Music Therapy Impacting Patients with Alzheimer’s Disease & Dementia

Famous jazz vocalist Tony Bennett’s experience with Alzheimer’s disease while actively performing the lyrics and melodies of a multitude of songs is a glimpse into the impact of music on brain function throughout cognitive decline. Dementia and Alzheimer’s disease affect a large number of older adults every year globally. In 2022, approximately 6.5 million people 65 years and older in America will be diagnosed with Alzheimer’s dementia (Alzheimer’s Association, 2022). While memory impairment and cognitive decline are the primary symptoms, agitation, anxiety, depression, and paranoia are among some of the other symptoms that affect people with Alzheimer’s disease (Brotons & Pickett-Cooper, 1996). Music therapists can address various behavioral, emotional, and cognitive goals with these patients.

Many types of music therapy interventions have been found to be successful in treating different behaviors and symptoms present within this population. One important goal is improving cognition. Movement and instrument playing interventions were found to be effective in improving next-day cognition and were greatly preferred by clients over other types of music interventions (Bruer, et. al., 2007). When facilitated by a board-certified music therapist, these interventions are accessible and adaptable to all clients regardless of their prior musical training or lack thereof. The goal of improving cognition can be achieved through more specific Neurologic Music Therapy (NMT) techniques. NMT techniques are a subset of music therapy interventions requiring special training and qualifications, which are used primarily in rehabilitative goals and settings. Techniques such as Associative Music and Memory training and Musical Executive Function training engage the patients and assist them in reaching orientation and cognitive goals through music (Álvarez, 2022). These focused interventions utilize music improvisation, singing, discussion, and other methods to provide cognitive stimulation.

“Sundown Syndrome” is an even more specific phenomenon that can be addressed by music therapists working with geriatric populations. Sundown syndrome, or sundowning, is the colloquial term for a set of negative behaviors that arise for dementia patients in the late afternoon or evening. These behaviors can include “confusion, disorientation, anxiety, agitation, aggression, pacing, wandering, resistance to redirection, screaming, yelling and so forth” (Khachiyants, 2011, p. 275). Agitation reduction is an important emotional and behavioral goal addressed by music therapists. Interventions such as therapeutic singing, instrument playing, movement with music, musical games, and improvisation have all been found to be effective in reducing agitation (Brotons & Pickett-Cooper, 1996). One study noted comments from caregivers that claimed patients were “more cooperative and responsive” following music therapy sessions (Brotons & Pickett-Cooper, 1996, p. 14). This implies that strategically timed music therapy sessions facilitated by a board-certified music therapist can be beneficial to improving the patient’s symptoms while aiding the jobs of the caregivers of patients actively experiencing sundowning. 

In addition to agitation and anxiety, music therapists can address depression symptoms in patients with Alzheimer’s disease and dementia. Reminiscence-based music therapy interventions use strategic familiar song choices and focused questions to facilitate discussion about certain topics. These types of interventions provide patients “a safe place to interact socially, to share their memories with other residents, and to improve self-image” (Ashida, 2000, p. 180). This positive social interaction and discussion leads to a decrease of depression symptoms among patients. Music therapists have the ability to positively impact many goal areas with patients with Alzheimer’s disease and dementia. The use of research-based interventions can improve the overall quality of life for patients in a rapidly growing geriatric population.

-Tess Vreeland, Music Therapy Intern

References

Álvarez, L. (2022). Neurologic music therapy with a habilitative approach for older adults with dementia: A feasibility study. Music Therapy Perspectives, 40(1), 76–83. https://doi.org/10.1093/mtp/miab021 

Alzheimer's disease facts and figures. Alzheimer's Disease and Dementia. (2022). Retrieved October 17, 2022, from https://www.alz.org/alzheimers-dementia/facts-figures 

Ashida, S. (2000). The effect of reminiscence music therapy sessions on changes in depressive symptoms in elderly persons with dementia. Journal of Music Therapy, 37(3), 170–182. https://doi.org/10.1093/jmt/37.3.170 

Brotons, M., & Pickett-Cooper, P. K. (1996). The effects of music therapy intervention on agitation behaviors of alzheimer's disease patients. Journal of Music Therapy, 33(1), 2–18. https://doi.org/10.1093/jmt/33.1.2 

Bruer, R. A., Spitznagel, E., & Cloninger, C. R. (2007). The temporal limits of cognitive change from music therapy in elderly persons with dementia or dementia-like cognitive impairment: A randomized controlled trial. Journal of Music Therapy, 44(4), 308–328. https://doi.org/10.1093/jmt/44.4.308 

