The Use of Music in Dementia Care

Authored by: Kim Warchol, OTR/L

For years I have been using music to reach deep into the memories and individuality of my clients with dementia. There are many benefits to using music as a therapeutic modality in OT/PT/ST interventions.

Music therapy in the dementia population can:

• Enhance quality of life and wellness
• Reduce stress
• Enhance memory
• Improve communication
• Express feelings
• Assist with physical rehabilitation

A therapist can use music as a therapeutic modality or a music therapist can partner with us during our interventions. According to the American Music Therapy Association:

Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program. (American Music Therapy Association definition, 2005)

Music is used with elderly persons to increase or maintain their level of physical, mental, and social/emotional functioning. The sensory and intellectual stimulation of music can help maintain a person's quality of life.

A recent article entitled Mindwise written by Oliver Sacks, a neurologist and author, printed in Oprah Magazine, described the value of music to enhance connections to memories.

" . . . musical activity involves many parts of the brain (emotional, motor, and cognitive areas), even more than we use for our other great human achievement, language. This is why it can be such an effective way to remember or to learn."

" . . . people with Alzheimer's disease and other dementias can respond to music when nothing else reaches them. Alzheimer's can totally destroy the ability to remember family members or events from one's own life—but musical memory somehow survives the ravages of the disease, and even in people with advanced dementia, music can often reawaken personal memories and associations otherwise lost."

"Improvements of mood, behavior, even cognitive function—once set off by music can sometimes persist for hours or even days in people with dementia. Researchers are only beginning to study the secrets of why and how this happens . . ."

Music has helped to facilitate many wonderful outcomes during therapy sessions. I believe these outcomes would not have been achieved without music. I will share a couple special stories with you.

• Bill was afraid to walk and had difficulty following directions. He was functioning at approximately Allen Level 3.0. We learned that he loved classical music. I invited the music therapist who was employed by the nursing home to attend our session. She chose a couple songs she felt would best tap into his long-term memory and capture his interest. We stood Bill and cued him to walk a few steps. Simultaneously the music therapist began to play the song. We quickly saw Bill's cadence match the music rhythm. We utilized the music to help cue Bill to change the speed in which he walked and to increase his distance. Once I learned the value of the music to gain Bill's attention and to cue him, I shared this information with Physical Therapy. The music therapist recorded the song in order for the PT to use this in therapy sessions to enhance ambulation skills.

• Millie was depressed. She recently moved into our assisted living facility through much encouragement from her daughters. Millie was functioning at Allen Level Low 4 and had been living alone. Upon entering our community she immediately withdrew and isolated herself from others. She refused to bathe or dress herself, go out to the dining room to eat, or join in any activities. She began to lose weight and due to her behavior she required extensive assist for most ADLs and she was occasionally combative. During preparation for my assessment I spoke with her daughters to learn about her interests. They told me about Millie's love of music. Millie played the banjo for years. In fact, she used to go to nursing homes to entertain. I used this beloved musical interest to coax Millie back into life. I asked her daughter to bring in her banjo, and as I developed a therapeutic relationship I was successful in encouraging her to play again. It started slowly but didn't take long before Millie's interest in life was back. This then translated to her ability to perform ADLs at her best ability, eating to regain the weight, socializing, and even entertaining others.

• Bob experienced very shallow breathing due to Parkinson's and he no longer communicated using words. He was functioning at Allen Level Low 3. The SLP decided to find a couple favorite, simple songs to use as a part of her treatment. She wanted to engage Bob in singing as a form of exercise to increase the depth and strength of his breaths and as a form of communication. Bob was a guy who clearly had a love of people. Even though he didn't speak, he communicated with touch and he always followed his favorite staff and residents around. Bob clearly had much love inside that he wanted to express. I never heard Bob utter a word until . . . . It was the birthday of Bob's favorite CNA. The SLP brought Bob over to the table where the CNA was celebrating. The SLP told the CNA that Bob had a special gift. She then lit the candles and started Bob in song. It was a moment I will never forget. Bob held the hand of the CNA and sang Happy Birthday at a volume that rocked the dining room. There wasn't a dry eye in the room, including Bob's. He not only had amazing volume supported by a strong diaphragm, but he expressed his feelings of love and friendship to his favorite CNA through words and song.

Music can be used in so many ways and for so many purposes in Dementia Therapy. Get creative and get personal. Find the specific songs that were special to your clients and awaken their interest and attention. Connect to their memories to facilitate movement, quality of life, improved ADLs, and communication. The list is practically endless. Think of the many reimbursable outcomes that can be better facilitated through the use of music during therapy sessions. It works and it's fun too.

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