1. National Hospice and Palliative Care Organization’s Palliative Care Resource Series Songs of the Dying: The Case for Music Therapy in Pediatric Palliative and Hospice Care Written 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

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 Psychosocial & Emotional
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 Spiritual
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