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2008 Conference Research

The Effects of Rhythmic Auditory Stimulation on Gait Disturbance of Patients With Cerebellar Ataxia

Mutsumi Abiru, Chizuru Nakano, Yutaka Kikuchi, Koji Tokita, Yoshiko Mihara, Mikio Fujimoto, & Ban Mihara, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Japan


 Seven patients with cerebellar ataxia (six male and one female, aged 61.1±18.6, disease duration 36.6±10.5) were enrolled in this study. The type of stroke was 2 cerebral hemorrhages and 5 cerebral infarctions. The lesion site was localized by MRI (3 cerebellum, 2 ventral pons, 2 medulla oblongata). The mean score of Functional Independence Measure was 110.7±9.8 (motor: 77.3±8.7, cognitive: 33.4±1.6). The mean score of Trunk Impairment Scale was 17.1±5.1.  In addition to conventional gait trainings (60 min/day, 7 times/week) by physical therapists, RAS gait trainings (30 min/day, 5 times/week) were applied for 22.2 days±13.2 days by music therapists. Tempo of RAS was set to a specific tempo for each patient, and then the tempo was increased/decreased (by 3-5%) when necessary. All auditory cues were played on the Autoharp. After the pattern of auditory stimulation to enhance their movement was established, their preferred music was then applied to enhance their motivation.  The cadence, stride length, step length (affected/unaffected side), velocity, and stride width were measured by 3-dimentional-motion analysis before and after RAS intervention. The analysis of previous RAS intervention was implemented to study the immediate effect of rhythm, and the analysis of after RAS intervention was implemented to study long-term effect of RAS.  Wilcoxon signed-rank test was used for statistical analyses. All data were presented as mean ± SD.  As an immediate effect, right after the rhythmic stimulation, cadence(74.8±22.8 steps/min to 89.4±22.1 steps/min), stride length(0.67±0.18 m to 0.78±0.21 m), affected side of step length(0.33±0.09 m to 0.40±0.11m), unaffected side of step length(0.33 ±0.11m to 0.38±0.10m), velocity(0.4 ±0.2 m/min to 0.6±0.2 m/min), and single support phase(29.8±5.7 % to 31.9±5.9 %) were significantly increased respectively (p<0.05). Double support phase(40.5±11.6 % to 34.9±12.9 %) was significantly decreased (p<0.05). Stride width (0.23±0.05 m to 0.20±0.06 m) was not changed (p=0.09 ). As a long term effect, after the all RAS sessions, cadence(74.8±22.8 steps/min to 93.6±20.9 steps/min), stride length(0.67±0.17 m to 0.97±0.28 m), affected side of step length(0.33±0.08 m to 0.48±0.12 m), unaffected side of step length(0.32±0.11 m to 0.49±0.16 m), velocity(0.43±0.19 m/min to 0.78±0.31 m/min) and single support phase(29.8±5.7 s to 36.3±6.2 s) were significantly increased respectively (p<0.05). Double support phase(40.5±11.6 s to 27.2±13.6s) was significantly decreased (p<0.05). Stride width (0.22±0.05 m to 0.22±0.02 m) was not changed (p=0.09 ).  The above data indicates that RAS for the stroke patients with cerebellar ataxia had beneficial effects on their gait. Furthermore, the combinations of RAS and conventional gait training have promising effects on their gait disturbance.

The Effect of Music on Pediatric Anxiety and Pain During Medical Procedures in the Main Hospital or in the Emergency Department

Sabina Barton, MT-BC, NICU MT-BC
Florida State University
Tallahassee Memorial Healthcare


The purpose of this study was to use music to distract and relax pediatric patients during medical procedures. Procedural support via live music therapy interventions included a variety of activities such as music paired with breathing exercises, counting to music, developing sequence in song, and manipulation of musical and play objects. Because invasive and non-invasive are two radically different types of procedures, two separate experimental designs were implemented and administered to a total of 40 pediatric patients between the ages of 5 and 12, in the main area and the emergency department of a southeastern regional hospital in North Florida. Invasive procedures included intravenous starts, finger pricks, incision and draining, suturing, and removal of foreign material in the skin. Non-invasive procedures included X-rays, computed tomography scans, and breathing treatments. All subjects were randomly assigned to a control or experimental group. Demographics were collected on all pediatric patients; this information included gender, age, procedure, and length of procedure.  For self-report, The Pain Intensity and Assessment Tool, modeled after the Wong-Baker FACES Pain Rating Scale, was administered to each child pre and post treatment to measure each child's level of pain, and modified to measure each child's level of anxiety. Results indicated no significant difference in control versus experimental groups receiving either invasive or non-invasive procedures in the main hospital or emergency centers. Mean and standard deviation scores, however, showed a decrease in anxiety and pain levels when comparing pre to post procedures. A behavioral checklist was used post-intervention to record the number of times an anxiety-related behavior occurred. Regardless of procedure, groups receiving music intervention displayed fewer aversive behaviors than groups that did not. In addition, patient satisfaction with MT assistance during the medial procedures was 100%.

Premature Infants' Lullaby Rating Scale: Content Validity and Reliability

Debbie Bates, MMT, LCAT, MT-BC, Akron Children's Hospital and The Cleveland Music School Settlement; Ronna Kaplan, MA, MT-BC, The Cleveland Music School Settlement; Anne Reed, MT-BC, Beechbrook; Courtney Whitmer, MMT, MT-BC, Family Connections


The Premature Infants' Lullaby Rating Scale (PILRS) is an in-depth assessment of recorded music. Its purpose is to classify lullaby recordings with regard to the appropriateness for use with premature infants. The PILRS rates a lullaby collection in its entirety and assesses ten music elements: vocals, instrumentation, timbre, tempo, meter, harmony, style, melody, rhythm, and dynamics. Songs on each album are assessed individually and then compared to each other to achieve a final stimulation rating.  The purpose of this research study was to evaluate the reliability of the tool, Premature Infants' Lullaby Rating Scale. The hypothesis for this study was that the PILRS is a reliable tool by which to evaluate the sedative nature of commercially recorded music.  Institutional Review Board (IRB) approval was granted by a Midwestern children's hospital for the duration of the study. All changes to study protocols, including repeated phases of testing, were done with permission by the IRB.  Participants were given background information about the PILRS, participation requirements for their particular phase of the research study, potential risks of participation, how confidentiality and anonymity would be maintained, as well as the contact information of the researchers and the IRB.  Consent for participation was implied through research packets that were completed and returned.  The research was designed in three phases. Phase 1 consisted of Content Validity, in which three board-certified music therapists with advanced degrees and extensive clinical music therapy experience in neonatal intensive care were asked to evaluate the PILRS for content review. Phase 2 consisted of a small-group reliability test to determine if the musical element categories of the PILRS accurately reflected the sedative nature of music. Six professional members of the Association for Ohio Music Therapists were asked to rate five lullabies individually, using the PILRS and also providing a subjective rating for each lullaby using a scale of 1-4, where 1 equaled highly sedative and 4 equaled minimally sedative. The five lullabies were chosen for their contrasting musical elements, including vocalizations, instrumentation, tempo, harmony, and style. Phase 3 consisted of a large-group reliability test to determine whether or not the PILRS was effective for evaluating an entire commercially recorded lullaby CD. Forty participants were randomly selected from the 2006 AMTA Music Therapy Sourcebook and asked to utilize the PILRS to rate Olivia Newton-John's Warm and Tender lullaby CD.  Based on preliminary statistical analysis completed after Phase 2 of research, the PILRS tool was revised. The first two phases of research were repeated before proceeding to the third and final research phase. The reported results are for those of the revised (current) PILRS tool.  For Phase 2, internal consistency of the subjective ratings and the ratings derived by using the PILRS was determined by computing Chronbach's alpha. A Chronbach's alpha coefficient > 0.7 is generally considered adequate for reliability of a scale (DeVillis, 1991; Nunnally & Bernstein, 1994). For Phase 3, internal consistency of the PILRS ratings was computed using Chronbach's alpha.  Interrater reliability for all phases was assessed by examining the intraclass correlation coefficients (ICC) for both the subjective and PILRS ratings. An ICC of .75 or higher is considered a good indicator of intterater reliability (Dworkin, Le Resche & DeRouen, 1988; Portney & Watkins, 2000).  In Phase 2, the Chronbach's alpha for the subjective score was very high, a = .86, while the interrater reliability was ICC = .46. The internal consistency of the PILRS was a = .98, and the interrater reliability was ICC = .73. In Phase 3, both the internal consistency (a = .90) and the interrater reliability (ICC = .82) of the PILRS were very high. The high interrater reliability would indicate that the scoring instructions and items within the PILRS are clear and readily understandable by those therapists using it.  Further research to test the validity of this tool is needed, however, it is hoped that this tool will provide music therapists who work in neonatal intensive care units (NICU) with a concrete method by which to evaluate recorded music and help them to choose recorded music that is developmentally appropriate for their patients. It may also help music therapists to identify individual tracks on lullaby recordings that are appropriate for NICU patients and families to facilitate the creation of individualized compilation recordings.

