mjhs music therapy: keys to dementia care
DESCRIPTION
A workbook that outlines how skilled nursing facilities can utilize a multidisciplinary care planning process led by music therapists—aided and supplemented by direct care staff—to provide individualized and small-group music-based activities. The information will also support your music therapists or other qualified health care professionals who train other dementia care providers, especially Certified Nursing Assistants and other direct care staff.TRANSCRIPT
COVER
music therapy keys to Dementia
Care
music therapy keys to Dementia
Care
Research suggests that more than 70 percent of skilled nursing facility residents over age 75 have dementia. Clinically significant neuro-psychiatric symptoms, such as agitation,
depression and wandering, are found in more than 63 percent of moderately to severely-impaired residents with dementia. These same symptoms interfere with function, social interaction and care delivery. Traditional management includes chemical and physical restraint, often resulting in detrimental side effects. Through a generous grant from the New York State Department of Health, MJHS developed the enclosed protocols to show how music interventions offer safe, non-pharmacological approaches to relieve symptoms of dementia.
Over the period of three years, the innovative music therapy programs at Shorefront and Menorah Centers for Rehabilitation and Nursing Care were implemented and evaluated. The enclosed materials outline how skilled nursing facilities across New York can utilize a multidisciplinary care planning process led by music therapists—aided and supplemented by direct care staff—to provide individualized and small-group music-based activities. The information will also support your music therapists or other qualified health care professionals who train other dementia care providers, especially Certified Nursing Assistants and other direct care staff.
Each section, along with the accompanying DVD, gives dementia care providers additional tools to utilize during activities of daily living. The described music-assisted activities, namely sing-a-longs, tonal activities, as well as “music & movement,” are designed specifically for skilled nursing facility residents with moderate to severe dementia. Implementation is inexpensive and training can be completed in one day or one week.
Results from our evidence-based research demonstrate that creative, musical activities help reduce depression and decrease agitation; residents often return to a calm state. In addition, music can improve resident range-of-motion, which can help prevent falls or other incidents. An additional benefit is that caring for residents who are happy increases efficiencies in resident care. This can lead to higher job satisfaction, as well as recruitment and retention of more highly trained staff.
During the past three years, MJHS has trained numerous staff on music-assisted care techniques. The results show a higher level of care, with stronger bonds between residents, family members, as well as staff.
We are confident you will have the same experience.
Sincerely,
MJHS Music Therapy TeamKendra Ray, MBA, LCAT, MT-BCMichael McGaughy, MT-BCScott Stuart, MA, MT-BC
INTRODUCTION
Dear Administrator:
Music Therapy Keys to Dementia Care
Section 1 6
TABLE OF CONTENTS
n SECTION 1
Overview of dementia, agitation and depression (15 Minutes) 11
n SECTION 2
iPod—How to use in music-assisted care (30 Minutes) 17
n SECTION 3
Singing protocol, followed by practice group (60 Minutes) 21
n SECTION 4
Music & Movement (30 Minutes) 25
n SECTION 5
Music-assisted range-of-motion, followed by practice group 29
(60 Minutes)
n SECTION 6
iPod—Working with playlists (30 Minutes) 33
n SECTION 7
Tonal protocol, followed by practice group (60 Minutes) 41
n SECTION 8
Music-assisted bathing and wound care (60 Minutes) 55
n SECTION 9
Key elements of a successful music program (15 Minutes) 61
n SECTION 10
Music intervention questionnaire (30 Minutes) 73
n SECTION 11
Music intervention questionnaire answers 77
Section 1
Overview of Dementia, Agitation and Depression
Music Therapy Keys to Dementia Care
Section 1 11
Dementia is a chronic disease that affects the ability to function independently due to progressive cognitive decline1. A diagnosis of dementia is often a life-changing, distressing event that affects patients, their families and caregivers. A patient with dementia may experience:
n Memory loss
n Language deficiency
n Judgment impairment
n Periods of anxiety and restlessness
n Executive functioning decline2
Behavioral and psychological symptoms of dementia are seen in the majority of nursing home residents. In fact, 90 percent of residents with dementia will develop behavioral and psychological symptom, including:
n Agitation
n Depression
n Wandering3
Understanding Behaviors
A behavior is a means of communicating feelings and needs. Research indicates that people with dementia are more easily agitated because the brain has physically changed and no longer functions in a healthy manner4.
SECTION 1
Overview of Dementia, Agitation and Depression
1 Plassman BL, Langa KM, Fisher GG, et al. Prevalence of dementia in the United States: The aging, demographics, and memory study. Neuroepidemiology. 2007;29(1-2):125-132. doi: 10.1159/000109998.
2 Drouillard N, Mithani A, Chan P. Therapeutic approaches in the management of behavioral and psychological symptoms of dementia in the elderly. BC Medical Journal. 2013;55(2):90-96.
3 Drouillard N, Mithani A, Chan P. Therapeutic approaches in the management of behavioral and psychological symptoms of dementia in the elderly. BC Medical Journal. 2013;55(2):90-96.
4 Treatment of dementia and agitation: A guide for families and caregivers. J Psychiatr Pract. 2007;13(3):207-216. doi: 10.1097/01.pra.0000271667.53717.9f.
Music Therapy Keys to Dementia Care
Section 1 12
Agitation
Agitation occurs in 40 - 60 percent of patients in residential and long-term care. Exhibited symptoms include:
n Physical aggressiveness
n Restlessness and pacing
n Verbal insults and shouting
n Shouting and disruptive vocalizations
n Wandering and exit-seeking behaviors5
The four A’s of agitation are:
“4 A’s”
n Amnesia — memory loss
n Aphasia — inability to use words or inability to understand words of others
n Agnosia — inability to recognize objects or faces
n Apraxia — inability to perform familiar motor tasks6
5 Drouillard N, Mithani A, Chan P. Therapeutic approaches in the management of behavioral and psychological symptoms of dementia in the elderly. BC Medical Journal. 2013;55(2):90-96.
6 Harper N. Train the trainer workshop: Alzheimer’s disease and dementia care. New York, NY: MJHS; 2007.
EARLY STAGES
Amnesia—Reminders or cues
Aphasia—Written or demonstrated
Agnosia—Gesture,demonstrate or assist to start
Apraxia—Hand over hand
LATER STAGES
Music Therapy Keys to Dementia Care
Section 1 13
Depression
Depression with dementia is one of the most common mental disorders seen in clinical practice7. It is also associated with psychological and behavioral symptoms.8 However, depression is often under diagnosed in nursing home residents. Some causes of depression with dementia include:
n Mental reaction to decline in cognition
n Recurrence of early and mid-life depression
n Vascular depression
n Decline associated with Alzheimer’s disease
Some symptoms of depression include:
n Irritability
n Agitation
n Anxiety9
Music activities versus music therapy
Research suggests that non-pharmacological interventions, such as music therapy, should be an early pursuit for treatment of behavioral and psychological symptoms. Music therapy, a noninvasive treatment, is the intentional use of music to achieve a therapeutic goal that can contribute to the quality of life for a person diagnosed with dementia10. An ideal psychosocial care plan should emphasize the following:
n Interest
n Social activities including music
n Comfort11
It is important to distinguish between music activities and music therapy. Music activities provide diversions and may be meaningful, as well as motivating. Music therapy is used to achieve specific goals, facilitated by a credentialed music therapist and addresses holistic needs.
7 Kobayashi T, Kato S. Depression-dementia medius: Between depression and the manifestation of dementia symptoms. Psychogeriatrics. 2011;11:177-182.
8 Prado-Jean A, Couratier P, Druet-Cabana M, et al. Specific psychological and behavioral symptoms of depression in patients with dementia. Geriatric Psychiatry. 2010;25:1065-1072.
9 Prado-Jean A, Couratier P, Druet-Cabana M, et al. Specific psychological and behavioral symptoms of depression in patients with dementia. Geriatric Psychiatry. 2010;25:1065-1072.
10 Clair AA, Memmott J, eds. Therapeutic uses of music with older adults. Second ed. Silver Spring, MD: American Music Therapy Association; 2008.
