MJHS Music Therapy: Keys to Dementia Care

COVER

music therapy keys to Dementia

Care

music therapy keys to Dementia

Care

Research suggests that more than 70 percent of skilled nursing facility residents over age 75 have dementia. Clinically significant neuro-psychiatric symptoms, such as agitation,

depression and wandering, are found in more than 63 percent of moderately to severely-impaired residents with dementia. These same symptoms interfere with function, social interaction and care delivery. Traditional management includes chemical and physical restraint, often resulting in detrimental side effects. Through a generous grant from the New York State Department of Health, MJHS developed the enclosed protocols to show how music interventions offer safe, non-pharmacological approaches to relieve symptoms of dementia.

Over the period of three years, the innovative music therapy programs at Shorefront and Menorah Centers for Rehabilitation and Nursing Care were implemented and evaluated. The enclosed materials outline how skilled nursing facilities across New York can utilize a multidisciplinary care planning process led by music therapists—aided and supplemented by direct care staff—to provide individualized and small-group music-based activities. The information will also support your music therapists or other qualified health care professionals who train other dementia care providers, especially Certified Nursing Assistants and other direct care staff.

Each section, along with the accompanying DVD, gives dementia care providers additional tools to utilize during activities of daily living. The described music-assisted activities, namely sing-a-longs, tonal activities, as well as “music & movement,” are designed specifically for skilled nursing facility residents with moderate to severe dementia. Implementation is inexpensive and training can be completed in one day or one week.

Results from our evidence-based research demonstrate that creative, musical activities help reduce depression and decrease agitation; residents often return to a calm state. In addition, music can improve resident range-of-motion, which can help prevent falls or other incidents. An additional benefit is that caring for residents who are happy increases efficiencies in resident care. This can lead to higher job satisfaction, as well as recruitment and retention of more highly trained staff.

During the past three years, MJHS has trained numerous staff on music-assisted care techniques. The results show a higher level of care, with stronger bonds between residents, family members, as well as staff.

We are confident you will have the same experience.

Sincerely,

MJHS Music Therapy TeamKendra Ray, MBA, LCAT, MT-BCMichael McGaughy, MT-BCScott Stuart, MA, MT-BC

INTRODUCTION

Dear Administrator:

Music Therapy Keys to Dementia Care

Section 1 6

TABLE OF CONTENTS

n SECTION 1

Overview of dementia, agitation and depression (15 Minutes) 11

n SECTION 2

iPod—How to use in music-assisted care (30 Minutes) 17

n SECTION 3

Singing protocol, followed by practice group (60 Minutes) 21

n SECTION 4

Music & Movement (30 Minutes) 25

n SECTION 5

Music-assisted range-of-motion, followed by practice group 29

(60 Minutes)

n SECTION 6

iPod—Working with playlists (30 Minutes) 33

n SECTION 7

Tonal protocol, followed by practice group (60 Minutes) 41

n SECTION 8

Music-assisted bathing and wound care (60 Minutes) 55

n SECTION 9

Key elements of a successful music program (15 Minutes) 61

n SECTION 10

Music intervention questionnaire (30 Minutes) 73

n SECTION 11

Music intervention questionnaire answers 77

Section 1

Overview of Dementia, Agitation and Depression


Section 1 11

Dementia is a chronic disease that affects the ability to function independently due to progressive cognitive decline1. A diagnosis of dementia is often a life-changing, distressing event that affects patients, their families and caregivers. A patient with dementia may experience:

n Memory loss

n Language deficiency

n Judgment impairment

n Periods of anxiety and restlessness

n Executive functioning decline2

Behavioral and psychological symptoms of dementia are seen in the majority of nursing home residents. In fact, 90 percent of residents with dementia will develop behavioral and psychological symptom, including:

n Agitation

n Depression

n Wandering3

Understanding Behaviors

A behavior is a means of communicating feelings and needs. Research indicates that people with dementia are more easily agitated because the brain has physically changed and no longer functions in a healthy manner4.

SECTION 1

Overview of Dementia, Agitation and Depression

1 Plassman BL, Langa KM, Fisher GG, et al. Prevalence of dementia in the United States: The aging, demographics, and memory study. Neuroepidemiology. 2007;29(1-2):125-132. doi: 10.1159/000109998.

2 Drouillard N, Mithani A, Chan P. Therapeutic approaches in the management of behavioral and psychological symptoms of dementia in the elderly. BC Medical Journal. 2013;55(2):90-96.


4 Treatment of dementia and agitation: A guide for families and caregivers. J Psychiatr Pract. 2007;13(3):207-216. doi: 10.1097/01.pra.0000271667.53717.9f.


Section 1 12

Agitation

Agitation occurs in 40 - 60 percent of patients in residential and long-term care. Exhibited symptoms include:

n Physical aggressiveness

n Restlessness and pacing

n Verbal insults and shouting

n Shouting and disruptive vocalizations

n Wandering and exit-seeking behaviors5

The four A’s of agitation are:

“4 A’s”

n Amnesia — memory loss

n Aphasia — inability to use words or inability to understand words of others

n Agnosia — inability to recognize objects or faces

n Apraxia — inability to perform familiar motor tasks6


6 Harper N. Train the trainer workshop: Alzheimer’s disease and dementia care. New York, NY: MJHS; 2007.

EARLY STAGES

Amnesia—Reminders or cues

Aphasia—Written or demonstrated

Agnosia—Gesture,demonstrate or assist to start

Apraxia—Hand over hand

LATER STAGES


Section 1 13

Depression

Depression with dementia is one of the most common mental disorders seen in clinical practice7. It is also associated with psychological and behavioral symptoms.8 However, depression is often under diagnosed in nursing home residents. Some causes of depression with dementia include:

n Mental reaction to decline in cognition

n Recurrence of early and mid-life depression

n Vascular depression

n Decline associated with Alzheimer’s disease

Some symptoms of depression include:

n Irritability

n Agitation

n Anxiety9

Music activities versus music therapy

Research suggests that non-pharmacological interventions, such as music therapy, should be an early pursuit for treatment of behavioral and psychological symptoms. Music therapy, a noninvasive treatment, is the intentional use of music to achieve a therapeutic goal that can contribute to the quality of life for a person diagnosed with dementia10. An ideal psychosocial care plan should emphasize the following:

n Interest

n Social activities including music

n Comfort11

It is important to distinguish between music activities and music therapy. Music activities provide diversions and may be meaningful, as well as motivating. Music therapy is used to achieve specific goals, facilitated by a credentialed music therapist and addresses holistic needs.

7 Kobayashi T, Kato S. Depression-dementia medius: Between depression and the manifestation of dementia symptoms. Psychogeriatrics. 2011;11:177-182.

8 Prado-Jean A, Couratier P, Druet-Cabana M, et al. Specific psychological and behavioral symptoms of depression in patients with dementia. Geriatric Psychiatry. 2010;25:1065-1072.

9 Prado-Jean A, Couratier P, Druet-Cabana M, et al. Specific psychological and behavioral symptoms of depression in patients with dementia. Geriatric Psychiatry. 2010;25:1065-1072.

10 Clair AA, Memmott J, eds. Therapeutic uses of music with older adults. Second ed. Silver Spring, MD: American Music Therapy Association; 2008.

