comparison of different methods for eliciting exercise-to-music for clients with alzheimer's...

Journal of Music Therapy, XL(1), 2003, 41-56 © 2003 by the American Music Therapy Association

Comparison of Different Methods for Eliciting Exercise-to-Music for Clients with Alzheimer's Disease

Andrea M. Cevasco, MMEd, MT-BC

Roy E. Grant, PhD, RMT

The University of Georgia

Many of the noted problems associated with Alzheimer's disease (AD) sometimes can be delayed, retarded, or even reversed with proper exercise and interaction with the environment. An overwhelming body of research efforts has revealed that music activity brings about the greatest degree of responsiveness, including exercise, in clients with AD;yet, specific techniques which elicit the greatest amount of physical responses during the music activities remain unidentified. The purpose of this study was two-fold: comparing two methods of intervention and comparing responses to vocal versus instrumental music during exercise and exercise with instruments. In Experiment 1 the authors compared 2 treatment conditions to facilitate exercise during music activities: (a) verbalizing the movement for each task once, one beat before commencing, followed by visual cueing for the remainder of the task; (b) verbal and visual cueing for each revolution or change in rhythm for the duration of the task. Data collection over 38 sessions consisted of recording theparticipation of each client at 30-second intervals for the duration of each treatment condition, indicating at each interval whether the client was participating in the designated movement (difficult), participating in exercise approximating the designated movement (easy), or not participating. Results indicated that the continuous verbal cueing/easy treatment elicited significantly greater participation than one verbal cue/difficult treatment, p < .05. Furthermore, the approximation/precise response (easy) resulted in significantly greater responses than the precise response (difficult), p < .001.

The authors thank Cori Pelletier, who was a senior music therapy major at The University of Georgia during the time of this study, for her attendance, participation, and data collection during the entire .length of Experiment 2.

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42 Journal of Music Therapy

In Experiment 2 the responses to types of music, vocal versus instrumental, during types of activities, exercise with and without instruments, were examined. Data were collected over 26 sessions, 52 activities, in the same 2 assisted living facilities as those in Experiment 1, but one year later. Results indicated that both the type of activity and the type of music had some effect on participation. Also, data indicated participation in exercise to instrumental music was significantly greater than exercise with instruments to vocal music, p < .05.

Alzheimer's Disease (AD) is the most common dementia disorder, affecting the brain and its cognitive functioning, including impaired memory. It is a degenerative disease for which there is no known cause or cure at this time, with a slow onset and a continuous decline in cognitive abilities. Also, personality changes, physiological decline, and a loss in social and occupational functioning occur throughout the course of the disease (Atlanta Area Chapter Alzheimer's Association [AACAA], 1996; American Psychiatric Association: Diagnostic and statistical manual of mental disorders FV-TR [DSM IV-TR], 2000). Currently as many as four million Americans are experiencing effects of AD, including approximately half of all nursing home patients (AACAA, 1996).

Common physiological problems of clients experiencing AD include apraxia, dizziness, exhaustion, swollen ankles, arthritis, osteoporosis, and a decline in endurance, mobility, balance, strength, range of motion, hearing, and vision (Hellen, 1998). Particular decline in psychomotor skills include those involving speed and perceptual integrative abilities (Botwinick, 1967; Hellen, 1998). Further areas of decline include blood flow, air intake, and oxygen uptake (Squyres, 1996). Cognitive factors include decline in memory, awareness, attention span, orientation to environment, ability to follow directions, judgement and the ability to recall how to begin familiar tasks (AACAA, 1996; Clair, 1996; DSM-IV-TR, 2000; Hellen, 1998). Amid varying degrees of confusion, clients with AD take longer to perceive and process stimuli, need longer to recall appropriate answers and responses, and need longer to initiate and execute responses. Speed and accuracy are affected further with rules, sequences, and coordination processes (Birren, 1959; Cowdry, 1958; DSM-IV-TR, 2000; Hellen, 1998). AD clients also experience problems in the affective domain including depression, abnormal fluctuation in mood, and even complaining, swearing,

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43 Vol. XL, No. 1, Spring 2003

and verbal and physical aggression, none of which may have been peculiar to the individuals previously (Anderson & Braun, 1995; Clair, 1996; DSM-IV-TR, 2000; Grant, lecture, August, 1999; Hellen, 1998). All of these problems contribute to decline in communication and/or social interaction skills; there are periodic episodes of confusion and loss of expressive communication skills.

