Applications of Clinical Improvisation and Aesthetic Music Therapy in Medical Settings: An Analysis of Debussy’s ‘L’isle joyeuse’

2014 ◽  
Vol 6 (2) ◽  
pp. 61
Author(s):  
Colin Andrew Lee ◽  
Amy Clements-Cortés
Keyword(s):  
Clinical Outcome ◽  
Music Therapy ◽  
Clinical Outcomes ◽  
Changing Environment ◽  
Music Therapists ◽  
Medical Settings ◽  
Clinical Improvisation ◽  
Medical Music Therapy ◽  
Musical Process

The application and use of clinical improvisation is an important technique in medical music therapy. Through the analysis of Debussy’s ‘L’isle joyeuse’ this study aims to provide the beginnings of a new way of working within a music-centered philosophy for music therapists in medical settings. The piece is divided into eight sub-sections, offering practical suggestions for how the music can be adapted and used for specific clinical outcomes. Each analysis may be used separately to create smaller improvisations or collectively in varying combinations, to create larger improvisations. Throughout the study connections are made between musical process and clinical outcome. Due to the transparent and ever-changing environment of patient’s experiences in hospital settings, the potential for the free-flowing form of improvisation is emphasized as an important clinical technique. This paper offers a contemporary and musically scientific view of clinical improvisation in medical settings.

scholarly journals A Survey of Music Therapists Working in Pediatric Medical Settings in the United States

2020 ◽  
Vol 57 (1) ◽  
pp. 34-65 ◽  
Author(s):  
David Knott ◽  
Marial Biard ◽  
Kirsten E Nelson ◽  
Stephanie Epstein ◽  
Sheri L Robb ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care ◽  
Clinical Practice ◽  
Service Delivery ◽  
Music Therapy ◽  
The United States ◽  
Survey Study ◽  
Music Therapists ◽  
Medical Settings ◽  
Music Therapist

Abstract Music therapy is becoming a standard supportive care service in many pediatric hospitals across the United States. However, more detailed information is needed to advance our understanding about current clinical practice and increase availability of pediatric music therapy services. The purpose of this cross-sectional survey study was to collect and summarize data about music therapists working in pediatric medical settings. Specifically, we collected information about (1) therapist demographics, (2) organizational structure, (3) service delivery and clinical practice, and (4) administrative/supervisory responsibilities. Board-certified music therapists working in pediatric medical settings (n = 118) completed a 37-item online questionnaire. We analyzed survey data using descriptive statistics and content analysis. Findings indicated that there is a ratio of approximately one music therapist for every 100 patient beds, that one-third of respondents are the only music therapist in their setting, and that half of the surveyed positions are philanthropically funded. Prioritizing patient referrals based on acuity was common (95.7%, n = 110), with palliative care and pain as the most highly prioritized needs. More than half of respondents reported serving in high acuity areas such as the pediatric intensive care, hematology/oncology, or neonatal intensive care units. We recommend replication of this survey in five years to examine growth and change in service delivery among pediatric music therapists over time, with additional studies to (a) explore how therapist-to-patient ratios influence quality of care, (b) identify factors that contribute to sustainability of programs, and (c) determine how expansion of services support a broader population of patients and families.

Using the Evidence Based Medicine Framework to Support Music Therapy Posts in Healthcare Settings

2002 ◽  
Vol 16 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Jane Edwards
Keyword(s):  
Music Therapy ◽  
Evidence Based Medicine ◽  
Clinical Effectiveness ◽  
Evidence Based ◽  
Music Therapists ◽  
Medical Settings ◽  
The Past ◽  
Healthcare Settings ◽  
Research Findings ◽  
Based Medicine

The Evidence Based Medicine (EBM)1 framework has been incorporated into the field of healthcare practice over the past decade. Whatever our stance as to its benefits and disadvantages, more and more music therapists in health departments and related clinical posts will be asked to account for their work using this approach to the documentation of clinical effectiveness. It is important that music therapists working within clinical service guidelines understand the framework of EBM and are aware of ways in which they can include its precepts in their justifications for practice and posts. The levels of evidence in an EBM approach are presented and discussed and the issues particular to the application of music therapy research findings are explored. Given the author's experience in paediatric medical settings, some of the examples in this paper will refer to the children's hospital context in particular.

Researching Music Therapy in Medical Settings

2015 ◽  
Author(s):  
Cynthia M. Colwell
Keyword(s):  
Music Therapy ◽  
Physiological Responses ◽  
Muscle Tension ◽  
Medical Procedures ◽  
Music Therapists ◽  
Medical Settings ◽  
Developmental Regression ◽  
Therapy Interventions ◽  
The Impact

Research has indicated that music therapy is effective in hospital contexts for managing pain, reducing anxiety, ameliorating social isolation, slowing the impact of cognitive or developmental regression or delays, expressing emotions, and altering physiological responses as medically needed. Music can impact physiological responses including heart rate, blood pressure, pulse oxygenation, pain indicators, respiration, muscle tension, cardiac output, and immunologic function. Participation in music therapy interventions can improve treatment adherence, reduce deleterious symptoms of diseases and effects of medical procedures, and generally enhance quality of life in an unfamiliar and potentially unappealing environment. This chapter will describe a sample of how music therapists have conducted research in medical contexts and will present ways in which such research can be planned and undertaken.