11 Kobayashi T, Kato S. Depression-dementia medius: Between depression and the manifestation of dementia symptoms. Psychogeriatrics. 2011;11:177-182.


Section 1 14

Suggested strategies for the “Four A’s”

Early Stages

Later Stages

Amnesia gReminders or cues

Aphasia gWritten or demonstrated

Agnosia gGesture, demonstrate or assist to start

Apraxia gHand over hand


Section 1 15

SECTION OPENERSection 2

iPod—How to Use in Music-Assisted Care

Aphasia gWritten or demonstrated


Section 1 16


Section 1 17

The iPod is a creative tool that is easy to transfer and adaptable to different situations in activities of daily living. It is important to learn to use the technique outlined in this curriculum prior to use with residents diagnosed with dementia. Mastery of the iPod will make learning the protocols a much easier process.

Directions for using the iPod shuffle (fourth generation)

n Ensure the iPod is off. The switch’s background should be silver.

n Turn iPod on by moving the switch 1 or 2 notches.

- If using a protocol playlist, slide the switch one notch to play songs in order. The switch will be in the middle position, the background silver and green.

- If not using a protocol playlist, slide the switch two notches to shuffle: The switch’s background will be green.

n Plug speaker cord into the iPod and turn speakers on by sliding the switch on speakers.

n To hear the title and artist information for the current song, press and quickly release the voiceover button (next to the on/off switch).

SECTION 2

iPod—How to Use in Music-Assisted Care

volume up button

voiceover button

three-way switch

all green: shuffle

all silver: off

switch in the middle: play in order

speaker or headphone

volume down button

play/pause button

next/fast forward button

clip

previous/rewind button

Section 2


Section 1 18


Singing Protocol, Followed by Practice Group


Section 1 20


Section 1 21

This protocol uses live and/or recorded music to facilitate a meaningful opportunity to foster socialization and improve mood.

Staff Requirements: CNA

Desired Objectives:

n Prevent or reduce verbal and/or physical agitation during activities of daily living

n Calm agitated residents

n Improve mood

n Decrease wandering

n Improve socialization

Entrance Criteria: Residents with mid-stage dementia who exhibit one or more of the following behaviors: wandering, agitation or depression.

Exit Criteria: Resident with no signs of improvement after four weeks or the behavior negatively impacts the involvement of others.

Group Size: Small, no more than six residents

Duration: 30-40 minutes

Safety Considerations

Environment: All equipment should be clean and without any sharp edges. Keep the floor area free of clutter.

Risks: Residents with high anxiety levels may become agitated with this group. Ensure no residents are noise-sensitive.

Facility & Equipment Required

Facility: Private rooms or resident lounges, areas with reduced distractions

Equipment: iPod, speakers, digital music software, digital music library, song sheets or songbook

SECTION 3

Singing Protocol, Followed by Practice Group

Section 3


Section 1 22

Methods:

1) Prepare a sing-a-long playlist on the iPod and adjust the volume of the mini-speakers before gathering residents (refer to the provided iPod player directions).

2) Gather the group in a circle and explain that you will be singing along to many different and familiar songs. Invite residents to join in the singing.

3) Begin the playlist and start singing along with the first song. Pass out song sheets as needed.

4) When the playlist has finished (or if the residents express a desire to end the sing-a-long at any point), turn off the iPod.

5) Talk with residents about the music, unless limited by a language barrier or cognitive impairments. Example questions:

a. Does this music seem familiar to you? b. What kind of music is this? c. What does the music make you think of? d. Who do you think is singing?

6) If they are able to answer, ask residents “Did you enjoy the music?”

Section 3


Section 1 23Section 3


Protocol: Music & Movement


Section 1 24


Section 1 25

This protocol involves leading a small group of residents in a movement activity with recorded music. The intention is to keep the residents engaged in the music activity so the symptoms of wandering and depression either lessen or do not appear.

Staff Requirements: CNA

Desired Objectives:

n To improve mood, as evidenced by smiling, laughing or making positive comments.

n To decrease wandering by remaining in program.

Entrance Criteria: Resident has a diagnosis of mid-stage dementia with wandering or depression.

Exit Criteria:

n Resident’s behavioral symptoms worsen and/or negatively affect the involvement of other residents.

n Resident begins to leave the group independently, or asks to be taken out of the group.

Group Size: Small group, approximately 4-6 residents



Environmental Risks: Ensure all equipment is clean, and keep the floor area free of clutter.

Client Risks: Instruct each resident to make comfortable movements. Pay close attention to each resident’s posture, facial tension and reports of pain or exhaustion. Stop the movement activity and encourage the resident to rest if he or she exhibits signs of physical discomfort. Report sustained complaints or signs of pain to nurse.


Facility: Small activity room or lounge

Equipment: iPod, portable speakers, chiquitas, egg shakers, jingle bells, scarves

Method

1) Prepare activity before gathering residents for music group:

a. Set the iPod to a playlist designed for movement.

b. Place rhythm instruments and scarves so that you can easily access them.

SECTION 4

Protocol: Music & Movement

Section 4


Section 1 26

2) Once group members are in a circle, explain that they will listen to music while making movements using rhythm instruments and scarves. Emphasize that each resident should only complete comfortable movements. Instruct residents to let you know if they are experiencing any discomfort during the movement activity.

3) Turn on the iPod and speakers. Ask residents if the volume is too loud or too soft, and adjust it if necessary.

4) Offer a rhythm instrument to each resident, giving a choice between different instruments and colors. Ensure the instrument handle faces the resident. If the resident does not want an instrument, respect this decision. Mention that the residents can make the movements without the instruments.

5) Call out and then demonstrate movements.

6) Ask each resident to suggest or show one movement, and direct the group to copy it.

7) After 10-15 minutes, collect the rhythm instruments from each resident.

8) Explain that a cool down with scarves is next.

9) Hand out scarves, giving each resident a choice of color. If a resident does not want one, respect this choice and say that movements may be done without scarves.

10) Instruct residents to take a few deep breaths and direct them to follow your slow and easy movements.

11) After five minutes, announce that residents can relax and that you will collect the scarves.

12) Turn off the music. Ask the residents, “Did you enjoy the music?” Also ask how each resident is feeling.

13) Lead a discussion about the music activity, giving each resident an opportunity to express his or her own opinion. Ask specific questions about the recorded music. Be sure to take time to practice active listening with each resident. Your response should be of a positive nature, even if the resident had a negative view.

Section 4


Section 1 27


Music-assisted Range-of-Motion, Followed by Practice Group


Section 1 28


Section 1 29

This program uses recorded music to motivate the resident’s active involvement in range-of- motion exercises, increase reality orientation, improve mood and decrease wandering.

Staff Requirements: At least one CNA or one caregiver

Desired Objectives:

n Increased level of involvement in range-of-motion exercises, as seen when resident completes, or makes active efforts to complete, the exercises.

n Improved range-of-motion, as evidenced by resident’s increased range-of-motion.

n Increased reality orientation, as seen by verbal comments relating to the present moment.

n Improved mood, as seen by positive verbal comments and brightened affect.

n Decreased wandering, as seen when the resident stays with caregiver or staff member during the range-of-motion exercises.

Entrance Criterion: Resident has moderate dementia, with or without depression, is withdrawn, shows verbal or nonverbal signs of poor mood, and/or has range-of-motion exercises in the individual rehabilitation plan that the resident resists.

