Taking Forward Music Therapy : Shaping The Future
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Issue : 4
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December 2015
the HARMoNY Volume : IV
Issue : 4
Dec 2015
EDITOR’S DESK Hello Readers, Here is what we have in store for this quarter's bulletin. The theme of the current year's cover pages of “The Harmony” is Ragamala Paintings. Ragamala paintings of medieval Indian period depict expression of different ragas through imagery. They are visual representations of different musical modes capable of evoking pleasant feelings, mood or emotions on the performer and the listener of the raga. Guided and unguided Imagery techniques of music therapy are popular in the western countries and are used in medical settings to relax the patients and alleviate their anxiety and depressive symptoms. More studies are needed to test the efficacy of using Ragamala visual illustrations as tools in guided imagery techniques in Indian context. In this issue, as usual, there is a featured article on the topic “Effect of relaxing music on blood pressure and heart rate in hospitalized pre-hypertensive women in 3rd trimester of pregnancy: A randomized control study.” There is also an article on application of SOLO Taxonomy in evaluating the students' learning outcome. There is also a flash news on the Master's degree program in Medical Music Therapy being launched by CMTER in a pioneering effort. This is already a productive year for CMTER with many significant advances made and please have a look at this bulletin and do not hesitate to email to musictherapy@mgmcri.ac.in to know more about us especially about the exciting program “ DRUMMING FOR WELLNESS” planned for all faculty and students of SBV. Happy reading.
Inside this issue Editorial Featured article Solo Taxonomy in Music Therapy Flash News
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EFFECT OF RELAXING MUSIC ON BLOOD PRESSURE AND HEART RATE IN HOSPITALIZED PRE-HYPERTENSIVE WOMEN IN 3RD TRIMESTER OF PREGNANCY: A RANDOMIZED CONTROL STUDY SUMATHY SUNDAR, BHUVANESWARI RAMESH AND ANANDARAJ R blood pressure between 80 to 89 mm Hg; based
Abstract :
upon the average of two or more properly
Objective : To observe effect of relaxing music on
measured readings at each of two or more visits
systolic blood pressure, diastolic blood pressure
after an initial screen [1]. Prehypertension is more
and heart rates in hospitalized pre-hypertensive
prevalent than hypertension. Prevalence of
pregnant women in 3rd trimester of pregnancy
prehypertension in Indian adults is estimated to be between 40 to 60% [2, 3].
Methods : 60 hospitalized pre-hypertensive pregnant women in 3rd trimester of pregnancy
Pathophysiologically, prehypertensive adults share
were included in the study. They were divided in to
many risk factors with hypertensive patients.
experiment (n=30) and control (n=30) groups by
Prehypertensive adults are also significantly more
randomization. Experiment group received 3 15-
likely to develop hypertension as compared to
minute-sessions of receptive music therapy in form
normotensive adults; with higher rates of target
of non-rhythmic instrumental music. Control group
organ damage and cardiovascular complications.
did not receive music therapy intervention. Blood
Hence prehypertension is considered an
pressure and heart rates were measured before
intermediate step during progression from “normal
and after each session.
blood pressure” to “hypertension” by many
Results : Experiment group showed significant
authorities. Management of prehypertensive is
reduction in systolic blood pressure, diastolic blood
usually life style modifications, including sodium-
pressure and heart rate after each session of
restricted diet, DASH (Dietary Approaches to Stop
receptive music therapy. In comparison between
Hypertension) diet, weight reduction, physical
two groups, systolic blood pressure showed
activity, alcohol moderation, tobacco abstinance,
significant reduction. No subject experienced any
stress reduction, etc.
adverse effect.
