individually with the Piano Wizard technology. Three research questions were examined in this study. 1) Is Piano Wizard an effective tool to teach older adults piano? 2) Does participation in a music-based lifelong learning program enhance older adult’s subjective well-being? 3) What are older adults’ perceptions of music technology as an instructional method? Results of standardized well-being measures revealed that older adult participants perceived an increase in their subjective well-being. Results of a researcher-developed survey revealed that older adults perceived that the piano lessons provided them with a weekly meaningful activity; and that the lessons required the use of cognitive skills and fostered discipline through weekly lessons and at-home practice. Additionally, older adult participants’ perceived benefits of the Piano Wizard teaching method pertained to visual and audio feedback, ability to adjust the tempo while playing, and the overall teaching method. Implications for practice with older adults will be discussed.
Auditory Perception of Emotion in Sung and Instrumental Music in Children with Autism Spectrum Disorders
Laura Brown & Judith Jellison (The University of Texas at Austin)
People on the autism spectrum present many different behavioral characteristics. At the core of the diagnosis of autism are social and communication deficits (American Psychiatric Association, 2000). Of those social deficits, one common problem is emotion perception. Children with autism have difficulty perceiving emotions from both visual (Harms, Martin, & Wallace, 2010) and auditory stimuli (Rutherford, Baron-Cohen, & Wheelwright, 2002). Deficits in emotion perception ability may be attributed to sensory processing deficits in children with autism.
There is clear research indicating that children with autism process auditory stimuli in unique ways (Haesen, Boets, & Wagemans, 2011). Many children with autism have advanced local auditory processing, meaning they can tune into small details of sound better than their typically developing peers. Two theories exist that identify the enhanced local processing abilities of children with autism. Weak Central Coherence argues that people with autism have impaired global processing and enhanced local processing, while Enhanced Perceptual Functioning only argues for enhanced local processing abilities of people with ASD. An example processing an auditory stimuli more locally is attending closely to the pitch of speech instead of listening to the words and pitch as a whole.
Though children with autism may not be able to perceive emotion from visual stimuli or auditory speech well as typical children, they can perceive emotion from music (Heaton et al., 1999; Heaton et al., 2008; Quintin et al., 2010). Studies examining the ability to perceive emotion in music have been limited to instrumental (i.e., piano and orchestral) examples. The purpose of the current study is to investigate the ability of children with autism to identify emotion from three different types of musical examples: instrumental, instrumental with sung vowels, and instrumental with nonsense words: short, spoken stories with emotional content will serve as a non-music control (baseline). This study will extend current research by investigating if the presence of verbal stimuli impairs the ability of children with ASD to perceive emotions from music. Specific research questions are as follows:
1) Can children with autism match the implied emotion in both sung and instrumental examples to a line drawing of a face?
2) Does the addition of nonsense words to the sung condition inhibit the identification of emotions?
3) What are the differences in accuracy of emotional perception between three types of musical examples and the non-music control?
4) Does response time differ across the non-music control and three types of music conditions?
Participants will range form ages 8-13 and will be included regardless of sex or ethnic background. Only participants who meet the diagnostic criteria for Autism Spectrum Disorder using the Autism Diagnostic Observation Schedule (ADOS) and are verbal will be included in the study. In addition, only children who are verbal will be included in order to screen for children with higher functioning autism. Parental consent will be required for participation and the research protocol will be approved through the IRB process.
The experiment will take place in a quiet, small room at a local university or if necessary at a location more convenient for the family. Each participant will be seated in front of a laptop computer and asked to view a PowerPoint presentation. Examples will progress automatically with pauses between each example.
Participants will listen to short musical examples (instrumental, sung with syllables, and sung with nonsense words) or stories, and identify the emotion for each example by pointing to a line drawing of a happy or sad face on the computer screen. Instrumental and sung examples will be selected from the "happy" and "sad" melodies used by Heaton, Hermelin, and Pring (1999). A female doctoral voice student will record the sung and story examples, and each example will be approximately 10 seconds in length.
Each session will be videotaped and measures of accuracy as well as latency of response will be examine and reported. Results will be analyzed using visual analysis techniques common to single subject methodologies.
This study will be conducted early in September and the full report completed prior to the national conference of the American Music Therapy Association.
A Comparison among Children’s Emotional Interpretation of Atonal Western Art Music, Tonal Western Art Music, and Tonal Classical Jazz Music
Jane W. Cassidy (Louisiana State University) & Nyomi Washington (Agnes Scott College)
The purpose of this study was to examine children’s interpretation of composer’s intended emotional expression in tonal and atonal music. Eligible participants for this project included 97 children between the ages of five and 12 enrolled in a day camp located on the campus of a large Southern university. While all children participated in the music activity, only the results from those whose parents signed a consent form and who signed an assent form on the day of data collection (N = 63) were included in the data set. Exception from IRB oversight was granted.
A digital recording was made for use in data collection. The stimulus tape consisted of six excerpts; two selections in each of three categories. The three style categories were tonal western art music, atonal western art music, and classical jazz music. The two songs in each of the three categories were chosen to represent opposite moods. The label that each selection received was determined by the composer’s intended emotional content. The term "brisk but light," and titles A Musical Joke and Sing, Sing, Sing were indications of uplifting or happy composer intentions. The term "sehr langsam" translated as very slow or sluggish, title Overture to Goethe’s Tragedy, and the piece Goodbye Pork Pie Hat written as an elegy for the great saxophonist Lester Young were indications of morose or sad composer intentions.
For the collection of data, participants listened to an excerpt and then filled out a short survey consisting of the following three questions: "Does this piece sound happy or sad?" "Do you like this music?" and "How would you describe this music?" For the first question children circled either a happy or a sad face; response options for the second question were thumb up, thumb down, or thumb and fingers making an "ok" sign. Lines were provided for the children to respond in a free operant manner to the last question. Children listened to an excerpt (approximately one minute long) and then answered the three questions in their booklet. Children participated in the project in groups of approximately 20 in a classroom with desks and chairs and a portable CD player.
In order to determine whether or not the children could correctly determine the intended emotional content of the music, they listened to musical excerpts and circled a happy face or a sad face. Responses were considered correct if the child circled the icon matching the composers intended portrayal. Results of a two-way chi square showed a significant difference between the correct and incorrect interpretations of the various musical selections, Χ2 (374,5) = 70.86, p < .001. The participants were able to correctly identify the intended emotional content of the happy tonal, sad tonal, happy jazz, and sad atonal pieces with little difficulty. The interpretations of the sad jazz and happy atonal pieces were more evenly distributed between correct and incorrect responses. However, the majority of the interpretations of the happy atonal piece were incorrect.
Further data were collected in order to determine children’s preferences for the musical selections. Children were asked to circle an icon representing whether they liked the piece, disliked the piece, or thought it was ok. Frequencies of responses were categorized by piece. Results of a two way chi square test indicate there was a significant difference among children’s preferences across pieces, Χ2 (372,10) = 54.35, p < .001. The happy tonal piece received the most "like" responses, whereas the sad atonal piece was clearly the least liked selection. Responses to the other four selections (sad tonal, happy and sad jazz pieces, and happy atonal piece) were more evenly distributed across preference categories.
Children were asked to describe the music they heard and their descriptions were grouped into five categories: judgmental, emotional/mood, musical terms, style, and reference. Judgmental responses consisted of statements that passed judgment on the musical selections. Emotional/mood responses consisted of responses that indicated the music put the children in a certain mood or made them feel a certain way. The responses that were categorized under musical terms consisted of references to certain aspects of the music. Style responses indicated that the music reminded the child of a particular type of music. Reference responses were those that indicated the music reminded the children of a movie or a particular setting. All responses were labeled and counted, with some children making multiple comments that fell in different categories and others making no comments. Judgmental responses predominated in the data and reference responses were the fewest.
A Preliminary Analysis of a Developmental Music Therapy Program for Premature Infants: A Pilot Study
Andrea M. Cevasco (University of Alabama)
Researchers have systematically investigated the effects of music research on premature infants since the early 1990s, providing evidence-based practice in the Neonatal Intensive Care Unit (NICU) (Caine, 1991; Cassidy & Standley, 1998; Cevasco & Grant, 2005; Cevasco, 2008; Coleman, Pratt, Stoddard, Gerstmann, & Abel, 1997; Collins & Kuck, 1996; Standley, 1998; Standley 2000, Standley, 2003; Whipple, 2000; Whipple, 2005). A meta analysis on music for premature infants indicated statistically significant effects, especially for positive physiological responses, decreased length of hospitalization (LOH), weight gain, feeding, and decreased stress responses (Standley, 2003). All studies in the meta-analysis had positive effect sizes (Cohen’s d ranged from .46 to 1.95).
Since October of 2009, music therapy services have been provided to premature infants in a 25-bed NICU located in the southeastern region of the U.S. Services have not been provided for infants younger than 27 weeks post corrected age (PCA) because additional research is needed to determine whether music therapy will be beneficial or contraindicated for this vulnerable population (infants 25-27 weeks PCA who weigh less than two pounds). Only two researchers have used music with infants 26 weeks PCA and older, but there was not a lot of information regarding the number of infants who were 26 weeks PCA or receiving ventilator assistance at the time of music therapy.
Initially, music therapy services at this southeastern hospital consisted of live music listening opportunities for infants 28 weeks and older, provided by a board-certified music therapist who had NICU music therapy training or by a music therapy student directly supervised by the NICU music therapist. After nine months, the music therapist approached the head nurse and neonatologists about the possibility of starting music and multimodal stimulation (MMS) protocol. At this time we are providing the live music listening protocol at the hospital, typically for infants 27 weeks to 30 weeks who are receiving oxygen via ventilator or nasal cannula and the MMS for infants who are typically 33 weeks PCA and older; however, many infants between 30-33 weeks PCA are not receiving music therapy due to the large number of infants in the NICU and time constraints. Even when providing music therapy services in the NICU two hours a day across five days a week, it is often hard to provide live music to every infant in the NICU.
This study is one longitudinal study with 3 phases (Study 1, Study 2, and Study 3); infants are randomly assigned to the music therapy treatment group or no music group. Infants in the music therapy group receive music therapy according to the post corrected age at the time when parental consent is given. The purpose of Study 1 is to examine, in a safe and systematic method, the effects of live music on physiological and behavioral parameters of 25-27 week PCA infants. Infants in the experimental group who were 25 to 26 weeks PCA received 15 minutes of music therapy (4 minutes of singing alternating with 1 minute of silence), 2-4 days per week. Infants’ behavioral states were video recorded the 10 minutes before, during music therapy, and 10 minutes post music therapy. Infants’ physiological data (oxygen saturation, heart rate, and respiration) were recorded from the monitors 10 minutes before, during music therapy, and 10 minutes post music therapy. Physiological data was averaged and reported every 12 seconds by the hospital’s medical equipment. Once infants reached 27 weeks PCA guitar accompaniment was added to the music therapy treatment. Fingerpicking was performed at 1 note per second in a very slow, even manner.
The purpose of Study 2 was to determine if 28-30 week PCA infants might benefit from recorded music (a recording of the music therapist’s singing while providing finger picking guitar accompaniment, played on an iPod) compared to the live music (music therapist singing while providing finger picking guitar accompaniment). Determining the age infants can benefit from recorded music rather than live music will allow the music therapist to provide live music to a greater number of younger infants, in which volume, speed, and amount of stimulation can be constantly adjusted for those with less neurological development and regulation. Recorded music can be used with older infants. Infants who were 28 – 30 weeks PCA and considered medically stable to receive this intervention were randomly assigned to receive live music or recorded music first. Live and recorded music consisted of the same songs performed in the same order, sung and played by the same female music therapist. Both live and recorded music conditions lasted 30 minutes in length. Study 2 consisted of the same dependent variables and data collection procedures as Study 1.
The purpose of Study 3 was to continue to provide extended recorded music listening for infants 30-32 PCA and music listening alternating with MMS for premature infants 33 weeks PCA through discharge. Recorded music was provided Monday through Friday, alternating a half a hour of music with a half a hour of silence across four hours. Once infants were 33 weeks, they were eligible for MMS to assist in neurological growth and development. On days when infants did not receive MMS, they then received the recorded music listening protocol. Dependent variable included length of time receiving oxygen, weight gain, length of time to full bottle feeds, and length of hospitalization. Data has been collected since May 2011.
Older Adults Preferences for Popular Songs from the 1900s-1960s to Use in Singing and Listening Activities: A Preliminary Analysis
Andrea M. Cevasco (University of Alabama) & Kimberly VanWeelden (Florida State University)
Older adults prefer singing and listening activities over other music activities, and they preferred popular music over other types of music. Other than the study conducted by VanWeelden and Cevasco (2009), which only consisted of 36 participants listening to 36 popular songs and songs from musicals, a large-scale study of song preferences has not been conducted to address the music preferences of the current aging population. Thus, the purpose of this study was to determine older adults' preferences for specific popular songs, across the 1900s-1960s, that might be used for music listening and singing activities and therapeutic interventions. Specifically, participants’ indicated if they: 1) had heard the song before, 2) would prefer to sing the song, and 3) would want to listen to the song. Also, participants communicated the degree to which they liked each song as well as stated any particular memories they associated with the song. Further analysis also indicated whether song preferences were within the "young adult years" theory, proposed by Gibbons (1977). A total of 240 older adults participated in the study, ages 70 and older. Twenty songs from each decade (1900s-1960s) were selected, resulting in a total of 140 songs. Song selection was based on previous research studies. Three age sub-groups of older adults (70-79, 80-89, and 90+) listened to the songs. Thus, a total of 20 participants in each age bracket listened to each playlist of songs. This resulted in a total of 60 individuals who listened to each playlist (e.g., playlist 1 = 20 participants 70-79 years of age, 20 participants 80-89 years of age, and 20 participants 90+ years of age). At this time data is being collected, and a preliminary analysis will be provided at the conference.
Effects of Music Therapy on Relaxation, Pain, Anxiety, and Nausea in Surgical Oncology Patients: Determining Maintenance of Immediate Gains
Jenna Chaput & Michael J. Silverman (University of Minnesota)
Background: Researchers have consistently found that music therapy can be an effective psychosocial intervention for oncology patients. However, due to shortened inpatient hospital stays, there is a need to determine maintenance of single-session treatment gains with this clinical population.
Objective: The purpose of this study was to evaluate maintenance of music therapy treatment gains concerning relaxation, pain, anxiety, nausea, and perception of music therapy with patients on a surgical oncology unit during an inclusive design.
Methods: Participants were adult oncology patients (n = 41) and their caregivers (n = 4) receiving care on a surgical oncology unit. Participants completed five separate 10-point Likert-Type Scales at pretest, posttest, and 30 to 45-min follow-up. Participants received 20-min music therapy sessions consisting of patient-preferred live music.
Results: Analyses of variance (ANOVA) were computed on all patient data and indicated significant differences in relaxation, anxiety, and pain between pretest and posttest and pretest and follow-up measures. However, there were no significant differences from posttest to follow-up, indicating maintenance of treatment gains. Mean ratings for relaxation, pain, nausea, and perception of music therapy tended to slightly improve from posttest to follow-up.
Conclusions: From the results of this study, it seems that single-session music therapy can be an effective and potentially lasting psychosocial treatment intervention for relaxation, anxiety, and pain for patients on a surgical oncology unit. Limitations and suggestions for future research are provided.
The Effect of Music Therapy on Patients' Anxiety and Perception during Radiation Oncology Simulation and Treatment
Olena Chorna (Florida State University)
The purpose of this study was to examine the effect of music therapy on patient anxiety and perception during radiation oncology procedures.The design of this study included experimental and control groups with pre-test and multiple post-test data collection. Groups were randomly assigned to experimental (music) and control (standard treatment) groups and included patients with head/neck, abdomen and breast treatment area (N = 26). The dependent variables included a Visual Analog Scale (VAS) anxiety measure, items from the Hospital Consumer Assessment of Healthcare and Provider Services/Picket and the facility Music Therapy satisfaction questionnaires. Results of a Two-Way Analysis of Variance with repeated measures revealed significantly lower post-test procedural anxiety between the experimental and control group across procedures after the simulation, the first treatment and the fifth. Patients’ overall rating of the experience during each visit was significantly different between groups and across conditions. Overall, music therapy decreased anxiety, especially at the time of the first treatment.
Treatment Outcomes of Orff-based Music Therapy in a Juvenile Detention Center
Cynthia M. Colwell, Claire Ghetti & Elizabeth Burdette (University of Kansas)
A juvenile delinquent is an individual who has committed a delinquent act (found guilty of a criminal offense). Students in the detention system may be adjudicated delinquent, have adjudication withheld, or awaiting adjudication by the courts (McWhirter, McWhirter, McWhirter, & McWhirter, 2007). Crimes for which offenders may be adjudicated include: violent crimes, property crimes, and status offenses. Violent crimes include murder, forcible rape, robbery, and aggravated assault. Property crimes include burglary, larceny, theft, and arson. Status offenses include running away, truancy, and underage drinking (Fact Sheet: Juvenile Delinquency, nd).
Interventions most effective with juvenile delinquents include those based in social learning theory that target behavior change through social interaction and role-playing positive behaviors with individuals they most comfortably interact with and relate to, typically their peers. Cognitive-behavior therapies are also effective and target replacing negative thoughts with positive ones with opportunities for practice (O’Connor, 2008). Interventions with the greatest impact on recidivism (repeat offense) include interpersonal skills training, individual counseling, behavioral programs and teaching family homes (Lipsey, Wilson, & Cothern, 2000). Therefore, interventions should include social interaction requiring interpersonal skills, behavioral training focusing on positive thoughts and behaviors, and an opportunity to practice these skills with peers.
Music therapy can naturally facilitate social/interpersonal interactions, development of positive thoughts while role-playing these behaviors, typically through verbalizations as a result of musical intervention. Traditional approaches include song writing, lyric analysis, and drumming (Seagren, 2009). Seagren found communication to be the most common domain with specific outcomes including making choices, appropriate verbal interactions, conversation skills, self-expression, and group cohesion.
The Orff Schulwerk philosophy combines elements of speech, rhythm, movement, dance, and song (AOSA, 2010). Orff starts with voice/speech before adding melody and begins with body percussion before adding instruments (Bitcon, 2000; Orff, 1963). Orff Schulwerk has been expanded to working with individuals with special needs in educational environments and to clients in music therapy settings (Colwell, 2005; 2009; Colwell, Achey, Gillmeister & Woolrich, 2004; Copans-Astrand, 2000; Hilliard, 2007; Voigt, 2003) and complements philosophies ranging from Improvisational Music Therapy to Behavioral Music Therapy (Bruscia, 1998; Register & Hilliard, 2007). The purpose of this research study was to compare two music therapy protocols (lyric analysis/songwriting and Orff-based) on verbalizations of students in a day school program at a juvenile detention center.