Exit Criterion: Decline in the resident’s health that prohibits him or her from engagement in range-of-motion exercises.

Group Size: One resident

Duration: 5 – 20 minutes


Environmental Risks: The floor should be free of clutter. The resident should be seated in a firm chair with a straight back.

Client Risks: Avoid risk of overexertion by paying close attention to the resident’s posture, facial tension and verbal reports of exhaustion. Adjust or stop the exercises and music, when appropriate.


Facility: Common area or resident’s room

Equipment: CD player, CD that is customized to resident’s music preferences and range-of- motion session, iTunes, CD-burning software

SECTION 5

Music-assisted Range-of-Motion, Followed By Practice Group

Section 5


Section 1 30

Methods:

1) Identify the resident’s personal music preferences, based on comments by the resident, family members or caregivers.

2) If no information is available regarding music preferences, consult the music therapist or recreation therapist.

3) Create a music compilation CD for the range-of-motion session. The first track should have a slow beat. Subsequent tracks should have a faster beat.

4) Greet the resident and ask, “Is it okay if I turn on some music?”

5) If the resident agrees, play the CD’s first track.

6) Adjust the volume of the music to the resident’s preferred listening level.

7) Toward the beginning of the second track, initiate and facilitate range-of-motion exercises that serve the resident’s individualized plan of care.

8) If the resident resists engaging in the exercises, encourage participation. If the resident still resists, allow him or her to stop.

Guidelines for Music-Assisted Range-of-Motion:

n Select music based on the resident’s music preferences. Always consider the resident’s music preferences and responses first.

n If there is no information available regarding the resident’s music preferences or responses, choose music that was popular when the resident was 20-30 years of age. When possible, choose music that reflects the resident’s cultural background.

n The music selection for the first track should have a slow beat, and be instrumental. This track will be in the background during greeting time.

n Music selections for the second and following tracks should have a fast beat, and may be instrumental or vocal. This upbeat music is meant to motivate the resident to complete the exercises.

Music Suggestions for Greeting (Track 1):

Title Composer and Lyricist ArtistInstrumental music Various Kenny GInstrumental music Various Yanni“Adagio for Strings” Samuel Barber Various

Music Suggestions for Range-of-Motion Exercises (Track 2 until end):

Song Title Composer and Lyricist Artist“Alexander’s Ragtime Band” Berlin Various“Anchors Aweigh” Zimmerman and Miles Various“Give My Regards to Broadway” Cohan Various“Hava Nagilah” Hebrew Folk Song Moshe Nathanson“Quizas, Quizas, Quizas” Osvaldo Farres Various

Section 5


Section 1 31


iPod—Working With Playlists


Section 1 32


Section 1 33

Playlists are helpful compilations of songs that are saved on the iPod for repeated use. This program includes playlists created for the outlined protocols. For example, the Music & Movement protocol has a playlist titled “For Movement”. Use of this playlist can motivate residents, improve mood, as well as decrease stress and burden on caregivers and/or residents.

In general, playlists should reflect the resident’s musical preferences. If the resident’s preference is unknown, choose songs that were popular when the resident was 20-30 years of age, remaining mindful of his or her cultural background.

Choose a playlist on the iPod:

n To choose a playlist, press and hold down the VoiceOver button until it beeps.

n The current playlist will be named, followed by others.

-To go forward, press and release arrows on the right >>|.

-To go backward, press and release arrows on the left |<<.

n Press and release the center button || to select a playlist.

n Adjust the volume as needed.

n On speakers, slide dial to the right to get louder and to the left to get softer.

n On iPod, press + to get louder and – to get softer.

n To skip to the next song, press and release the button on right side >>|.

n To return to the previous song, press and release the button on the left side |<<.

n To put the music on hold, press and release the center button ||.

n To turn the music back on, press and release the center button again ||.

n To reset the shuffle, first turn it off. Wait ten seconds, then slide the switch to either shuffle or play in order.

Playlist Order

1. All songs

2. Caribbean

3. Classical

4. Energizing

5. Movement *

6. Music-assisted care *

SECTION 6

iPod: Working with Playlists

7. Sing-a-long *

8. Italian

9. Jazz

10. Jewish

11. Oldies

12. Relaxing

13. Russian

14. Latin

* Protocol playlists

Note: iTunes software is necessary to create playlists for the iPod.

Section 6


Section 1 34

Playlists should reflect resident preferences and the cultural diversity of the resident population.

Playlists Designed for Protocols: Play songs in order

Sing-a-long (24 minutes) Tonal (7 minutes)

Music & Movement (25 minutes) Music-assisted bathing (32 minutes)

Music-assisted range-of-motion (24 minutes) Music-assisted wound care (27 minutes)

Side by Side I’ll Be Seeing YouKate Smith

You Are My Sunshine Learnin’ the BluesRosemary Clooney

Hava Nagilah The Music of IsraelThe Moshe Silberstein Ensemble and Chorus

Tumbalalaika Yiddish Folk and TheatreTheodore Bikel

Quizas, Quizas, Quizas Cuba BellaCelia Cruz

Michael Row the Boat Ashore Sing AlongPeter, Paul and Mary

Red River Valley Sing AlongFrank Corrales and Cisco Trio

Tzenah Tzenah Jewish Play AlongThe Neshoma Orchestra

God Bless America The Best of Kate SmithKate Smith

Sing-a-long Playlist (24 minutes)

Song-Artist Album

Section 6


Section 1 35

Under the Boardwalk Rock n’ Roll 1964The Drifters

Love Me or Leave Me Rat Pack Disc 2Sammy Davis, Jr.

Cheek to Cheek Pop Standards Ella Fitzgerald

Hava Nagilah Jewish Play AlongThe Neshoma Orchestra


Stars and Stripes Forever Great Orchestra MarchesLondon Festival Orchestra

Thais: Meditation Most RelaxingMassenet Classical Album

Music & Movement (25 minutes)

Song-Artist Album

Concerto for Violin and Orchestra No. 1 The Romantic ViolinMax Bruch

Alexander’s Ragtime Band VariousElla Fitzgerald

Semper Fidelis Sousa Marches Forever John Philip Sousa

Beyond the Sea Pop Standards Vol. 6Bobby Darin


Clair de Lune Most Relaxing ClassicalDebussy Album in the World

Music-assisted Range-of-Motion (24 minutes)

Song-Artist Album

Section 6


Section 1 36

Red River Valley Sing AlongFrank Corrales and Cisco Trio

Tzenah Tzenah Jewish Play AlongThe Neschoma Orchestra

Oh, Susanna Sing Along Frank Corrales and Cisco Trio

Tonal (7 minutes) Use C and G Tone bars

Song-Artist Album

In the Mood Glenn Miller 1938-1942Glenn Miller Disc 2

What A Wonderful World Pop Standards Vol. 6Louis Armstrong

Chattanooga Choo Choo Glenn Miller 1938-1942Glenn Miller Disc 2

Over the Rainbow The Complete MastersJudy Garland (Plus)

That’s Amore Rat Pack Disc 2Dean Martin

What I Did for Love Pop Standards Vol. 5, Shirley Bassey Side 1

At Last Glenn Miller 1938-1942 Glenn Miller Disc 2

The Girl from Ipanema Pop Standards Vol. 4Sinatra/Jobim

Beyond the Sea Pop Standards Vol. 6Bobby Darin

Cheek to Cheek Pop Standards Vol. 2Ella Fitzgerald

Music-assisted Bathing (32 minutes)

Song-Artist Album

Section 6


Section 1 37

Be creative and design your own playlists using these genres as a reference tool.