Researchers have agreed that lack of interchange with the environment leads to further deterioration and that positive effects of programs involving active participation will be seen in physiological, cognitive, affective, and social areas (Anderson & Braun, 1995; Clair, 1996; Friedman & Tappen, 1991; Meddaugh, 1987; Namazi, Gwinnup, & Zadorozny, 1994). In fact, studies indicate that many of the noted problems sometimes can be delayed, retarded, or even reversed with proper exercise and interaction with the environment (DeVries, 1969; Grant, 1970; Hopkins, Murrah, Hoeger, & Rhodes, 1990; Morey et al., 1989).

Several researchers have indicated that AD clients who participated in exercise programs exhibited a reduction in agitated behaviors including complaining, verbal aggression, physical aggression, restlessness, and wandering, as well as improvements in communication abilities and mood (Friedman & Tappen, 1991; Hellen, 1998; Namazi et al., 1994; Squyres, 1996). Anderson and Braun (1995) concluded that over time, when AD clients participated in stretching exercises their range of motion increased, and they reached, turned, and moved in various directions with less pain. Also, they reported use of exercise as an alternative to restraints for AD residents, to provide a meaningful activity as an intervention, and to refocus behavior through use of familiar normalization activities and active exercise opportunities. They emphasized the importance of regularly scheduled structured routines.

Numerous researchers have reported that institutionalized geriatric patients and other older adults experiencing arthritis, hypertension, or heart disease who participated in an exercise program experienced increased activity level, decreased heart rate and resting heart rate, and decreased systolic blood pressure (Clark, Wade, Massey, & Van Dyke, 1975; Morey et al., 1989; Stamford, 1972). Other reports of physiological improvements include increased flexibility and strength, while psychological improvements included memory and cognitive test scores, higher scores on verbal fluency, and a decline in behavior ratings (Blumenthal et al., 1991; Molloy, Beerschoten, Borrie, Crilly, & Cape, 1988; Morey et al., 1989; Powell, 1974). Clarkson

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Smith and Hartley (1989) also found that older adults who exercised scored significantly greater on cognitive tasks involving reasoning, memory, and reaction time. Other reported results of regular exercise have included improvements in strength/endurance, body agility, flexibility, body fat, balance, cardiorespiratory endurance, increase in peak oxygen uptake, and improvements in high-density lipoprotein cholesterol levels, which might possibly reduce the risk of ischemic heart disease (Hopkins et al., 1990; Posner et al., 1992; Reaven, McPhillips, Barnett-Connor, & Criqui, 1990).

Blumenthal et al. (1991) discovered that older adults who participated in aerobic exercise training increased their functional capacity, reduced depression, and experienced improvements in mood. Reuben, Laliberte, Hiris, and Mor (1990) found that increasing and decreasing exercise levels in both directions were correlated with changes in mental health status. The participants' mental health scores increased as exercise levels were increased and dropped as exercise levels declined.

Guidelines for Exercise/Movement Activities with AD Clients

Different suggestions have been made as to the amount and intensity of exercise needed for AD clients, ranging from twice or more daily at the same time every day (Hellen, 1998) to three times daily (Squyres, 1996) including 5 to 15 minutes of stretching exercises emphasizing arms and shoulders, back and chest, stomach, thighs and calves, the hips, the knees, and ankles (Anderson & Braun, 1995; Squyres, 1996). Squyres (1996) advocated side bends, toe touches, sit-ups, leg lifts, and other exercises; clients who were capable of higher intensity exercise continued with 20 to 30 minutes of aerobic exercise.

