In Perfect Harmony

By Allegra Hein, Beta Psi, Indianapolis Alumni | Photos courtesy of the Great American Songbook Foundation

Growing up in a family of professional musicians, I had early exposure to the benefits of music performance, listening and participation. As a pianist, I learned how to engage in preferred music as a means of personal emotional expression and well-being. However, it was not until I started studying music therapy that I began to learn the true potential impact of music on health.

Did you know board-certified music therapists can use music to rehabilitate speech after a stroke, improve gait, decrease pain and anxiety and much more? I certainly did not know that, even though I had been surrounded by music my entire life. The power of music is truly incredible. From birth to death, most individuals develop a personal connection with music and associate various songs or artists with life events. This is particularly true for individuals with dementia, as musical memories are recalled more vividly than nonmusical memories. Music encourages individual growth, expression, reminiscence and connection that lasts a lifetime.

More than 6 million Americans are currently living with Alzheimer’s disease and other dementias. Dementia is an umbrella term for loss of memory and other cognitive abilities severe enough to interfere with daily life. The most common form of dementia is Alzheimer’s disease, which accounts for 60-80% of cases. Other forms of dementia include: Lewy body, vascular dementia, frontotemporal dementia, mixed dementia (from more than one cause) and other dementias related to Parkinson’s disease or Huntington’s disease. These progressive diseases involve multiple stages of decline which often require an increase in care for the individual.

Receiving a dementia diagnosis is extremely difficult, both for the individual and for their families and loved ones. The progression of these diseases is such that in the mid to late stages, individuals will decline significantly in mobility and cognition. For the individual, this often results in loss of independence and verbal communication and sometimes causes the individual to experience agitating behaviors. For families and loved ones, these stages create new challenges when navigating how to care for and interact with their loved one. There is no cure for dementia-related diseases. Current pharmaceutical treatments target only symptoms of the disease and often cause the individual to experience severe side effects. Considering these challenges, focus has shifted in recent years to more holistic approaches to care. Music therapy is one such approach and offers the individual and their care partners the opportunity to stay connected throughout disease progression.

During the early 20th century, musicians, physicians and psychiatrists began to observe potential health benefits of music in a variety of settings. In the 1950s, while focusing on physical and psychological care of World War II veterans, the music therapy profession was officially established. Today, music therapy is defined as the use of music, by a board-certified music therapist, to improve functioning in areas such as cognition, communication, social skills, motor skills and mental and emotional health. The music therapist-board certified (MT-BC) designation is achieved after completing a four-year degree from an accredited institution, a clinical internship and passing the Certification Board for Music Therapists exam. There are approximately 8,000 MT-BCs in the United States serving populations including: intellectual and developmental disabilities, addiction, neurological rehabilitation, hospice and palliative care, veterans, various hospital settings and older adults (dementia and Alzheimer’s disease). Approaches to treatment vary depending on population and setting; however, board-certified music therapists are trained to achieve greater responses to nonmusical goals as compared to those using music for entertainment or recreation.

Music is an effective therapeutic tool because it stimulates both hemispheres of the brain simultaneously, rather than one localized region. Using client-preferred music and an individualized treatment plan developed by the MT-BC, individuals can achieve cognitive, physical, social and emotional goals through music. Rather than teaching clients how to play a musical instrument (unless this is a client-specific goal), music therapy focuses less on the music produced in each session and more on the processes learned through each musical experience which can be transferred into the client’s activities of daily living. Learning or improving these skills can be more easily achieved through music therapy because of how music stimulates the brain.

In my time as music therapist in a senior community setting with older adults with dementia, I had the pleasure of seeing the “power of music” on a daily basis. Some of my most meaningful experiences were with our residents with late stage dementia. As mentioned previously, this is a stage where verbal communication becomes more difficult; however, after participation in music therapy interventions, residents were singing lyrics of familiar songs (in their entirety!) and participating in spoken conversation, following the musical experience.

Most clinical (led by an MT-BC) and nonclinical music experiences are positive and can increase or maintain various activities of daily living and connection. However, because music is such a powerful experience, adverse reactions can occur. MT-BCs are trained to respond in the moment to over-stimulation, agitation, negative physiological responses, trauma-based responses and/or music-induced seizures, all of which can happen when engaging in music. It is important for anyone engaging in a nonclinical musical experience, with any population, to be aware that these adverse responses could occur. In these situations, it is important for the facilitator to consult with an MT-BC to better understand how to respond to potential adverse reactions and when to seek additional help from a music therapist or other healthcare professional.