11 Kobayashi T, Kato S. Depression-dementia medius: Between depression and the manifestation of dementia symptoms. Psychogeriatrics. 2011;11:177-182.
Music Therapy Keys to Dementia Care
Section 1 14
Suggested strategies for the “Four A’s”
Early Stages
Later Stages
Amnesia gReminders or cues
Aphasia gWritten or demonstrated
Agnosia gGesture, demonstrate or assist to start
Apraxia gHand over hand
Music Therapy Keys to Dementia Care
Section 1 15
SECTION OPENERSection 2
iPod—How to Use in Music-Assisted Care
Aphasia gWritten or demonstrated
Music Therapy Keys to Dementia Care
Section 1 16
Music Therapy Keys to Dementia Care
Section 1 17
The iPod is a creative tool that is easy to transfer and adaptable to different situations in activities of daily living. It is important to learn to use the technique outlined in this curriculum prior to use with residents diagnosed with dementia. Mastery of the iPod will make learning the protocols a much easier process.
Directions for using the iPod shuffle (fourth generation)
n Ensure the iPod is off. The switch’s background should be silver.
n Turn iPod on by moving the switch 1 or 2 notches.
- If using a protocol playlist, slide the switch one notch to play songs in order. The switch will be in the middle position, the background silver and green.
- If not using a protocol playlist, slide the switch two notches to shuffle: The switch’s background will be green.
n Plug speaker cord into the iPod and turn speakers on by sliding the switch on speakers.
n To hear the title and artist information for the current song, press and quickly release the voiceover button (next to the on/off switch).
SECTION 2
iPod—How to Use in Music-Assisted Care
volume up button
voiceover button
three-way switch
all green: shuffle
all silver: off
switch in the middle: play in order
speaker or headphone
volume down button
play/pause button
next/fast forward button
clip
previous/rewind button
Section 2
Music Therapy Keys to Dementia Care
Section 1 18
SECTION OPENERSection 3
Singing Protocol, Followed by Practice Group
Music Therapy Keys to Dementia Care
Section 1 20
Music Therapy Keys to Dementia Care
Section 1 21
This protocol uses live and/or recorded music to facilitate a meaningful opportunity to foster socialization and improve mood.
Staff Requirements: CNA
Desired Objectives:
n Prevent or reduce verbal and/or physical agitation during activities of daily living
n Calm agitated residents
n Improve mood
n Decrease wandering
n Improve socialization
Entrance Criteria: Residents with mid-stage dementia who exhibit one or more of the following behaviors: wandering, agitation or depression.
Exit Criteria: Resident with no signs of improvement after four weeks or the behavior negatively impacts the involvement of others.
Group Size: Small, no more than six residents
Duration: 30-40 minutes
Safety Considerations
Environment: All equipment should be clean and without any sharp edges. Keep the floor area free of clutter.
Risks: Residents with high anxiety levels may become agitated with this group. Ensure no residents are noise-sensitive.
Facility & Equipment Required
Facility: Private rooms or resident lounges, areas with reduced distractions
Equipment: iPod, speakers, digital music software, digital music library, song sheets or songbook
SECTION 3
Singing Protocol, Followed by Practice Group
Section 3
Music Therapy Keys to Dementia Care
Section 1 22
Methods:
1) Prepare a sing-a-long playlist on the iPod and adjust the volume of the mini-speakers before gathering residents (refer to the provided iPod player directions).
2) Gather the group in a circle and explain that you will be singing along to many different and familiar songs. Invite residents to join in the singing.
3) Begin the playlist and start singing along with the first song. Pass out song sheets as needed.
4) When the playlist has finished (or if the residents express a desire to end the sing-a-long at any point), turn off the iPod.
5) Talk with residents about the music, unless limited by a language barrier or cognitive impairments. Example questions:
a. Does this music seem familiar to you? b. What kind of music is this? c. What does the music make you think of? d. Who do you think is singing?
6) If they are able to answer, ask residents “Did you enjoy the music?”
Section 3
Music Therapy Keys to Dementia Care
Section 1 23Section 3
SECTION OPENERSection 4
Protocol: Music & Movement
Music Therapy Keys to Dementia Care
Section 1 24
Music Therapy Keys to Dementia Care
Section 1 25
This protocol involves leading a small group of residents in a movement activity with recorded music. The intention is to keep the residents engaged in the music activity so the symptoms of wandering and depression either lessen or do not appear.
Staff Requirements: CNA
Desired Objectives:
n To improve mood, as evidenced by smiling, laughing or making positive comments.
n To decrease wandering by remaining in program.
Entrance Criteria: Resident has a diagnosis of mid-stage dementia with wandering or depression.
Exit Criteria:
n Resident’s behavioral symptoms worsen and/or negatively affect the involvement of other residents.
n Resident begins to leave the group independently, or asks to be taken out of the group.
Group Size: Small group, approximately 4-6 residents
Duration: 20-30 minutes
Safety Considerations
Environmental Risks: Ensure all equipment is clean, and keep the floor area free of clutter.
Client Risks: Instruct each resident to make comfortable movements. Pay close attention to each resident’s posture, facial tension and reports of pain or exhaustion. Stop the movement activity and encourage the resident to rest if he or she exhibits signs of physical discomfort. Report sustained complaints or signs of pain to nurse.
Facility & Equipment Required
Facility: Small activity room or lounge
Equipment: iPod, portable speakers, chiquitas, egg shakers, jingle bells, scarves
Method
1) Prepare activity before gathering residents for music group:
a. Set the iPod to a playlist designed for movement.
b. Place rhythm instruments and scarves so that you can easily access them.
SECTION 4
Protocol: Music & Movement
Section 4
Music Therapy Keys to Dementia Care
Section 1 26
2) Once group members are in a circle, explain that they will listen to music while making movements using rhythm instruments and scarves. Emphasize that each resident should only complete comfortable movements. Instruct residents to let you know if they are experiencing any discomfort during the movement activity.
3) Turn on the iPod and speakers. Ask residents if the volume is too loud or too soft, and adjust it if necessary.
4) Offer a rhythm instrument to each resident, giving a choice between different instruments and colors. Ensure the instrument handle faces the resident. If the resident does not want an instrument, respect this decision. Mention that the residents can make the movements without the instruments.
5) Call out and then demonstrate movements.
6) Ask each resident to suggest or show one movement, and direct the group to copy it.
7) After 10-15 minutes, collect the rhythm instruments from each resident.
8) Explain that a cool down with scarves is next.
9) Hand out scarves, giving each resident a choice of color. If a resident does not want one, respect this choice and say that movements may be done without scarves.
10) Instruct residents to take a few deep breaths and direct them to follow your slow and easy movements.
11) After five minutes, announce that residents can relax and that you will collect the scarves.
12) Turn off the music. Ask the residents, “Did you enjoy the music?” Also ask how each resident is feeling.
13) Lead a discussion about the music activity, giving each resident an opportunity to express his or her own opinion. Ask specific questions about the recorded music. Be sure to take time to practice active listening with each resident. Your response should be of a positive nature, even if the resident had a negative view.
Section 4
Music Therapy Keys to Dementia Care
Section 1 27
SECTION OPENERSection 5
Music-assisted Range-of-Motion, Followed by Practice Group
Music Therapy Keys to Dementia Care
Section 1 28
Music Therapy Keys to Dementia Care
Section 1 29
This program uses recorded music to motivate the resident’s active involvement in range-of- motion exercises, increase reality orientation, improve mood and decrease wandering.
Staff Requirements: At least one CNA or one caregiver
Desired Objectives:
n Increased level of involvement in range-of-motion exercises, as seen when resident completes, or makes active efforts to complete, the exercises.
n Improved range-of-motion, as evidenced by resident’s increased range-of-motion.
n Increased reality orientation, as seen by verbal comments relating to the present moment.
n Improved mood, as seen by positive verbal comments and brightened affect.
n Decreased wandering, as seen when the resident stays with caregiver or staff member during the range-of-motion exercises.