The Perception of Pre-Internship Training for New Music Therapists

Melita Belgrave, MM; Lori Gooding, MM; Satoko Mori-Inoue, MM;
The Florida State University


 The purpose of this study was to examine the perceptions of pre-internship clinical training for new music therapists who had been practicing in the field of music therapy for 5 years or less. A brief survey was sent via email to current professional American Music Therapy Association members with 5 years or less experience. Questions were asked about pre internship clinical experiences, including questions about supervision practices, observation and leading opportunities, opportunities for exposure to different populations and perception of preparedness after pre-intem clinical training. Additional questions about the institution size, size of the surrounding area and availability of instruments and equipment were also asked.

Perioperative Music and Its Effects On Anxiety, Hemodynamics, and Pain In Women Undergoing Mastectomy

Pamela G. Binns-Turner, Ph.D., CRNA, Union University, Jackson, Tennessee; Gwendolyn Boyd, M.D., University of Alabama at Birmingham, Birmingham, AL; Erica R. Pryor,Ph.D., University of Alabama at Birmingham, Birmingham, AL; Jacqueline Ann Moss, Ph.D., University of Alabama at Birmingham, Birmingham, AL; Carol Prickett, Ph.D., University of Alabama, Tuscaloosa, AL; Lynda Harrison, Ph.D., FAAN, University of Alabama at Birmingham, Birmingham, AL


The study purpose was to examine the effects of a perioperative music intervention on changes in mean arterial pressure (MAP), heart rate (HR), anxiety, and pain in women with a diagnosis of breast cancer undergoing mastectomy surgery. The convenience sample included 30 women between the ages of 42 and 70 who were undergoing mastectomy in a large urban hospital in the southern United States. Exclusion criteria included male gender, psychiatric disorder, use of psychotropic medications, cognitive mental disability, and American Society of Anesthesiologists (ASA) status 4 or greater. In a quasi-experimental, repeated measures design, participants were randomized equally into music intervention and control groups. Women in the intervention group listened to music throughout the perioperative period, and women in the control group did not listen to music. Study variables were measured preoperatively (T1) and postoperatively (T2) at the time of discharge from the recovery room. Independent t-tests were used for statistical analyses of change scores. Results indicated that women in the music group had a decreased MAP from T1 to T2, whereas women in the control group had an increase in MAP (p=.003).  Women in the music group had a decrease in level of anxiety from T1 to T2, whereas anxiety levels increased from T1 to T2 for women in the control group (p=.000). Women in the intervention and control groups had increased levels of pain from T1 to T2, but this increase was significantly lower for women in the intervention group (p=.007). There were no significant group differences for heart rate change scores.

Experiences and Concerns of Students During Music Therapy Practica: A Quasi Replication of Wheeler's (2002) Study

Laura S. Brown, MT-BC
Appalachian State University


Wheeler (2002) studied student experiences and concerns about music therapy practica. In this extension of Wheeler's study, 6 students were interviewed twice during the semester, 2 in each of three levels of practicum. The common themes that resulted from the student interviews were challenges of the practicum setting and population, personal challenges encountered during the practicum setting, preparation, the student-client relationship, and supervision. Overall, interviewing the students resulted in gaining significant insight about the practicum experience from a student perspective.

Music Perception and Self-Reported Cognitive Dysfunction in Breast Cancer Survivors

Debra Burns, PhD, IU School of Music @ IUPUI; Tonya Bergeson-Dana, PhD, IU School of Medicine; Brian Schneider, MD, IU School of Medicine; Frederick W. Unverzagt, PhD, IU School of Medicine; Victoria Champion, DNS, lndiana University Simon Cancer Center


The integration of music-based interventions into traditional cancer care continues to gain momentum. Several studies have examined the benefits of music interventions during active cancer treatment. Results of these studies are mixed, with both positive and null findings. Studies with null findings are often underpowered and the interventions are not theoretically derived 8.  Additionally, recent literature suggests that the neurotoxic effects of adjuvant treatments may change the perceptual and cognitive processes required for music experiences, negatively influencing the potential benefits of music during adjuvant treatment.  A variety of chemotherapy agents have ototoxic effects that can decrease both high and low frequency hearing. Additionally, a recent preliminary study documented high rates of reduced hearing sensitivity in women receiving adjuvant treatment for breast cancer. Several studies have shown that chemotherapy may also induce cognitive impairments such as decreased information processing speed motor function verbal memory visuospatial skill, and visual memory. It is unclear whether reports of qualitatively different and negative musical listening experiences in cancer patients who have received chemotherapy are due specifically to the ototoxic effects (i.e., hearing loss) or to more general neurotoxic effects (e.g., decreased cognitive function).  Alternatively, the emotional impact of the diagnosis and cancer treatment could alter patients' music listening experience perhaps making patients more sensitive to the emotional content within musical pieces or making aesthetic experiences more difficult. Finally, it is also unclear whether such changes in music perception are domain-specific (i.e., limited to music) or domain-general (i.e. cognition). Therefore, determining the impact of hearing and perceptual changes to music as a result of adjuvant breast cancer treatment is essential to determine whether or not current music-based interventions are relevant to this population. This could have wide-ranging implications for the use of music within oncology.  Therefore, the overall goal of this study is to examine if self-reported cognitive dysfunction in breast cancer patients who have received adjuvant cancer treatment is related to performance on auditory-based perceptual tests. 

 Comparison of Board-Certified Music Therapists and Music Therapy Students/Interns' Use of Technology to Meet Specific Therapeutic Outcomes

Andrea M. Cevasco, The University of Alabama; Angie Hong, Carolina Center for Music Therapy, LLC


Recently researchers have focused on differences in age cohort's use of technology in society, including their experience with technology, amount of money spent on various types of technology, use of specific types of technology, and even attitudes toward technology. From November 2007 through April 2008 Cevasco and Hong conducted a survey of technology use by board-certified music therapists (MT-BC) and music therapy students and interns (MTSI). The survey assessed use of computers, software, and portable music devices, herein referred to as technology, used by MT-BC as well as MTSI to address specific therapeutic goals and objectives in their clinical work. The purpose of this study was to compare similarities and differences of these two groups. A total of 110 MTSI and 233 MT-BC completed the survey. Based on the aforementioned technology devices, both MT-BC and MTSI used technology for a variety of music therapy interventions. While MTSI had greater access to technology than MT-BC, oftentimes MT-BC utilized technology more than students for their clinical work. Overall, a majority of both MT-BC and MTSI agreed that they would benefit from receiving basic training on how to use technology effectively as well as occasional in-service training on how to use technology effectively. 

Effect of Music on Cancer Patients: A Meta-Analysis

Andrea M. Cevasco and Carol A. Prickett
The University of Alabama


Cancer is the second leading cause of death in the United States (Centers for Disease Control, 2008). In the United States approximately 11,098,450 people were diagnosed with cancer on January 1, 2005; this number represents those who had been diagnosed with cancer, had active disease, and were cured of their disease (Ries, Melbert, Krapcho, Stinchcomb, Howlader, Homer, et al., 2008). In 2008 it is estimated that 1,437,180 people will be diagnosed with cancer, and 565,650 people will die of cancer. About 40% of individuals born today will be diagnosed with cancer during their lifetime (Ries, Melbert, Krapcho, Stinchcomb, Howlader, Homer, et al., 2008).Some types of cancer react best to a single type of treatment; however, other types of cancer are treated through combinations of treatment (National Cancer Institute [NCI], 2006). Common treatment methods include surgery, radiation therapy, or chemotherapy. Other treatments involve hormone therapy or biological therapy. Sometimes stem cell transplantation is used so a patient is able to receive high dosages of chemotherapy or radiation therapy. Side effects are commonly experienced by cancer patients, which varies according to the type and amount of the treatment. Furthermore, side effects are different for each person and can even change from treatment to treatment. Health care teams, consisting of nurses, dietitian, physical therapist, and others provide recommendations to help individuals handle the various side effects (NCI, 2006).A recent literature review indicated that music has been used to help cancer patients prior to, during, and following cancer treatment (Cevasco, 2008). Additional analysis, however, might be advantageous in understanding the value of music in the treatment of cancer patients. A meta-analysis is a statistical procedure in which quantitative research data are compiled and statistically analyzed. This allows greater confidence in making conclusions about the effectiveness of specific clinical procedures. Standley (1986) conducted the first meta-analysis in music therapy, evaluating music in medical and dental treatment. Over the past twenty years additional music therapy meta-analysis have been conducted, including treatment of individuals with dementia (Koger, Chapin, & Brotons, 1999), premature infants (Standley, 2002), psychiatric patients (Silverman, 2002), pediatric patients (Standley & Whipple, 2003), and individuals experiencing stress (Pelletier, 2004).The purpose of this meta-analysis is to determine the overall impact of music interventions by comparing music versus nonmusic conditions on individuals undergoing cancer treatment. Included were quantitative studies that dealt with individuals undergoing cancer treatment. Studies involving hospice or palliative care patients as well as cancer treatment for management of cancer pain of hospice patients were not included. 

