NICU Music Therapy...That's a Thing?

 

NICU Music Therapy…That’s a Thing?

 

Yes, friends. NICU Music Therapy is most certainly a “thing.”

 

In fact, it’s an incredibly beneficial thing.

 

For over 20 years, extensive research has been conducted to explore the effects and benefits of music therapy in the NICU. Based on that research, evidence-based practices have been developed that are being used in many NICU’s across the country. These practices include:

 

  • Infant-Directed Singing

 

  • Multimodal Neurological Enhancement (also known as Multimodal Stimulation)

 

  • Pacifier-Activated Lullaby (PAL)

 

Over the next 3 or so weeks, we will be exploring these different practices, what they are, how they benefit premature infants, as well as the parents AND the hospitals in which music therapy is present.

 

Remember, everything we discuss will be practices that are based off of over 20 YEARS of research conducted at The Florida State University.

 

We are so excited to dive into this with you, because this is an area near and dear to our hearts.

 

See you back here next week!

 

Photo: Downloaded from http://amtapro.musictherapy.org/?p=895

 

Music Therapy in the NICU

The NICU is a scary place for parents. They watch their little ones sleep in little beds, swaddled with wires and cords, all hooked to machines that beep and blink. Then we (music therapists) come in to the, already terrifying, environment and suggest Neurodevelopmental Stimulation (previously known as multimodal stimulation).

You want to do what to my child?

Neurodevelopmental Stimulation is a technique used by NICU music therapists to help the infant tolerate and process different kinds of stimulation in their environment. This process helps the infant get ready to go home sooner by being able to remain calm in “over-stimulating” situations.

Neurodevelopmental Stimulation uses music in a slow, repetitive, lullaby format that doesn’t exceed a volume level of 60 decibels. The process begins with guitar followed by humming. Singing is then added, followed by massage. After the massage sequence is completed, rocking begins including the massage. Finally, the sequence is faded out once the 20 minutes is reached.

The massage progression follows the largest part of the body to the smallest part of the body and front to back (head, back, throat, arm, abdomen, leg, cheek, forehead, and nose to ear). The massage uses two to three fingers with a firm but gentle stroke. The infant needs to feel the massage but not enough to hurt or tickle them. As the massage begins, if signs of over-stimulation are observed, pause and give the infant time to calm and then restart.

Girls vs. Boys

A study found that males who received only singing and no guitar went home “15.7 days sooner than males who received guitar in addition to singing.” Furthermore, females in the experiment who received guitar in addition to singing went home “12 days sooner than females who were only sung to.” (Walworth, D., Standley, J., Robertson, A., Smith, A., Swedberg, O., & Peyton, J. (2012). Effects of neurodevelopmental stimulation on premature infants in neonatal intensive care: Randomized controlled trial. Journal of Neonatal Nursing, 18, 210-216.) From this study we learned that girls thrive with guitar while boys do not.

Here’s your sign

During this process observations are taken for over-stimulation and positive responses. Signs of over-stimulation are: halt hands, tongue protrusions, arched back, finger splays, red face, grimace, hiccups, and startle reflex. Positive responses are: smiling, head orientation, cooing, snuggling, and eye contact.

The entire process takes 20 minutes. Neurodevelopmental stimulation should only be implemented, at most, two times per day and never more than 20 minutes.

Personal Observations

I attended the NICU training institute at Tallahassee Memorial Hospital in Florida, in conjunction with Florida State University. Over the course of two days, I soaked up so much information plus received hands-on experience. Not only are the babies precious, but very intelligent. I was not expecting these little ones to be able to express “this is too much” or “oh, that’s nice, more!” through the use of their body language. It was exciting to use music therapy in a unique way to meet the needs of these NICU babies.

 

 

 

 

Research Review: Music Therapy in the NICU

Standley, J. (2012). Music therapy research in the NICU: an updated meta-analysis. Neonatal Network: The Journal of Neonatal Nursing. 31(5). 312-316.

It’s Spring! And everything’s coming up…baby! The George Center is in full blown baby mode in preparation for the birth of the first born son to Director Jamie George. Furthermore, I’m about to become an aunt for the first time later this June. Now seemed like the perfect time to dive into some research about music therapy in the neonatal intensive care unit (NICU).

Preterm birth occurs when a baby is born prior to 37 weeks of pregnancy. Last year, the CDC reported that preterm birth affected nearly 500,000 babies in the U.S., or in other words 1 and every 8 infants born. The earlier in pregnancy a baby is born, the greater the likelihood for the baby to development long term health issues. Research indicates that severity of prematurity at birth is highly correlated with lowered cognition at school age and future need for special education. Not only can preterm birth have lasting consequences for the baby and family members but it’s also incredibly costly. On average, premature births account for $26 billion dollars each year. So, what can be done to help reduce this cost to the health care system and more importantly, support premature babies and their families? NICU Music Therapy, that’s what!

