Content uploaded by Stefano Federici
Author content
All content in this area was uploaded by Stefano Federici on Mar 07, 2019
Content may be subject to copyright.
134
Copyright © All rights are reserved by Stefano Federici.
Scholarly Journal of Psychology
and Behavioral Sciences
Research Article
Music Therapy Effects in People with Dementia
Martina Pigliautile1, Francesco Delicati2, Roberta Cecchetti1, Patrizia Bastiani1, Michela Scamosci1, Simonetta
Cesarini3, Giuseppe Menculini4, Annalisa Longo1,2, Patrizia Mecocci1 and Stefano Federici5*
1Section of Gerontology and Geriatrics, Department of Medicine, Perugia, Italy
2A.M.A.T.A. UMBRIA, Perugia
3Residenza Protetta Fontenuovo, Perugia, Italy
4Residenza Protetta Creusa Brizzi Bittoni, Città della Pieve, Perugia, Italy
5Department of Philosophy, Social & Human Sciences and Education, University of Perugia, Perugia, Italy
*Corresponding author: Stefano Federici, Department of Philosophy, Social & Human Sciences and Education, Perugia, Italy
Received: January 12, 2019 Published: February 21, 2019
Abstract
Objective: Based on the biopsychosocial model, we developed a paradigm to explore if music therapy (MT) is effective in
increasing the well-being of persons with dementia.
Method: A randomized controlled trial, mixed method design was used. Twenty-seven persons with moderate/severe dementia
split into an experimental (n = 16; MT and standard care) and a control (n = 11; standard care only) group were subjected to a cycle
health-related states), and outcome measures (psycho-behavioral disturbances and quality of life) were associated with qualitative
analysis of the participants’ behavior during MT sessions.
Results: The study showed that MT is effective in reducing psycho-behavioral disturbances and maintaining a good quality of
information on patient behavior during the MT.
Conclusions: The paradigm was suitable to integrate quantitative and qualitative data on the effectiveness of MT interventions.
Keywords:
Introduction
The effectiveness of music therapy (MT) in the management
of behavioral and psychological symptoms of dementia (BPSD)
is well documented in the literature [1-8]. However, evidence for
of evidence-based practice in MT for dementia has been noted by
several scholars [10-13], who also found methodological limitations
in participant selection to the studies, small sample size, lack of
randomization and blinded evaluation, group dissimilarity at
baseline, no test-retest studies, and lack of a control group [16].
Researchers must face a twofold challenge:
a. adopt a research method able to mix quantitative and
qualitative data that come from the interacting and complex
domains of human functioning and affect the progressive and
unpredictable course of dementia;
b. select a homogenous sample able to be representative of
the studied condition (dementia), so different from individual
geriatric medicine, the health status of older people with dementia
and therefore the effectiveness of the MT should be evaluated
This multidimensional, multidisciplinary diagnostic instrument
DOI:
ISSN: 2641-1768
Citation: . Music Therapy Effects in People with Dementia. Sch J Psychol
& Behav Sci. 2(2)-2019. SJPBS MS.ID.000132. DOI: .
Volume 2 - Issue 2 Copyrights @ Stefano Federici, et al.
Sch J Psychol & Behav Sci
135
was designed to collect data on the medical, psychosocial, and
functional capabilities and limitations of older patients. The
geriatric assessment differs from a standard medical evaluation
because it takes into account also nonmedical domains emphasizing
on human functioning as a person–environmental interaction and
integrating medical, psychological, and social models of human
include similar assessment domains: health condition, body
functions and structures, activities, participation, and contextual
factors, and share a common approach to the assessment of the
person as a whole within the context of both person’s capacities
and expectations and supportive resources of the environment.
The second challenge posed to researchers is strongly correlated to
health status of people with dementia and the substantial individual
differences in the course of dementia, the scholar should remain
cautious in generalizations, provide clear patient anamnestic
descriptions, and develop a longitudinal design to control individual
variability in the course of the disease to control what characterizes
individual history with respect to the effectiveness of the MT
intervention [3]. Innovative paradigms and research protocol have
been recently presented and mixed method [21]. have been used in
order to capture MT effects.
Study Paradigm
To overcome those challenges, the present study developed a
paradigm to assess the effectiveness of an MT treatment in people
with moderate/severe dementia, by adopting a biopsychosocial
trial experiment was designed to gather quantitative data on
cognitive reserve, severity of dementia, comorbidity, cognitive
and physiological functions, and psychological functioning and
behavior, and qualitative data involving the phenomenological
observation of the MT interventions.
Expected Results
To dispose of a paradigm able to study music therapy effects
in participants with dementia. To demonstrate the usefulness of
our paradigm to explore if MT is effective, we expect to observe the
following results;
a) Those who receive MT should have a lower level of BPSD,
was expected from studies founding that MT is useful for the
management of BPSD in older people with dementia [2,9,22].
goal in the treatment of dementia [11,23]. This result will replicate
dementia [1,9,12,15].
c) Those receiving MT will have a lower level of salivary cortisol,
indicative of a lower level of stress, than those in the control group.
This result will replicate a previous study by Suzuki et al. [24]. who
found a diminished secretion of cortisol correlated with positive
psychological well-being in people with dementia.
d) Those receiving MT will be able to recognize nonverbal
is effective for expanding group participation, archaic expressive,
and relational nonverbal abilities in those with moderate/severe
dementia [2,25].
Method
Participants
The study was a mixed method single-blinded randomized
controlled trial performed in two Italian nursing homes. The
were established by a consensus of experts (geriatricians and
psychologists). Inclusion criteria were:
a. Diagnosis of Alzheimer or vascular dementia or mixed
Manual of Mental Disorders: DSM-IV-TR criteria (DSM-IV [26];
b. Moderate or severe stage of dementia according to the
c. Scores between 0 and 20 on the Mini Mental State
Examination [28].