Playlists Organized by Music Type: May use shuffle

Chinese Jazz Oldies

Classical Jewish Russian

Italian Latin Soul/R&B/Motown

Part 1

Air, Sinfonia in G VariousBach

Largo from Piano Concerto No. 3 VariousBeethoven

Intermezzo in E flat VariousBrahms

Part 2

Meet Me in St. Louis VariousMills and Sterling

When Johnny Comes Marching Home VariousGilbert (Lambert)

Stars and Stripes Forever VariousSousa

Music-assisted Wound Care (27 minutes)

Song-Artist Album

Section 6


Section 1 38

Chinese Chinese Traditional Music

Classical -Mozart: Concertos for Two and Three Pianos -Classical Escape Bach -Sonatas for Piano and Violin - Most Relaxing Classical Album in

the World…Ever

Italian -Italian Music Odyssey -Viva Italia! All the Favorite Italian Songs

Jazz/Big Band - An Anthology of Big Band Swing (1930-1955) Disc 2

-Lady Day’s 25 Greatest: 1933-1944 -Pop Standards Vol.1 – 7 -Rat Pack -Glenn Miller 1938-1942 Disc 2

Jewish -The Music of Israel - To Life!: Songs of Chanukah and other

Jewish Celebrations -Yiddish Folk and Theatre Songs -Jewish Play Along

Caribbean/Latin -Beautiful Barbados -Medley Tropical -Celia Cruz Greatest Hits -2 Grandes de la Salsa

Oldies -Rock n’ Roll 1962-1967 -25 All-Time Greatest Hits

Russian -Russian Classical Guitar Music. -Romance, Folk Songs - Songs of Russia Old & New/Songs of

a Russian Gypsy -Balalaika Favorites

Soul/R&B/Motown -James Brown Mix -What’s Going On (Marvin Gaye) -Smokey Robinson -Al Green’s Greatest Hits -25 All-Time Greatest Hits

Album Recommendations for Additional Playlists

Playlist Album(s) Recommended

Section 6


Section 1 39


Tonal Protocol, Followed By Practice Group


Section 1 40


Section 1 41

Tonal: 1- and 2-chord songs Staff Requirements: CNA

Desired Objectives

n Prevented or reduced verbal and/or physical agitation during activities of daily living

n Calming of agitated residents

n Improved socialization as evidenced by singing or humming lyrics

n Improved mood as evidenced through words and facial expressions

n Decreased wandering

Entrance Criteria: Residents with mid-stage dementia who exhibit one or more of the following behaviors: wandering, agitation or depression.

Exit Criteria: Residents who show no signs of improvement after four weeks or whose behavior negatively affects other participants.

Group Size: Small group; 4-6 residents



Environment: All equipment should be clean and without any sharp edges. Keep the floor area free of clutter.

Client Risks: Ensure residents are not noise sensitive. Residents with high anxiety levels may become agitated in this group.


Facility: Activity or similar room away from distractions

Equipment:

n Set of bass tone bars that are individually labeled C, G and C (Orff) with mallets (refer to the appropriate song sheets for instructions on when to play the tone bars C or G for the songs listed below).

n A table for the tone bar and for residents with limited motor skills.

n Suzuki hand bells.

SECTION 7

Tonal Protocol, Followed By Practice Group

Section 7


Section 1 42

Methods

1) The group is gathered in a circle.

2) First, show the residents the tone bars and then demonstrate how to use them. Then, pass out the mallets holding the ball end so residents reach for it with their dominant hand. Next, hand out the tone bars.

3) The CNA should then demonstrate a rhythm (i.e. slow and steady or fast, loud, soft, etc).

4) Instruct the residents to hold their hands up and play together.

5) When the residents have mastered this, start singing. The CNA should conduct residents according to the song sheets in this guide.

6) When finished singing, ask residents to reflect on the sounds the group created. Practice active listening with each resident. Respond positively, even if the resident had a negative view.

7) Repeat steps 2-5.

Suggested Songs for Tonal Activity

“Row, Row, Row Your Boat”

“Michael Row the Boat Ashore”

“Three Blind Mice”

“Hot Cross Buns”

“You Are My Sunshine”

“Oh Susanna”

“Clementine”

“De Colores”

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lly a

nd c

old

, hal

lelu

jah

Chi

lls t

he b

od

y b

ut n

ot

the

soul

, ha

llelu

jah

Mic

hael

row

the

bo

at a

sho

re, h

alle

luja

h

Mic

hael

row

the

bo

at a

sho

re,

halle

luja

h

Mic

hael

row

the

bo

at a

sho

re, h

alle

luja

h

Mic

hael

row

the

bo

at a

sho

re,

halle

luja

h



Cle

men

tine

In a

cav

ern,

in a

can

yon

Exc

avat

ing

for

a m

ine

Dw

elt

a m

iner

fort

y n

iner

And

his

d

aug

hter

C

lem

enti

ne

Oh

my

dar

ling

, oh

my

dar

ling

Oh

my

dar

ling

, C

lem

enti

ne!

Tho

u ar

t lo

st a

nd

go

ne fo

reve

r

Dre

adfu

l s

orr

y,

Cle

men

tine



I’ve

Bee

n W

ork

ing

on

the

Rai

lro

ad

I’ve

bee

n w

ork

in’ o

n th

e ra

ilro

ad,

All

the

live

long

d

ay

I’ve

bee

n w

ork

in’ o

n th

e ra

ilro

ad,

Just

to

p

ass

the

tim

e aw

ay

Do

n’t

you

hear

the

whi

stle

blo

win

g?

Ris

e up

so

ear

ly

in t

he m

orn

Do

n’t

you

hear

the

cap

tain

sh

out

ing

“Din

ah, b

low

yo

ur

horn

?”

Din

ah, w

on’

t yo

u b

low

,

Din

ah, w

on’

t yo

u b

low

,

Din

ah, w

on’

t yo

u b

low

yo

ur h

orn

?

Din

ah, w

on’

t yo

u b

low

,

Din

ah, w

on’

t yo

u b

low

,

Din

ah, w

on’

t yo

u b

low

yo

ur

horn

?



You

are

My

Su

nshi

ne

You

are

my

suns

hine

, my

onl

y su

nshi

ne

You

mak

e m

e h

appy

whe

n sk

ies

are

gra

y

You’

ll ne

ver

kno

w d

ear

how

muc

h I

love

yo

u

Ple

ase

do

n’t

take

my

sun

shin

e a

way

You

are

my

suns

hine

, my

onl

y su

nshi

ne

You

mak

e m

e h

appy

whe

n sk

ies

are

gra

y

You’

ll ne

ver

kno

w d

ear

how

muc

h I

love

yo

u

Ple

ase

do

n’t

take

my

sun

shin

e a

way

The

oth

er n

ight

dea

r as

I la

y sl

eep

ing

I dre

amed

I h

eld

yo

u in

my

arm

s

Whe

n I

awo

ke d

ear

I was

mis

take

n

So

I la

y d

own

my

hea

d a

nd c

ried



Oh

Su

san

na

I cam

e fr

om A

laba

ma

with

a

banj

o on

my

knee

,

I’m g

oing

to L

ouis

iana

, m

y tr

ue lo

ve fo

r to

se

e.

