David Aldridge, Saturday 5 September, 2015, Music Therapy and Dementia Care in the 21st Century, Department of Music & Performing Arts, Angela Ruskin University, Cambridge.
Department of Music & Performing Arts Faculty of Arts, Law & Social Sciences Angela Ruskin University, Cambridge.
Music Therapy and Dementia Care in the 21st Century Saturday 5 September, 2015
Music therapy practice and research – 25 years on David Aldridge, B.ED., B.Phil., PhD., FRSM. Researcher, Nordoff-Robbins Zentrum Witten, Germany
www.nordoff-robbins.org 1
David Aldridge, Saturday 5 September, 2015, Music Therapy and Dementia Care in the 21st Century, Department of Music & Performing Arts, Angela Ruskin University, Cambridge.
Relevant material to this presentation is published below: Aldridge, G. & Aldridge, D. Melody in Music Therapy. A Therapeutic Narrative Analysis. Jessica Kingsley, London 2008. Aldridge, D. Suicide: The tragedy of hopelessness. Jessica Kingsley, London 1998 . Aldridge, D. Music therapy research and practice in medicine: From out of the silence. Jessica Kingsley, London 1996.
Aldridge, D. (editor) Music therapy and neurological rehabilitation: Performing health. London: Jessica KIngsley Publishers 2005. Aldridge, D. (editor) Case study designs in music therapy. London: Jessica Kingsley Publishers 2004. Aldridge,D. (editor) Music therapy in dementia care: More new voices. Jessica Kingsley, London 2000. Aldridge,D. (editor) Music therapy in palliative care: New voices. Jessica Kingsley, London 1999.
available at Jessica Kingsley Publishers, Londonhttp://www.jkp.com 2
David Aldridge, Saturday 5 September, 2015, Music Therapy and Dementia Care in the 21st Century, Department of Music & Performing Arts, Angela Ruskin University, Cambridge.
Relevant bibliography of journal articles Aldridge, D., 2007, Living as jazz. Journal of Holistic Healthcare, 4, 2, 28-31.
Aldridge, D. 1995 De la Musique en tant que Thérapie de la Maladie d’Alzheimer. Alzheimer Actualities, 99:6-11.
Aldridge, D., 2007, My Top Ten. Geriatrie Journal, 2, 37-39.
Aldridge, D. 1994 Alzheimer’s Disease: rhythm, timing and music as therapy. Biomedicine and Pharmacotherapy, 48(7), 275-281.
Aldridge, D., 2007, Essen mit Musik. pflegen:Demenz, 2, 26-29.
Aldridge, D. 1993 Music and Alzheimer’s disease - assessment and therapy: a discussion paper. Journal of the Royal Society of Medicine, 86: 93-95.
Aldridge, D., 2007,Spirituality, Hope, and Music Therapy in Palliative Care. In I. Serlin (ed), Whole Person Healthcare, The Arts and Health (Vol. 3, pp. 189-200). London: Praeger.
Aldridge, D. 1992 An ecosystemic research paradigm I. Complementary Medical Research, 6(1):25-35.
Jungblut, M., Gerhard, H. and Aldridge, D. 2006, Die Wirkung einer spezifischen musiktherapeutischen Behandlung auf die sprachlichen Leistungen eines chronisch kranken Globalaphasikers – eine Falldarstellung. Neurologie & Rehabilitation, 12, 6, 339-347.
Aldridge, D. 1992 An ecosystemic research paradigm II. Complementary Medical Research, 6(1):36-45.
Aldridge, D. (2005). Spirituality and medicine: complementary perspectives. Spirituality and Health International, 6(2), 71-80.
Aldridge, D. and Aldridge, G. 1992 Two epistemologies: music therapy and medicine in the treatment of dementia. The Arts in Psychotherapy 19: 243-255.
Aldridge, D. (2005). Vielleicht werde ich einfach nur alt. Musiktherapeutische Umschau, 26(2), 151-55.
Aldridge, D. 1991 Healing and medicine. Journal of the Royal Society of Medicine, 84, 516-518.
Ridder, H.-M., & Aldridge, D. (2005). Individual music therapy with persons with frontotemporal dementia: Singing dialogue. Nordic Journal of Music Therapy, 14(2), 91-106.