Exclusion criteria were;
I. Wandering;
II. Diagnosis of frontotemporal dementia;
IV. Vegetative state;
V. Use of corticosteroids.
Informed consent was obtained from proxies.
treated with usual activities (group games, arts, motor or sensorial
activities when not involved in music therapy. S.F., not involved
simple randomization was used.
Citation: . Music Therapy Effects in People with Dementia. Sch J Psychol
& Behav Sci. 2(2)-2019. SJPBS MS.ID.000132. DOI: .
Volume 2 - Issue 2 Copyrights @ Stefano Federici, et al.
Sch J Psychol & Behav Sci
136
Experimental Condition
The program consisted of 20 MT sessions: once a week for 60
min. per session over 5 months. The model of the intervention [29]
belongs to the humanistic MT [30-32] The MT intervention can
be ascribed among the active techniques, characterized by direct
interactions with participants using musical improvisation with
the aim of stimulating communication skills, improving relational
abilities, and reducing BPSD [33]. The intervention was conducted
in a structured therapeutic setting, in a large and quiet room of
the nursing home where participants dwelled. Music therapy was
conducted by a professional music therapist together with a formal
caregiver of the nursing home. Number of participants was 10 in a
nursing home and 6 in the other.
Measures
summarized in Table 1. These measures consisted of the following:
Table 1: Timetable of experimental procedure and timing of measures collection.
Pre–MT MT Post–MT
TIME T0 T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11
Health status
measures
MMSE MMSE MMSE MMSE
WHODAS 2.0 WHODAS 2.0 WHODAS 2.0
Outcome
measures
NPI NPI NPI NPI NPI
MT sessions (S1–S20)
S2; S11; S20
Microanalysis
ADCS–ADL = Alzheimer Disease Cooperative Study-Activities of Daily Living; CDR = Clinical Dementia Rating Scale; CDS = Cornell
Depression Rating Scale; CIRS-s/c = Cumulative Illness Rating Scale severity/comorbidity; CMAI = Cohen–Manseld Agitation
Inventory; CO = salivary cortisol level; grey = MT sessions; Microanalysis = sessions video analyzed; MMSE = Mini Mental State
Examination (row score); NPI = Neuropsychiatric Inventory; QOL–C = Quality of Life Alzheimer Disease caregiver version; QOL–P
= Quality of Life Alzheimer Disease patient version; S = music therapy session; T = month of the experimental phase; WHODAS 2.0
= World Health Organization Disability Assessment Schedule 2.0.
I. Clinical Interview on Socio-Demographic and Clinical
Data (C–Int): An interviewer asked participants questions about
cultural person capital (cognitive reserve index), medical history,
and pharmacological treatment.
II. Cortisol Biological Marker (CO): The measure of salivary
collected from passive drooling. Unstimulated whole saliva is the
baseline saliva present in the oral cavity for the majority of a 24–
hour period. To avoid variations due to circadian rhythm, saliva
session (10 a.m.) and immediately after the session (11 a.m.) in
both groups.
III. Cumulative Illness Rating Scale (CIRS) [34]: It is a
IV. Clinical Dementia Rating (CDR) [27]: is a global staging
measure of dementia.
V. Mini Mental State Examination (MMSE) [28]: This is the
most commonly used screening test of cognitive functions.
VI. Alzheimer Disease Cooperative Study-Activities of Daily
Living (ADCS-ADL) [35]: This is an inventory to assess activities of
daily living for clinical trials in dementia.
VII. World Health Organization Disability Assessment
Schedule 2.0 (WHODAS 2.0) [36,37]:
instrument to provide a standardized cross-cultural method for
measuring activity limitations and participation restrictions, largely
employed in geriatric settings [38]. The Italian 12-item version of
the WHODAS 2.0 interviewer-administered proxy form was used
Citation: . Music Therapy Effects in People with Dementia. Sch J Psychol
& Behav Sci. 2(2)-2019. SJPBS MS.ID.000132. DOI: .
Volume 2 - Issue 2 Copyrights @ Stefano Federici, et al.
Sch J Psychol & Behav Sci
137
VIII. Neuropsychiatric Inventory (NPI) [39]: assesses
neuropsychiatric disturbances common in dementia together
with the amount of caregiver distress engendered by each of the
neuropsychiatric disorders.
IX. Cornell Scale for Depression in Dementia (CDS) [40]:
interviews with both the patient and an informant to evaluate
depression in dementia. It was also validated in patients with
moderate to severe dementia [41].
X. Cohen-Mansfield Agitation Inventory (CMAI) [42]: In
this questionnaire, caregivers rate the frequency of manifestations
of agitated behaviors in elderly persons. The Italian 30-item proxy
version [43,44]. was administered.
XI. The Quality of Life – Alzheimer’s Disease scale (QOL–
AD) [45]: Developed for individuals with dementia, it comprises
XII. Microanalysis on MT sessions’ Video Clips
(Microanalysis) [46,47]:
client in a music therapy treatment. A consensus of experts (music
therapist and psychologist) developed criteria to identify the
patient’s and music therapist’s salient behaviors (e.g., when the
patient joins in singing, plays, smiles, shows a gaze orientation,
spontaneously moves their body, etc.) during MT intervention
(videotaped). A trained group of psychology students analyzed
the video of the MT sessions. Starting from the results of this
analysis, the music therapist composed a video clip consisting of
the most salient moments of the therapy of each participant. The
microanalysis provides a clear distinction between description,
employed in geriatric medicine.