Khachiyants, N., Trinkle, D., Son, S. J., & Kim, K. Y. (2011). Sundown Syndrome in persons with dementia: An update. Psychiatry Investigation, 8(4), 275. https://doi.org/10.4306/pi.2011.8.4.275

The Benefits of Music Therapy for Children with Hearing Impairment

During human evolution, the auditory system was important for those who would gather or hunt for food in order to be aware of their surroundings, especially with the looming threat of predators (Posner, 1980). It was imperative that the hearing of these hunters and gatherers were perfectly balanced. With under-sensitive hearing they would not be aware of their surroundings, and over-sensitive hearing would create an improper response to auditory stimuli (Näätänen, 1992), such as a branch falling and the hunter thinking that they were being hunted by a predator. In addition to hearing being a warning system, the auditory system is important for verbal and gestural communication. While some sounds and gestures made by humans evolved into languages, others suggest that variations of these sounds created music and dance (Mithen et al., 2006). As researched by Patel (2010), the more one delves and explores language and music, the more we can exhibit the greater capabilities of the auditory system.

Music has been seen and proven to be a beneficial tool for brain development. Some benefits include an increase in auditory skills and neural structures (Hyde et al. 2009), sound perception, sound discrimination, attention allocation (Dittinger et al. 2017), verbal intelligence, phonological awareness (Tierney et al. 2015), and faster neuronal timing (White-Schwoch et al., 2013), to name a few. But what happens when a child develops a hearing impairment? Are they stripped of these benefits due to their reduced ability to hear the music that they are being treated with?

According to The Diagnostic Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013), hearing impairments can be one of many causes of language disorders, speech disorders, stuttering, Attention-Deficit/Hyperactivity Disorder, and Specific Learning Disorder, to name a few. Without speech therapy, music therapy, or the use of a cochlear implant, a child with a hearing impairment may not be able to acquire all the benefits otherwise attained by those with therapy and/or assistive devices. According to a collection of research compiled by Dr. Ritva Torppa and Dr. Minna Huotilainen (2019) of Helsinki University, 80% of studies in their article published in Hearing Research concluded that musical skills and perception, linked to speech patterns and sentence emphasis, have been further developed with musical interventions in children with hearing impairments. Other benefits of musical interventions include an increase in speech perception, language acquisition and skills, perception of sounds, auditory attention, and auditory working memory, which are important for learning and educational success. 

In addition to the compiled research, Torppa and Huotilainen (2019) created the following list of recommendations for those caring for individuals treating those with hearing impairments to make sure that they receive as many benefits from music as they can:

“1. Start using music systematically at an early age, before implantation or the application of hearing aids. Continue musical activities for more than one year, to improve speech perception.

2. Use bodily movements in the rhythm of the music. Use orientations.

3. Use singing as your main instrument, especially with a young child.

4. Engage children in musical activities in small groups; use several musical instruments and pictures/toys presenting lyrics.

5. Use plenty of repetition.

6. Use plenty of turn-taking.

7. Give advice to families on how to use music with their child.

8. Use computer games and apps to help the child perceive and produce sounds.

9. Give advice to school music teachers.

10. Support musical hobbies of teenagers with hearing impairments.”

-Jackson Arnold, Music Therapy Intern

Works Cited

Dittinger E, Chobert J, Ziegler JC and Besson M (2017) Fast Brain Plasticity during Word Learning in Musically-Trained Children. Front. Hum. Neurosci. 11:233. doi: 10.3389/fnhum.2017.00233

Hyde, K.L., Lerch, J., Norton, A., Forgeard, M., Winner, E., Evans, A.C., Schlaug, G., 2009. Musical training shapes structural brain development. J. Neurosci. 29, 3019-3025. https://doi.org/10.1523/JNEUROSCI.5118-08.2009.

Mithen, S., Morley, I., Wray, A., Tallerman, M., Gamble, C., 2006. The Singing Neanderthals: the Origins of Music, Language, Mind and Body, by Steven Mithen. Weidenfeld & Nicholson, London, 2005.

Näätänen, R. (2018). Attention and brain function. (Psychology library edition. Neuropsychology; Vol. 8). Routledge. https://doi.org/10.4324/9780429487354.

Patel, A.D., 2010. Music, Language, and the Brain. Oxford university press.

Posner, M.I., 1980. Orienting of attention. Q. J. Exp. Psychol. 32 (1), 3-25. https://doi.org/10.1080/00335558008248231.

