Taking Forward Music Therapy : Shaping The Future
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the HARMoNY Bulletin
CENTER FOR MUSIC THERAPY EDUCATION AND RESEARCH Volume : IV
Issue : 3
September 2015
the HARMoNY Volume : IV
Issue : 3
Sep 2015
EDITOR’S DESK Hello Readers, Here we are, delighted to bring out the third issue of our quarterly bulletin for this year. Bringing forward our usual enthusiasm in updating the readers of the activities of CMTER, this issue also reports a number of significant advances made by the Center in the last few months. The featured article is about a recent study done by the faculty of CMTER in collaboration with the department of pediatrics on the topic " Live music therapy as an active focus of attention for pain and behavioral symptoms of distress during pediatric immunization" reporting the various results of the study. "Also presented
is a brief report on the
International Conference on Music Therapy held on 23.06.2015 at our college campus to the benefit of all faculty and students who were not able to attend this event. Further, there is an announcement regarding the formation of research clusters from CMTER in partnership with CIDRF which will operate to encourage faculty and students to work collaboratively and engage in high quality music therapy research. As always, there is media coverage information on CMTER and yet another announcement regarding the establishment of a clinical observership program for overseas music therapy students/professionals.
Wishing you all a happy reading time
Inside this issue Editorial Featured article CMTER in the Media Launch of International Observership Program Research Clusters from CMTER Announcement
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Issue : 3
Sep 2015
LIVE MUSIC THERAPY AS AN ACTIVE FOCUS OF ATTENTION FOR PAIN AND BEHAVIORAL SYMPTOMS OF DISTRESS DURING PEDIATRIC IMMUNIZATION Sumathy Sundar , Bhuvaneswari Ramesh , Priyanka B Dixit , Soma Venkatesh ,
1
Prarthana Das , D. Gunasekaran
5
2
3
4
6
Consultant and Head, Center for Music Therapy Education and Research Tutor, Center for Music Therapy Education and Research Lecturer, Center for Music Therapy Education and Research Assistant Professor, Department of Pediatrics Assistant Professor, Department of Pediatrics Professor and Head, Department of Pediatrics (This manuscript has been accepted for publication in Clinical Pediatrics) Key-words: Music Therapy, Immunization,
Abstract :
Vaccination, Pain, Pain perception
100 children coming for routine immunization to
Introduction :
pediatric out-patient department were included and were divided into experiment (n=50) and
Pediatric immunization procedures are one of the
control (n=50) groups. Experiment group received
most painful and frightening experiences during
live music therapy during immunization procedure.
i nfa n cy
Control group received no intervention. Modified
an d
c h il d h oo d.
Inj ec t i on s
fo r
immunizations are part and parcel of growing up
Behavior Pain Scale (MBPS), 10-point pain levels,
and are repeatedly administered and cannot be
and 10-point distress levels were documented by
avoided. The pain associated with such injections
parents. Duration of crying spells was recorded by
is a source of distress for children, their parents and
investigators. Pre- and post- immunization blood
those administering the injections. If not
pressures and heart rates of parents holding the
addressed, this pain can lead to pre procedural
children were also measured and recorded by
anxiety in future, needle fears and also health care
investigators. Independent and Paired t-Tests were
avoidance behaviours including non adherence to
used for analysis. All three domains of MBPS and
immunization schedules.
duration of crying showed significant improvement
Conversely, minimizing
pain during childhood vaccination can help to
(P < 0.05) in experiment group. Pain and distress
prevent distress, development of needle fears and
levels also showed statistically non-significant
also health care avoidance behaviours including to
improvement in experiment group. Blood pressure
maintain and promote trust in health care providers
and heart rate of parents showed no difference.
[1].
Music therapy could be helpful to children, parents and health care providers by reducing discomfort of
Music has been explored as a source of distraction
the child during pediatric immunization injection
and active focus of attention to positively affect the
procedures
distress levels and pain perception of the children
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during immunization procedures. Some research
The parents were also asked to rate pain and
studies have shown that musical interventions
distress levels from 0 to 10 points (0 for no pain or
reduce pain perception and distress levels during
distress and 10 for worst pain or distress
injection immunization procedures [2].
respectively). Investigator also noted the times when subjects started and stopped crying. Systolic
Methodology :
blood pressure, diastolic blood pressures and heart
The study was carried out at Pediatric Out-Patient
rates of parents holding the children were
Department at Mahatma Gandhi Medical College &
measured before and after the immunization
Research Institute (MGMCRI), Pondicherry, India.
procedure in both the groups. The results were
Children less than 18 months of age coming for
analyzed by using Independent and Paired T Tests.
routine immunization were included in the study.