Aldridge, D. 1991 Aesthetics and the individual in the practice of medical research: a discussion paper. Journal of the Royal Society of Medicine, 84: 147-50.
Aldridge, D. (2004). Musiktherapie in der Behandlung von Demenz. Geriatrie Journal, 4, 24-27.
Aldridge, D. and Brandt, G. 1991 Music therapy and Alzheimer’s disease. Journal of British Music Therapy, 5(2), 28-63.
Jungblut, M. & Aldridge, D. (2004). Musik als Brücke zur Sprache - die musiktherapeutische Behandlungsmethode SIPARI bei Langzeitaphasikern. Neurologie & Rehabilitation, 10(2), 69-78.
Aldridge, D. 1990 Making and taking health care decisions. Journal of the Royal Society of Medicine, 83 , 720-723.
Aldridge, D. 1998 Music therapy and the treatment of Alzheimer’s disease. Journal of Clinical Gerontopsychology 4,1, 17-30.
1989
Aldridge, D. 1998 Life as jazz: hope, meaning and music therapy in the treatment of life-threatening illness. Advances in Mind-Body Medicine 14, 271-282.
Aldridge, D. 1989 Music, communication and medicine. Royal Society of Medicine, 82 , 743-746.
Aldridge, D. 1990 The delivery of health care alternatives. Journal of the Royal Society of Medicine, 83 , 179-182. Aldridge, D. 1989 Music as identity. Journal of Neuroscience, 45 , 162.
Aldridge, D. 1989 A phenomenological comparison of the organization of music and the self. Arts in Psychotherapy, 16 , 91-97.
Aldridge, D. 1995 Music Therapy and the treatment of Alzheimer’s disease. Clinical Gerontologist, 16(1): 41-57.
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David Aldridge, Saturday 5 September, 2015, Music Therapy and Dementia Care in the 21st Century, Department of Music & Performing Arts, Angela Ruskin University, Cambridge.
community hospital in Herdecke, Germany request by psychiatrist team of integrated medicine practitioners diagnosis questioned - assessment project in local residential home for the elderly goal-oriented intervention NOT entertainment Aldridge, D. and Brandt, G. (1991). Music therapy and Alzheimer’s disease. Journal of British Music Therapy, 5, 2, 28-63. Aldridge, D. (1993). Music and Alzheimer's disease - assessment and therapy: a discussion paper. Journal of the Royal Society of Medicine, 86, 93-95. Aldridge,D. (2000) Music therapy in dementia care: More new voices. Jessica Kingsley, London 4
David Aldridge, Saturday 5 September, 2015, Music Therapy and Dementia Care in the 21st Century, Department of Music & Performing Arts, Angela Ruskin University, Cambridge.
early onset dementia As neurological diseases are classically “diseases of the elderly,” it has been argued that people are now living longer to develop diseases that they would not have lived long enough to have acquired in previous times (the Gompertzian theory). While this process might partially account for the some of the rises, the disproportionate rises in the incidence over a relatively short time suggest other factors. if people in their 40’s and 50’s are being diagnosed with early onset dementia, then that has ramifications for family and community care. Pritchard C, Rosenorn-Lanng E. Neurological deaths of American adults (55-74) and the over 75's by sex compared with 20 Western countries 1989-2010: Cause for concern. Surg Neurol Int 2015;6:123.
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An ecosystemic perspective • behaviours performance in context • dialogic-degenerative diseases relational • change sign from - to + • repertoire of responses
cognitive resources
• personal, relational, institutional, cultural Aldridge,D. (1984/1998) Suicide: The tragedy of hopelessness. London: Jessica Kingsley . Aldridge, D. (1996). Music therapy research and practice in medicine: From out of the silence. London: Jessica Kingsley. Aldridge, D. (2011). Song as life is ending. Journal of Holistic Health Care, 8, 1, 41-44 6
An ecosystemic perspective • management of arousal • expressions/utterances/cries/gestures are an re-cognise attempt to achieve cognition • con-sciousness is also relational
knowing with
• communication can be achieved without words AND has its ground in musicality prosodic elements Aldridge, D. and Brandt, G. (1991). Music therapy and Alzheimer’s disease. Journal of British Music Therapy, 5, 2, 28-63. Aldridge, D. (1996). Music therapy research and practice in medicine: From out of the silence. London: Jessica Kingsley. 7
Foundations of communicating interpersonally • arousal
•prosody
rhythm, stress, and intonation of speech
•timing
• attention
•melody
• affect
•pitch
• action
m a ks i i nn gg i mn ug s i c 8
Management of arousal intensity
agitated hyperarousal
excited calm hyporarousal
Duration
9
unresponsive
Management of arousal duration
too short
too long
Duration 10
David Aldridge, Saturday 5 September, 2015, Music Therapy and Dementia Care in the 21st Century, Department of Music & Performing Arts, Angela Ruskin University, Cambridge.