Several clinicians have suggested consistency when facilitating mobility activities as well as providing verbal and visual cues and instructions, facilitating physical guidance, and breaking down tasks into simple steps (Chavin, 1991; Cordrey, 1994; Hellen, 1998; Smith, 1990). They also suggested demonstrating the exercises slowly and repeating each rotation until it is completed correctly or at the clients' optimal ability level.

Music as a Motivator for Participation in Exercise/Movement Activities

Even with the strong indications of the positive effects of proper exercise and interaction with the environment, it is quite clear that

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the collective impairments of AD make exercise difficult for many clients (Hellen, 1998). Types of interaction may be difficult. They may lack motivation and complain of physical pain (R. E. Grant, lecture, August, 1999; Simpson, 1986).

Several researchers have concluded that clients with AD instinctively respond to familiar music with hand clapping, finger tapping, toe tapping, and singing. They further conclude that popular music from early adult years elicits and facilitates emotional and physical responses (Gibbons, 1977; Grant, 1970; Olson, 1984; Wylie, 1990). Sacks (NAMT, 1996) stated that the power of music encompasses the entire brain, and if either side of the brain or even both sides of the brain might be impaired by stroke or by other impairments such as AD, the capacity for musical responses is still present. He further advised his colleagues to use music because of its power to bring ability where there has been disability, to unlock doors and bring freedom to those who have been locked in, and because music through its intrinsic joyfulness brings delight.

Kovach and Henschel (1996) found that music activities ranked at the top of numerous activities in terms of eliciting participation in group activities. Groene, Marble, and Kantar (1998) investigated the participation of AD clients with moderate to severe cognitive decline in sing-along and exercise-to-music sessions. A significantly greater response occurred during the exercise-to-music sessions. In a different study preference of five different music activities was determined by the amount of time residents with Alzheimer's disease actively participated (Brotons & Pickett-Cooper, 1994). Playing instruments resulted in the greatest amount, of participation while movement/dancing was second. Hanson, Gfeller, Woodworth, Swanson, and Garand (1996) found a greater proportion of high response occurred during high demand movement activities by participants with AD and other related disorders at all levels of cognitive functioning.

Bumanis and Yoder (1987) investigated the effects of a musicand-dance group versus traditional reality orientation group with clients exhibiting mild to severe confusion, disorientation, and memory loss. Clients exhibiting mild confusion, disorientation, and memory loss who participated within a music/dance group were more alert and enthusiastic and had a greater improvement in social adjustment and emotional well being than those in the traditional reality orientation group.

Meddaugh (1987) incorporated an exercise-to-music group for

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nine abusive patients who were dependent in activities of daily living, were considered confused by the nursing staff, arid displayed unacceptable behavior such as spitting, hitting, or scratching. Throughout the 9-week study the staff noted an increase in ability to participate in the exercises, a decrease in verbal swearing by one patient, an increase in talking and smiling, an increase in ability to follow directions, and an improvement in staff morale.

A survey of the literature did not reveal specific techniques identified for eliciting optimal participation of clients with AD during movement and exercise activities in music therapy sessions. Only one article was found in which researchers investigated effects of live vocal music versus instrumental music on physical rehabilitation exercises of elderly clients; the study included only six treatment sessions (Johnson, Otto, & Clair, 2001).

Some of the literature cited herein may seem outdated; however, we included some of the significant contributions by researchers over the past 4 decades to indicate trends. Some of the seemingly dated citations do not appear in recent research studies but are important in following the consistency of information related to AD and the characteristics and needs of these clients. Much of this literature is still pertinent for researchers today, in that only recently we as music therapists have begun to determine particular techniques in addressing specific needs that have been identified for decades.

The purpose of this study was two-fold. In Experiment 1, the authors compared two different methods of eliciting specified movements during music-and-movement activities; verbal cues presented only once, one beat before each new movement were compared with continuous verbal cueing simultaneously paired with each rotation of the movements. In Experiment 2, the effects of vocal music versus instrumental music on participation during exercise and exercise with instruments were examined.