Music therapy is known to be effective for
Conclusion : Listening to relaxing music can
hypertensive and prehypertensive adults [4,5].
reduce blood pressure and heart rates in
Music therapy is also known to be beneficial to
hospitalized pre-hypertensive pregnant women
pregnant women during pregnancy as well as
during 3rd trimester. The blood pressure lowering
during labor [6]. However, little is known about
effect of relaxing music listening is more significant
effects of music therapy on cardiovascular vitals
for systolic blood pressure. Receptive music
(blood pressure and pulse rates) in prehypertensive
therapy seems to be safe in pregnant women.
pregnant women. We decided to study effects of receptive music therapy on blood pressure and
Introduction :
pulse rate in hospitalized prehypertensive women in 3rd trimester of pregnancy.
Prehypertension is defined as systolic blood pressure between 120 to 129 mm Hg or diastolic
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Methods :
Results :
The study was conducted in antenatal ward of
Out of total 60 subjects, 5 from experiment group
Mahatma Gandhi Medical College & Research
and 3 from control group had withdrawn
Institute (MGMCRI), Pondicherry, India. The study
themselves from the study. Hence 25 subjects in
design was that of a randomized controlled trial
experiment group and 27 subjects from control
without blinding. 60 hospitalized women in 3rd
groups were included for analysis.
trimester of pregnancy with prehypertension were
Means, standard errors and confidence intervals of
included in the study. They were divided into
pre-session and post-session systolic blood
experiment and control group; each consisting of
pressures, diastolic blood pressures and heart rates
30 subjects. Randomization was done by using
of subjects in experiment groups are shown in Table
sequential method; so that subjects with alternate
1. Analysis of pre-session and post-session
registration numbers formed each group. Women
observations in experiment group indicates
with history of hypertension before or during
significant improvement in all three parameters (F=
pregnancy, taking antihypertensive medications or
47.894; P<0.00; = 0.750); systolic blood pressure
any other medications affecting blood pressure,
(mean sq = 1984.602; F = 85.26; p<0.01; =
having other medical conditions or pregnancy
0.630), diastolic blood pressure (mean sq = 812.500;
related complications, with hearing problems were
F = 24.086; p<0.01; = 0.325), and heart rate (mean
excluded. Informed written consent was obtained
sq = 679.892; F = 53.451; p<0.01; = 0. 515).
from all the subjects and the study was approved by institutional ethical committee of the MGMCRI.
Means and standard deviations of pre-session and post-session observations for each of the three
The experimental group received 3 sessions of
sessions for both groups are shown in Table 2.
receptive music therapy with relaxing music; the 1st session at 8:30 am on the 1st day of music
As may be noted in the graph and descriptive data,
therapy, the 2nd session at 3:00 pm on the same
post treatment measures of Systolic and Diastolic
day and the last (3rd) session at 8:30 am on the
pressure are lower than pre-treatment measures
next day. Duration of each session was 15 minutes.
for both the experiment group as well as control
The relaxing music that we used for our study
group. However, Systolic measure is much lower in
consisted of 4 sound tracks of instrumental music
the post-treatment for experiment group compared
played over piano, guitar and flute. The music was
to the control group where no music treatment was
without lyrics and non-rhythmic. Blood pressure
given. This is further analyzed in the sections
and heart rates were measured both before and
below. While Systolic pressure in the Pre-treatment
after each session and recorded by the investigator.
condition seems to be marginally lower for the
The control group did not receive music therapy.
control group, the reduction of systolic pressure in
Their pre-session blood pressure and heart rate
the post-treatment condition is steeper in the
were measured at 8:30 am on the 1st day , 4:00 pm
experiment group. Diastolic pressure on the other
on the same day and and at 8:30 am on the next
hand is higher for the control group both pre-
day. They were asked to lie down quietly for 15
treatment as well as post-treatment. The reduction
minutes and then their post-session blood pressure
in diastolic pressure seems higher in the 1st music
and heart rates were measured.
session than in the others.
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The interaction effect of pre-session and post-
such as stress-induced increased blood pressure in
session observations with the between subject
health adults, intraoperative patients, post-
factor of the two study groups is also significant
operative patients, etc [8,9,10].
(F=3.512; P= 0.022 with an effect size =0.180).