Music stimulation can be processed early in development and has unique auditory input and neurologic consequences for preterm infants. Board-certified music therapists specialized in NICU music therapy are using music in hospitals across the country to enhance the developmental care and maturation of preterm infants. Music therapists are providing short periods of continuous music playing during times when infants are in the incubator. This exposure to music is eliciting calmer preemies, increasing weight gain, stabilizing physiologic measures and increasing oxygen saturation levels. Infants listening to music also reached discharge criteria significantly sooner.
Other music procedures are being incorporated as well. Possibly one of the most fascinating (in my opinion) being utilized within the NICU is the pacifier activated lullaby (PAL). This device is a pacifier fitted within an adapter that activates a CD player. Sensors in the PAL detect correct non-nutritive sucking and provide immediate musical reinforcement to the infant in the form of a lullaby. Subsequently, premature infants receiving the PAL double pacifier sucking rates, in turn increasing feeding rates. In addition research has indicated that implementation of the PAL greatly reduces length of hospital stay. And this friends, directly impacts that whopping $26 billion dollar yearly cost of care for premature infants in the U.S.

There is a significant body of research spanning the last 20 years that compares standard NICU care with music versus standard NICU care without music. In fact, the research supports that music has a positive and significant benefit within the NICU setting. Music is pacifying and increasing infant tolerance of stimulation. It’s increasing feeding ability, promoting sleep following painful nursing procedures, and promoting attachment with infants’ mothers.

More research is definitely warranted, particularly in areas of infant communication and language stimulation through sung lullabies. However, in all, the potential for growth and increased implementation of NICU music therapy is huge! It is my hope that we continue to investigate the impact of music within this setting and delve further into the long-term developmental outcomes that music may offer for premature infants.

The George Center has two NICU-certified music therapists on staff! Learn more with our free consultation offer!

 

Image credit: Flickr user tamakisono

16 Quick Hitting NICU Music Therapy Facts That Will Blow Your Mind

If we've said it once, we've said it a thousand times: what separates music therapy from music used therapeutically is the research-based support of our interventions. Some of the most interesting research in our field involves music therapy used with premature infants in the Neonatal Intensive Care Unit. Here's 16 research findings about music therapy in the NICU, complete with links to the studies!

Oxygen Saturation

  • “Infants hearing music had significantly fewer occurrences of Oximeter alarms during auditory stimuli than did those listening to the mothers' voice.” Tweet This

Standley, J. M., & Moore, R. (1995). Therapeutic effects of music and mother’s voice on premature infants. Pediatric Nursing, 21 (6), 509-512,
574.

http://psycnet.apa.org/psycinfo/1996-28041-001

  • Music (listening) had noticeably positive effects on oxygen saturation levels, heart rate, and respiratory rate.” Tweet This

Cassidy, J.W., & Standley, J. M. (1995). The effect of music listening on physiological responses of premature infants in the NICU. Journal of Music Therapy, 32 (4), 208-227.

http://psycnet.apa.org/psycinfo/1996-28041-001

  • Listening to recorded music increased oxygen saturation levels in premature infants. Tweet This

Moore, R., Gladstone, I., & Standley, J. M. (1994). Effects of music, maternal voice, intrauterine sounds, and white noise on the oxygen saturation levels of premature infants. Paper presented at: Meeting of the National Association for Music Therapy, Inc; November 1994; Orlando, FL.

  • “…Results showed that premature infants receiving music therapy with endotracheal suctioning had a significantly higher SPO(2); than
    that when not receiving music therapy (p <.01), and the level of oxygen saturation returned to the baseline level faster than when they did not
    receive music therapy (p <.01).”

Chou, L. L., Wang, R. H., Chen, S. J., Pai, L. (2003). Effects of music therapy on oxygen saturation in premature infants receiving endotracheal
suctioning. Journal of Nursing Research, 11 (3), 209 – 216.

http://www.ncbi.nlm.nih.gov/pubmed/14579198?dopt=Abstract

Heart Rate

  • “(Listening to live singing) lowered Ss' heart rate, increased oxygen saturation, and reduced distress behaviors” Tweet This

Coleman, J. M., Pratt, R. R., Stoaddard, R. A., Gestmann, D. R., & Abel, H. (1997). The effects of the male and female singing and speaking voices on
selected physiologial and behavioral measures of premature infants in the intensive care unit. International Journal of Arts Medicine, 5 (2),
4-11.

http://psycnet.apa.org/psycinfo/1998-10127-001

  • “Live music therapy had no significant effect on physiological and behavioral parameters during the 30-minute therapy; however, at the 30-minute interval after the therapy ended, it significantly reduced heart rate (150 ± 3.3 beats/min before therapy vs 127 ± 6.5 beats/min
    after therapy) and improved the behavioral score (3.1 ± 0.8 before therapy vs 1.3 ± 0.6 after therapy
    , p < 0.001).”

