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

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    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.
    Original languageEnglish
    Place of PublicationAalborg Universitet
    PublisherInstitut for Musik og Musikterapi, Aalborg Universitet
    Number of pages357
    Publication statusPublished - 2003


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