Procedure
The study covers a period of twelve months (T0–T11). Twenty
music therapy sessions (S1–S20) were administered to two
experimental groups, once a week in the morning, for 60 min. per
session over 5 months (T3–T8), starting three months after the
patient eligibility assessment (T0). The MT treatment was evaluated
longitudinally four times: (i) at the beginning of the MT treatment
(T3), (ii) at the beginning of the fourth month of treatment (T6),
(iii) at the end of the MT treatment (T8), (iv) and three months after
time of the second MT session (S2), midway through the sessions
(S11), and at the time of the last session (S20). Samples were
immediately before the beginning of the MT session (10:00 a.m.)
and immediately after (11:00 a.m.). Those in the control group had
were also videotaped for the microanalysis. As Microanalysis is a
very long procedure, it was conducted limited to three clinical case
their assessments of the patients/participants neuropsychiatric
restrictions (WHODAS 2.0). Patients were assessed on the cognitive
involved in the salivary cortisol level analysis. Table 1 summarizes
the timing of measures collection. The professional administering
interviews and measures and respondents involved in the study
therapist was unaware of the changes in cognitive, functioning, and
behavioral status measured during the study (Table 1).
Analysis
Mann–Whitney and Wilcoxon tests were performed on
conducted, using the bootstrap method. Analyses were performed
through IBM – Statistical Package for the Social Sciences, version
by Ridder [46].
Results
Demographic
differences in health status measures and outcome measures were
the study and two were hospitalized. So for these cases, some data
are missing.
Health Status
decreased from T0 to T3 (p=0.020) and T6 to T8 (p=0.003) and
(p=0.003). No differences were found on the health status measures
Citation: . Music Therapy Effects in People with Dementia. Sch J Psychol
& Behav Sci. 2(2)-2019. SJPBS MS.ID.000132. DOI: .
Volume 2 - Issue 2 Copyrights @ Stefano Federici, et al.
Sch J Psychol & Behav Sci
138
Outcome
Figure 1: Signicant differences between EG and CG on outcome measures detected with Wilcoxon non-parametric statistic.
The horizontal axis indicates month of the experimental phase (T); the vertical axis indicates QOL scores (range 0–48, the
higher scores, the better QOL–AD).
Table 2: Differences in health status and outcome measures between samples using Wilcoxon non-parametric statistic.
Measures Group T0 T3 T6 T8 T11
Health status measures
2.31
2.56 (0.63)
p = 0.816
2.40
p = 0.482
2.80 (0.92)
(0.50)
1.81
(0.38) p = 0.422
1.82 (0.41)
1.82
(0.41)
(0.43) 1.81
(0.41)
3.94
3.93
p = 0.640
3.54
(2.38) 4.22
(2.22)
MMSE
(5.89) p = 0.145
11.93
p = 0.369
(4.30) p = 0.482
16.12
(4.42)
13.44
(4.88)
14.25
(4.13)
(4.80)
WHODAS
2.0 21.00
(10.83) p = 0.452
(5.95) p = 0.610
18.31
(9.09) p = 0.422
24.00
(10.19)
24.18
(9.43)
19.09
(12.98)
(12.13) p = 0.180
8.31
p = 0.336
12.06
(12.83) p = 0.135
(11.88)
p = 0.456
5.63
6.90
(6.31) 6.00 (5.39)
(3.95)
Outcome measures
T0 T3 T6 T8 T11
NPI 21.40
(18.44)
14.50
(12.18) p = 0.942
12.31
(11.39) p = 0.586
(14.02) p = 0.136
21.13
p = 0.392
22.00
(15.39)
13.36
(9.40)
14.60
(12.00) 9.22 (9.36) 19.12
Citation: . Music Therapy Effects in People with Dementia. Sch J Psychol
& Behav Sci. 2(2)-2019. SJPBS MS.ID.000132. DOI: .
Volume 2 - Issue 2 Copyrights @ Stefano Federici, et al.
Sch J Psychol & Behav Sci
139
(10.21)
p = 0.838
41,13
36,13
41,69
p = 0.241
44,53
(14.00)
p = 0.591
43,00
(11.16)
40,20
(10.56)
38,22
(9.13)
35,90
(8.03)
40,88
(12.44)
6.33
p = 0.305
3.62
(4.18) p = 0.421
1.33
(2.26) p = 0.428
1.94 (2.43)
(1.48) p = 0.402
(3.61)
4.10
(2.92)
3.20
(4.621) 3.00
(5.18)
31.12
(4.55)
(6.80) p = 0.622
32.85
p = 0.053
33.00
(6.62) p = 0.254
(9.51)
35.80
(9.03)
29.40
(5.68)
(6.04) p = 0.164
32.81
(6.48) p = 0.065
(6.04) p = 0.310
31.93
(5.94)
28.45
(6.05)
(9.14)
(8.50)
ADCS–ADL = Alzheimer Disease Cooperative Study-Activities of Daily Living; CDR = Clinical Dementia Rating Scale; CDS =
Cornell Depression Rating Scale; CIRS-s/c = Cumulative Illness Rating Scale severity/comorbidity; CMAI = Cohen–Manseld
Agitation Inventory; MMSE = Mini Mental State Examination (row score); NPI = Neuropsychiatric Inventory; QOL–C = Quality of
Life Alzheimer Disease caregiver version; QOL–P = Quality of Life Alzheimer Disease patient version; WHODAS 2.0 = World Health
Organization Disability Assessment Schedule 2.0.
Figure 2: Results of the outcome measures detected with the Wilcoxon non-parametric statistic. The horizontal axis indicates
month of the experimental phase (T); the vertical axis indicates the scores on the measures.
NPI = Neuropsychiatric Inventory (range 0–144, the higher the score, the higher the level of neuropsychiatric disturbances);
CDS = Cornell Depression Rating Scale (range 0–38, the higher the score, the higher the level of depression); CMAI = Cohen–
Manseld Agitation Inventory (range 0–210, the higher the score, the higher the level of agitation); QOL–C = Quality of Life
Alzheimer Disease caregiver version (range 0–48, the higher the score, the better the QOL–AD).