Entrance Criterion: Resident has moderate dementia, with or without depression, is withdrawn, shows verbal or nonverbal signs of poor mood, and/or has range-of-motion exercises in the individual rehabilitation plan that the resident resists.
Exit Criterion: Decline in the resident’s health that prohibits him or her from engagement in range-of-motion exercises.
Group Size: One resident
Duration: 5 – 20 minutes
Safety Considerations
Environmental Risks: The floor should be free of clutter. The resident should be seated in a firm chair with a straight back.
Client Risks: Avoid risk of overexertion by paying close attention to the resident’s posture, facial tension and verbal reports of exhaustion. Adjust or stop the exercises and music, when appropriate.
Facility & Equipment Required
Facility: Common area or resident’s room
Equipment: CD player, CD that is customized to resident’s music preferences and range-of- motion session, iTunes, CD-burning software
SECTION 5
Music-assisted Range-of-Motion, Followed By Practice Group
Section 5
Music Therapy Keys to Dementia Care
Section 1 30
Methods:
1) Identify the resident’s personal music preferences, based on comments by the resident, family members or caregivers.
2) If no information is available regarding music preferences, consult the music therapist or recreation therapist.
3) Create a music compilation CD for the range-of-motion session. The first track should have a slow beat. Subsequent tracks should have a faster beat.
4) Greet the resident and ask, “Is it okay if I turn on some music?”
5) If the resident agrees, play the CD’s first track.
6) Adjust the volume of the music to the resident’s preferred listening level.
7) Toward the beginning of the second track, initiate and facilitate range-of-motion exercises that serve the resident’s individualized plan of care.
8) If the resident resists engaging in the exercises, encourage participation. If the resident still resists, allow him or her to stop.
Guidelines for Music-Assisted Range-of-Motion:
n Select music based on the resident’s music preferences. Always consider the resident’s music preferences and responses first.
n If there is no information available regarding the resident’s music preferences or responses, choose music that was popular when the resident was 20-30 years of age. When possible, choose music that reflects the resident’s cultural background.
n The music selection for the first track should have a slow beat, and be instrumental. This track will be in the background during greeting time.
n Music selections for the second and following tracks should have a fast beat, and may be instrumental or vocal. This upbeat music is meant to motivate the resident to complete the exercises.
Music Suggestions for Greeting (Track 1):
Title Composer and Lyricist ArtistInstrumental music Various Kenny GInstrumental music Various Yanni“Adagio for Strings” Samuel Barber Various
Music Suggestions for Range-of-Motion Exercises (Track 2 until end):
Song Title Composer and Lyricist Artist“Alexander’s Ragtime Band” Berlin Various“Anchors Aweigh” Zimmerman and Miles Various“Give My Regards to Broadway” Cohan Various“Hava Nagilah” Hebrew Folk Song Moshe Nathanson“Quizas, Quizas, Quizas” Osvaldo Farres Various
Section 5
Music Therapy Keys to Dementia Care
Section 1 31
SECTION OPENERSection 6
iPod—Working With Playlists
Music Therapy Keys to Dementia Care
Section 1 32
Music Therapy Keys to Dementia Care
Section 1 33
Playlists are helpful compilations of songs that are saved on the iPod for repeated use. This program includes playlists created for the outlined protocols. For example, the Music & Movement protocol has a playlist titled “For Movement”. Use of this playlist can motivate residents, improve mood, as well as decrease stress and burden on caregivers and/or residents.
In general, playlists should reflect the resident’s musical preferences. If the resident’s preference is unknown, choose songs that were popular when the resident was 20-30 years of age, remaining mindful of his or her cultural background.
Choose a playlist on the iPod:
n To choose a playlist, press and hold down the VoiceOver button until it beeps.
n The current playlist will be named, followed by others.
-To go forward, press and release arrows on the right >>|.
-To go backward, press and release arrows on the left |<<.
n Press and release the center button || to select a playlist.
n Adjust the volume as needed.
n On speakers, slide dial to the right to get louder and to the left to get softer.
n On iPod, press + to get louder and – to get softer.
n To skip to the next song, press and release the button on right side >>|.
n To return to the previous song, press and release the button on the left side |<<.
n To put the music on hold, press and release the center button ||.
n To turn the music back on, press and release the center button again ||.
n To reset the shuffle, first turn it off. Wait ten seconds, then slide the switch to either shuffle or play in order.
Playlist Order
1. All songs
2. Caribbean
3. Classical
4. Energizing
5. Movement *
6. Music-assisted care *
SECTION 6
iPod: Working with Playlists
7. Sing-a-long *
8. Italian
9. Jazz
10. Jewish
11. Oldies
12. Relaxing
13. Russian
14. Latin
* Protocol playlists
Note: iTunes software is necessary to create playlists for the iPod.
Section 6
Music Therapy Keys to Dementia Care
Section 1 34
Playlists should reflect resident preferences and the cultural diversity of the resident population.
Playlists Designed for Protocols: Play songs in order
Sing-a-long (24 minutes) Tonal (7 minutes)
Music & Movement (25 minutes) Music-assisted bathing (32 minutes)
Music-assisted range-of-motion (24 minutes) Music-assisted wound care (27 minutes)
Side by Side I’ll Be Seeing YouKate Smith
You Are My Sunshine Learnin’ the BluesRosemary Clooney
Hava Nagilah The Music of IsraelThe Moshe Silberstein Ensemble and Chorus
Tumbalalaika Yiddish Folk and TheatreTheodore Bikel
Quizas, Quizas, Quizas Cuba BellaCelia Cruz
Michael Row the Boat Ashore Sing AlongPeter, Paul and Mary
Red River Valley Sing AlongFrank Corrales and Cisco Trio
Tzenah Tzenah Jewish Play AlongThe Neshoma Orchestra
God Bless America The Best of Kate SmithKate Smith
Sing-a-long Playlist (24 minutes)
Song-Artist Album
Section 6
Music Therapy Keys to Dementia Care
Section 1 35
Under the Boardwalk Rock n’ Roll 1964The Drifters
Love Me or Leave Me Rat Pack Disc 2Sammy Davis, Jr.
Cheek to Cheek Pop Standards Ella Fitzgerald
Hava Nagilah Jewish Play AlongThe Neshoma Orchestra
Quizas, Quizas, Quizas Cuba BellaCelia Cruz
Stars and Stripes Forever Great Orchestra MarchesLondon Festival Orchestra
Thais: Meditation Most RelaxingMassenet Classical Album
Music & Movement (25 minutes)
Song-Artist Album
Concerto for Violin and Orchestra No. 1 The Romantic ViolinMax Bruch
Alexander’s Ragtime Band VariousElla Fitzgerald
Semper Fidelis Sousa Marches Forever John Philip Sousa
Beyond the Sea Pop Standards Vol. 6Bobby Darin
Quizas, Quizas, Quizas Cuba BellaCelia Cruz
Clair de Lune Most Relaxing ClassicalDebussy Album in the World
Music-assisted Range-of-Motion (24 minutes)
Song-Artist Album
Section 6
Music Therapy Keys to Dementia Care
Section 1 36
Red River Valley Sing AlongFrank Corrales and Cisco Trio
Tzenah Tzenah Jewish Play AlongThe Neschoma Orchestra
Oh, Susanna Sing Along Frank Corrales and Cisco Trio
Tonal (7 minutes) Use C and G Tone bars
Song-Artist Album
In the Mood Glenn Miller 1938-1942Glenn Miller Disc 2
What A Wonderful World Pop Standards Vol. 6Louis Armstrong
Chattanooga Choo Choo Glenn Miller 1938-1942Glenn Miller Disc 2
Over the Rainbow The Complete MastersJudy Garland (Plus)
That’s Amore Rat Pack Disc 2Dean Martin
What I Did for Love Pop Standards Vol. 5, Shirley Bassey Side 1
At Last Glenn Miller 1938-1942 Glenn Miller Disc 2
The Girl from Ipanema Pop Standards Vol. 4Sinatra/Jobim
Beyond the Sea Pop Standards Vol. 6Bobby Darin
Cheek to Cheek Pop Standards Vol. 2Ella Fitzgerald
Music-assisted Bathing (32 minutes)
Song-Artist Album
Section 6
Music Therapy Keys to Dementia Care
Section 1 37
Be creative and design your own playlists using these genres as a reference tool.
