Carme Solé, Melissa Mercadal-Brotons, Adrián Galati, Mónica De Castro; Effects of Group Music Therapy on Quality of Life, Affect, and Participation in People with Varying Levels of Dementia, Journal of Music Therapy, Volume 51, Issue 1, 1 March 2014, Pages 103– 125, https://doi.org/10.1093/jmt/thu003
Music is present in every stage of a person’s life. Think of when you listen to the radio and a song from childhood comes on. Oftentimes songs from the past are the ones that people know the best. Music stimulates our brains in a way that long-term memory is accessed so that we can use it when we hear a familiar particular song. Long-term memory is located in various parts of the brain, the hippocampus being the catalyst. When we are able to make music with others through singing, and enjoy knowing every word of a song we haven’t heard in years, we also experience positive feelings. There is enjoyment and comfort in knowing the music we hear. Individuals living with dementia do not get to experience the easiness of knowing in everyday life due to the nature of their diagnosis. Dementia affects orientation and overall awareness. Even in early stages of dementia, individuals may experience the uneasiness that feeling overly forgetful can bring.
As an intern at the George Center for Music Therapy I am involved with several memory care groups and get to observe multiple settings where dementia patients receive music therapy services. This article topic stuck out to me because it poses important questions and sets a foundation for future research, while validating therapeutic approaches already being used. Through the article, “Effects of Group Music Therapy on Quality of Life, Affect, and Participation in People with Varying Levels of Dementia”, music therapists examined how music therapy positively impacts the lives of individuals living with dementia. The study included 16 individuals with dementia. The Global Deterioration Scale was used to measure cognitive functioning amongst the 16 participants (Solé, Mercadal-Brotons, Galati, & De Castro, 2014). Their functioning levels ranged from mild (9) to moderate (5) and severely impaired (2).
Dementia is defined in general as a neurodegenerative disease that is characterized by the progressive loss in memory as well as other mental functions including language and judgment. Due to the of the nature of these types of diseases, therapeutic techniques that involve multiple parts of the brain are important. According to this study Alzheimer’s disease is the leading type of dementia that affects people in the United States. It has been reported that 60 percent of all dementia cases are of the Alzheimer’s disease (Solé, Mercadal-Brotons, Galati, & De Castro, 2014). This study further supports the importance of research in these areas where music therapy is involved. Individuals with dementia that are receiving services deserve the most effective interventions. Music therapy provides just that! As I continued to read the article, it became evident how an individual’s quality of life is positively affected by music therapy in a group setting.
Although this study had a small sample size of 16 individuals, three groups according to stage of dementia were formed. These stages were low, moderate, and high levels of dementia. Each group met for 12 weeks and received 45-50 minutes of music therapy once a week (Solé, Mercadal-Brotons, Galati, & De Castro, 2014). Documentation was done through the help of registered nurses before, during, and after each group session. Quality of life was measured using the Government of Catalonia (GENCAT) questionnaire. This questionnaire consisted of 69 questions revolving around eight different dimensions. These dimensions were emotional well-being, interpersonal well-being, material well-being, personal development, physical well-being, self-determination, social inclusion, and equal rights. The individual’s scores in these domains reflected their overall quality of life. Participation was measured through data collection as well as through video analysis. Sessions 1, 6, and 12 were video recorded and analyzed for each group. But enough of the data details, let’s dive into the music therapy specifics!
For each group the music therapy interventions used centered around stimulating cognitive functions, social interactions, and motor skills. Motor skills were addressed through instrument playing. Other musical activities during each group included singing, listening to music, movement to music, and improvisation (Solé, Mercadal-Brotons, Galati, & De Castro, 2014). The music used for the groups was selected based off of personal preferences of the group members. In my experience using familiar music is especially important with this population when trying to evoke active participation. Each session included opening activities, like a hello song, one main activity, and a closing activity.
As data continued to be collected weekly, it became obvious which areas of the patient’s lives were being most influenced during the study. Participation and affect amongst the group was measured through observation. During observation the categories being measured were verbalizations, physical contact, visual contact, active participation, and emotions (facial affect and body expressions). Each group recorded the same pretest and posttest weekly, and each domain within the test was tracked statically. Some of the areas to show the largest changes were emotional well-being and personal development. However, emotional well-being was the only domain to show a statistically significant increase, recorded as Mdn=21 pretest to Mdn=23 posttest (Solé, Mercadal-Brotons, Galati, & De Castro, 2014). Although the personal development domain did not reap significant results, the data still presented interesting outcomes. I felt it was worth noting that the medians for all groups in that measurement either stayed the same or increased. The extent of these results was interesting and sets a wonderful foundation for future research.
As I near the midpoint of my internship at The George Center, I continue to learn more about every population and clinical environment we serve as music therapists. Since personal development and emotional well-being had such positive outcomes in this study, I would like to close by briefly discussing those in the memory care setting. As this study emphasizes, every part of the therapeutic interaction and participation within a group is important. I especially loved that this study used primarily patient preferred music and that the comfort that can bring was reflected in the patient’s emotional responses. When patients have decreased levels of anxiety or have the opportunity to increase their overall mood, this benefits the whole body. I have experienced firsthand the benefits of group music making with dementia patients. Although personal development is hard to measure with this population due to the degenerative nature of dementia, there are still many promising examples. It is always a special moment when an individual comes out of their shell to sing several verses of a song from memory, or passionately plays an instrument with peers. After a moment like this, many times that individual sustains attention and participation for the rest of that session.
Working with the George Center I have learned so much about this population and I feel confident about the interventions we use within each session. I can leave the facilities knowing we left a positive and lasting impact. This article simply confirms the importance of group music therapy in the healthcare of individuals with dementia. It screams, Music therapy works- pass it on! And that I will do! Before reading this article I was relying on past experiences and learning as I went with this population. I have learned that patient preferred music and being able to play in the original styles of songs evokes more of a positive response in memory care groups especially. As a new professional a big challenge is expanding my repertoire. This article was a great reminder that I can never know enough music. I look forward to passing on more research like this and continually retaining knowledge through the clinical experiences this internship offers.