W
ORKING WITHC
AREGIVERSMusic therapists may work with family members and caregivers to provide ideas for shared leisure activities involving music. This is particularly significant for family members of nonverbal patients. Interacting in musical activities that are personally meaningful may enhance the time spent with their loved one. By providing guidelines for how to involve their loved one in music choices, active listening, and responses to the music, a shared musical experience may be facilitated. This may be more fulfilling for both patient and caregiver than just putting on a CD in the background.
R
ESEARCHE
VIDENCEVery little research has been conducted on the efficacy of music therapy interventions with critical care populations. One early music therapy study examined operant conditioning with three LAS patients. Recorded music was used as a reward for switch-pressing and demonstrated patient-initiated movement (Boyle & Greer, 1983). There is little empirical research evaluating live music therapy interventions. Formisano (2001) used standardised tools, in addition to video analysis with blinded assessors, to evaluate the effect of improvisational music therapy in 34 patients in LAS. The assessment tools used included Glasgow Outcome Scale (Jennett & Bond, 1975), Disability Rating Scale (Rappaport et al., 1982), Coma Recovery Scale (Giacino, Keznarsky, & De Luca, 1991), and Post-Coma Scale (Formisano, Vinicola, & Carlesimo, 1996). Although data from the evaluation scales were inconclusive, blinded observations from the video footage suggested improvements in psychomotor initiative (inertia) and decreases in psychomotor agitation. Aldridge and colleagues (1990, 1995) have also reported effects of live, improvised singing on heart rate, respiration, EEG measures, and voluntary movements. However, these publications did not report any measures taken to reduce risk of bias and chance influencing results. Well-designed studies, using control subjects and random group allocation, are greatly needed in this area.
To date, only one study has examined the effects of music therapy with PTA patients (Baker, 2001a, 2001b). Results of this randomized, controlled trial demonstrated significant increases in orientation and decreases in agitation following familiar music listening, but no change following the control condition (no music). A recent Cochrane Review found only one unpublished music therapy study using patient-selected, live music interventions with mechanically ventilated patients (Bradt et al., 2010). Results of this study suggested that the music therapy intervention significantly decreased heart and
respiration rates (Phillips, 2007). Several music medicine studies have shown that listening to prerecorded music can reduce state anxiety, levels of pain perception, and blood pressure in critical care and mechanically ventilated populations (Bradt et al., 2010; Chlan, 1995; White, 2000; Wong et al., 2001).
S
UMMARY ANDC
ONCLUSIONSAlthough the three subgroups of critical care patients described in this chapter each present with differing etiology and clinical presentation, there are some areas of similarity and shared need. Regulation of the sensory environment is vital due to the growing body of evidence on the detrimental effect of noise on recovery and sleep in critical care settings. Increased heart rate, poorer immune function, and impairments in cognitive function are just a few of the negative effects cited. The application of music therapy to promote rest and sleep in a sensory-regulated environment is therefore strongly indicated. The environmental enrichment literature also supports the application of music therapy for patients in low awareness states. Through a rich and musically stimulating environment, patients are enticed to respond, and these responses are musically reinforced.
A range of possible indications for music therapy intervention with critical care patients has been presented in this chapter. These include, but are not limited to: assessment of awareness, sensory stimulation, decreasing agitation, promoting sleep, increasing orientation, decreasing anxiety, pain management, encouraging purposeful behavior, and providing opportunities for creative expression. Receptive and improvisational techniques are the primary modes of music therapy intervention with this clinical population due to the minimal range of responses possible for most patients.
The music therapy methods described in this chapter have been employed in clinical practice based on the foundations of neuroscience and music psychology research. Our understanding of how music is processed in the brain at a neurological level (in terms of arousal, awareness, and attention) and at a psychological level (in terms of anxiety, pain perception, and sense of control) continues to grow. Efficacy research on music therapy interventions with this population is urgently needed, however. In particular, research utilizing scientifically robust design and methodology is required. It is hoped that the methods described in this chapter will inspire music therapists not only to work with patients in critical care, but also to conduct empirical research that will contribute to the knowledge base informing this work.
A
CKNOWLEDGMENTI would like to acknowledge and thank Janeen Bower for her valuable feedback in the preparation of this chapter.
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