Melbourne Conservatorium of Music - Theses
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ItemMusical Care: Exploring a person-centered caregiver singing protocol in dementia care in South Africa( 2023-10)This thesis includes three studies which aimed to explore the role of a formal caregiver-led singing training protocol in the delivery of person-centered care for people living with dementia, and how this might support caregivers in South Africa. A systematic mixed studies review was conducted to examine literature relating to formal caregiver training in live music for use in one-on-one caring contexts. Nine English, peer-reviewed studies adhered to the inclusion criteria. Integration of thematic analysis and narrative synthesis findings indicated that training caregivers in live music applied during care situations may contribute to significant reductions in dementia symptoms, resistiveness, and elicit mutual experiences of wellbeing and relationship between formal caregivers and residents. This benefitted person-centered care by supporting communication, easing care, and capacitating caregivers to meet the needs of people with dementia. Findings encouraged caregiver training but illustrated gaps in training component details and the lack of music therapists’ involvement. The action research qualitative study aimed to co-design and refine a person-centered caregiver singing (PCCS) protocol. PCCS is defined as singing in a manner that employs various prosodic and empathic musical elements to aid communication and promote feelings of connection, safety, validation and that aims to enhance the delivery of person-centered care. Ten caregivers from two care homes participated in four iterative cycles of: ‘workshop, interview, and amendment;’ an observation phase; and one-on-one interviews. This process culminated in the final version of the PCCS workshop. Thematic analysis findings suggested that PCCS was a helpful, relevant and easy-to-implement resource for caregivers. The Person-Centered Caregiver Singing Model illustrated the interplay between benefits to caregiver capabilities (including self-efficacy); mutual wellbeing; relational mutuality and reciprocity; the environment; and positive caregiving experience. PCCS implementation was not always successful due to residents’ unpredictable moods and caregivers’ perception of their own music skills. The sharing of music therapy-informed skills contribute to the caregivers’ safe and effective application of attuned singing, which may help them better attune to and meet residents’ needs. The third study was a mixed methods study exploring caregivers’ experiences and acceptability of the PCCS protocol. Forty-one formal caregivers from seven care homes attended one PCCS workshop and completed a questionnaire containing a Likert scale and space for written reflections. Findings were integrated inductively using seven components of acceptability. These illustrated the caregivers’ positive caregiving experiences and enhanced capabilities, improvements in residents’ observed wellbeing, empathic connections, and extension of PCCS benefits beyond the one-one-one care situation. Implementation challenges included limited song repertoire and residents’ unpredictability. Nonetheless, PCCS was considered useful, effective, and highly acceptable. Overarching findings suggest that person-centered caregiver singing is a helpful, relevant, highly acceptable resource that may contribute to caregivers’ delivery of person-centered care. PCCS may promote positive aspects of caregiving and highlights the value of caregivers’ own personhood as essential to quality care provision. Findings affirm the significance of inter-disciplinary skills-sharing by music therapists and support the application of PCCS within care homes in South Africa and similar contexts. Recommendations include booster workshops to support appropriate and sustainable application and the inclusion of family members and other staff in PCCS training. Further research could offer insight into cost-effectiveness of PCCS, test PCCS in similar and other contexts, further develop the PCCS questionnaire, and explore outcomes relating to caregiver self-efficacy and PCCS with family caregivers.
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ItemExploring the rehabilitative potential of familiar song for paediatric patients presenting with an acute disorder of consciousness( 2023)This thesis includes four studies that contribute to the exploration of the rehabilitative potential of familiar song for children presenting with an acute disorder of consciousness (DoC) following severe acquired brain injury (ABI). A DoC is common sequelae of severe ABI in children, and is the result of a sudden interruption in the complex interplay of arousal and awareness. While evidence supporting the use of music in the assessment and treatment of adults presenting with a DoC continues to emerge, the unique developmental context of paediatric ABI necessitates child specific research. Four discrete studies are included in thesis and contribute to the research agenda of describing the behavioural and neural responses to familiar song of children presenting with an acute DoC. The systematic review ‘The Neurophysiological Processing of Music in Children: A Systematic Review with Narrative Synthesis and Considerations for Clinical Practice in Music Therapy’ included 46 neuroimaging studies describing music processing in neurotypical children aged 0-18 years. The narrative synthesis yielded a timeline of significant developments of musical processing. Further, comprehensive considerations for clinical practice for music therapists working with paediatric neurologic population were developed. The results of the systematic review provide a theoretical foundation for the use of familiar song to support consciousness recovery in children presenting with a DoC. When developing the study to empirically describe the neural and behavioural responses to familiar song of children presenting with an acute DoC, it was necessary to first develop a tool to objectively describe behavioural responses. The Music Interventions in Paediatric DoC Behaviour Observation Record (MBR) was developed and piloted. Results of the pilot established that the MBR has content validity, and sufficient inter-rater-reliability to objectively capture the subtle and idiosyncratic responses of children presenting with a DoC during a music therapy intervention. Subsequent to the completion of the pilot, the MBR was utilised in the collection of behavioural data in the case study of a child presenting with an acute DoC The use of EEG in music therapy research with children presenting with a DoC affords the opportunity to describe responses even in the absence of an observable behaviour. To pilot the use of EEG with children, a feasibility study (n = 4) was undertaken using data pragmatically collected within the acute hospital setting. Unique changes in the underlying frequency components of the EEG were recorded during the song condition that were not observed in either the comparative speech or noise conditions. The study showed feasibility of a uniquely hypothesis driven method of multivariate EEG analysis, and added to the current knowledge base by describing the EEG signal in response to whole song as an ecologically valid music stimulus. The piloting of the MBR and multivariate method of EEG analysis ultimately supported the development of multiple baseline crossover case study, of an 11-year old presenting with an acute DoC, in which the behavioural and neural responses to song were described. For this child, familiar song was found to stimulate a greater behavioural and neural response, indicative of an increase in arousal and awareness, than comparative speech or noise conditions. This study provides foundational evidence supporting the use of familiar song to increase consciousness in children presenting with an acute DoC following severe ABI