Differences in outcome measures were observed within and
differences within samples in dementia-related neuropsychiatric
disturbance detected using the Wilcoxon non-parametric statistic.
Citation: . Music Therapy Effects in People with Dementia. Sch J Psychol
& Behav Sci. 2(2)-2019. SJPBS MS.ID.000132. DOI: .
Volume 2 - Issue 2 Copyrights @ Stefano Federici, et al.
Sch J Psychol & Behav Sci
140
to T3 (p = 0.054), and scores remained lower at T6 (p = 0.001),
which took place between T6 and T8 (p = 0.018). With respect to the
(p = 0.043) and T3 vs. T8 (p = 0.043). Figure 2 displays the graphs
shows increases from pre to post MT in S2, S11, and S20, as well
appeared to be stressful. Some patients did not secrete enough
patients for S2, S11, and S20. The mean value in S2 increased from
obtained from nine patients for S2, S11, and S20. The mean value in
Figure 3: Pre- (MT intervention vs. control condition) and post-CO levels in CG and EG.
Diagrams on the left, CO collected during session time 2 (S2), diagrams in the middle are for S11, and diagrams on the right
are for S20.
c = CG (control group) patients; e = EG (experimental group) patients.
Microanalysis of Mrs. R. a Patient of the
Experimental Group
Mrs. R. microanalysis is reported because she represents an
emblematic clinical case for the age, the severity of the clinical
condition and the sensorial impairment. This patient was a 91 year–
disease, chronic obstructive bronchopneumopathy, controlled
hypothyroidism, polyarthritis, and suffered from a hip fracture
self-administered measures were provided by a formal caregiver
(healthcare provider employed in the nursing home). At T0 and
T3, she needed help in all basic and instrumental activities of daily
of a fork or a spoon. At T6 and T8, she combed her hair, asking to
throughout the study. Pharmacological treatment remained stable
Citation: . Music Therapy Effects in People with Dementia. Sch J Psychol
& Behav Sci. 2(2)-2019. SJPBS MS.ID.000132. DOI: .
Volume 2 - Issue 2 Copyrights @ Stefano Federici, et al.
Sch J Psychol & Behav Sci
141
after. On the NPI at baseline, Ms. R presented severe delusions,
hallucinations, sleep disturbances, and sometimes depressive
symptoms (NPI = 46 at T0; NPI = 36 at T3; NPI = 11 at T6; NPI = 52
at T8; NPI = 43 at T11).
She was verbally aggressive and engaged in repetitive actions
evidenced a progressive increase in involvement in the MT (eye
contact, language, and spontaneous movement). (Figure 4) The
music therapist reported that Mrs. R reveals receptive participation
in the MT by listening, marking the beat, and playing the maracas.
Her behavioral response in the sessions was very positive, and
She was also emotionally affected by the songs, showing interest
in the therapist (e.g., by searching for a touch). Based on the video
analysis (Supplemental Material), it was concluded that Mrs. R.
Figure 4: Mrs. R.’s salient behaviors (see sorting bar by value) computed as a proportion of their duration in seconds. S indicates
session time (s1, etc.).
Table 3: Outcomes from the MT analysis.
Mrs. R.’s outcomes from the MT.
Examples of Analyst’s observation of meaningful events of the MT sessions’ video.
(See also Table 1, column A of the Supplemental Material).
She was engaged in the songs.
Mrs. R. plays the maracas, keeping the rhythm of the music. She moves her head and
shoulders with a pleasant and smiling expression. Towards the end of the instrumental
She smiles. Mrs. R. […] makes a gesture with the head, smiles happily and takes part in the group’s
She actively participated.
She responded relevantly.
She took the initiative.
She understood that the therapist was offering contact
and was aware of and appreciated the contact.
She was able to express pleasure and contentment.
sequence 3).
She engages in a dialogue with the therapist.
with a pleased expression.
She was linguistically and verbally stimulated.
In the column on the right, clips and sequences refer to the video consisting of the most salient moments of the therapy of Mrs. R.
created by the therapist (Supplemental Material).
Citation: . Music Therapy Effects in People with Dementia. Sch J Psychol
& Behav Sci. 2(2)-2019. SJPBS MS.ID.000132. DOI: .
Volume 2 - Issue 2 Copyrights @ Stefano Federici, et al.
Sch J Psychol & Behav Sci
142
Table 4: Videoclip analysis related to Mrs. R. Analyst = Trained student of psychology; Mrs. R. = Clinical case; MT = Music Therapy;
Therapist = Music Therapist (Francesco Delicati).
A – Analyst’s observation of meaningful events of the
MT sessions’ video.
B – Therapist’s interpretation of events
reported in column A. (The MT thinks
about that…)
C – Therapist’s reflection on the Mrs.
R.’s response to the MT reported in
columns A and B.
Clip 1
Sequence 1
The Therapist knells down behind a senior woman of
the group in a wheelchair. He sings a musical motif of
welcome and plays the guitar. He concludes with a positive
expression and applause. Mrs. R. is sitting next to the old
woman in a wheelchair. She packs away a paper towel in her
waistcoat’s pocket and takes part to the applause.
Despite the blindness, Mrs. R. seems to
be present in the situation: during the
applause, she also joins the other people
clapping her hands as an automatic
response.
Mrs. R. shows an active involvement
(claps her hands).
Sequence 2
Mrs. R. keeps clapping. The Therapist addresses her asking
her name to the group. He crouches in front of her and
touches her hand softly repeating her name (an animator
says her name). Mrs. R. responses at the touch of the hand
slightly moving hands towards Therapist. She repeats
her name and smiles.Mrs. R. responses at the touch of the
hand, moving towards Therapist. She repeats her name and
smiles.