Participants, between 12 and 18, were remanded by court order to a 5-day per week day school program at the county Juvenile Detention Center. The frequency of males (90%) was higher than that of females (10%). Informed consent was obtained from the parent/guardian of each adolescent and each adolescent was asked to reply to a minor assent statement. The typical day program consists of attention to science, language arts/English, social studies, and different social skills treatment interventions. As part of these interventions, they attended a music therapy group session once per week lasting approximately 60 minutes. A teacher and a corrections officer were in attendance. One therapist led the group while a second facilitated data collection.
The design for this study was an ABAB reversal behavioral design. A was a traditional approach that included, Drumming, Lyric Analysis and Song-Writing and served as the baseline, "standard care" for this population. B was Orff-based Music Therapy focused on active music engagement that introduced musical parts in a layering format so that each individual was able to participate successfully in the final musical product with opportunities for improvisation and creativity.
Data was frequency of verbal comments by participants, length of each verbal utterance, and whether comments were self-initiated or as a result of a verbal prompt (group or individual) by therapist or peer. A written transcript of the audio taped comments was completed. Comments were coded and categorized for themes. Graphic analysis of frequency data, length of utterances, and prompted versus self-initiated verbalizations was completed.
In addition, the study incorporated a quasi-experimental design to assess 6-month recidivism rates; recidivism was defined as any additional committed offense that results in a conviction. The current study used a historical comparison group to determine differences in recidivism rates between study participants and controls matched for offenses and age at current offense (Armelius & Andreassen, 2009). The historical comparison group was taken from juveniles attending the same facility prior to the implementation of the experimental program. Data for the historical controls regarding initial convictions, age at initial offense, and re-reconvictions at 6-month follow-up were obtained from facility records. Data regarding offense, age at current offense, and eventual reconvictions at 6-month post-study follow-up were obtained for experimental participants from facility records.
Effects of Music Therapy on Perception of Stress, Relaxation, Mood, and Side Effects in Solid Organ Transplant Patients: Preliminary Analyses of a Randomized and Controlled Trial
Ian Crawford & Michael J. Silverman (University of Minnesota)
Background: Solid organ transplant donors and recipients typically present with a variety of potential stressors both pre- and posttransplant, which may lead to symptoms such as psychological distress and depression. To date, however, no randomized and controlled music therapy trials exist for this population.
Purpose: The purpose of the study was to determine the effects of music therapy on stress, relaxation, mood, and perception of side effects in hospitalized solid organ transplant donors and recipients utilizing a randomized control trial.
Method: Participants were randomly assigned to experimental or control conditions in a pre- posttest single-session design. As sense of control has also been associated with positive health outcomes in solid organ transplant patients, participants were offered the choice of receiving either patient-preferred live music or a brief harmonica lesson followed by a blues jam session with guitar accompaniment.
Results: Results indicated no significant pretest between-group differences. Concerning posttest differences, there was a significant between-group difference in relaxation, with participants in the experimental having higher relaxation scores. Other mean differences, although not statistically signficant, indicated that participants in the experimental condition tended to have lower mean stress, better mood, and lower perception of side effects scrores than participants in the control condition.
Conclusions: From the results of this randomized and controlled study, it seems that music therapy can be an effective psychosocial intervention for solid organ transplant patients. Limitations of the study, suggestions for future research, and implications for clinical practice are provided.
The Effect of Visual and Kinesthetic Prompts on the Auditory Processing of Students who are Deaf and Hard-of-Hearing
Alice-Ann Darrow (Florida State University) & Julie Novak (Colorado School for the Deaf and Blind)
Purpose of the Study
The purpose of this study was to examine the effect of visual and kinesthetic prompts on the auditory processing of students with moderate and severe hearing losses. Auditory processing was examined under the following four conditions: (1) listening only, (2) listening with visual prompts, (3) listening with kinesthetic prompts, and (4) listening with both visual and kinesthetic prompts.
A learning style is the method by which a person begins to process, comprehend and learn new information. Nearly all learners have a preferred learning style or a preferred combination of learning styles. These learning styles are generally considered to be: visual, auditory, tactile, or kinesthetic. For example, a child who is a visual learner can likely learn through all sensory mediums, but is a more efficient learner when new information is presented in a visual format—such as books, diagrams, charts and demonstrations. There are a number of factors that can determine a child’s learning style. Life experiences, heredity, environment, personality, temperament, culture, and family context are just a few of these contributing factors (Boyles & Contadino, 1998).
Fleming and Bonwell (1998) have identified some of the characteristics that children typically display when they have a particular learning style. It may seem reasonable to assume that deaf and hard-of-hearing children’s preferred learning style must be visual, tactile, or kinesthetic; however, such is not the case. It is obviously to their advantage if they are visual, tactile or kinesthetic learners, some children with hearing losses are "wired" to be auditory learners. These children must rely more on secondary learning styles; therefore, often making learning more challenging. Many deaf and hard of hearing children have developed their visual sense by default, and consequently, teachers of deaf and hard-of-hearing children often rely on conveying information through the visual mode. Because of the importance of drawing on their students’ strengths, educators of the deaf and hard-of-hearing have long explored various sensory approaches to instruction. Some researchers have found multimedia instruction to be more beneficial for students with hearing losses (Dowaliby & Lang, 1999).
Participants were students at a state school for the deaf (N = 30) with either moderate (n = 13) or severe (n = 17) hearing losses. Participants listened to 16 five-note motifs with four motifs under each of the following four conditions: (1) listening only, (2) listening with visual prompts, (3) listening with kinesthetic prompts, and (4) listening with both visual and kinesthetic prompts. The order of conditions and motifs were randomized among the 30 participants. Participants rehearsed each of sixteen target motifs five times under the four sensory conditions. After the fifth administration of the motif, participants completed a match-to-sample listening task. They were asked to listen to three motifs and to identify which of the three motifs was the target motif and they had just rehearsed. The number of motifs correctly identified under each of the four conditions was tallied, as well as the number of motifs correctly identified under the four conditions between participants identified as having a moderate or severe hearing losses.
Results and Discussion
Results indicated that participants identified significantly more target motifs under condition four —listening with both visual and kinesthetic prompts. There were no significant differences between the number of motifs correctly identified under conditions one, two, and three—listening only, listening with visual prompts, listening with kinesthetic prompts. Participants with moderate hearing losses identified significantly more motifs correctly than did participants with severe hearing losses, although both groups of participants identified more motifs correctly using additional sensory input. These findings indicate that students who deaf and hard-of-hearing do benefit from the multimedia presentations of new information. Results corroborate frequent pedagogical suggestions found in the literature that utilizing a multi-sensory approach is beneficial for many students with hearing losses. Future researchers may wish to attempt to identify participants’ individual learning styles and then determine if a relationship exists between their preferred learning style and their responses to listening tasks presented under various sensory mediums.
Musical Imitation and Children with Autism Spectrum Disorders
Krystal Demaine (Lesley College)
It is commonly reported that children with autism exhibit poor imitation of gestures and motor actions, which offer a rationale for the commonly noted limitations communication and social tuning among this population. For the nearly 25% of children with autism spectrum disorders who are considered non-verbal, developmental social benchmarks can be hard to achieve. Notably though, children with autism frequently show unique musical interests and abilities; and music therapy as a clinical intervention has aided in social engagement, emotional tuning, and interpersonal communication. The aim of this study was to identify through observation how non-verbal children with autism imitated musical phrases in a single music therapy session. Four children (three boys and one girl, aged 4-11) participated in a single one-on-one, improvised music session with a music therapist. Improvised musical phrases were performed live, with voice and / or a musical instrument, and the child participant was given space to respond freely. The session was video-taped and coded, and imitations of musical phrases produced by the children were analyzed. Five different types of musical imitation were found. These were identified through the imitation of pitch or rhythm with the use of voice, musical instrument, or both. Social responses that occurred after the musical imitations support literature indicating that musical engagement may lead to social responses such as eye contact, joint attention, increased social engagement, and affective cueing. Possible trends, associations, and future directives are discussed.
University Music Therapy Clinics: A Survey
Ellary Draper (University of Texas at Austin)
Universities around the world establish clinics on campus for various uses, including research, opportunities for those in the community to receive services, as well as for students to gain experiences in their field. The purpose of this study was to survey universities with on-campus music therapy clinics to examine and describe the following: (a) number of clients served, (b) groups or individual services primarily offered, (c) if part- or full-time board certified music therapists are employed by the clinic, (d) if board certified music therapists employed are considered university employees, (e) how payment rates, if any, are set and distributed, (f) if private insurance reimbursement is accepted, and (g) if scholarships are available to clients unable to afford services.
A total of 12 universities were surveyed, with 5 allowing responses to be used for research purposes. The number of clients served ranges from 14 to 75, with one no response. Four of the five university clinics offer both group and individual services, however, two of those universities indicated that the majority of services provided are individual. While board certified music therapists are working in all 5 clinics, only one university indicated the university employs the music therapists full-time. Two universities indicated graduate students supervise practicum students in their clinics. One university has 3 adjunct professors responsible for clinical supervision in the clinic. One university has part-time music therapists who are paid hourly and are not university employees.
At this time, none of the university clinics surveyed accept private insurance reimbursement as payment for services. Two of the clinics accept donations for services, and the money is then used to purchase equipment and supplies for the clinic. One university uses a sliding scale to determine payment on a case-by-case basis, and the money is paid to the university, while another has a set rate established that is paid to the university. Another university charges for sessions and payments to the full-time music therapists are handled by an agency. Each university, in accordance with their payment policy, handles scholarships differently. For those where set-rates are used, scholarships are available, while another university uses a sliding scale to assist clients. The universities that accept donations do not have a scholarship program, as they turn no one away for services.
In conclusion, these results can offer guidance for other universities that want to start university clinics with ideas on how to structure staffing and payments. It seems as though as a profession as we move to insurance reimbursement that university clinics may consider adding this to their payment programs, if nothing else as a model to their students how to pursue insurance reimbursement. This data can also provide us with guidance as we move towards best practice across clinical settings. It is clear that university clinics are offering a their communities a valuable service, sometimes for free, providing services on campus. They are also providing opportunities for students to learn from board certified music therapists as they practice and work with clients in these clinics, moving the classroom into the clinic.
Multi-Modal Stimulation for Infants Born with Neonatal Abstinence Syndrome: A Clinical Description of a Pilot Program. National Institute for Infant and Child Medical Music Therapy
Judy Nguyen Engel & Erica Bailey (Yale New Haven Children's Hospital), Darcy Walworth & Jayne M. Standley (Florida State University)
Participants for this clinical trial with data collection were 17 infants diagnosed with NAS, treated with morphine, and referred for music therapy. Infants were given one 30 minute trial of multi-modal stimulation (MMS). We recorded 4 areas of data: infant responses on MMS, Neonatal Abstinence Syndrome (NAS) daily scores, the nurses' Neonatal Infant Pain Score (NIPS), and weight. Despite positive nursing anecdotal responses, none of these data showed clear benefits of MMS. The MMS scores did reveal that 12 of the 17 infants earned the highest possible score, indicating that they could tolerate multi-modal stimulation to all parts of the body in the presence of both music and proprioceptive stimuli. Therefore, MMS was clearly not exacerbating oversensitivity, an important finding. Non-pharmacologic interventions for NAS symptoms include recommendation for reduced touch. Thus, MMS may be valuable for touch tolerance and nurturing, but additional assessments are needed to fully document possible benefits.
Popular Music as a Socialization Agent for a High School Boy with Asperger’s Syndrome: A Case Study—Part II
Mathieu C. Fredrickson, Clifford K. Madsen & William E. Fredrickson (Florida State University)
Asperger’s syndrome is popularly described as a disorder on the autism spectrum manifested most often by difficulty sustaining typical social interactions, particularly with peers. The subject of this case study was a 15-year-old male with Asperger’s in a mainstreamed high school setting. In a previous study the subject was given an MP3 player and told that he could keep it if he completed some tasks. The subject asked 5 boys and 5 girls, of his choosing, to tell him what their favorite song was and why they liked it. Then he was given a gift card and instructed to find the various pieces of music on-line and download them to the MP3 player. He listened to the music and wrote a paragraph about each piece explaining why his peers said they liked those tunes and what things about the music or lyrics he thought caused them to like it. When asked about whether or not he was aware of this music before the project and how he liked the music the subject indicated that this was not the type of music he listened to but that he had enjoyed coming to know some of these songs and would continue to listen to some of them. He also stated that he felt that he was "friends" with some of the peers with whom he had interacted during the project.
In the next phase of the study the boy was given a copy of the novel "Dear John". Among a number of themes about human relationships the book includes a father with autistic tendencies who is portrayed as distant from his son (John). The subject was asked to read the book and pay particular attention to the relationships between the characters. After a few chapters the boy asked if the father in the book had Autism and what his next assignment would be after reading the book. He was told that his next task was to create a "Soundtrack" by finding five songs that he thought the son in the book might ask his father to listen to in order to improve their relationship. The subject was also asked to write a short paragraph for each song explaining why it might make their relationship better.
The five songs selected by the subject were "The First Time" by Simpson & Jackson, "Collision of Worlds" by Williams, "The Distance" by Hot Chelle Rae, "The Rainbow Connection" by Ascher & Williams, and "The Man on the Left" by Metivier. It is interesting to note that several of the songs originally considered for inclusion in the current list were discovered in the previous project and had been listened to regularly during the intervening time. Since the previous project the subject has collected a variety of other popular songs using his MP3 player, began regularly listening to music on various styles of radio stations, and reported conversations about music with peers. In examining the written paragraphs the subject was much more easily able to identify the point of view of the father character and had difficulty understanding why the son had to work so hard to connect with his father since "the father is the one who is autistic, so it should be easier for the son to understand what to do".
Augmentative and Alternative Communication in Music Therapy for Persons with Autism: A Recommended Practice Model
Anita L. Gadberry (Marywood University)
Music therapists work with the communication needs of persons with Autism Spectrum Disorder (ASD). Though music therapy provides a unique environment for expression and responses from individuals limited in communication, a means for communication beyond the therapy session is essential for the development of viable communication skills. Augmentative and Alternative Communication (AAC) provides a means for functional communication and generalization of skills. This paper presents a review of current research lending support to a Recommended Practice model for music therapy for individuals with ASD including the use of AAC.
Use of Songwriting in Increasing Group Cohesion and Reducing Negative Symptoms of Schizophrenia: A Literature Based Study
Juan V. Garcia-Bossio (Drexel University)
The purpose of this literature-based study was to investigate the effects of group songwriting on negative symptoms of schizophrenia and group cohesion. Several studies showed the effectiveness of music therapy in reducing negative symptoms of schizophrenia. Music therapy has also been effective in increasing group cohesion in various populations. The music therapy technique of songwriting has been successful in increasing group cohesion in other populations, but there is little literature about the use of this particular technique in patients exhibiting negative symptoms of schizophrenia. In this study, a systematic review of following areas of literature was conducted: music therapy and schizophrenia, inpatient group therapy, negative symptoms of schizophrenia, inpatient length of stay, other creative arts therapies and schizophrenia, neuroscience literature related to schizophrenia, and music therapy applications such as songs and songwriting
The results of this study suggest that group songwriting could be an effective technique for music therapists to use in order to increase group cohesion when working with patients exhibiting negative symptoms of schizophrenia. Clinical examples of the use of this technique in this population were presented, and a group songwriting method for increasing group cohesion and reducing negative symptoms of schizophrenia was proposed in this study.
The Impact of Music Therapy on Negative Affect of People with Co-Occurring Substance Use Disorders and Mental Illnesses: A Single Group, Pretest-Posttest Design
Susan C. Gardstrom, Jacklyn Neforos & Joy Willenbrink (University of Dayton)
The purpose of this study was to examine the impact of music therapy on the self-reported negative affect of people with co-occurring substance use disorders and mental illnesses, also termed "dually diagnosed." Negative affect, such as anxiety, sadness, and fear, has been linked to initial substance use, craving, and relapse among individuals who are in or have been in treatment (Cheetham, 2010).
Participants in this study were female and male adult residents of an Integrated Dual Diagnosis Treatment unit (IDDT) within a larger substance use disorder treatment program in the Great Lakes Region. Each participant had a primary diagnosis of substance use disorder and a secondary mental illness, unknown to the researchers unless the participant chose to share this information. Typical diagnoses were confirmed by the program staff as Affective Disorders (Depression, Bi-Polar Disorder) and Anxiety Disorders (Post Traumatic Stress Disorder). In rare cases, residents were diagnosed with Personality Disorders, Schizophrenia, and Schizo-Affective Disorder. No noticeable symptoms of psychosis were noted by the researchers during music therapy sessions. All residents took psychotropic medications.
The research team included a university faculty member MT-BC and student music therapists (SMTs) from an AMTA-approved undergraduate training program in the Great Lakes Region. Forty-minute music therapy sessions were held twice weekly for a period of fifteen weeks. Sessions were co-led by two SMTs with the supervising faculty MT-BC present and participatory in all sessions. Participant attendance was voluntary and was generally noted at 75% or better. Group size ranged from 5 to 16 participants. After the group convened and settled, sessions began with the distribution of a pre-session survey. The surveys were coded to maintain participant anonymity, and completion of the surveys was completely voluntary. Surveys included three Likert scales on which participants were invited to rate current feeling levels of anxiety, sadness, and fear. These same surveys, anonymous and voluntary, were conducted post-session.
Music therapy methods used for warm-up and core experiences during the sessions included receptive, improvisation, re-creation, and composition (Bruscia, 1998). Although the generation of overarching group goals was difficult due to high turnover among residents living in the facility, common clinical goals throughout the study period included increasing emotional self-awareness and expression, improving perception of self-efficacy, increasing effective group communication, and increasing use of music as a healthy coping mechanism. The use of an adapted clinical decision tree (Eyre, 2008) within sessions allowed treatment to be highly reflexive in an attempt to best suit the needs and interests of the constantly changing group dynamic.
Analysis of data is in progress, with a projected completion date of September 30, 2011. Preliminary results indicate that music therapy group sessions had a positive impact on participant-rated levels of anxiety, sadness, and fear. More often than not, the program residents noted a decrease in levels of negative affect from the beginning to the end of the sessions. Participants also frequently verbally testified within the music therapy sessions regarding the positive impact of music therapy on emotional regulation and expression. Music therapy was described as a means of stress relief, method of coping with anxiety, and medium for accessing concealed feelings and emotions. In addition, music therapy was described as helping to lift mood and revitalize spirits. Unsolicited descriptions of session content also shed light upon which experiences are best suited to decreasing feelings of anxiety, sadness, or fear, and which experiences may lead to a heightened awareness and/or experiencing of stated feelings.
