Music Therapy in Pediatric Palliative and Hospice Care

1. National Hospice and Palliative Care Organization’sPalliative Care Resource SeriesSongs of the Dying: The Case for Music Therapy in Pediatric Palliative and Hospice CareWritten by: Yelena Zatulovsky, LCAT, MA, MT-BC, CCLS, HPMT

2. Objectives • Understand Music Therapy • Define Music Therapy • Describe Goals of Care • Discuss the role of Music Therapy in Hospice Care

3. Understanding Music Therapy • Hearing is our first and last sense • Hearing is developed in the womb • Music is central to nearly every culture in the world • Music is multi-faceted – can have somatic, emotional and cognitive effects • Gate Control Theory – music is as powerful a stimulus as pain

4. What is Music Therapy? Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program. American Music Therapy Association (Cited from www.musictherapy.org)

5. Defining Music Therapy • Established health profession • Title protected – only a Board-Certified Music Therapist (MT-BC) can provide music therapy • Address physical, emotional, cognitive, psychosocial, spiritual needs • Evidence-Based Treatment includes creating, singing, moving to and/or listening to music and does not require the client to have any musical ability

6. Elements of Music Manipulated by MT-BCs • Rhythm – affects both body and emotion – heart rate, respiration, and brain waves are influenced by the vibrations of music toward stimulation or sedation • Tone – determined by distinctive rate of vibration affects both physically and psychologically • Melody – stimulates memory, emotion, images, associations • Harmony – simultaneous vibration of several tones toward harmonious blend or strident dissonance in cycle of tension release • Timbre – the unique quality of sound of an instrument – the human voice included, which elicits different emotional responses

7. Defining Music Therapy • For D (4 year old) and her family, primarily used as an avenue of communication for those with difficulty verbally expressing • Research supports efficacy • Overall physical rehabilitation and facilitating music • Increasing motivation to become involved in treatment • Emotional support • Outlet for expression of feelings • Provides a sense of control and support for anticipatory grief and pre-bereavement

8. Goals of Care Examples • Somatic & Medical • Adjunctive or alternative pain management • Promotion of physical comfort and reduction of stress • Aide for respiratory conditions • Procedural support during examinations, treatments, or activities of daily living (including terminal extubations and compassionate weans) • Psychosocial & Emotional • Assessment and treatment of anxiety, depression and/or related symptoms • Offers developmentally-appropriate and non-verbal forms of communication and support • Provides safe, supportive and creative outlet for emotional expression and/or actualization of issues

9. Goals of Care Examples • Cognitive & Neurologic • Promotes verbal engagement within a patient’s expressive capacity and improves interaction due to bridging of strengths in each hemisphere • Increased motivation towards expressive skills • Receptive cognition may be improved for a variety of differential dementia and disease-related dementia symptoms due to tapping into long-term memory • Spiritual • Exploration of existential issues and meaning-making • Support through spiritual comfort, ritual and practice • End-of-life vigil for patient and family support • Funeral/memorial planning

10. Examples of Music Therapy Interventions • Prompt & Existential Processing • Sweet By and By – music used as a stimulus to begin verbal processing with Mr. S (an 87 year old) Baptist with a diagnosis of Lewy Body Dementia whose decline included periods of agitation • Music-based life review and reminiscence • The Barney Song & Always – songs with personal meaning to P (a 32 year old mother) which helped her say goodbye to her children • Lyric Analysis • Hold My Hand – a piece used with K (a 12 year old) and her family who were reluctant to tell her she is dying; she knew • Iso-principle • Music that initially matches then is modified (in a chaining fashion) to increase comfort (physiologically, emotionally, psychologically…)

11. Conclusion “Music puts everything you wish you could say into words and melody. Music takes the moments you’ll never forget and makes them permanent.” Stephen Gomez