Introducing Music Therapy to Hospitalized Adults in Medical Settings: A Thematic Analysis

2021 ◽  
Author(s):  
Chantise J Hunt ◽  
Michael J Silverman
Keyword(s):  
Music Therapy ◽  
Thematic Analysis ◽  
Future Research ◽  
Structured Interviews ◽  
Ethical Considerations ◽  
Music Therapists ◽  
Medical Settings ◽  
Music Therapist ◽  
Live Music ◽  
Clinical Benefits

Abstract Music therapy can decrease illness- and treatment-related symptoms for adults in medical settings. In these environments, service users often decide to accept or decline music therapy after a brief introduction by the music therapist. As there is limited literature exploring the challenges related to these introductions, the purpose of this interpretivist study was to describe how music therapists introduce music therapy in the form of patient-preferred live music (MT-PPLM) in adult medical settings to augment the likelihood of patients accepting treatment. We conducted semi-structured interviews with nine participants who had experience providing MT-PPLM in adult medical settings. In this exploratory interpretivist study, we used an inductive approach to thematic analysis and incorporated member-checking to augment trustworthiness and credibility of the results. We identified three themes (supported by eight subthemes depicted in parentheses): (A) Offer patient a unique interaction through verbal and nonverbal techniques (Provide opportunities for patient control; Engage patient through nonmedical dialogue; and Use affect and body language to convey a different demeanor); (B) Clarify expectations related to patient and session (Avoid the word “therapy”; Use the music to explain the intervention; and Mention clinical benefits to describe what the patient can expect from the session); and (C) Respond to patient’s verbal and nonverbal communication (Assess patient and adapt introduction; and Validate patient’s response). The findings offer introductory techniques for music therapists that may increase the likelihood of adults in medical settings accepting MT-PPLM. Implications for clinical practice, ethical considerations, limitations, and suggestions for future research are provided.

scholarly journals Listening in the Ambient Mode: Implications for Music Therapy Practice and Theory

2014 ◽  
Vol 14 (2) ◽  
Author(s):  
Michael Viega
Keyword(s):  
Music Therapy ◽  
Clinical Outcomes ◽  
Raw Materials ◽  
Liminal Space ◽  
Music Therapists ◽  
Ambient Music ◽  
Theoretical Paper ◽  
Mode Of Being ◽  
Function Structures

This theoretical paper explores the function, structures, and experience of listening to and creating ambient music, and encountering the ambient mode of being (Jaaniste, 2007). In the ambient mode of being, a listener becomes immersed in the raw materials of sonic environments (soundscapes) and nomadically shifts awareness across the terrains of these environments- simultaneously experiencing being in a liminal space and grounded in the here-and-now. For music therapists this might mean navigating and attuning to the lo-fidelity soundscapes in various levels of health and helping people achieve hi-fidelity and clarity on individual, community, cultural, and spiritual levels of existence. The ambient mode of being suggests that music therapists can access these levels simultaneously by entering into a creative state of listening in which pervasive ambience becomes salient within the musical relationships built in music therapy. Implications of the ambient mode of being for music therapy practice and theory will b be explored. Clinical outcomes related to encountering the ambient mode of being are discussed including capturing distant or forgotten parts of one’s self and making them salient again.

Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

2020 ◽  
Author(s):  
Jung-Won Lim ◽  
Yong-Beom Park ◽  
Dong-Hoon Lee ◽  
Han-Jun Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Functional Score ◽  
Manipulation Under Anesthesia ◽  
Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

Clinicopathological and Imaging Features Predictive of Clinical Outcome in Metaplastic Breast Cancer

2020 ◽  
Vol 16 (6) ◽  
pp. 729-738
Author(s):  
Ga Young Yoon ◽  
Joo Hee Cha ◽  
Hak Hee Kim ◽  
Hee Jung Shin ◽  
Eun Young Chae ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Tumor Size ◽  
Multivariable Analysis ◽  
Disease Free Survival ◽  
Imaging Features ◽  
Peritumoral Edema ◽  
Imaging Findings ◽  
Metaplastic Breast Cancer

Background: Metaplastic breast cancer (MC) is a rare disease, thus it is difficult to study its clinical outcomes. Objective: To investigate whether any clinicopathological or imaging features were associated with clinical outcome in MC. Methods: We retrospectively evaluated the clinicopathological and imaging findings, and the clinical outcomes of seventy-two pathologically confirmed MCs. We then compared these parameters between triple-negative (TNMC) and non-TNMCs (NTNMC). Results: Oval or round shape, and not-circumscribed margin were the most common findings on mammography, ultrasound (US), and magnetic resonance imaging (MRI). It was mostly a mass without calcification on mammography, and revealed complex or hypoechoic echotexture, and posterior acoustic enhancement on US, and rim enhancement, wash-out kinetics, peritumoral edema, and intratumoral necrosis on MRI. Of all 72, 64 were TNMCs, and eight were NTNMCs. Clinicopathological and imaging findings were similar between the two groups, except that MRI showed peritumoral edema more frequently in TNMCs than NTNMCs (p=0.045). There were 21 recurrences and 13 deaths. Multivariable analysis showed that larger tumor size and co-existing DCIS were significantly predictive of Disease free survival (DFS), and larger tumor size and neoadjuvant chemotherapy were significantly predictive of overall survival (OS). Conclusion: MC showed characteristic imaging findings, and some variables associated with survival outcome may help to predict prognosis.

