To the Editor:
I read with interest the recent article by Dr Nahama Glynn on "The Music Therapy Assessment Tool" (Journal of Gerontological Nursing. 1992; 18(l):3-9). I have been a practicing music therapist for 12 years and I am currently a doctoral candidate in human development at the University of Maryland. My dissertation will focus on the development of a music-based assessment instrument for use with frail elderly individuals.
Of particular concern was Dr Glynn's statement that "no specific reference has been found in the literature regarding the use of music as a therapeutic modality with Alzheimer's patients." Your readers should be aware that a research base in this area is being developed. For example, the research of Clair and Bernstein (199Oa) has shown that despite continued physical, social, and cognitive decline, individuals with Alzheimer's dementia can continue to function successfully in structured music group experiences. They have also demonstrated that duration of various types of responses (ie, vibrotactile, nonvibrotactile, and singing) differ significantly (Clair, 1990b).
Millard and Smith (1989) found that a therapeutic singing group increased designated social and physical behaviors. Smith (1986) found that selected music activities increased cognitive performance as measured by the MMSE (Folstein, 1975). In a study by Prickett and Moore (1991), individuals with Alzheimer's dementia demonstrated greater accuracy in tasks requiring recall of words to familiar songs versus tasks requiring recall of spoken words alone. Responses to tasks incorporating music and movement have been described (Shively, 1986), and a case study approach has been used to report reality-based responses to musical stimuli in an individual severely impaired with Alzheimer's dementia (Lipe, 1991).
From a music therapy perspective, certain methodological difficulties were encountered with this study, such as the rationale for choice of music and for method of presentation of musical stimuli. Certain questions can also be raised about the validity of the Richardson's Nursing Observation Guide as a basis for such an assessment. Specifically, what is the assessment conveying about the relationship between responses to musical stimuli and functional level?
In the event that the Journal plans to continue to publish articles pertaining to music and the elderly, I suggest that a qualified music therapist be recruited to serve on the Journal's Editorial Review Board. Such an individual would be sensitive to these types of issues and would ensure that prospective contributors are also sensitive to them, thus maintaining high standards in published research.
Clair, A., Bernstein, B. A preliminary study of music therapy programming for severely regressed persons with Alzheimer's-type dementia. Joumal of Applied Gerontology 1990a; 9:299-311.
Clair, A., Bernstein, B. A comparison of singing, vibrotactile and nonvibrotactile instrumental playing responses in severely regressed persons with dementia of the Alzheimer's type. Journal of Music Therapy 1990b; 27:19-125.
Folstein, M., Folstein, S-, McHugh, R Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189-198.
Lipe, A. Using music therapy to enhance quality of life in a client with Alzheimer's dementia: A case study. Music Therapy Perspectives 1991; 9:102-105.
Mulard, K., Smith, J. The Influence of group singing therapy on the behavior of Alzheimer's disease patients. Journal of Music Therapy 1989; 26:58-70.
Prickett, C., Moore, R. The use of music to aid memory of Alzheimer's patients. Journal of Music Therapy 1991; 28:101-110.
Shively, C, Henkin, L. Music and movement therapy with Alzheimer's victims. Music Therapy Perspectives 1986; 3:56-58.
Smith, G. A comparison of the effects of three treatment interventions on cognitive functioning of Alzheimer patients. Music Therapy 1986; 6A:41-56.
Anne Lipe, MM, RMT-BC
The Author Responds:
Initially, I would like to thank Ms Lipe, who has taken time out from the development of her own music-based tool with the elderly to comment on my recent article in the Journal. Unfortunately, when I conducted my last literature search just prior to submitting my manuscript for publication, none of the articles to which Ms Lipe refers in her letter were listed. It is very heartening that the recent research with Alzheimer's patients and the use of music has demonstrated that individuals with Alzheirner's disease can continue to function successfully in structured music group experiences. This is especially so because the Music Therapy Assessment Tool (MTAT) has not yet been used to quantify the actual interplay of biopsychosocial dimensions of Alzheimer's patients within their environment. It should be remembered that the MTAT was designed and developed primarily by nurses to measure this interaction.
My article clearly explains the rationale behind the selection of the music. Melodies with distinct rhythmic patterns were chosen to enhance behavioral repatterning; familiar music was selected to facilitate communication and socialization; and ethnic and nostalgic melodies were used to stimulate recall and reminiscence. Rationale for their use was appropriately documented from the current literature.
The MTAT was also designed and developed to facilitate research that is aimed at defining particular nursing interventions that would maximize the Alzheimer's disease patient's quality of life. It should be stated that the use of music as a therapeutic modality is both a feasible and viable nursing care intervention. Because nurses do not claim to be music therapists, nor are all nurses accomplished singers or instrumentalists capable of presenting and performing live music to their patients, a means of delivering the music in a clear and appropriate manner using fine quality stereophonic equipment was found.
Nahama J. Gfynn, EdD, RN
Georgia State University
School of Nursing