A case (study) for hospital-based music therapy

When I met three year old Mia (name changed), she had been crying in her room for a few hours and I think I was sent in as the nurse’s last resort. I demonstrated both a tambourine and a shaker and handed them to her, both of which she threw. Then I started playing my guitar and she calmed down. When I started singing a song- “Here Comes the Sun”, I think, she started screaming again and I quickly switched back to instrumental music knowing that she might be overstimulated. Eventually, she fell asleep.

In our second session, the nurse referred me to her again with more specific requests. Mia had a brain injury and had a team of therapists trying to help her speak, move, and find comfort. Noticing that she took well to the music, they hoped I’d be able to connect with her further and get her to participate more than saying “no”. This is a great referral- a child with specific goals who’s had difficulty responding to therapies. When I first started at the hospital a few years back, staff would say, “Music lady’s here!” and then find the happiest kids, sometimes siblings of patients, to join the music group. It was fun, and the kids definitely got some energy out, but we weren’t always addressing any specific goals or objectives- and that’s what makes music therapy different from a volunteer performing playing in the lobby (which is also highly beneficial!). I had a great session in Mia's room, making up songs with vowel sounds so she could practice speech- she could only handle one person at a time, so our sessions were one-on-one and she also had speech, OT, PT, and probably others. We met a few times for music therapy.

This morning I saw Mia as soon as I walked onto the children’s floor- a nursing student was pushing her up and down the hallways, the only thing that seemed to keep her calm. When she stopped in the playroom, Mia would cry out for more motion. I waited til they were back in her room and then I took out my guitar to do a session with Mia. It was time for OT (occupational therapy) and the OT (an incredibly calm and effective therapist) said Mia hated the OT room and she’d come back when I was done so that she might be a bit calmer. I offered to play quiet music in the background during OT. Here’s the thing: Were I still working in New York, where music therapy was an integral part of the care team, this would have been poorly worded and therefore dismissed. But in Maine, where many of the staff don’t know me and may never have heard of music therapy, if I offer to “co-treat”, it often sounds like I’m overstepping or they just can’t imagine what that would look like. So background music is a safe introduction to get in the room when you know a client will benefit.

The OT, PT, nursing student and I went into the occupational therapy room with Mia in her wheelchair. Mia was already agitated just being there so I started playing guitar- a loudly strummed B7 chord, to catch her attention, and then landing on the E and moving it up the neck for new voicings. She watched me and reached out, so I scooted closer to her. Mia strummed the guitar up and down and laughed. I said, “Wow Mia, what a cool room we’re in!” and pointed out some of the colors in the room. The other staff members joined in and we improvised a song about the colorful tools in the room- balls, weights, toys. We brought a ball into play, which she was given and a basketball hoop was pulled closer for her to throw it into. At first Mia didn’t want the ball, but the OT made it a game for her to get the ball, and once Mia was holding it I played an A7 chord and sang, “and up up up….” (in an ascending scale) while she lifted the ball up and tossed it into the basket above her. When the ball went through the basket, I landed on the D chord and sang, “And IN!” and we all clapped. We did this many times and then transitioned Mia to the lap of the PT on an exercise ball. We sang an “up and down” song and got Mia comfortable being out of her chair. The OT grabbed a toy that looked like a drum, with five slots in the top of different shapes. There were little pieces of each shape that were to be dropped into the slots and made a “whoosh”ing noise as they fell into the drum. As Mia worked to fit each piece into the correct slot, I kept my guitar quiet- the reward of the “whoosh” sound was enough for her to feel motivated, and I didn’t need to add any sounds. Extra noise could have distracted her, overstimulated her senses, or interrupted what the OT was getting her to work on.

We ended the session by Mia sitting in the PT’s lap and holding her stuffed toy while the occupational therapist massaged her left arm- the side she hadn’t been using since her injury. This was saved for the end of the session since Mia despises being touched on that side, so we started by having an ipad out with an app open that allows you to trace your finger through the ‘sky’ and make star trails. I improvised some quiet instrumental music between G and C, which in music therapy is called ‘holding’- keeping to just a few simple chords can provide a structure that makes clients feel safe. Mia was tracing with her right hand, and then the OT gently lifted her left arm up and she began tracing with her left hand, too. She was distracted by the music and the reward of seeing her star trails, so she allowed for this- when the ipad was taken away, she let the OT massage her left arm and stretch it out while I played guitar. She cried a bit, but remained still.

Mia’s progress in the session shows how creating a relationship with a music therapist can be beneficial to a patient and to the care team. Working together, we used music as a distraction, as a reward, and as the motivation. Responding to Mia’s actions and moods through musical improvisation meant that she felt understood and was more motivated to participate in the therapy session. The music pushed her to lift higher, stretch longer, and laugh in the middle of crying.

At the end of the session while I was packing up my guitar, one of the therapists said, “The music therapy made such a huge difference, we should have it every week!” Obviously this makes me happy individually, but this is what I’m trained to do- this IS music therapy. And I’m actually at this hospital every week, but they haven’t integrated it into their care plans yet- so not only do I have no access to client records, but there’s no record kept of which clients have music therapy and when. It’s great when I get to co-treat, but I often see clients alone so I’m going off information I gather just from a quick scan of the room and how they’re behaving on the day I see them. Imagine how much further we could go if music therapists, who have specific training in privacy law, infection control, and ethics; knew what their patients were working on during their hospital stay and could tailor the music to that. And imagine if the medical staff could then see in the client’s records that the patient made a quicker recovery time, used less pain medication, or walked a few extra rounds, when they had music therapy… because I know that! But sometimes I am a tree falling in an empty forest. 

So- if you’re a nurse, a therapist, or even a family member in a hospital, and you see someone walking down the hall with a guitar… find out if they’re a board-certified music therapist. And if they are, see what they might be able to do to make your day easier. :) We LOVE sharing music.