scholarly journals Deep phenotyping classical galactosemia: clinical outcomes and biochemical markers

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Mendy M Welsink-Karssies ◽  
Sacha Ferdinandusse ◽  
Gert J Geurtsen ◽  
Carla E M Hollak ◽  
Hidde H Huidekoper ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Newborn Screening ◽  
Clinical Outcomes ◽  
Movement Disorders ◽  
Brain Mri ◽  
Primary Ovarian Insufficiency ◽  
Ovarian Insufficiency ◽  
Classical Galactosemia ◽  
Intellectual Outcome

Abstract Early diagnosis and dietary treatment do not prevent long-term complications, which mostly affect the central nervous system in classical galactosemia patients. The clinical outcome of patients is highly variable, and there is an urgent need for prognostic biomarkers. The aim of this study was first to increase knowledge on the natural history of classical galactosemia by studying a cohort of patients with varying geno- and phenotypes and second to study the association between clinical outcomes and two possible prognostic biomarkers. In addition, the association between abnormalities on brain MRI and clinical outcomes was investigated. Classical galactosemia patients visiting the galactosemia expertise outpatient clinic of the Amsterdam University Medical Centre were evaluated according to the International Classical Galactosemia guideline with the addition of an examination by a neurologist, serum immunoglobulin G N-glycan profiling and a brain MRI. The biomarkers of interest were galactose-1-phosphate levels and N-glycan profiles, and the clinical outcomes studied were intellectual outcome and the presence or absence of movement disorders and/or primary ovarian insufficiency. Data of 56 classical galactosemia patients are reported. The intellectual outcome ranged from 45 to 103 (mean 77 ± 14) and was &lt;85 in 62%. Movement disorders were found in 17 (47%) of the 36 tested patients. In females aged 12 years and older, primary ovarian insufficiency was diagnosed in 12 (71%) of the 17 patients. Significant differences in N-glycan peaks were found between controls and patients. However, no significant differences in either N-glycans or galactose-1-phosphate levels were found between patients with a poor (intellectual outcome &lt; 85) and normal intellectual outcome (intellectual outcome ≥ 85), and with or without movement disorders or primary ovarian insufficiency. The variant patients detected by newborn screening, with previously unknown geno- and phenotypes and currently no long-term complications, demonstrated significantly lower galactose-1-phospate levels than classical patients (P &lt; 0.0005). Qualitative analysis of the MRI’s demonstrated brain abnormalities in 18 of the 21 patients, more severely in patients with a lower intellectual outcome and/or with movement disorders. This study demonstrates a large variability in clinical outcome, which varies from a below average intelligence, movement disorders and in females primary ovarian insufficiency to a normal clinical outcome. In our cohort of classical galactosemia patients, galactose-1-phosphate levels and N-glycan variations were not associated with clinical outcomes, but galactose-1-phosphate levels did differentiate between classical and variant patients detected by newborn screening. The correlation between brain abnormalities and clinical outcome should be further investigated by quantitative analysis of the MR images. The variability in clinical outcome necessitates individual and standardized evaluation of all classical galactosemia patients.

Ethical Issues in Private Practice: A Phenomenological Investigation of Music Therapy Business Owners

2021 ◽  
Author(s):  
Kyle Wilhelm ◽  
Lindsey Wilhelm
Keyword(s):  
Music Therapy ◽  
Private Practice ◽  
Phenomenological Study ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
The United States ◽  
Business Owners ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Music Therapists

Abstract As a music therapy private practice is both a business and a healthcare service, it should adhere to ethical standards from both disciplines. However, this topic has rarely been examined in the music therapy literature. The purpose of this phenomenological study was to explore ethical dilemmas experienced by music therapy business owners (MTBOs) in their private practice and how MTBOs avoid or address ethical dilemmas. Utilizing convenience and snowball sampling techniques, 21 MTBOs in the United States were interviewed using semi-structured interviews. To answer the two areas of inquiry, we identified three themes and 12 subthemes: (1) Ethical issues related to client welfare, (2) Ethical issues related to business relationships and operation, and (3) Strategies to address or avoid ethical dilemmas. MTBOs also shared how they ensure ethical behavior in themselves, with their employees or independent contractors, and when interacting with professionals outside the private practice. These findings provide a better understanding of MTBOs’ lived experiences of ethics in their private practice and may benefit other music therapists who are in private practice or are wanting to go into private practice. Limitations and recommendations for further research are provided.

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