Melbourne Conservatorium of Music - Theses
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ItemThe markers of interplay between the music therapist and the medically fragile newborn infant( 2007)An emergent qualitative design provided the scaffolding for the micro-analysis of video footage and subsequent video-cued discussion with four reviewers. The collated material was used to prepare thick descriptions which were annotated for infant and therapist behaviours. A further thematic analysis of these behaviours provided 14 sets of behaviours used by the medically fragile newborn infants to indicate availability for interplay and 20 sets of behaviours used by the therapist in response to the infant. The interaction of these categorised behaviours provided seven markers of interplay between the music therapist and the medically fragile newborn infant.
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ItemMusic therapy's relevance in a cancer hospital researched through a constructivist lens( 2001-09)A constructivist research paradigm informed an investigation of the relevance of music therapy (MT) in a cancer hospital, that is, (a) what did MT do(?) and (b) did it help? Over three months, criterion sampling was used to elicit interpretations from five sources: 128 patients who participated in MT, 27 patients who overheard or witnessed MT, 41 visitors, 62 staff, and the researcher who was also the MT clinician in this study. The researcher’s interpretations were recorded in a reflexive clinical journal and the respondents’ interpretations were written on anonymous open-ended questionnaires. The MT program was predominantly characterised by the use of patient and visitor selected live music. Thematic analysis, informed by grounded theory (Strauss & Corbin, 1990), and content analyses were performed on the five groups of data with the support of ATLAS/ti (Muhr, 1997) software. Many patients and visitors who experienced MT reported that MT elicited a range of affective responses and altered imaginings. Responses were especially characterised by memories being revisited but also characterised by the respondents’ “transportation” to new spaces or thoughts and physical sensations. Some staff and patients who overheard MT also reported similar experiences. The researcher, and often staff and visitors, also perceived that MT elicited affective and imagined sensations in patients.
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ItemThe experience of group music therapy for six bereaved adolescents( 2001-08)This research is an investigation of the experience of group music therapy for bereaved adolescents. In order to collect the data for this project, the researcher facilitated ten music therapy sessions with six young people utilising two music therapy techniques: group improvisation and group music sharing. At the conclusion of sessions, the researcher conducted in-depth interviews with the participants in which they described their experience of being in the music therapy group. The interviews were transcribed and analysed using the qualitative research methodology of phenomenology, based on the Giorgi (1975) model. The results of this investigation showed that their developmentally appropriate desires for fun, freedom, control and the achievement of group cohesion were essential in order for the six bereaved adolescents to successfully address the emotions of grief and share stories that strengthen continuing bonds with their loved ones who have died. Significantly, the young people noted that music sharing and improvisation allowed them to express their feelings, including negative feelings, as well as share their stories without relying solely on the use of words. Some felt that participation in the group had also facilitated discussion of their grief in diverse environments, or that it had promoted an examination of existential issues related to their loss.
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ItemMaking a connection: randomised controlled trial of family centred music therapy for young children with autism spectrum disorder( 2012)Young children with autism spectrum disorder vary greatly in their social and communication skills, from non-verbal and difficult to engage socially, to using some sentences and showing social interest in other people. For those children who are non-verbal and difficult to engage socially, there is minimal evidence to help parents and early childhood intervention service providers determine which interventions will most successfully foster the social communication development of these young children. There is, however, increasing awareness in the literature of the positive impacts a strong parent-child relationship can have on social communication development in both typically developing children and children with ASD. The use of music therapy to assist children with autism to develop social communication skills has a long history, dating back to the 1960s. While the use of music therapy with children who have social communication impairments has been widely described, evidence into the effectiveness of music therapy with children with autism spectrum disorder has primarily taken the form of case studies, small quasi experimental research and small experimental designs. This mixed-methods study aimed to investigate whether family-centred music therapy positively influenced the social communication development of preschool aged children with severe autism spectrum disorder. 23 children between the ages of 3 and 6 years and their families were randomly allocated to either the treatment group or the control; with each participant receiving 16 weeks of family-centred music therapy sessions which took place in the family home. A variety of data was collected including 4 standardised measures, 1 non-standardised measure, a survey of the use of music in the home, and a structured interview with the participating parent. Quantitative analysis showed that children in the treatment group made improvements in the quality of their social interactions in the home and community, as well as their level of engagement within the music therapy sessions. The qualitative and mixed data analysis suggested that there were also improvements in the closeness of the parent-child relationship. Further, parents were able to adapt music activities to support their child in various activities in the home and community. These outcomes provide preliminary support for family-centred music therapy’s effectiveness in promoting developmental change in children’s social communication skills, and fostering greater closeness in the parent-child relationship.
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ItemThe rehabilitative effects of piano-playing music therapy on unilateral and bilateral motor coordination of chronic stroke patients: a MIDI analysis( 2007)This study examined the effects of piano-playing music therapy on the motor coordination of stroke patients using MIDI-based analysis to measure finger coordination. Within a modified controlled trial, twenty participants were assigned to either a music therapy treatment group or a control group. Half-hour individual music therapy sessions comprising various piano-playing techniques were conducted three days per week for four weeks, consisting of 12 sessions in total. Using the MIDI analysis, the participants’ finger movements were measured before and immediately after the interventions. A five-point scale assessment was also undertaken as a secondary outcome measurement. The results of performance comparison between the groups in pre and post-tests showed statistically significant improvements in timing consistency, velocity evenness, accuracy of key striking, and stability of synchronizing two-key striking. This indicates that piano-playing music therapy could be a viable intervention in rehabilitating motor coordination of chronic stroke patients.