Experiment 1 Method

Subjects. Subjects included 14 clients, 4 males and 10 females, in assisted living facilities who were diagnosed with early to middle stages of AD. Criterion for inclusion was limited to those clients who evinced ability to participate in imitative tasks and follow verbal directions. Many clients in the late stage of dementia were included in all groups, but were not included in the data analysis.

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Materials. Music chosen for Experiment 1 included vocal and instrumental music from 1900s-1950s. The musical selections were taken from the Time-Life Music: Your Hit Parade series (McCardell, 1988-1991), Best of Glenn Miller Recordings, American Legends: Louis Armstrong (Handy, 1914), and Hits of the Roaring Twenties (Pell, 1997).

Procedure. The treatment conditions were implemented during 38 sessions, weekly or twice weekly, over a period of 8 months. Two methods of conducting movement activities, each lasting an average of 3 minutes, were implemented in each 50-minute session, one near the beginning and the other near the end, the order randomly determined. The two movement activities were interspersed among other activities such as singing with guitar; reminiscing using the flute, which is the lead therapist's major instrument; rhythm activities to recorded and live music; and listening to live music.

The therapist employed two methods of conducting the two activities. In Method 1, the therapist gave a one- or two-word verbal direction one beat before initiating each new movement but continued demonstrating the movement. In Method 2, the therapist gave continuous verbal cues simultaneously with each rotation of the movement as well as demonstrating. Eleven selected movements remained constant over the course of the study, and four were incorporated into each movement activity on a rotating schedule (see Table 1). Variations included arms moving in parallel motion, one at a time, or in alternating motion or legs moving in parallel motion, one at a time, or in alternating motion. During all activities the clients were seated in a semicircle. Furthermore, the movements were presented in different sequences and in different rhythm combinations of the whole note, half note, and quarter note to recorded music from the 1920s through the 1950s. Each movement consisted of either four or eight rotations. Each musical selection was played until its completion as the composer intended; the therapist structured the movements throughout each piece of music to its end to facilitate any degree of closure as designated by the composer and provided by the performers—augmentation, ritardando, repetition, rubato, or other means.

Data collection consisted of recording the participation of each client for the duration of each exercise-to-music activity, indicating at each 30-second interval whether each client participated in the designated movement, participated in exercise approximating the

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TABLE i Movements Incorporated into Experiment 1

Arms/hands Push/pull (arms fully extended in front of body, pulled back to shoulders)

Up/down (hands at shoulders, fully extended above head, and pulled down to shoulders)

Down/up (hands at shoulders, extended down to knees, and back to shoulders)

Open/close (fingers extended, clinched tightly in fists) Palms up/down (wrists rotated 180 degrees)

Legs/feet Forward/back (legs fully extended in front of body, toe touching floor, and back)

Side/middle (legs extended outward to side, toe touching floor, and back)

Stomping (feet lifted in marching motion) Kicking (legs extended forward to 180-degree angle and back) Up/down (toes flexed upward and downward) Up/down (heels flexed upward and downward)

designated movement, or did not participate. Upper-level and graduate students enrolled in university music therapy classes served as data collectors. A total of 12 persons were trained and maintained in excess of 80% level of reliability.

Two students served as data collectors per each session. Each pair of data collectors had six trials over three training sessions before the data were tabulated. After the training sessions the lead therapist provided feedback and suggestions to the students. When the training period was completed, the data were maintained at or above 80% reliability level or the data were discarded and the criteria were reviewed with the pair of students.

Results

A treatments-by-treatments-by-subjects data analysis indicated no significant difference between the two treatment conditions, continuous cueing versus cueing at the beginning of each task, F(\, 13) = 2.62, p > .05. Participation, whether by approximation/precise response (easy) versus only the precise response (difficult) resulted in a significant difference, F(l, 13) = 21.708, p < .001. The interactive effect of treatment versus participation was insignificant, F(l, 13) = .0479, p > .05. A Scheffe post-hoc test revealed that the continuous cueing/easy treatment resulted in greater participation than the one cue/difficult treatment, F(3, 52) = 2.98, p < .05 (see Figure 1).

