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February 2014 VOL 5, NO 1
Music & Medicine: A Dynamic Partnership
Lisa A. Raedler, PhD, RPh
Memphis, TN—The final address of the Fourth Annual Conference of the Academy of Oncology Nurse & Patient Navigators (AONN+) in Memphis, Tennessee, was delivered by Deforia Lane, PhD, MT-BC. Dr Lane is the Associate Director of the Seidman Cancer Center, and Director of Music Therapy at University Hospitals of Cleveland, Seidman Cancer Center, and Rainbow Babies & Children’s Hospital. She is also an opera singer and breast cancer survivor.
Dr Lane earned her PhD in Music Education from Case Western Reserve University, and is board certified as a Music Therapist. She is nationally renowned for developing music therapy programs for diverse populations, including the mentally handicapped, abused children, geriatrics, psychiatric patients, adult and pediatric patients with cancer, and the terminally ill. She is a spokesperson for the American Cancer Society, the organization for which she composed and recorded the song, “We Can Cope.” In 1994, Dr Lane received honorary membership into the Oncology Nursing Society.
When introducing Dr Lane, Lillie Shockney stated, “You are in for a treat! A major treat!... You have expressed a lot of interest in complementary and alternative medicine…[Deforia] is an amazing individual whom I have had the wonderful opportunity to hear before.”
Before launching her presentation titled “Music & Medicine: A Dynamic Partnership,” Dr Lane proffered an eloquent “Deforia-devised” definition of oncology nurse navigators: “You are an eclectic group of women and men who have efficiency in their DNA; multitasking skills galore; the ability to navigate physical, social, psychological needs of patients and families; and who balance ever-changing, ever-challenging personalities of a multidisciplinary team.” Dr Lane expressed respect and gratitude for nurse navigators, who “carry the weight of care upon broad shoulders.”
What Is Music Therapy?
Dr Lane introduced nurse navigators to what she termed “a most magnificent profession”: music therapy. Music therapy is the clinical- and evidence-based use of music interventions to accomplish specific patient goals. Music therapists—credentialed professionals who have completed an approved music therapy program—customize their approach to each patient as they develop therapeutic relationships. They help clients improve their health in several domains, including cognitive functioning, motor skills, emotional development, social skills, and quality of life. The music experiences that therapists use to achieve their treatment goals range from free improvisation and singing to listening to, discussing, and moving to music.
How Are Music Therapists Trained and Certified?
Dr Lane indicated that more than 7000 music therapists are board certified in the United States. They are educated at 1 of 70 colleges and universities with bachelors-, masters-, or doctoral-level music therapy programs. A degree in music therapy requires proficiency in guitar, piano, voice, music theory, music history, reading music, improvisation, as well as varying levels of skill in assessment, documentation, and other counseling and healthcare skills depending on the focus of the particular university’s program. To become board certified, a music therapist must complete a music therapy degree from an accredited American Music Therapy Association (AMTA) program at a college or university, successfully complete a music therapy internship, and pass the board certification examination in music therapy. The credential Music Therapist-Board Certified (MT-BC) is granted by the Certification Board for Music Therapists (CBMT) upon successfully passing the board certification examination.
The Impact of Music Therapy
Dr Lane is enthused about the ubiquity of music. “Music is our first cry and our last breath. It is a part of our culture. It is a part of our ethnicity. For many of us, it is a part of our celebrations. It is everywhere!” By asking the audience to participate by clapping and singing, Dr Lane demonstrated just how relevant music is to our mood and physiologic functioning. “Music, with its rhythms, can lower blood pressure, heart rate, and respiration rate…. This beautiful thing called music can literally adjust your behavior. It can stimulate past memory…. People who cannot talk can sing.”
Using the example of a woman with metastatic breast cancer, Dr Lane described how music therapists assess patients, formulate treatment goals and concrete intervention plans, and then collect data regarding patient outcomes. With a music therapist’s help, Dr Lane’s hypothetical breast cancer patient–—who is also a mother and wife and who feels depressed and anxious—learns to write a song for her daughter, including lyrics and rhythms. Music therapists collect and document data about how long the patient engages, her attitude, her degree of involvement in the song-writing activity, her ambulation, and pain scale ratings.
Clinical outcomes associated with music therapy can be significant. Dr Lane stated, “This is a magnificent time to be a music therapist.” She highlighted examples of Nathaniel Ayers, a Julliard cellist diagnosed with schizophrenia and for whom “music has been an anchor,” and Representative Gabrielle Giffords, who was critically injured by a gunshot wound to the head. “[Ms Giffords’s] music therapist used a neurologic music therapy technique, called melodic intonation therapy, to address her speech.”
The therapeutic effects of music have already been investigated in a variety of clinical scenarios and healthcare settings. “There is a great deal that we know about how we respond to music. We take evidence-based studies and theories, and use them to help our patients,” according to Dr Lane. Using personal examples and referencing literature, she explained that babies can be conditioned to respond to music before they are born. Crying babies will calm to the same music that was played to them in utero.