Arnon S, Shapsa A, Forman L, et al. (2006). Live music is beneficial to preterm infants in the neonatal intensive care unit environment. Birth 33 (2), 131–136.

http://onlinelibrary.wiley.com/doi/10.1111/j.0730-7659.2006.00090.x/abstract;jsessionid=4B288D983597839C50BA760004348962.f01t01?deniedAccessCustomisedMessage=&userIsAuthenticated=false

Behavior State

  • “Live music therapy had no significant effect on physiological and behavioral parameters during the 30-minute therapy; however, at the 30-minute interval after the therapy ended, it significantly reduced heart rate (150 ± 3.3 beats/min before therapy vs 127 ± 6.5 beats/min after therapy) and improved the behavioral score (3.1 ± 0.8 before therapy vs 1.3 ± 0.6 after therapy, p < 0.001).” "(Behavioral score) was given a numerical score as follows: 1, deep sleep; 2, light sleep; 3, drowsy; 4, quiet awake or alert; 5, actively awake and aroused; 6, highly aroused, upset, or crying; and 7, prolonged respiratory pause > 8 seconds.

Arnon S, Shapsa A, Forman L, et al. (2006). Live music is beneficial to preterm infants in the neonatal intensive care unit environment. Birth, 33 (2):131–136.

http://onlinelibrary.wiley.com/doi/10.1111/j.0730-7659.2006.00090.x/abstract;jsessionid=4B288D983597839C50BA760004348962.f01t01?deniedAccessCustomisedMessage=&userIsAuthenticated=false

  • Music reinforced non-nutritive sucking resulted in “lower during-heelstick behavior state means, less time in undesirable behavior states, lower during- and post-heelstick stress level means, and smaller behavior state and stress level differences between intervals.” Tweet This

Whipple J. (2008). The effect of music-reinforced nonnutritive sucking on state of preterm, low birth weight infants experiencing heel stick. Journal Music Therapy 46 (3), 227–272.

http://psycnet.apa.org/psycinfo/2008-16464-001

  • “Music stimulation…significantly reduced the daily group mean of stress behaviors for the experimental group.” Tweet This

Caine J. (1991). The effects of music on the selected stress behaviors, weight, caloric and formula intake, and length of hospital stay of premature and
low birth weight neonates in a newborn intensive care unit. Journal Music Therapy 28 (4), 180–192.

http://www.ncbi.nlm.nih.gov/pubmed/10160836

Length of Stay

  • “Music stimulation…significantly reduced length of the NBICU and total hospital stays.” Tweet This

Caine J. (1991). The effects of music on the selected stress behaviors, weight, caloric and formula intake, and length of hospital stay of premature and
low birth weight neonates in a newborn intensive care unit. Journal Music Therapy 28 (4), 180–192.

http://www.ncbi.nlm.nih.gov/pubmed/10160836

  • “Experimental (group) left the NICU 3 days earlier” (Experimental group exposed to live singing” Tweet This

Coleman, J. M., Pratt, R. R., Stoaddard, R. A., Gestmann, D. R., & Abel, H. (1997). The effects of the male and female singing and speaking voices on
selected physiologial and behavioral measures of premature infants in the intensive care unit. International Journal of Arts Medicine, 5 (2),
4-11.

http://psycnet.apa.org/psycinfo/1998-10127-001

  • “(Infants) born very early (24–28 gestational weeks) were discharged sooner than non-music infants in that age range.” Tweet This

Standley J., Swedberg O. (2010). NICU music therapy: post hoc analysis of an early intervention clinical program. Arts Psychotherapy 38 (1) 36–40.

http://www.sciencedirect.com/science/article/pii/S0197455610001280

Feeding

  • Results showed that the intervention significantly increased feeding rates. Music functioned as reinforcement and the sucking
    behavior transferred from a nonnutritive to a nutritive event.”

