Music Therapy
Throughout history, music has been used to facilitate healing. Aristotle believed the flute in particular was powerful. Pythagoras taught his students to change emotions of worry, fear, sorrow, and anger through the daily practice of singing and playing a musical instrument. The first accounts of the influence of music on breathing, blood pressure, digestion, and muscular activity were documented during the Renaissance (Munro and Mount, 1978). Music, more than the spoken word, "lends itself as a therapy because it meets with little or no intellectual resistance, and does not need to appeal to logic to initiate its action . . . [and] is more subtle and primitive, and therefore its appeal is wider and greater" (Altshuler, 1948). This wide appeal, as well as the considerable research base, suggests music may be used more and more both by itself and in conjunction with other treatments to ameliorate certain illnesses. Music therapy began as a profession in the 1940s, when the Veterans Administration ~Hospital incorporated music into rehabilitation programs for disabled soldiers returning from World War II. The National Association for Music Therapy, Inc. (NAMT), was established in the United States in 1950. At the same time, degree programs were developing to educate and train professional music therapists. Since then, the organization has established curricular programs in music therapy, which include both clinical practice and internships at sites in a wide variety of medical and community settings; organized an impressive scientific database for the profession; developed standards of practice and a code of ethics; and fostered the development of a theoretical rationale for music's beneficial effect on the mind and body. There are more than 5,000 registered music therapists (R.M.T.s) in the United States, and more than 80 undergraduate and graduate degree programs. In addition, there are 165 clinical internship training sites. A baccalaureate degree in music therapy requires course work in music therapy; psychology; music; biological, social, and behavioral sciences; disabling conditions; and general studies. It includes field work in community facilities or on-campus clinics serving individuals with special needs. After graduation, a student must ~serve a 6-month internship in an approved facility to be eligible to take the exams to become a board-certified therapist. Two refereed journals are sponsored by NAMT: the Journal of Music Therapy and Music Therapy Perspectives. Three published indexes in music therapy exist with more than 6,000 citations of periodical articles published between 1960 and 1980 (Eagle, 1976, 1978; Eagle and Minter, 1984). An electronic database of medical music therapy (Computer-Assisted Information Retrieval Service System, CAIRSS) has been established with citations from more than 1,000 journals including empirical studies, case reports, and program reviews. Music therapy is used in psychiatric hospitals, rehabilitation facilities, general hospitals, outpatient clinics, day care treatment centers, residences for people with developmental disabilities, community mental health centers, drug and alcohol programs, senior centers, nursing homes, hospice programs, correctional facilities, halfway houses, schools, and private practice. ~Music therapy is used to address physical, psychological, cognitive, and social needs of individuals with disabilities and illnesses. After assessing the strengths and needs of each client, a qualified music therapist provides the appropriate treatment, which can include creating music, singing, moving to music, or just listening to it. Music therapy can be used to meet medical goals in many areas, including the following: • Physical and emotional stimulation for those with chronic pain or impaired movement. Music evokes a wide range of emotional responses. It can be a sedative to promote relaxation, or it can be a stimulant to promote movement to other physical activity (Coyle, 1987; Kerkvliet, 1990; Zimmerman et al., 1989). • Communication for those with autism or communication disorders. Music is a unique form of communication. Using music with people who are nonverbal or who have difficulty communicating facilitates their social interaction and may increase their functioning (Grimm and Pefley, 1990; Street and Cappella, 1989).~ • Emotional expression for those with mental health problems. Music can be used to express a wide variety of emotions, ranging from anger and frustration to affection and tenderness. These feelings often take the form of vocalizations that may or may not employ words (Jochims, 1990; Schmettermayer, 1983). • Associations with music for those with Alzheimer's disease and other dementias. Selecting music from an individual's past may evoke memories of times, places, and persons. These memories can contribute additional information to the treatment of the individual (Clair and Bernstein, 1990; Gibbons, 1988; Hanser, 1990). Research accomplishments. Thousands of specific research studies have been undertaken in the clinical uses of music in medical and dental treatment, and many others are currently in process. Among those clinical uses are the following: • As an analgesic. As early as 1914, Kane investigated using a phonograph in the operating room for calming patients prior to anesthesia. Music as an analgesic for dental ~procedures was one of the earliest and most thoroughly investigated areas. It also has been used successfully during childbirth and with obstetric patients. A 1985 study using music as an anxiolytic showed suppressed stress hormone levels in orthopedic, gynecologic, and urologic surgery patients (Bonny and McCarron, 1984; Frandsen, 1989). • As a relaxant and anxiety reducer for infants and children. Many studies have dealt with music's effect on hospitalized infants and pediatric patients. Lullabies in the neonatal nursery increased the weight gain and movements of newborns; music activities reduced fear, distress, and anxiety in hospitalized infants, toddlers, and their families and promoted "wellness" attributes in very ill children (Aldridge, 1993; Armatas, 1964; Atterbury, 1974; Chetta, 1981; Crago, 1980; Daub and Kirschner-Hermanns, 1988; Fagen, 1982; Kamin et al., 1982; Locsin, 1981; MacClelland, 1979; Mullooly et al., 1988; Oyama et al., 1983; Sanderson, 1986; Tanioka et al., 1985). • With burn patients. Burn patients experienced alleviation of aesthetic sterility and distraction from constant pain.~ • With terminally ill individuals. Cancer patients, using music therapy, increased their ability to discuss their feelings and talk about the trauma of the disease (Fagen, 1982; Frampton, 1986; Gilbert, 1977; Walter, 1983). • With persons with cerebral palsy. As early as 1950, music therapy together with physical therapy was shown to reduce the neurological problems of children with cerebral palsy. • With individuals who have had strokes or have Parkinson's disease. Federal funding from the Administration on Aging is currently being used for research into the effects of music therapy and physical therapy on people with strokes or Parkinson's disease. • With persons who have sensory impairments or AIDS. Many studies have explored the applications of music therapy to individuals who have sensory impairments (visual and hearing), mental retardation, or AIDS. ~ • With elderly persons. In 1991 the U.S. Senate Special Committee on Aging convened a hearing on the therapeutic benefits of music for elderly persons, which included neurologist Dr. Oliver Sacks, singer Theodore Bikel, rock musician Mickey Hart, music therapists, and clients. The hearing record documents in detail the benefits of music therapy to the elderly (Special Committee on Aging, 1991). After the hearing, Senator Harry Reid (D-NV) introduced the Music Therapy for Older Americans Act, which was later folded into the Older Americans Act Amendments of 1992. This act lists music therapy as both a supportive and a preventive health service. The new Title IV initiative creates research and demonstration projects and education and training initiatives, for which Congress appropriated nearly $1 million. In 1993, six nationwide music therapy projects were funded (Renner, 1986). • With persons with brain injuries. In 1993, the Office of Alternative Medicine awarded one of its first 30 grants "to investigate any beneficial effects of a specific music therapy intervention on empirical measures of self-perception, empathy, social perception, depression, and emotional expression in persons with brain injuries." This research is now ~under way (Lehmann and Kirchner, 1986; Lucia, 1987). Research needs and opportunities. In areas where it has not been done, systematic review and meta-analysis should be performed to assess the quality and outcomes of the research. In addition, further research is needed in the following areas: • Neurological functioning, communication skills, and physical rehabilitation. • Perception of pain, need for medication, and length of hospital stay. • Cognitive, emotional, and social functioning in those with cognitive impairments. • Emotional and social well-being of caregivers and families of those with disabilities. • Clinical depression and other mental disorders. ~ • Disease prevention and health promotion of persons with disabilities

 

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