Playlists Organized by Music Type: May use shuffle
Chinese Jazz Oldies
Classical Jewish Russian
Italian Latin Soul/R&B/Motown
Part 1
Air, Sinfonia in G VariousBach
Largo from Piano Concerto No. 3 VariousBeethoven
Intermezzo in E flat VariousBrahms
Part 2
Meet Me in St. Louis VariousMills and Sterling
When Johnny Comes Marching Home VariousGilbert (Lambert)
Stars and Stripes Forever VariousSousa
Music-assisted Wound Care (27 minutes)
Song-Artist Album
Section 6
Music Therapy Keys to Dementia Care
Section 1 38
Chinese Chinese Traditional Music
Classical -Mozart: Concertos for Two and Three Pianos -Classical Escape Bach -Sonatas for Piano and Violin - Most Relaxing Classical Album in
the World…Ever
Italian -Italian Music Odyssey -Viva Italia! All the Favorite Italian Songs
Jazz/Big Band - An Anthology of Big Band Swing (1930-1955) Disc 2
-Lady Day’s 25 Greatest: 1933-1944 -Pop Standards Vol.1 – 7 -Rat Pack -Glenn Miller 1938-1942 Disc 2
Jewish -The Music of Israel - To Life!: Songs of Chanukah and other
Jewish Celebrations -Yiddish Folk and Theatre Songs -Jewish Play Along
Caribbean/Latin -Beautiful Barbados -Medley Tropical -Celia Cruz Greatest Hits -2 Grandes de la Salsa
Oldies -Rock n’ Roll 1962-1967 -25 All-Time Greatest Hits
Russian -Russian Classical Guitar Music. -Romance, Folk Songs - Songs of Russia Old & New/Songs of
a Russian Gypsy -Balalaika Favorites
Soul/R&B/Motown -James Brown Mix -What’s Going On (Marvin Gaye) -Smokey Robinson -Al Green’s Greatest Hits -25 All-Time Greatest Hits
Album Recommendations for Additional Playlists
Playlist Album(s) Recommended
Section 6
Music Therapy Keys to Dementia Care
Section 1 39
SECTION OPENERSection 7
Tonal Protocol, Followed By Practice Group
Music Therapy Keys to Dementia Care
Section 1 40
Music Therapy Keys to Dementia Care
Section 1 41
Tonal: 1- and 2-chord songs Staff Requirements: CNA
Desired Objectives
n Prevented or reduced verbal and/or physical agitation during activities of daily living
n Calming of agitated residents
n Improved socialization as evidenced by singing or humming lyrics
n Improved mood as evidenced through words and facial expressions
n Decreased wandering
Entrance Criteria: Residents with mid-stage dementia who exhibit one or more of the following behaviors: wandering, agitation or depression.
Exit Criteria: Residents who show no signs of improvement after four weeks or whose behavior negatively affects other participants.
Group Size: Small group; 4-6 residents
Duration: 30-40 minutes
Safety Considerations
Environment: All equipment should be clean and without any sharp edges. Keep the floor area free of clutter.
Client Risks: Ensure residents are not noise sensitive. Residents with high anxiety levels may become agitated in this group.
Facility & Equipment Required
Facility: Activity or similar room away from distractions
Equipment:
n Set of bass tone bars that are individually labeled C, G and C (Orff) with mallets (refer to the appropriate song sheets for instructions on when to play the tone bars C or G for the songs listed below).
n A table for the tone bar and for residents with limited motor skills.
n Suzuki hand bells.
SECTION 7
Tonal Protocol, Followed By Practice Group
Section 7
Music Therapy Keys to Dementia Care
Section 1 42
Methods
1) The group is gathered in a circle.
2) First, show the residents the tone bars and then demonstrate how to use them. Then, pass out the mallets holding the ball end so residents reach for it with their dominant hand. Next, hand out the tone bars.
3) The CNA should then demonstrate a rhythm (i.e. slow and steady or fast, loud, soft, etc).
4) Instruct the residents to hold their hands up and play together.
5) When the residents have mastered this, start singing. The CNA should conduct residents according to the song sheets in this guide.
6) When finished singing, ask residents to reflect on the sounds the group created. Practice active listening with each resident. Respond positively, even if the resident had a negative view.
7) Repeat steps 2-5.
Suggested Songs for Tonal Activity
“Row, Row, Row Your Boat”
“Michael Row the Boat Ashore”
“Three Blind Mice”
“Hot Cross Buns”
“You Are My Sunshine”
“Oh Susanna”
“Clementine”
“De Colores”
Section 7
Music Therapy Keys to Dementia Care
Section 1 43Section 7
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Music Therapy Keys to Dementia Care
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eve
r se
e su
ch a
sig
ht in
you
r lif
e
As
thre
e bl
ind
mic
e
Music Therapy Keys to Dementia Care
Section 1 46 Section 7
Ho
t cr
oss
bu
ns
Hot
cro
ss b
uns
Hot
cro
ss b
uns
One
a p
enny
, tw
o a
penn
y
Hot
cro
ss b
uns
Hot
cro
ss b
uns
Hot
cro
ss b
uns
If yo
u ha
ve n
o d
augh
ters
Giv
e th
em to
you
r so
ns
Music Therapy Keys to Dementia Care
Section 1 47Section 7
Mic
hael
, Row
The
Bo
at A
sho
re
Mic
hael
row
the
bo
at a
sho
re, h
alle
luja
h
Mic
hael
row
the
bo
at a
sho
re,
halle
luja
h
Mic
hael
row
the
bo
at a
sho
re, h
alle
luja
h
Mic
hael
row
the
bo
at a
sho
re,
halle
luja
h
Sis
ter
help
to
tri
m t
he s
ail,
halle
luja
h
Sis
ter
help
to
tri
m t
he s
ail,
hal
lelu
jah
Sis
ter
help
to
tri
m t
he s
ail,
halle
luja
h
Sis
ter
help
to
tri
m t
he s
ail,
hal
lelu
jah
Riv
er J
ord
an is
chi
lly a
nd c
old
, hal
lelu
jah
Chi
lls t
he b
od
y b
ut n
ot
the
soul
, ha
llelu
jah
Riv
er J
ord
an is
chi
lly a
nd c
old
, hal
lelu
jah
Chi
lls t
he b
od
y b
ut n
ot
the
soul
, ha
llelu
jah
Mic
hael
row
the
bo
at a
sho
re, h
alle
luja
h
Mic
hael
row
the
bo
at a
sho
re,
halle
luja
h
Mic
hael
row
the
bo
at a
sho
re, h
alle
luja
h
Mic
hael
row
the
bo
at a
sho
re,
halle
luja
h
Music Therapy Keys to Dementia Care
Section 1 48 Section 7
Cle
men
tine
In a
cav
ern,
in a
can
yon
Exc
avat
ing
for
a m
ine
Dw
elt
a m
iner
fort
y n
iner
And
his
d
aug
hter
C
lem
enti
ne
Oh
my
dar
ling
, oh
my
dar
ling
Oh
my
dar
ling
, C
lem
enti
ne!
Tho
u ar
t lo
st a
nd
go
ne fo
reve
r
Dre
adfu
l s
orr
y,
Cle
men
tine
Music Therapy Keys to Dementia Care
Section 1 49Section 7
I’ve
Bee
n W
ork
ing
on
the
Rai
lro
ad
I’ve
bee
n w
ork
in’ o
n th
e ra
ilro
ad,
All
the
live
long
d
ay
I’ve
bee
n w
ork
in’ o
n th
e ra
ilro
ad,
Just
to
p
ass
the
tim
e aw
ay
Do
n’t
you
hear
the
whi
stle
blo
win
g?
