1. Sensory Sounds: Joining Music Therapy and Recreation Therapy in Advanced Dementia Care Karie Bilger, BMT, MTA Music Therapist St. Joseph’s Health Centre, Guelph University of Windsor Music Therapy Student Conference March 14, 2009

2. Music Therapy and Dementia MT is a safe and effective method for treating agitation and anxiety in moderate and severe dementia MT is a safe and effective method for treating agitation and anxiety in moderate and severe dementia ( (Svansdottir, H.B. & Snaedal, J. 2006) MT can actually improve cognition in individuals with dementia for a period of time (Bruer, R. et. al., 2007) MT can actually improve cognition in individuals with dementia for a period of time (Bruer, R. et. al., 2007) MT can reduce symptoms of depression in individuals with dementia (Ashida, S., 2000) MT can reduce symptoms of depression in individuals with dementia (Ashida, S., 2000)

3. Music Therapy and Dementia It is astonishing to see mute, isolated, confused individuals warm to music, recognize it as familiar, and start to sing, start to bond with the therapist…there is a sudden attention…distracted eyes fasten on the player. Torpid patients become alert and aware; agitated ones grow calmer… (Sacks, O., 2007, p. 344).

4. Sensory Stimulation and Dementia Institutionalized individuals with dementia face physical and environmental factors that deprive them of sensory experiences. Deprivation can contribute to depressive symptoms which can cause further confusion and difficult behaviour. (Bryant, W., 1991) Institutionalized individuals with dementia face physical and environmental factors that deprive them of sensory experiences. Deprivation can contribute to depressive symptoms which can cause further confusion and difficult behaviour. (Bryant, W., 1991) Sensory stimulation interventions lead to improved adaptive behaviours and, “observable changes in levels of interaction, active looking, and interest.” Sensory stimulation interventions lead to improved adaptive behaviours and, “observable changes in levels of interaction, active looking, and interest.” (Spaull, D. et. al., 1998, p.77) Multi-sensory environments have been found to enhance communication and engagement in surroundings. These environments can allow individuals with dementia to experience ‘quality time’ with others. (Hope, K.W., 1998). Multi-sensory environments have been found to enhance communication and engagement in surroundings. These environments can allow individuals with dementia to experience ‘quality time’ with others. (Hope, K.W., 1998).

5. Snoezelen “To reach out, to seek, to relax” “To reach out, to seek, to relax” Began in Holland in the 1980s Began in Holland in the 1980s Used in many different populations for: Used in many different populations for: –Therapy/rehabilitation –Recreation/leisure –Relaxation/stress management –Education Provides an environment that gently stimulates all sensory modalities Provides an environment that gently stimulates all sensory modalities Creates a secure space where clients may explore and relax Creates a secure space where clients may explore and relax Highly successful activity which can be non-directive Highly successful activity which can be non-directive

7. Sensory Sounds Music Therapy & Recreation Therapy in Advanced Dementia Co-led program (Music Therapy and Recreation Therapy) Co-led program (Music Therapy and Recreation Therapy) Theme-based sessions (e.g. “Winter,” “Love is in the Air,” “Colours”) Theme-based sessions (e.g. “Winter,” “Love is in the Air,” “Colours”) All five senses, plus cognition are stimulated through music, sensory experiences and discussion/reminiscence All five senses, plus cognition are stimulated through music, sensory experiences and discussion/reminiscence Sessions are tailored to the abilities of clients (varying stages of dementia) Sessions are tailored to the abilities of clients (varying stages of dementia)

8. Sensory Sounds Music Therapy & Recreation Therapy in Advanced Dementia Goals for Program: Goals for Program: –To enhance quality of life –To increase social interaction –To enhance communication and creative self-expression –To increase sensory stimulation –To promote relaxation and diminish anxiety –To enhance reality orientation Sessions Include: Sessions Include: –Singing familiar songs –Small instrument playing –Group and individual drumming –Discussion –Reminiscence –Sensory experiences –Relaxation

9. Sensory Sounds Sample Session Plan Colours 1. Greeting Song 2.The Yellow Rose of Texas [Show colour, show a lemon, smell the lemon, picture of a yellow rose] 3.Red River Valley [Show colour, taste strawberries] 4.Beautiful Brown Eyes [Show colour, taste chocolate, smell coffee beans] 5.By the Light of the Silvery Moon [Show colour, touch/look at jewellery] 6.Five Foot Two Eyes of Blue with small instruments [Show colour, show picture of baby w/blue eyes, touch blue jeans] 7.Group Drumming on gathering drum 8.Relaxation: Somewhere Over the Rainbow [Fibre optic spray] 9. Closing Song

10. Sensory Sounds Client Responses Eye contact Eye contact Smiling Smiling Laughing Laughing Crying Crying Tapping toes/hands to music Tapping toes/hands to music Bobbing head to music Bobbing head to music Clapping in time to music Clapping in time to music Dancing/Swaying (standing or in chair) Dancing/Swaying (standing or in chair) Moving hands to music (eg. Conducting) Moving hands to music (eg. Conducting) Singing words/phrases Singing words/phrases Vocalizing (eg. humming, la) Vocalizing (eg. humming, la) Playing basic beat Playing basic beat Imitating rhythms Imitating rhythms Initiating rhythms Initiating rhythms Following tempo/style changes Following tempo/style changes Verbal responses to discussion/stimuli Verbal responses to discussion/stimuli Non-verbal responses to discussion/stimuli Non-verbal responses to discussion/stimuli Interaction with therapists Interaction with therapists Interaction with group member Interaction with group member Visual tracking Visual tracking

11. Sensory Sounds Client Responses Purposeful, Meaningful Interactions with Others and the Environment!!

12. Bibliography Bruer, R., Spitznagel, E. & Cloninger, C. (2007). The Temporal Limits of Cognitive Change from Music Therapy in Elderly Persons with Dementia or Dementia-Like Cognitive Impairment: A Randomized Controlled Trial. The Journal of Music Therapy XLIV, 4, 308- 328. Bryant, W. (1991). Creative Group Work with Confused Elderly People: A Development of Sensory Integration Therapy. British Journal of Occupational Theray 54, 187-192. Hope, K.W. (1998). The effects of multisensory environments on older people with dementia. Journal of Psychiatric and Mental Health Nursing 5, 377-385. Sacks, O. (2007). Musicophilia Tales of Music and the Brain. New York: Alfred A. Knopf. Sato, A. (2000). The effect of reminiscence music therapy sessions on changes in depressive symptoms in elderly persons with dementia. The Journal of Music Therapy Vol. 37, No. 3 p.170-82. Spaull, D., Leach, C., & Frampton, I. (1998). An Evaluation of the Effects of Sensory Stimulation with People Who Have Dementia. Behavioural and Cognitive Psychotherapy 26, 77-86. Svansdottir, H.B. & Snaedal, J. (2006). Music therapy in moderate and severe dementia of Alzheimer's type: A case-control study. International Psychogeriatrics Vol 18(4), pp. 613- 621. Worldwide Snoezelen. (2009). www.worldwidesnoezlen.com