Results :
Children with hearing problems were excluded. The aim of study was to assess effect of live music
Results of Modified Behavior Pain Scale (MBPS) for
therapy intervention on pain, distress and
each of three domains (facial expression, cry and
physiological parameters of the parent holding the
movements), 10-point pain levels and 10-point
child during painful immunization procedures in
distress levels for both experiment and control
children. Total 100 children were included in the
groups are shown in Table 1. All three domains of
study. They were divided into experiment and
MBPS have shown significant improvement in
control groups by block randomization in blocks of
experiment group (P < 0.05). Pain levels and
10. Each group consisted of 50 subjects. Written
distress levels have also shown improvement in
informed consent was obtained from the parent of
experiment group, the difference being not
each of the subject before inclusion into the study.
statistically significant.
The study was approved by Institutional Ethical
Mean duration of crying spells was 25.02 (Âą 13.98
Committee of MGMCRI.
SD) seconds in experiment group and 41.66 (Âą
The experiment group received music therapy
17.29 SD) seconds in control group. The difference
intervention. The subjects in experiment group
was statistically significant with P < 0.05 (T Test
were exposed to singing and musical instrument
5.2923, P value 0.000000738).
playing along with visual aids (hand puppets and
Within experiment group, systolic blood pressure
finger puppets) during the procedure of
and heart rates of the parents holding the children
immunization. The control group received no
showed improvement after music therapy
intervention during the immunization procedure.
intervention; the difference not being statistically
The parents of the subjects were asked to fill
significant (Table 2). All three physiological
Modified Behaviour Pain Scale (MBPS) to measure
parameters failed to show significant improvement
pain levels in their children. Modified Behavior Pain
in comparison between experiment and control
Scale [1, 3] that we used in our study is commonly
groups (Table 3).
used with infants during office procedures such as immunizations. It evaluates 3 parameters â&#x20AC;&#x201C; facial
Table 1. Comparison of Modified Behaviour Pain
expression, cry and movements. Minimum and
Scale (MBPS), pain levels and distress levels
maximum possible scores are 0 and 10 respectively.
between experiment and control group
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Table 1. Comparison of Modified Behaviour Pain Scale (MBPS), pain levels and distress levels between experiment and control group
Facial Expression Cry
Movements
Pain level
Distress level
Group
Mean Rank
Sum of Ranks
Experiment
37.98
1899
Control
63.02
3151
Experiment
39.52
1976
Control
61.48
3074
Experiment
38.28
1914
Control
62.72
3136
Experiment
46.79
2339.5
Control
54.21
2710.5
Experiment
46.57
2235.5
Control
52.31
2615.5
Mann Whitney U
p-value
624
0.0000
701
0.0001
639
0.0000
1064.5
0.1960
1059.5
0.3154
Table 2. Comparison of pre- and post- blood pressures and heart rates of parents holding the children in both experiment and control groups Pre-test means Post-test means with SD (mm Hg) with SD (mm Hg)
t-TEST
p - value
Experiment Group Systolic BP
119.25 ± 16.31
117.82 ± 15.59
0.6802
0.4996
Diastolic BP
75.38 ± 9.74
79.8 ± 19.68
1.5823
0.1200
Heart Rate
93.36 ± 15.78
91.17 ± 14.08
1.1594
0.2519
Systolic BP
118.14 ± 12.6
118.94 ± 10.86
0.5856
0.5608
Diastolic BP
74.58 ± 10.33
74.28 ± 15
0.1521
0.8797
Heart Rate
92.48 ± 12.74
90.84 ± 13.54
1.1157
0.2700
Control Group
Table 3. Comparison of blood pressure and heart rate of parents holding the children between experiment and control groups Pre - test
Post - test
Experiment vs Control Groups
t-TEST
P-VALUE
t-TEST
P-VALUE
Systolic BP
0.3778
0.7064
0.4168
0.6777
Diastolic BP
0.3915
0.6962
1.5629
0.1213
Heart Rate
0.3023
0.7631
0.1171
0.9070
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interventions during immunizations. We measured
Discussion :
blood pressure and heart rate of parents holding
Immunization is the one of the most common
children as a proxy measure for parental anxiety.