In summation, this study highlights the impact of music therapy on negative affect, which has been linked to detrimental outcomes among individuals with substance use disorders. The study also describes music therapy with groups of people with dual diagnoses and who reside in short-term inpatient care, a topic with a limited foundation of music therapy research serving to inform clinical work and development of related theory.
Effect of Music Therapy with Emotional-Approach Coping on Pre-Procedural Anxiety in Cardiac Catheterization
Claire M. Ghetti (University of Kansas)
Individuals undergoing cardiac catheterization, and related procedures such as electrophysiological studies involving cardiac catheter placement, are likely to experience elevated anxiety periprocedurally, with highest anxiety levels occurring in the waiting period immediately prior to the procedure. Elevated anxiety has the potential to negatively impact these individuals psychologically and physiologically in ways that may interfere with the procedure itself. Pre-medication via various common anxiolytics does not always adequately lower patients’ level of perceived anxiety, and at high dosages such medication may interfere with patient compliance during the procedure itself.
This study evaluated the use of music therapy, with a specific emphasis on emotional-approach coping, immediately prior to cardiac catheterization in order to impact periprocedural outcomes. All participants (N = 37) were out-patients on the cardiovascular treatment and recovery unit of a large, Midwestern teaching hospital. Twenty-four participants were male and 13 female, with ages ranging from 36 to 88 years of age; mean age was 63.6 years and median age was 67 years. Thirty-two participants were awaiting cardiac catheterization procedures while five were scheduled for electrophysiological studies. Participants met inclusion criteria if they were: currently awaiting elective cardiac catheterization or electrophysiological study; able to speak and read English; cognitively oriented to person, place, and time; free from major auditory deficit; hemodynamically stable, and 18 years of age or older.
The randomized, pre-test/post-test control group design consisted of two experimental groups—the Music Therapy with Emotional-Approach Coping group (n = 13), and a talk-based Emotional-Approach Coping group (n = 14), compared with a standard care Control group (n = 10). The two experimental groups were administered by the same researcher, a board-certified music therapist with several years of clinical experience within a hospital setting. Each participant received a single treatment or control session delivered in his or her private room on the cardiovascular treatment and recovery unit, during the period immediately prior to elective cardiac catheterization or electrophysiological study.
Dependent variables included psychological (positive and negative affective states, pain, coping self-efficacy, and satisfaction with hospitalization) and physiological parameters (heart rate, respiratory rate, oxygen saturation, and blood pressure) related to anxiety, and subsequent procedure-related outcomes (procedure length, and amount of anxiolytics and analgesics required during the procedure). A repeated measures ANOVA for the positive affect scale of the PANAS indicated a statistically significant effect for time, Wilks’s = .82, F(1, 34) = 7.37, p = .010, multivariate 2 = .18; and a statistically significant effect for group, Wilks’s = .78, F(2, 34) = 4.92, p = .013, multivariate 2 = .22. Follow-up comparisons using paired samples t-tests indicated that the MT/EAC treatment group demonstrated a statistically significant increase in positive affect from pre- to post-test, t(12) = -3.26, p = .007, whereas the EAC and control groups did not demonstrate significant increases in positive affect.
Results indicated a significant overall decrease in negative affect for all participants in the study, regardless of group membership. Heart rate, respiratory rate, and oxygen saturation levels did not differ significantly between groups. The MT/EAC group demonstrated a statistically significant increase in systolic blood pressure from pre-test to end of study intervention while the EAC group demonstrated a significant increase in diastolic blood pressure from pre-test to post-test. The observed mean increase in systolic blood pressure was less than 10% over baseline, and thus likely reflects a benign increase in sympathetic nervous system arousal due to engagement in active music making. Though group means display a trend toward the MT/EAC group having shortest procedure length and least amount of anxiolytic required during the procedure, while the EAC group had least amount of analgesic required during the procedure, none of these differences was statistically significant.
Results support the use of music therapy with an emphasis on emotional-approach coping to improve positive affective states in adults awaiting elective cardiac catheterization and electrophysiological study. Statistically significant improvements in positive affect were seen after a single session of music therapy lasting 30-minutes in length. Conversely, participants who received a talk-based emphasis on emotional-approach coping or standard care did not demonstrate improvements in positive affect.
The Power of Imagery in the Bonny Method of GIM. Connecting with the Inner World: A Case Study
María Montserrat Gimeno (State University of New York at New Paltz)
Elena was a 38 year-old woman diagnosed with Mild Depression. She was from Chile and recently had moved to the United States. Elena was married and had three children. She was having difficulties to adjust to the new culture. Her knowledge of English was limited, and her husband was in the school. She had lost her father when she was young, and reported that he was abusive. However, she was compliant to her mother who was living with her.
Elena tended to withdraw from peers and used to verbalize self-defeating statements during sessions, which denoted lack of self-esteem and self-confidence. Her mood appeared depressed and her affect blunted. The core of her depressed mood seemed to be related to her lack of self-identity, and her co-dependency with her mother. The main goal addressed in the music therapy session was to discover her self-identity and to become independent from her mother. Self-exploration during sessions included finding her strengths and inner resources. At the same time decision-making abilities were addressed.
Elena underwent a series of eleven GIM sessions. During this time she was able to connect with her inner self, and brought insights into her life. The sessions were based on the reflective mode in music therapy. The process involved listening to classical music in a relaxed state to invite images in the form of daydreams, memories, colors, feelings, kinesthetic, and sensory reactions to arise from the deep or her inner self. The programs used for these sessions were Imagery, Caring, Positive Affect, Transitions, Explorations, Relationships, Nurturing, Creativity, and Pick Experience (Bonny, 1978). The client was very receptive to the music, allowing it to lead her. The music evoked the flow of images and emotions throughout the sessions. The mandalas that she drew after each session illustrate the process of her journey.
The Effect of Music Therapy on the Emotional Expressivity of Children and Adolescents who have Experienced Abuse or Neglect
Sharon M. Graham (Florida State University)
The purpose of this study was to determine the effect of music therapy on the emotional expressivity of children and adolescents who have experienced abuse or neglect. All participants (N=22) had been removed from their homes and placed in group foster homes. Female participants were randomly assigned to control and experimental groups. Due the request of the foster guardians to not separate the male participants, the males in this study served as their own control in a pre-test, post-test wait-list control design. Treatment interventions consisted of lyric analysis, songwriting, improvisational instrument playing, and musical games in which participants were asked to encode and decode various emotions. Assessment measures included the following: the Emotional Expressivity Scale (EES; Kring, Smith, & Neale, 1994): a 17-question self-report measure in which participants read and rated statements about their emotional expression on a 6-point Likert scale; observational ratings by an expert panel of judges, who rated both the degree and appropriateness of participants’ videotaped emotional expressions (happiness, sadness, anger, disgust, and surprise); and a post-session questionnaire for foster parents to determine whether they perceived any effects the music therapy treatment had on the participants. Results indicate a statistically significant difference in EES scores between control and experimental conditions, and an increase in both the degree and appropriateness of all five emotions expressed by participants in the experimental condition, several of which were statistically significant.
Analysis of Novices’ Explorations with a KORG Music Synthesizer
Dianne Gregory (Florida State University) & Darcy Walworth (University of Louisville)
This feasibility study was designed to address several questions: Can music synthesizer novices without written or verbal instructions (1) enjoy exploring the device, (2) discover functions of important buttons and (3) create and record a layered product and if so, within what time frame? Answers to these questions, if positive, may provide support for a protocol for using music synthesizer explorations as interventions in medical music therapy programs, particularly for adolescent and adult patients.
Thirty one college students (22 females, 9 males) participated in the study. Seventeen were music majors (including 15 music therapy majors) and 14 were nonmusic majors (including 6 Arts in Medicine volunteers in a local hospital). All participants reported no experience with a synthesizer panel. Four reported minimum experience with keyboard synthesizers.
Twelve groups were scheduled based on students’ appointment selections. Five groups had 2 players and 7 had 3 players. Each group met in a soundproof room containing a video camera, three chairs, and a circular table. On the table were 2 Sony mini speakers, a KORG Kaossilator Pro synthesizer (an 8.5 x 8.5 in panel with a 3 x 4 in touchpad)- and a small sign, "Press the touchpad lightly with your finger." After reading an explanation of the study and signing permission forms, participants began exploring the device. Each group began with the same sound generated (P168) and was recorded for 10 minutes. Participants then completed a questionnaire requesting demographic information, perceptions of the experience, and ideas for hospital applications.
Measures included behavioral observations and tabulations of written responses. The behavioral observation was divided into 10 sec observe and 5 sec record intervals. Behavioral codes included ontask motor (using button and/or touching pad), ontask passive (eye contact, only, with the device), and offtask (absence of ontask). Also marked on the observation form were individuals’ verbalized solutions (e.g., "this button…") and the interval in which the first product (at least 2 loops recorded) occurred. A Likert-type scale (1 = definitely no, 7 = definitely yes) was used to tabulate written responses.
Exploration time was almost equally divided between ontask playing (M=53.83, SD =22.15) and watching (M =41.74, SD =21.15). Only 2.41% of the intervals were offtask. The majority of participants (N=26) verbalized at least one solution. Participants’ verbalization frequency ranged from 0 (N=5) to 8 (N=1) (M = 2.35). Participants responded positively (M= 5.97, SD = .98) to the question, "Did you enjoy playing with the KORG?" and less positively (M= 5.13, SD = 1.33) to the comparison question "Do you enjoy experimenting with electronic devices in general?" The feasibility question "Based on your experience today, do you think adolescent and adult hospital patients would enjoy playing with the KORG?" received the most positive response (M=6.10, SD =.99). Statistical comparisons of music and nonmusic majors’ data revealed no significant differences.
Eight of the 12 groups created at least one product within the allotted time (see chart below). There were no similarities regarding number (2 versus 3 people), majors, or mixed or same sex groups. Characteristics of the remaining 4 groups (N=10 females) revealed no pattern for number in group or major. In fact, ontask percentages and ratings of these participants revealed little difference from the group’s measures (e.g., KORG enjoyment (M=6.5, SD=.71), electronic devices enjoyment (M=5.30, SD=1.33) and music therapy applicability (M=6.20, SD =.79).
Group Sex Major Time of First Product Total # of Products
1 1 Female
1 Male Music Therapy 1:45 3
2 3 Females Music Therapy 4:00 3
3 1 Male
2 females Music Therapy 5:00 3
4 2 Females
1 Male Music
Music Therapy 5:30 1
5 1 Female
2 Males Non music 5:45 3
6 2 Females Non music
Music 6:30 3
7 1 Female
1 Male Music Therapy
Non music 8:00 1
8 3 Males Non music 9:30 1
The request for "ideas about how to help hospital patients use the KORG for distraction or entertainment purposes" elicited 18 comments about providing simple instructions before or after experimentation. Most of these comments included qualifiers about instructions such as "not too much" or "only the very basic functions." Eight comments were potential therapeutic applications (e.g., "during painful procedures," "for self expression").
Results suggest that it is possible for novices (1) to enjoy a brief exploration period with a KORG synthesizer with another person, (2) to maintain attention to the variety of sounds produced by random exploration, and (3) to remain engaged during non-layering and layering play. Slight enjoyment of experimentation with electronic devices may be a prerequisite but music skills do not seem to predict or enhance enjoyment. The fact that leaderless groups successfully collaborated with an unfamiliar, relatively complex device without written or verbal instructions suggests a follow-up study in hospital settings.
"Letters Home": An Analysis of an Internship "Distance" Course
Robert Groene (University of Missouri – Kansas City)
The purpose of this study was to determine the effectiveness of a music therapy internship distance course. The course was designed to increase communication and information dissemination between a music therapy academic program and its interns during internship, increase intern awareness of information aiding transition from intern to professional, and to allow internship in-depth information to be archived for viewing by future music therapy pre-internship students from the academic program. The course requirements included six Monthly Reports and four specific Assignments. Interns were pre-informed that the course Monthly Reports and Assignments would be archived for future pre-internship student viewing. For this study analysis, all Monthly Reports and Assignments were filtered to remove identifying information of the interns, the internship sites, and the internship supervisors. The filtered Monthly Reports and Assignments were from eight interns at eight different internship sites in 5 different states over the course of 9 months. Word count and content of the filtered Monthly Reports and Assignments were analyzed by the Linguistics Inquiry Word Count (LIWC2007) program (Pennebaker, Booth, & Francis, 2007). Results indicated that: (a) all Monthly Reports and Assignments were turned in within the required time frames, indicating a noteworthy increase in communications between the intern and the academic program; (b) One intern's unique Monthly reporting style resulted in a significantly greater amount of information; (c) Linguistic inquiry revealed significant intern gains in Positive over Negative Emotions, Insight, Social Competency over Anxiety; and Achievement; (d) Information from the Monthly Reports and Assignments will leave a rich amount of information for future interns. Future course revisions as a result of the information learned from this study are discussed.
The Immediate Effects of Rhythmic Arm Swing and Finger Tapping Exercises on Gait of Parkinson's Patients
Marion Z. Haase (Colorado State University)
This study investigated the immediate effects of a rhythmic arm swing exercise vs. a rhythmic finger tapping exercise on gait parameters of individuals in the early stages of Parkinson’s disease (PD). The study design was a randomized control trial involving three experimental conditions: control group, tapping group and arm swing group. Each patient participated in only one of these experimental conditions. Pre-test and post-test of walking at preferred speed were employed for each participant. All participants were rated between 0 and 2 in the Hoehn and Yahr scale. Tapping participants were instructed to tap on a metal plate (while seated) to the beat of an external auditory cue from a metronome set to 120% pre-test walking cadence, for three, 1-minute intervals with 30 seconds of rest in between each interval. The arm swing participants were instructed to swing their arms (while seated) with the beat from a metronome set to 120% pre-test cadence, for three 1-minute intervals with 30 seconds of rest in between each interval. Control group participants were instructed to remain seated for 4 minutes. Hand and arm function were assessed using the Nine Hole Peg Test (NHPT), motor functions were assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS) parts III and IV, and balance was assessed using the Berg’s Balance Scale. Gait parameters were recorded at the sampling rate of 500Hz with a computerized foot sensor system. The walking data was analyzed off-line by a personal computer with the interface hardware and analysis software. Changes in velocity, stride length and cadence were recorded during the pre-test and the post-test.
Primary analysis indicated that the tapping treatment increased the absolute cadence in subjects (mean change = 4.400 steps/min, standard error = 1.399 steps/min, p=0.0051), while the arm swing protocol did not have a significant effect on absolute cadence (mean change = -0.356 steps/min, standard error = 1.234 steps/min, p=0.776). The control condition also resulted in no significant change in absolute cadence (mean change = 0.443 steps/min, standard error = 1.399 steps/min, p=0.755). Secondary analysis involving comparison in change of scores between pre and post tests across groups indicated that the tapping treatment’s effect was significantly different from the arm swing protocol’s results within the parameter of absolute cadence (p=0.0191). Results suggest immediate effects of the arm-swing exercise on gait parameters are not statistically significant, while a pre-gait tapping protocol resulted in immediate effects (increased absolute cadence) that were of statistical significance.
The tapping protocol’s effect on cadence suggests that rhythmic finger tapping as a pre-gait exercise may lead to uncued higher step frequencies and gait velocities in Parkinson’s disease, and that a seated pre-gait arm-swing exercise may not cause immediate significant changes in gait. A possible explanation for the statistically insignificant change in gait parameters during the arm swing exercise is fatigue – this exercise required more work than the other two conditions, and testing took place immediately after completing the exercise. Other possible confounding variables are the possibly reduced amplitude of the arm swing during the exercise, and the possibility that arm-swing decoupled from locomotive leg movements may have limited effects on gait. Tapping to a beat, however, may have immediate carryover effects perhaps due to its being a non-locomotive motion that can be isolated as a rhythmic pre-gait exercise.
These findings suggest that a rhythmic tapping exercise may be beneficial to patients with Parkinson’s disease, and may increase their walking cadence. However, arm-swing in PD remains a problem due to it’s reduced amplitude as a symptom of the disease, and this negatively affects gait parameters. Further research is necessary to investigate new ways to improve arm-swing and consequently gait parameters in PD patients.
Evaluation of Parent's Use of a Music CD Combined with Developmentally Appropriate Activities as a Cost-Effective Music Extension Program for Premature Infants after Being Discharged from the Hospital
Ellyn L. Hamm & Andrea M. Cevasco (The University of Alabama)
This research study investigates parent’s use of the CD "Baby Beats." "Baby Beats" is a CD of songs for infants and young children given to parents upon their infant’s discharge from the neonatal intensive care unit (NICU). A music therapy student performed the lullabies and folksongs recorded on "Baby Beats" in the style taught thru NICU-MT training. Along with the recording parents were given a booklet of developmentally appropriate activities to use with their infants while listening to the CD. Two weeks after discharge the parents were called and asked to answer a follow-up survey regarding their use of the CD and music with their infant. Parents were asked to respond to how important it is to use music, how often they use music, when they use music with their infant, and how their infant responds to music. Clinical implications are discussed.
Modern Technology in the Service of Music Therapy
Kimberlee Headlee (Arizona State University)
In the last few decades, the rapid development of electronic music technologies has changed the way society interacts with music, which in turn impacts the profession of music therapy. Though a few instances can be found, music therapy has not extensively explored the integration of new technology into clinical practice. However, current research trends show a willingness and excitement to explore the possibilities (Nagler, 2011; Ramsey, 2011; Magee et al., 2011; Magee & Burland, 2008; Magee 2006). The project described in this paper intends to demonstrate one of these possibilities by combining modern technologies to create an interactive musical system with practical applications in music therapy. In addition to designing a practical tool, the project aims to question the role of technology in music therapy and to provoke discussion on the scope of the definition of technology in music therapy.
Technology’s novelty, multimedia capabilities, and multi-facet interactions create intrigue and motivation to engage in music therapy, especially for certain clientele. In addition, for some clients, adaptive technology is the only access to independence and musical expression. Certain technology can also assist in the collection of quantitative data, an essential task in justifying music therapy in the research community. Overall, technology has the capacity to extend the reach of music therapy’s therapeutic benefits across wide-ranging populations and goals.
The past decade has seen exploration of many technologies, including computer composition software (Whitehead-Pleaux et al., 2011; Magee et al., 2011), standalone technology, interactive visualizations (Hunt, 2004; Neighbour, 2002; Rothstein, 1991) continued development of non-traditional electronic instruments (Vaudreuil, 2001; Ayling, 2010), and more recently, gesture interfaces, including motion capture with laptop cameras (Oliveros et al., 2011), full-body motion capture (Lem & Paine, 2011), and adaptations of game technology (Freed et al., 2009). Gestural interfaces make up a class of technology that allows body movement to be used for musical expression. They are part adaptive instrument, part electronic instrument, part computer software and part assistive technology, and can include both video motion capture and other external hardware. Their adaptability, novelty, and inherent ability to facilitate embodiment make them worth exploring as a therapeutic intervention.
