Singing Dialogue : Music therapy with persons in advanced stages of dementia. A case study research design

    Publikation: Bog/antologi/afhandling/rapportPh.d.-afhandlingForskning

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    Resumé

    Personer med en primær degenerativ demens vil på senere stadier af sygdommen have vanskeligheder med at omsætte sanseindtryk og med at udtrykke sig verbalt. Det kan føre til problemer med at indgå i dialog med andre. Psykosociale behov kan vanskeligt opfyldes uden muligheder for at være i dialog, hvilket igen fører til sekundære symptomer på selve demenssygdommen.

    I dette forskningsprojekt tages der udgangspunkt i brugen af velkendte sange i musikterapi som en måde at indgå i dialog hvor kommunikationen er tilpasset den enkelte person. Forskningsdesignet er et fleksibelt design baseret på en integration af definerede metoder og med data bestående af video observationer, pulsmålinger samt observationer udført af personale, eksterne observatører og af musikterapeuten.

    Den første del af forskningen består af 6 casestudier hvor fysiologiske data indgår i analysen sammen med de øvrige observationer. Næste del er en hermeneutisk analyse af observationer, som er udført af eksterneobservatører. Dette munder ud i en systematisk opstilling af gestisk respons samt en kodning og kategorisering af de kvalitative aspekter af denne. I en tredje del samles de to indfaldsvinkler, og udvalgte eksempler fra casestudierne analyseres med udgangspunkt i de kategorier der førhen er opstillet, og som beskriver forskellige grader af kommunikation.

    Resultaterne viser at 1) Sang her en positiv indflydelse på de 6 personer med svær demens. Denne indflydelse kan defineres ud fra graden af kompliance, ændringer i pulsfrekvens og ud fra forskellige måder at deltage i musikterapien på. 2) De seks deltagere formår at kommunikere med musikterapeuten, og denne kommunikation kan karakteriseres ud fra et system af kommunikative signaler der afspejler forskellige grader af kommunikation: grundstemning,receptiv deltagelse, socialitet, aktiv deltagelse, kommunikativ musikalitet samt dialog. Der ses en sammenhæng mellem et afbalanceret arousalniveau og mere intensive grader af kommunikation. 3) I 5 ud af 6 konkrete tilfælde viser musikterapien en indflydelse på aspekter i dagliglivet udover musikterapien, defineret i et statistisk signifikant fald i pulsfrekvens i en periode før og efter terapien for personer med svær demens som udviser agiteret adfærd.

    Deltagerne viser tydeligt at de har gavn af musikterapiforløbet, og vigtigst: disse 6 svært demensramte kommunikerer, og de lader sig lede til en tilstand hvor dialog kan opstå. Sangene er udtryk for en struktur som kan fungere som opmærksomhedsstimulering ved at formidle stabilitet samt sociale og kontekstuelle cues. Sangene har ydermere den funktion at de kan bruges til regulering af arousal, således at deltageren kan ledes til en tilstand hvor vedkommende er mest opmærksom overfor sansestimuli. Dette giver de bedste betingelser for at indgå i dialog med et andet menneske.
    OriginalsprogEngelsk
    Udgivelses stedAalborg Universitet
    ForlagInstitut for Musik og Musikterapi, Aalborg Universitet
    Antal sider357
    StatusUdgivet - 2003

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    music therapy
    singing
    dementia
    research planning
    dialogue
    human being
    communication
    song
    participation
    sociality
    hermeneutics
    therapist
    coding
    profit
    music
    video
    staff
    Disease
    language

    Citer dette

    Ridder, H. M. O. (2003). Singing Dialogue : Music therapy with persons in advanced stages of dementia. A case study research design. Aalborg Universitet: Institut for Musik og Musikterapi, Aalborg Universitet.
    Ridder, Hanne Mette Ochsner. / Singing Dialogue : Music therapy with persons in advanced stages of dementia. A case study research design. Aalborg Universitet : Institut for Musik og Musikterapi, Aalborg Universitet, 2003. 357 s.
    @phdthesis{72c09dd00ced11dbb2f1000ea68e967b,
    title = "Singing Dialogue : Music therapy with persons in advanced stages of dementia.: A case study research design",
    abstract = "Persons suffering from primary degenerative dementia at later stages of the disease experience problems in perceiving environmental information and in expressing themselves in verbal language. This leads to difficulties in entering and maintaining dialogue. Failing possibilities of entering dialogue, psychosocial needs are not easily fulfilled, which leads to serious secondary symptoms of dementia. In this research the use of familiar songs in music therapy is suggested as a way of entering dialogue, where the communication is adjusted to the individual person. A flexible mixed-method research design is carried out based on video observations, heart rate data, and observations from staff, external assessors, and the music therapist. One part of the research consists of 6 case studies where physiological data are used to validate observational data. Next part is a hermeneutic analysis of observations done by external assessors, leading to a catalogue of gestural responses and a coding and categorization of the qualities of these responses. In a third part examples from the case studies are analysed, using the categories that evolved in the previous part and describing various levels of communication. The results show that; 1) Singing has a positive influence on the 6 participants, defined by degree of compliance, by changes in heart rate levels, and by various ways of taking part in the music therapy; 2) The six participants communicate responsively, and this communication can be recognised by a system of communicative signs, representing different levels of communication: emotional valence, receptive participation, sociality, active participation, communicative musicality, and dialogue. There exists a relationship between a balanced arousal level and communication at more intensive levels for all six participants; 3) In 5 of 6 concrete cases music therapy shows an influence on aspects in residential daily life, defined in a statistical significant decrease in heart rate levels pre/post therapy, for persons with severe dementia showing agitated behaviour. The participants clearly profit from the music therapy sessions, and most important: these persons suffering from severe dementia are communicating and are able to be brought into a state where a communicative dialogue takes place. The songs offer a structure, which functions in focussing attention by mediating stability, as well as social and contextual cues. Additionally the songs are used in regulating the arousal level of the participant towards environmental attention and a state most optimal for entering dialogue.",
    author = "Ridder, {Hanne Mette Ochsner}",
    year = "2003",
    language = "English",
    publisher = "Institut for Musik og Musikterapi, Aalborg Universitet",