recurring painful health-related procedures in clinical practice, as most of the vaccines are
Our study showed significant improvement in all
available in injectable forms only with exclusion of a
three parameters of Modified Behaviour Pain Scale
few oral/nasal vaccines. Various measures to
(MBPS); i.e., facial expression, cry and movements
reduce pain during immunization have been
and also in duration of crying spells.
explored,
during
distress levels as measured by parents shown
topical
improvement but was not statistically significant.
anaesthetics, oral analgesics, oral sucrose
Our study did not show improvement in
solutions, positioning, tactile stimulation, skin-
physiological parameters recorded for the parent
cooling techniques, use of microneedles, skin-to-
holding the child during the immunization injection
skin care, psychological interventions, distraction,
procedure.
including breastfeeding
immunization
procedure, use
of
music therapy, etc [4, 5, 6, 7, 8, 9, 10]. Music
Pain and
Limitation of our study was the fact that parents
therapy offers a safe and harmless intervention for
were used as proxy to measure pain and distress
reducing pain in children.
levels of children. However, a recent study has
Yinger [2] reported that children who received
shown that parents' proxy pain scores can be
music therapy were better able to cope with their
reliably used as a surrogate measure for
immunization and showed less distress. Parents
measurement of pain in children [14].
displayed fewer distress - promoting behaviours
Conclusion :
and nurses used a great proportion of coping promoting behaviours during music therapy
Live music therapy reduces duration of crying
treatment. Malone [11] reported the use of live
spells, improves pain perception and reduces
music therapy to reduce behavioural distress in
distress levels in children undergoing painful
children who were administered needle insertions
immunization procedures. Blood pressure and
to be beneficial. Noguchi [12] used recorded music
heart rate of the parent holding the child during the
as procedural support for children receiving
immunization procedure are not significantly
immunization. Parent and nurse behaviours have
affected. For routine and essential painful
been noted to influence child behaviours during
procedures such as immunization in children, music
medical procedures [13].
therapy could be very helpful to children, parents and health care providers by reducing discomfort of
So far, the investigator did not come across any
the child.
study which examined the effect of music therapy interventions with the use of visual aids impacting the behaviours of the infants, parents and the health care professional administering the immunisation and the physiological responses of the
parents
of the children
receiving
the
immunization. Hence, this study was undertaken to record the behavioural to music therapy 6 2
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References 1.
Taddio A, Appleton M, Bortolussi R, Chambers C, Dubey V, Halperin C, et al. Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline. CMAJ 2010; 182 (18): E843-55. doi: 10.1503/cmaj.101720.
2.
Yinger, OS. (2013). Music therapy as procedural support for young children undergoing immunizations: A randomized controlled study. Music Therapy Perspectives. volume 31.
3.
Taddio A, Nulman I, Koren BS, Stevens B, Koren G. A revised measure of acute pain in infants. J Pain Symptom Manage. 1995 Aug; 10(6): 456-63.
4.
Shah V, Taddio A, Rieder MJ; HELPinKIDS Team. Effectiveness and tolerability of of pharmacologic and combined interventions for reducing injection pain during routine childhood immunizations: systemic review and meta-analyses. Clin Ther 2009; 31(Suppl 2): S104-47.
5.
McCall JM, DeCristofaro C, Elliott L. Oral sucrose for pain control for nonneonate infants during minor painful procedures. J Am Assoc Nurse Pract. 2013 May; 25(5): 244-52. doi: 10.1111/j.17457599.2012.00783.x. Epub 2012 Sep 24.
6.
Kim YC, Park JH, Prausnitz MR. Microneedles for drug and vaccine delivery. Adv Drug Deliv Rev. 2012 Nov; 64(14): 1547-68. doi: 10.1016/j.addr.2012.04.005. Epub 2012 May 1.
7.
Johnston C, Campbell-Yeo M, Fernandes A, Inglis D, Streiner D, Zee R. Skin-to-skin care for procedural pain in neonates. Cochrane Database Syst Rev. 2014 Jan 23; 1: CD008435. doi: 10.1002/14651858.CD008435.pub2.
8.
Uman LS, Birnie KA, Noel M, Parker JA, Chambers CT, McGrath PJ, Kisely SR. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev. 2013 Oct 10; 10: CD005179. doi: 10.1002/14651858.CD005179.pub3.
9.