It r

aine

d al

l nig

ht t

he d

ay I

left

The

wea

ther

it w

as d

ry,

The

sun

so h

ot I

froz

e to

dea

th

Sus

anna

, don

’t yo

u

cry.

Oh

! Sus

anna

,

Oh

don’

t you

cry

for

me,

‘Cau

se I’

ve c

ome

from

A

laba

ma

With

my

banj

o on

m

y kn

ee



De

Co

lore

s

De

Col

ores

, De

colo

res

se v

iste

n

los

com

pos

en la

P

rim

aver

a

De

Col

ores

, De

colo

res

son

los

para

jitos

Que

Vie

nen

De

Afu

era

De

Col

ores

, De

colo

res

es e

l arc

o

iris

Que

vem

os L

ucir.

Y p

or e

so

los

gra

ndes

.

Am

ores

de

Muc

hos

Col

ores

me

gust

an a

mi.

Y p

or E

so lo

s g

rand

es

Am

ores

de

muc

hos

Col

ores

me

gust

an a

mi




Music-assisted Bathing and Wound Care


Section 1 54


Section 1 55

Music-Assisted Bath/Shower This program uses recorded music to reduce aggressive behaviors in a resident who is receiving a bath or shower.

Staff Requirements: At least 1 CNA or one caregiver

Desired Objectives

n Improved mood, as seen by positive verbal comments and brightened affect.

n Decreased physical tension, as seen by less muscle rigidity.

n Relaxation, as seen by closing eyes and non-resistance of care.

n Prevented or reduced aggressive behaviors, such as kicking, yelling or hitting.

Entrance Criterion: The resident has moderate dementia, with or without depression. The resident resists being bathed. The resident displays aggressive behaviors, such as yelling, hitting and kicking, during bathing/showering or during the preparation for bathing/showering. The resident is not sensitive to noise.

Exit Criterion: The resident’s aggressive behaviors do not improve over the course of four music-assisted baths/showers. The resident’s aggressive behaviors worsen during two music-assisted baths/showers.

Group Size: 1 resident

Duration: 30–60 minutes


Environmental Risks: All music-related equipment should be waterproofed and disconnected from an electrical outlet.

Resident Risks: Respect the resident’s right to refuse the bath/shower or the music.


Facility: Shower-room, or wherever bathing/showering occurs.

Equipment: Waterproof CD player, CDs, CD-burning software such as iTunes.

SECTION 8

Music-assisted Bathing and Wound Care

Section 8


Section 1 56

Method

1) Customize the CD based on the resident’s personal music preferences and on the music that has historically relaxed the resident.

2) If no information is available on effective music or preferences, consult the music or recreation therapist.

3) Set up music where the bath/shower will take place. Place the CD in the CD player and press play, adjusting the volume to match the resident’s preferred listening level.

4) If the preparation for the bath/shower occurs in a different location from the bath/shower, set up another CD player and CD in this location. Place a copy of the customized CD or one with similar music in the CD player and press play, adjusting the volume to match the resident’s preferred listening level.

5) Prepare the resident for the bath or shower.

6) If aggressive behavior or high stress level occurs, redirect the resident.

7) If aggressive behavior or high stress level worsens, change the track.

8) If aggressive behavior or high stress level further worsens, turn off the music.

9) Give the bath or shower, continuing to follow the three previous steps as needed.

Guidelines for Music-Assisted Bathing:

n Select music based on the resident’s music preferences. Pay attention to verbal and nonverbal responses.

n If there is no information regarding the resident’s music preferences, choose music that was popular when the client was 20-30 years of age. If possible, choose music that reflects the resident’s cultural background.

Music Suggestions:

Song Title Composer and Lyricist Artist

“In the Mood” Garland and Razaf Glenn Miller“Chattanooga Choo Choo” Gordon and Warren Glenn Miller “Singin’ in the Rain” Brown and Freed Gene Kelly“What a Wonderful World” Thiele and Weiss Louis Armstrong“Over the Rainbow” Arlen and Harburg Judy GarlandPopular songs Various Frank Sinatra

Section 8


Section 1 57

Music-assisted Wound Care This program uses recorded music before and during wound care in order to increase the resident’s physical comfort, reduce the resident’s perception of pain and induce a relaxation response. The recorded music will also be used to prevent or reduce any aggressive behaviors, such as yelling, crying, pinching and biting during wound care, and to allow the nurse to more easily complete wound care.

Staff Requirements: At least one CNA or one caregiver, as well as one nurse

Desired Objectives

n Increased physical comfort, as seen by less muscle tension or less aggressive behaviors.

n Decreased perception of pain, as seen by fewer nonverbal or verbal signs of discomfort, such as yelling and moaning.

n Relaxation, as seen by eyes closing, sleep, less muscle rigidity.

n Fewer or no aggressive behaviors, as seen by the absence of hitting, biting or pinching, or a reduction in these behaviors.

n Less resistance to wound care, as noted by nurse’s observation.

Entrance Criterion: The resident has moderate dementia, with or without depression. The resident requires wound care, and shows signs of physical discomfort during wound care, such as crying, screaming and moaning. The resident may or may not exhibit aggressive behaviors during wound care, such as hitting, punching and biting.

Exit Criterion: The resident demonstrates no change in physical discomfort or aggressive behaviors over the course of three wound care sessions. The resident expresses preference to have no music during wound care. Signs of physical discomfort or aggressive behaviors worsen over the course of one session.

Group Size: One resident.

Duration: As needed, prior to and during wound care.


Environmental Risks: Floor and bed should be free of clutter. Padding should surround floor and bed.

Resident Risks: Respect the resident’s wishes regarding music during wound change.


Facility: Private room

Equipment: CD player, 2 CDs that are customized to resident’s music preferences, 1 CD with slow preferred music, 1 CD with upbeat preferred music, iTunes, CD-burning software.

Method

1) Identify the resident’s personal music preferences, per information given by the resident, family members or caregivers.

2) If no information is available regarding music preferences, consult the music or recreation therapist.

Section 8


Section 1 58

3) Create music compilation CDs for the wound care sessions. Music on the first CD should be slow. Music on the second CD should be upbeat.

4) Greet the resident and ask, “Is it okay if I turn on some music?”

5) If the resident agrees, play the CD with slow music.

6) Adjust the volume of the music to the resident’s preferred listening level.

7) Just before the nurse begins wound care, change the CD and play another CD with upbeat music.

8) Increase the volume of the music on signs of physical discomfort, such as crying and yelling, or aggressive behaviors, such as hitting or pinching.

9) Decrease the volume of the music on signs of relaxation and decreased aggressive behaviors, and/or the ending of the wound change.

Guidelines for Music-Assisted Bathing:

n Select music based on the resident’s music preferences. Always consider the resident’s music preferences and responses first.

n If there is no information available regarding the resident’s music preferences or responses, choose music that was popular when the resident was 20-30 years of age. When possible, choose music that reflects the resident’s cultural background.

n Music selection for the first CD should have a slow beat and be instrumental. Play these tracks before wound care begins. They should help the resident relax.

n Music selections for the second CD should have a fast beat, whether instrumental or vocal.

n If the resident shows signs of relaxation, return to the slow music that was played before wound care began. This music is meant to reinforce the relaxation response, and to have a soothing effect.