Choral Singing in Prisons: A Collective Case Study of Five Male Prison Choirs

Mary Cohen, PhD, University of Iowa


Research and historical documents suggest that prison choirs may help with inmate rehabilitation. This multiple case study examines the history and practices of five U.S. male prison choirs and their perceived impact. Research questions addressed were: (a) What are the histories and practices of these five choirs? (b) How do prison choir conductors and inmate singers perceive their programs? (c) What are the personal, societal, and musical implications of choirs in prison contexts? (d) How does this information enlighten future prison choir practice and research? Primary sources included recordings of the choirs, paper programs, pictures, open ended questionnaires completed by seven prison choir conductors, follow up interviews with the conductors, observations of rehearsals and performances, and informal interviews with inmates. Other data collected included an online survey completed by audience members (N-35), field notes, and researcher reflections. Open coding, axial coding, and selective coding were employed to analyze data. Despite contrasts in prison contexts where these five choirs are based, common themes were evident across all choruses. Conductors indicated that learning to sing, focus, and develop a sense of group responsibility was a slow process for inmates, many of whom had not participated in choirs in the past. Choral performances provided a means for inmates to develop self esteem, promoted positive social interactions, and led to changes in behaviors. Each prison chorus offered a safe environment for inmates to explore their feelings and to build group trust. Inmates in all the choruses recognized their choral participation as an opportunity to do something positive for society. Specific future research directions such as examining pedagogical practices of prison choirs, disciplinary reports of inmate singers, self esteem measurements, and family perspectives of prison choir participation are suggested.

Recovery of Motor Skills: A Cellist's Journey

Elaine J. Colprit, Bowling Green State University


In this study I documented the performance of an advanced cello student during his recovery from traumatic brain injury. Lessons are ongoing, but the videotapes analyzed for this investigation were recorded during a sixth month period of cello instruction. Lessons were intended to encourage (1) recollection of simple tunes known to the student before the injury occurred, (2) correct alignment of cello and player's body, (3) balanced posture, which includes position of legs, feet, and torso, (4) independent action of the left hand fingers and arm, including spacing for half, and whole steps between fmgers (5) ability to locate first position on fingerboard (first finger one whole step above the open string), (6) ability to balance the bow hold between the fingers and the thumb and to adjust the hand, fingers, and thumb as the bow travels from frog to tip and back, (7) ability to coordinate physical gestures in time, (8) ability to read written symbols and to perform pitch and rhythm, (9) ability to maintain body posture to support cello over a long period of time, and (10) ability to realize previously known tunes on the cello. Secondary goals included facilitating practice in (1) pairing words and pitches with symbols, (2) articulating thoughts in spoken words, (3) singing, and (4) extending the student's span of attention. One of the most difficult aspects of rehabilitative instruction is that progress is not necessarily continuous, sustained, or linear. This makes planning and carrying out instruction and designing appropriate assessment measures problematic, especially for a teacher who is accustomed to supporting sequential learning. Often the student in this study plays with coordinated physical gestures for only a few seconds perhaps due to either a decrement in attention span or an inability to sustain muscle control. Post lesson observation of video recordings makes it easier to recognize moments in which a student demonstrates musical skills and motor skills essential for successfully playing the cello. In this study I attempt to document reawakening of previously learned skills by describing student behaviors during performance of scales, or phrases of a melody in terms of long term goals for reclaiming the ability to play the cello independently.

A Content Analysis of Articles Addressing the Orff Approach with Special Populations Published in the Journal of Music Therapy, Music Therapy Perspectives and Orff Echo

Cynthia Colwell, PhD, MT-BC, The University of Kansas


 The researcher was interested in examining what work has been completed and disseminated using the Orff approach with special populations either in a music education setting with individuals with special needs or in a music therapy setting with diverse clients. The intent of this study was to examine anecdotal and research materials that have integrated the Orff process with individuals with special needs in music education and music therapy in an effort to outline a research agenda for the use of the Orff approach with special populations. To this end, the purpose of this study was to locate articles addressing the Orff approach with special populations in professional journals of the American Music Therapy Association (AMTA) and the American Orff­Schulwerk Association (AOSA) through a content analysis approach. A content analysis is a systematic method for determine the presence of certain words or concepts and compressing large amounts of text in to content categories following specific predetermined guidelines (Krippendorff, 2004; Neuendorff, 2002; Stemler, 2001; Weber, 1990).Articles were examined and data were categorized and recorded on a Coding Form. The Coding Form recorded: (a) journal, (b) date of publication, (c) volume, issue, pages, (d) name of the authors, (e) authors credentials, (f) special population addressed, (g) age grouping of the population, (h) setting for the intervention, (i) Orff technique or media mentioned, (j) article type, and (k) educational or therapeutic intended outcomes. The researcher provides a reference list of articles that were included in the categorization and a brief narrative summation of information found in these articles beyond that which was coded. In addition to this categorization, the researcher summarized the content of the articles in an effort to determine a potential research agenda for using the Orff process with special populations in educational and therapeutic settings.

Participants' Perceived Personal and Therapeutic Effects from Participation in an Intergenerational Music Program

Alice-Ann Darrow; Melita Belgrave
The Florida State University


 The purpose of the present study was to examine older persons' and college music majors' perceived personal and therapeutic effects from participation in an intergenerational music program. Twenty college music majors and twenty-two older adults served as participants in the present study. Participants were given a pre­assessment—the Age Group Evaluation and Description (AGED) Inventory to determine their pre-existing attitudes toward four groups: college males, college females, senior males, and senior females. Following the pre-assessment, participants met twice a week for eight weeks to rehearse standard rock songs from the 1970s to the 1990s. At the end of the eight weeks, participants gave a rock concert at the cooperating university college of music. After the concert, subjects were given a post-assessment using the same attitudinal scale. In addition, the older adults were interviewed in focus groups. The interviews were later transcribed and a content analysis done on the transcriptions. Results of the post-assessments indicated that attitudes of male and female college music majors improved toward themselves and each other. Their attitudes toward the older adults also moved in a positive direction. No differences were found in the attitudes of the older adults toward themselves, but significant differences were found in their attitudes toward the college-age participants. From the content analysis of interviews, the older adults identified twenty-three perceived therapeutic benefits that resulted from their participation in the intergenerational music program. From an analysis of survey comments, college students identified eighteen personal benefits that results from their participation in the intergenerational music program.  

Immediate Effects of Music Therapy Interventions on Persons in an Intensive Outpatient Psychiatric Treatment Program: Analysis of Mean Changes within a Single Session

Cara Davis, MT-BC, NMT, University Hospitals Case Medical Center; Michael J. Silverman, PhD, MT-BC, University of Minnesota


There is a scarcity of quantitative psychiatric music therapy research (Choi, 1997; Gold, Heldal, Dahle, & Wigram, 2005; Silverman, 2003b). The purpose of this study was to evaluate the immediate effects of eight single music therapy interventions (music game, songwriting, lyric analysis, music drama, group improvisation, music and art, music listening, and music and relaxation) on psychiatric outpatients' perceptions of happiness, sadness, anxiety, feelings of discouragement, annoyance, energetic feelings, and perceptions of treatment continuity using a pre-posttest design similar to that of Silverman and Marcionetti (2004). Results indicated there was a statistically significant difference between the number of positive mood changes and the number of no changes or negative changes, with the number of positive mood changes occurring most frequently. Further, there was a statistically significant difference between the number of positive treatment continuity changes and the number of no changes or negative changes, with the number of positive treatment continuity changes occurring most frequently. Overall, it would seem that music therapy interventions tended to have positive effects on psychiatric consumer rated dependent mood and treatment continuity measures within the time constraints of a single session. The majority of participants indicated they thought music therapy interventions were beneficial. Further, the majority of participants indicated they would incorporate music into their daily lives. From the results of this study, it seems that a single music therapy session can have a positive impact upon psychiatric consumers concerning a number of mood and treatment continuity measures. Limitations of the study and suggestions for future research are discussed.

The Clinical Effects of Music Therapy in Palliative Medicine and Hospice Patients

Lisa M. Gallagher, M.A., MT-BC

The Harry R. Horvitz Center for Palliative Medicine at the Cleveland Clinic Taussig Cancer Center & The Cleveland Music School Settlement, Ellen Shetler, MT-BC; The Cleveland Music School Settlement & The Hospice of the Cleveland Clinic, Ruth Lagman, MD, MPH; Declan Walsh, MSc, FACP, FRCP; Edin Mellar P. Davis, MD, FCCP; Susan B. LeGrand, MD, FACP; The Harry R. Horvitz Center for Palliative Medicine at the Cleveland Clinic Taussig Cancer Center


     There are few quantitative studies involving music therapy with individuals with advanced illness.  The aim of this study was to assess the differences in clinical effects of music therapy in palliative medicine and hospice patients.  One hundred age and gender matched palliative medicine and hospice patients were retrospectively evaluated.  The effect of music therapy on these patients is reported.  Visual analog scales, the Happy/Sad Faces Assessment Tool, and a behavior scale were utilized to record pre- and post-music therapy scores.  Rating was done by music therapists.  Symptoms included pain, anxiety, depression, shortness of breath, and mood.  Behaviors were facial expression, body movement, and verbalizations/vocalizations.  A paired t-test (P<0.05) demonstrated that with palliative medicine and hospice all symptoms and behaviors improved and were statistically significant.  Only three of these were found to be statistically significant when compared between programs.  The effectiveness of music therapy in addressing specific goals was compared between programs using the Chi-square test (P<0.05).  The study results suggest that there are differences in responses to music therapy between palliative medicine and hospice patients.

