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Music therapy programs hit the right note

From autism to dementia to the end of life, music has the power to resonate and soothe

One day while leading one of his vintage-music reminiscing sessions at the Day Break adult day care in Sunnyvale, musicologist John Lehman finally got through to a man in his 80s who was agitated and restless because of his dementia.

During the session, the senior would leap up from his chair to tell Lehman the same joke over and over, then sit back down. He repeated the behavior more than 30 times throughout the hour — distracted and otherwise disengaged from the music at large.

Then Lehman played the next song, "As Time Goes By" from the movie "Casablanca," and witnessed the man's transformation.

"He just sat straight up like he got hit with a bolt of lightning. Then he calmly stood up, walked over to me and put his hand on my shoulder and said, 'You know, I was in the war,'" Lehman recalled.

The man began telling Lehman he remembered the song from his youth in 1944. He had been serving in the Japanese Army during WWII when America's Office of War Information aired popular songs of the time across airwaves in the Pacific Theater as part of its Voice of America radio broadcast.

Moments such as these illustrate the power of music and the efforts of music therapists, musicologists and researchers who are using music as therapy to help a broad range of people.

Music can provide a voice for a nonverbal child with autism, help people with dementia or Alzheimer's remember long-lost memories. It can also provide calm and peace to those in their last moments of life.

"Music touches on a lot of different places in people's brains and their lives," said Beth Hardy, a music therapist who holds a credential from the Certification Board for Music Therapists.

"We grew up with music. We are rhythmic people — our heartbeats, our cadence, our walk — we are a rhythm. ... We use music in every ritual of our lives. If you think of weddings, funerals, birthday parties, special events, music is the connecting factor through all those things."

In Suzanne Doi's K-5 classroom for students with special needs at Juana Briones Elementary School, board-certified music therapist Spencer Hardy strums his guitar and leads a small group of children in a catchy song.

"I have two shoes and one of them is a boogity woogity shoe," Hardy sings, motioning to the kids to try and touch their toes as they shake plastic eggs filled with sand to the beat of the music.

He points to a smiling girl in the center.

"OK, Ava, tell us what should we do next," as he hands her his iPad displaying colorful pictures of a head, legs, eyes and arms. Ava touches the screen and selects arms.

"I have two arms, and one of them is a boogity woogity arm," he sings while occupational therapists and classroom aides sing along as they raise some of the children's arms.

"Music is very calming for them; in some ways it's almost magical. They start to hear a song, and then they forget about everything else, or their bodies start moving in ways that maybe they weren't before," Doi said.

On the surface it might seem like Hardy is simply performing and entertaining the group, but in reality he is adjusting to each student's limited abilities, working to help develop their motor skills, establish communication, learn to make decisions, interact socially and make eye contact.

"There are a lot of social skills that are happening in the group that people may not think would happen in a music group," Doi said. "All those things that we take for granted ... are things that sometimes we have to be taught, and I think (with music therapy) that's a really nice way to do it in a very low-key, non-pressured situation."

Hardy specializes in working with kids and young adults in the special-needs community, particularly those on the autism spectrum. He leads group-therapy sessions once a week for students at Juana Briones and Greendell schools in Palo Alto, meets one-on-one with clients at his private practice in Los Altos, and is collaborating with fellow music therapist Beth Robinson as they prepare to launch their joint practice, Rainbow Music Therapy (www.rainbowmusictherapy.com), at the end of this month.

In his work, Hardy sees a wide range of students with all types of abilities.

Some of his students are nonverbal, so he uses devices like an iPad or speech recorder to help a student learn how to communicate what they would like to do. For students who have impulsive behaviors he will introduce drumming and percussive instruments to keep them focused on a beat. Oftentimes Hardy says his students have perfect pitch or rhythm but struggle with making mistakes as they try to play the music that is playing perfectly in their head.

"Music within itself creates a nonthreatening environment where people are able to sort of relax and feel safe and comfortable in this idea of creating music together and be themselves in that space. And then from there, as a therapist, I can meet a child on the same level through music and from there we can grow together," he said.

Doi has seen it firsthand in her classroom. One of her students has learned how to clap on her own by participating in Hardy's weekly sessions. Doi says that the music frees and empowers her kids to express themselves.

"There's something about the rhythm of the music that's very soothing for our students, it's very freeing. They all really respond to music in lots of different ways," she said. "It gives them a very intimate experience with music and gives them a lot of opportunities to show their joy."

Parent Lisa Zuegel agrees. She is able to better communicate with her son Jeffrey, 14, through Jeffrey's love of songs and music. Jeffrey was diagnosed with low-muscle-tone cerebral palsy and displays some behaviors akin to autism.

"Jeffrey makes up songs all the time. ... It's a good way for us to connect with him," she said. "He's telling us a story through the song."

On a recent Friday at BridgePoint at Los Altos, a senior community, musicologist Lehman breaks out in a big grin as he takes 94-year-old Edy Lynch's arms. The two begin to swing to the lively beat of Glenn Miller's "Imagination" from 1944. When Fred Astaire's "Isn't This a Lovely Day" from 1935 plays, resident Janine Breitbart sings every word. And during 1947's "Managua, Nicaragua" by Guy Lombardo and his Royal Canadians, Fran Nuelle dances in her chair and sways her head.