Music Suggestions for Slow CD

(Music played prior to wound care and after signs of relaxation)

Selection Title Composer

“Air, Sinfonia in G” Bach

“Largo from Piano Concerto No. 3” Beethoven

“Intermezzo in E Flat” Brahms

Music Suggestions for Upbeat CD

(Music played right before and during wound care)

Song Title Composer and Lyricist

”Meet Me In St. Louis” Mills and Sterling

“When Johnny Comes Marching Home” Gilmore (Lambert)

“Stars and Stripes Forever” Sousa

Section 8

Section 9

Key Elements of a Successful Music Program


Section 1 60


Section 1 61

PreparationMusic therapy is key to dementia care. Successful programs have a clear framework and adjust to resident needs. Before a group is created, ask:

n What is the atmosphere on the floor today?

n Which residents in the group are not feeling well?

n Who has declined and may no longer be appropriate?

n What do residents most like?

n Is there an activity from previous sessions that did not work well and why?

n Have the residents asked for a different song?

Communication

Many residents with dementia are also hearing impaired. When speaking with residents, remember to:

n Talk at eye level.

n Use a friendly, welcoming tone.

n Remember culturally appropriate body language and actions.

n Speak slowly.

n Be patient.

Setup

The right setup helps programs thrive. Before residents arrive:

n Finalize activities, arrangements and music.

n Consider the best seating arrangement for residents. A line, semi-circle or complete circle may encourage maximum participation.

n Instruments and materials, including song sheets, should be on the table—making them easy to access and use.

SECTION 9

Key Elements of a Successful Music Program

Section 9


Section 1 62

Facilitation

How information is delivered can make or break an activity. A good facilitator will:

n Speak slowly and clearly so residents can understand.

n Give physical and/or verbal cues and know when to use either or both techniques.

n Rephrase directions when necessary, so all residents can be as fully engaged as possible.

n Offer simple and direct directions in a friendly tone.

n Adjust the volume or activity according to resident wishes.

Section 9Section 3 Section 9



Mu

sic

Act

ivit

y C

ard

s fo

r C

NA

s

Th

ese

card

s p

rovi

de

key

gu

idel

ines

fo

r le

adin

g m

usi

c ac

tivi

ties

wit

h re

sid

ents

w

ho h

ave

dem

enti

a an

d m

ay s

eem

ag

itat

ed, a

gg

ress

ive

or

wit

hd

raw

n.

Mu

sic

acti

viti

es c

an h

elp

to

:

n C

alm

res

iden

ts

n I

mp

rove

moo

d

n D

ecre

ase

wan

der

ing

n R

educ

e ve

rbal

and

phy

sica

l agi

tatio

n

n I

mp

rove

soc

ial i

nter

actio

n


Section 1 64

Key

Po

ints

to

Co

nsi

der

1. P

repa

re

n I

f the

resi

dent

is h

ighl

y se

nsiti

ve to

noi

se, d

o no

t inc

lude

the

resi

dent

.

n L

earn

the

resi

dent

’s fa

vorit

e m

usic

by

aski

ng th

e re

side

nt, s

taff

or fa

mily

, and

use

that

mus

ic

whe

neve

r pos

sibl

e.

n T

ry to

find

a q

uiet

room

that

will

hav

e m

inim

al d

istr

actio

ns.

n S

et u

p th

e ro

om a

nd a

ll eq

uipm

ent b

efor

e th

e re

side

nt is

pre

sent

.

2. R

esp

ectf

ully

lead

act

ivit

y

n T

ell t

he re

side

nt w

hat y

ou p

lan

to d

o th

roug

hout

the

sess

ion.

n A

sk if

the

mus

ic is

too

soft

or t

oo lo

ud. A

djus

t as

need

ed.

n I

nvite

resi

dent

s to

par

ticip

ate.

If o

ne re

fuse

s, in

vite

that

resi

dent

to s

tay

and

just

list

en to

the

mus

ic. I

f

the

resi

dent

stil

l ref

uses

, sto

p th

e m

usic

or h

elp

the

resi

dent

leav

e th

e gr

oup.

3. E

nd t

he m

usic

act

ivit

y

n I

n th

e la

st fi

ve m

inut

es, l

et th

e re

side

nt k

now

the

mus

ic w

ill e

nd.

n A

sk th

e re

side

nt if

he

or s

he e

njoy

ed th

e m

usic

.

Section 9


Section 1 65

Sin

g-a

-lo

ng

Ste

ps

1. G

athe

r re

sid

ents

in a

circ

le a

nd e

xpla

in t

hat

you

will

b

e si

ngin

g al

ong

to fa

mili

ar s

ong

s. In

vite

the

m to

join

in

the

sing

ing.

2. T

urn

on m

usic

: sel

ect

a si

ng-a

-lon

g p

layl

ist.

Pas

s ou

t so

ng s

heet

s as

nee

ded

.

3. A

t th

e en

d o

f eac

h so

ng, p

ut t

he m

usic

on

hold

. Ta

ke a

few

min

utes

to d

iscu

ss t

he m

usic

with

the

re

sid

ents

. For

exa

mp

le:

n D

oes

thi

s m

usic

see

m fa

mili

ar?

n W

hat

kind

of m

usic

is t

his?

n W

hat

do

es t

he m

usic

mak

e yo

u th

ink

of?

n W

ho d

o yo

u th

ink

is s

ingi

ng?

n D

id y

ou e

njoy

the

mus

ic?

4. W

hen

the

pla

ylis

t ha

s fin

ishe

d (o

r if

the

resi

den

ts

exp

ress

a d

esire

to e

nd t

he s

ing

-a-l

ong

at a

ny p

oint

),

turn

off

the

MP

3 p

laye

r.

Gro

up

Siz

e: S

mal

l (no

mor

e th

an 6

res

iden

ts)

Du

rati

on

: 30-

40 m

inut

esS

pec

ial E

qu

ipm

ent:

iPod

pla

yer

and

sp

eake

rs, s

ong

shee

ts o

r so

ngb

ook

n R

esid

ent

has

mid

-sta

ge d

emen

tia

n E

xhib

its s

ymp

tom

s of

wan

der

ing,

ag

itatio

n or

dep

ress

ion

n R

esid

ent

show

s no

sig

ns o

f im

pro

vem

ent

afte

r 4

sess

ions

n B

ehav

ior

nega

tivel

y im

pac

ts t

he

invo

lvem

ent

of o

ther

s

sto

p

go

Section 9



Ton

al/1

& 2

Cho

rd S

ong

s

Ste

ps

1. G

athe

r gr

oup

in a

circ

le.

2. S

how

res

iden

ts t

he t

one

bar

s an

d d

emon

stra

te h

ow to

us

e th

em. P

ass

out

mal

lets

and

the

n th

e to

ne b

ars.

3. D

emon

stra

te a

rhy

thm

(i.e

. slo

w a

nd s

tead

y, fa

st, l

oud

, so

ft, e

tc.)

4. T

hen

inst

ruct

res

iden

ts to

all

pla

y to

geth

er. S

ee s

ong

chor

d s

heet

s fo

r 1-

chor

d s

ong

s.