Ris
e up
so
ear
ly
in t
he m
orn
Do
n’t
you
hear
the
cap
tain
sh
out
ing
“Din
ah, b
low
yo
ur
horn
?”
Din
ah, w
on’
t yo
u b
low
,
Din
ah, w
on’
t yo
u b
low
,
Din
ah, w
on’
t yo
u b
low
yo
ur h
orn
?
Din
ah, w
on’
t yo
u b
low
,
Din
ah, w
on’
t yo
u b
low
,
Din
ah, w
on’
t yo
u b
low
yo
ur
horn
?
Music Therapy Keys to Dementia Care
Section 1 50 Section 7
You
are
My
Su
nshi
ne
You
are
my
suns
hine
, my
onl
y su
nshi
ne
You
mak
e m
e h
appy
whe
n sk
ies
are
gra
y
You’
ll ne
ver
kno
w d
ear
how
muc
h I
love
yo
u
Ple
ase
do
n’t
take
my
sun
shin
e a
way
You
are
my
suns
hine
, my
onl
y su
nshi
ne
You
mak
e m
e h
appy
whe
n sk
ies
are
gra
y
You’
ll ne
ver
kno
w d
ear
how
muc
h I
love
yo
u
Ple
ase
do
n’t
take
my
sun
shin
e a
way
The
oth
er n
ight
dea
r as
I la
y sl
eep
ing
I dre
amed
I h
eld
yo
u in
my
arm
s
Whe
n I
awo
ke d
ear
I was
mis
take
n
So
I la
y d
own
my
hea
d a
nd c
ried
Music Therapy Keys to Dementia Care
Section 1 51Section 7
Oh
Su
san
na
I cam
e fr
om A
laba
ma
with
a
banj
o on
my
knee
,
I’m g
oing
to L
ouis
iana
, m
y tr
ue lo
ve fo
r to
se
e.
It r
aine
d al
l nig
ht t
he d
ay I
left
The
wea
ther
it w
as d
ry,
The
sun
so h
ot I
froz
e to
dea
th
Sus
anna
, don
’t yo
u
cry.
Oh
! Sus
anna
,
Oh
don’
t you
cry
for
me,
‘Cau
se I’
ve c
ome
from
A
laba
ma
With
my
banj
o on
m
y kn
ee
Music Therapy Keys to Dementia Care
Section 1 52 Section 7
De
Co
lore
s
De
Col
ores
, De
colo
res
se v
iste
n
los
com
pos
en la
P
rim
aver
a
De
Col
ores
, De
colo
res
son
los
para
jitos
Que
Vie
nen
De
Afu
era
De
Col
ores
, De
colo
res
es e
l arc
o
iris
Que
vem
os L
ucir.
Y p
or e
so
los
gra
ndes
.
Am
ores
de
Muc
hos
Col
ores
me
gust
an a
mi.
Y p
or E
so lo
s g
rand
es
Am
ores
de
muc
hos
Col
ores
me
gust
an a
mi
Music Therapy Keys to Dementia Care
Section 1 53Section 7
SECTION OPENERSection 8
Music-assisted Bathing and Wound Care
Music Therapy Keys to Dementia Care
Section 1 54
Music Therapy Keys to Dementia Care
Section 1 55
Music-Assisted Bath/Shower This program uses recorded music to reduce aggressive behaviors in a resident who is receiving a bath or shower.
Staff Requirements: At least 1 CNA or one caregiver
Desired Objectives
n Improved mood, as seen by positive verbal comments and brightened affect.
n Decreased physical tension, as seen by less muscle rigidity.
n Relaxation, as seen by closing eyes and non-resistance of care.
n Prevented or reduced aggressive behaviors, such as kicking, yelling or hitting.
Entrance Criterion: The resident has moderate dementia, with or without depression. The resident resists being bathed. The resident displays aggressive behaviors, such as yelling, hitting and kicking, during bathing/showering or during the preparation for bathing/showering. The resident is not sensitive to noise.
Exit Criterion: The resident’s aggressive behaviors do not improve over the course of four music-assisted baths/showers. The resident’s aggressive behaviors worsen during two music-assisted baths/showers.
Group Size: 1 resident
Duration: 30–60 minutes
Safety Considerations
Environmental Risks: All music-related equipment should be waterproofed and disconnected from an electrical outlet.
Resident Risks: Respect the resident’s right to refuse the bath/shower or the music.
Facility & Equipment Required
Facility: Shower-room, or wherever bathing/showering occurs.
Equipment: Waterproof CD player, CDs, CD-burning software such as iTunes.
SECTION 8
Music-assisted Bathing and Wound Care
Section 8
Music Therapy Keys to Dementia Care
Section 1 56
Method
1) Customize the CD based on the resident’s personal music preferences and on the music that has historically relaxed the resident.
2) If no information is available on effective music or preferences, consult the music or recreation therapist.
3) Set up music where the bath/shower will take place. Place the CD in the CD player and press play, adjusting the volume to match the resident’s preferred listening level.
4) If the preparation for the bath/shower occurs in a different location from the bath/shower, set up another CD player and CD in this location. Place a copy of the customized CD or one with similar music in the CD player and press play, adjusting the volume to match the resident’s preferred listening level.
5) Prepare the resident for the bath or shower.
6) If aggressive behavior or high stress level occurs, redirect the resident.
7) If aggressive behavior or high stress level worsens, change the track.
8) If aggressive behavior or high stress level further worsens, turn off the music.
9) Give the bath or shower, continuing to follow the three previous steps as needed.
Guidelines for Music-Assisted Bathing:
n Select music based on the resident’s music preferences. Pay attention to verbal and nonverbal responses.
n If there is no information regarding the resident’s music preferences, choose music that was popular when the client was 20-30 years of age. If possible, choose music that reflects the resident’s cultural background.
Music Suggestions:
Song Title Composer and Lyricist Artist
“In the Mood” Garland and Razaf Glenn Miller“Chattanooga Choo Choo” Gordon and Warren Glenn Miller “Singin’ in the Rain” Brown and Freed Gene Kelly“What a Wonderful World” Thiele and Weiss Louis Armstrong“Over the Rainbow” Arlen and Harburg Judy GarlandPopular songs Various Frank Sinatra
Section 8
Music Therapy Keys to Dementia Care
Section 1 57
Music-assisted Wound Care This program uses recorded music before and during wound care in order to increase the resident’s physical comfort, reduce the resident’s perception of pain and induce a relaxation response. The recorded music will also be used to prevent or reduce any aggressive behaviors, such as yelling, crying, pinching and biting during wound care, and to allow the nurse to more easily complete wound care.
Staff Requirements: At least one CNA or one caregiver, as well as one nurse
Desired Objectives
n Increased physical comfort, as seen by less muscle tension or less aggressive behaviors.
n Decreased perception of pain, as seen by fewer nonverbal or verbal signs of discomfort, such as yelling and moaning.
n Relaxation, as seen by eyes closing, sleep, less muscle rigidity.
n Fewer or no aggressive behaviors, as seen by the absence of hitting, biting or pinching, or a reduction in these behaviors.
n Less resistance to wound care, as noted by nurse’s observation.
Entrance Criterion: The resident has moderate dementia, with or without depression. The resident requires wound care, and shows signs of physical discomfort during wound care, such as crying, screaming and moaning. The resident may or may not exhibit aggressive behaviors during wound care, such as hitting, punching and biting.
Exit Criterion: The resident demonstrates no change in physical discomfort or aggressive behaviors over the course of three wound care sessions. The resident expresses preference to have no music during wound care. Signs of physical discomfort or aggressive behaviors worsen over the course of one session.
Group Size: One resident.
Duration: As needed, prior to and during wound care.
Safety Considerations
Environmental Risks: Floor and bed should be free of clutter. Padding should surround floor and bed.
Resident Risks: Respect the resident’s wishes regarding music during wound change.
Facility & Equipment Required
Facility: Private room
Equipment: CD player, 2 CDs that are customized to resident’s music preferences, 1 CD with slow preferred music, 1 CD with upbeat preferred music, iTunes, CD-burning software.