This project uses modern gestural technology to elicit musical feedback, and is intended for use in a clinical setting with children with moderate disabilities. The system is a software/hardware package that is designed to be an inexpensive, user-friendly, portable tool for music therapy. The Microsoft Kinect, a commercial 3D motion capture gaming device released in late 2010, was chosen as the sensing device because of its low cost, small size, and simple interface, yet retaining superb sensing capabilities (Naone, 2011). The system uses open source code to gather data from the Kinect, and software written by the author in Max/MSP to parse movement data into sound. There are two modes of the system: the first sonifies specific movement tasks like kicking, reaching, and balancing, based on the theory of Patterned Sensory Enhancement (Thaut 2005) to motivate movement and retrain the brain; and the second is an interactive musical play space that reacts to movement within the space in direct but not immediately obvious ways. The music occurs in response to various movements of the body, including location and amount of motion. The goal of the second mode is to encourage exploration of space and the body, musical expression, play, and social interaction.
The system design will be evaluated through qualitative research in the form of an anonymous survey, in-person interviews, and a focus group, all of trained music therapists who can evaluate the system for its musical qualities and its applicability to music therapy practice. The IRB for this research has been obtained, but at the time of submission, the evaluation procedures had not taken place. All evaluation will be complete at the time of the presentation. The responses in the evaluation will be used for future iterative design of this project and to inform other future projects with technology. It is the author’s hope that the project will encourage meaningful dialogue between music technologists and music therapists that will further progress towards this important research avenue. Collaboration and discussion are vital to successfully integrating technology into music therapy practice, an addition that will expand the scope of the field and may eventually lead to the growth of the profession.
An Investigation of Services and Program Offerings for Adults with Developmental Disabilities in the State of Florida
Julia Heath (Florida State University)
The purpose of this study was to investigate services and program offerings for adults with developmental disabilities in the state of Florida. Agencies (N = 380) listed on The Able Trust website were investigated to determine the types of services offered (Guided Living, Advocacy, Other, Insufficient Information). Agencies were organized by region dictated by The Able Trust (Northwest, North Central, Northeast, East Coast, Gulf Coast, Central, Southwest, and South). Of the total agencies listed, the Guided Living agencies (n = 146) were investigated to document program offerings. Program offerings (n = 283) of interest in this study included: Music, Job Training, Life Skills, Social/Leisure, Social/Sports, and Other.
This study revealed the lack of music program offerings in the state of Florida (n = 16). The program offering with the highest percentage was Job Training (n = 77). Future research in this area should include using music for transition from public school to guided living, training recreational activity directors for music inclusion, and the incorporation of music education into agencies for adults with developmental disabilities. Site visits to determine the quality of program offerings would also be useful in future investigations.
Preferred Music Genre Used for Recreation by Undergraduate Music Students
Michael W. Hudson (Florida State University)
In order to meet the needs of the client, it is essential that the music therapist have a large and varied repertoire of popular music genres and styles. A great deal of one’s popular music knowledge is generally acquired from listening to music in social and recreational settings. In the academic setting, collegiate music curriculums primarily teach Western art music or "classical" music as the predominant genre rather than more modern genres of popular, rock, folk, or sacred music. The purpose of this study is to investigate which genres of music undergraduate music majors prefer to listen to when they are outside of the collegiate academic music setting. It is the aim of the investigator to ascertain if undergraduate music majors’ recreational listening preferences outside of the academic setting aligns with the same genre of music that they are exposed to in the college music classroom. If not, what music do they prefer, and how can collegiate music programs offer more opportunities for pre-service music therapists to expand their popular music repertoire.
Eighty-eight undergraduate music majors attending a large southeastern university completed a researcher designed survey asking which genre of music they prefer to listen to for recreation. Participants provided demographical information such as gender, instrument or voice, and year in school. For this study, recreation was defined as any activity outside of the participants’ academic music responsibilities. Results indicated undergraduate music students preferred the music genre of Rock/Pop (40.91%) for recreational use. The genre of Classical (21.59%) was the second most preferred recreational music followed by Jazz (7.95%), Country Western (6.82%), Rap/Hip Hop, Religious/Gospel and World (5.68%), Easy Listening (4.55%), and Electronic (1.14%). Further results indicated that Rock/Pop was also the preferred genre of music for recreational use among both male and female instrumentalists and vocalists.
Functional Musicianship of Music Therapy Students Entering Internship
Carrie Jenkins (Drury University)
Functional musicianship as an important skill in the education and training of music therapists has a long history in the music therapy profession and is presently included among the AMTA Professional Competencies. Although the literature acknowledges the importance of functional musicianship in the practice of music, there are indications that students may be arriving for internship with inadequate functional musicianship skills. Although the university is considered the most appropriate setting for the teaching of functional musicianship, there are indications that internship directors may have to address fundamental skills. The purpose of this study, therefore, was to gather updated information concerning perceptions of internship directors (IDs) on the extent music therapy students are arriving to internship with adequate functional music skills. A secondary purpose of this study was to determine if any significant improvement in functional piano skill preparation has occurred since these skills were last evaluated in 1986.
Questionnaires were sent to internship directors at AMTA roster internship sites. The questionnaires included functional musicianship skills in the areas of keyboard, voice, guitar, percussion, and improvisation as listed in the AMTA Professional Competencies. IDs were requested to rate the importance and mastery of each skill using five-point early Likert scales. The anchors for importance were: not important (1), somewhat desirable (2), desirable (3), very desirable (4), and essential (5). The mastery anchors were: Unprepared for internship (1), below expectations for entry into internship (2), meets expected competency level to enter internship (3), exceeds expected competency level to enter internship (4), and professional competency level (5). In addition, in an effort to determine whether progress had been made since 1986 in the teaching of functional piano skills, those piano skills rated as "very desirable" or "essential" to the practice of music therapy (Cassity, 1987) were included in the questionnaire for reevaluation. The same Likert scale as the one used in the former study was used in the present study to reevaluate the skills.
The results indicated IDs considered voice skills (4.74) to be most important, followed by guitar skills (4.53), piano/keyboard skills (4.06), percussion skills (3.85), and improvisational skills (3.80). Students were rated as meeting expected competency level to enter internship on all three AMTA vocal skills or competencies. However, they were rated below expected competency level on every AMTA professional competency relating to guitar skills, keyboard skills, percussion skills, and improvisation skills.
Because of the number of statistical tests presented for this study, α was reduced to .01. IDs consider some functional skill areas to be significantly more important than others. These skills areas are, in order of most importance, voice, guitar, and piano (H= 9.92; p < .01). However, there was significantly greater consensus, or agreement, of the importance of voice and guitar than for keyboard, percussion and improvisation skills (U = 0; p<.002), indicating the latter skills may be more important in some settings than others. There was a tendency for keyboard skills to be perceived as more important than percussion and improvisation skills (p=.03).
A significant association was found between the importance and mastery ratings of voice, guitar and keyboard skills (rs = .93, p<.001), indicating IDs considered pre-interns to be better prepared in skill areas they consider most important to music therapy practice. A significant difference was observed in ratings indicating level of mastery, with the greatest mastery for voice, followed by guitar and piano (H = 8.33; p = .01).
Finally, the present study reexamined the perceived mastery level and importance of piano skills listed in the 1986 survey (Cassity, 1987). Results indicated IDs in the present study perceived piano skills to be significantly less important (U = 27 ; p =.002) than they did in 1986. Although this data indicates piano to be less important, other data in the present study indicates piano, along with percussion and improvisation, continues to be an important skill area for the practice of music therapy. There was no significant difference in perceived mastery of functional piano skills over the past twenty-five years indicating a lack of progress in the teaching of functional piano skills. The major recommendation of this study is that greater emphasis be placed in music therapy education on the teaching of guitar, keyboard, percussion, and improvisation skills.
Music Therapy and Breast Milk for Premature Mothers: An Exploratory Study
Douglas Keith (Georgia College & State University)
Problem: Inadequate nutrition is a significant public health problem. Maternal breast milk is considered the nutritional "gold standard" for all infants, especially premature infants. However, preterm mothers are at 2.8 times the risk of not producing adequate milk than term mothers (Hill, Aldag, Chatterton, & Zinaman, 2005). Multiple factors affect the production of milk, including stress, fatigue, and the separation of the breastfeeding dyad, e.g., when mother or infant is hospitalized. The objective of this study was to examine the effects of music therapy-based listening interventions on the quantity and quality of breast milk produced by mothers using a breast pump.
Method: Mothers of 162 preterm infants were randomly assigned to one of four groups. The control group received standard nursing care, while mothers in the three experimental groups additionally listened to a recording one of three listening interventions while using the pump. Data were analyzed using mixed model repeated measures with SAS Proc Mixed. The three experimental groups were compared to the control group to determine efficacy. Multiple comparisons were adjusted using the Bonferroni correction.
Results: Mothers in the experimental groups produced significantly more milk (p<.0012). Mothers in these groups also produced milk with significantly higher fat content during the first six days of the study.
Conclusions: The interventions provide an inexpensive and efficacious method for providing a sustainable source of breast milk for neonates being treated in the NICU which in turn has tremendous public health potential.
A Comparative Study on Music Preference between School-Aged Children with Cochlear Implant and Normal Hearing
Soo. J. Kim, E.M. Kwak, G.E. Yoo & S.Y. Hwang (Myongji University, South Korea)
Purpose and Background
This study was to examine music preferences of schoold-aged cochlear implant (CI) recipients in comparison with normal hearing (NH) children. The cochlear implantation has been regarded as an effective and safe treatment for deafness, and a body of literature demonstrated positive outcomes regarding language development and hearing improvements (Gfeller, et al., 2000; Gfeller, et al., 2002; Gfeller, et al., 2006; Nakata et al., 2005). Unfortunately, there is relatively little understanding of music perception skills and limitations in processing and appreciating musical input among CI users. Most CI music perception studies have been conducting with adult CI recipients who were post-lingually deafened. Child implant users differ from adults in terms of the absence of music experiences; therefore, little information is available regarding music perception and preference among CI children. However, considering that the importance of early intervention for children with CI recipients has been of increasing interest, investigation of music preferences of these children was expected to provide useful information in proposing beneficial music therapy intervention.
Participants were 12 CI recipients and 155 age-matched NH children. CI children were recruited from a hospital in Seoul and they had cochlear implants for longer than two years (M= 4.7). NH children were randomly sampled from an elementary school in Seoul. All participants were asked to respond to a questionnaire and rate their music preferences.
Questionnaire was consisted of five areas; 1) preference of voice according to age and gender, 2) preference of pitch (high vs. low), 3) preference regarding the type of music performance including instrument types and the size of performance, 4) musical genre preference, and 5) music preference according to the environment where music was provided (inside vs. outside of school).
The results showed that while 58.33% of CI recipients preferred child voices, 71.61% of NH children preferred adult voices. For preferred singers, a greater portion of both groups preferred female singers over male singers. For preferred frequency range, both of CI and NH groups preferred higher frequency. Among vocal only, instrumental only, vocal and instrumental music, 91.67% of CI recipients and 73.55% of NH children were found to prefer vocal and instrumental music. With regard to preferred musical styles, while CI children gave the highest rating (M= 3.58) to Korean folk songs on the 5-point Likert scale, popular music and TV and soundtrack music were found to be the highest-rated styles (M= 3.83) for NH children.
These results indicate that self-rated music preferences of CI recipients may be affected by a musical environment that these children have experienced. The results also imply that the provision of appropriate musical input and experiences would significantly affect future music preferences and appreciation of CI children. Providing useful information about music preferences of CI recipients in comparison with NH children, this study has significant implications for further studies on this population.
Study of Accent-Based Music Speech Protocol Development for Improving Voice Problems in Stroke Patients with Mixed Dysarthria
Soo Ji Kim & Ui Ri Jo (Myongji University, South Korea)
Purpose & Background
This study was to develop an accent-based music speech protocol(AMSP) to address voice problems of stroke patients with mixed dysarthria. Previous music therapy literature has examined musical elements in dysarthric speech to regulate the speech motor function by providing rhythmic cues and temporal and melodic alterations (Haneishi, 2001; Pilon, McIntosh, & Thaut, 1998; Tamplin, 2008). Integration of accent in music applications such as singing and chanting for dysarthric speech may enhance acoustical components of speech parameters because producing accentuated sound stimulate respiratory controls and glottal attack.
Six stroke patients (mean age = 58.83) with mixed dysarthria participated in this study. All subjects are diagnosed as stroke within one year, and diagnosed as dysarthria within one year, showed no hearing and visual difficulties, and singed written consent forms including video/audio consent forms.
Each session was conducted for 30 minutes and 12 sessions including pre- and post-test were administered for each patient. For examining the effectiveness of protocol, the measures of maximum phonation time(MPT), fundamental frequency(F₀), average intensity(dB), jitter, shimmer, noise to harmonics ratio(NHR), and diadochokinesis(DDK) were compared between pre and post-test and analyzed with a paired sample t-test.
AMSP protocol consisted of four stages. First stage was warm-up(4 minutes). Subjects were asked to stretch both arms and move up and down slowly. If subject is hemiplegia, he or she was asked to hold involved hand with healthy hand. Trunk rotation and head movements were followed. All movements were accompanied with steady and sedative music with four beats.
Second stage was respiratory training (4 minutes). Subjects were asked to breath in and out with his or her hands on the abdomen following the researcher’s demonstration. This stage is accompanied by keyboard scale playing with ascending and descending melody lines.
Third stage was vocalization (10 minutes). In this stage, the researcher hold a hand drum and played two times for preparation beats, and then subjects vocalized /a/ pretending yawning. This exercise is to facilitate open the throat and relaxation of muscles involved in vocalization. Then, subjects were asked to sing a simple song with /a/, /e/, /i/, /o/, /u/, or combination of two of them. After completion of singing with vowel sound, subjects were asked to vocalize the same vowel sound two times in a row, accentuating on second vowel (/a/ - >/a/:). The second accentuated vowel was longer than the first one. The researcher added more vowels according to subjects’ physical conditions.
At last, melodic chant with accent was performed (12 minutes). Six Korean traditional chanting repertoires were selected. Subjects chanted with accents in conjunction with hand drumming on the every first and third beat. Various lyrics and number of syllables were included.
The results showed that the measures of MPT, F₀, dB, and sequential motion rates(SMR) were significantly increased after administering the protocol(p< .05). Also, there were statistically significant differences in the measures of shimmer, and alternating motion rates(AMR) of the syllable /Kə/ between pre- and post-test(p< .05).
The results indicated that the accent-based music speech protocol may improve speech motor coordination including respiration, phonation, articulation, resonance, and prosody of patients with dysarthria. This suggests the possibility of utilizing the music speech protocol to maximize immediate treatment effects in the course of a long-term treatment for patients with dysarthria.
Teens’ Perceptions of Music Therapy Following Spinal Fusion Surgery
Charmaine Kleiber & Mary Adamek (The University of Iowa)
Spinal fusion (SF) for adolescent idiopathic scoliosis (AIS) is one of the most painful surgeries performed on adolescents. Music Therapy is an intervention shown to decrease postoperative pain intensity in adult samples. Currently at our hospital, a Music Therapist (MT) visits AIS patients on postoperative day 2 when the adolescent gets out of bed to a chair for the first time. As in many hospitals, resources are limited and the therapist can only provide one session per patient. We wanted to know if using other methods for delivering music (e.g., IPod, IPad, website) in addition to the usual individualized music therapy session would be desirable. Our first step was to ask adolescents’ their opinion.
Purpose/ Research Question
The purpose of this study was to explore teens’ memories on the effects of Music Therapy and their recommendations for use with future patients. The specific research questions were:
• What do adolescents who received music therapy after SF surgery remember about the therapy?
• What do they wish they had known about music and pain management before surgery?
In this qualitative study, approved by the IRB, we sent letters of invitation to 30 adolescents who had experienced SF and music therapy within the previous 24 months. Of the 12 subjects who responded, 8 were available for phone interview. An undergraduate music therapy student conducted phone interviews using predetermined questions and then transcribed the audio recording. The primary investigators individually used thematic analysis techniques to formulate interpretive themes, and then discussed their ideas to expand and/or consolidate themes.
Teens’ reported changes in perceptions of pain and mood following music therapy, with most experiencing decreased pain and decreased negative emotions such as anger and anxiety. They commented on the importance of individualizing therapy, including the ability to choose preferred music. The presence and interaction with the MT was perceived to be an important part of the therapy. Preparation for surgery was a strong theme. Most participants thought that it would be useful to know about music therapy before surgery. Suggestions were to hear advice from previous SF patients, know how music therapy would help, bring preferred music, and practice relaxation with the music preoperatively. The iPad was the suggested technology for watching and listening to pre-recorded music in the hospital.
Conclusion and implications
This study has implications for the preoperative preparation of SF patients. Methods to introduce adolescents to music therapy and how to use music for relaxation need to be developed.
The Effects of a Social Skills Song on the Social Initiation Behaviors of Adolescents with Autism
Deborah L. Layman & Amy M. Lumadue (Creating Connections Company & Kent State University)
The Centers for Disease Control (CDC) identifies social skills as one of the most frequent areas of challenge for individuals on the autism spectrum ("Signs and Symptoms," n.d.). In fact, some researchers state that these social deficits may actually be the most significant and handicapping feature of autism (Rogers, 2000). According to Weiss & Harris (2001), individuals with autism often have difficulty in initiating and responding to social approaches. As a result, many intervention models focus on these challenges, including peer training, social reinforcement, parent-implemented script fading, video feedback, and social stories. A number of research studies have shown that social stories can be effective tools in the development of social skills (Crozier & Tincani, 2007; Delano & Snell, 2006; Schneider & Goldstein, 2010; Karkhaneh, Clark, Ospina, Seida, Smith, & Hartling, 2010; Kokina & Kern, 2010; and Reichow & Sabornie, 2009).
Music can also be a successful intervention in promoting social skill development in children with autism (Finnigan & Starr, 2010; Wigram & Gold, 2009; and Duffy & Fuller, 2000). In fact, two studies were found that incorporate the idea of musically-adapted social skills songs to address behavioral or social skills. Brownell (2002) investigated the effect of musically adapted social stories on the behaviors of students with autism and found that the reading and singing conditions were significantly more effective in decreasing targeted behaviors than the control baseline condition. Pasiali (2004) explored the application of prescriptive therapeutic songs on promoting social skills in three children with autism. Using an ABAB reversal design, Pasiali found that there was some indication that prescriptive songs are a viable intervention for children with autism, even though the results were inconclusive. However, no studies were found that incorporate the use of a social skills song (i.e., musically adapted social story) in teaching initiation.