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Experiment I Participation Percentages

Method I, Difficult Method I, Easy Method II, Difficult Method II, Easy

FIGURE i. Participation percentages based on cueing methods and difficulty levels of response.

Discussion

Even continuous cueing did not produce the precise responses demonstrated by the therapist (difficult), but did result in communication between therapist and client to facilitate meaningful exercising with at least approximations (easy). These data may be affected by the short-term memory deficit of clients with AD, necessitating continuous reminders, but they also suggest that multi-sensory stimuli, auditory/visual, on a continuous basis resulted in optimal meaningful exercise by these clients with AD. Furthermore, these data indicate that by virtue of the continuous changes of sequences of movements and changes in rhythmic patterns these clients learned new material. Perhaps this multi-sensory approach merits further evaluation for learning new material, both musical behaviors and adaptive skills via music for clients with AD.

Experiment 2

Method

Participants. Subjects in Experiment 2 consisted of 12 participants, 1 male and 11 females diagnosed with early and middle stages of AD. Experiment 2 was conducted in the same two assisted

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living facilities, basically with the same clientele, although due to the typical turnover in facilities providing services for persons with AD, there were minor differences in the two groups. Some of the clients participated for the duration of both experiments, while some participated in parts of both and some participated only in Experiment 2, but only those who evinced the cognitive ability to imitate tasks and follow directions were included in the study. Many clients who were in the late stage of AD were included in the groups, but were not included in the data analysis. Also, as is typical in these types of facilities there was variation, and will be, on a daily basis in the makeup of groups. In the authors' opinions the turnover on a daily basis was an insignificant factor in the data analysis. All clients were given credit for the number of tasks for which they were present.

Materials. The music chosen for Experiment 2 included vocal and instrumental music from the 1900s-1950s. Any vocal arrangement that included 30 seconds or more of instrumental interludes was discarded. The sources of musical selections were the Time-Life Music: Your Hit Parade series (McCardell, 1988-1991), Best of Glenn Miller Recordings, American Legends: Louis Armstrong (Handy, 1914), and Hits of the Roaring Twenties (Pell, 1997).

Procedure. Four conditions were compared throughout the study—exercise to vocal music, exercise to instrumental music, exercise with instruments to vocal music, and exercise with instruments to instrumental music. The research was conducted across 26 sessions, 52 activities, at two assisted living facilities, 1 year later than Experiment 1. Sessions took place weekly or twice weekly throughout the course of the study. Two exercise activities, approximately 3-minutes, with and without instruments, were implemented in each 50-minute session, one near the beginning and the other near the end. These were interspersed among other music activities such as singing with guitar or autoharp, reminiscing using the flute, and listening to live music. The clients remained seated in a semicircle during all activities. Twenty-six vocal and 26 instrumental selections were chosen from the 1900s through the 1950s. The schedule of utilization for the four conditions and the musical selections were determined by random order, while seven selected movements remained constant over all activities in some combination (see Table 2). The exercise movements with the arms were conducted with and without instruments. Variations included mov

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TABLE 2 Movements Incorporated into Experiment II

Movements Description

Push/pull Arms fully extended in front of body, back to shoulders Up/down Arms fully extended above head, down to shoulders

Arm fully extended above head across midline, back to shoulder Down/up Hands at shoulders, extended down to knees, and back to shoulders

Hand at shoulders, extended down to opposite knee (crossing midline horizontally)

Across Hand at shoulder, extend across midline horizontally at shoulder height, and back to shoulder

Palms Wrists rotated 180 degrees

ing arms one at a time, or both in parallel or alternating motion. Furthermore, the movements were presented in different sequences and in different rhythm combinations of the whole note, half note, and quarter note. Continuous cueing was given in all activities, following the results of Experiment 1. Four rotations of each movement occurred before the therapist introduced another movement.