As a professional, it is a special experience to use music to connect with individuals with dementia. One of my favorite components of this connection is the impact on an individual’s family and loved ones. Sharing with families how they can use music to re-establish a connection with their loved one is very meaningful. These experiences have encouraged me to educate other care partners, health care professionals and arts organizations on how to use music with older adults and older adults with dementia in a safe and effective way.

Since 2018, I have had the pleasure of consulting with a group music program for older adults called Perfect Harmony, offered by the Great American Songbook Foundation in Carmel, Indiana. Perfect Harmony helps care partners identify appropriate generational music and activities to engage older adults in a shared music experience. My purpose as a consultant with Perfect Harmony has been to educate staff and volunteers about the most effective use of music with older adults. Renée La Schiazza, director of programs at the Great American Songbook Foundation, shares more information about Perfect Harmony’s current offerings:

“Perfect Harmony was developed five years ago by the Great American Songbook Foundation with the idea of returning to the way music was originally enjoyed — as a community experience in which family, friends and loved ones grabbed a piece of sheet music, gathered around a piano and enjoyed music together. Over the course of the past year, Perfect Harmony has evolved into an online resource to continue serving older adults in Indiana and across the country, especially those who are struggling with isolation and limited social engagement due to the COVID-19 health crisis.

“Developed in consultation with a board-certified music therapist and sponsored by American Senior Communities, Perfect Harmony engages participants in singing, movement, playing instruments and discussing experiences related to memorable songs. Listening to music can be beneficial, but we know that there are increased benefits, such as social engagement and cognitive stimulation, when you can do even more to engage individuals in a musical experience. Perfect Harmony offers a range of resources that can be helpful for care partners, including downloadable lyric sheets, generational music playlists, activity outlines, discussion prompts, music videos and more.

“The songs that the Perfect Harmony program selects are aligned with the music that was popular when most older adults were in their late teens or early adulthood. Research suggests that music from this period of a person’s life has a special significance due to biological factors and life experiences that connect our memories to feelings we experienced during that transformational time. For older adults today, this tends to be music from the Great American Songbook, the most important and influential American popular songs, Broadway hits and jazz standards from the early 20th century that have stood the test of time.

“Each month, we release online video resources and music activities that are beneficial in both an individual and group setting and are created with a cohesive theme in mind. Family care partners, activity directors and other healthcare professionals from over one hundred eldercare organizations across the state of Indiana and as far as Canada take advantage of Perfect Harmony’s free online resources each month.”

Leonard Bernstein said, “Music can name the unnameable and communicate the unknowable.” This is true at any stage of life and representative of the vastness of music’s power, both inside and outside of a clinical setting. Consider different ways you can incorporate music into your daily routine: 1. Create personalized playlists for relaxation or movement 2. Develop a self-history of preferred music and/or music associated with key moments in your life to share with friends and family 3. Learn a new instrument 4. Engage in songwriting or other forms of self-expression through music 5. Incorporate Perfect Harmony resources for professional or personal use

The Certification Board for Music Therapists

www.cbmt.org American Music Therapy Association

www.musictherapy.org Alzheimer’s Association

www.alz.org The Great American Songbook Foundation, Perfect Harmony

TheSongbook.org/PerfectHarmony

Allegra Hein (Beta Psi, Indianapolis Alumni) is a graduate of Roosevelt University’s Chicago College of Performing Arts (B.M.) and Ohio University (M.M.), majoring in piano performance. Recent awards include the Mu Phi Epsilon Laverne Jackson Memorial Music Therapy Scholarship and earning first prize in the Ohio Federation of Music Clubs Collaborative Piano Competition. She has been featured live on WFMT, Chicago’s Classical Music radio station, with her mom, Dr. Rebecca Sorley (Kappa, Indianapolis Alumni). Hein has been a board-certified music therapist (MT-BC) since 2016 and has experience working with older adults and individuals with intellectual and developmental disabilities. Hein serves as Program Coordinator for the Marianne Tobias Music Program, a live music performance-based program at Eskenazi Health, Indianapolis's essential hospital. Additionally, she performs regularly throughout Indianapolis as a collaborative pianist, serves as principal keyboardist for the Carmel Symphony Orchestra and provides music therapy consultation to local arts organizations.