Method
1) Identify the resident’s personal music preferences, per information given by the resident, family members or caregivers.
2) If no information is available regarding music preferences, consult the music or recreation therapist.
Section 8
Music Therapy Keys to Dementia Care
Section 1 58
3) Create music compilation CDs for the wound care sessions. Music on the first CD should be slow. Music on the second CD should be upbeat.
4) Greet the resident and ask, “Is it okay if I turn on some music?”
5) If the resident agrees, play the CD with slow music.
6) Adjust the volume of the music to the resident’s preferred listening level.
7) Just before the nurse begins wound care, change the CD and play another CD with upbeat music.
8) Increase the volume of the music on signs of physical discomfort, such as crying and yelling, or aggressive behaviors, such as hitting or pinching.
9) Decrease the volume of the music on signs of relaxation and decreased aggressive behaviors, and/or the ending of the wound change.
Guidelines for Music-Assisted Bathing:
n Select music based on the resident’s music preferences. Always consider the resident’s music preferences and responses first.
n If there is no information available regarding the resident’s music preferences or responses, choose music that was popular when the resident was 20-30 years of age. When possible, choose music that reflects the resident’s cultural background.
n Music selection for the first CD should have a slow beat and be instrumental. Play these tracks before wound care begins. They should help the resident relax.
n Music selections for the second CD should have a fast beat, whether instrumental or vocal.
n If the resident shows signs of relaxation, return to the slow music that was played before wound care began. This music is meant to reinforce the relaxation response, and to have a soothing effect.
Music Suggestions for Slow CD
(Music played prior to wound care and after signs of relaxation)
Selection Title Composer
“Air, Sinfonia in G” Bach
“Largo from Piano Concerto No. 3” Beethoven
“Intermezzo in E Flat” Brahms
Music Suggestions for Upbeat CD
(Music played right before and during wound care)
Song Title Composer and Lyricist
”Meet Me In St. Louis” Mills and Sterling
“When Johnny Comes Marching Home” Gilmore (Lambert)
“Stars and Stripes Forever” Sousa
Section 8
Section 9
Key Elements of a Successful Music Program
Music Therapy Keys to Dementia Care
Section 1 60
Music Therapy Keys to Dementia Care
Section 1 61
PreparationMusic therapy is key to dementia care. Successful programs have a clear framework and adjust to resident needs. Before a group is created, ask:
n What is the atmosphere on the floor today?
n Which residents in the group are not feeling well?
n Who has declined and may no longer be appropriate?
n What do residents most like?
n Is there an activity from previous sessions that did not work well and why?
n Have the residents asked for a different song?
Communication
Many residents with dementia are also hearing impaired. When speaking with residents, remember to:
n Talk at eye level.
n Use a friendly, welcoming tone.
n Remember culturally appropriate body language and actions.
n Speak slowly.
n Be patient.
Setup
The right setup helps programs thrive. Before residents arrive:
n Finalize activities, arrangements and music.
n Consider the best seating arrangement for residents. A line, semi-circle or complete circle may encourage maximum participation.
n Instruments and materials, including song sheets, should be on the table—making them easy to access and use.
SECTION 9
Key Elements of a Successful Music Program
Section 9
Music Therapy Keys to Dementia Care
Section 1 62
Facilitation
How information is delivered can make or break an activity. A good facilitator will:
n Speak slowly and clearly so residents can understand.
n Give physical and/or verbal cues and know when to use either or both techniques.
n Rephrase directions when necessary, so all residents can be as fully engaged as possible.
n Offer simple and direct directions in a friendly tone.
n Adjust the volume or activity according to resident wishes.
Section 9Section 3 Section 9
Music Therapy Keys to Dementia Care
Section 1 63Section 9
Mu
sic
Act
ivit
y C
ard
s fo
r C
NA
s
Th
ese
card
s p
rovi
de
key
gu
idel
ines
fo
r le
adin
g m
usi
c ac
tivi
ties
wit
h re
sid
ents
w
ho h
ave
dem
enti
a an
d m
ay s
eem
ag
itat
ed, a
gg
ress
ive
or
wit
hd
raw
n.
Mu
sic
acti
viti
es c
an h
elp
to
:
n C
alm
res
iden
ts
n I
mp
rove
moo
d
n D
ecre
ase
wan
der
ing
n R
educ
e ve
rbal
and
phy
sica
l agi
tatio
n
n I
mp
rove
soc
ial i
nter
actio
n
Music Therapy Keys to Dementia Care
Section 1 64
Key
Po
ints
to
Co
nsi
der
1. P
repa
re
n I
f the
resi
dent
is h
ighl
y se
nsiti
ve to
noi
se, d
o no
t inc
lude
the
resi
dent
.
n L
earn
the
resi
dent
’s fa
vorit
e m
usic
by
aski
ng th
e re
side
nt, s
taff
or fa
mily
, and
use
that
mus
ic
whe
neve
r pos
sibl
e.
n T
ry to
find
a q
uiet
room
that
will
hav
e m
inim
al d
istr
actio
ns.
n S
et u
p th
e ro
om a
nd a
ll eq
uipm
ent b
efor
e th
e re
side
nt is
pre
sent
.
2. R
esp
ectf
ully
lead
act
ivit
y
n T
ell t
he re
side
nt w
hat y
ou p
lan
to d
o th
roug
hout
the
sess
ion.
n A
sk if
the
mus
ic is
too
soft
or t
oo lo
ud. A
djus
t as
need
ed.
n I
nvite
resi
dent
s to
par
ticip
ate.
If o
ne re
fuse
s, in
vite
that
resi
dent
to s
tay
and
just
list
en to
the
mus
ic. I
f
the
resi
dent
stil
l ref
uses
, sto
p th
e m
usic
or h
elp
the
resi
dent
leav
e th
e gr
oup.
3. E
nd t
he m
usic
act
ivit
y
n I
n th
e la
st fi
ve m
inut
es, l
et th
e re
side
nt k
now
the
mus
ic w
ill e
nd.
n A
sk th
e re
side
nt if
he
or s
he e
njoy
ed th
e m
usic
.
Section 9
Music Therapy Keys to Dementia Care
Section 1 65
Sin
g-a
-lo
ng
Ste
ps
1. G
athe
r re
sid
ents
in a
circ
le a
nd e
xpla
in t
hat
you
will
b
e si
ngin
g al
ong
to fa
mili
ar s
ong
s. In
vite
the
m to
join
in
the
sing
ing.
2. T
urn
on m
usic
: sel
ect
a si
ng-a
-lon
g p
layl
ist.
Pas
s ou
t so
ng s
heet
s as
nee
ded
.
3. A
t th
e en
d o
f eac
h so
ng, p
ut t
he m
usic
on
hold
. Ta
ke a
few
min
utes
to d
iscu
ss t
he m
usic
with
the
re
sid
ents
. For
exa
mp
le:
n D
oes
thi
s m
usic
see
m fa
mili
ar?
n W
hat
kind
of m
usic
is t
his?
n W
hat
do
es t
he m
usic
mak
e yo
u th
ink
of?
n W
ho d
o yo
u th
ink
is s
ingi
ng?
n D
id y
ou e
njoy
the
mus
ic?
4. W
hen
the
pla
ylis
t ha
s fin
ishe
d (o
r if
the
resi
den
ts
exp
ress
a d
esire
to e
nd t
he s
ing
-a-l
ong
at a
ny p
oint
),
turn
off
the
MP
3 p
laye
r.
Gro
up
Siz
e: S
mal
l (no
mor
e th
an 6
res
iden
ts)
Du
rati
on
: 30-
40 m
inut
esS
pec
ial E
qu
ipm
ent:
iPod
pla
yer
and
sp
eake
rs, s
ong
shee
ts o
r so
ngb
ook
n R
esid
ent
has
mid
-sta
ge d
emen
tia
n E
xhib
its s
ymp
tom
s of
wan
der
ing,
ag
itatio
n or
dep
ress
ion
n R
esid
ent
show
s no
sig
ns o
f im
pro
vem
ent
afte
r 4
sess
ions
n B
ehav
ior
nega
tivel
y im
pac
ts t
he
invo
lvem
ent
of o
ther
s
sto
p
go
Section 9
Music Therapy Keys to Dementia Care
Section 1 66 Section 3
Ton
al/1
& 2
Cho
rd S
ong
s
Ste
ps
1. G
athe
r gr
oup
in a
circ
le.