Data collection consisted of recording the participation of each client for the duration of each exercise-to-music activity, indicating at each 30-second interval whether each client participated in the designated movement, participated in exercise approximating the designated movement, or did not participate. A senior university music therapy student with substantial clinical experiences served as the data collector. Six trials over three sessions were designated practice trials for the data collector, during which time she received evaluation and feedback from the lead therapist.

Results

Treatment of data included the effect of vocal versus instrumental music on participation during exercise with and without musical instruments. A treatments-by-treatments-by-subjects ANOVA revealed that the type of music, vocal versus instrumental, had some effect on participation, F(\, 11) = 3.83, p< .09, and approached significance in participation according to the type of activity, exercise with or without instruments, F(l, 11) = 4.67, p < .06 (see Figure 2). No significance was found on the interactive effects of type of music and type of activity, F(l, 11) = .12, p> .10. A post-hoc t test for sig

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Experiment 2 Participation Percentages

87

Exercise to Vocal Exercise with Exercise to Exercise with

Music Instruments to Instrumental Instruments to Vocal Music Music Instrumental

Music

FIGURE 2. Participation percentages based on vocal versus instrumental music and type of

activity, exercise versus exercise with instruments.

nificance of related measures showed that exercise to instrumental music resulted in significantly higher participation than exercise with instruments to vocal music, t= 2.6, p< .05. Also, exercise to instrumental music was somewhat greater than exercise to vocal music, t = 1.85, p < .10, and exercise to vocal music was somewhat greater than exercise with instruments to vocal music, t = 1.91, p< .09. No significance was found between exercise to instrumental music versus exercise with instruments to instrumental music, t = .84, p> .10; exercise to vocal music versus exercise with instruments to instrumental music, 't = .23, p > .10; and exercise with instruments to vocal music vs. exercise with instruments to instrumental music, f=1.22,/».10.

Discussion and Conclusions

The authors decided to evaluate the interaction of factors with p < .10 because of the trends inherent in the data. A careful review of these data probably will yield more questions than answers, thus

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the need for replication and similar research on this important and growing population. Instrumental music resulted in more participation than vocal music: exercise to instrumental music was somewhat greater than exercise to vocal music, exercise with instruments to instrumental music resulted in more participation than exercise with instruments to vocal music, and exercise to instrumental music resulted in significantly greater participation than exercise with instruments to vocal music. Thus, it seems that the type of music, instrumental in this case, certainly has an advantage on the outcome in exercise tasks. The authors agree that perhaps the competing stimuli of verbal cueing during the vocal music contributed to more participation during instrumental music. Depending on the degree of impairments, many clients with AD do not have the ability to discriminate between the vocal cues and the vocal music. Oftentimes the clients do not attend to a designated task while listening to the words of the music; many times during the study it was observed that clients stopped participating in the designated task but sang with the vocal music.

In the foregoing paragraph, we discussed the importance of instrumental music and its effect on participation in exercise tasks. In addition, we must look at type of activity, which approached significance at p < .06, wherein exercise resulted in greater participation than exercising with instruments. As shown in Figure 2, exercise to vocal music was greater than exercise with instruments to vocal music and exercise to instrumental music was slightly higher than exercise with instruments to instrumental music. The authors submit that lower participation during exercise with instruments occurred due to competing responses such as grasping, manipulating, and playing the instruments while at the same time following directions by the therapist. Thus, perhaps clients in the later stages of AD are not capable of performing two tasks simultaneously.

Replication and further research is essential on the effects of instrumental and vocal music. More research is merited in finding techniques to elicit participation in exercise for the simple fact that exercise is so essential, and that under the proper conditions music elicits exercise/movement. It is recognized that the demeanor and personality of the therapist, the musicianship, and the ability to command attention and create meaningful relationships with the clients are factors that will affect the outcome of such efforts.