Therefore, the purpose of this study was to examine the effects of social skills song on the social initiation behaviors of three adolescents with autism. This quasi-experimental study utilized an ABACA design, with a fourth baseline added at the end to examine transfer of skills to a non-music setting. Subjects were three adolescent males (aged 13-16), each diagnosed with autism. Subjects received group co-treatment therapy (music therapy and DIR®/Floortime™) every other week for eight months. Each baseline phase lasted two sessions and each intervention phase was conducted for four sessions. Null hypotheses were as follows:
Ho1: There will be no difference between baseline observational data (first A) and observational data after Intervention I (second A).
Ho2: There will be no difference between baseline observational data (first A) and observational data after Intervention II (third A).
Ho3: There will be no difference between observational data after Intervention I (second A) and observational data after Intervention II (third A).
During each baseline (A), subjects were observed while completing a previously learned group music task without therapist facilitation. During the first intervention (B), the music therapist taught the social skills song to the subjects and facilitated role-play of the specific social initiation behaviors targeted in the song (e.g., eye contact, physical touch to gain attention, etc.). During the second intervention (C), subjects engaged in singing the social skills song with the music therapist, then completed the previously learned group music task with therapist facilitation to practice social initiation behaviors. Data was collected during baseline phases only via event recording on an author-created data sheet. Due to the limitations of this study, the authors served as trained observers and inter-rater agreement was 98% (average) throughout the length of the study.
The authors are in process of finishing data collection during the final add-on phase of the non-music baseline. Collected data will be analyzed to examine several different outcomes, including comparisons of the behaviors exhibited each baseline phase. Preliminary anecdotal analysis of the data is promising, as it shows a solid increase between the first and second baselines and a continued increase from the first to final music baseline. In addition, the behaviors demonstrated during the additional non-music baseline indicate that subjects are able to transfer and generalize learned social initiation skills. Data will need to be analyzed to determine if there is statistical significance in any of these anecdotal findings. Analysis will commence once the final baseline is completed.
Five Notes Therapy - A Schema for Integrating the Music Therapy & Music Composition Departments
Michael Legge (Five Notes Therapy, Levittown, PA)
The purpose of this study was to determine the immediate effects of recreational music therapy interventions on psychiatric inpatients’ mood utilizing an inclusive research design. Participants (N = 41) were acute psychiatric inpatients. Using the Quick Mood Scale (Woodruffe-Peacock, Turnbull, Johnson, & Elahi, 1998), the researchers compared pre- and posttest measures in participants' moods after 10 different types of recreational music therapy interventions. Each of the 10 interventions was tested three times. Results indicated positive and significant changes in four of the six mood factors after a single recreational music therapy session: (1) wide awake/drowsy, (2) relaxed/anxious, (3) cheerful/depressed, and (4) friendly/aggressive. There were no significant between-intervention differences concerning mood. From the results of this study, it seems that recreational music therapy interventions can have an immediate positive impact on acute psychiatric inpatients’ moods. Limitations and implications for clinical practice are provided. Additional research is warranted to better test and identify successful protocols that aid psychiatric patients in generalizing skills learned in treatment to the community.
Music the Lived Experience of the Adolescent Listening to Preferred Music
Michael J. Mahoney (Drexel University)
This phenomenological study is an initial inquiry of the experiences had by normal adolescents listening to their favorite music. During interviews that included sections for music listening, the researcher asked four teens open-ended questions aimed at uncovering the thoughts, feelings, body responses and other responses experienced while listening.
Results vary so dramatically among the four participants that no generalized account is possible. There are some common threads, though these should not be considered trends across the entire adolescent population, due to the nature of the study. These trends include:
o Fond memories of family and friends
o Consideration of values
o Thoughts and feelings about hearing the music before
o Improvement in mood
o Projecting one’s own feelings onto the music
o Drawing connections between favorite music and other media
In accordance with Moustakas’ Phenomenological Research Methods, there are three distinct sections of results for each co-researcher, completed at specific points in the data analysis process. The Textural Description organizes the data based upon each participant’s perception of his or her own listening experience. The Imaginative Variation is a fictional account of the experience, as imagined by the researcher, based upon important themes that emerge from the data. The purpose of the Imaginative Variation is for the researcher to assemble the data from a fresh new perspective before arriving at an ultimate description of the experience, known as the Structural Description.
Participant 101, a 13 year-old Caucasian male, often remembers the first time he heard a favorite song as he listens in the present. He relates to different musical elements separately, such as the "standout instrument," the tempo and the subject matter of the lyrics. He brings the distinct elements together during his listening experience in an intentional way such that they improve his mood. Interestingly, he feels that the music does this on its own, using language that reflects his perception that the music itself becoming happier. In the Imaginative Variation for 101, the researcher casts him as a scientist, combining various substances (which represent musical elements) to achieve his own desired result.
Participant 102, a 17 year-old Caucasian male, values his music for its connections with his past, present and future. Fond memories, current concerns and future plans all cross his mind during a listening process during which he skips from song fragment to song fragment in his digital music library, sometimes tuning into a song for as little as 10 seconds before moving on to something different. In the Imaginative Variation for 102, the researcher casts him as a young entrepreneur cruising around his home city one last time before relocating to pursue an exciting new business venture elsewhere. This theme is connected to 102’s imagination about college being sparked by his favorite songs.
Participant 103, a 16 year-old African-American male, uses music as part of his crucial morning ritual, providing him with motivation and energy for the day ahead. He interacts deeply with the music as it is happening, feeling sometimes that the music is physically moving him. Loud bass frequencies can give him the impression that his entire world is shaking. He uses music to mark off his identity and values, and applies a creative component as well, imagining extra musical and visual elements being added to the music as he listens. In the Imaginative Variation for 103, the researcher casts him as a thrill-seeking storm chaser who photographs tornados and uses the images to create his own original art, a reflection of the creative component of his listening experience.
Participant 104, a 17 year-old Caucasian female, demonstrates two distinct listening experiences. One experience helps her express an identity as an emotional, adventurous and creative person interested in exploring the world the way her mother did after high school. In contrast, the other listening experience lets her reign in her more expressive traits to help her feel more relaxed. For 104’s Imaginative Variation, the researcher casts her as a girl who rides a boat quietly down a stream each weekend for years before experiencing the rush of speed and purposefulness afforded by attaching a sail. She learns also that her mother traveled the same route when she was young.
Recommendations are made for future research. The data from this study could be used to develop a method to define types of music listeners. Certain factors that increase the likelihood of a teen’s requiring music therapy for mental health reasons (factors such as a history of trauma, personality type and socio-economic background) may influence that teen’s listening experience in a predictable way. With this background, the clinician could create listening experiences more likely to produce the desired result. By being more aware of the client’s listening experience, the music therapist can make more intentional choices and provide better treatment.
Parents’, Teachers’, and Administrators' Perceptions of Music Therapy in Schools
Michelle Marpole (Florida State University)
The purpose of this research was to examine teachers,’ administrators,’ and parents’ perceptions of music therapy in schools and its effectiveness with various disabilities and age groups. Perceptions of music therapy were examined in relation to participants’: (a) previous knowledge of music therapy and (b) belief that music therapy will be beneficial to students with disabilities and address their Individualized Education Plan (IEP) goals. Parents, teachers, administrators, and paraprofessionals from an elementary and a middle school in the Southeastern United States served as participants. Participants completed a 14-item questionnaire that addressed the three research questions and included items related to participants’ demographic information, previous knowledge of music therapy, perceptions of music therapy effectiveness, and disabilities and age groups with which music therapy is perceived to be effective. Results indicated that 65% of participants had heard of music therapy, and 60% had seen a music therapy group with children. The behavioral approach to music therapy was most familiar to participants but some participants had also heard of neurologic music therapy, psychodynamic music therapy, and Orff-Schulwerk. Eighty-seven percent of the participants agreed that music therapy was beneficial for students with disabilities, and participants felt music therapy was most effective in addressing the emotional and social goals of students with disabilities. Participants’ rank order for disability groups that would benefit from music therapy was: (1) speech/language impairment, (2) specific learning disability, (3) emotional disturbance, and (4) autism. Participants’ rank order for age groups that would benefit from music therapy was: (1) 0-5 years old, (2) 6-10 years old, (3) 11-15 years old, and (4) 16-18 years old. These findings indicate that parents, teachers, and administrators perceive music therapy to be effective with school-age students who have various disabilities, particularly younger children. Additionally, results from this study corroborate previous research regarding the perceived effectiveness of music therapy with other populations. Implications for practice and suggestions for future research are also discussed.
Music Therapy and Bonding: A Need for Connection in Hospice Families
Erin McAlpin (University of Missouri- Kansas City)
Music therapists that work in hospice settings facilitate meaningful interactions between patients and their family members. Program goals are often to facilitate life review, aid in pain control, and strengthen spiritual or religious beliefs. Clinical-based music applications are often implemented to reduce patients’ isolation, frustration, and stress. Music interventions are also used in hospice settings to increase patients’ quality of life and the frequency of meaningful interactions and bonding experiences with individuals in their environment. When creating opportunities for interactions the music therapist may take on the role of communicator between the patient and their family members. Within moments that are difficult, music becomes a bridge for connection and communication. The purpose of this study was to explore the practice wisdom employed by hospice music therapists and discover interventions designed to increase frequency of meaningful interactions and bonding between patients are their family members. This study examined the following questions: a) How do music therapists create opportunities for meaningful interactions and bonding between patient and their family members? b) What interventions do music therapists employ to create opportunities for meaningful interactions and bonding between patient and family members? c) During what time in a session and/or treatment do music therapists create opportunities for meaningful interactions and bonding between patient and family members? Ten music therapists located in a large Midwestern state were recruited to participate in the current study. Participants were identified through a local music therapy social networking group and snowball sampling. Participants were required to have current or past experience working in the hospice setting as a music therapist. An in-depth interview was conducted by the researcher with participants either in-person or over-the-phone. The in-depth interview contained 13 open-ended questions and probes that pertained to the music therapists’ observations, clinical wisdom, professional insight, and musical elements. Interview questions included the following: (a) Please describe your experience with hospice music therapy and families. (b) How would you define meaningful interactions and bonding? (c) How does meaningful interactions and bonding fit into your treatment plans? (d) How do you adjust your session to organic moments of meaningful interaction and bonding? (e) How do you facilitate or structure meaningful interactions and bonding? (f) Why do you facilitate or structure meaningful interactions and bonding? (g) What strategies have you developed to encourage family bonding? (h)What interventions have you developed to encourage family bonding? (i) What obstacles have you overcome when facilitating family bonding? (j)What musical elements are used to encourage family bonding? (k) How do you set up the environment for meaningful interactions and bonding? (l) What are the outcomes/results of meaningful interactions and bonding? (m) What are your recommendations for developing a program aimed at meaningful interactions and bonding? Interviews were audio and video-taped for later data analysis. Interviews were transcribed and analyzed using Linguistic Inquiry and Word Count (LIWC). LIWC is a text analysis software program used to calculate writing or daily speech and is designed to analyze over 70 dimensions of language. Categories include general descriptors, linguistic dimensions, psychological constructs, personal concern, paralinguistic dimensions, and punctuation. Transcribed interviews are analyzed by psychological constructs including social processes (family, friends), affective processes (positive emotion, negative emotion, anxiety, anger, sadness), cognitive processes (insight, discrepancy), perceptual processes (see, hear, feel), and biological processes (body, health). Content was placed into themes and analyzed data from LIWC is described via frequencies and percentages. Results of the analysis will be discussed within the framework for clinical practice in hospice. Suggestions will be discussed on how to transfer findings to other settings that foster familial interactions and bonding such as music therapy with adoptive families.
Bio-Guided Music Therapy
Eric B. Miller (Montclair University)
This presentation presents concepts from Dr. Miller’s (June 2011) book, Bio-guided Music Therapy (Jessica Kingsley Publishers, London) Dr. Miller provides the music therapy practitioner with a rationale, historical context and detailed step-by-step, how-to instructions for utilizing real-time physiological data driven music therapy. Interventions are outlined for various purposes and populations. Some of the target complaints discussed include, stress, anxiety, high blood pressure, Raynaud’s disease, neuromuscular deficiencies, ADHD, Autism, depression, phobias, and addictions. In the workshop format, this session delivers hands-on experience in creating musical environments based on real-time physiological output of muscle tension, heart-rate, skin conductance and EEG brainwaves. Dr. Miller views biofeedback as the ultimate bridge between Eastern and Western healing philosophies.
Update Singing Ranges and Song Preferences for Senior Song Fest
Randall Moore (University of Oregon)
Purpose of this study was to update previous research (1992) by describing song preferences and singing ranges of senior singers in order to make current a publication of Senior Songfest. Thirty retired citizens (mean age = 85.7) rated their preferences for 102 selected song titles on a paper-pencil survey. Responses on the survey indicated positive attitudes about most song titles using a Likert scale of 1-5 where 1 is really like and 5 is really dislike; mean rating for 102 song titles was somewhat positive at 2.17. Over 95% of subjects recognized the selected songs. Top 10 rated songs were 5 patriotic, 3 popular, and 2 hymn titles. To check singing ranges, 32 women (mean age = 76) completed a singing test that measured comfortable singing ranges. Data from this test showed a singing range of 21 semitones whose mean limits were C5 down to Eb3 where middle C = C4. These findings are similar to previous research and suggest when singing with seniors that therapists use song ranges below C5.
The Applications and Implications of Religious Music in Music Therapy
Marisol Norris (Drexel University)
The purpose of this study was to gain knowledge and deeper understanding of the use of religious music in the field of music therapy. A large body of literature identifies the presence and benefits of music and spirituality within healthcare settings. Nevertheless, a lack of systematic inquiry regarding religious music in music therapy was found. To better understand religious music use within the scope of practice, professional members of the American Music Therapy Association (AMTA) were surveyed. Of the 2425 AMTA professional members invited to participate in this study, 271 responded to the online survey.
Over the span of two weeks, respondents provided useful data leading to an increased comprehension of the therapeutic environment as it pertains to religious music. Research findings identified the frequency of religious music use; populations most and least influenced by its use; and the numerous affect/emotional, physical, musical, and verbal responses. A majority of therapists reported using religious music either sometimes (40.2%) or often (35.8%). Furthermore, over 60% of therapists reported a difference in patient responses between the use of religious music and non-religious music.
Although therapists noted patients’ responses to be influenced by his/her musical preference, overall patients’ affect/emotional responses were "positive." Positive results were reported by therapists to include muscular relaxation, pain reduction, communication, and increased eye contact and orientation. Research findings also identified patients’ expressed feelings of hope, increased introspection, connection to others, and connection to a higher power. Furthermore, descriptive data reported patient activity to include prayer and religious gestures within therapy sessions. Although research was not extensive enough to conclude the variances in degree of impact between religious and non-religious music, research noted the general use of religious music was positive within the therapeutic environment.
The Comparison of Three Selected Music/Reading Activities on Second Grade Students’ Story Comprehension, On-Task/Off-Task Behaviors and Preferences for the Three Selected Activities
Amanda Azan Oliver (Florida State University)
Research suggests that music is beneficial in teaching both academic and social skills to young children. The purpose of this study was to compare three selected music/reading activities on second-grade students' story comprehension scores, on-task/off-task behaviors, and preferences for the three selected activities. The control condition was reading story with no music (SNM). The two experimental music conditions were: (1) reading story with choral refrain throughout (SCR) and (2) reading story with instrumental accompaniment throughout (SIA). Participants in the study were children (N=38) ages 7-8 years old, enrolled in one of three second-grade classes at a public elementary school in Northern Florida. The order of conditions was counterbalanced among the classes to control for order effects. Each class received one reading activity per week for a total of three consecutive weeks. Following each reading activity, participants were given a 10-question story comprehension test and a preference assessment. Classes were also videotaped for later analyses of on-task and off-task behaviors during each reading activity. Results indicated a significant difference in story comprehension scores among the conditions for Classes B and C. Results indicated no significant difference in story comprehension scores among the conditions for Class A. Further analyses revealed that students in two of the three classes made significantly higher comprehension scores when story reading was paired with the music conditions than the no music condition. Analysis of participants’ on-task behaviors revealed the highest percentage of on-task behaviors was during music condition two (story with instrumental accompaniment), followed by music condition one (story with choral refrain). The lowest percentage of on-task behaviors was during the control condition (story with no music). Results also revealed that participants had no significant preferences for the three conditions. These findings suggest that pairing stories with music can be an effective tool in promoting second-grade students’ on-task behaviors, and enhancing their story comprehension scores and their preferences for reading activities.
Capturing the Complex Nature of Client Responses: A Meta-Analysis of Qualitative Research in Music Therapy
Varvara Pasiali (Queens University of Charlotte)
Background: Qualitative researchers focus on in depth descriptions of clinical processes attempting to capture the complex nature of client responses to music therapy interventions. There are no attempts in the literature to synthesize existing information in order to identify commonalities.
Objective: The goal of this study was to synthesize information from published qualitative studies in which music therapy sessions were a direct source of data. The synthesis highlighted both observed outcomes, data analysis techniques, main outcomes of each study, and applicability of findings for clinicians.
Methods: I identified sources by conducting electronic databases research, reviewing bibliographical lists included in Aigen (2008a; 2008b), reviewing the indexes of major music therapy journals, and the published volumes of Qualitative Inquiries in Music Therapy. After removing duplicates and screening studies for meeting eligibility criteria, I identified a total of 28 studies to review for the meta-analysis.
Results: I divided these studies in five categories based upon the clientele that served as research participants. In the studies with adults who have psychosocial needs or mental health disorders (n=10), finding significance and understanding how adults construct and interpret clinical improvisations was the common theme of five studies, a topic that clinicians who use improvisational techniques may find useful. In the remainder four studies the researchers used an inductive process of developing clinical hypotheses as well as treatment theories directly from clinical experience which clinicians working with similar clientele may find useful. One study identified the client’s derived meaning and significance resulting from attending music therapy sessions. From the studies with children who have developmental, genetic, and/or neurologic disorders (n=6), two studies used a hermeneutic design focusing on therapist’s responses to clients. Three studies synthesized data from multiple case studies and may provide clinicians insight on how they can support, observe, and evaluate communicative responses during the sessions. Lastly one study focused on the therapist’s responses when a client experiences seizures. A total of three studies examined responses of children who have psychosocial needs or mental health disorders to music therapy (n=3). Two focused on identifying the meaning of clinical improvisations and one described group dynamics and expression of feelings. Only two studies examined family based therapy (n=2) focusing both on relationship issues and parent-child interactions. Seven studies described music therapy with individuals who had medical conditions (n=7). Findings of these studies included detailed description of a session with a dying patient, client feelings evoked during music therapy sessions, and supporting parent-child relationships within a medical setting. Two studies described ways music therapy provided emotional support for adults who had neurologic disorders and one study identified specific music therapy techniques a therapist used when working with children who had neurologic disorders.