Therapist involves the group towards Mrs.
R. Aware of her blindness he establishes a
contact through a twofold communication:
verbal (repeating her name) and tactile
(touching her hand). Mrs. R seems
pleasantly surprised by the Therapist’s
contact. She seems to search for the contact
with Therapist hand who plays the guitar.
She appears pleased and happy to receive
interest from others.
Mrs. R. shows interest in the Therapist.
She takes the initiative to contact
him. She expresses intentionality,
responsiveness and a positive state of
mind.
Sequence 3
The Therapist welcomes Mrs. R. involving the rest of
the group, orienting gaze and the face. He alternates
gesticulation (arm and right hand) to playing guitar.
He keeps the time of the song. He concludes by saying
Mrs. R. claps her hands and smiles. She brings her hand
near the face and caresses herself hands together. During
the welcome song, she nods several times, smiles and moves
her lips.
The therapist looks and indicates Mrs. R. He
wants to focus group’s attention towards
her. Mrs. R. seems focused on welcome
song listening. She expresses pleasure and
wonders with body language (e.g., slightly
open mouth, the nodding). She seems to feel
recognized as a special person. She seems to
participate using lips movements… probably
a hint of singing.
Mrs. R. listens and is involved with her
body. She participates in the experience.
Sequence 4
The Therapist gets up and betakes oneself towards a
participant, asking for Mrs. R.’s name to the group. A group
member touches Mrs. R. She rolls over her nearby and
smiles. She searches physical contact with Therapist’s arms,
but she touches the guitar.
The Therapist is too fast in his going from
one group member to another. Mrs. R.
requires more time. Probably she could be
express more emotions and could receive
more sense of recognition if more time was
given. However, this mistake is compensated
by the contact with her neighbor, who
empathized with her. In fact, she expresses
a need of contact with Therapist, searching
his hands. Mrs. R. is present to the situation.
She seems to perceive her person as part of
the group. She seems very happy while claps
her hands and smiles.
Mrs. R. shows a receptive involvement
(e.g., she orients herself towards
Therapist) and she takes the initiative
searching for a contact.
Clip 2
Sequence 1
to gratify, enhance and involve Mrs. R. Mrs.
R. seems much focused on listening. I think
she recognizes herself in the phrase “you
nodding and has a prolonged smile an
aspect that gives me the idea of recognizing
herself in a familiar song. She expresses
pleasure probably because familiarity
induces feelings of security. Using the
request to complete the musical phrase,
the Therapist uses the question/answer
technique to stimulate the participation.
Mrs. R. plays the maracas, listens and
recognizes the song.
Citation: . Music Therapy Effects in People with Dementia. Sch J Psychol
& Behav Sci. 2(2)-2019. SJPBS MS.ID.000132. DOI: .
Volume 2 - Issue 2 Copyrights @ Stefano Federici, et al.
Sch J Psychol & Behav Sci
143
Sequence 2
The Therapist is kneeling in front of four group members
He plays the accordion with the left hand and emphasizes
the musical syllables. At the same time, he moves the right
hand toward participants and chants the syllables of the
the maracas. When the noun is pronounced (Rosamunda
sound similar to her name), she starts to listen. When the
nods, moves her head and smiles. The Therapist’s gaze is
oriented toward the group. He gesticulates with the right
hand while he plays the guitar with the left hand. He signs
with the participants and passes the musical phrase. He
moves her head and mentions some words of the lyric.
The Therapist involves the group to enhance
Mrs. R. and to stimulate her participation.
In addition, the musical phrase facilitates
the group’s attention for her. Mrs. R. seems
actively listening. In fact, she holds maracas,
nods her head and hints to sing.
Mrs. R. is so stimulated by the familiar
song, that she tries to sing some words
of the text.
Sequence 3
hand close to Mrs. R.’s hand, and he repeats the musical
phrase to her. At the touch of Therapist’s, Mrs. R. starts to
play the instrument.
The Therapist concludes its stimulation
activity on Mrs. R. With his actions, he
communicates that she is the center of the
attention and that she is the protagonist
of the song. The touch of her hand in
association with the musical phrase is
evidence of this.
Because of Therapist’s contact, Mrs. R.
plays the maracas independently by her
ability to keep time.
Sequence 4
The Therapist starts again to sing the song. He articulates
the musical part, playing the accordion. Sometimes he stops
the musical part and continues only with the voice. He
moves the right hand in towards the group. Mrs. R. doesn’t
play her instrument in time with music and, at the end of
the song, she slows down the shaking of the maracas and
Therapist’s voice.
The Therapist plays the accordion and
stops to put in evidence the words of the
song. Mrs. R. constantly participates in
the activity of singing and playing the
instrument with pleasure. The slowdown
in playing the maracas seems an attempt
to keep time. Although she sings a unique
participation.
Mrs. R. participates. She plays the
maracas, tries to keep time and sings
during the song.
Sequence 5
The Therapist leaves the song and starts to play the
rest of group start playing instruments, trying to keep the
rhythm proposed by Therapist. Mrs. R. plays the maracas
in keeping the rhythm of the music. She moves her head
and shoulders with a pleasant and smiling expression.
Towards the end of the instrumental part, she slows down
the rhythm.
playing accordion after have obtained
the involvement of the group. Playing the
accordion, he follows the rhythm proposed
by Mrs.’s maracas, a signal of listening and
attention. Mrs. R. seems present and active
in the experience as her body movement
reveals. She plays maracas for a long time
and she smiles most of the time.
