‘The world needs to come into music’

Deborah Husbands reports from a conference examining the utility of music interventions in neurological disorders of older people.

Founded in 1977 by legendary violinist Yehudi Menuhin and his friend, Ian Stoutzker CBE, UK charity Live Music Now joined forces here with the Royal Society of Medicine to consider core benefits for music interventions. The conference brought together a diverse mix of academics, medical practitioners, journalists and musicians. Following the opening address by Ewan Dawson (Executive Director for Live Music Now), Dr Peter Freedman, a retired consultant physician and endocrinologist, sparked interest with the biblical account of King Saul’s rages which were soothed by David’s skillful handling of the harp. This was a pointer to the power of music for alleviating medical health issues.

With saxophone in hand, Professor Raymond MacDonald, Head of Music at Edinburgh University, went on to soothe the audience with a soulful rendition, transforming the audience into a mass choir to demonstrate relative pitch. Despite occasional discord, there was general agreement around tonality, reminding us that we’re all inherently musical. We were also reminded of the ubiquitous, emotional, engaging, distracting, physical, ambiguous and communicative nature of music. Yet, music is not without methodological issues, more so because of its link to identity and the social self. Professor MacDonald highlighted potential confounds for both quantitative and qualitative music intervention studies. The primary aim, he said, is to be systematic and rigorous, while acknowledging the ambiguity of experience.

Dr Wendy Magee of Temple University, USA followed by highlighting the importance of systematic reviews, practitioner experience and patient/client preferences in music intervention studies. Using video, she demonstrated how gait rhythmic auditory stimulation in neuro-rehabilitation patients can be an effective motivator for engagement with therapy, leading to functional gains. Adding musical stimuli to neurological input shifts focus away from pain perception to the music itself. Dr Magee referred to the shooting of US Congress Representative Gabrielle Gifford as a further example of music therapy-aided recovery following major neurological trauma. Citing behavioural studies of people in acute phases after stroke (e.g. Särkämö et al., 2008), she explained that music listening (including audio books) during those early stages helps with verbal memory and attention, and reduces depression. However, she cautioned that, at times, music can provide too much information. It is a complex intervention and the person’s other needs and issues must be taken into account.

With our ‘choir’ now in situ, Professor Grenville Hancox (Artistic Director, Canterbury Canata Trust) had us engaged in a musical singing sequence to illustrate work being done with patients with Parkinson’s Disease. From an evolutionary biology perspective, he pointed out that sound modulation existed long before the evolution of language, and continues to manifest in laughter, music and dance, and religion and ritual. Long-term music-making and singing activity can influence plastic changes in the brain, and he recounted the case of PD patient, Tony Lord, who has difficulty with speech but sings heartily without impediment.

Interesting insights into the role music plays in stroke treatment came from Professor Frederike van Wijk of Glasgow Caledonian University. A large sample survey (McKevitt et al., 2011) indicated that stroke survivors are left with visible and invisible problems. This led Professor van Wijk to emphasise the importance of providing ‘politician-proof’ evidence for safety and cost effectiveness of music interventions if we are to secure funding for continued research into life after stroke. More high-quality random controlled studies are needed to show benefits of therapeutic activities that enable people to continue their lives with dignity and value.

Professor Norma Daykin and David Walters (Head of Centre for Arts as Wellbeing) – both from the University of Winchester – presented music intervention as a treatment for dementia, showcasing a trained musician in guided practice. With reference to ‘musical affordances’ (DeNora, 2003), Professor Daykin explored the power of music to facilitate connection, expression, empowerment, skill and memory in dementia patients. There was also a nod to using music interventions in other institutional settings, such as prisons. However, the numbers are important. We need large cohorts to identify possible correlations between interventions and outcomes. David Walters suggested that an interaction of the art and health sectors could lead to new CDP pathways.

Following lunch and poster viewing, Professor Martin Green OBE, Chief Executive for Care England, reminded us of the importance of music for well-being. The nurturing element of music, he said, has the ability to re-connect us with our life-world and that of others. He shared Naomi Feil’s touching account of validation therapy, where singing with an emotional connection and touch provided security and comfort for a patient with advanced dementia who, at times, was empowered to respond rhythmically and connect vocally. Music technology (an iPod and headphones) was shown to have a restorative effect for ‘Henry’, another patient with advanced dementia who, according to Oliver Sacks’ accompanying commentary, was ‘quickened’ by the music. And the effect continued even after the headphones were removed. Henry was able to sustain lively autobiographical conversation about music from his era.

Before the Q&A session with a panel comprising the day’s speakers and Julian West, Creative Music Leader, the audience was treated to a musical intervention: a cello performance of ‘Orbit’ (Philip Glass) by Hermione Jones. Concluding comments were that far from being embryonic, music interventions include a range of methodologies developed over many years; but the quality of evidence is now under closer scrutiny. This can only lead to better quality research, to include qualitative methods. While there may be musical boundaries for practice, research and interventions, efforts should be concentrated on developing a continuum of practice that meets standards of rigour.

There is now an emerging understanding of the scope of skills required when working with vulnerable people or those with challenging behaviours. This includes better recognition of emotions (e.g. agitation vs. excitement), the patient experience and pathology. Complex patients tend to be referred to music therapists when conventional treatments don’t work; yet there is a large role for the arts in clinical settings. The consensus from this conference is there is a strong argument for music interventions to become part of mainstream treatment for neurological disorders in older people. Giving the final words to Henry: ‘I figure right now the world needs to come into music’.

- Deborah Husbands is a Doctoral Researcher at the University of Westminster.

References

DeNora, T. (2003). After Adorno: Rethinking Music Sociology. Cambridge University Press.

Gladys Wilson and Naomi Feil. Available on YouTube at: https://www.youtube.com/watch?v=CrZXz10FcVM

McKevitt, C., Fudge, N., Redfern, J. et al., (2011). Self-reported long-term needs after stroke. Stroke, 42, 1398-1403.

Old Man in Nursing Home Reacts to Hearing Music From His Era. Available on YouTube at: https://www.youtube.com/watch?v=NKDXuCE7LeQ

Särkämö, T., Tervaniemi, M., Laitinen, S. et al. (2008). Music listening enhances cognitive recovery and mood after middle cerebral artery stroke. Brain, 131, 866-876. 

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