Sensory Sounds: Joining Music Therapy and Recreation Therapy in Advanced Dementia Care

1. Sensory Sounds:Joining Music Therapy and Recreation Therapy in Advanced Dementia Care Karie Bilger, BMT, MTA Music Therapist St. Joseph’s Health Centre, Guelph University of Windsor Music Therapy Student Conference March 14, 2009

2. Music Therapy and Dementia • MT is a safe and effective method for treating agitation and anxiety in moderate and severe dementia (Svansdottir, H.B. & Snaedal, J. 2006) • MT can actually improve cognition in individuals with dementia for a period of time (Bruer, R. et. al., 2007) • MT can reduce symptoms of depression in individuals with dementia (Ashida, S., 2000)

3. Music Therapy and Dementia It is astonishing to see mute, isolated, confused individuals warm to music, recognize it as familiar, and start to sing, start to bond with the therapist…there is a sudden attention…distracted eyes fasten on the player. Torpid patients become alert and aware; agitated ones grow calmer…(Sacks, O., 2007, p. 344).

4. Sensory Stimulation and Dementia • Institutionalized individuals with dementia face physical and environmental factors that deprive them of sensory experiences. Deprivation can contribute to depressive symptoms which can cause further confusion and difficult behaviour. (Bryant, W., 1991) • Sensory stimulation interventions lead to improved adaptive behaviours and, “observable changes in levels of interaction, active looking, and interest.” (Spaull, D. et. al., 1998, p.77) • Multi-sensory environments have been found to enhance communication and engagement in surroundings. These environments can allow individuals with dementia to experience ‘quality time’ with others. (Hope, K.W., 1998).

5. “To reach out, to seek, to relax” Began in Holland in the 1980s Used in many different populations for: Therapy/rehabilitation Recreation/leisure Relaxation/stress management Education Provides an environment that gently stimulates all sensory modalities Creates a secure space where clients may explore and relax Highly successful activity which can be non-directive Snoezelen

7. Sensory SoundsMusic Therapy & Recreation Therapy in Advanced Dementia • Co-led program (Music Therapy and Recreation Therapy) • Theme-based sessions (e.g. “Winter,” “Love is in the Air,” “Colours”) • All five senses, plus cognition are stimulated through music, sensory experiences and discussion/reminiscence • Sessions are tailored to the abilities of clients (varying stages of dementia)

8. Goals for Program: To enhance quality of life To increase social interaction To enhance communication and creative self-expression To increase sensory stimulation To promote relaxation and diminish anxiety To enhance reality orientation Sessions Include: Singing familiar songs Small instrument playing Group and individual drumming Discussion Reminiscence Sensory experiences Relaxation Sensory SoundsMusic Therapy & Recreation Therapy in Advanced Dementia

9. Sensory SoundsSample Session Plan Colours 1. Greeting Song 2. The Yellow Rose of Texas [Show colour, show a lemon, smell the lemon, picture of a yellow rose] 3. Red River Valley [Show colour, taste strawberries] 4. Beautiful Brown Eyes [Show colour, taste chocolate, smell coffee beans] 5. By the Light of the Silvery Moon [Show colour, touch/look at jewellery] 6. Five Foot Two Eyes of Bluewith small instruments [Show colour, show picture of baby w/blue eyes, touch blue jeans] 7. Group Drumming on gathering drum 8. Relaxation: Somewhere Over the Rainbow [Fibre optic spray] 9. Closing Song

10. Eye contact Smiling Laughing Crying Tapping toes/hands to music Bobbing head to music Clapping in time to music Dancing/Swaying (standing or in chair) Moving hands to music (eg. Conducting) Singing words/phrases Vocalizing (eg. humming, la) Playing basic beat Imitating rhythms Initiating rhythms Following tempo/style changes Verbal responses to discussion/stimuli Non-verbal responses to discussion/stimuli Interaction with therapists Interaction with group member Visual tracking Sensory SoundsClient Responses

11. Sensory SoundsClient Responses Purposeful, Meaningful Interactions with Others and the Environment!!

12. Bibliography Bruer, R., Spitznagel, E. & Cloninger, C. (2007). The Temporal Limits of Cognitive Change from Music Therapy in Elderly Persons with Dementia or Dementia-Like Cognitive Impairment: A Randomized Controlled Trial. The Journal of Music Therapy XLIV, 4, 308-328. Bryant, W. (1991). Creative Group Work with Confused Elderly People: A Development of Sensory Integration Therapy. British Journal of Occupational Theray 54, 187-192. Hope, K.W. (1998). The effects of multisensory environments on older people with dementia. Journal of Psychiatric and Mental Health Nursing 5, 377-385. Sacks, O. (2007). Musicophilia Tales of Music and the Brain. New York: Alfred A. Knopf. Sato, A. (2000). The effect of reminiscence music therapy sessions on changes in depressive symptoms in elderly persons with dementia. The Journal of Music Therapy Vol. 37, No. 3 p.170-82. Spaull, D., Leach, C., & Frampton, I. (1998). An Evaluation of the Effects of Sensory Stimulation with People Who Have Dementia. Behavioural and Cognitive Psychotherapy 26, 77-86. Svansdottir, H.B. & Snaedal, J. (2006). Music therapy in moderate and severe dementia of Alzheimer's type: A case-control study. International PsychogeriatricsVol 18(4), pp. 613-621. Worldwide Snoezelen. (2009). www.worldwidesnoezlen.com