The Impact of Live Religious Music Versus Live Secular Music on Pre-Wandering Behaviors of Persons Diagnosed with Dementia of the Alzheimer’s Type

Renata L. Geyer, M.M. MT-BC


The purpose of this study was to identify the impact of live religious music versus live secular music during a music therapy session on pre-wandering behaviors of persons diagnosed with dementia of the Alzheimer's type. A secondary purpose for this study was to identify the impact of live music therapy, using religious and secular music, on wandering behaviors occurring on a nursing unit. It was hypothesized that live religious music would help to decrease pre-wandering behaviors more than live secular music within a music therapy session. It was also hypothesized that music therapy, whether consisting of religious or secular music, would help to decrease wandering behaviors on a nursing unit. A pretest-posttest control group design with two dependent variables, pre-wandering and wandering behavior was used. For the purpose of this study, pre-wandering behavior was defined as a subject's attempt to perform motor activity that takes the individual from a seated position to a position in which contact is no longer made with the seat of the chair. In addition, the individual must also take at least one step to move away from the chair. Wandering was defined as aimless or purposeful motor activity that causes a social problem such as getting lost, leaving a safe environment or intruding in inappropriate places.

The Effect of Behavioral Contracting on the Acquisition of Guitar Performance Skills in a College Level Beginning Guitar Class

Lori F. Gooding, MM, MT-BC, The Florida State University


The purpose of this study was to determine the impact of behavioral contracting on the acquisition of guitar performance skills in a college beginning guitar class. Participants (N=27) were divided into four groups, with 2 groups serving as control (G1, G2) and two groups serving as experimental (G3, G4). After taking baseline data for all groups, a multiple baseline format was implemented, with participants in the experimental groups (G3 and G4) receiving behavioral contracts in which group members were allowed to make structured choices about evaluation procedures. Members of the experimental groups were also allowed to select a reward to be earned if all contract stipulations were met. Data on speed increase and accuracy were collected via videotaping and analyzed by an independent reviewer. . All groups improved in both speed and accuracy, with the control groups improving speed by an average of 41% (G1) and 38% (G2). The experimental groups improved speed by an average of 76% (G3) and 67% (G4), with each group improving an average of 8% beyond the required amount to meet contract stipulations. A 2-way repeated- measures ANOVA indicated a significant difference in speed increase between both control groups and experimental Group 3 and a significant difference between experimental Group 4 and control Group 2. Though there was a decrease in errors / across time, there was no significant difference among the groups in error reduction. However, it is important to note that the contracting groups started with fewer errors and saw the greatest decrease in errors during their contracting conditions.

Instruction and Accessibility Analysis of Commercial DVDs for Beginning Guitarists

Dianne Gregory, The Florida State University


Guitar classes are popular alternatives in middle and high school general music education and excellent opportunities for including students in special education programs in the regularly scheduled music instruction. Options for guitar teachers include modifying traditional instructional methods for all students, accommodating the needs of students with disabilities, and adapting instruments for individuals. Commercially produced DVDs, primarily designed for self-directed instruction, are also popular and could possibly bridge the gap for all students between class instruction and practice at home. Does the content of commercial DVDs address skills related to MENC standards? Are some DVDs more accessible than others for students with disabilities? Seventy one new guitar instruction DVDs were added to during 2007. A listing of the top 100 best sellers of all available DVDs, including the new ones, revealed a preponderance of DVDs devoted to either a single style of a specific guitarist (e.g., Eric Johnson, Stevie Ray Vaughn), a specific type of guitar (e.g. electric, bass), or a specific genre (blues, soul, rock, jazz). Only 19 were specific to general guitar instruction. The top 4 that included "beginning" in the title, the subtitle or the description (#1, 4, 24, and 91) were selected for this analysis. They are: House of Blues Beginning Guitar (2005), Learning Guitar for Dummies (2001), Hal Leonard Guitar Method for Beginner Acoustic and Electric (2000), and eMedia Essential Guitar (2006). Descriptions of content revealed different song selections, different chord instruction sequence, and different strum and pick patterns across the 4 DVDs.  MENC Music Education Standards for middle school and high school students related to guitar performance were used to determine the appropriate "grade level" of each DVD based on the evaluation of content. All DVDs appeared appropriate for high school students and relevant to the MENC standards. Only Learning Guitar and eMedia Essential Guitar seemed appropriate and relevant for middle school students. Additional content analysis revealed that each DVD had a unique set of "bells and whistles" that separated it from the others such as random "pop up" facts (Learning Guitar) and bottom-of-the-screen tab and notation (eMedia Essential Guitar). Each DVD was also analyzed using a content delivery checklist based on accepted principles for learning: Was the delivery sequential, cumulative and repetitive? Although the content varied across the DVDs, three of them met these criteria but used different methods, such as reviews, quizzes, and repetitive menus. Each DVD was also analyzed across several factors related to accessibility for students with learning and physical disabilities. The factors included (1) single concept presentation within a unit, (2) rate of speech, (3) consistent visual display across chapters, (4) split screen applications, (5) use of color, (6) print size, (7) verbal descriptions of written words, (8)static or animated visual cues, (9) demonstrations, (10) closed captioning, and (11) transcriptions. No single DVD excelled in all of the accessibility factors. The analysis, however, provides the strengths and weaknesses of single DVDs and possibly functions as a guide for selecting a single beginning guitar instruction DVD for an individual student or a group of students with similar needs.

The Use of the Lydian Mode in American Popular Culture: Implications for Music Therapy

Robert Groene, University of Missouri — Kansas City


The Lydian Mode has been used in American culture to often represent feelings and values related to nostalgia, happiness, wonder, and the fantastic. Its pervasiveness in concert music, musicals, film soundtracks, television shows, commercials and (after reflection) in the presenter's own compositions has intrigued the presenter to try to identify the programmatic and cultural messages its composers wish to impart. As such, the Lydian Mode can be a potential tool for music therapy personal and clinical work with a variety of populations. This paper will explore the Lydian Mode and its variations through identified cultural examples and its implications for music therapy clinical work.

Between Group Differences and Changes in Perceptions of Students in the Music Therapy Introductory Course: A Mixed Methods Approach

Ann Houck, PhD, MT-BC; Michael J. Silverman, PhD, MT-BC
University of Minnesota


 The introduction to music therapy course is often the first formal experience students have with the profession. This course can be a method of attracting/recruiting majors and, therefore, potentially increasing the size of the field. However, although there is a good deal of literature concerning the training of upper level music therapy students, there is little published research on students enrolled in the introductory music therapy course. The purpose of this study was to study changes and between group differences of students in an Introduction to Music Therapy course using qualitative and quantitative methods in a pre-posttest design. Results indicated music therapy majors were more excited and interested in the course and thought it was less difficult than groups composed of other majors. Music therapy majors were the only group to have a mean increase in "excitement about becoming a music therapist" from pre to posttest. Additionally, perceptions concerning clinical populations that students were interested in changed over the course of the semester. Participants indicated that ability to relate, interpersonal, and therapeutic skills were the most important qualities of music therapists, although musical ability was never selected. Participants had a number of concerns about the profession, primarily lack of jobs and lack of awareness of music therapy. During pre and posttest, participants tended to indicate that people would be interested in becoming a music therapist due to a passion for music and altruism. Definitions of music therapy changed from pre to posttest and tended to indicate a deeper understanding of the variety of clinical populations served and a more evidence-based and scientific approach to the profession. Suggestions for future research, implications for therapy and education, and limitations of the study are provided.

The Development of a Music Therapy Protocol for Determining the Spiritual Needs of Hospice Patients

Ann J. Whitehead Houck, Ph.D., University of Minnesota


 The innovative use of music with those facing end-of-life issues provides a positive influence on patients' physical, emotional, social, and spiritual well-being (Foxglove & Tyas, 2000). Clair (1996) outlines a number of reasons to show music therapy's viability in hospice and palliative care. Among the reasons she lists are for reminiscence and life review, relating to others, distraction from pain, emotional comfort, relief from anxiety, provision of enjoyment, and release in the last hours of life. Aldridge (1996) recognizes that terminally ill patients and their loved ones undergo challenges and changes with which they must cope as they deal with end of life issues. Along with physical, personal and relationship changes, spiritual changes are also present and need to be recognized.