Conclusions: An overarching theme of all 28 studies was describing therapeutic processes within the context of relationships. The majority of the studies reviewed used improvisational music therapy approaches. Further diversification of qualitative research is needed both in the type of therapeutic approach and the research questions asked.
Psychiatric Inpatients’ Perspectives of Music Therapy and Other Psychosocial Treatments: An Interview-Based Study
Sarah E. Pitts & Michael J. Silverman (University of Minnesota)
Previous researchers have found that psychiatric patients rated music therapy as more enjoyable and therapeutic than other activity therapies. However, there are no currently studies during which researchers asked patients their specific perspectives concerning therapeutic programming and interventions they feel are beneficial using an interview-based approach. Therefore, the purpose of this study was to investigate patients’ perspectives on music therapy group sessions as well as other treatment groups while hospitalized in an intermediate-care inpatient psychiatric facility. Seven participants on an intermediate-care psychiatric unit were interviewed about their perspectives concerning music therapy and other psychosocial treatment groups offered on the unit. Results indicated that music therapy was chosen as most helpful in seven of nine goal areas. Participants’ specific comments were thematically analyzed. Five themes were identified as the most recurrent among all responses: identity, self-expression, healing, group cohesion, and the role of the therapist. Results are consistent with previous quantitative research on patients’ perspectives on their treatment. Limitations of the study, implications for clinical practice, and suggestions for future research are included.
Performance Anxiety: Effects of Performing with the Music versus Performing Music from Memory
Grant Powell & Barbara Wheeler (University of Louisville)
This study examined whether having the music visible to college music students when performing is the best solution in alleviating the performance stress of having to prepare and perform music from memory. This was examined as an attempt to help contribute in finding a coping strategy for college music students in dealing with the effects of performance anxiety. This was carried out by examining a sample of seven undergraduate music students of various ages and musical backgrounds, in which their anxiety levels were tested after they performed for the researcher by having them rate their anxiety levels through the use of a Likert scale on a scale of 1 to 5. Each student was randomly assigned to either perform with the music in front of him/her or from memory. It was determined through an independent sample t-test that having students perform with the music in front of them did not significantly reduce their anxiety levels in comparison to the students who performed music from memory. Based on these findings and the findings of the research literature, more research is needed to find a proven coping strategy to help music students and musicians deal with performance anxiety.
Assessment of Short Term Memory for Rhythmic Reproduction in Residents on a Dementia Unit
Lee Anna Rasar, Iansa Zaldarriaga, Kathryn Henderson & Rachel Philipps (University of Wisconsin – Eau Claire)
The goals of this research project are to identify the ability of residents with dementia to perform specific rhythm patterns which are modeled during specific song presentations; to identify types of cues which are effective in elicitation of performance of specific rhythm patterns associated with specific songs by nursing home residents with dementia; and to identify the ability of residents with dementia to demonstrate rhythmic patterns spontaneously when hearing songs for which they had previously learned rhythm patterns but without the rhythm patterns being presented as a model for them.
This project will examine the short term memory skills for rhythmic reproduction in residents on a dementia unit during the summer 2011 semester. Previous work with residents on this dementia unit revealed their ability to replicate rhythm patterns modeled for them by initially learning those patterns and then by performing them over a four-week period, spontaneously demonstrating them over time when hearing the associated songs. Their performances demonstrated their ability for success in the arena of short term memory tasks and their retention skills for newly learned material. The current research on short term memory for people with dementia has focused on spontaneous rhythmic responses and on the effects of musical stimulation on aspects of cognition, language, and social interaction but not specifically on rhythmic memory. This project will further examine rhythmic tasks with respect to short term memory for people with Alzheimer’s Disease and related dementias and will include an opportunity to educate caregivers and significant others of people with dementia on how to engage them in meaningful interaction using music and rhythm and to encourage them to present new material to the people on the dementia unit.
Live music will be presented on piano for residents on the dementia unit to enable the musical volume and tempo as well as the musical flow and focus on the rhythmic patterns to be manipulated spontaneously to reflect the residents’ responses while a music therapy student will lead the residents in rhythm patterns during the song performances. Two other students will independently record rhythm patterns which are performed by residents during each song. Rhythmic song sessions would be held three times weekly for four weeks during July and August 2011, with each session including twenty minutes of active rhythmic performances by the residents. The length of each session will vary based on the amount of time needed to initially establish engagement with the rhythmic replication of patterns modeled by the student. Once the group members as a whole have entrained with the modeled rhythmic accompaniment, the twenty minute segment will be implemented. It is anticipated that the Battle Hymn of the Republic may serve as a good song to use to establish the entrainment prior to the data taking phase of each session as the residents have demonstrated the ability to play rhythm patterns during this song and really enjoy doing so. Residents will be provided with tambourines which they use for other music therapy activities and which they enjoy playing. Rhythm patterns which are performed on tambourines, patted on body, tapped out with feet, or hummed/sung will be recorded and noted, although the intention is for the residents to perform the rhythm patterns on the tambourines.
Songs presented will include songs that are known and appreciated by the particular group members on the unit at the time of the project. Prior to the data taking phase of the project, the lead student researcher will assist the faculty member who will present songs on piano in working with residents on the dementia unit to choose songs that are familiar to them and appreciated by them. They will also develop a listing of associated rhythm patterns to teach for each song and data sheets will be prepared for the two students who will independently record the data. All members involved in the research grant will be oriented prior to the data taking phase of the project. Plans for using cues to elicit the performance of rhythm patterns will be documented and may be adapted as the project advances.
Assessment of Types of Learning Engagement Which Contribute to Integrative Learning
Lee Anna Rasar, Amber Tappe & Iansa Zaldarriaga (University of Wisconsin – Eau Claire)
This project will examine student reports of their own engagement in integrative learning in music therapy across the Fall 2010 semester using a definition of integrative learning in music therapy which was developed through a previous literature-based research project. Integrative learning in music therapy involves the application of information from one context into a different context which occurs when a person is able to see connections of value between the pieces of information. The thinking process which enables one to see the connections results from encoding information with multiple perspectives with anticipation that the information may be used in the future for a variety of applications. Integrated learning also includes the process of discernment following analysis and synthesis to determine what is therapeutic and what could or did pose danger. Integrated learning is based on an awareness of the depth and breadth of perspective held by each person involved in the learning process (self, peers, staff, supervisors, clients).
For this project students provided descriptions of how they made connections and specified which types of connections were useful in the processes of metacognition, dialectical reflection, and self-awareness in weekly written reflections and discussion. Metacognition included clinical applications related to knowing what one knows and does not know, predicting outcomes, planning ahead, efficiently apportioning time and cognitive resources, and monitoring effects to solve a problem or learn. Dialectical reflection included putting multiple perspectives into play with each other to produce insight, looking forward to goals to attain, casting backward to examine what has been experienced and learned, combining the processes of projecting and reviewing, and placing projects and reviews into dialogue to discover what one knows, has learned and might understand. Self-awareness included awareness of own learning styles related to needs for different types of academic tasks, strategies and methods for acquiring, integrating, thinking about and using new knowledge, how prior content knowledge can be applied in clinical work, and present and future contexts in which new information could be useful.
Students also described how engagement in specific processes was beneficial, including but not limited to intentionality about the process of acquiring learning; empowerment by mastery of intellectual and practical (music, clinical) skills; application of knowledge through real-world engagement; and formulation of questions to explore to improve both depth and breadth of awareness/knowledge.
Comments from verbal sharing were recorded and typed up. Results will be analyzed using coding scheme and unitizing methodology along with frequency tracking for the larger sets of responses noted: interdisciplinary and cross-theory connections, frequency of use of different methods for acquiring learning, and intentionality in designing and following through with learning processes. Applications for non-academic contexts, dialectical reflection, metacognition, and self-awareness were reported by multiple students. Student responses explained how they demonstrated intentionality when problem solving, when directing their own therapeutic work, and when making connections across theory, practice, disciplines, and in specific contexts. Descriptions of methods used to acquire learning and evaluation of the implications of choices on their professional life and society as a whole were also noted. Although students were not specifically asked about courses which integrated into other learning areas for them, every student identified courses which were useful.
Elements of integrative learning which were examined included the need for students to obtain mastery of skills and to secure content in their knowledge base in the following layers identified as important in integrative learning as well development of the ability to integrate these pieces within their clinical work. These common elements are required for students to make good clinical decisions on the spot and to continue with their musical presentations within the execution of music therapy sessions. Layers internal to music include the properties of music and the musical elements as well as the performer’s musical ability and performance. In integrative learning, choices of music are intentional with respect to the impact of these aspects of the music on desired outcomes. Layers of integration required for musical presentation include: memory for lyrics, melody, harmonic structure and rhythm; ability to perform with musical flow; ability to play with passion and emotional communication/motivation; ability to sing while simultaneously performing musically; ability to LEAD while singing and simultaneously performing; ability to pay attention to responses of clients while simultaneously presenting performance; ability to respond to clients while simultaneously performing; and ability to make therapeutic decisions while observing and responding to clients while simultaneously presenting musical performance. Layers of integration required for therapeutic intervention include: ability to identify major goals in therapy; ability to structure music activities to target therapeutic goals; and skill in evaluation of therapeutic choices with respect to effectiveness in elicitation of therapeutic responses. Layers of integration required to design, present, and evaluate therapeutic activities include awareness of background, relationships, beliefs, and values.
East meets West: Comparing On- and Off-Task Responses of Thai Music Therapy Participants by Musical Selection – A Post Hoc Analysis
Dena Register (University of Kansas), Lindsey Williams & Xavier Fleming (University of Missouri-Kansas City)
Clients were participants in one of two outpatient neurological rehabilitation programs. Patient diagnosis included individuals who had experienced a stroke, traumatic brain injury or were diagnosed withdementia. A representative sample of 8 sessions (n=4 Adult sessions at Rehabilitation Center A; n=4 Adult sessions at Medical Center B) wasselected for task analysis of music therapy application by type of music (Traditional Thai music, Thai language, Western-style music and English music), as well as by instructional language (English, Thai, or Nonverbal) using SCRIBE – video observation software. Data were also analyzed initially for patient on-task/off-task behaviors during music therapy sessions. Because an overwhelming level of on-task behavior was indicated during initial observation, researchers took a descriptive approach to the types of music therapy applications utilized in addition to length and number of applications. Session plan descriptions and observational data indicate overall positive,engaged responses from clients, caregivers and staff during this implementation process. There are many culturally specific observations including: 1:1 client to caregiver ratio; caregivers engaged during all sessions (1:1 client to caregiver ratio); and client's affective response regardless of language or music type used. Graphic analysis of the amount of time per application andnumber of applications reflect the inexperience of the Thai students as they began to take over planning and implementation of the sessions. Future analysis will explore and compare these indicators as Thai students gain additional experience.
The Perceptions and Attitudes of Michigan General Music Educators Regarding Undergraduate Preparation, Training Experiences, and Additional Support Services Available for Working With Special Learners in the Music Classroom: A Pilot Study
Laurel Rosen-Weatherford & Brian Wilson (Western Michigan University)
The purpose of the present study was to examine Michigan general music teachers’ perceptions and attitudes about (a) their academic preparation for working with special learners and (b) the inclusion of special needs students in their classrooms. One hundred and five general music educators belonging to the Michigan Music Educators Association were invited to participate in this study. Ten educators responded and completed the online 27 item questionnaire. The results of this study are presented with discussion related to previous and future research as well as implications for both music educators and music therapists working in school settings.
Parents’ and Nurses’ Perceptions of Music Therapy on a Pediatric Unit
Ericha A. Rupp & Michael J. Silverman (University of Minnesota)
The purpose of this study was two part: (1) to determine how parents/caregivers of children on a pediatric intensive care unit perceive music therapy after observing a single music therapy session and (2) to determine how nurses on a pediatric intensive care unit perceive music therapy after eight months. Participants included parents or primary caregivers (N = 80) present in the room immediately following a 15-min music therapy session and nursing staff (N = 7) who have been working on the pediatric unit and observed or participated in a music therapy session during the past eight months. After music therapy treatment, the parent/primary caregiver participants completed a brief researcher-created posttest. Nurses completed a brief researcher-created posttest after music therapy had been on the unit for eight months. Quantitative results indicated that both parent/caregiver and nurse participants had high perceptions of how therapeutic, enjoyable, beneficial, and helpful music therapy was for the children/patients. Additionally, 93.8% of parent/caregiver participants indicated they would like a Board Certified music therapist in the future for their child and 77.5 % indicated they would pay for music therapy services. Regardless of participant type, written comments were positive and supported the use of music therapy on a pediatric unit. Limitations of the study and suggestions for future research are included.
Effects of Pitch, Rhythm, and Harmony on Short- and Long-Term Visual Recall in Children with Autism Spectrum Disorders
Edward T. Schwartzberg & Michael J. Silverman (University of Minnesota)
Background: Researchers have suggested that children with Autism Spectrum Disorders (ASD) are often visual learners. As such, educators and clinicians have programmed accordingly, using a variety of visual aids to augment teaching and learning.
Purpose: The purpose of the study was to examine paired associate effects of speech, rhythm, pitch, and harmony on short- and long-term recall of visual information in children with ASD.
Methods: The principle investigator (PI) collected phase one data (n = 42 children with ASD) during three separate one-week summer camps and phase two data (n = 14 neuro-typical children) during an academic year at a local religious institution. Participants received each of the seven-item visual stimuli paired with a music condition (speech, rhythm, pitch, or harmony) on consecutive days of camp (for individuals with ASD) or weekly at a religious institution (for neuro-typical individuals). Each order was paired with one of the music conditions. The PI tested participants in both short- and long-term conditions.
Results: Results for phase one were statistically significant for term, with more accurate recall during the short-term phase. Although not significant, short- and long-term recall were best during the harmony condition and lowest in the speech condition. Across all conditions, participants had better recall during sequential positions of primacy and recency. Neuro-typical participants had higher mean recall across all four music conditions and two terms than participants with ASD.
Feasibility of Orff-Based Music Therapy on the Identification and Development of Positive Coping Strategies in Children with Psychiatric Issues: Case Studies
Elizabeth Shain (University of Kansas)
The purpose of this study was to evaluate the feasibility of Orff-based music therapy interventions to promote the identification and development of positive coping strategies in hospitalized children with psychiatric issues. Single-session case studies were implemented for this study with each session being conducted on an individual basis. The protocol used in this study was developed by this researcher over the course of several months of clinical sessions in the acute child psychiatric unit of a large Midwestern university hospital. Each session in this study was thirty minutes in length and included Active Music Engagement (AME) using classroom percussion instruments followed by Orff-based lyric analysis and a closing song. All music used in this study was composed by this researcher. Two different Orff orchestrations were used depending on the age of the participant. Children ages 10-12 participated in an Orff chant using body percussion and a speech ostinato. Children ages 5-9 participated in a C pentatonic Orff orchestration using a metallophone and a song about the "sad robot." Children were divided by age to allow for age-appropriate musical and lyrical content. A total of three participants were included in the study, ranging in age from 9-12. Participants included one female and two males. Two of the three participants had experienced music therapy prior to this study and the same two participants had at least one previous hospitalization for aggressive outbursts. All three participants carried a secondary diagnosis of ADHD and the two male participants carried a primary diagnosis of Bipolar Mood Disorder NOS. The female participant carried a primary diagnosis of Mood Disorder NOS. Outcomes expected from each session included verbal identification and specific statements of positive coping strategies for use outside the session and the unit and a reduction in externalizing behaviors. All three participants were able to identify at least one positive coping strategy and no externalizing behaviors were observed in any of the sessions. Although no formal conclusions can be drawn from these case studies, a few trends were observed. First, all participants exhibited a greater number of on-task behaviors during moments of live music making when compared to discussion portions of the session and passive listening portions of the session. Second, all participants were able to successfully perform the Orff orchestrations within a reasonable number of trials (three or fewer). Finally, all participants were able to successfully identify at least one positive coping strategy for use in moments of stress and anxiety. Along with these trends, this study highlighted the potential for the use of Orff-based music therapy in a mental health setting with children. This study also highlighted the versatility and usefulness of Robb's contextual support model for music therapy by utilizing this framework in Orff-based music therapy. This study grew out of several months of practical clinical experience in the child psychiatric unit and the protocols used were designed for use with a variety of psychiatric illnesses. Studies for protocol development as well as studies for specific childhood diagnoses would be useful in generalizing the effectiveness of Orff-based music therapy for use in any mental health setting with children. As this was a feasibility study, this researcher recommends that future researchers attempt to quantify the effectiveness of Orff-based music therapy and generalize the effects to any mental health setting with children. It is also recommended that future researchers attempt to quantify the effects of an Orff-based music therapy protocol for use with a variety of childhood psychiatric illnesses.
A different way to Measure Perceptions of Expressivity in Music
Jay Silveira (Oregon State University) & Clifford K. Madsen (Florida State University)
Researchers have long advocated the need for studies that address how subjects listen to music and evidence responses across time (Aiello, 1994). In the late 80s a device was developed to facilitate this measurement. Presently there is a large body of research in which subjects manipulate a Continuous Response Digital Interface (CRDI) designed to test ongoing responses over extended time periods. The CRDI is capable of sampling from one to thousands of times per second, and various dial overlays allow separate experiments across various topics of interest. Digital data produce many graphic displays for subsequent analysis and interpretation.
Early research was concerned with what musicians as well as nonmusicians considered the emotional content of music and their own "aesthetic response" (Capperella, 1989; Gregory, 1989; Madsen, 1990; Madsen, Brittin, & Capperella-Sheldon, 1993; Madsen, Byrnes, Capperella-Sheldon & Brittin, 1993; Robinson, 1988). Later investigations used a two-dimensional CRDI to study ongoing responses (Madsen, 1998). The very latest device allows a listener to actually interpret music by controlling any aspect the listener desires to manipulate. For example, in one such study the speed of a soloist’s rubato was manipulated to coincide simultaneously with an orchestral recording (Johnson & Madsen, in press). Other comparisons dealt with subjects’ responses to short music excerpts using only a traditional Likert scale in relationship to later investigations specifically designed to test short listening excerpts compared to CRDI measurements (Geringer & Madsen, 1995/1996). While these studies demonstrate a very high degree of reliability, they also indicate that use of the CRDI does not give much additional information compared to an ordinary paper and pencil test for short music excerpts, i.e., 10-seconds to 120-seconds. (Madsen & Geringer, 1999, p. 90). Other questions remained regarding the CRDI measuring device, especially where large amounts of data are compared using arithmetic means (Duke, 2001). These studies indicate that overall continuous measurements are indeed, different from collective mean responses. More important to the measurement issue is the effect that physically manipulating the CRDI dial might have on enhancing aesthetic response because of heightened attention necessitated as an artifact of the task (Madsen & Coggiola, 2001). The purpose of the present study was to attempt to measure expressivity in an ongoing nonverbal manner, which would provide a graphic description on expressivity across time.
