Liz Marsh, MT-BC Isaac Zika, MTI

•  Middle Stage (Moderate) – o  As symptoms increase and brain

functioning decreases, this stage can take several years to run it’s course. Symptoms will become noticeable not just to family and close friends, but even to others briefly interacting with your loved one. Damage to brain makes it difficult to express thoughts and perform routine tasks

o  Symptoms: •  Not only trouble finding words, but

mixing up words

•  Feeling moody or withdrawn; getting frustrated or angry, often acting in unexpected ways

•  Gradual loss of orientation x3: time, place, situation

•  Difficulty following multi-step directions, recognizing patterns or routines

•  Changes in sleeping patterns; restless at night

•  Personality and behavioral changes

•  Early Stage (Mild) – o  Mild changes in ability to think

and learn, can still socialize and conduct most typical daily activities.

o  Symptoms: •  Word finding

•  Remembering names •  Performing tasks in

distractible settings; ie: work, social settings

•  Misplacing objects •  Increased trouble planning

or organizing

•  Late Stage (Severe or Advanced) – o  At this stage the disease has progressed to the point of the loved one

unable to complete any task without assistance of some kind. •  Symptoms:

o  Loss of ability to respond appropriately, or at all, to environment; awareness and orientation to surroundings is nonexistent

o  Loss of communication skills; may still say words or phrases but communication is very difficult and frequently situationally inappropriate.

o  Loss of physical abilities; typically walking, feeding, control of bowel/bladder and they become increasingly vulnerable to infections.

Neuritic Plaques Neurofibrillary Tangles

•  Abnormal clusters of protein fragments built up between nerve cells. Commonly found in brains of elderly, but are excessive in the cortex of someone with Alzheimer’s disease

•  Surrounded by deteriorating neurons that produce acetylocholine (neurotransmitter essential for processing memory and learning)

•  Twisted remains of a protein which is essential for maintaining proper cell structure

•  It is not known whether the plaques and dangles are the cause of Alzheimer’s disease or part of the results of the disorder, but these two together create cell death and tissue loss, both detrimental to brain function

•  Whether a musician or not, music affects the brain in more ways than one may think; elicits universal brain response.

•  Music stimulates more parts of the brain simultaneously than any other daily task.

•  Every genre and every song has it’s own map of brain activity; a unique combination of feelings and thoughts eliciting specific emotions, physical, and behavioral responses.

•  Releases dopamine, which increases attention in frontal lobe and is associated with pleasure in limbic system

•  Lowers cortisol •  Music is associated with immunoglobin A and white

blood cell production, linked to immunity

Daniel J. Levitin & Mona Lisa Chandra: The neurochemistry of music

•  Stimulate physical activity •  Stimulate language processing •  Encourage appropriate emotional responses •  Stimulating memory recall •  Cross-stimulating sides of brain: language, emotion,

visual aspects •  Medial, pre-frontal, cortex one of last sections of

brain affected by disease is stimulated by familiar sounds

•  Left vs. Right side of brain in dementia

We all are born with rhythm; Rhythm surrounds us! o  Organizes internal bodily functions o  Organizes physical functions o  Involuntary at times

Music Therapy and Rhythmic Approaches o  Michael Thaut, Ph.D - NMT o  Rhythm and speech disorders – MIT, RSC o  Rhythm disturbances in Alzheimer’s Disease

Everybody up!

What is music therapy??

The clinical and systematic use of music as an evidence-based

practice to achieve non-musical goals.

Main Methods •  Receptive •  Re-creative •  Improvisational •  Composing

MT Models

•  Bonnie Method of GIM •  Creative MT – Nordoff and Robbins •  Behavioral MT

•  NMT •  Analytic MT – Mary Priestly •  Benenzon – Latin America

•  https://www.youtube.com/watch?v=CrZXz10FcVM •  Gladys and Naomi

•  Music assisted reminiscing o  Goal: to increase cognitive stimulation and social interactions

•  Music assisted relaxation o  Goal: to decrease anxiety/behaviors and/or re-direct from stressors

•  Lyric Cueing/Fill in the blank o  Goals: Increase cognitive stimulation. Increase word finding. Give opportunity for

success. Maintain verbal skills.