Prospective Music Teachers Reflect on First Experiences as Artists in Elementary Classrooms

Jacqueline Henninger, Laurie Scott, Judith Jellison, The Center for Music Learning
The University of Texas at Austin


 We examined changes that took place in the perceptions of 18 prospective music teachers during their first experiences performing and teaching in two different field experiences in elementary music classrooms. The field experience provided students with an opportunity to combine their excellent musicianship with newly learned teaching skills in a performance-type format. Based on instruction and feedback from the course, each undergraduate integrated their knowledge and skills into written plans from which they taught twice—each lesson with a different classroom in one grade level (most often fifth grade). Following each experience, participants were asked to individually view videotapes of their lessons, analyze the experience using specially designed observation forms, select two 10-minute excerpts (one labeled by the participant as "good" and the other "not so good"), and write two reflection paragraphs, one for each excerpt.    To analyze paragraphs written by undergraduates in the study, ideas were coded as positive, negative, or neutral using the categories of Teacher (Use of strategies; Affect; Music skills and knowledge; Other) and Students (Music skills and knowledge; Social skills; Affect; Other). Although 75% of all statements related to participants’ perceptions of themselves as teachers and only 25% related to their students’ behaviors, changes were reflected for several categories between the first and second experiences. Participants gave greater attention to the "Student Music Behaviors" in Experience II than they had in Experience I.  Overall, however, participants were more positive about their use of strategies and expressed less negative affect.  

Students Pursuing a Degree in Music at the Undergraduate and Graduate Level: A Qualitative Study on Motivation

Rachael L. Johnson, Western Illinois University


 This study was undertaken to gain a better understanding of the motivations of students pursuing a degree in music at the undergraduate and graduate level. There were 4 undergraduate music students and 1 graduate music student who participated in a 30-minute interview answering 8-10 guiding questions about their motivations. The interviews yielded 27 pages of transcript with differences and similarities in how and what each participant spoke about concerning motivation. Five main factors are discussed including practicing, audience, interest, privilege and relationship. The concept of right and wrong motivations was also discussed.

Music Therapy as a Supplemental Teaching Strategy for Kindergarten ESL Students

Roy Kennedy, The University of Georgia


The purpose of this study was to give a descriptive account of the use of music therapy techniques on the English speaking and story retelling skills of Kindergarten students in English as a Second Language (ESL) classes. Nine students in a community based after-school ESL class and 9 students in a regular public school ESL class received music therapy sessions designed as supplemental teaching strategies in addition to their regular ESL classroom routines. Observers indicated that both groups performed well on story retelling skills and English speaking skills; although, the after-school ESL group performed better than the public school group. This study suggests that the community setting may be a more relaxed and less intimidating environment for young English language learners.

The Relationship Between Pitch Processing and Phonological Awareness in Five- and Six-Year-Old Children

Linda M. Lathroum MA, MT-BC, Doctoral Candidate, University of Miami


Studies have shown that phonological awareness is a good predictor of children's later reading success. Phonological awareness is the awareness that spoken language can be subdivided into words, syllables, and phonemes. Additionally, phonological awareness involves perceiving, manipulating, separating, and blending sounds in speech. Research suggests an apparent overlap between pitch processing skills and phonological awareness. This perceptual overlap revolves around the fact that children appear to perceive and organize tonal patterns into auditory Gestalts in the same way that they perceive and process linguistic sounds related to phonological awareness. Additionally, the same neuroanatomical structures are involved in these two processes. Participants (N=27) were five- and six-year-old-children in three private classrooms in South Florida. Participants' parents filled out a demographic questionnaire. The investigator administered the Primary Measures of Music Audiation Test (PMMA) in order to assess pitch processing. The pitch or tonal sub-test was administered. This test measures pitch processing by assessing audiation, or the skill of organizing isolated pitches into tonal patterns. Additionally, the investigator assessed phonological awareness skills using the Comprehensive Test of Phonological Processing (CTOPP). Three tasks were used to assess the phonological awareness of five- and six-year-old children: elision, blending words, and sound matching (first sound and last sound). The phonological awareness component of the CTOPP is a composite score of the three sub-tests. This study supports the need for further research regarding the relationship between pitch processing and various components of phonological awareness. Additionally, this study's findings could be used to develop therapeutic interventions for children who are at high risk for reading disabilities.

The Effect of Developmental Speech-Language Training through Music on Speech Production in Children with Autism Spectrum Disorders

Hayoung A. Lim, Ph.D., MT-BC, NMT, Sam Houston State University


Children with Autism Spectrum Disorders demonstrate deficits in speech and language, with the most outstanding speech impairments being in comprehension, semantics, prosody, and pragmatics. Perception and production of music and speech in children with ASD appear to follow the same principles of Gestalt pattern perceptual organization. In addition, common neuroanatomical structures and similar patterns of cortical activation mediate the perception and production of speech and music. Therefore, the purpose of this study was to explore how the perception of musical stimuli would impact the perception and production of speech and language in children with ASD. The study examined the effect of developmental speech-language training through music on the speech production of children with ASD. The participants were 50 children with ASD, age range 3 to 5 years, who had previously been evaluated on standard tests of language and level of functioning. The children completed the pre­test, six sessions of training, and the post-test. The pre-and post-tests consisted of the Verbal Production Evaluation Scale (VPES) and measured each participant's verbal production including semantics, phonology, pragmatics, and prosody, of 36 target words. Eighteen participants completed music training, in which they watched a music video containing six songs and pictures of the 36 target words. Another group of eighteen participants completed speech training, in which they watched a speech video containing six stories and pictures of target words. Fourteen participants were randomly assigned to a no-training condition. Results of the study showed that participants in both music and speech training significantly increased their scores on the VPES from the pre-test to the post-test. Both music and speech training were effective for enhancing participants' speech production including semantics, phonology, pragmatics, and prosody. Participants who received music training made greater progress on speech production than participants who received the speech training; however, the difference was not statistically significant. Results of the study also indicated that the level of speech production was influenced by the level of functioning in children with ASD. An interaction between level of functioning and training conditions on speech production approached significance. The results indicate that both high and low functioning participants improved their speech production after receiving either music or speech training; however, low functioning participants showed a greater improvement in speech production after the music training than after the speech training. Collectively, music training was more effective for speech production in low functioning children with ASD than was speech training. The study suggests that the superior performance in speech production in children with ASD who received music training might be generated from music stimuli which were organized by the Gestalt laws of pattern perception. In conclusion, children with ASD appear to perceive important linguistic information (i.e., target words) embedded in music stimuli, and can verbally produce the words as functional speech. These results provide evidence for the use of music as an effective way to enhance speech production in children with ASD.

A Cross-cultural Comparison of an Audio-Visual Presentation

Katia Madsen, Louisiana State University; Clifford K. Madsen, John M. Geringer, Florida State University


 This study is an extension of a line of research that investigated musicians’ perceptions of a performance of Strauss’ Blue Danube Waltz performed by the Vienna Philharmonic Orchestra when the performance was edited such that it included portions of five orchestral performances with five different conductors. Participants were graduate music majors in Argentina (N = 30) who indicated their focus of attention to designated music elements while listening to the performance without seeing the video, and who then commented on the total listening experience after experiencing the audio-visual presentation. A one-way ANOVA with repeated measures indicated a significant difference (p = .017) across focus of attention elements. Subsequent statistical analysis revealed that participants focused their attention less on "everything" than they did on the "dynamic" and "melodic" elements of the performance. Participants focused on the "melodic" elements of the performance more than the "timbral" elements. No other significant differences were found. As in the previous studies, no participants identified that the performance had been an edited version of different conductors conducting different orchestras. It seems that when musicians listen to music within context, there is a "gestalt" effect that may influence their perceptions, even when they report focusing their attention more on individual aspects of the music than on "everything."

The Effect of Music Therapy on Relaxation, Anxiety, Pain Perception, and Nauseain Adult Solid Organ Transplant Recipients: A Pilot Study

Amy T. Madson, Michael J. Silverman
University of Minnesota


Organ transplant recipients characteristically experience low levels of relaxation and high levels of anxiety, pain, and nausea. Although music therapy has demonstrated effectiveness in ameliorating these types of conditions with patients in other areas of medical hospitals, no studies have quantitatively evaluated the effects of music therapy on solid organ transplant patients. The purpose of this study was to assess the impact of single session music therapy on anxiety, relaxation, pain, and nausea levels in patients recovering on the transplant unit of the hospital utilizing a pre-posttest design. Participants (N= 59) received an individual 15-35 minute music therapy session consisting of live patient-preferred music and therapeutic social interaction. To remain consistent with the hospital's evaluative instruments during this pilot study, participants' self-reported levels of anxiety, relaxation, pain, and nausea, were based on separate ten-point Likert-type scales. Changes in affect and verbalizations were observed, and anecdotal data were collected from participants and hospital staff. Results indicated there were significant improvements in self-reported levels of relaxation, anxiety, pain, and nausea (p < .001). Chi square tests demonstrated increases in positive verbalizations and positive affect to be statistically significant. All participants reported that they would like to receive music therapy again during a future long-term hospital stay. From the results of this pilot study, it seems that music therapy can be a viable psychosocial intervention for hospitalized postoperative solid transplant patients. Implications for clinical practice and suggestions for future research are provided.

