Music Soothes The Ravaged Brain
by Dorita S. Berger, adjunct faculty Conservatory of Music Kean University, Union, NJ
dsberger@mags.net
on her face, and fear in her
eyes.She scanned around the room as she sauntered toward the couch, dragging her legs in a very unstable
walk.Collette was grunting sounds of disap- proval, resistance, disturbance. Mumble… mumble…mumble… mumbling some low- tone jumbled commentary we could not un-
derstand.She gazed intensely at my face ex- pecting a response to her gibberish chatter.I did not understand what she was trying to communicate, but I smiled and continued singing “Hello Collette” to the tune from Hello Dolly. It took some 10 minutes to settle her comfortably onto the couch on which she would remain during our session. Collette has been suffering from De-
C
mentia with Lewy Body (DLB) for several years, progressively losing speech, cognition, motor control, self-care skills, and more. De- mentia with Lewy bodies overlaps clinically with Alzheimer’s and Parkinson’s diseases but is more associated with the latter. Within DLB, the loss of cholinergic (acetylcholine- producing) neurons is thought to account for the degradation of cognitive functioning, as in Alzheimer’s disease, while the loss of dopaminergic (dopamine-producing) neu- rons is thought to account for the degrada- tion of motor control, as in Parkinson’s dis- ease. Thus, DLB is similar in some ways to both the dementia resulting from Alzheim- er’s disease and the movement problems of Parkinson’s disease. Collette’s demeanor re- sultant from her diagnoses is/was generally morose, unresponsive, quite stubborn and feisty, resistant to any new undertaking, fear- ful of crowded environment, and frightened when her friend Laura was not immediately available. I was told that she is very difficult to handle, has very little self-care skills, can be quite belligerent and moody. Added to this is Collette’s continual loss of expressive language. She mumbles gibberish continu-
TEMPO
ollette walked into the room with a frown on her brow, a look of doubt and confusion
ally and incomprehensibly to others, though it often seems as though she understands what it is she is trying to
convey.These char- acteristics are inherent in the dementia diag- nosis. It is unclear how self-aware Collette is regarding her condition and behaviors. It is also unclear whether she can still read or fully comprehend complex spoken language. In addition, her information processing and responsiveness is extremely slow, and she can be quite unresponsive to directives much of the time. Music Therapy has been known to have
positive impact on several dementia symp- toms, including long-term memory retriev- al, movement organization, self-awareness, and some cognitive abilities. Mood shifts are common in patients with dementia, pre- dominantly triggered by inner systemic fear responses. Music has been known to calm systemic fear responses. There has also been some research on music’s ability to influ- ence and help increase dopaminergic neu- rons. Music indeed has a great influence on movement, and has been known to induce organized movement activities throughout the body, from heart-rate to rhythmic head swings, shoulder bounces, to fancy hip and foot work akin to ‘dancing’. So there we were: Collette, her col- league Laura, my music therapy assistant Christine, and another music therapy col- league, Bruce, about to experience a 1-hour music encounter once or twice a week, over a period of three months.What was designed as a one-on-one music therapy session was, in reality, a group encounter with Collette being the center of attention, and the rest of us participating together in a ‘group music making session’.In fact, this format hit upon a very unusual and one-of-a-kind situation: Collette had the advantage of observing and imitating non-diagnosed persons (i.e., “typi- cally functioning” individuals) surrounding her in making music.
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This was quite interesting, because most of the time, such diagnosed persons meet in group therapy sessions with other diagnosed persons, who may or may not provide “positive role models” to be imitated during music-making. In addition, the only person receiving attention from this ‘group’ was Collette, who indicated strong aware- ness that she was the center of the attention, by her smiles, exaggerated responses, fleeting eye movements focused on each of us from time to time, and other indicative gestures. In all, five persons partook in this activ- ity, with occasional additional one or two non-diagnosed visitors, increasing the size of this group from time to
time.Therefore, although the focus was one-on-one, with ac- tivities and music selected specifically to ad- dress Collette’s diagnosed issues, the sessions felt more like “party” than therapy, which served to calm Collette’s “fear” and anxiety. My clinical goals for Collette were:
1. Reduction of “fear” response (5+ minutes quiet listening to start session); 2. Consistent engagement musically and jointly with us; 3. Organized rhythmic movements, such as pulsed hand-clapping, dancing (even when seated), marching, drumming, playing xylophone in tempo, etc.; 4. Breath control (blowing recorder in pulsed tempo), vocalizing (singing) and language use (recalling lyrics and fill-in songs), rhythmic speaking; 5. Verbal response to simple ques-
tions (i.e., “did you like this song?”, “what’s your favorite song?”, “which instrument(s) would you like to play?”… etc.) My notes from the first session, after Collette settled onto the couch, and we four circled in chairs around her, were as follows: Hello Song: Hello Collette (to tune of
“Hello Dolly”). I was at the piano, Bruce and Christine held guitars, Laura had a tambou-
rine.Placed before Collette were a pair of ma- racas, a tambourine, and a small 5-tone xylo-
OCTOBER 2013
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