The music and dancing form Lehman's year-long exploratory "Vintage Music Therapy Program," which he leads twice a week at the center, as well as at SarahCare of Campbell adult day care center and the Alzheimer's Activity Center in San Jose. Lehman, executive director of the nonprofit Senior New Ways based in Palo Alto and an avid private music collector, began to test out the program after witnessing how seniors immediately responded to hearing music of their youth at a Christmas program at the Los Altos United Methodist Church.

"I chose Christmas songs that haven't been played on the radio in over 60 years, and this group of 80-year-olds could identify the song and the performer's names in less than 8 seconds. ... After an hour I was just blown away," he said.

After being awarded a grant by the Los Altos Community Foundation funded by the David and Lucile Packard Foundation, Lehman launched the program through Senior New Ways last April. He leads seniors ages 70-98 on an hour-long "reminiscing session" using a portable speaker and iPod filled with more than 40,000 songs from the 1920's through early 50s.

BridgePoint resident Janine Breitbart has a special fondness for hearing the music of the Big Band Era.

"My brother just loved the Big Band Era. It was always just a continuum in my soul and in my being," she said. "Listening to it is just a continuation of what's been in my heart."

Though Lehman leads the weekly sessions to a variety of seniors with varying degrees of mental agility and sharpness, he is most excited about the prospect of studying how music can help those with dementia and Alzheimer's disease. He lost his mother, an aunt and two cousins to the disease and notes that dementia rates are expected to rise significantly as Baby Boomers age.

He says his work is informed by the neurological research of music on the brain and memory from neuroscientists Oliver Sacks and Daniel Levitin.

"I read in Levitin's book 'This Is Your Brain On Music' that what you hear as a teenager, because of hormones and emotional development and brain acceleration, you never forget," he said. "Even though you may think you forgot it and you don't hear the music for 50, 60, 70 years ... who you were necking with in the backseat, when you went to prom, all that stuff, the emotion of it, the smells, the sound, everything is captured and it's really cemented in there."

In the spring Lehman says he will begin working with researchers from the Alzheimer Disease Research Center at USC to conduct research on how the program may affect the cognition levels of Alzheimer's patients by administering a series of regular memory tests within a control group.

"It is tremendously important to identify modifiable factors that might contribute to healthy cognition in old age. Music is particularly promising because it engages cognition, emotion, physical movement and social engagement," stated Dr. Margaret Gatz, professor of psychology, gerontology and preventative medicine at USC who will be overseeing the research with doctoral student Alison Balbag.

Marguerite Manteau-Rao, a licensed clinical social worker with a private psychotherapy practice in Palo Alto and clinical director of the Lakeside Park specialized elder-care facility in Oakland, agrees about the profound effects that music and music-centered activities can have on the mind of someone with dementia or Alzheimer's. Music tied to one's memory can help an unresponsive person "come to life" or immediately calm a person experiencing a hallucination onset by the disease, she said.

"It can be pretty dramatic, and it's really like medicine for people with dementia — and it's not just the music itself but all the music-related activities that are spurred by a shared music experience such as reminiscing, and singing, dancing, all of that," she said.

Lehman also considers music as medicine in a way.

"This is like going to RiteAid and getting a prescription: It might not take effect overnight, but it's going to take effect."

After her mother was diagnosed with Alzheimer's, Manteau-Rao realized she was still able to share experiences and memories with her mom over the phone when all other forms of communication had been lost, by singing French drinking songs together — some of her mother's favorite songs during her youth.

Last year she created a personalized music program for residents at the Lakeside Park community and has recently developed Carenga; an app for the iPad that primarily gives caregivers and family members a way to set-up personalized playlists and share songs and lyrics.

One of her main passions at the moment is bringing personalized music into other care facilities to help patients with dementia establish a better quality of life.

"It's one way to easily bring personalization particularly in institutions where it's so hard because of logistics to have every person being recognized for who they are," she said. "Personalized music is just like food ... and from the research it's also a quick pathway into the brain and accessing all these parts of the brain that sometimes become dormant or nonaccessible because of the dementia."

Manteau-Rao points to the research currently being conducted by Dr. Petr Janata at UC Davis, who has been studying how the brain responds to music that conjures memories. The study, "The neural architecture of music-evoked autobiographical memories," found that a section of the pre-frontal cortex, oftentimes the last intact region of the brain of someone with Alzheimer's, retrieves memories when a familiar song is played.

Dr. Walter Greenleaf, director of the Mind Division at the Longevity Center at Stanford University, a center dedicated to studying how our culture can respond to aging and living longer, agrees that personalized music for people with cognitive impairments can act as a way to connect family members.

"One of the cool things about the use of music here is that it can form a bridge to allow someone who's not a clinician to have a way of interacting," he said. "And that's really key both for the person who has Alzheimer's but also for their family members who are really thirsty for having a way to have a dialogue, even if its not a verbal dialogue, to share something."