The main mechanism for blood pressure lowering
This indicates that the pre-treatment and post-
effect of music has been postulated to be stress-
treatment measure differences also vary across the
reducing effect of music [11]. However, the
experimental and control groups. In this condition
physiology of chronic stress-response is very
only systolic measure was significant (mean sq =
complex; involving multiple interactions between
239.768; F = 10.301; p<0.002; = 0.171);
psychology, neurology and hormonal system.
The main effects of the within subjects factor -
Hence blood pressure lowering effect of music
music sessions - was also significant indicating that
seems to be multifactorial.
there was variation on measures across the three
Our study shows that listening to relaxing music
sessions (F= 2.464; p=0.038; = 0.247). The main
can reduce blood pressure and heart rate in
effects was again significant only for the systolic
prehypertensive pregnant women during 3rd
pressure (mean sq = 395.946; F = 9.24; p<0.01; =
trimester of pregnancy. Most of the studies in male
0.156).
and female adults have shown that blood pressure
Estimated marginal means of systolic blood
lowering effect of music listening is more on systolic
pressure, diastolic blood pressure and heart rate in
blood pressure as compared to diastolic blood
both experiment group and control groups are
pressure. Our study in pregnant women also has
shown in Figure 1. Reduction in all three
reflected similar findings. This could be due to the
parameters was seen in experiment group as
fact that systolic blood pressure is more affected by
compared to control group, however, significant
stress response and sympathetic nervous system
reduction was seen in systolic blood pressure only.
arousal, while factors affecting diastolic blood pressure are multiple.
None of the subjects reported any adverse effect
Limitations of our study were inclusion of only
during the study.
hospitalized pregnant women during 3rd trimester,
Discussion :
use of digital sphygmomanometer, and non-
Receptive music therapy is becoming more popular
blinding. The study also did not record long term
as a non-pharmacological management of
effect of music therapy on blood pressure and heart
hypertension. Various studies have shown that
rates.
listening to music reduces blood pressure. Some
Conclusion :
studies have shown that particular type of music (e.g., Mozart's classical music) is more effective for
Listening to relaxing music can reduce blood
reducing blood pressure, while some types of music
pressure and heart rates in hospitalized pre-
(e.g., rock music) can elevate blood pressure [7].
hypertensive pregnant women during 3rd
The same study by Crippa G, et al. [7], has also
trimester. The blood pressure lowering effect of
shown that listening to classical music reduces
relaxing music listening is more significant for
heart rate significantly. Listening to music has also
systolic blood pressure. Receptive music therapy
shown to reduce blood pressure in various settings
seems to be safe in pregnant women. 5
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Table 1 : Pre Post Treatment Measure
Systolic
Diastolic
Heart Rate
Pre Post Treatment
95% Confidence Interval Mean
Std. Error
Lower Bound
Upper Bound
Pre - Treatment
123.895
.762
122.364
125.425
Post - Treatment
118.847
.743
117.355
120.339
Pre - Treatment
86.564
2.307
81.930
91.198
Post - Treatment
83.334
2.345
78.624
88.043
Pre - Treatment
93.090
.793
91.496
94.683
Post - Treatment
90.135
.856
88.415
91.855
Table 2 : Mean Values of Systolic And Diastolic Pressure Across Treatment Conditions and Study Groups Systolic Pressure
S1Presys
S1Postsys
S2Presys
S2Postsys
S3Presys
S3Postsys
Diastolic Pressure
Study Group
Mean
Std. Deviation
N
Study Group
Mean
Std. Deviation
N
Experiment
127.52
5.53569
27
Experiment
85.0741
14.80365
27
Control
124.68
4.46953
25
Control
88.0000
21.36976
25
Total
126.1538
5.20326
52
Total
86.4808
18.13294
52
Experiment
118.1111
7.69282
27
Experiment
79.8519
15.31139
27
Control
121.5200
6.90483
25
Control
86.4400
22.82557
25
Total
119.7500
7.45411
52
Total
83.0192
19.38414
52
Experiment
124.4074
8.26140
27
Experiment
84.7778
12.21391
27
Control
123.4000
7.61577
25
Control
90.5200
20.21575
25
Total
123.9231
7.89601
52
Total
87.5385
16.63620
52
Experiment
119.3704
6.69183
27
Experiment
82.7037
14.02145
27
Control
120.6800
6.28305
25
Control
85.9600
20.29261
25
Total
120.0000
6.46863
52
Total
84.2692
17.22528
52
Experiment
121.4815
6.44724
27
Experiment
84.3704
13.53954
27
Control
121.8800
7.25328
25
Control
86.6400
20.42645
25
Total
121.6731
6.78152
52
Total
85.4615
17.06213
52
Experiment
115.5185
7.32945
27
Experiment
81.4074
13.22951
27
Control
117.8800
7.80128
25
Control
83.6400
20.64558
25
Total
116.6538
7.57934
52
Total
82.4808
17.06101
52
S1Presys
S1Postsys
S2Presys
S2Postsys
S3Presys
S3Postsys
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fig 1: Combined marginal mean for Pre and post treatment systolic and diastolic measures in the two study groups
We can see from the figure that Systolic for the experiment group falls more steeply than for the control group. This indicates an interaction effect between the study-groups and treatment levels. This means that there is a significant effect of the treatment on the measures in the two groups.
We can see from the figure that the experimental group is lower in the pretreatment and post-treatment diastolic. measures
The mean values of the heart rate for the experimental group is also lower than that of the control group. The heart rate indicates a reduction in the post-treatment measurement in both groups
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Application of SOLO (Structure of the Observed Learning Outcome) Taxonomy in Music Therapy Sumathy Sundar, Parin Parmar, Sethuraman KR Although “true understanding” is always expected
Abstract
from students in any subject, this becomes of
Written examinations and verbal viva-voces are
paramount importance in music therapy education;
time tested methods used by educators to evaluate
because
whether the learning outcome objectives are met
of
its
multidisciplinary
and
multidimensional nature. In academic exams,
adequately. It is important that the educators use
evaluation of memorizable facts is usually easier as
structured and objective methods to evaluate
compared
learning outcomes. Use of unstructured methods in
to
evaluation
of
knowledge,
understanding and skills.
examinations may result in biased evaluations which do not reveal the exact learning outcome and
Sethuraman KR1 observed that a hierarchical
also can de-motivate the students who may end up
Structure of Observed Learning Outcome – SOLO –
getting frustrated. Learning music therapy is
Taxonomy described by Biggs and Collis in 19822
complex to the students as the training exposes
helps an educator to be more critical and accurate
them to many interdisciplinary concepts which they
in assessment of learning outcome of the students
have to integrate to understand the applications.
in cognitive domain in medical education and
This article attempts to discuss application of SOLO
described the five levels of SOLO with worked out
taxonomy as an evaluating method in music
sample answers to make the abstract concrete for
therapy education. SOLO taxonomy seems to have
medical education. This article attempts to describe
a very good potential to evaluate the extent to
similarly through worked out sample answers in
which the students have understood the concepts
music therapy that could be categorised into five
and also their ability to transfer their knowledge
levels of SOLO to the question "Explain what kind of
into applications.
musical experiences can you plan to relax a patient/client?".
Introduction
The answers could be categorised into five levels of
Music therapy is a unique combination of art and
SOLO as follows:
science; a discipline that touches multiple
Level 1: Pre-structural
disciplines – music, psychology, clinical medicine, anthropology, acoustics of sound, neurology of
The answers are simple, tautological, transductive
music, ... – the list can be still extended. The
and bound to specifics. In simple terms, the
students who enrol into professional courses in
question is merely reworded to resemble an
music therapy are also from different academic
intelligent answer!
backgrounds. Hence a neutral yet comprehensive evaluation of music therapy students could be one
Since music is known to have relaxing properties,
of the most desirable aspects of music therapy
musical experiences using relaxing music can be
education.
planned as researches have proved that these experiences relaxes the patient/client.
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suitably prepared and the patient also should be
Level 2 : Uni-structural
instructed to adopt a relaxed and comfortable body
The answers contain "generalisations" in terms of
posture. Based on research so far, minimum
just one aspect.
duration of receptive music therapy to achieve
All instrumental musical pieces especially with slow
optimum relaxation in the patient/client is 10 to 20
tempo, soft timbre, predictable rhythm and with
minutes daily for 4 weeks.
ragas with long frequency notes can be used for
Level 5: Extended Abstract
relaxing a patient as these properties have been studied and known for their relaxation properties.
These answers are characterised by deduction and
Musical pieces having these properties or
induction.
composing music by controlling these elements of
generalisations beyond what is strictly required by
music like timbre, tempo, melody and rhythm to the
the question.
desired effect could be planned and administered to
The answers cover situations and
There is no one particular music that can always
relax a patient/client.
cause relaxation to all at all times and so it is important to make an assessment of the musical
Level 3: Multi-structural
profile of the client which includes assessing
The answers reveal generalisations in terms of a
musical training aspects, musicality levels, family
few limited and independent aspects.
traditions, musical preferences and listening
Instrumental musical pieces especially with slow
pattern before choosing the music with the
tempo, soft timbre, ragas with long frequency notes
properties of relaxation.
and predictable rhythm can be used for relaxing a
A relaxing music stimulus can act as an external
patient. Music therapy should be delivered in
pacemaker that entrains the biological rhythms of
peaceful environment. The patient/client should be
the human body. Hence instrumental musical
made to listen to the music for 10 to 20 minutes
pieces, especially with slow tempo, soft timbre,
daily for 4 weeks.
ragas with long frequency notes and predictable rhythm can be used for relaxing a patient. The
Level 4 : Relational
environment also can affect the mental status of
The answers are characterised by induction and
the patient, hence music therapy should be
generalisations within a given context using related
delivered in a peaceful atmosphere.
aspects.
The
environment must be suitably prepared and the
A relaxing music stimulus acts as an external
patient should also be instructed to adopt a relaxed
pacemaker that entrains the biological rhythms of
and comfortable body posture. Based on research
the human body. Hence instrumental musical
so far, minimum duration of receptive music
pieces, especially with slow tempo, soft timbre,
therapy to achieve optimum relaxation in the
ragas with long frequency notes and predictable
patient is 10 to 20 minutes daily for 4 weeks.
rhythm can be used for relaxing a patient. The
However, the music should be selected according to
environment do affect the mental status of the
patient's preference because music with all
patient, hence music therapy should be delivered in
desirable relaxing qualities could be ineffective if it
a peaceful atmosphere. The environment must be
is inappropriate to the patient's cultural or social 9
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deep or strategic learning outcome.
background, musical profile or traditions. Also, a thorough evaluation of the patient from
The extended abstract uses inductive and
psychological point-of-view should be done before
deductive logic in the answer. Deduction is to
planning music therapy. Ensuring suggestion for
mention the facts and deduce the principle behind
appropriate medical care is also important as the
those. The sample answer clearly goes beyond the
patient's/client's condition requires.
simple question “what kind of musical experiences can you plan for relaxing a patient”. The answer
Discussion
deserves 80 to 100% of total marks. Such answers
Pre-structural level answers are simple and indicate superficial learning or memorised facts.
Dec 2015
indicate a deep understanding and a higher
The
conceptualization of the topic by the student, and
sample answer says that as music has relaxing
uses link words like 'notwithstanding', 'moreover'
properties, music therapy can be planned for
and 'however'.
relaxation. This is a simple tautological answer which deserves 0 to 20 % of total marks. Such
Usually, pre-structural, uni-structural and multi-
answers indicate that the student has not really
structural answers can be assessed quantitatively;
understood the topic.
relational and extended abstract answers require qualitative assessment.
Uni-structural answers discuss one aspect of the question and reveal some understanding of an
Evaluation by SOLO Taxonomy could lose its
aspect of the topic. The sample answer shows that
effectiveness if “higher level” answers are already
the student has understanding of one aspect –
“given” by the educator during classes. Some
“qualities of music” – and has not discussed other
“factual” questions are inappropriate for evaluation
aspects for relaxation. The answer deserves 20 to
by SOLO taxonomy like – “Give names of scientists
40 % of total marks.
who developed technique of guided imagery”, etc. The answers to such questions are usually at pre-
Multi-structural answers reveal understanding of
structural level.
more than one aspects of the topic but they are
Conclusion
described independently. In the sample answer, more than one aspects are touched upon – quality
It is apparent that SOLO taxonomy is of great use in
of music, surroundings, and duration – but in an
classifying the learning outcome in the cognitive
unconnected manner. The answer deserves 40 to
domain for use by music therapy educators too.
60 % of total marks. Such answers indicate piece-
The 5 levels of SOLO lends itself well to a 5-point
meal learning of superficial or strategic type.
graded assessment as recommended by
Relational answers are logical but only use the
educationists. Since music therapy training
inductive type of logic, i.e., from the main
program is introduced from the health sciences
principles, the related points are derived in the
university and the evaluation methods also are
answer. In the sample answer, more than one
similar to those in health care education; SOLO
aspects are described in a more connected and
assessment can be utilised by all of us for accurate
logical manner, using link words like 'hence',
and a more objective assessment of individual
'therefore', and 'because'. The answer deserves 60
answers, especially for descriptive and viva
to 80 % of total marks. Such answers indicate a
answers in music therapy education. 10
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References 1.
Prakash ES, Narayan KA, Sethuraman KR. Student perceptions regarding the usefulness of explicit discussion of â&#x20AC;&#x153;Structure of the Observed Learning Outcomeâ&#x20AC;? taxonomy. Advances in Physiology Education Published 1 September 2010 Vol. 34 no. 3, 145-149 DOI: 10.1152/advan.00026.2010 (accessed on 21-09-2015).
2.
Biggs JB and Collis KF. Evaluating the Quality of Learning. New York & Sydney: Academic Press, 1982.
3.
Marton F, Housnell D and Entwhistle N. The Experience of Learning. Edinburgh: Scottish Academic Press, 1984.
Taking Forward Music Therapy : Shaping The Future
CENTER FOR MUSIC THERAPY EDUCATION AND RESEARCH offers The First Post Graduate Degree In Music Therapy In The Country Degree : M.Sc. in Medical Music Therapy Time frame : 2 years Nature of the course : Part-time /weekly 5 days/ 4 hours a day from Mondays through Fridays Delivery : Mahatma Gandhi Medical College and Research Institute Campus Eligibility Criteria : Any Bachelors degree preferably in science or any health care/ allied health care profession with demonstrable strong skills in music. Lateral entry permitted for 2nd year of the Masters degree on completion of 1 year equivalent PGDMT program from CMTER/elsewhere. Student Learning Outcome : Students become skilled music therapists and this is the primary learning outcome. Students are trained in advanced-level of clinical practice by honing their clinical and music therapy skills integrating current research in the field Enhance their personality in physical, psychological and spiritual dimensions. Become reflective, and become sensitive to the aesthetic and therapeutic qualities of music. In addition, they develop a commitment to the subject of music and its therapeutic use. To develop professionalism in the areas of Music Therapy Standard of Practice and professional competencies and code of ethics. Choose and research two specialized clinical areas To become informed about music therapy research and ethics Integrate and engage in quantitative and qualitative research in their clinical music therapy work For more details contact at : musictherapy@mgmcri.ac.in 11
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
Ms. A.N. Uma
Members Dr. S. Srirangaraj
Dr. V.R. Hemanth Kumar Dr. Sobana Jaiganesh Mrs. Asha Suresh Babu Ms. Vijay Chitra
12