Brain-Jamming for Focus: Helping AHDH Children with Music and Neurofeedback

Eric B. Miller, Ph.D. MT-BC, Expressive Therapy Concepts


Within the backdrop of a societal healthcare paradigm swing, this study of EEG neurofeedback with music therapy protocols added an experimental group (NF-MUS) to an existing Philadelphia Office for Mental Health multi-site study of two traditional neurofeedback (NF) protocols. Thirty-eight subjects completed the pre- and postintervention assessment comprised of the Stroop, Toni-3, NEPSY Attention/Executive core domain score, Conners CPT and ADHD Parent and Teacher Rating Scales Revised (S). NF-MUS subjects also received pre- and post-quantitative EEG (QEEG) topographical brain-mapping. NF-MUS utilized a Theta/Beta protocol variation, incorporating brain-triggered musical tones assigned to Theta amplitude in key with background musical selections. Individual results within the NF-MUS group showed improvement on NEPSYcore domain scores and improvement individually on the Stroop Color and Word tests, but showed mixed results on the combined Stroop Color/Word test. Three out of four NF-MUS subjects improved their TONI quotient. CPT results were mixed, with some individuals displaying dramatic improvement on the CPT's ADHD index score. A paired samples T-test showed no significant differences between pre- and post-Toni-3 scores or Stroop Color/Word scores. Significant improvement was found for the Stroop Color and Stroop Word scores individually and for the NEPSY Executive Function/Attention subscale index scores. Between-group analysis showed the NF-MUS group significantly superior to the other NF groups and control subjects on three measures: the NEPSY audio subtest (p = .01); the Conners Parent Rating Scale ADHD index (p = .015); and, the Conners Parent Survey Cognitive subscale (p = .043). Differences in QEEG brain maps ranged from very little change pre- and postintervention to noticeable normalization patterns. NF-MUS subjects decreased their Theta/Beta ratio (p=.004) and increased their SMR (p=.012) as hypothesized. Theta reduction alone, however, was not significant (p=.189).These results indicate that a brain-triggered musical component to neurofeedback protocols may yield superior remediation of ADM symptoms than standard neurofeedback protocols. Acceptance of these results and incorporation of findings into clinical practice, however, is unlikely until further investigation corroborates these results, and medical community attitudes continue to shift in the direction of holistic therapies.

Influence of Music Teacher Affect on Kindergartner's Affective Responses and Participation in Music Class

Randall Moore, University of Oregon; Sally Webber, Adams Elementary School


 A music specialist taught four 20 minute music lessons with 20 Kindergartners in their classroom over a four week period. A total of 80 minutes were videotaped with two cameras to observe affective responses of teacher and students. Primary activity focused on singing songs and using movements to enhance contextual meaning of song lyrics. Subjects were six year old children who were completing one year of Kindergarten education in a neighborhood school; composition of students included one autistic boy and children from Hispanic, African-American, Asian and Caucasian backgrounds, all of whom spoke English. Purpose of the study was to observe the influence of teacher's affective behavior and students' affective responses. Procedures followed permission requirements of the school district and initial acceptance of school teacher and principal. Students' parents all signed a consent statement allowing their children to be videotaped for research purposes. Two professional photographers videotaped four 20-minute music lessons using two video cameras, and results were combined into one film with running time shown in minutes and seconds for analysis purposes. Two observers independently observed the 80 minutes of film and rated the percent on-task of subjects, type of motions exhibited by teacher and students, as well as their affective behavior during lessons. Affective responses were counted by frequency and intensity and included visual and aural behaviors. Observational data were collected at 20 second intervals or three times per minute. Observers marked intensity of affective responses on a scale from 1-5 with 1 being low intensity and 5 being high intensity. Typical affective responses were observed visually and aurally and included such behaviors as smiling, laughing, sadness, and crying. Animated movements were seen as affective expressions of student involvement. Cheerful and sad moods were incorporated into selected songs and participants demonstrated clear contrasts in affective responses. Humorous songs included such titles as, "One Finger-One Thumb Keep Moving" and "Hokey-Pokey" which contrasted with the sad lyrics of "Don Gato." The illustrated text of "Don Gato" was used to focus attention from the teacher onto written lyrics that were enhanced by colorful drawings in a printed text. Contrasts between facial expressions of glee and sober feelings were observed in video observation. Results showed that students imitated the music teacher's physical and affective responses throughout the lessons. The animated character of the music teacher was reflected almost immediately in the students' responses. Over 90% on-task behavior occurred in the group of subjects. Focused observation on the autistic subject revealed a much higher involvement in group activities during music activities compared with non-music learning periods. The classroom teacher was startled by the high rate of participation of her group of students and in particular, by the high on-task behavior of the student with autism. Classroom teacher remarks revealed high consistency with observational findings and indicated that individuals showed more on-task behaviors during music lessons when singing with highly animated movements as contrasted to passive music listening which opened each day's classroom activities. Findings corroborate A. Bandura's research that consistently found the prominent and powerful influence of teacher modeling on student behavior. Recommendations for music therapists and teachers suggest that song leaders will have more positive influences on clients and students when they utilize animated and enthusiastic presentations when song leading. Affective responses of the music teacher in this study were instantly reflected in students' reactions and led for over 90% participation and 80% affective responses in all subjects. Students' behavior mirrored the affective behavior of the music teacher and the nature of materials presented.

The Effect of Music Listening on the Let Down Reflex and Milk Production while Pumping

Valerie Oakley, The Florida State University


The purpose of this study was to determine whether music had an effect on the let down aim and milk production during a breast pumping session. The subject participated in four breast pumping sessions. Sessions were designed in the complete reversal method, with music interventions being used in the second and fourth sessions. Results showed that there was no difference in the time that the let down reflex took. There was an increase in milk volume when the subject listened to music while pumping.

Expectations of Two Undergraduate Music Therapists Regarding the Role of theClinical Practicum Supervisor

Varvara Pasiali, MME, MT-BC, NMT, LCAT, Michigan State University


The purpose of this study was to identify expectations of undergraduate music therapy students (n=2) regarding the role of the clinical supervisor and the process of supervision. Both participants had completed all required core music therapy coursework, including clinical practicum. Data included one personal semi-structured interview with each participant regarding their experiences and thoughts. Results included themes and salient points about: (a) Treatment Planning Skills, (b) Professional Role, (c) Treatment Implementation, (d) Music Skills, (e) The Therapeutic Relationship, and (f) Assessment and Documentation. The participants also shared thoughts about most and least valuable aspects of the program as well as most and least useful advice received during clinical supervision. Discussion includes the researcher's interpretations and conclusions as well as implications for future research.

Word Usage and Thematic Content of Song Lyric Analyses: A Comparison of Adolescents Living in Community and Residential Environments

Thomas J. Petterson, Florida State University


Interventions for adolescents at-risk may be viewed as a form of treatment and preventative care. Although many adolescents already exhibit high-risk behaviors before being exposed to any sort of formal treatment, more severe consequences can be anticipated in the absence of sufficient intervention. Many guidelines are used in order to determine the most appropriate setting for intervention to take place. The most frequently mentioned principle is that of least restrictive environment; identifying a treatment setting which is least disruptive to the individual's natural environment, yet still efficiently addresses the individual's needs. In surveying the treatment options available to adolescents, a continuum becomes apparent. At the least restrict end of this continuum are nonresidential treatments, including outpatient, home- and school-based therapies. At the most restrictive end of the continuum are inpatient hospitalization and institutional treatment. Information on evidence-based practices within these settings is essential to providing optimal service delivery and treatment for adolescents. An individual's music of choice tends to carry a special level of significance in the lives of adolescents. Songs are a medium through which adolescents communicate regularly, articulating values and beliefs with comfort and ease. Songwriting and lyric analysis are two music therapy techniques which take advantage of the communicative aspect of songs and the appeal of preferred music. Songwriting and lyric analysis are highly adaptable forms of therapeutic interventions, and both have been found to be highly effective with adolescent-aged youth. The purpose of this study was to examine the compare the thematic content and word use patterns found lyric analysis responses and songwriting lyrics of at-risk adolescents from community and residential settings. Adolescents living in a voluntary, short-term residential facility (n = 15) and adolescents living with family members in a typical home environment (n 15) served as participants. The study was conducted in three phases: a lyric analysis phase, participant interview phase, and group songwriting phase. During the first two phases, participants individually listened to two popular songs—one rap and R&B, and then responded orally to a series of questions regarding the lyrics of each song. Oral responses of participants were audio recorded and transcribed. Content analysis was employed to code interview responses and participant-composes song lyrics into thematic categories. Linguistic Inquiry and Word Count, a software program that analyzes the content of written text, was also employed to identify trends in word usage. Content analysis revealed a focus on themes within the responses of the residential group that was not found in the community group. These themes were: regret, loss of control, feeling restrained, and finding happiness regardless of wealth. Conversely, song lyric lines of the community group contained more thematic content in the categories of negative experiences and social/peer groups. Significant differences were also found in the lyric analysis responses of the two at-risk groups. Word use of the community group was significantly greater than the residential group in two categories—total pronouns and impersonal pronouns. Similarities were found between the two at-risk groups in their use of feeling words, their music preferences, and thematic category of family in their lyric analyses and songwriting lyrics. Data found in this study align with typical therapeutic objectives of adolescents receiving residential and non-residential treatment. The alignment indicates that lyric analysis and songwriting interventions may be effective methods for providing therapy to at-risk youth. Additionally, finding of this study suggest that adolescents are willing to disclose information and engage in dialogue related to therapeutic issues within the context of lyric analyses and songwriting. These music therapy interventions, therefore, appear to be viable and effective therapeutic strategies for use with at-risk adolescent populations.