Despite the blindness, Mrs. R. and
Therapist establish a relationship
using non-verbal deliveries, complicity,
help, and support of the group. The
use of a familiar song and secondarily
by physical contact (hands). Despite
sometimes the rhythm of maracas differ
from the accordion; the Therapist and
Mrs. R. go hand in hand in the same
relationship through singing and playing.
Clip 3
Sequence 1
The Therapist, sitting among the elderly, plays the accordion
maracas (she doesn’t play it) oriented towards the therapist
and the accordion (source of the sound). During the melodic
rhythm part of the sing, she begins to move the head.
Mrs. R. listens, and when the therapist plays
the melodic rhythm part, she starts to move
the head.
Mrs. R. shows receptive participation,
and she engages in a dialogue with the
Therapist.
Sequence 2
The Therapist plays the accordion with a detached
articulation, especially in the rhythmic part. While the other
elders keep the rhythm playing their instruments, Mrs. R.
moves her head to the rhythm of the song.
The Therapist’s mode of playing the
accordion (detached) seems to give energy
to the group. Mrs. R. seems to know the
song very well. She follows the rhythm
continuously with head’s movement,
especially during the melodic-rhythmic part.
The rhythm is the most important factor in
her musical fruition.
Mrs. R. responds to the stimulation
moving her head. She shows active
participation and seems inside the
rhythm of the song.
Citation: . Music Therapy Effects in People with Dementia. Sch J Psychol
& Behav Sci. 2(2)-2019. SJPBS MS.ID.000132. DOI: .
Volume 2 - Issue 2 Copyrights @ Stefano Federici, et al.
Sch J Psychol & Behav Sci
144
Sequence 3
The Therapist continues to play. He directs his gaze and
listens to an old woman in a wheelchair, at the left of Mrs.
playing (detached) tambourine. Mrs. R. continues to mark
the rhythm. She moves the head and the upper part of the
shoulders. At the same time, she sings of the refrain.
The Therapist continues to play with
movement of the old woman on the left of
Mrs. R. The tambourine’s rhythm simplify
Mrs. R.’s participation.
Mrs. R. shows active participation with
the involvement of the body’s movements
and by singing.
Sequence 4
The Therapist continues to play with the technique of
detached and moves his gaze and his attention to Mrs. R.
She moves her head imperceptibly, and the upper part of
the body, at the rhythm of the music. Mrs. R. continues to
mark the rhythm of the song at the body level. Although she
is sitting, the head’s movement involves the upper part of
the body.
The Therapist controls what happens inside
the group. His highlighting, resuming and
emphasizing the musical modalities of each
person allows to enhance what each person
does and to put these activities at the service
of the group. Even if Mrs. R. does not show
changes in her being in the experience, she
maintains her modality and this “going to
seems very pleasant for her. Mrs. R. seems
together with the knowledge and familiarity
of the song.
Mrs. R. engages a dialogue with the
therapist and the group. She shows active
participation marking the beat, phrasing
the melodies and singing.
Clip 4
Sequence 1
The Therapist takes up his guitar and kneels in front of
Mrs. R. She plays the xylophone, beating with energy with
a wand on the wooden keys. The Therapist plays the guitar
accompanying and supporting the motif created by Mrs. R.’s
beating on the xylophone.
Mrs. R. is active and determinate. She plays
the xylophone producing a casual melody
with decision and energy. The Therapist
carries out a task of support to Mrs. R.
the guitar that remains in the background
Mrs. R. plays a random rhythmic-melodic
motif on the xylophone and takes the
initiative. She is actively involved.
Sequence 2
R. plays xylophone’s keys listening to the therapist’s words.
pleased expression.
interact with Mrs. R. His’s words carry
R. seems very happy for Therapist’s words.
She responses with a pleased expression
maintaining her musical activity.
Mrs. R. is immersed in the percussive
action and continues with constancy and
commitment, without stopping. She was
not distracted from Therapist’s words an
aspect that denotes mastery and security
in this activity.
Sequence 3
The Therapist knells down in front of Mrs. R. and continues
to play the guitar, accompanying her. Mrs. R. plays the
xylophone, while another old woman, at the left of Mrs. R.,
plays the tambourine on the table of her wheelchair with
a drumstick. Meanwhile, the Therapist turns his gaze on
towards other women who seem not to respond to music.
Mrs. R. and the Therapist, along with
another woman, continue in their collective
performance. The Therapist seems to look
around to monitor what is happening and if
anything changes.
Mrs. R. remains immersed in the
percussive action with constancy. She is
involved and not appears tired.
Sequence 4
The Therapist shortly stops playing the guitar. He takes
a drumstick and begins to hit a vertical drum on his left.
While Mrs. R. plays the xylophone, the Therapist restarts to
play the guitar and turns his gaze toward a senior woman
on his left. He alternatively plays the guitar and gives two
bangs on the drum. The senior woman stays still and looks
away. She is observed by the senior woman, who plays the
drum.
The Therapist, continuing to play, tries to
stimulate, with his gaze and the drum, a
senior woman who stays still and distracted.
Mrs. R. is actively involved. She continues
to play the xylophone.
Citation: . Music Therapy Effects in People with Dementia. Sch J Psychol
& Behav Sci. 2(2)-2019. SJPBS MS.ID.000132. DOI: .
Volume 2 - Issue 2 Copyrights @ Stefano Federici, et al.
Sch J Psychol & Behav Sci
144
Sequence 5 from 3.21
The Therapist plays the guitar and the drum. He still looks
at the senior woman who, being watched, looks at him
pleased. The senior woman who plays the drum is sited next
to Mrs. R. The woman mimics the Therapist playing also
another drum and looks pleased the Therapist. He smiles
and nods at her.
The Therapist tries to stimulate a senior
woman who seems to notice the Therapist’s
interest. The Therapist seems surprised
by the action of the woman who plays the
tambourine and smiles with complicity.