2. S
how
res
iden
ts t
he t
one
bar
s an
d d
emon
stra
te h
ow to
us
e th
em. P
ass
out
mal
lets
and
the
n th
e to
ne b
ars.
3. D
emon
stra
te a
rhy
thm
(i.e
. slo
w a
nd s
tead
y, fa
st, l
oud
, so
ft, e
tc.)
4. T
hen
inst
ruct
res
iden
ts to
all
pla
y to
geth
er. S
ee s
ong
chor
d s
heet
s fo
r 1-
chor
d s
ong
s.
5. W
hen
resi
den
ts s
eem
com
fort
able
pla
ying
the
tone
b
ars,
sta
rt s
ingi
ng.
6. A
fter
sin
ging
, tak
e tim
e to
dis
cuss
the
mus
ic w
ith
resi
den
ts. L
iste
n an
d p
ract
ice
activ
e lis
teni
ng. Y
our
resp
onse
sho
uld
be
of a
pos
itive
nat
ure,
eve
n if
the
resi
den
t ha
d a
neg
ativ
e vi
ew.
7. R
epea
t st
eps
4-6.
8. T
ry 2
-cho
rd s
ong
s. C
NA
will
con
duc
t re
sid
ents
ac
cord
ing
to s
ong
shee
ts p
rovi
ded
by
mus
ic t
hera
pis
t.
Gro
up
Siz
e: S
mal
l (4
resi
den
ts)
Du
rati
on
: 30-
40 m
inut
esS
pec
ial E
qu
ipm
ent:
Set
of t
one
bar
s w
ith
mal
lets
, son
g ch
ord
she
ets
(for
CN
A o
nly)
, sm
all t
able
for
inst
rum
ents
n R
esid
ent
has
mid
-sta
ge d
emen
tia
n E
xhib
its s
ymp
tom
s of
wan
der
ing,
ag
itatio
n or
dep
ress
ion.
n R
esid
ent
show
s no
sig
ns o
f im
pro
vem
ent
afte
r 4
sess
ions
n B
ehav
ior
nega
tivel
y im
pac
ts
invo
lvem
ent
of o
ther
s
sto
p
go
Section 9
Music Therapy Keys to Dementia Care
Section 1 67Section 3
Mu
sic
& M
ovem
ent
Ste
ps
1. T
urn
on m
usic
: sel
ect
a m
ovem
ent
pla
ylis
t or
one
tha
t in
clud
es t
he r
esid
ents
’ fav
orite
mus
ic.
2. A
rran
ge g
roup
mem
ber
s in
a c
ircle
.
3. B
efor
e b
egin
ning
mov
emen
ts, e
mp
hasi
ze t
hat
each
res
iden
t sh
ould
onl
y d
o a
mov
emen
t if
com
fort
able
; ins
truc
t th
em to
le
t yo
u kn
ow if
the
y ex
per
ienc
e an
y d
isco
mfo
rt.
4. S
tart
the
mus
ic a
nd h
and
out
rhy
thm
inst
rum
ents
. M
ovem
ents
can
be
mad
e w
ithou
t in
stru
men
ts if
the
re
sid
ent
wis
hes.
5. C
all o
ut e
ach
mov
emen
t, t
hen
dem
onst
rate
it a
nd in
vite
re
sid
ents
to
join
. Enc
oura
ge r
esid
ents
to s
ugge
st t
heir
own
mov
emen
ts.
6. A
fter
10
-15
min
utes
, col
lect
rhy
thm
inst
rum
ents
and
tel
l re
sid
ents
you
will
now
co
ol d
own
with
sca
rves
.
7. H
and
out
sca
rves
, off
erin
g ch
oice
of c
olor
. Hon
or w
ishe
s,
if a
resi
den
t d
eclin
es t
o us
e a
scar
f. M
ovem
ents
can
be
per
form
ed fr
ee-h
and
ed.
8. In
stru
ct t
he r
esid
ents
to
take
a fe
w d
eep
bre
aths
and
to
follo
w y
ou a
s yo
u m
ake
slow
and
eas
y m
ovem
ents
.
9. A
fter
5-1
0 m
inut
es o
f slo
w a
nd e
asy
mov
emen
ts, c
olle
ct
scar
ves
and
the
n tu
rn o
ff m
usic
.
10. T
ake
a fe
w m
inut
es t
o d
iscu
ss t
he s
essi
on, t
hen
sa
y go
od
bye
.
Gro
up
Siz
e: S
mal
l (4-
6 re
sid
ents
)D
ura
tio
n: 2
0-30
min
utes
Sp
ecia
l Eq
uip
men
t: iP
od p
laye
r an
d
spea
kers
, chi
qui
tas,
egg
sha
kers
, jin
gle
bel
ls, s
carv
es
n R
esid
ent
has
mid
-sta
ge d
emen
tia
n E
xhib
its s
ymp
tom
s of
wan
der
ing,
ag
itatio
n or
dep
ress
ion.
n R
esid
ent’s
beh
avio
ral s
ymp
tom
s w
orse
n or
neg
ativ
ely
imp
act
invo
lvem
ent
of o
ther
res
iden
ts
n S
igna
ls a
des
ire to
leav
e
sto
p
go
Section 9
Music Therapy Keys to Dementia Care
Section 1 68 Section 3
Mu
sic-
assi
sted
R
ang
e-o
f-M
oti
on
Ste
ps
1. T
urn
on m
usic
: sel
ect
a m
ovem
ent
pla
ylis
t or
one
tha
t in
clud
es t
he r
esid
ent’s
favo
rite
mus
ic.
2. S
eat
the
resi
den
t in
a fi
rm c
hair
with
a s
trai
ght
bac
k.
3. In
itiat
e an
d fa
cilit
ate
rang
e-of
-mot
ion
exer
cise
s th
at
serv
e th
e re
sid
ent’s
ind
ivid
ualiz
ed p
lan
of c
are.
4. A
void
ris
k of
ove
r-ex
ertio
n b
y p
ayin
g cl
ose
atte
ntio
n to
th
e re
sid
ent’s
pos
ture
, fac
ial t
ensi
on a
nd v
erb
al r
epor
ts o
f
exha
ustio
n. A
dju
st o
r st
op t
he e
xerc
ises
and
mus
ic w
hen
app
rop
riate
.
5. If
the
res
iden
t re
sist
s en
gagi
ng in
the
exe
rcis
es,
red
irect
the
res
iden
t b
y d
iscu
ssin
g th
e m
usic
. You
may
w
ant
to p
ause
the
ran
ge-o
f-m
otio
n ex
erci
ses
until
the
re
sid
ent
seem
s le
ss r
esis
tant
.
Gro
up
Siz
e: O
ne r
esid
ent
Du
rati
on
: 5-2
0 m
inut
esS
pec
ial E
qu
ipm
ent:
iPod
pla
yer
and
sp
eake
rs, fi
rm c
hair
with
str
aigh
t b
ack
n R
esid
ent
has
mid
-sta
ge d
emen
tia
n S
how
s si
gns
of w
ithd
raw
al, p
oor
mo
od
n I
s re
sist
ant
to r
ehab
ilita
tion
pla
n ex
erci
ses
n D
eclin
e in
hea
lth p
rohi
bits
ra
nge-
of-m
otio
n ex
erci
ses
sto
p
go
Section 9
Music Therapy Keys to Dementia Care
Section 1 69Section 3
Mu
sic-
assi
sted
B
ath
/Sho
wer
Ste
ps
1. T
urn
on m
usic
for
resi
den
t 20
-30
min
utes
bef
ore
the
bat
hing
beg
ins:
sel
ect
a m
usic
-ass
iste
d c
are
pla
ylis
t or
on
e th
at in
clud
es t
he r
esid
ent’s
favo
rite
mus
ic.