Tierney, A., Krizman, J., Kraus, N., 2015. Music training alters the course of adolescent auditory development. Proc. Natl. Acad. Sci. U. S. A. 112, 10062-10067. https://doi.org/10.1073/pnas.1505114112.

Torppa, R., & Huotilainen, M. (2019). Why and how music can be used to rehabilitate and develop speech and language skills in hearing-impaired children. Hearing Research, 308, 108–122. https://doi.org/https://doi.org/10.1016/j.heares.2019.06.003

White-Schwoch, T., Carr, K.W., Anderson, S., Strait, D.L., Kraus, N., 2013. Older adults benefit from music training early in life: biological evidence for long-term training-driven plasticity. Journal of Neuroscience. 33 (45), 17667-17674. https://doi.org/ 10.1523/JNEUROSCI.2560-13.2013.

Dyslexia & Music

Dyslexia can be defined as a difficulty in learning at an expected level according to age, intelligence, and education, and has been increasingly recognized as a difference in cognition and learning rather than a deficit. Dyslexia is a variable condition, and not all children diagnosed experience the same difficulties or characteristics. Dyslexia is known to affect information processing and speed of processing, therefore impacting skills related to reading, writing, using symbols, and carrying out calculations. There are studies showing that children with dyslexia additionally can often experience social and emotional problems as a result of their learning difficulties as well (Eren B., 2017). 

 Many of the common difficulties associated with dyslexia also fall into the scope of music therapy practice. Music therapy aims to use music to achieve non-musical goals; such as developments in the cognitive, behavioral, physical, emotional, social and communication areas. This occurs through the incorporation of musical skills such as learning to sing, perform, compose, and analyze music. New studies are beginning to show that using musical interventions to treat children with dyslexia provides both therapeutic and educational support for these children by utilizing multi-and-interdisciplinary approaches. Instrument training has been explored in research when looking at the effects of music on the learning process, by focusing on skills such as sight reading, writing music, rhythmic exercises, improvisation, and public performances (Eren B., 2017).

Instrumental exploration and practice is a highly effective modality of addressing a variety of goals through activating multiple components of the central (brain and the spinal cord) and peripheral (nerves outside the brain and spinal cord) nervous system and can lead to numerous structural changes in the brain after only 15 months of training in early childhood. Musical practice activates multiple processing areas in the brain simultaneously, including auditory, motor, sensory, visual, and emotional processing. The sounds from the music are processed by auditory circuitry, which can also adjust signaling by the motor control centers. Sensory information received from fingers, hands and arms is sent to the brain for processing. If a student is reading music in the process, visual information is being sent to the brain for processing and interpreting commands for the motor centers. Lastly, the brain processes emotional responses to the music as well (Zatorre et al., 2007). Musical practice may therefore also be a strong tool in regard to improved learning and memory activity (Hyde et al., 2009)

A particular case study published by the Journal of Education and Practice in 2017 discusses the process and progress of a 15-year old boy diagnosed with dyslexia who undergoes adapted music lessons weekly over an 8 month period. Many creative teaching approaches were implemented to introduce and practice theoretical musical notation and other concepts. A positive and supportive therapeutic environmental aim was consistent throughout the study and positively impacted the student’s progress. Once initial music reading techniques are developed by means of practice and positive reinforcement, the musical output itself adds a level of motivation as well as a reward system with the accomplishment of creating music. The interpretation of written music text combines not just the act of reading notation, but also comprehension and translation into a physical action of producing the sounds on an instrument. The overall findings from the case study exemplify student progress in social and emotional development in addition to an increase in musicality skills, which played a significant role regarding his motivation for learning throughout the process (Eren B., 2017).

Growing research studies and reports exploring these topics continue to support the validity of the potential music therapy has to support children with dyslexic difficulties. An explorative study in 1994 researched areas regarding the relationship between musical ability and literacy skill, and found a direct relationship between the association of rhythmic ability and reading (Douglas S. & Williats, P, 1994). Additionally, a study in 2008 explored the relationship between music and phonological processing in normal-reading children and with children with dyslexia, and a strong relationship was found between musical discrimination abilities and language-related skills (Forgeard, M. et al., 2008) Further research is continuing to grow as more are beginning to see the fit for the incorporation of music therapy for the support and treatment for children with dyslexia. The next steps are to continue to expand the knowledge and practice of these techniques and advocate within education systems to help them gain more awareness of the benefits music therapy can have for students in the classroom. Music therapists are becoming more and more prominent within public school systems supporting children with special needs, and educators are continuing to see the benefits of music therapy within these settings. Continuing to grow the presence of music therapy within school systems could eventually pave the way to supporting children with dyslexia and other learning difficulties through music.