The Effects of a Music-based Literacy Curriculum on Essential Literacy Skills of Pre-Kindergarten children.

Dena Register, Ph.D., MT-BC, University of Kansas


The purpose of this study was to investigate the use of music to support early literacy learning in the early intervention classroom. Subjects (N=87) enrolled in one of six different Pre-Kindergarten classes in a public school and were grouped by district-determined classroom. Participating classes were assigned to one of three conditions each semester. During the fall semester groups were defined as 1) no music, 2) music for recreation and music learning and 3) music for literacy learning. In the spring semester the groups were altered. The no music group received music for recreation and music learning and the remaining two groups received music for literacy learning. All contact groups met one time per week for a total of fifteen weeks with sessions lasting approximately 30 minutes each. Subjects were be pre- and post-tested individually using two subtests of the Dynamic Indicators of Basic Early Literacy Skills (DIBELS). Groups engaged in music for literacy learning received music interventions designed to increase letter naming and initial sound fluency in early intervention. Children in the group that received music interventions to teach reading skills scored higher on the Initial Sound Fluency subtest. Results suggest that music interventions designed to teach specific material is more effective than music for general purposes.

The Effect of Songwriting on Knowledge of Coping Skills and Working Alliance in Psychiatric Patients: A Randomized Controlled Trial

Michael J. Silverman, University of Minnesota


 Coping skills are considered an essential part of healthy well-being while working alliance can be an indicator of therapeutic outcome and treatment retention. Presently, there is a lack of quantitative psychiatric research and researchers have not evaluated the effect of music therapy on these aforementioned variables. The purpose of this study was to determine the effects of a songwriting intervention on psychiatric patients' knowledge of coping skills and working alliance. Participants were randomly assigned to scripted and manualized experimental (n = 48) or control (n = 41) conditions. The experimental condition was a group psychoeducational music therapy songwriting session concerning coping skills while the control condition was a group psychoeducational session concerning coping skills. Results indicated no significant between group differences in measures of knowledge of coping skills, consumer working alliance, or enjoyment (p > .05), although the experimental condition tended to have slightly higher mean scores than the control group. However, there was a significant between group difference in measures of therapist working alliance (p < .001), with the experimental group scoring higher than the control group. All participants but one indicated they would attend another session if given the opportunity, suggesting that, regardless of condition, participants felt there was a therapeutic benefit from attending sessions. Results of this study are congruent with existing psychosocial research indicating diminutive differences between experimental and active control conditions. It seems that group songwriting about coping skills can be an effective psychosocial intervention for teaching psychiatric inpatients how to proactively manage their illness. Implications for clinical practice, limitations, and suggestions for future research are provided.

NICU Music Therapy: A 1-year Post Hoc Clinical Analysis of Premature Infant Characteristics and MT Interventions

Jayne M. Standley, PhD, MT-BC, NICU-MT; Olivia Swedberg, MM, MT-BC, NICU-MT
The Florida State University


 The incidence of premature births in the United States is increasing as are medical costs related to this problem. Research has shown benefits for NICU-MT in research with controlled clinical trials but small sample sizes. Such benefits have included significantly earlier discharge dates and a consistent pattern of increases in weight gain that have not been statistically significant. The NICU music therapy program at TMH has been in effect for over 5 years and includes referral for music listening, multi-modal stimulation, Pacifier-Activated-Lullaby treatment, and parent training in infant stimulation. Multi-site research has indicated that the length of stay for NICU infants at TMH is shorter than that in comparable NICUs in the Southeast. The purpose of this post hoc analysis of clinical records for all NICU infants treated at Tallahassee Memorial Hospital during the year 2006 was to describe the MT interventions provided by the Florida State University Medical Music Therapy Program and to ascertain whether music therapy contributed to patient benefits in hospital length of stay or weight gain. Further, the study analyzed whether benefits were differentiated by gender, severity of prematurity, length on ventilation, or other clinical diagnoses/medical interventions. The design of the study was post hoc analysis of clinical records. The dependent variables were length of NICU stay and weight gain. These data were collected by persons blind to the music therapy condition. The independent variable was music therapy treatment in the NICU vs NICU treatment without music therapy. Subjects were all infants born low birth weight in the calendar year 2006 and treated in the TMH NICU. Subjects were identified from the TMH medical records with clinical information obtained from Powerchart, the computerized medical records used at TMH and from departmental records of the Music Therapy Program. Infant records were excluded for those discharged to another hospital, rather than to home, and for those who died during their NICU stay. The sample size of NICU infants for 2006 was approximately 800 with approximately 45% of those having MT treatment. Since this was post hoc analysis of existing records, informed consent was not needed from individual patients, but IRB approval was obtained with a HIPPA waiver of confidentiality of records. Descriptive analyses by group were computed for severity of diagnoses, length of ventilation, and level of prematurity (extremely, very low birthweight, and low birthweight). For infants receiving music therapy, descriptive analyses were computed for days to discharge and weight gain by type of MT intervention (music listening, multi-modal stimulation, PAL treatment) and by duration of MT. Prior research at TMH shows that NICU infants receiving music therapy are discharged earlier than at other hospitals. This post hoc analysis describes the NICU-MT contribution to a nationally innovative and beneficial program of therapy for premature infants.

The Perception of Emotion in Music Among Women with Breast Cancer

Julie Stordahl, MA, MT-BC; Doctoral Candidate, The University of Miami


 Existing research indicates that women with breast cancer are likely to experience depression. In addition, an estimated 70 – 100% of cancer patients experience significant fatigue following cancer treatment. Fatigue contributes to greater levels of depression, anxiety, and mood disturbance. Chemotherapy is a common treatment for breast cancer. Both depression and chemotherapy may influence the perception of sensory stimuli, which may include the perception of music and of emotion in music. The purpose of this study was to determine the perception of emotion in music and the perceived magnitude of emotion in music among breast cancer survivors and women who have not experienced breast cancer. Specifically, this study exposed any differences existing in the perception of music between breast cancer survivors and women who have not experienced breast cancer. Demographic data were collected to identify and compare participants' age and cultural affiliation. Medical data were obtained to determine presence or absence of breast cancer. For those participants with breast cancer, information was reported by the participant concerning time of diagnosis, type and stage of breast cancer, and completed treatment(s). The breast cancer survivors responded similarly to the comparison group in terms of the perception of emotion in music and the perceived magnitude of emotion in music. When the data were averaged according to group, no differences were found. However, when data for each of the 15 test items were analyzed, statistically significant differences were found between the two groups for three individual test items.

Exploring Music in the Lives of Breast Cancer Survivors: A Qualitative Research Study

Julie Stordahl, MA, MT-BC. Doctoral Candidate, The University of Miami


 This study is comprised of two case studies exploring the unique role and function of music in the life of a breast cancer survivor. During the course of this research, I conducted two observations and two interviews. I observed and interviewed "C," an avid dancer, and "Z," an accomplished soprano. Both women are also breast cancer survivors.I observed C during a belly dance class that she attends regularly; I observed Z as she sang with her church choir during a religious service. Field notes were taken during each observation. Then, after each observation, I interviewed the two women. The interviews were audio-recorded and transcribed.As part of the data analysis, both the observation notes and interviews were coded, using both open and axial codes, and then placed into clusters. I compared the codes and clusters within each data set and across the two data sets. The analysis suggests that life-long involvement with music or dance served as a buffer following the diagnosis of breast cancer. As the result of their respective illness experiences, both C and Z developed a personal philosophy and continued to be involved with music or dance, although in a modified manner. The model below was developed after to reflect the commonalities in the two case examples.