5. W

hen

resi

den

ts s

eem

com

fort

able

pla

ying

the

tone

b

ars,

sta

rt s

ingi

ng.

6. A

fter

sin

ging

, tak

e tim

e to

dis

cuss

the

mus

ic w

ith

resi

den

ts. L

iste

n an

d p

ract

ice

activ

e lis

teni

ng. Y

our

resp

onse

sho

uld

be

of a

pos

itive

nat

ure,

eve

n if

the

resi

den

t ha

d a

neg

ativ

e vi

ew.

7. R

epea

t st

eps

4-6.

8. T

ry 2

-cho

rd s

ong

s. C

NA

will

con

duc

t re

sid

ents

ac

cord

ing

to s

ong

shee

ts p

rovi

ded

by

mus

ic t

hera

pis

t.

Gro

up

Siz

e: S

mal

l (4

resi

den

ts)

Du

rati

on

: 30-

40 m

inut

esS

pec

ial E

qu

ipm

ent:

Set

of t

one

bar

s w

ith

mal

lets

, son

g ch

ord

she

ets

(for

CN

A o

nly)

, sm

all t

able

for

inst

rum

ents

n R

esid

ent

has

mid

-sta

ge d

emen

tia

n E

xhib

its s

ymp

tom

s of

wan

der

ing,

ag

itatio

n or

dep

ress

ion.

n R

esid

ent

show

s no

sig

ns o

f im

pro

vem

ent

afte

r 4

sess

ions

n B

ehav

ior

nega

tivel

y im

pac

ts

invo

lvem

ent

of o

ther

s

sto

p

go

Section 9



Mu

sic

& M

ovem

ent

Ste

ps

1. T

urn

on m

usic

: sel

ect

a m

ovem

ent

pla

ylis

t or

one

tha

t in

clud

es t

he r

esid

ents

’ fav

orite

mus

ic.

2. A

rran

ge g

roup

mem

ber

s in

a c

ircle

.

3. B

efor

e b

egin

ning

mov

emen

ts, e

mp

hasi

ze t

hat

each

res

iden

t sh

ould

onl

y d

o a

mov

emen

t if

com

fort

able

; ins

truc

t th

em to

le

t yo

u kn

ow if

the

y ex

per

ienc

e an

y d

isco

mfo

rt.

4. S

tart

the

mus

ic a

nd h

and

out

rhy

thm

inst

rum

ents

. M

ovem

ents

can

be

mad

e w

ithou

t in

stru

men

ts if

the

re

sid

ent

wis

hes.

5. C

all o

ut e

ach

mov

emen

t, t

hen

dem

onst

rate

it a

nd in

vite

re

sid

ents

to

join

. Enc

oura

ge r

esid

ents

to s

ugge

st t

heir

own

mov

emen

ts.

6. A

fter

10

-15

min

utes

, col

lect

rhy

thm

inst

rum

ents

and

tel

l re

sid

ents

you

will

now

co

ol d

own

with

sca

rves

.

7. H

and

out

sca

rves

, off

erin

g ch

oice

of c

olor

. Hon

or w

ishe

s,

if a

resi

den

t d

eclin

es t

o us

e a

scar

f. M

ovem

ents

can

be

per

form

ed fr

ee-h

and

ed.

8. In

stru

ct t

he r

esid

ents

to

take

a fe

w d

eep

bre

aths

and

to

follo

w y

ou a

s yo

u m

ake

slow

and

eas

y m

ovem

ents

.

9. A

fter

5-1

0 m

inut

es o

f slo

w a

nd e

asy

mov

emen

ts, c

olle

ct

scar

ves

and

the

n tu

rn o

ff m

usic

.

10. T

ake

a fe

w m

inut

es t

o d

iscu

ss t

he s

essi

on, t

hen

sa

y go

od

bye

.

Gro

up

Siz

e: S

mal

l (4-

6 re

sid

ents

)D

ura

tio

n: 2

0-30

min

utes

Sp

ecia

l Eq

uip

men

t: iP

od p

laye

r an

d

spea

kers

, chi

qui

tas,

egg

sha

kers

, jin

gle

bel

ls, s

carv

es

n R

esid

ent

has

mid

-sta

ge d

emen

tia

n E

xhib

its s

ymp

tom

s of

wan

der

ing,

ag

itatio

n or

dep

ress

ion.

n R

esid

ent’s

beh

avio

ral s

ymp

tom

s w

orse

n or

neg

ativ

ely

imp

act

invo

lvem

ent

of o

ther

res

iden

ts

n S

igna

ls a

des

ire to

leav

e

sto

p

go

Section 9



Mu

sic-

assi

sted

R

ang

e-o

f-M

oti

on

Ste

ps

1. T

urn

on m

usic

: sel

ect

a m

ovem

ent

pla

ylis

t or

one

tha

t in

clud

es t

he r

esid

ent’s

favo

rite

mus

ic.

2. S

eat

the

resi

den

t in

a fi

rm c

hair

with

a s

trai

ght

bac

k.

3. In

itiat

e an

d fa

cilit

ate

rang

e-of

-mot

ion

exer

cise

s th

at

serv

e th

e re

sid

ent’s

ind

ivid

ualiz

ed p

lan

of c

are.

4. A

void

ris

k of

ove

r-ex

ertio

n b

y p

ayin

g cl

ose

atte

ntio

n to

th

e re

sid

ent’s

pos

ture

, fac

ial t

ensi

on a

nd v

erb

al r

epor

ts o

f

exha

ustio

n. A

dju

st o

r st

op t

he e

xerc

ises

and

mus

ic w

hen

app

rop

riate

.

5. If

the

res

iden

t re

sist

s en

gagi

ng in

the

exe

rcis

es,

red

irect

the

res

iden

t b

y d

iscu

ssin

g th

e m

usic

. You

may

w

ant

to p

ause

the

ran

ge-o

f-m

otio

n ex

erci

ses

until

the

re

sid

ent

seem

s le

ss r

esis

tant

.

Gro

up

Siz

e: O

ne r

esid

ent

Du

rati

on

: 5-2

0 m

inut

esS

pec

ial E

qu

ipm

ent:

iPod

pla

yer

and

sp

eake

rs, fi

rm c

hair

with

str

aigh

t b

ack

n R

esid

ent

has

mid

-sta

ge d

emen

tia

n S

how

s si

gns

of w

ithd

raw

al, p

oor

mo

od

n I

s re

sist

ant

to r

ehab

ilita

tion

pla

n ex

erci

ses

n D

eclin

e in

hea

lth p

rohi

bits

ra

nge-

of-m

otio

n ex

erci

ses

sto

p

go

Section 9



Mu

sic-

assi

sted

B

ath

/Sho

wer

Ste

ps

1. T

urn

on m

usic

for

resi

den

t 20

-30

min

utes

bef

ore

the

bat

hing

beg

ins:

sel

ect

a m

usic

-ass

iste

d c

are

pla

ylis

t or

on

e th

at in

clud

es t

he r

esid

ent’s

favo

rite

mus

ic.

2. In

form

the

res

iden

t th

at y

ou w

ill n

ow b

egin

the

bat

hing

, an

d a

sk if

the

mus

ic c

an c

ontin

ue.

