Harp Accompaning The Singing Voice

This project is dedicated to M. C.
who was a resident at the center
and who was my cheer leader,
“I love the harp music”, she would tell me every time I played in the Health Care Center.

Introduction

Playing my harp for older adults at a Pennsylvania senior facility seems to bring them pleasure, smiles and comfort. For over a year once a week I play melodies and songs for residents in two levels of care.

The Health Care Center residents require complete care and the Personal Care Unit residents are independent but need assistance. The majority of residents in both units have varying stages of dementia also called ADRD (Alzheimer’s disease and Related Disorders). There are several who have physical disabilities with degrees of dysfunction physically and cognitively. There are many with medical issues such as stroke, cardiovascular disease and physical decline and those receiving palliative care. For the wide variety of men and women with many types of conditions and medical issues, harp therapy seems to be appreciated and a service provided that is needed to increase wellbeing, quality of care, enjoyment and meaning to each individual.

In the fall, I purchased Edie Elkan’s book, Strike The Harp and Join the Chorus!
I consulted with Edie about my Master Practicum Project in January, 2012. I decided that my project would be to play chords and have the residents sing. After three teaching sessions I learned to play some of the chords that accompanied selected songs. I created the Observed Reaction Scale to measure how residents react to singing the songs with live harp accompaniment, and measured the reactions using the following domains: physical, cognitive, social and emotional.

Purpose

To discover how individuals between the ages of 80 to 100 with varying stages of dementia respond to familiar songs with live harp accompaniment.

Goal

To play at least six to eight familiar songs for residents who are in two different care units to compare the results and to observe their physical, cognitive, social and emotional responses while participating in a group setting.

Objectives

• to provide thirty (30) minute program
• to explain to the residents what the session is about
• to distribute song booklets to each person
• to encourage individuals to enjoy participating
• to give choices for songs
• to share history about specific pieces of music
• to observe the reaction of each individual using the Observed Reaction Scale

Literature Review

Researchers state in journals, books and periodicals that listening and singing to music are beneficial activities for older adults. They have found that music stimulates memory and provides meaning and a quality of life. Research and studies have increased within the last 20 years with emphasis and understanding that music is restorative to some degree for individuals with various types of dementia and ADRD (Alzheimer ’s Disease and Related Disorders).

What is dementia (Alzheimer’s Disease)?

It is a chronic progressive disease for individuals diagnosed with the loss of mental functions such as thinking, memory and reasoning. As the disease progresses there is disorientation to time, place and person. There is memory loss that affects daily tasks, problems with language, poor judgment, abstract thinking, and changes in mood, personality, behavior and loss of initiative. (WebMD)

Isolation is a big problem with these individuals. Loosing the ability to communicate creates loneliness, the inability to make choices, decrease sensory awareness, cognitive decline and physically inactive. In other words the physical, mental (cognitive), spiritual, emotional, and social factors become dysfunctional and disconnected due to the illness.

An individual may linger for many years depending on the type of dementia. There are various reasons for dementia; stroke, head injury, alcohol and drugs, vascular and circulatory disease, tumors, Lewy Body disease and Pick’s disease, AIDs, and nutritional deficiencies. Alzheimer’s disease causes 50 to 70% of all dementias and late stage AD includes almost half of those over the age of 85. (Cleveland Clinic/Web MD,1/31/05)

What are scientific findings?

Neuroscientists suggest that not all areas of the brain are affected with the disease at the same time. The prefrontal cortex is one of the last areas involved. The left is found to help with listening, language and movement. The right is involved with processing pitch, sound, identification of intensity and chords, melody and singing. The cerebellum (old brain) remains dominate where elements of music are preserved such as time, pitch and rhythm. Researchers are finding more information about the brain and discovering that both hemispheres are associated with music. That the elements of music, harmony, melody loudness, meter, pitch rhythm (timing) are still recognized by the brain. Aldridge, D., Levitin, D., Feinstein, M., (Institute for Music and Neurologic Function)

What happens to older adults with dementia and ADRD?

Diagnosis and testing determine the degree of dementia. At a certain point in the course of the disease an individual may be unable to speak or find the correct words to express feelings and needs. There is a decrease in sensory awareness such as hearing, olfactory, sight, tactile and taste. Often they are confused about whether it is night or day, what season they are in, lack of understanding, unable to problem solve, read, they constantly wander or are immobile and seem agitated and disorientated. And finally physiological systems fail and they succumb to death.
(Aldridge, D.)

Why do individuals respond to music and singing familiar songs?

In the early years of life one acquires a taste for the music they enjoy. Usually it is acquired very early and probably when they are in the teenage years. And these musical choices are “a vehicle for social bonding and cohesion. Emotional connection at this stage in life is strongest and the brain tags the emotional importance”. .” (Levitin p. 231-234) Emotions strengthen connections. Therefore, using familiar music that was once learned triggers memory, words and speech. One of the last remaining feelings for those with dementia is emotion. They can be highly sensitive and aware of feelings, ie. music and emotions.

What are the benefits of music and singing?

Music especially familiar songs increase focus, improve cognitive skills, self expression, awareness of self and others and reduces agitation. To increase focus use of rhythm has been beneficial because anticipation of the next beat is stimulating and is one of the elements in music that is most helpful in increasing speech and singing words. Interestingly, keeping the beat of a song with improvisation techniques using drum and stick is one method that researchers have found that helps stimulate the brain.