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    Ridder, HMO 2003, Singing Dialogue : Music therapy with persons in advanced stages of dementia. A case study research design. Institut for Musik og Musikterapi, Aalborg Universitet, Aalborg Universitet.

    Singing Dialogue : Music therapy with persons in advanced stages of dementia. A case study research design. / Ridder, Hanne Mette Ochsner.

    Aalborg Universitet : Institut for Musik og Musikterapi, Aalborg Universitet, 2003. 357 s.

    Publikation: Bog/antologi/afhandling/rapportPh.d.-afhandlingForskning

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    T2 - A case study research design

    AU - Ridder, Hanne Mette Ochsner

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    N2 - Persons suffering from primary degenerative dementia at later stages of the disease experience problems in perceiving environmental information and in expressing themselves in verbal language. This leads to difficulties in entering and maintaining dialogue. Failing possibilities of entering dialogue, psychosocial needs are not easily fulfilled, which leads to serious secondary symptoms of dementia. In this research the use of familiar songs in music therapy is suggested as a way of entering dialogue, where the communication is adjusted to the individual person. A flexible mixed-method research design is carried out based on video observations, heart rate data, and observations from staff, external assessors, and the music therapist. One part of the research consists of 6 case studies where physiological data are used to validate observational data. Next part is a hermeneutic analysis of observations done by external assessors, leading to a catalogue of gestural responses and a coding and categorization of the qualities of these responses. In a third part examples from the case studies are analysed, using the categories that evolved in the previous part and describing various levels of communication. The results show that; 1) Singing has a positive influence on the 6 participants, defined by degree of compliance, by changes in heart rate levels, and by various ways of taking part in the music therapy; 2) The six participants communicate responsively, and this communication can be recognised by a system of communicative signs, representing different levels of communication: emotional valence, receptive participation, sociality, active participation, communicative musicality, and dialogue. There exists a relationship between a balanced arousal level and communication at more intensive levels for all six participants; 3) In 5 of 6 concrete cases music therapy shows an influence on aspects in residential daily life, defined in a statistical significant decrease in heart rate levels pre/post therapy, for persons with severe dementia showing agitated behaviour. The participants clearly profit from the music therapy sessions, and most important: these persons suffering from severe dementia are communicating and are able to be brought into a state where a communicative dialogue takes place. The songs offer a structure, which functions in focussing attention by mediating stability, as well as social and contextual cues. Additionally the songs are used in regulating the arousal level of the participant towards environmental attention and a state most optimal for entering dialogue.

    AB - Persons suffering from primary degenerative dementia at later stages of the disease experience problems in perceiving environmental information and in expressing themselves in verbal language. This leads to difficulties in entering and maintaining dialogue. Failing possibilities of entering dialogue, psychosocial needs are not easily fulfilled, which leads to serious secondary symptoms of dementia. In this research the use of familiar songs in music therapy is suggested as a way of entering dialogue, where the communication is adjusted to the individual person. A flexible mixed-method research design is carried out based on video observations, heart rate data, and observations from staff, external assessors, and the music therapist. One part of the research consists of 6 case studies where physiological data are used to validate observational data. Next part is a hermeneutic analysis of observations done by external assessors, leading to a catalogue of gestural responses and a coding and categorization of the qualities of these responses. In a third part examples from the case studies are analysed, using the categories that evolved in the previous part and describing various levels of communication. The results show that; 1) Singing has a positive influence on the 6 participants, defined by degree of compliance, by changes in heart rate levels, and by various ways of taking part in the music therapy; 2) The six participants communicate responsively, and this communication can be recognised by a system of communicative signs, representing different levels of communication: emotional valence, receptive participation, sociality, active participation, communicative musicality, and dialogue. There exists a relationship between a balanced arousal level and communication at more intensive levels for all six participants; 3) In 5 of 6 concrete cases music therapy shows an influence on aspects in residential daily life, defined in a statistical significant decrease in heart rate levels pre/post therapy, for persons with severe dementia showing agitated behaviour. The participants clearly profit from the music therapy sessions, and most important: these persons suffering from severe dementia are communicating and are able to be brought into a state where a communicative dialogue takes place. The songs offer a structure, which functions in focussing attention by mediating stability, as well as social and contextual cues. Additionally the songs are used in regulating the arousal level of the participant towards environmental attention and a state most optimal for entering dialogue.

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    Ridder HMO. Singing Dialogue : Music therapy with persons in advanced stages of dementia. A case study research design. Aalborg Universitet: Institut for Musik og Musikterapi, Aalborg Universitet, 2003. 357 s.