•  Name that tune! o  Goals: Encourage memory recall. Maintain short term memory. Increase attention

span.

•  Re-creative playing – drums, tone chimes, shakers, Orff instruments, etc. o  Goals: Increase social interactions. Maintain gross/fine motor skills. Stimulate sense of

rhythm. Provide group cohesion/relationship building. Increase attention. Increase coordination. Increase attention to task.

•  Movement based experience – scarfs, parachute, theraband, etc. o  Provide increased sensory stimulation. Maintain gross/fine motor skills. Increase/

Maintain ROM. Increase/support positive mood.

•  Song writing o  Goals: Increase/support creativity. Promote voluntary creative speech. Provide

emotional support. Allow outlet for frustrations/emotions. Encourage group cohesion. Provide sense of accomplishment/closure. Encourage choices/decision making.

•  Stimulate/increase appetite •  Regulate sleeping patterns •  Evoking memories •  Forging relationships •  Creating structure/providing security •  Improving mood •  Decreasing stress/promote relaxation •  Creating positive atmosphere providing successful

experiences •  Giving the power of choice/sense of control •  Providing validation •  Maintaining physical, verbal, and social skills •  Increased awareness of self, others, and environment •  Provide reality orientation •  Encouraging emotional intimacy

Early Stage

•  Encourage dancing to music

•  Encourage music playing if person is experienced

•  Compile musical life review

•  Give music/lyric sheets to read from if success is expected

•  Gentle re-direction with music when appropriate

Middle Stage

•  Provide avenues for continued social interactions with both verbal and non-verbal expression

•  Increase physical activity with music

•  Encourage improved habits with music ie: eating, sleeping, walking

•  Use background music to enhance mood

•  Only use sheet music when helpful

•  Watch for overstimulation •  Encourage reminiscing

Late Stage

•  Provide background music for relaxation/enjoyment

•  Mostly receptive experiences

•  Provide physical touch/stimulation along with music

•  Individual personalization/knowing history is key in this stage

1. Place                                14. Noun 2. Famous Person                    15. Noun 3. Noun                                16. Body Part 4. Noun                                17. Unit of Measurement 5.   Body Part                        18. Emotion/Feeling 6.   Unit of Measurement 19. Verb 7.   Emotion/Feeling 8.   Verb 9. Adjective 10. Verb 11. Verb 12. Verb 13. Noun

I’m A Believer : re-written by the Power of Music Group!

I thought love was only true in 1.__________, meant for 2.__________ but not for me. 3.__________ was out to get me, that’s

the way it seemed, 4.__________ haunted all my dreams.

And then I saw her 5.__________, now I’m a believer! Not a 6.__________ of 7.__________ in my mind. I’m in love, ooooh, I’m a

believer, I couldn’t leaver her if I 8.__________.

I thought love was more or less a 9.__________ thing; the more I 10.__________ the less I 11.__________, oh yea. What’s the use of

12.__________? All you get is 13.__________. When I wanted 14.__________ I got 15.__________

And then I saw her 16.__________, now I’m a believer! Not a 17.__________ of 18.__________ in my mind. I’m in love, ooooh, I’m

a believer, I couldn’t leaver her if I 19.__________.

Well I woke up this morning (feeling) _________________ Yea, I woke up this morning (repeat) _________________ I didn’t feel like _____________________________________ I’d rather ___________________________________ instead.

•  Alive Inside – “The power of music itself is made quite clear; the immense power that music has for reaching folks who are very distant and in need of connection in their limited worlds” Prof. James Hiller, MT-BC, Ph.D Candidate

•  The movie highlights the notion of improving quality of life for individuals experiencing dementia with music they love. 

•  https://www.youtube.com/watch?v=EgNLLelQYwI •  https://www.youtube.com/watch?v=fyZQf0p73QM •  How is this different from what we do?

o MT focuses on interpersonal relationships o Clinical based goals and treatments