Singing embraces the past and memories begin to flow when the sound triggers emotional connections. The benefits of listening and singing aid the physical, mental, social and emotional qualities of a person.
For example music and singing,

• captivates and maintains attention
• stimulates and utilizes many parts of the brain
• easily adaptable for the person’s ability, success oriented for people from all abilities can participate
• aids memory and emotions
• supports and encourages movement
• social context; verbal and nonverbal
• choices give the individual increase control and autonomy
• attention and recall improves,
• agitation and wondering decreases,
• depression decreases,
• increases relaxation and enjoyment,
• control breath and pronunciation,
• singing with others brings a feeling of unity and identity,
• music, singing and the silences with in it provide verbal and nonverbal immediate feedback,
• stimulates and changes mood, thinking,
• physiology body chemistry changes, and
• increased orientation to events, seasons, people and places
  Eldridge D. Clair A.A.

In conclusion, the deficits associated with memory loss can be engendered with live harp music when older adults enjoy singing familiar songs. It restores a part of memory that had been lost. The vibrations of the harp are soothing, reducing stress and anxiety. Sand-Jeckin K., Emerson H., Rossa S. Dowdy A. et al.

Procedure

I provided live harp songs for two enhanced living units
After the introduction I said, “Join me in a song, we will be singing songs together as I accompany you with my harp”.

Group A:
Residents (10) were seated in the activity room.
I distributed song books that contain 15 songs. The songs that were provided in the booklet were familiar ones. This included songs that are usually familiar for this group. I asked for the residents to choose a song that they would enjoy singing.

Group B:
Residents (5) were asked if they would enjoy some music. They were seated in the gathering room. The residents were involved one-on-one with the harpist and the activity director. Song books were not distributed; rather, there was an introduction to each song by playing the melody or singing the song. Residents were asked questions about the songs, the melodies and words.

The Observed Reaction Scale was use for both groups. Appendix A

Observations & Results

Group A: (Assisted Living)
One interesting finding was that by playing one sting at a time, the residents were able to hear and follow the rhythm. Sometimes, I would begin the song and sing it until they recalled the melody and words. Then I accompanied with the harp chords, I IV and V. Sometimes we clapped to the rhythm.

It seemed that the favorite song to begin the session was The More We Get Together. In fact, I had trouble keeping up with this group as they began to sing especially as the group’s rhythm and off key expressions progressed. At times it was easier to play the complete melody. The residents began with song one (1) in the booklet and with the stories about the song history and conversations between songs we completed about six.

The Observed Reaction Scale indications follow. See Appendix B
Physically most everyone smiled, eyes were open and more than half moved arms, legs, waved hands, and half tapped foot or clapped. No one got up and danced!

Cognitively 80% sang, hummed or said the words, 50% knew the names of the songs and 40% suggested other songs. Example: Mairzy Doats, Edelweiss ( and they sang as I played the melody), and church songs were suggested. However, one lady sings in French beautifully Alouette and Frere Jacques. She loves to sing La Vie en Rose with accompaniment.

Socially, half or more of this group shared thoughts, conversations with others, individual responses and sang with the group.

Emotionally most everyone was alert, calm, laughed and seemed focused. One person was distracting the group by talking loud and making comments.

Group B: (Health Care Center)
This small group was able to listen and with cues encourage to sing. One gentleman raised his head and waved his hands in time with the music as I played. He spoke to me when I asked him about the songs. Another lady smiled and sang along as I play and seemed to enjoy knowing the melody and words. A resident that never seemed to speak and is legally blind responded to the song I’ve Been Working On the Railroad and sang the verses with me. Another lady continued to talk and listened when I played and sang Jesus Loves Me. One resident closed her eyes and seemed to listen, say the words of the song and when asked if she enjoyed the sound of the harp replied “yes”.

Other subjects could have been added to this group. However, due to the lack of assistance and configuration of the room this was not possible.

I play for the HCC every week for one hour. I can say that the sample in this project represents the Health Care residents and the amount of independent attention that each resident requires in order for them to participate. There definitely is response by most to the live harp music. As I observe, I can see their eyes brighten, their posture improve by sitting up straight and listenin (focused)g, verbal response, and often moments of relaxation and calming.

The Observed Reaction Scale indications follow. See Appendix C
Physically the reaction to the songs was more physical.
Arms and legs moved and feet tapped. Residents were awake, alert and watched as I played.

Cognitively residents in this group were not as verbal but acknowledged the music by humming. For example; one gentleman shook his head up and down when asked if he knew the song.

Socially the resident would speak when cued with the activity director and harpist, but not to each other.

Emotionally the residents were alert, calm and peaceful. However, one lady seemed distracted with her personal conversation which affected the others as observed by the activity director.

Conclusion

As a harp therapist I found that when I play for individuals with varying degrees of dementia that melodies and songs stimulate some part of the person. They seem to keep eyes open, smile, respond physically although small movements of hands, arms and legs, verbalize when prompted (Group B), and seem to be calm and relaxed.

In comparing the two groups there are positive responses to live harp music. I believe that the residents recognize the melodies and words of familiar songs. I recognized that resident’s seeing the harp and hearing the life harp music created response both physically and cognitively (verbally).

The A Group was more functionally able to participate by singing songs along with the harp even though most were in early stages of dementia. They listened as I told them the stories about the origin of the songs.

The B Group was less able to participate as a group singing together, but there was more physical response and verbal reaction especially when I gave individual attention to each person. I mentioned the stories about the songs in a few words when it was appropriate. Attention span seemed to be short for this group.

To Access The Appendices & References, Please Download The Word Document