The Therapist restores a positive assent
continuing to play and nodding. Mrs.
R. continues to play the xylophone. She
appears involved and happy.
Mrs. R. shows active participation with
an unusual instrument (the xylophone).
She keeps a fairly constant rhythm and
probably is not aware of the melody that
composes on the xylophone. It is positive
that she does not stop on a single key:
she beats and runs on more keys of the
xylophone. Perhaps she is not aware that
is in course an improvisation, but she
keeps playing together at the threesome.
She plays the xylophone energetically
receiving a response in terms of
vibration. The vibration involves her
body, and above all the arm that beats. It
to feel the sound and the vibration
product of his action.
Clip 5
Sequence 1
The Therapist kneels in front of the group that is disposed of
as a circle. He plays the accordion and sings with emphasis
gaze towards the women. He plays the instrument dilated
with his left hand and uses the other hand to scan the
rhythm to involve the group. The senior women hold hands
and move in time to the music; some of them sing. Mrs. R. is
involved and sings staying in times. In particular, she moves
the left arm connected to a senior woman particularly active
both in singing and in movement.
Mrs. R. is well integrated into this collective
action. Her face expresses concentration.
She sings the song staying in time and seems
women that held her hands.
The person is involved in the collective
action, participating with the movement
and singing.
Sequence 2
The Therapist interrupts the song and plays the
instrumental part of the song with the accordion. Some
women start to move to the rhythm of music and to sing.
Mrs. R. moves spontaneously to the rhythm of the music,
involving the body: the head in particular.
Mrs. R. continues to follow the behavior of
attention and participation with a slight
increase in the movement. She tries pleasure
from what she is doing. Thanks to her hand
content, she seems friendly: a positive
aspect considering the tendency to stiffen of
the blind persons.
Mrs. R. is fully integrated into the
collective motor action and seems happy.
Sequence 3
The Therapist ends the song playing with the left hand
Mrs. R. immediately after the musical closing and the olé
makes a gesture with the head, smiles happily and takes
part in the group’s applause. The Therapist, continuing
The Therapist concludes with a gesture
and an exclamation that are in line with
the energetic and emphatic way of playing.
and seems to give herself up to this state of
mind. She also demonstrates to warn the
musical closing of the piece with the head’s
gesture. The Therapist reinforces with the
praises, the esteem and the positive image
of the elderly, including Mrs. R. The group
The patient understands the musical
closing of the song. She is very happy and
content.
Sequence 4
The Therapist rises from the ground,and Mrs. R. says, “I am
applaud and touches Mrs. R.’s shoulder. Some members of
the group take part in the applause. Mrs. Ro. repeats, “I am
Mrs. R. concludes
Mrs. R. is very happy to make it clear and
state that she plays an important role:
she is the woman who has more years
than all the people present. The Therapist
plays with surprise and amused by Mrs.
R.’s exclamation. He answers her tone and
and seems very happy. Mrs. R. looks very
amused. She and the Therapist laugh
Mrs. R. exposes herself, expressing
what she considers a note of merit
(having more years). She takes the
initiative, trusts the situation and people
and communicates verbally with the
Therapist. The Therapist and Mrs. R. are
involved in a pleasure dialogue in which
play, emotion, and joy are present. The
music therapy gives pleasure, increases
the wellbeing, and reinforces Mrs. R.’s
identity and self-esteem thanks to the
Citation: . Music Therapy Effects in People with Dementia. Sch J Psychol
& Behav Sci. 2(2)-2019. SJPBS MS.ID.000132. DOI: .
Volume 2 - Issue 2 Copyrights @ Stefano Federici, et al.
Sch J Psychol & Behav Sci
145
Discussion
Several studies have suggested the possibility of innovative
paradigms able to capture MT effects in dementia [5,9,15].
The present study aimed to demonstrate the usefulness of our
biopsychosocial paradigm to explore if MT is useful. To reach
disturbances and quality of life in persons with moderate/
severe dementia living in a nursing home. Biological markers and
relational aspects of behavior were also assessed using salivary
cortisol analysis and Microanalysis, respectively. At the same
time, health status was monitored throughout the study with
biopsychosocial paradigm seems capable of capturing MT effects
on the degenerative and progressive process of ingravescent health
conditions that characterize dementia. In fact, as expected (second
manifest a lower level of behavioral and psychological symptoms
controversial about the effect of MT. Although Evans et al. [49] and
Suzuki et al. [24] found a diminished secretion of cortisol correlated
with positive psychological well-being, respectively in aging people
moderate and severe dementia after MT.
The fourth prediction—that social skills and participation would
be enhanced by MT—was supported. Through the Microanalysis,
it was possible to demonstrate that salient behaviors (e.g., when
the patient joins in singing, plays, smiles, makes appropriate eye
contact during interaction, spontaneously moves their body,
etc.) were enhanced, providing evidence that MT is effective for
enriching relational and communicative abilities in those with
moderate/severe dementia, as Raglio et al. [2] found. Despite her
emotions with the music therapist and participated actively in the
not negative stress (distress) [51], that is a consequence of patient’s
activation following the biopsychosocial intervention. In fact, as
interactions to stimulate participants) could increase cortisol.
Limitations of the Study
The small sample size, the heterogeneity of the subjects,
and the presence of formal caregivers reduced the possibility of
utility of our paradigm. The majority of the quantitative outcomes
issue. In dementia studies, statistical comparison between groups
(experimental and control) could be compromised by a twofold
expression of signs and symptoms of a single individual in the same
day; 2) the variability of the expression of signs and symptoms
among person with the same diagnosis. Nevertheless, in our study,
notable changes in individual measures was observed (although not
indubitably interesting, it is beyond the aim of the present study.