Standley J. M. (2003). The effect of music-reinforced non-nutritive sucking on feeding rate of premature infants. Journal Pediatric Nursing 18 (3)169–173.

http://www.sciencedirect.com/science/article/pii/S0882596303000332

  • “At 34 weeks, PAL trials significantly shortened gavage feeding length, and three trials were significantly better than one
    trial.”
     Tweet This

Standley J, Cassidy J, Grant R, et al. (2010). The effect of music reinforcement for non-nutritive sucking on nipple feeding of premature infants. Pediatric Nursing 36 (3) 138–145.

http://intraspec.ca/article36138145.pdf

Cost Effectiveness

  • With the use of PAL® the number of days a preterm infant will stay in the Neonatal Intensive Care Unit (NICU) is reduced by an average of five days, saving an average of $10,000 per infant.

http://www.research.fsu.edu/pal/about.html

  • “Annual Revenue for a 1/2 Time NICU-MT at Florida Hospital (40 Bed, Level III NICU) based on current reimbursement rates = $24,295" Tweet This

Robertson, A., Standley J.Premature Infants: Research Update and Evidence-Based Practice. Presented at: National Institute for Infant and Child Medical Music Therapy: Clinical Fieldwork at Florida Hospital; June 2009; Orlando, FL.

Interested in learning more about music therapy in the NICU? Sign up for a free consultation to learn about what a NICU music therapy program looks like!

 

 

Image credit: Flickr user tamakisono

Interview With Dr. Standley and Tasia Dockery

Greetings from the American Music Therapy Association National Conference in Jacksonville, Florida! We're enjoying some warm(er) weather and beautiful river views while taking in courses, trainings, presentations, and more!

In fact, Tasia is taking part in the Neonatal Intensive Care Unit Music Therapy certification program! Once she completes the training, she'll be the third NICU music therapist at The George Center.

Check out our interview below with Tasia and the leading researcher in the NICU music therapy world, the esteemed Dr. Standley!

 

Be sure to like us on Facebook to keep up with all our photos and updates from Jacksonville!

 

3 FASCINATING Studies on Music Therapy in Hospitals

Medical music therapy is a fast growing field, but it's far from "new!" There's some truly fascinating research out there on using music therapy to support standard medical procedures taking place in hospitals all across the country every day.

 

1. Live music therapy reduces time required for MRI scans (Walworth, D.D.)

5-minutes per scan saved when supported by a music therapist may not sound like a lot, but when you multiply that across the hundreds of MRI scans performed in major hospitals every year, you've saved some serious time! And we all know how much people LOVE shorter wait times...

 

2. Music therapy supported device increases effectiveness of feeding for premature babies (Cevasco, A.M.; Grant, R.E.)

The Pacifier Activated Lullaby (PAL) Device is a neat piece of music therapy technology that can shorten how long premature babies stay in the NICU. This study found that using the device 30-minutes prior to feeding increased the effectiveness of the feedings.

 

3. Patient-preferred music decreases anxiety, increases relaxation, and improves patient perception of hospitalization (Walworth, D.D.; Rumana, C.S.; Nguyen, J.; Jarred, J.)

As you might imagine, brain surgery can be a little stressful for patients. This study found that patients who received live music therapy (using patient preferred music, of course) had improved quality of life indicators prior to the procedure. That's a relief.

 

Did you know The George Center offers music therapy services to hospitals in the Atlanta area? Set up a consultation to learn more!

 

Image credit: Wikipedia Commons

 

 

3 Studies on the Cost Benefits of Music Therapy

Dated references to 90's movies aside, let's face it: budgets are tight right now. Doesn't matter if you're an individual, family, or healthcare facility. Whether you're state-funded, non-profit, or a privately held, starting new programs and hiring new people might just be out of the question until economic conditions improve.

But what if the program you were starting would actually save money? Better yet, what if it saved money without sacrificing quality of care? Better still, what if it improved quality of care? Got your attention?

Good.

We talk a lot on here about the benefits of music therapy for an individuals health and well-being, be it in individual private therapy settings or in hospitals, assisted living facilities, or clinics. But starting a music therapy program at a facility does bring new costs. We tip toe around the subject of finances in therapy sometimes because we all have therapist hearts, but let's face it, sometimes you just gotta say (all together now):

"Show me the money!"

Oh, I'll show you the money. What are the benefits of music therapy for a healthcare facilities bottom line? Can it save money while simultaneously improving outcomes?

Read on, Dear Reader. Here are 3 studies that support the cost benefits of music therapy:

 

Music therapy reduces cost per patient in hospice music therapy by $2,984.

In this study, music therapy reduced costs per patient by almost three thousand dollars. The program itself cost $3615, resulting in a cost-benefit ratio of .83. When using cost-per-patient-day, the ratio improves to .95. This indicates that in a hospice setting, music therapy is a cost-effective way to improve patient experiences.

 

Music therapy for procedural support slashes cost of echocardiogram in children by $74.24 per procedure.

By using a music therapist, children were able to complete echocardiograms without the need for medication and an RN, reducing costs by $74.24 per procedure. Nice!

 

NICU music therapy cuts an average of $10,000 off costs of a NICU stay.

That's a lotta cash! Saves the hospital money, saves the family money, saves everyone paying an insurance premium every month money, and most importantly, better outcomes for baby!