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References

American Psychiatric Association. (2002). Diagnostic and statistical manual of mental disorders (IV-TR). Washington, DC: American Psychiatric Association.

Anderson, M. A., & Braun.J. V. (1995). Caring for the elderly client. Philadelphia: F.A. Davis Company.

Atlanta Area Chapter Alzheimer's Association. (1996). Provider intensive training (4th ed.). Atlanta, GA: Atlanta Area Chapter Alzheimer's Association.

Best of Glenn Miller Orchestra [CD]. Quebec, Canada: Distributions Madacy Inc. Birren.J. E. (1959). Handbook of aging and the individual. Chicago: University of

Chicago Press. Blumenthal, J. A., Emery, C. F., Madden, D. J., Schniebolk, S., Walsh-Riddle, M.,

George, L. K., McKee, D. C., Higginbotharh, M. B., Cobb, F. R., & Coleman, R. E. (1991). Long-term effects of exercise on psychological functioning in older men and women.Journal of Gerontology, 46(6), 352-361.

Botwinick, J. (1967). Cognitive processes in maturity and old age. New York: Springer Publishing Co., Inc.

Brotons, M., & Pickett-Cooper, P. (1994). Preferences of Alzheimer's disease patients for music activities: Singing, instruments, dance/movement, games, and composition/improvisation.Journal of Music Therapy, 31, 220-233.

Bumanis, A., & Yoder, J. W. (1987). Music and dance: Tools for reality orientation. Activities, Adaptation, and Aging 70(1/2), 23-33.

Chavin, M. (1991). The last chord: Reaching theperson with dementia through thepowerof music. Mt. Airy, MD: Elder Song Publications, Inc.

Clair, A. A. (1996). Therapeutic uses of music with older adults. Baltimore, MD: Health Professions Press, Inc.

Clark, B. A., Wade, M. G., Massey, B. H., & Van Dyke, R. (1975). Response of institutionalized geriatric mental patients to a twelve-week program of regular physical activity. Journal of Gerontology, 30(5), 565-573.

Clarkson-Smith, L., & Hartley, A. A. (1989). Relationships between physical exercise and cognitive abilities in older adults. Psychology and Aging, 4, 183-189.

Cordrey, C. (1994). Hidden treasurer. Music and memory activities for people with Alzheimer's. Mt. Airy, MD: Elder Song Publications, Inc.

Cowdry, E. V. (1958). The care of the geriatric patient. St. Louis: The C.V. Mosby Co. DeVries, H. A. (1969). Guided exercise big boon to older people. Aging. Washing

ton: U.S. Department of Health, Education, and Welfare. Friedman, R., & Tappen, R. M. (1991). The effect of planned walking on communi

cation in Alzheimer's disease.Journal of American Geriatrics Society, 39, 650-654. Gibbons, A. C. (1977). Popular music preferences of elderly people. Journal of Mu

sic Therapy, 14, 180-189. Grant, R. E. (1970). The use of music therapy with geriatrics. Unpublished manu

script. Groene, R., Marble, G., & Kantar, S. (1998). The effect of therapist and activity

characteristics on the purposeful responses of probable Alzheimer's disease participants.Journal of Music Therapy, 35, 119—136.

Handy, W. C. (1914). St. Louis blues [Recorded by Jimmy Dorsey and His Orchestra]. On American legend: Louis Armstrong [CD]. Santa Monica, CA: Delta Music, Inc. (1996).

at Mem


ewfoundland on N

ovember 24, 2014


Dow

nloaded from



Hanson, N., Gfeller, K., Woodworth, G., Swanson, E. A., & Garand, L. (1996). A comparison of the effectiveness of differing types and difficulty of music activities in programming for older adults with Alzheimer's disease and related disorders. Journal of Music Therapy, 33, 93-123.

Hellen, C. R. (1998). Alzheimer's disease: Activity focuses care (2nd ed.). Boston: Butterworth Heinemann.

Hopkins, D. R., Murrah, B., Hoeger, W. W., & Rhodes, R. C. (1990). Effect of lowimpact aerobic dance on the functional fitness of elderly women. The Gerontological Society of America, 30, 189-192.

Johnson, G., Otto, D., & Clair, A. (2001). The effect of instrumental and vocal music on adherence to a physical rehabilitation exercise program with persons who are elderly.Journal of Music Therapy, 38, 82—96.

Kovach, C. R., & Henschel, H. (1996). Behavior and participation during therapeutic activities on special care units. Activities, Adaptation, and Aging, 20, 35-45.

McCardell, C. (1988-1991). Your hit parade [CD]. NY: Time-Life Music. Meddaugh, D. V. (1987). Exercise-to-music for the abusive patient. In T. L. Brink

(Ed.), The elderly uncooperative patient (pp. 147-154). New York: Haworth Press. Molloy, D. W., Beerschoten, D. A., Borne, M.J., Crilly, R. G., & Cape, R. D. T. (1988).

Acute effects of exercise on neuropsychological function in elderly subjects. Journal of American Geriatric Society, 36, 29-33.

Morey, M. C., Cowper, P. A., Feussner.J. R., DiPasquale, R. C., Crowley, G. M., Kitzman, D. W., & Sullivan, R. J. (1989). Evaluation of a supervised exercise program in a geriatric population. The Journal of American Geriatrics Society, 37, 348-354.

Namazi, K. H., Gwinnup, P. B., & Zadorozny, C. A. (1994). A low intensity exercise/movement program for patients with Alzheimer's disease: The TEMP-AD protocol.Journal of Aging and Physical Activity, 2, 80-92.

National Association for Music Therapy (Producer). (1996). Music therapy and medicine: Partnership in care. [Video]. (Available from the American Music Therapy Association, 8455 Colesville Rd., Suite 1000, Silver Spring, MD 20910).

Olson, K. (1984). Player piano music as therapy for the elderly. Journal of Music Therapy, 21, 47-52.

Pell, D. (1997). Hits of the roaring twenties [CD]. Minneapolis, MN: Simitar Entertainment, Inc.

Powell, R. R. (1974). Psychological effects of exercise therapy upon institutionalized geriatric mental patients.Journal of Gerontology, 29, 157-161.

Posner, J. D., Gorman, K. M., Windsor-Landberg, L., Larsen, J., Bleiman, M., Shaw, C., Rosenberg, B., & Knebl., J. (1992). Low to moderate intensity endurance training in healthy older adults: Physiological responses after four months. Journal of American Geriatrics Society, 40, 1-7.

Reaven, P. D., McPhillips, J. B., Barnett-Connor, E. L., & Criqui, M. H. (1990). Leisure time exercise and lipid and lipoprotein levels in an older population. Journal of American Geriatric Society, 38, 847-854.

Reuben, D. B., Laliberte, L., HirisJ., & Mor, V. (1990). A hierarchical exercise scale to measure function at the advanced activities of daily living (AADL) level. Journal of American Geriatric Society, 38, 855-861.

Simpson, W. M. (1986). Exercise: Prescriptions for the elderly. Geriatrics, 41', 95-100.

at Mem


ewfoundland on N

ovember 24, 2014


Dow

nloaded from



Smith, S. (1990). The unique power of music therapy benefits Alzheimer's patients. Activities, Adaptation, and Aging, 14, 59-63.

Squyres, B. N. (1996). Exercise and aging. In R. L. Dippel &J. T. Hutton (Eds.), Caringfor theAlzheimer patient (3rd ed.) (pp. 41-46). Amherst, NY: Prometheus Books.

Stamford, B. A. (1972). Physiological effects of training upon institutionalized geriatric men. Journal of Gerontology, 27, 451-455.

Wylie, M. E. (1990). A comparison of the effects of old familiar songs, antique objects, historical summaries, and general questions on the reminiscing of nursing home residents.Journal of Music Therapy, 27, 2-12.

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