In summary, the results suggested that the paradigm is effective
in demonstrating MT effects in patients with moderate/severe
dementia. Active MT is effective in preserving a higher quality of life
in institutionalized older adults with moderate/severe dementia.
According to demographic projections, the oldest old with dementia
will increase in the coming years, and it will be important to have
means available to reliably detect the effects of bioecopsychosocial
[53] (usually called non-pharmacological) interventions designed
to increase the quality of life in those with dementia.
Acknowledgement
This study was co-funded by Regione Umbria, Ricerca Sanitaria
(nursing homes’ social workers), the nursing homes’ healthcare
assistants, and the students of the Department of Philosophy, Social
& Human Sciences and Education, who supported the study.
References
1. Koger SM, Brotons M (2003) Music therapy for dementia symptoms.
2.
symptoms of dementia. Alzheimer Dis Assoc Disord 22(2): 158-162.
3.
Music, music therapy and dementia: A review of literature and the
recommendations of the Italian Psychogeriatric Association. Maturitas
Citation: . Music Therapy Effects in People with Dementia. Sch J Psychol
& Behav Sci. 2(2)-2019. SJPBS MS.ID.000132. DOI: .
Volume 2 - Issue 2 Copyrights @ Stefano Federici, et al.
Sch J Psychol & Behav Sci
146
4. Snowden M, Sato K, Roy Byrne P (2003) Assessment and treatment
of nursing home residents with depression or behavioral symptoms
5.
6. Pollack NJ, Namazi KH (1992) The Effect of Music Participation on the
Social Behavior of Alzheimer’s Disease Patients1. J Music Ther 29(1):
music recognition spared in dementia, and how can it be assessed? Med
Hypotheses 64(2): 229-235.
8.
Med 348(25): 2508-2516.
9.
10. Edwards J (2005) Possibilities and problems for evidence-based practice
in music therapy. Art Psychother 32(4): 293-301.
11. Haynes RB (2002) What kind of evidence is it that Evidence-Based
Medicine advocates want health care providers and consumers to pay
12.
Oxford University Press, New York, pp. 184-190.
13.
Therapy Today 4(5): 1-26.
14.
15.
16.
of musical interventions in dementia: methodological requirements of
Technology: The State of the Art. NY: Oxford University Press, New York,
p 1-9.
18.
19.
In: Federici S, Scherer MJ, editors. Assistive Technology Assessment
Handbook. 2nd
20.
21.
In: Mertens DM, Hesse-Biber S, editors. Mixed methods and credibility of
22. Ueda T, Suzukamo Y, Sato M, Izumi SI (2013) Effects of music therapy
on behavioral and psychological symptoms of dementia: a systematic
review and meta-analysis. Ageing Res Rev 12(2): 628-641.
23.
care today 8(4): 309-318.
24. Suzuki M, Kanamori M, Watanabe M, Nagasawa S, Kojima E, et al. (2004)
Behavioral and endocrinological evaluation of music therapy for elderly
patients with dementia. Nurs Health Sci 6(1): 11-18.
25.
Programming for Severely Regressed Persons With Alzheimer’s-Type
26. APA (American Psychiatric Association) (2000). Diagnostic and
Statistical Manual of Mental Disorders: DSM-IV-TR®. (4th edn); Arlington,
VA.
and scoring rules. Neurology 43(11): 2412-2414.
28.
practical method for grading the cognitive state of patients for the
clinician. J Psychiatr Res 12(3): 89-98.
29. Delicati F (2010) The heart does not forget: Music therapy and memories
30.
Roma, IT, Magi.
31.
32.
33.
34.
35.
An inventory to assess activities of daily living for clinical trials in
Alzheimer Dis Assoc Disord 11(Suppl 2): 33-39.
36. Üstü
Disability: Manual for WHO Disability Assessment Schedule (WHODAS
(2009) World Health Organization Disability Assessment Schedule II:
38.
Organization Disability Assessment Schedule 2.0: An International
39.
psychopathology in dementia. Neurology 44(12): 2308-2314.
40.
41.
123-124.
42.
43.
44.
intervention on antisocial behavior in patients suffering from
1-8.
45.
Alzheimer’s Disease: Patient and caregiver reports. Journal of Mental
Health and Aging 5(1): 21-32.
Citation: . Music Therapy Effects in People with Dementia. Sch J Psychol
& Behav Sci. 2(2)-2019. SJPBS MS.ID.000132. DOI: .
Volume 2 - Issue 2 Copyrights @ Stefano Federici, et al.
Sch J Psychol & Behav Sci
147
46.
T, editors. Microanalysis in Music Therapy: Methods, Techniques and
Ridder HM, Wigram T, Ottesen AM (2009) A pilot study on the effects
of music therapy on frontotemporal dementia-developing a research
protocol. Nordic Journal of Music Therapy 18(2):103-132.
48. Svansdottir HB, Snaedal J (2006) Music therapy in moderate and severe
dementia of Alzheimer’s type: A case-control study. Int Psychogeriatr
18(4): 613-621.
49.
secretory activity in older people in relation to positive and negative
well-being. Psych neuroendocrinology 32(8):922-930.
50.
51.
Illness. The International Journal of Psychiatry in Medicine 5(4): 321-
333.
52.
days and bad days in dementia: a qualitative chart review of variable
symptom expression. Int Psychogeriatr 26(8): 1239-1246.
53.
A New Terminology and a New Paradigm. Am J Alzheimers Dis Other
To Submit Your Article Click Here:
Submit Article
Scholarly Journal of Psychology
and Behavioral Sciences
Assets of Publishing with us
•
• Immediate, unrestricted online access
• Rigorous Peer Review Process
•
• Unique DOI for all articles
DOI:
