Melbourne Conservatorium of Music - Research Publications
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ItemParticipant-selected music and physical activity in older adults following cardiac rehabilitation: a randomized controlled trial(SAGE PUBLICATIONS LTD, 2017-03)OBJECTIVE: To evaluate effects of participant-selected music on older adults' achievement of activity levels recommended in the physical activity guidelines following cardiac rehabilitation. DESIGN: A parallel group randomized controlled trial with measurements at Weeks 0, 6 and 26. SETTING: A multisite outpatient rehabilitation programme of a publicly funded metropolitan health service. SUBJECTS: Adults aged 60 years and older who had completed a cardiac rehabilitation programme. INTERVENTIONS: Experimental participants selected music to support walking with guidance from a music therapist. Control participants received usual care only. MAIN MEASURES: The primary outcome was the proportion of participants achieving activity levels recommended in physical activity guidelines. Secondary outcomes compared amounts of physical activity, exercise capacity, cardiac risk factors, and exercise self-efficacy. RESULTS: A total of 56 participants, mean age 68.2 years (SD = 6.5), were randomized to the experimental ( n = 28) and control groups ( n = 28). There were no differences between groups in proportions of participants achieving activity recommended in physical activity guidelines at Week 6 or 26. Secondary outcomes demonstrated between-group differences in male waist circumference at both measurements (Week 6 difference -2.0 cm, 95% CI -4.0 to 0; Week 26 difference -2.8 cm, 95% CI -5.4 to -0.1), and observed effect sizes favoured the experimental group for amounts of physical activity (d = 0.30), exercise capacity (d = 0.48), and blood pressure (d = -0.32). CONCLUSIONS: Participant-selected music did not increase the proportion of participants achieving recommended amounts of physical activity, but may have contributed to exercise-related benefits.
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ItemExploring the Self through Songwriting: An Analysis of Songs Composed by People with Acquired Neurodisability in an Inpatient Rehabilitation Program(Oxford University Press, 2017-03-01)Background: Neurological trauma is associated with significant damage to people’s pre-injury self-concept. Therapeutic songwriting has been linked with changes in self-concept and improved psychological well-being. Objective: This study analyzed the lyrics of songs composed by inpatients with neurological injuries who participated in a targeted songwriting program. The aim of this study was to understand which of the subdomains of the self-concept were the most frequently expressed in songs. Methods: An independent, deductive content analysis of 36 songs composed by 12 adults with spinal cord injury or brain injury (11 males, mean age 41 years +/– 13) were undertaken by authors 1 and 2. Results: Deductive analysis indicated that when writing about the past self, people created songs that reflected a strong focus on family and descriptions of their personality. In contrast, there is a clear preoccupation with the physical self, on the personal self, and a tendency for spiritual and moral reflections to emerge during the active phase of rehabilitation (song about the present self). Statistical analyses confirmed a significant self-concept subdomain by song interaction, F(10, 110) = 5.98, p < .001, ηp2 = .35), which was primarily due to an increased focus on physical self-concept and a reduced focus on family self-concept in the present song, more than in either past or future songs. Conclusions: The analysis process confirmed that songwriting is a vehicle that allows for exploration of self-concept in individuals with neurological impairments. Songwriting may serve as a therapeutic tool to target the most prevalent areas of self-concept challenges for clients undergoing inpatient neurological rehabilitation programs.
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ItemExploring the feasibility of a music-assisted relaxation intervention to assist with the initiation of non-invasive ventilation in people with Motor Neuron Disease(International Association for Music & Medicine, 2017)Background: Transitioning to non-invasive ventilation (NIV) can cause anxiety in people with Motor Neuron Disease (MND), which may reduce adherence rates. Music therapy has demonstrated positive effects with mechanical (invasive) ventilation. Method: This feasibility study examined the effects of music-assisted relaxation (MAR) on NIV adherence, anxiety, and quality of life for people with MND. Data were collected at baseline, 7-days post, and 3-months post NIV implementation. Results: Of 18 consenting participants, 15 chose the MAR condition. Results suggested that supporting NIV transition within the first 7 days may be advantageous for long-term adherence. No effects were found for anxiety or quality of life. Limitations included small sample size, lack of an adequate control, and possible ceiling effects on the instruments used. Qualitative data indicated most participants considered the relaxing and distracting effects of MAR were useful. Conclusions: In this small sample, we found some demand for and acceptability of a music-based intervention in this setting. Participants reported differing experiences of using MAR, and there were technical and logistical issues regarding timely and accessible provision of a MAR intervention within the treatment trajectory of NIV implementation. Conflicting quantitative and qualitative data support the need for mixed method research in this area.
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ItemTherapeutic singing protocols for addressing acquired and degenerative speech disorders in adults(Oxford University Press, 2017)The ability to communicate and make oneself understood is integral to a person’s quality of life. It affects social interaction, educational and vocational opportunities, and ultimately independence and sense of self. Unfortunately, speech production is often impaired as a result of neurological damage (e.g., traumatic brain injury, stroke) or disorders (e.g., Parkinson’s disease). There are many similarities and shared neural mechanisms between speech and singing. For example, both singing and speech utilize rhythm, pitch variation, tempo, dynamics, articulation, and respiratory support. Music therapists manipulate these elements of music when addressing therapeutic goals for people with neurogenic speech disorders. Many clinical protocols to address speech disorders in adults have now been published to guide clinical practice in music therapy. This paper summarizes existing music therapy and singing-based protocols used to address commonly occurring acquired or degenerative speech disorders, namely dysarthria, dysphonia, dysprosody, and apraxia of speech. We examine individual and group therapy protocols used in medical and community settings for people with neurogenic speech disorders caused by traumatic brain injury, stroke, spinal cord injury, and Parkinson’s disease. We highlight the strengths and limitations of these protocols and make recommendations for clinical practice.
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ItemNo Preview AvailableParkinSong: A Controlled Trial of Singing-Based Therapy for Parkinson's Disease(SAGE PUBLICATIONS INC, 2019-06)Background. Communication impairment is one of the most common symptoms of Parkinson's disease (PD), significantly affecting quality of life. Singing shares many of the neural networks and structural mechanisms used during speech and, thus, has potential for therapeutic application to address speech disorders. Objective. To explore the effects of an interdisciplinary singing-based therapeutic intervention (ParkinSong) on voice and communication in people with PD. Methods. A controlled trial compared the effects of the ParkinSong intervention with an active control condition at 2 dosage levels (weekly vs monthly) over 3 months, on voice, speech, respiratory strength, and voice-related quality-of-life outcomes for 75 people living with PD. The interdisciplinary ParkinSong model comprised high-effort vocal and respiratory tasks, speech exercises, group singing, and social communication opportunities. Results. ParkinSong intervention participants demonstrated significant improvements in vocal intensity (P = .018), maximum expiratory pressure (P = .032), and voice-related quality of life (P = .043) in comparison to controls. Weekly ParkinSong participants increased vocal intensity more than monthly participants (P = .011). Vocal intensity declined in nontreatment control groups. No statistical differences between groups on maximum phonation length or maximum inspiratory pressure were observed at 3 months. Conclusions. ParkinSong is an engaging intervention with the potential to increase loudness and respiratory function in people with mild to moderately severe PD.
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ItemPersonal identity narratives of therapeutic songwriting participants following Spinal Cord Injury: A case series analysis(Taylor & Francis, 2018-07-04)Context/Objective: Spinal Cord Injury (SCI) patients face unique identity challenges associated with physical limitations, higher comorbid depression, increased suicidality and reduced subjective well-being. Post-injury identity is often unaddressed in subacute rehabilitation environments where critical physical and functional rehabilitation goals are prioritized. Therapeutic songwriting has demonstrated prior efficacy in promoting healthy adjustment and as a means of expression for post-injury narratives. The current study sought to examine the identity narratives of therapeutic songwriting participants. Design: Case-series analysis of the individual identity trajectories of eight individuals. Setting: Subacute rehabilitation facility, Victoria, Australia. Participants: Eight individuals with an SCI; 7 males and 1 female. Intervention: Six-week therapeutic songwriting intervention facilitated by a music therapist to promote identity rehabilitation. Outcome Measures: Identity, subjective well-being and distress, emotional state. Results: Three participants demonstrated positive trajectories and a further three showed negative trajectories; remaining participants were ambiguous in their response. Injury severity differentiated those with positive trajectories from those with negative trajectories, with greater injury severity apparent for those showing negative trends. Self-concept also improved more in those with positive trajectories. Core demographic variables did not however meaningfully predict the direction of change in core identity or wellbeing indices. Conclusion: Identity-focused songwriting holds promise as a means of promoting healthy identity reintegration. Further research on benefits for those with less severe spinal injuries is warranted.
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ItemNo Preview AvailableA therapeutic songwriting intervention to promote reconstruction of self-concept and enhance well-being following brain or spinal cord injury: pilot randomized controlled trial(SAGE PUBLICATIONS LTD, 2019-06)OBJECTIVE: To determine the size of the effects and feasibility (recruitment and retention rates) of a therapeutic songwriting protocol for in-patients and community-dwelling people with acquired brain injury or spinal cord injury. DESIGN: Randomized controlled trial with songwriting intervention and care-as-usual control groups, in a mixed measures design assessed at three time points. PARTICIPANTS: A total of 47 participants (3 in-patients with acquired brain injury, 20 community participants with acquired brain injury, 12 in-patients with spinal cord injury, and 12 community participants with spinal cord injury: 23 1208 days post injury). INTERVENTIONS: The intervention group received a 12-session identity-targeted songwriting programme, where participants created three songs reflecting on perceptions of past, present, and future self. Control participants received care as usual. MEASURES: Baseline, postintervention, and follow-up measures comprised the Head Injury Semantic Differential Scale (primary outcome measure), Patient Health Questionnaire-9, Emotion Regulation Questionnaire, and Satisfaction with Life Scale. RESULTS: No significant between group pre-post intervention differences were found on the primary self-concept measure, the Head Injury Semantic Differential Scale ( p = 0.38, d = 0.44). Significant and large effect sizes from baseline to post between groups in favour of the songwriting group for Satisfaction with Life ( p = 0.04, n2 p = 0.14). There were no significant between group pre-post interaction effects for the Emotion Regulation Suppression subscale ( p = 0.12, n2 p = -0.08) although scores decreased in the songwriting group over time while increasing for the standard care group. There were no significant differences in baseline to follow-up between groups in any other outcome measures. Recruitment was challenging due to the small number of people eligible to participate combined with poor uptake by eligible participants, particularly the in-patient group. Retention rates were higher for the community-dwelling cohorts. CONCLUSION: This study demonstrates the challenges in recruitment and retention of participants invited to participate in a music therapy study. Findings suggest this identity-focused therapeutic songwriting protocols may be more beneficial for people who have transitioned from in-patient to community-contexts given the greater proportion of participants who consent and complete the intervention. Preliminary effects in favour of the intervention group were detected in a range of well-being measures suggesting that a larger study is warranted.
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ItemExploring self-concept, wellbeing and distress in therapeutic songwriting participants following acquired brain injury: A case series analysis(Taylor & Francis, 2020-02-07)Acquired brain injury (ABI) presents a significant threat to sense of self and necessitates a complex process of psychosocial adjustment. Self-concept changes remain understudied in the early stages of inpatient rehabilitation. The aim of the current study was to examine changes in self-concept, distress, wellbeing and functional skills for five inpatients undertaking a music therapy intervention within a subacute rehabilitation centre in Victoria, Australia. Participants completed a six-week, 12-session therapeutic songwriting programme to produce past-, current- and future-self-focused songs. A range of self-concept, subjective wellbeing and distress measures were completed pre-, mid- and post-intervention. A descriptive case series approach was applied to determine trends in pre-post scores for five individual cases. Participants showing the greatest gains across self-concept and subjective wellbeing indices also showed the greatest functional gains on the Functional Independence Measure (FIM) from admission to discharge. The current study highlights the importance of examining early changes in self-concept, wellbeing and distress in subacute rehabilitation, and suggests that individualised songwriting programmes warrant further research attention in neurological populations.
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ItemParkinSong: Outcomes of a 12-Month Controlled Trial of Therapeutic Singing Groups in Parkinson's Disease(IOS Press, 2020-07-28)Background: Parkinson’s disease (PD) frequently causes progressive deterioration in speech, voice and cognitive aspects of communication. These affect wellbeing and quality of life and are associated with caregiver strain and burden. Therapeutic singing groups can ameliorate PD-related communication disorders and increase social interaction and wellbeing for caregivers and care recipients. Objective: To analyse the effects of ParkinSong group singing sessions on Parkinson’s communication and wellbeing outcomes for people with PD and caregivers over 12 months. Methods: A 4-armed controlled clinical trial compared ParkinSong with active non-singing control conditions over 12 months. Two dosage levels (weekly versus monthly) were available for each condition. ParkinSong comprised high-effort vocal, respiratory and speech exercises, group singing, and social interaction. PD-specific outcomes included vocal loudness, speech intelligibility, maximum phonation time, respiratory muscle strength, and voice related quality of life (QoL). Wellbeing outcomes were also measured for caregivers and care recipients. Results: We recruited 75 people with PD and 44 caregivers who attended weekly ParkinSong, monthly ParkinSong, weekly control or monthly control groups. We found significant improvements in the primary outcome of vocal loudness (p = 0.032), with weekly singers 5.13 dB louder (p = 0.044) and monthly singers 5.69 dB louder (p = 0.015) than monthly controls at 12 months. ParkinSong participants also showed greater improvements in voice-related QoL and anxiety. Caregivers who attended ParkinSong showed greater reductions in depression and stress scores. Conclusions: This 12-month controlled clinical trial of ParkinSong demonstrated improvements in speech loudness and voice-related QoL for participants with PD, and enhanced wellbeing for both caregivers and care recipients. No adverse effects were reported over 12 months and improvements were sustained.
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ItemNo Preview AvailableEmpowering Caregivers of People Living with Dementia to Use Music Therapeutically at Home: Design Opportunities(ACM, 2020-12-02)Human-computer interaction researchers have explored how to design technologies to support people with dementia (PwD) and their caregivers, but limited attention has been given to how to facilitate music therapy in dementia care. The use of music to help manage the symptoms of dementia is often guided by a music therapist who adapts the intervention to respond to the changing needs of the person living with dementia. However, as the incidence of dementia increases worldwide, individualised therapy programs are less feasible, making it valuable to consider technology-based approaches. In this paper, we analyze data from case studies of home-based music therapy training interventions with two families. The findings show that embodied interactions supported the therapist in responding to the needs of the PwD and built an empathic environment that empowered the caregivers' learning. We discuss opportunities and challenges for designing technologies that support family caregivers' therapy-informed music use in dementia care.