Harmony news letter sep 2015

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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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.

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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