2. In
form
the
res
iden
t th
at y
ou w
ill n
ow b
egin
the
bat
hing
, an
d a
sk if
the
mus
ic c
an c
ontin
ue.
3. If
yes
, or
if th
e re
sid
ent’s
agi
tatio
n ha
s no
t w
orse
ned
, le
t th
e m
usic
con
tinue
.
4. W
hile
bat
hing
the
res
iden
t, n
otic
e an
y ag
gres
sive
b
ehav
iors
or
gene
ral a
gita
tion
; if e
ither
incr
ease
s, d
irect
th
e re
sid
ent
to li
sten
to t
he m
usic
. If t
hey
cont
inue
to
incr
ease
, cha
nge
the
mus
ic t
o a
diff
eren
t tr
ack
or p
layl
ist.
If
the
aggr
essi
on o
r ag
itatio
n ris
es, t
urn
off t
he m
usic
.
Gro
up
Siz
e: O
ne r
esid
ent
Du
rati
on
: 30-
60 m
inut
esS
pec
ial E
qu
ipm
ent:
iPod
pla
yer
an
d s
pea
kers
n R
esid
ent
resi
sts
bei
ng b
athe
d
n D
isp
lays
agg
ress
ive
beh
avio
rs p
rior
to,
or d
urin
g, b
athi
ng/s
how
erin
g
n A
ggre
ssiv
e b
ehav
iors
do
not
imp
rove
ov
er t
he c
ours
e of
4 s
essi
ons
or w
orse
n th
roug
hout
2 s
essi
ons
sto
p
go
Section 9
Music Therapy Keys to Dementia Care
Section 1 70 Section 9
Mu
sic-
assi
sted
W
ou
nd
Car
e
Ste
ps
1. T
urn
on m
usic
20
-30
min
utes
bef
ore
wou
nd c
are
is
sche
dul
ed to
beg
in: s
elec
t a
mus
ic-a
ssis
ted
car
e p
layl
ist
or o
ne t
hat
incl
udes
the
res
iden
t’s fa
vorit
e m
usic
.
2. F
ive
min
utes
bef
ore
wou
nd c
are,
ask
the
res
iden
t if
th
e m
usic
can
con
tinue
.
3. If
yes
, or
if si
gns
of a
gita
tion
and
dis
com
fort
hav
e no
t w
ors
ened
, let
mus
ic c
ontin
ue a
s w
ound
car
e b
egin
s.
4. If
the
re is
an
incr
ease
in t
he r
esid
ent’s
sig
ns o
f phy
sica
l d
isco
mfo
rt o
r ag
itatio
n, d
irect
the
res
iden
t to
list
en t
o th
e m
usic
. If t
he s
igns
con
tinue
to
incr
ease
, cha
nge
the
mus
ic
to a
diff
eren
t so
ng o
r p
layl
ist.
If t
he s
igns
ele
vate
, tur
n
the
mus
ic o
ff.
Gro
up
Siz
e: O
ne r
esid
ent
Du
rati
on
: As
need
ed, p
rior
to a
nd d
urin
g w
ound
car
eS
pec
ial E
qu
ipm
ent:
iPod
pla
yer
and
sp
eake
rs, p
add
ing
arou
nd fl
oor
and
bed
n R
equi
res
inte
nse
wou
nd c
are
and
sho
ws
sign
s of
phy
sica
l dis
com
fort
or
exhi
bits
ag
gres
sive
beh
avio
rs d
urin
g w
ound
car
e
n R
esid
ent
says
no
to m
usic
at
any
time
n S
igns
of p
hysi
cal d
isco
mfo
rt o
r ag
gres
sive
b
ehav
iors
wor
sen
n R
esid
ent
show
s no
imp
rove
men
t in
phy
sica
l d
isco
mfo
rt o
r b
ehav
iors
aft
er 3
diff
eren
t at
tem
pts
sto
p
go
Music Therapy Keys to Dementia Care
Section 1 71Section 9
Section 10
Music Intervention Questionnaire
Music Therapy Keys to Dementia Care
Section 1 72
Music Therapy Keys to Dementia Care
Section 1 73
1. Peggy is throwing her food again and agitating other residents. What kind of music should you offer Peggy to reduce her throwing behaviors?
a. Slow, instrumental music
b. Peggy’s favorite songs
c. Music that you find calming
d. All of the above
2. Russell is refusing to get out of bed this morning. He is having difficulty getting motivated. Name three items from the movement protocol that you should use to motivate Russell.
1.
2.
3.
3. Lacy repeatedly wanders around the nursing station, calling for a nurse. You checked her for pain and other signs of discomfort. Which protocol do you use to help reduce her wandering, and why? What playlist would you chose from the iPod?
Music Intervention Questionnaire
SECTION 10
Section 10
Music Therapy Keys to Dementia Care
Section 1 74 Section 10
4. Name two of your residents with whom you can use each protocol:
a. Tonal
b. Movement
c. Bathing
d. Wound Care
Choose an iPod playlist for each resident.
Music Therapy Keys to Dementia Care
Section 1 75Section 9
SECTION OPENERSection 11
Music Intervention Questionnaire Answers
Music Therapy Keys to Dementia Care
Section 1 76
Music Therapy Keys to Dementia Care
Section 1 77
SECTION 11
Music Intervention Questionnaire Answers
1) Peggy is throwing her food again and agitating other residents. What kind of music should you offer Peggy to reduce her throwing behaviors?
a. Slow, instrumental music
b. Peggy’s favorite songs
c. Music that you find calming
d. All of the above
The correct answer is d. The best approach is to sing or play Peggy’s favorite song that is slow and calming. Music that is slow in tempo can reduce the state of agitation for everyone in the room, especially Peggy.
2) Russell is refusing to get out of bed this morning. He is having difficulty getting motivated. Name three items from the movement protocol that you should use to motivate Russell.
The correct answers are rhythm instruments, scarves or other props, as well as iPod and speakers.
3) Lacy repeatedly wanders around the nursing station, calling for a nurse. You checked her for pain and other signs of discomfort. Which protocol do you use to help reduce her wandering, and why? What playlist would you chose from the iPod?
The correct answer is Music & Movement. The use of this playlist requires minimal set-up and can be facilitated on a one-to-one basis. It is best to use a playlist that involves moderately slow to upbeat music that represents the culture of the resident that you are working with.
4) Name two of your current residents with whom you can use each protocol:
Sample answers:
a. Tonal Beth Tonal
b. Movement Joseph Music & Movement
c. Bathing Beth Music-assisted Bathing
d. Wound Care Joseph Music-assisted Wound Care
Section 11
Music Therapy Keys to Dementia Care
Section 1 78
This project was made possible through a grant from the New York State Department of Health. Continued funding for
this program provided by MJHS Foundation.
Mary Mittelman, DrPH, of New York University’s Langone Medical Center’s Center of Excellence on Brain Aging provided
scientific oversight of the project. Suzanne Fitzsimmons, Nurse Practitioner, of University of North Carolina, provided
clinical guidance and supervision.
For more information on music therapy call 1-855-241-4313
MJHS Foundation provides financial assistance for the charitable efforts of MJHS and its affiliated agencies.
The philanthropic spirit of The Four Brooklyn Ladies has been a cornerstone and guiding philosophy of MJHS for more than 100 years. The culture of philanthropy they inspired led to the formation
of MJHS Foundation, which has been instrumental in raising the funds necessary for the provision of charitable health care as well as the development of innovative services and programs to serve our growing community. The extraordinary efforts of MJHS would not be made possible without grants
from MJHS Foundation, which relies on the support of generous donors like you and employees through
the Employee Giving Campaign.
www.mjhs.org (855) 860-0981
MJHS does not discriminate against any person on the basis of race, color, national origin, disability, gender or age in admission, treatment, or publication in it’s programs, services, and activities or in employment. For further information about this policy, contact the MJHS Compliance Officer at 718-921-8400.