Effects of Caregiver-Based Educational Music Therapy on Depression and Satisfaction with Life in Acute Care Psychiatric Patients and their Caregivers
Michael J. Silverman (University of Minnesota)
Background: Although family-based psychoeducation is considered an evidence-based treatment for psychiatric consumers, no music therapy studies have been published utilizing this treatment technique.
Objective: The purpose of this study was to determine the effects of caregiver-based educational music therapy on acute care psychiatric patients and caregivers using psychometric instruments during a randomized controlled clinical trial with three-month follow-up.
Methods: Participants (n = 11 patients and n = 21 caregivers) were randomly assigned to one of three treatment groups: educational music therapy, education, or non-educational music therapy.
Results: While the sample size is small and generalizations of quantitative results are premature, patient participants in the educational music therapy condition tended to have lower mean stress scores and higher satisifaction with life scores. Caregiver participants in the educational music therapy condition tended to have lower mean stress scores and higher satisfaction with life and perceptions of helpfulness. Emerging themes from qualitative analysis of therapist treatment notes included: 1) complexity of treatment; 2) action-oriented future dialogue; 3) structure; 4) treatment eagerness; 5) problem-solving techniques; 6) flexibility, and 7) enjoyment and appreciation.
Conclusions: Family-based educational music therapy may be an engaging and effective method to augment treatment for psychiatric consumers and their caregivers. Limitations of the study, implications for clinical practice, and suggestions for future research are provided.
Effects of Recreational Music Therapy on Mood and Perceived Helpfulness in Acute Psychiatric Inpatients
Michael J. Silverman & Sara Rosenow (University of Minnesota)
The purpose of this study was to determine the immediate effects of recreational music therapy interventions on psychiatric inpatients’ mood utilizing an inclusive research design. Participants (N = 41) were acute psychiatric inpatients. Using the Quick Mood Scale (Woodruffe-Peacock, Turnbull, Johnson, & Elahi, 1998), the researchers compared pre- and posttest measures in participants' moods after 10 different types of recreational music therapy interventions. Each of the 10 interventions was tested three times. Results indicated positive and significant changes in four of the six mood factors after a single recreational music therapy session: (1) wide awake/drowsy, (2) relaxed/anxious, (3) cheerful/depressed, and (4) friendly/aggressive. There were no significant between-intervention differences concerning mood. From the results of this study, it seems that recreational music therapy interventions can have an immediate positive impact on acute psychiatric inpatients’ moods. Limitations and implications for clinical practice are provided. Additional research is warranted to better test and identify successful protocols that aid psychiatric patients in generalizing skills learned in treatment to the community.
Music Therapy Salaries from 1998 - 2010: A Descriptive and Comparative Study
Michael J. Silverman (University of Minnesota), Amelia G. Furman (Minneapolis Public School), Jennifer Leonard (University of Minnesota), Elizabeth Stephanz (University of Minnesota) & Rachel McKee (University of Minnesota)
Background: Although the American Music Therapy (AMTA) publishes salary data in its yearly Member Sourcebook, to date, these data have not been descriptively analyzed or compared with other salary data sets.
Purpose: The purposes of this study were to descriptively analyze music therapy salary data from 1998 - 2010 and to compare recent music therapy salary data with those of other related helping professions.
Methods: Music therapy salary data were obtained from the 1998 - 2010 AMTA Sourcebooks. To compare music therapy salary data with other helping professional salary data, United States government websites were used.
Results: From 1998 - 2010, music therapists’ salaries increased by an overall mean of $15,231. Although music therapists had higher mean salaries than recreational therapists, their salaries were lower than middle school teachers, middle school special educators, registered nurses, and occupational therapists. Concerning music therapists’ age categories, the salary levels increased in concordance with the number of years in the profession. Music therapists working in academic settings tended to have the highest salaries while music therapists working with geriatric populations tended to have the lowest salaries.
Conclusions: Overall trends indicated music therapists’ salaries tend to increase over time, regardless of region, population, setting, and age. Due to the way salary data were collected by AMTA and descriptively analyzed in the current study, the authors provide a number of caveats and advise against generalizations. Limitations of the study and suggestions for future inquiry are provided.
20 Years of Music Therapy Research in the NICU: An Updated Meta-Analysis
Jayne M. Standley (Florida State University)
To provide an overview of developmental and medical benefits of music therapy for premature infants
Sample: Empirical studies using music in care of premature infants in the Neonatal Intensive Care Unit
Main Outcome: The analysis of 30 studies revealed that NICU-MT was highly beneficial with an overall large, significant effect size (Cohen’s d=.82). Effects due to music were in a positive direction.
Results: Results of the current analysis were virtually identical to a prior meta-analysis (d=.83) of the first 10 studies in this field (Standley, 2002) and included extended uses of music. Benefits were greatest for live MT and for use with the most severely premature infants (birth weight <1000g, birth gestational age< 28 weeks). Results justify the inclusion of evidence-based NICU-MT protocols in best practice standards for treatment of severely premature infants.
A Clinical Case Study Using Songwriting as a Preventive Music Therapy Intervention for At-Risk Inner City Adolescent Girls
Rebekah Stewart (University of Missouri-Kansas City), CharCarol Fisher (Operation Breakthrough), Deanna Hanson-Abromeit (University of Missouri-Kansas City) & Elizabeth Merz (Operation Breakthrough)
Preventive intervention models in at-risk populations have not been given adequate attention in the field of music therapy research. As a result, there is little-to-no current framework for developing evidence-based interventions in at-risk populations, especially during adolescence. This clinical case study exemplifies an emerging evidence-based framework for interventions with at-risk adolescent females and describes the outcomes of a songwriting intervention. For purposes of this study, "at-risk" has been operationally defined as an imbalance between typical developmental expectations and the increasing adverse effects on later development based on population-specific factors (Armstrong & Boothroyd, 2007; Crosnoe, Wirth, Pianta, Leventhal & Pierce, 2010; McWhirter, et al., 1998; Perry, 2006; Smokowski, Mann, Reynolds & Fraser, 2004).
During adolescence, risk factors that have a strong influence on development are gender, socioeconomic status and domestic living situation. Females are at higher risk for internalizing symptoms, depression, and other mental health issues in adolescence. Depressive symptoms and an inability to manage sadness are linked with drug use and risky sexual behaviors that could potentially lead to pregnancy (Babington, Kelley & Patsdaugher, 2009; Broman, 2007; Kuortti & Kusonen, 2009; Lancot & Smith, 2001; Sabia & Rees, 2008; Smith, Buzi & Weinman, 2010). Emotional competence (awareness, expression, and regulation) plays a key role as either a risk or protective factor in predicting risky adolescent behaviors such as drug or alcohol use, delinquent or risky sexual behaviors, and smoking (Hessler & Katz, 2010).
A preventive music therapy group for adolescent girls at an inner city child development center was developed to minimize further delinquency and other risk behaviors. The group was funded by an urban women’s foundation and consisted of nine participants. Sessions were one hour across 8 weeks divided into two segments; songwriting for 4 weeks and song production for 4 weeks. This paper reports on the outcomes of the four-week songwriting intervention. The primary goal was promote the protective factor of increased emotional competence through contextual application of emotions. A board-certified music therapist and a music therapy graduate student co-led the sessions.
Each client completed a needs assessment of primary risk behaviors. Twenty-five percent of clients had previous sexual experience; all reported birth control use, but only half reported condom use to prevent disease. Of the clients who did not yet report sexual activity, 50% anticipated use of condoms and 33% anticipated using birth control. Only 14% reported trying alcohol and cigarettes, and there was no report of previous drug use. Seventy-five percent of clients reported previous suspension from school and one was currently suspended.
Songwriting has been used as an intervention for emotional expression and identity formation in adolescent girls recovering from anorexia nervosa (McFerran Baker, Patton & Sawyer, 2006), thus the general steps outlined by McFerran, et al., were adapted for this group.
The use of preferred music heightens the brain’s pleasure response, acting as a motivator and catalyst for intervention (Salimpoor, Benevoy, Larcher, Dagher & Zatorre, 2011). Without these considerations, clients will most likely disengage; therefore, cultural context and client-preferred musical style are essential. Participant preferred styles were rap, R&B, and hip-hop, thus they were the styles used in songwriting.
The songwriting intervention lasted over a period of 4 weekly, 1-hour long sessions. Clients were led through the process by the therapists, and although all material for the lyrics was original to the clients, therapist prompting and discussion facilitated the direction that the song took. Discussions were based on what clients would do in a similar situation, or what they thought would be an appropriate response and why. A post-hoc content analysis of the lyrics demonstrated an unhealthy emotional response to the lyrical context during Week 1. The topic related to being treated with disrespect in a relationship, but being unable to leave an unfaithful partner. The second and third weeks of intervention reflected an increasing understanding of self-empowerment and a move towards a congruent emotional response to the situation. Lyrics reflected that the situation must change and taking a stand in self-protection. The final week of intervention exhibited a complete shift in response to the lyrical situation from Week 1. The sadness and despair indicated at the beginning of the song was shifted towards taking control of the situation and being independent of the relationship. The self-empowerment and independence found at the end of the song is evidence of the effectiveness of songwriting within a therapeutic relationship towards the emotional processing of the clients.
It is recommended that future studies document the therapist effect through the songwriting process as an essential aspect of reliable data collection and interpretation. Further research to evaluate the effects of songwriting and other music therapy interventions in this population is needed. A post-test of risky behaviors would be recommended as well to evaluate the indirect effect of music therapy on risky behaviors and likelihood of resiliency.
Impact of Music Therapists’ Religious Beliefs on Clinical Identity and Professional Practice
Paige A. Robbins Elwafi (Cincinnati, OH)
A significant life change of joining a new religion inspired the researcher to look at her personal experiences of religious beliefs and clinical practice, as well as a small group of music therapists who practice other religions. The resulting qualitative study will be presented, detailing the design, analysis, and results.
Training in Musical Caregiving: A Husband Sings to his Wife with Alzheimer's Disease for Increased Orientation and Engagement
Joanna Swift (Drexel University)
The purpose of this study was to determine if training unpaid family caregivers of persons with Alzheimer’s disease in musical approaches to caregiving would result in reduced stress and depression that may come from caring for a loved one with dementia. The secondary purpose was to examine the effectiveness of such training to increase mutual engagement and communication between the caregiver and care recipient and decrease agitation in the care recipient. One caregiver/care recipient pair was recruited from a local support group sponsored by the Alzheimer’s Association and this pair participated in an eight-week data collection period. During this time, the caregiver was trained by the researcher in musical approaches to caregiving and he was asked to execute these approaches independently with his wife during four weeks of this data collection period. Data was collected through standardized questionnaires used to detect caregiver stress and depression, as well as interviews conducted by the researcher. It was found that this caregiver had great success in using one of the approaches, singing to his wife as a way to decrease resistance during caregiving activities that had been known to cause agitation. This resulted in reported decreased stress levels with the caregiver. Additionally, the caregiver expressed happiness in being able to engage with his wife, who is in the very late stages of dementia. Incorporating singing into his caregiving routine facilitated his ability to connect with her in a way that had not been possible for some time.
A Survey of Music Therapist Involvement in the Foster Care System
Mark Toole (Georgia College & State University)
The foster care system services countless children every day. There were 463,000 children in foster care homes in the United States during 2009 (childwelfare.gov, 2010). These children grow up without the influence of parents. They must deal with the emotional burden of being in unfamiliar settings while going through the early development stages of their lives. Often, this burden results in developmental delays that manifest into emotional and behavioral disorders. Over 70% of children who are in foster care for a year are diagnosed with developmental delays(Jee,2009). Of these children, two thirds responded to therapy sessions positively. The remaining third of this study were children who were the most extreme cases of behavioral disorder.
There are many reasons that children come to foster care, which can be divided into two major categories. The first category is when a parent can no longer take care of the child. This can mean that the parent does not have the financial ability to provide a safe environment for the child, or it be that the parent is mentally unfit to care for the child. The second major category is when there is some sort of abuse involved and the child is taken from the situation for their safety. (Cantos, 2010) The types of abuse range from neglect to sexual or physical abuse.
The first home a child will be placed in is usually with a relative. Often, a child will not be able to move in with a relative. This kind of foster care is called non-relative in home foster care and this is the most common. There are also group homes, hospital/ institutions, and relative in home foster care. Children in institutions and hospitals represent the smallest portion of children in foster care. (Chernoff, 1994)
When children enter foster care they are given a general test called the "Parents’ Evaluation of Developmental Status" (PEDS). Its purpose is to give a brief overview of their mental state and developmental state(www.pedstest.com, 2010). The test is intended to be filled out by the caregiver, but in most cases the primary caregiver is no longer available. Children coming from abusive situations will likely show signs of emotional and developmental delays. In some cases, due to malnourishment, children are physically stunted and will be found in earlier stages of development physically.
The foster care system’s first step in caring for the child is to take care of physical health problems such as malnourishment or injury. After that, they will evaluate the child’s mental health. The most common disorders that are found in foster care are behavioral disorders. There is speculation that the high rate of diagnoses is because the test is given to the caregivers, who can be biased. Others speculate that the high number comes from misinformation given in order to receive medicaid. Since all children who are sexually abused and enter into foster care automatically qualify for medicaid, the speculation seams plausible (Chernoff, 1994). Another common disorder found in foster children is attachment disorders. These will range from children who are overly attached, to children who are completely detached.The problem is usually addressed from the perspective of the child’s ability to naturalize into foster care.
The strategy for children in out-of-home care begins at admission. The service provides an initial assessment of the child. These are guidelines that were set out by the Child Welfare League of America (Child Welfare League of America, 1988). Within 30 days of arrival, the child receives a comprehensive examination. Pediatricians then develop a preventative health care plan which includes their physical and mental health (Simms, 1991). The children are given opportunities for specialized care as needed. As pediatricians work to help the child’s health, social workers will often be involved in a program called Family Reunification Program. The program focuses on maintaining relationships with the child's family. Some methods for developing those relationships includes individual counseling sessions, group sessions and a support group for the parent (Simms, 1991).
Children in foster care run a very high risk of having some sort of developmental disorder. The percent of children in foster care with developmental delays have shown to be as high as 80% in some places, though some foster homes will have a very low diagnosis rate (Jee, 2009).
The difference in diagnosis was studied and it was suggested that the "Ages and Stages" questionnaire be used to help properly diagnose developmental delays in foster care children. When tested, the results showed that the original diagnostic tool was unable to sufficiently diagnose about half of the children who had developmental delays (Jee, 2009).
Therapy given to children in foster care has shown to be ineffective. A study shows that children who stayed in therapy for 7 months had decreased their high risk behaviors as compared to those who stayed in 4 months of therapy or less (Cantos, 2010). Children in foster care will average out to living in three different homes. Foster parents will often drop a child off at the therapy sessions, instead of staying with them, which is necessary in many therapeutic strategies with children. There are also several studies that show foster parents to perceive behavioral problems in the child when therapists and teachers have not (Cantos, 2010). There is a need for foster parents to become more involved with the process of the child being treated.
There is a therapeutic technique that has not been documented in the foster care system. It is a unique activity-base therapy called music therapy.
Music therapy is an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals.
Though music therapy has been used with children in many ways, there has been little specific documentation of it being used in foster care. Currently music therapy is used in the school system as a tool for children with special needs and for children who are normally functioning. Children also see music therapists in private sessions. Music therapy has seen great successes in many of the areas that children have needs for in foster care. Music has even been shown to improve teens with anxiety problems or stress.(Miller, 2010)
One particular disorder in the foster care population is anxiety disorders. Anxiety disorders are one of the most common problem among the paediatric population (Labellarte, 1999). The disorder can manifest itself as separation anxiety, panic disorders, and depression. Every day problems can seem simple, but the stress that most can bear becomes an unbearable burden to someone suffering from an anxiety disorder.
Music as a means to manage stress is a technique that some people learn over time and experience. Though the credit here may be given to the mere aesthetic enjoyment of music, other aspects of music have proven to be useful as well. A study took place to measure the effects of music lessons on children suffering from anxiety disorders. The results showed that the children were more confident, social, and independent (Walker, 2002).
The foster care system has been showing a decline in children being served over the last 8 years from 552,000 to 463,000(childwelfare.gov, 2010). Though this slight decline seems promising, there is no indication that the need for foster care is ever going away. It seems that children will always be dealing with situations that are much tougher than a child ought to bear. These same children will often have developmental disabilities that range from behavioral and emotional problems to physical disorder such as stunted growth. Some of these conditions were preexisting, but some surface while the child is in the system (dosReis, 2001). The conditions that are commonly found in foster care children have all seen success in other fields by music therapists. With so many commonalities between the success in music therapy and the needs in foster care, it is curious as to why there is scarce information on the two subjects together. Would a survey of music therapists reveal that more work is being done with foster care children, or none at all?
The Relationships between Music Perception and Cognitive Domains in Breast Cancer Survivors
Alan Tyson (Indiana University & IUPUI), Debra Burns (Indiana University & IUPU), Tonya Bergeson-Dana (Indiana University), Susan Perkins (Indiana University), Frederick W. Unverzagt (Indiana University) & Victoria Champion (Indiana University)
Breast cancer is the most common form of cancer in women. Fortunately, there have been significant advances in treatment leading to improved survival rates. These improved survival rates have resulted in increased attention to late effects or residual treatment effects. For instance, some breast cancer survivors report negative changes in cognitive function attributed to chemotherapy-related treatments. Music cognition, a form of cognition, however, does not seem to be negatively affected by chemotherapy. The goal of this study was to explore the relationships between music cognition and standard cognitive domains in breast cancer survivors compared to age and education matched healthy women.
Effects of Music Therapy on Patients and Caregivers on a Oncology-Hematology Unit: Final Analyses of a Single-Session Randomized Design
Jennifer M. Ulmer, Erin Lane & Michael J. Silverman (University of Minnesota)
The American Cancer Society (2009) estimates that almost 1.5 million new cancer cases were diagnosed during 2009 in the United States, resulting in over half a million cancer-related deaths that year. Music therapy may help address psychosocial concerns of hospitalized cancer patients and contribute to management of unpleasant symptoms and side effects. The purpose of this study was to determine the effect of a single music therapy session on stress, pain, nausea, sense of well-being, and treatment perceptions on patients and caregivers on a medical oncology-hematology unit. Participants (N = 47) were randomly assigned to a wait-list control or experimental group. Control participants completed a brief questionnaire to assess symptoms before receiving patient preferred live music performed by the researchers. Experimental participants completed the questionnaire after receiving a single dose of music therapy. The only variable that reached statistical significance was perception of therapeutic effectiveness of music therapy, with the experimental group having a higher rating. The experimental group tended to have more positive ratings for stress and nausea. Concerning caregivers, participants in the experimental condition had higher ratings of stress and well-being than participants in the control group. Limitations of the study, implications for clinical practice, and suggestions for future research are provided.