The Effects of Participation in a Structured Music Group on the Development of Infants andToddlers: Parents' Perceptions and Use of Music Activities in Other Settings

Olivia L. Swedberg, MME, MT-BC, NICU-MT; Jayne M. Standley, Ph.D., MT-BC, NICU-MT; Darcy D. Walworth, Ph.D., MT-BC, NICU-MT; The Florida State University

Miriam G. Hillmer, MME, MT-BC, NICU-MT; Tallahassee Memorial HealthCare


Three interactive music groups designed to teach developmental skills, separated by the age of the children (6-11 months, 12-17 months, and 18-23 months), meet for 30 minutes weekly and are led by a music therapist. Each group follows a 12-week curriculum of age-appropriate music activities to promote child development. During the music groups, music therapists educate parents in ways to use music with their children to promote development. Parents and music therapists also model and encourage appropriate cognitive, communication, motor, and social skills for infants and toddlers. During their child's first visit to the group, parents receive a packet with lyrics of songs that are used in the curriculum, a packet with American Sign Language signs that are paired with songs in the curriculum. Within the first few weeks of attendance, parents also receive a free CD which contains age-appropriate songs for young children. Parents are given a new handout each week which gives ideas of other developmentally appropriate activities, some of which involve music, to try at home with their children. A questionnaire regarding parents' use of songs and activities from the groups in other settings was distributed to all parents (approximately 80) of infants and toddlers who attended the groups over a period of six months. The questionnaire consisted of four questions: 1.)        Since you began attending the music group, how often have you used songs/activities from the curriculum with your child outside of the group?  [Options for response were "never", "1-2 times", "3-5 times", or "6 or more times".]  2.) How often have you used activities from the handouts? [Options for response were "never", "1-2 times", "3-5 times", or "6 or more times".]  3.)     Which activities do you use with your child outside of the group? [Activities performed each week in the group were listed as follows: greeting songs, transitional songs, songs with sign language, songs with movement, songs with puppets, songs with stories, songs with scarves, songs with emotions, and songs for affection and bonding.] Please check all that apply and list any specific songs used for each activity.4.)  Have you noticed any development in your child that you attribute to use of the music curriculum? Please explain. Questionnaires were returned by 20 parents (approximately 25% of all parents surveyed) regarding their use of songs and activities in other settings. All parents who responded reported using songs and activities outside of the group at least once. The majority of parents (85%) reported using songs and activities in other situation at least six times. Almost all parents (95%) reported using activities from handouts outside of the group at least once, while most parents (60%) reported using activities from handouts at least three times. Songs and activities most frequently mentioned by parents as having been used outside of the group are (in order of frequency): transitional songs (mentioned by 95% of parents), greeting songs (90%), songs for affection and bonding (60%), and songs paired with movement (55%). Songs paired with scarves (used for color identification and visual tracking) and songs paired with sign language were the two types of activities that were cited least often by parents as being used outside of the group. Most parents wrote on the questionnaire the names of the songs and activities that they frequently use in other situations. Songs identified by more than five respondents include (in order of frequency): "Hello, Baby, How are You Today?" (a greeting song), "All Done" (a transitional song), "Time to Go" (a greeting song), and "If You're Happy and You Know It" (a song used to practice emotional identification). Many parents wrote positive comments about the benefits of participation in the groups on their children's development, reported using songs and activities learned in the group in multiple other settings (at home, when traveling, while shopping, etc.), and reported making up their own songs/activities based on their experiences with the group. The results of the questionnaire indicate that direct parent instruction in a music group setting with demonstration of appropriate activities and handouts describing ways to use music at home is an effective format for teaching parents to use music with their children to enhance development. Songs and activities that teach and reinforce social skills were most often used by parents in other situations.

Recognition of Geriatric Popular Song Repertoire: A Comparison of Senior Citizens and Music Therapy Students

Kimberly VanWeelden, Florida State University; Andrea M. Cevasco, University of Alabama


 The purpose of the study was to compare senior citizens' and music therapy students' recognition of 32 specific popular songs and songs from musicals. Results found 90% or more of the seniors had heard 28 of the 32 songs, 80% or more of the graduate students had heard 20songs, and 80% of the undergraduates had heard 18 songs. The seniors only correctly identified three songs with 80% or more accuracy, which the graduate students also correctly identified; the undergraduates identified only two of the three same songs. Seniors only identified the decades of 3 songs with 50% or greater accuracy. However, neither the undergraduate nor graduate students were able to identify any songs by the correct decade with over 50% accuracy. Further results are discussed.

Effects of Developmental Music Groups For Parents And Premature or Typical Infants Under Two Years On Parental Responsiveness And Infant Social Development

Darcy D. Walworth, Ph.D., NICU-MT, MT-BC


 The purpose of this study was to examine the effect of music therapy intervention on premature infants' and full term infants' developmental responses and parents' responsiveness. Subjects (n=56) were parent-infant dyads who attended developmental music groups or a control condition assessing responsiveness during toy play. All subjects were matched according to developmental age and were also matched by group for socioeconomic status and for maternal depression. Types of infant play and parent responsiveness were measured using observation of a standardized toy play for parent-infant dyads. Observations were coded with the number of seconds spent in each behavior using the SCRIBE observation program. Parents completed a questionnaire on the perception of their infant's general development, interpretations of their child's needs, the purpose of using music with their child, and their child's response to music. The infants attending the developmental music groups with their parents demonstrated significantly more social toy play (p < .05) during the standardized parent-infant toy play than infants who did not attend the music groups. While not significant, graphic analysis of parent responsiveness showed parents who attended the developmental music groups engaged in more positive and less negative play behaviors with their infants than parents who did not attend the music groups. This study demonstrates the first findings of positive effects of developmental music groups on social behaviors for both premature and full term infants under two years old.

Educational Supports for Students with Special Needs: Preservice Music Educators' Perceptions

Jennifer Whipple, PhD, MT-BC, Charleston Southern University; Kimberly VanWeelden, PhD, Florida State University


 Historically, music educators have expressed concerns about inadequate preparation to work with students with special needs, specifically desiring acquisition of new skills and competencies related to instruction adaptation for students with special needs. Therefore, it is important to identify those educational supports which are most beneficial to beginning teachers in order for university music education faculty to prepare them for working with special learners. Preservice music educators (N= 30) taught general music concepts to secondary students with special needs in a self-contained classroom during a 5-week field experience, and subsequently completed a survey regarding the importance of color coding, icons, echoing, buddy system, and other visual aides in general music, ensemble, and private studio settings. Results indicated that preservice teachers considered echoing to be significantly more important than written words, color coding, icons, and buddy system in general music, ensemble, and private studio settings combined; considered icons, echoing, buddy system, and other visual aides to be better than written words, and icons to be better than color coding in general music settings; and considered echoing to be more important than icons in ensemble settings, and more important than all other supports in private studio settings. However, when survey responses were examined for preservice teachers divided by semester in which they participated in the field experience (n = 15 for each of two semesters), results were somewhat different. Similar to combined semester results, responses from the semester I indicated that preservice teachers perceived echoing to be more important than written words, color coding, and icons for all settings combined; and when divided into separate educational settings, preservice teachers perceived echoing to be better than the same three supports in ensemble settings, and better than all other types of supports in private studio settings. However, responses from semester II indicated that for teaching in general music, ensemble, and private studio settings combined, preservice teachers perceived both echoing and color coding to be more important than written words; and when divided by educational setting, they perceived all types of supports to be better than written words in general music settings; color coding to be better than written words, icons, buddy system, and other visual aides in ensemble settings; and echoing to be better than written words and color coding in private studio settings.In addition, the survey included items which asked preservice teachers to evaluate the same supports as well as the use of small groups or stations for implementing assessments in general music and ensemble settings. Responses of preservice teachers in both semesters separate and combined reached some consensus in that, in addition to other significant difference pairings, the use of small groups or stations was consistently rated significantly higher than echoing for implementing assessments in general music and ensemble settings combined and in general music settings alone. Potential explanations for the between-semester differences in perceptions of educational supports for use in instruction are discussed, as are plans for additional data collection and implications for further research.

The Effect of a Live Music Interaction on the Stress Levels of Hospice Staff Members During a Hospice Interdisciplinary Team Meeting

Natalie Wlodarczyk, MM, MT-BC, NICU-MT, Florida State University


The purpose of this study was to determine the effect of live music on the stress levels of hospice interdisciplinary team (IDT) members. This study used a post-test only reversal design (ABAB) and participants were used as their own control. The design was counter-balanced (BABA) for half of the participants to control for order effect. Session A consisted of participants indicating their current level of stress on a Visual Analogue Scale (VAS) at the start of the IDT meeting. Session B consisted of participants listening to three minutes of live music provided by a music therapist with voice and guitar followed by participants indicating their current level of stress on the VAS. The study took place in the conference rooms of a local hospice. The members of four different hospice interdisciplinary teams agreed to participate in the study. The participants (N= 23) included nurses, home health aides, doctors, social workers, volunteers, and chaplains. Data were collected over a period of four weeks during weekly IDT meetings. All participants gave written consent prior to participation in the study. Data results were graphically and statistically analyzed after four weekly IDT meetings using a Friedman Two-Way Analysis of Variance (ANOVA). Results of self-report stress showed no significant difference between experimental and control conditions, k = 4, df = 3, &#967;r² = 4.33, p = 0.23, p > .05. Sequential graphed responses without regard to condition across the four weeks showed a slight decline in stress that may have been due to repeated use of the VAS. Free responses collected from participants support the use of live music in the IDT meetings as a favorable practice among hospice workers, and though the study did not yield significant results, several implications for future researchers in the area of music for stress relief for hospice staff are presented.  

Harmonica Therapy: The Healing and Health Power of Playing the Harmonica

Victor Yun, PhD, Stanford University Medical School Health Improvement Program (HIP)


The basic concepts presented in this article are based on consolidation of the existing body of knowledge, wisdom, traditions, anecdotal testimonies and evidence not only from harmonica playing communities and the general public but also from medical science communities. Working hypotheses regarding the physiology of harmonica playing and the theoretical implications for health benefits have been steadily on the rise in recent years. This article offers guiding principles for researching the supportive elements of harmonica, an instrument believed to be a source of life power and energy that harmonizes mind, body and soul. Thus harmonica therapy can be regarded as an integral part of mainstream music therapy.