-Laura Sidwell, Music Therapy Intern

References

Douglas S. & Williats, P. (1994). The relationship between music and literacy skills, Journal of Research and Reading, 17(2), 99-107. 

Eren, B. (2017, June 30). Music and dyslexia: The therapeutic use of instrument (piano) training with a child with dyslexia (a case study). Online Submission. Retrieved October 17, 2022, from https://eric.ed.gov/?id=ED577839 

Forgeard, M., Schlaug, G., Norton, A., Rosam, C., & Iyengar, U. (2008). The relationship between music and phonological processing in normal-reading children and children with dyslexia, Music Perception, 25(4), p.383-390. 

Hyde, K.L., Lerch, J., Norton, A., Forgeard, M., Winner, E., Evans, A.C. & Schlaug, G. (2009). Musical training shapes structural brain development, The Journal of Neuroscience, 29(10), 3019-25. 

Zatorre, R. J., Chen, J. L. & Penhune, V. B. (2007). When the brain plays music: auditory-motor interactions in music perception and production, Nature Reviews Neuroscience, 8, (July 2007), 547-558.

Article Review: Music Therapy and Communication Disorders

Article Review: “Music Improves Social and Participation Outcomes for Individuals With Communication Disorders: A Systematic Review”

Tess Vreeland

Communication is a relatively large goal domain in the field of music therapy due to its importance in activities of daily living for all people. With more recent research, the strategies and results of music with communication goals have improved and expanded. Dr. Boster and others published a research review titled “Music Improves Social and Participation Outcomes for Individuals With Communication Disorders: A Systematic Review” in 2020. The purpose of their research was to explore the effects of arts-based interventions on the socialization and participation of people with communication disorders. However, the researchers involved in this review noted that most of the studies fitting the criteria for the review used specifically music-based interventions. The structure of their review consists of explanations of communication disorders, definitions of social and participation outcomes for people with communication disorders, and an explanation of arts-based interventions targeting these goals. The researchers then outline the criteria for the articles examined which resulted in 86 articles being included in the review to cover the categories of communication disorders as follows: pediatrics with Autism Spectrum Disorder, pediatrics with developmental and acquired disabilities, adults with developmental disabilities, and adults with acquired disabilities. The conclusion consists of a discussion of the commonalities among the various study results and implications for music therapy benefiting patients with communication disorders.

The results of this review are separated by category of participants in each study. For the pediatrics with Autism Spectrum Disorder, some of the social and participation variables with positive increases include: joint attention; participation in group and peer interactions; verbal and nonverbal expression and engagement; and emotional understanding among many others. The results for the pediatric population with developmental or acquired disabilities show suggestive positive trends in variables such as frequency of verbal and nonverbal responses, engagement and participation in peer or group interactions, use of appropriate nonverbal communication, and attention to tasks among other variables. Frequency of group interactions and the understanding and expression of pragmatics were the primary positive findings in studies with adults with developmental disabilities. For adults with acquired disabilities including Alzheimer’s Disease, TBIs and Parkinson’s Disease, the primary positive trends involved frequency of verbal and nonverbal behaviors and engagement and participation in groups. 

The researchers hypothesize in the discussion section that the increase in music as a tool to aid communication disorders may be attributed to “the continued rise of music therapy as an evidence-based treatment strategy, the accessible nature of music for individuals with disabilities, and the communicative nature of music” (Boster, et. al., 2020, p. 31). The researchers highlight the meaning of the results, limitations (such as sample size) across the studies reviewed, and supported reasons why music therapy is effective in addressing communication goals. Music is an extremely accessible therapeutic medium for all ages and abilities and logistically in a variety of settings; however, the researchers note that “casual listening of music on mobile devices is not the same as music therapy that is guided or facilitated by music therapists” (Boster, et. al., 2020, p. 31). This study is important in furthering the collaboration between music therapists, speech-language pathologists, and other professionals supporting communication goals. Through reviewing and analyzing the existing research, Dr. Boster and others concluded that music-based interventions have shown to benefit individuals with communication disorders.

For the full article, please visit https://doi.org/10.1093/jmt/thaa015. 