Join in the Joy of Music: Promoting Joint Attention for Young Children with Autism
Potheini Vaiouli & Hannah Schertz (Indiana University)
Autism is a disorder that is present from birth and affects essential human behaviors, such as social interaction, the ability to communicate ideas and feelings, expressive forms of imagination, and relationships with others (ECA, 2001). A central feature of autism is difficulty with social skills. Research on the communication patterns of children with autism revealed that children with autism initiated fewer bids for interaction, continued fewer conversational turns, and showed less sympathy or interest for the perspectives of the persons with whom they were interacting (White et al., 2007; Jones & Schwartz, 2008; Bellon-Harn & Harn, 2006, Whalen, Schreibman, and Ingersoll, 2006).
Social skills and the ability to communicate do not happen in a vacuum (Bellini, 2008). Preverbal competencies lay an important foundation that support higher social functions and verbal language (Schertz & Odom, 2007). According to research, an important foundation for language and social competency is joint attention (Paparella & Kasari, 2004; Adamson & Russell, 1999; Mundy et al, 1986). Joint attention is defined as the ability to respond to a partner’s bids for interaction in relation to an external focus, and the ability to show an awareness of the partner’s mutual interest for the purpose of social sharing rather than requesting (Schertz & Odom, 2006; Carpenter & Tomasello, 2000; Adamson et al., 2001). Joint attention appears in forms of both responding and initiating and is supported by turn taking, eye contact, face-to-face engagement, and affect sharing (Kasari, Freeman and Paparella, 2001; Odom, Rogers, McDougle, Hume, & McGee, 2007; Bellini, 2007).
Recent studies in music therapy have shown that a child-centered approach in improvised music therapy interventions can increase joint attention and social engagement in children with autism (Kim, Wigram, & Gold, 2008; Kim et al, 2009). Kim and colleagues (2008) studied the positive effects of improvisational music therapy on emotional expression, emotional engagement, interpersonal initiatives, and responsiveness during joint attention episodes, in children with autism between 3 and 5 years. The results showed an improvement for the participants in social expressions and inter-affectivity. Other research found that improvisation music therapy increased spontaneous eye contact, promoted turn-taking, and helped children acquire non-verbal and/or gestural communication skills (Holck, 2004; Oldfield, 2006; Wigram, 2002; Plahl, 2000; Wigram, 2002; Trevarthen, 2002; Buday, 1995; Browell 2002; Farmer 2003).
The purpose of this study was a) to determine whether improvisational music therapy can promote joint attention; b) to explore parents’ and teachers’ perspectives such as perceptions on the child’s growth, importance of music therapy in the development of the child, and underlying factors that might influence the child’s growth, through a qualitative analysis of the data. The research hypothesis was that children with autism who receive music-centered improvisational music therapy will increase expression of joint attention through actions of turning to faces, turn taking, response to joint attention and initiating joint attention.
A mixed method design was implemented for the purposes of this research for a period of 8 months. All three children received individual music therapy sessions once a week in the music room of the school. The music therapy intervention last for approximately 30-40 minutes and it was delivered by a board-certified music therapist. Data collection continued for the entire duration of the project.
A multiple baseline design was used to determine causal relationships between the music therapy intervention and the child’s performance in the four stages of social competency: focusing on faces, turn-taking, responding to joint attention, and initiating joint attention. Also, the primary investigator conducted semi-structured, open-ended interviews with the parents and the educators of the three participants. For this purpose the researcher met with the parents and the educators of the three children respectively, three times during the project, once in the beginning, once in the middle and once at the end of the project. A complementary qualitative analysis of the interviews explored the perceptions’ of parents and educators of the children regarding the music therapy intervention, their observations to the child’s response to the music-therapy experience, their understanding of the child’ growth, and variables that may have influenced the outcomes.
The findings of this study are encouraging regarding the efficacy of music therapy interventions for promoting social interaction in students with autism, showing that improvisational music therapy has potential to promote pro-social and social interaction for young children with autism as it creates preconditions for joint attention, reciprocal engagement, and interpersonal responses through the process of music making. The data analysis indicates that the participants exhibit improvement in spontaneous eye contact, alternating eye contact, and turn taking. Reports from the teachers and the parents of the children also report generalization of joint attention actions to the kindergarten classroom and to the family environment of the participants.
Music Educators’ Perceived Effectiveness of Inclusion of Students with Special Needs: A Comparison of 20 Years
Kimberly VanWeelden (Florida State University) & Jennifer Whipple (Charleston Southern University)
This study sought to examine whether music teachers’ perceptions of effectiveness of inclusion, curriculum adaptations/modifications, or student achievement had altered from previous research findings 20 years ago. Music educators (N = 1194) representing all 50 states responded to a survey fashioned after a similar instrument used by Gfeller, Darrow, and Hedden (1990). Results indicate positive increases over the past 20 years in which teachers generally felt the students were successfully integrated, their music needs were being met, and they did not hinder the progress of typically developing peers. Additionally, teachers felt comfortable adapting and/or modifying their regular curriculum to meet the needs of students with special needs and reported these students were graded on the same standards of musical achievement. Further results and educational implications are discussed.
Perceptions of Educational Preparation and Instructional Supports Available for Inclusion of Students with Special Needs in Music: A Comparison of 20 Years
Kimberly VanWeelden (Florida State University) & Jennifer Whipple (Charleston Southern University)
This study sought to examine whether music teachers’ perceptions of their educational preparation and availability of instructional supports had altered from previous research findings 20 years ago. Music educators (N = 1128) representing all 50 states responded to a survey fashioned after a similar instrument used by Gfeller, Darrow, and Hedden (1990). Results indicated slight positive increases over the past two decades in regard to types of course offerings, in-service attendance and availability, involvement in the IEP process, placement decisions, consultation with special education experts, and provision of adequate preparation time and resource materials/adaptive devices. Results also indicated current music education practices, (e.g., music specific coursework, workshops, and in-services) created greater feelings of preparedness to work with students with special needs and increased attendance at additional educational opportunities. Further results and educational implications are discussed.
Content Analysis of Course Offerings in AMTA-Approved Training Programs
Eric G. Waldon & Feilin Hsiao (University of the Pacific)
Introduction: For decades, authors have explored music therapy training curricula across the United States. Presently, there are 67 undergraduate training programs that are approved by the American Music Therapy Association (AMTA). While all of these programs, by virtue of being approved by the AMTA, provide a common slate of coursework and training consistent with the AMTA Professional Competencies (AMTA, 2010), there likely exist some content differences based on the expertise or specialties of various faculty at those institutions.
Purpose: The purpose of the current investigation was to systematically study the undergraduate curricula of AMTA-approved programs using a content analysis method.
Method and Design: The investigators compiled a dataset consisting of the curricula from the AMTA-approved undergraduate/certification programs listed in the 2010 AMTA Membership Sourcebook. Data were obtained by online search of program websites and, in some cases, direct communication with program directors (when data could not be obtained by website search alone). Using the AMTA Professional Competencies as a guide, the investigators cross-tabulated each program’s course offering (based on the description of each course) with one (or more) competency.
Results: Among those schools included in the analysis, variability was noted in the following areas:
• Amount of practicum (pre-internship fieldwork) required: M = 4.37 terms; SD = 1.44 terms; Range = 2 – 9 terms
• Programs requiring an improvisation course/ensemble: 21(31.9%)
• Programs requiring a research course beyond 1 term of psychology of music: 43 (65.1%)
• Programs requiring introduction to psychology (included if a prerequisite for abnormal psychology): 47 (71.2%)
• Programs requiring abnormal psychology outside a core MT course offered within the school of music: 57 (86.3%)
• Programs requiring an anatomy/physiology course: 51 (77.2%)
• Programs requiring a course specifically on the topic of exceptional children/special education: 37 (56%)
• Programs requiring a course in developmental psychology (or similar): 23 (34.8%)
Discussion: Given the variability in course and content offerings among the training programs sampled, the authors encourage further investigation of the following: Practica (timing and amount required); Improvisation Instruction (amount and means of instruction); Research Training (types of instruction, amount, and whether courses were taken outside the music therapy core or school of music); and Social/Natural Science Requirements (the variety offered and amount).
Influences of Music Therapists' Worldviews on Work in Different Countries
Barbara L. Wheeler (Beach Haven, NJ) & Felicity Baker (University of Queensland, Australia)
This research investigated the worldviews that music therapists hold and how these influence their music therapy practice and teaching. Culture for this project was defined as "the behaviors and beliefs characteristic of a particular social, ethnic, or age group" (Dictionary.com). Twelve participants who had lived and worked in 16 different countries and had experience as both music therapy clinicians and teachers, participated. They were asked, "What views do you hold that are a part of your culture that you believe may influence your music therapy or teaching of music therapy?" The researchers performed an inductive analysis of the data using principles of grounded theory methods. Four themes were found to represent the main influences of culture relevant to music therapy as understood and described by the participants: the influence of culture in shaping worldviews, on clinical practice, on teaching, and on perception and thinking about the therapeutic process. These themes and constructs that constitute each are presented, along with quotations to illustrate each. Participants’ views of culture and worldview are also presented. Implications of this research for the teaching and practice of music therapy in a multicultural world are discussed.
A Phenomenological Experience of Singing Vocal Harmony with another Person
Krista Winter (Drexel University)
The purpose of this phenomenological study was to gain insight and a deeper understanding of the experience of singing vocal harmony with another person. Semi-structured interviews were conducted with four adults capable of singing vocal harmony. Minimal prior research to explain a person’s perception and psychological experience of singing vocal harmony has been published. Through informal conversation the researcher discovered that vocal harmony is often utilized within clinical practice, but there is no literature to support its use or omission.
Four healthy adult participants met individually with the researcher for an interview that mixed verbal and musical components. During the interview, the participant recalled and described their previous experiences singing in vocal harmony, sang a song of their choice with the researcher in vocal harmony, and then described this experience. Following data analysis the major findings of this research indicate that the experience of singing vocal harmony includes the building and expression of relationships, intrapersonal and interpersonal insight, movement and action, and beauty.
This study discovered that there are implications for the clinical use of vocal harmony when working with patients who have reported prior experience and expressed a preference for vocal harmony. Recommendations were made for future research regarding vocal harmony, its use and application within the field of music therapy.
Assessing Parents’ Needs and Attitudes: Considerations for Parent Training Planning in Music on Parent-Child Interactions for Children with Developmental Delays
Yen-Hsuan Yang (Florida State University)
The purpose of this study was to investigate parents’ perceived training needs and attitudes toward the use of music with their children who have developmental delays. Parent participants were recruited through an early intervention organization—Early Steps—in the Southeastern region of the US. Participants’ children were all under three years of age and were eligible to receive early intervention services.
Parent participants were mothers, fathers, or family representatives (N = 106). They responded to a questionnaire that queried about the following: (1) parents’ attitudes toward the use of music; (2) parents’ perceived skills, and comfort level with music; (3) perceived characteristics of parent-child interactions in play; and (4) types of training needs.
Participant responses indicated that the most frequent music activities used in the home were singing nursery rhymes, finger plays, and children’s songs. In contrast, parents sang or played live music for the purposes of movement the least frequently. Furthermore, the responses revealed that parents used live music significantly less frequently than recorded music. Responses also indicated that in nearly all of the families, mothers were the music activity providers for their children, whereas less than half of the families indicated that fathers were the music providers.
A Likert-type scale was employed to measure parents’ perceived musical abilities and attitudes toward the use of music with their children. The three most prevalent parental attitudes toward music were: (1) music entertains my child and changes his/her mood positively; (2) music soothes my child, and (3) music bonds me with my child. The top three perceived parental music skills were (1) singing along with recorded music, (2) being able to clap different rhythms, and (3) moving freely with the music. Perceived parental weaknesses were: (1) modifying music, and providing variety in the music by changing tempo and dynamics, (2) singing unaccompanied music in tune, and (3) knowing how to use props with music (i.e., books, scarf, puppets, etc.). When asked how participants learned songs, most parents reported that they learned songs by ear, whereas only about a third of the parents learned by reading music. In addition, the parents felt more comfortable singing to their children than dancing and playing instruments with their children.
Results indicated that parental characteristics during parent-child interactions were mostly positive. Most parents felt they had successful experiences helping their children play with toys or interact with other people. In addition, a little over half of the parents reported that they always responded consistently and positively to their children. When asked if they knew how to respond properly when their children showed distress, less than half of the parents knew for sure that they were capable of doing so. In regard to children’s responsiveness, parents reported that nearly 20% of the children always followed parents’ directions, and 42% of the children always appeared interested when parents introduced a new object to them. Lastly, parents tended to be more child-centered than parent-centered during play.
Parent participants expressed interest in learning more about the benefits of using music to enhance their children’s communication, cognition, and social interactions. Over a third of parents suggested the music program last 20 to 30 minutes per session. Most of the parents stated that they were interested in participating in a free training program offered to teach them ways of using music to facilitate parent-child interactions. Several parents stated that possible deterrents to participation were lack of time or not having the musical equipment needed to engage in music activities with their children. Overall, these findings indicate that many of the participants have parenting needs, are open to using music with their children, and would be interested in participating in a music therapy program designed for parents of children with developmental delays.
The Effects of Participation in a Group Music Therapy Voice Protocol (G-MTVP) on the Intensity, Fundamental Frequency, Fundamental Frequency Variability, Breath Support, Jitter, and Shimmer of Individuals with Parkinson Disease
Olivia Swedberg Yinger (Florida State University)
Many individuals with Parkinson Disease experience speech impairments, including reduced loudness, monotone speech, hoarse voice, and higher frequency perturbation or "jitter." Dopaminergic drugs, which are commonly used to treat the symptoms of Parkinson Disease, have mixed results at treating associated speech impairments. The Lee Silverman Voice Treatment (LSVT) is widely accepted as the most effective treatment for speech impairments related to Parkinson Disease, yet relatively few people with Parkinson Disease receive LSVT, which is typically administered through individual sessions with a speech therapist. In 2001, Eri Haneishi created a Music Therapy Voice Protocol (MTVP) which incorporates aspects of LSVT to improve the speech of people with Parkinson Disease through individual sessions with a music therapist. A Group Music Therapy Voice Protocol (G-MTVP) was developed by this researcher in an attempt to provide additional motivation for individuals with Parkinson Disease to seek treatment for impaired speech in a social, motivating setting. G-MTVP includes 50 minutes of opening and closing conversation, physical, facial, and breathing warm-ups, vocal exercises, and singing, all focusing on increasing phonatory effort to maintain vocal strength. This study examined the effects of participation in G-MTVP on the intensity, fundamental frequency, fundamental frequency variability, breath support, jitter, and shimmer of individuals with Parkinson Disease over the course of six to eight weeks using a one-group pre-test post-test design. Individuals with Parkinson Disease (N = 10) participated in G-MTVP once or twice a week for six to eight weeks. Participants’ speech was recorded during a pre-test prior to the first session, during a probe test after two to four weeks of participation, and during a post-test after six to eight weeks of participation. During the pre-test, the probe test, and the post-test, participants’ speech was recorded while reading a passage aloud, engaging in 30 seconds of conversational speech, and sustaining an /a/ vowel for as long as possible. A one-way ANOVA for repeated measures was used to compare pre-test, probe, and post-test measures of intensity, jitter, and shimmer. Results showed a significant difference in the intensity of speech when reading a passage aloud, F (2, 18) = 9.65, p = .001, ηp2 = .637. Post-hoc tests using a Bonferroni correction indicated a significant difference for the reading passage between the pre-test (M = 49.67, SD = 5.2) and probe (M = 53.13, SD = 2.12) and the pre-test and post-test (M = 55.61, SD = 6.01). The intensity of conversational speech increased from pre-test (M = 46.22, SD = 3.98) to probe (M = 49.35, SD = 4.85) and probe to post-test (M = 50.9, SD = 7.78), although this increase was not significant. No significant differences for measures of jitter, shimmer, or sustained vowel duration were found (p > .05). Because males and females differ in terms of fundamental frequency, fundamental frequency variability, and duration of sustained phonation, these measures were analyzed separately for males and females using a Friedman Analysis of Variance. No significant differences were found between pre-test, probe, and post-test measures of fundamental frequency or fundamental frequency variability (p > .05) for males or females. Although the changes were not significant, fundamental frequency variability of conversational speech increased for both males and females from pre-test to post-test, although a decrease for male participants was noted at the probe. Female participants also showed a consistent increase in fundamental frequency variability of the reading passage. A consistent trend toward increased breath support for male participants, as measured by the ability to sustain an /a/ vowel for longer periods of time, was noted over the course of the study. On average, the maximum duration of sustained vowel phonation was greater for males than for females. Jitter and shimmer remained fairly constant over the course of the study. Participants showed normal levels of vocal jitter, which may be attributable to vocal training. In spite of the degenerative nature of Parkinson Disease, participants showed improvements in acoustic parameters of speech over six to eight weeks of participation in G-MTVP, indicating that G-MTVP has potential benefits for improving and maintaining vocal functioning of individuals with Parkinson Disease in a motivating, social setting. Findings are discussed with regard to the influences of musical participation on dopaminergic activity.
Levels of Evidence in the Journal of Music Therapy from 2000-2009: Descriptive Analyses by Year and Clinical Population
Andrea Bora Yun & Michael J. Silverman (University of Minnesota)
Background: The Journal of Music Therapy (JMT) is the premiere journal in the music therapy field. Regarding the articles in this journal, levels of evidence are an important component for ranking and evaluating studies in the contemporary approach to evidence-based practice.
Purpose: The purpose of this study was to systematically examine the levels of evidence from articles published in JMT from 2000 – 2009 using the classification established by Melnyk and Fineout-Overholt (2005).
Method: The authors independently categorized levels of evidence for all JMT studies from 2000 - 2009 (N = 183). Initial reliability concerning levels of evidence categorization was high and discrepancies were resolved to reach a final reliability quotient of 1.00.
Results: Most JMT studies were level VI (n = 83, 45.36%) or level II (n = 32, 17.49%). The populations most studied were other (n = 31, 16.94%), non-disabled persons (n = 24, 13.12%), medical/surgical (n = 16, 8.74%), Alzhiemers/dementia (n = 12, 6.56%), and school age populations (n = 12, 6.56%). The majority of these studies were categorized as level VI and level II studies.
Conclusions: As many systematic reviews only include level II evidence, there is a need for additional randomized and controlled trials. However, randomized trials are typically based upon results of other levels, so additional qualitative, behavioral, descriptive, and single-case designs are also warranted. The variety of research designs and clinical populations are a testament to the breadth of JMT and the profession. Limitations of the study and suggestions for future research are provided.