At the other end of the age spectrum, Dr Lane introduced the audience to a gentleman with late-stage Alzheimer’s using a video recording. “You can see that he cannot find his way to his room or tell you his name. He mumbles and does not look at [the music therapist]. But, the minute she started playing, what happened? The video shows how the man calms down. He makes eye contact with his therapist, and then he says to her in a very clear and lucid voice. ‘I like it! Don’t you?’”
Other poignant examples of the effects of music therapy were illustrated in a series of video recordings of stroke victims who were unable to ambulate effectively. Dr Lane explained that rhythmic auditory stimulation, a neurologic music therapy technique, can help such patients as they undergo rehabilitation. One of the patients, a young man who suffered a stroke, is very unsteady at the onset of the video. His physical therapist works with him, while the music therapist simply watches from a distance. The video shows the patient’s faltering gait and his lack of arm swing. Later in the session, this patient’s music therapist uses rhythmic auditory stimulation—a simple metronome ticking, no music. When the metronome is on, the patient walks more comfortably, his arms swing in a coordinated manner, and he is steady. While viewing the video with the audience, Dr Lane smiled proudly. “This is magnificent to watch!”
Dr Lane explained that clinical research shows that hospitalized patients who walk, “IV poles and all,” while listening to live music of the genre they prefer, walk farther and perform more exercise repetitions. “They are propelled by the music, which synchronizes the body.”
Music Therapy in Palliative Care Patients
Shifting her focus to the cancer arena, Dr Lane recalled a randomized controlled study of music therapy and its effects on chronic pain in hospitalized patients. This study randomized 200 palliative care patients to standard care alone, which included medical and nursing care plus scheduled analgesics, or standard care plus music therapy. The study objective was to reduce the amount of pain that patients experienced as measured by validated pain scale ratings.
Patients in the experimental group met with a music therapist who conducted a single 20-minute music therapy intervention that was directed at lowering pain. The intervention included guided imagery, followed by live slow-tempo harp music. (The goal of guided imagery is to employ mental images, as well as effective breathing and relaxation techniques, to minimize pain.) Dr Lane noted that the researchers used standardized pain assessments pre- and postintervention, including use of a 0 to 10 numeric rating scale (NRS).
The research to which Dr Lane referred was recently published by Kathy Jo Gutgsell, PhD, the music therapist who played at the bedside of all patients in the experimental group (J Pain Symptom Manage. 2013;45:822-831). This study demonstrated that both the music therapy and control groups showed significant declines in pain using the NRS from pre- to posttest (mean change of 1.94 for music therapy and 0.56 for control). However, a significantly greater change (P <.0001) was seen in the music therapy group. Dr Gutgsell and colleagues concluded that, based on these data, “palliative care clinicians may confidently refer trained music therapists to treat pain in this vulnerable population.” As Dr Lane reviewed these findings at the AONN+ meeting, she exclaimed, “Look at that P value! Now that made me hoop, holler, and shout!”
Music Therapy and Preventive Medicine
Shifting to the role of music in facilitating community-level relationships and outreach, Dr Lane recalled statistics related to the higher rate of mortality associated with breast cancer in African American women. “When given an opportunity to speak with women of color who were 60 years and over using music therapy, I said ‘yes!’ I did not have a clue how I was going to do it, but I said yes.”
Dr Lane and colleagues, both of whom were also breast cancer survivors, created Project Temple, an outreach program in which music therapists visited churches, inner city apartment buildings, and senior citizen homes to talk about breast cancer screening through use of a musical skit. “[In the skit,] we talked about [cancer and cancer screening] as though we were sitting around a kitchen table. We sang the songs that helped us through our journey…. We called it ‘Sing, Sister, Sing.’ And each of us gave our personal testimony, if you will, at the end [of the skit].”
Dr Lane smiled as she recalled Project Temple participants. She noted that many were initially very skeptical (“I’ll listen to this, but...”), ultimately asking her and her colleagues, “Can you put your finger right here? Do you think that is cancer? I’ve had that for a couple of months.” She laughed, “Are those 44DDs? I have stroked many a breast!”
Project Temple was a real success: Dr Lane described that participants loosened up, sang along, and asked many questions. They also agreed to free mammograms and were able to have the procedure conducted in the mobile van that accompanied the actors. In all, Dr Lane estimated that she and her colleagues have reached more than 3000 women. “It was wonderful!”
“Communicating from the Heart”
Dr Lane concluded her presentation by singing a poignant spiritual that was taught to her by her mother. “To me, the most beautiful part of using music with people is communicating from the heart and giving them a voice.”
Lillie Shockney, the program chair, agreed. “We may see hundreds or even thousands of cancer patients, but that patient only sees one of us. That patient will remember you forever. If you did the right thing, as an advocate and a navigator…that patient will remember it forever.”
To learn more information about music therapy and to find a certified music therapist, visit www.musictherapy.org.