3. If

yes

, or

if th

e re

sid

ent’s

agi

tatio

n ha

s no

t w

orse

ned

, le

t th

e m

usic

con

tinue

.

4. W

hile

bat

hing

the

res

iden

t, n

otic

e an

y ag

gres

sive

b

ehav

iors

or

gene

ral a

gita

tion

; if e

ither

incr

ease

s, d

irect

th

e re

sid

ent

to li

sten

to t

he m

usic

. If t

hey

cont

inue

to

incr

ease

, cha

nge

the

mus

ic t

o a

diff

eren

t tr

ack

or p

layl

ist.

If

the

aggr

essi

on o

r ag

itatio

n ris

es, t

urn

off t

he m

usic

.

Gro

up

Siz

e: O

ne r

esid

ent

Du

rati

on

: 30-

60 m

inut

esS

pec

ial E

qu

ipm

ent:

iPod

pla

yer

an

d s

pea

kers

n R

esid

ent

resi

sts

bei

ng b

athe

d

n D

isp

lays

agg

ress

ive

beh

avio

rs p

rior

to,

or d

urin

g, b

athi

ng/s

how

erin

g

n A

ggre

ssiv

e b

ehav

iors

do

not

imp

rove

ov

er t

he c

ours

e of

4 s

essi

ons

or w

orse

n th

roug

hout

2 s

essi

ons

sto

p

go

Section 9



Mu

sic-

assi

sted

W

ou

nd

Car

e

Ste

ps

1. T

urn

on m

usic

20

-30

min

utes

bef

ore

wou

nd c

are

is

sche

dul

ed to

beg

in: s

elec

t a

mus

ic-a

ssis

ted

car

e p

layl

ist

or o

ne t

hat

incl

udes

the

res

iden

t’s fa

vorit

e m

usic

.

2. F

ive

min

utes

bef

ore

wou

nd c

are,

ask

the

res

iden

t if

th

e m

usic

can

con

tinue

.

3. If

yes

, or

if si

gns

of a

gita

tion

and

dis

com

fort

hav

e no

t w

ors

ened

, let

mus

ic c

ontin

ue a

s w

ound

car

e b

egin

s.

4. If

the

re is

an

incr

ease

in t

he r

esid

ent’s

sig

ns o

f phy

sica

l d

isco

mfo

rt o

r ag

itatio

n, d

irect

the

res

iden

t to

list

en t

o th

e m

usic

. If t

he s

igns

con

tinue

to

incr

ease

, cha

nge

the

mus

ic

to a

diff

eren

t so

ng o

r p

layl

ist.

If t

he s

igns

ele

vate

, tur

n

the

mus

ic o

ff.

Gro

up

Siz

e: O

ne r

esid

ent

Du

rati

on

: As

need

ed, p

rior

to a

nd d

urin

g w

ound

car

eS

pec

ial E

qu

ipm

ent:

iPod

pla

yer

and

sp

eake

rs, p

add

ing

arou

nd fl

oor

and

bed

n R

equi

res

inte

nse

wou

nd c

are

and

sho

ws

sign

s of

phy

sica

l dis

com

fort

or

exhi

bits

ag

gres

sive

beh

avio

rs d

urin

g w

ound

car

e

n R

esid

ent

says

no

to m

usic

at

any

time

n S

igns

of p

hysi

cal d

isco

mfo

rt o

r ag

gres

sive

b

ehav

iors

wor

sen

n R

esid

ent

show

s no

imp

rove

men

t in

phy

sica

l d

isco

mfo

rt o

r b

ehav

iors

aft

er 3

diff

eren

t at

tem

pts

sto

p

go



Section 10

Music Intervention Questionnaire


Section 1 72


Section 1 73

1. Peggy is throwing her food again and agitating other residents. What kind of music should you offer Peggy to reduce her throwing behaviors?

a. Slow, instrumental music

b. Peggy’s favorite songs

c. Music that you find calming

d. All of the above

2. Russell is refusing to get out of bed this morning. He is having difficulty getting motivated. Name three items from the movement protocol that you should use to motivate Russell.

1.

2.

3.

3. Lacy repeatedly wanders around the nursing station, calling for a nurse. You checked her for pain and other signs of discomfort. Which protocol do you use to help reduce her wandering, and why? What playlist would you chose from the iPod?

Music Intervention Questionnaire

SECTION 10

Section 10



4. Name two of your residents with whom you can use each protocol:

a. Tonal

b. Movement

c. Bathing

d. Wound Care

Choose an iPod playlist for each resident.




Music Intervention Questionnaire Answers


Section 1 76


Section 1 77

SECTION 11

Music Intervention Questionnaire Answers

1) Peggy is throwing her food again and agitating other residents. What kind of music should you offer Peggy to reduce her throwing behaviors?

a. Slow, instrumental music

b. Peggy’s favorite songs

c. Music that you find calming

d. All of the above

The correct answer is d. The best approach is to sing or play Peggy’s favorite song that is slow and calming. Music that is slow in tempo can reduce the state of agitation for everyone in the room, especially Peggy.

2) Russell is refusing to get out of bed this morning. He is having difficulty getting motivated. Name three items from the movement protocol that you should use to motivate Russell.

The correct answers are rhythm instruments, scarves or other props, as well as iPod and speakers.

3) Lacy repeatedly wanders around the nursing station, calling for a nurse. You checked her for pain and other signs of discomfort. Which protocol do you use to help reduce her wandering, and why? What playlist would you chose from the iPod?

The correct answer is Music & Movement. The use of this playlist requires minimal set-up and can be facilitated on a one-to-one basis. It is best to use a playlist that involves moderately slow to upbeat music that represents the culture of the resident that you are working with.

4) Name two of your current residents with whom you can use each protocol:

Sample answers:

a. Tonal Beth Tonal

b. Movement Joseph Music & Movement

c. Bathing Beth Music-assisted Bathing

d. Wound Care Joseph Music-assisted Wound Care

Section 11


Section 1 78

This project was made possible through a grant from the New York State Department of Health. Continued funding for

this program provided by MJHS Foundation.

Mary Mittelman, DrPH, of New York University’s Langone Medical Center’s Center of Excellence on Brain Aging provided

scientific oversight of the project. Suzanne Fitzsimmons, Nurse Practitioner, of University of North Carolina, provided

clinical guidance and supervision.

For more information on music therapy call 1-855-241-4313

MJHS Foundation provides financial assistance for the charitable efforts of MJHS and its affiliated agencies.

The philanthropic spirit of The Four Brooklyn Ladies has been a cornerstone and guiding philosophy of MJHS for more than 100 years. The culture of philanthropy they inspired led to the formation

of MJHS Foundation, which has been instrumental in raising the funds necessary for the provision of charitable health care as well as the development of innovative services and programs to serve our growing community. The extraordinary efforts of MJHS would not be made possible without grants

from MJHS Foundation, which relies on the support of generous donors like you and employees through

the Employee Giving Campaign.

www.mjhs.org (855) 860-0981

MJHS does not discriminate against any person on the basis of race, color, national origin, disability, gender or age in admission, treatment, or publication in it’s programs, services, and activities or in employment. For further information about this policy, contact the MJHS Compliance Officer at 718-921-8400.

MJHS Music Therapy: Keys to Dementia Care

Documents

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music movement

music interventions

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