"This is strictly about enhancing the quality of life," Manteau-Rao said. "It's a great way to engage a person and sometimes enable them to speak again and talk about their memories."

In a sun-filled room on the fourth floor of the VA Palo Alto Health Care System, music therapist Beth Hardy pulls up a chair and her guitar beside Army Lt. Col. Christopher Manak's bed and asks him to pick a song from a printed list of popular and patriotic songs. The Vietnam veteran, who is staying in the hospital for a temporary palliative care respite, selects a song and together they sing, "You are my sunshine, my only sunshine, you make me happy, when skies are grey." A moment later his 4-year-old granddaughter joins in with a few shakes from a percussive shaker.

Everyday on the hospital's hospice unit, Hardy meets with patients and caters her music sessions to try and help ease their physical and emotional pain, reduce anxiety and also to bring family members together who are seeking to reminisce and connect with their dying relative.

"I think a lot of times families might not know how to interact with their loved one who is dying and can't respond to them," she said. "And often how music plays into that is that it gives people an opportunity to engage with that person in a different way by singing to them or holding their hand while I play a song that they might have danced to at their wedding or a song that they loved together. It gives them a chance to be of service and to show that person that they are there."

When families are in the room, Hardy tries to bring everyone together either by singing or playing some of the instruments she brings with her. Sometimes she also records the sessions on her laptop so the memory is saved for the family afterward. She sees the music as a way to allow families to make a few last memories together and manage grief.

"Having them be able to play music with their loved one can really decrease a lot of the tension in the room, a lot of the fear and anxiety ... and also help them to have this amazing memory and experience before the person passes away." she said.

The work can be emotionally trying, especially when a patient is not awake or responsive and there are no family members to retrieve personal information about the patient's music preferences. When that is the case, Hardy plays open guitar to try and increase their relaxation and slow their breathing down.

Through her work, Hardy says that using music as therapy can often be the easiest way to connect people when other forms of communication are lost or too difficult.

"I like to think of music therapy as coming in through the backdoor — the music is the way in with someone — and then after connecting through music there's an opportunity to really connect verbally and find out what it is they need, what it is they're struggling with right now," Hardy said.

John Lehman echoes that sentiment: "If I want to explain something to you, I'll use words. If I want you to know how I feel, I'll use music."

Comments

 +   Like this comment
Posted by Michele Dauber
a resident of Barron Park
on Jan 31, 2014 at 8:29 am

This year's Audience Award for documentary at the Sundance Film Festival was the movie Alive Inside, featuring the work of Music and Memory (musicandmemory.org). The film was fantastic, and there was not a dry eye in the packed theater during screenings. Everyone should visit the website and see the film and then learn how to donate and ipod, and participate in this important initiative.


 +   Like this comment
Posted by Olenka Villarreal
a resident of Community Center
on Jan 31, 2014 at 10:20 am

3 cheers for Spencer! As Ava's mom (referenced in the article), we have thoroughly enjoyed his music sessions over the years. Ava typically has a hard time sitting still, but when she is in her hour-long class, she stays fully engaged as Spencer works his magic.

Spencer's commitment to serve this population was underscored when, at a recent community function, a parent of a typically-developing child asked him to play at an upcoming birthday party. To this, Spencer replied that there are so many talented musicians who can perform for them and not enough to work with those with special needs. He politely declined the invitation, saying his time is best serving these kids.

Because music is such a powerful connector for ALL kids, I'll take this opportunity to mention there will be several interactive musical zones in the soon-to-be-built Magical Bridge Playground in Mitchell Park. Stay tuned and come and play with us once the park is built this fall! (www.magicalbridge.org)


 +   Like this comment
Posted by Member
a resident of Downtown North
on Jan 31, 2014 at 10:47 am

Both John Lehman and Marguerite Manteau-Rao, mentioned in this great article, will be making a free presentation for the community on Thursday, June 19 at 7pm at Avenidas Rose Kleiner Center in Mountain View. Along with Linda Sullivan Baity, they will talk about how music, art and horticulture can be used as therapy for older adults. Mark your calendars if you want to attend this interesting session.


 +   Like this comment
Posted by Suzanne Lyon
a resident of another community
on Feb 1, 2014 at 7:14 am

This is a wonderful article. I'm glad someone also mentioned the Music & Memory program where they are collecting iPods to be used for residents in nursing homes. Music is magical and another way to make use of it to engage and calm dementia patients is to reminisce using a LifeSongs book. LifeSongs lets you tell a person's life story through 12 photo collages, but you also can record 12 separate songs that help to trigger memories. Learn more and share at www.LifeSongs.info.


 +   Like this comment
Posted by Nora Charles
a resident of Stanford
on Feb 1, 2014 at 5:28 pm

Nora Charles is a registered user.

Thank you to Veronica Weber for such a moving piece and to everyone involved in these wonderful programs. When my mother was dyig and had lost most speech she still responded to music. She loved big band music and the crooners and would sometimes try to sing along. It was so good to know that the music she'd loved so much gave her some comfort at the end.


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