DeMore M, Cohen LL. Distraction for pediatric immunization pain: a critical review. Journal of Clinical Psychology in Medical Settings. 2005 Dec; 12(4): 281-91.
10. Taddio A,
Chambers CT, Halperin SA et al. Inadequate pain management during childhood
immunizations. evidence based review and recommendations. Paediatrics 2007; 119: e1184-98 11. Malone, A.B.(1996) The effects of live music on the distress of pediatric patients receiving intravenous starts, venepunctures, injections and heel sticks. Journal of Music Therapy, 33, 19-33. 12. Noguchi, KL.The Effect of Music versus Non music on Behavioural signs of distress and self-report of Pain in pediatric injection patients. Journal of Music Therapy (2006) 43 (1):16-38. 13. Blount, RL. Zempsky, WT., Jaaniste, T., Evans,S.,Cohen, LL., Devine, KA. & Zeltzer, LK (2009) Management of pediatric pain and anxiety due to medical procedures. In M.C. Roberts & R.G. Steele (Eds.) Handbook of pediatric psychology (14th ed.,pp-171-88. Newyork. The Guildford Press. 14. Khin Hla T, Hegarty M, Russell P, Drak-Brockman TF, Ramgolam A, von Ungern-Sternberg BS. Perception of pediatric pain: a comparison of postoperative pain assessments between child, parent, nurse, and independent observer. Paediatr Anaesth. Nov 2014; 24(11): 1127-31. doi: 10.1111/pan.12484.Epub 2014 Jul 30. 2 7
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Sep 2015
CENTER FOR MUSIC THERAPY EDUCATION AND RESEARCH announces International Clinical Music Therapy Observership Program An International clinical music therapy observership program has been established from CMTER to provide an opportunity to music therapists from around the world to learn about the three tiered music therapy program integrating professional training, patient care services and research and/orthe hospital based music therapy culture in India. This program also helps an overseas music therapist to observe and interact closely with the practising clinical music therapists from Center for Music Therapy Education and Research and participate in the day to day clinical and educational activities of the Center without directly involving in patient care services. Eligibility : Any international and professionally trained music therapist /an internship trainee from a university based music therapy program who can make his/her own arrangements for visa, accommodation and hospitality during the period of stay during the observership program. Fees : Non-refundable fee of 250 US dollars per month. Period of Observership: Generally from one to two months and also applications processed on a case to case basis if more time is needed
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Sep 2015
CMTER RESEARCH CLUSTERS The research clusters were formed from CMTER in collaboration with CIDRF which operate to encourage faculty and students to work collaboratively and engage in high quality music therapy research
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CMTER RESEARCH CLUSTERS 1.
Traditional Music Healing Practices Aim : To objectify and create evidence for traditional healing practices to be integrated in clinical practice
2.
Interdisciplinary Collaborations and Patient Outcomes Aim : To encourage and strengthen evidence by interdisciplinary collaborations to improve Quality of Life and Patient outcomes
3.
Community Health and Well-being Aim : To create awareness and serve families and communities with music as a cultural resource and defence for health
4.
Mind Body Medicine Aim :
To foster high quality music therapy research on influence of music on autonomic nervous System, psychoneuroimmunology and psychoneuroendocrinology.
5.
Education and Professional Training Aim : To help students and faculty to learn and practice music therapy skills and to prepare them for teaching and research opportunities and make them global players.
Taking Forward Music Therapy : Shaping The Future
Stay Tuned to
The Best Practicing Models of Music Therapy Around The World Reliable Resource for Evidence-based Practice Await CMTER'S announcement on
BEST PRACTICE DAY IN MUSIC THERAPY 2016
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Taking Forward Music Therapy : Shaping The Future
CENTER FOR MUSIC THERAPY EDUCATION AND RESEARCH
Editorial Board
Patrons Shri. M.K. Rajagopalan, Chairman Prof. Dr. Rajaram Pagadala, Chancellor Editor-in-Chief : Dr. Sumathy Sundar Advisory Board
Executive Editors
Prof. Dr. K.R. Sethuraman
Prof. Dr. A.R. Srinivasan
Prof. Dr. N. Ananthakrishnan
Prof. Dr. B. Sivaprakash
Prof. Dr. S. Krishnan
Members
Ms. A.N. Uma
Dr. S. Srirangaraj Dr. V.R. Hemanth Kumar Dr. Sobana Jaiganesh Mrs. Asha Suresh Babu Ms. Vijay Chitra