Reference

Boster, J. B., Spitzley, A. M., Castle, T. W., Jewell, A. R., Corso, C. L., & McCarthy, J. W. (2020). Music improves social and participation outcomes for individuals with Communication Disorders: A systematic review. Journal of Music Therapy, 58(1), 12–42. https://doi.org/10.1093/jmt/thaa015

Music Therapy in the Classroom: Benefits for Students with Learning Disabilities

Approximately 33% of students receiving special education services in schools are diagnosed with a specific learning disability (National Center for Education Statistics, 2022). Music therapists working in classrooms have the tools and skills to reach students with a wide spectrum of disabilities, such as those with various SLDs. Specific learning disabilities differ with each student and discipline (e.g., reading, math, writing, etc.). Much of the research regarding music therapy and learning disabilities is related to reading skills specifically. 

Viewing reading as solely a visual experience can lead to frustration with students who struggle with reading related SLDs and teachers alike. However, the task of reading becomes more accessible when addressed as a multisensory activity. In order to read effectively, a child needs to successfully master “eye tracking, eye-hand coordination, spatial relationships and spacing, visual perception, tactile perception, organization of thought, auditory perception, self-control to sustain attention, symbolism, and rhythmic timing” (Colwell, 2002, p. 13). To address these skills, music therapists can utilize manipulatives, instruments, visuals, and rhythms and melodies contributing to the academic information. The multisensory nature of music provides opportunities to facilitate the growth of these skills, leading to improvement of overall reading ability for all students. This is especially beneficial for those with SLDs who struggle with more traditional approaches. 

Music therapy goals such as attention and memory can coincide with more specific goals for each student’s skills. Studies have shown that students receiving music therapy services had consistently lower off-task behavior when working on reading skills within the sessions than those who did not have this type of engagement (Register, et. al., 2007). Short-term memory is also a common pre-academic skill that students with SLDs must work through. Musical mnemonics, which are short musical repetitions of specific academic content, have been widely implemented in general education classrooms for students with and without specific learning disabilities to aid with memory (Gfeller, 1983, p. 188). Addressing pre-reading and functional classroom skills can facilitate more effective progress, with more individualized skills being addressed for the student with a specific learning disability.

While attention, behavior, and sensory elements of reading are broad underlying skills of learning, reading comprehension, vocabulary acquisition and knowledge, and decoding lead to different therapeutic approaches and focuses within sessions. Music has auditory, visual, and tactile structure to reinforce these concepts in an engaging way. A student receiving music therapy will likely engage in active and passive interventions that support “better discrimination for perceiving language, clearer articulation, and… positive transfers from music skills to the development of language and reading skills” (Register, et. al., 2007, p. 25). Auditory awareness is another specific skill crucial to reading comprehension. Music therapy interventions properly facilitated can address pitch, rhythm, and volume discriminations (Roskam, 1979, p. 36). These skills can transfer to crucial foundations of reading comprehension and general auditory perception and awareness.

All students are heterogeneous in their learning styles, so it is important to acknowledge and “continually consider the importance of individualized treatment planning” in these settings, as well as remain informed on increasing research concerning the best music implementation to address SLDs (Gfeller, 1984, p. 13). Music being used as a structure for academic information is valuable, but also using music as positive reinforcement and reward provides a balance that makes music therapy effective and enjoyable. One of the most important benefits of music supporting students with learning disabilities aside from the improvement of the actual academic skills is the positive association with an often frustrating task. 

-Tess Vreeland, Music Therapy Intern

References

Colwell, C. M., & Murlless, K. D. (2002). Music Activities (singing vs. chanting) as a vehicle for reading accuracy of children with learning disabilities: A pilot study. Music Therapy Perspectives, 20(1), 13–19. https://doi.org/10.1093/mtp/20.1.13.

Gfeller, K. E. (1983). Musical Mnemonics as an aid to retention with normal and learning disabled students. Journal of Music Therapy, 20(4), 179–189. https://doi.org/10.1093/jmt/20.4.179.

Gfeller, K. E. (1984). Prominent theories in learning disabilities and implications for music therapy methodology. Music Therapy Perspectives, 2(1), 9–13. https://doi.org/10.1093/mtp/2.1.9.

National Center for Education Statistics. (2022). Students With Disabilities. Condition of Education. U.S. Department of Education, Institute of Education Sciences. Retrieved August 29, 2022, from https://nces.ed.gov/programs/coe/idicator/cgg.

Register, D., Darrow, A.-A., Swedberg, O., & Standley, J. (2007). The use of music to enhance reading skills of second grade students and students with reading disabilities. Journal of Music Therapy, 44(1), 23–37. https://doi.org/10.1093/jmt/44.1.23.

Roskam, K. (1979). Music therapy as an aid for increasing auditory awareness and improving reading skill. Journal of Music Therapy, 16(1), 31–42. https://doi.org/10.1093/jmt/16.1.31.