Assessment Improvised music therapy appears to offer the opportunity
to supplement mental state examinations * in areas
where those examinations are lacking:
• intentionality, attention to, concentration on and perseverance with the task in hand are important features of producing musical improvisations and susceptible to being heard in musical playing
• episodic memory can be tested in the ability to repeat short rhythmic and melodic phrases (Jacobsen, J.-H. et.al. (2015). Why musical memory can be preserved in advanced Alzleimer's disease. Brain.
• sensitive to small changes
• occurs in less threatening context
• non-pharmacological intervention * Aldridge, D. and Aldridge, G. (1992). Two epistemologies: Music therapy and medicine in the treatment of dementia. The Arts in Psychotherapy, 19, 243-255. * Aldridge, D. (1993). Music and Alzheimer's disease - assessment and therapy: a discussion paper. Journal of the Royal Society of Medicine, 86, 93-95. 11
David Aldridge, Saturday 5 September, 2015, Music Therapy and Dementia Care in the 21st Century, Department of Music & Performing Arts, Angela Ruskin University, Cambridge.
in music we oer the time frame of an E
X
T
E
N
melody now
D
E
D
phrasing now now
O
W
timing now now now
now now
N
now
in a cultural context that makes sense that is; song form that promotes participative knowledge
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David Aldridge, Saturday 5 September, 2015, Music Therapy and Dementia Care in the 21st Century, Department of Music & Performing Arts, Angela Ruskin University, Cambridge.
CD resources; for relatives and carers, for dining rituals Educational resources; for relatives and carers Staff training
Aldridge, D. (2007) Essen mit Musik. pflegen:Demenz, 2, 26-29. Aldridge, D. (2011) Song as life is ending. Journal of Holistic Health Care, 8, 1, 41-44
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David Aldridge, Saturday 5 September, 2015, Music Therapy and Dementia Care in the 21st Century, Department of Music & Performing Arts, Angela Ruskin University, Cambridge.
Benefits of music therapy • trained therapist / clear goals • tailored to meet the needs of individual patients • promotes dialogue • re-integrates the person with surroundings, prevents isolation • offers a flexible structure for processing temporal information • non-pharmacological intervention • as much as an intervention with staff !! 14
Jungblut, M. & Aldridge, D. (2004) “Musik als Brücke zur Sprache - die musiktherapeutische Behandlungsmethode “Sipari” bei Langzeitaphasikern”, Neurologie & Rehabilitation, 2, 69-78. 16
David Aldridge, Saturday 5 September, 2015, Music Therapy and Dementia Care in the 21st Century, Department of Music & Performing Arts, Angela Ruskin University, Cambridge.
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Jungblut, M. & Aldridge, D. (2004) “Musik als Brücke zur Sprache - die musiktherapeutische Behandlungsmethode “Sipari” bei Langzeitaphasikern”, Neurologie & Rehabilitation, 2, 69-78.
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David Aldridge, Saturday 5 September, 2015, Music Therapy and Dementia Care in the 21st Century, Department of Music & Performing Arts, Angela Ruskin University, Cambridge.
Benefits of music therapy • regulates emotional expression-inhibition, stabilizes emotions - arousal management • motivates communication and participation without being speech dependent • attention, arousal, affect and action embodied in musical per-form-ance • cognitive resources depleted by arousal and social anxiety
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David Aldridge, Saturday 5 September, 2015, Music Therapy and Dementia Care in the 21st Century, Department of Music & Performing Arts, Angela Ruskin University, Cambridge.
we are part of the the ecological context of healing, we ask together, what is possible ? moving from pathology to performance and thereby enlarge the repertoire of performance music therapy is about the art of being human in challenging situations and times the World Health Organisation states that the disabled have a right of access to their culture and through music therapy we enable this access for those challenged by speech and cognitive restrictions. 20