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ItemUsing song-choice in music therapy to improve the communication skills of adults with profound and multiple disabilities( 2009)A multiple case study design was used to examine the effect of a song-choice intervention on the communication skills of adults with profound and multiple disabilities in individual music therapy. Five females participated in three song-preference assessment sessions and ten song-choice intervention sessions on a weekly basis. In the preference assessment sessions, each participant was provided with a different set of eight songs that were sung with guitar accompaniment by researcher. Affective responses to each song were analyzed and four preferred and non-preferred songs were identified. In the 30-minute song-choice intervention, each participant was offered four song-choice opportunities, with each allowing for several attempts. When the participant clearly indicated their choice of song between a pair of preferred and non-preferred songs, the researcher verbally validated it and immediately sang the chosen song, actively interacting with the participant. All sessions were video-taped and the participants’ and therapist’s behaviors during the song-choice processes were analyzed. The analysis of this data resulted in three clear outcomes. First, most participants expressed consistent affective responses to different songs and it was more obvious when provided with a highly preferred song. Second, all participants were able to choose songs which were intentional decisions as they selected their preferred songs 73 % of the time. Third, most participants gained improved communication skills. Specifically (a) two participants developed intentional choice-making behaviors such as alternating eye-gaze between a song-card and the researcher, and picking up a song-card from two song-cards, and (b) three participants improved intentional communication skills by clearly displaying their facial expressions and voices. The findings have implications for providing adults with profound and multiple disabilities with opportunities to express preference and choice, which ultimately improve their quality of life.
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ItemThe accumulative effects of music therapy on dementia-related speech deficits in a sub-acute hospital setting( 2011)A single blinded randomised control trial was conducted to determine the accumulative effects of Music Therapy on dementia-related speech deficits. The hypotheses to be tested whether a programme of MT will result in greater improvement in dementia-related spontaneous speech deficits (in particular naming), than a programme of DT and 2) whether a programme of either MT or DT will result in a reduction in dementia-related spontaneous speech deficits (in particular naming) compared to a non intervention (control) group. Fifty-one participants with moderate to severe dementia, were randomised into 3 groups, one being the control group, the other two groups receiving either Music Therapy (MT) or Diversional Therapy (DT) (referred to as Recreational Therapy in the USA). The 45 to 60 minute Music Therapy and Diversional Therapy sessions were run concurrently every Monday, Wednesday and Friday morning for 3 weeks by the author, a Registered Music Therapist or a Diversional Therapist. The Music Therapy sessions consisted of MT techniques previously used in Music Therapy dementia-related language studies, which included singing familiar songs, word cueing, instrument playing, music and reminiscence and music and movement. The Diversional Therapy activities were based on cognitive activities, physical stimulation and creative expression through arts and crafts activities. Data was collected at baseline and within 48 hours of the final session by the chief investigator and the research assistant. Data was generated by the following validated and standardised tools for the field of dementia: the Boston Naming Test Short Form (Mack, Freed, Williams, & Henderson, 1992), the Animal Naming Test (Spreen & Strauss, 1998), the Mini Mental State Examination (Folstein, Folstein, & McHugh, 1975), Geriatric Depression Scale, short version (Sheikh, 1986; Yesavage et al., 1983) and the Digit Span Test (Hunsley, Hanson, & Parker, 1988). Using a one-way repeated ANOVA the changes in the scores of the MT group were compared to the DT group (hypothesis 1), and score changes in both the MT and DT group were compared to the non-intervention (NI) group (hypothesis 2). Results of the one way repeated ANOVA did not support the two hypotheses. Changes in the scores of the secondary outcome measures using a one way repeated ANOVA also did not support the two hypotheses. Possible reasons for the null hypotheses are discussed including the research design, choice of research tools, and the challenges faced when conducting research studies within the dementia population. This study, with its large participant numbers and stringent research design significantly contributes to MT research literature. This study is also the first of its kind to define the MT technique of “word cueing”. Recommendations for future MT and dementia-related language deficits are discussed.
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ItemAn investigation of premature infant response to recorded music with maternal involvement versus no maternal involvement: a randomised control trial( 2011)The incidence of premature birth has increased over the past two decades in Australia. While survival rates have improved and stabilised, there has not been a decrease of neuro-developmental and behavioural problems arising from prematurity. Because of this, there is an increasing understanding of the need to address non-medical needs of the premature infant in hospital including the integral role of the family during this time. In a repeated-measures randomised control trial, this study sought to determine the effect of maternal presence on the premature infant’s physiological and behavioural response to recorded music and on infant status overall. Participants were 22 clinically stable premature infants (born at >28 weeks gestation and enrolled at >32 weeks gestation) and their mothers in the NICU. Both Experimental and Control groups were exposed to one session consisting of a baseline of 6 minutes of ambient noise, followed by two alternating 6 minute periods of music and no-music (total 30 minutes). The Experimental group infants had the mother present for the first twelve minutes (baseline and first music period) compared to the Control group without mother present at any time. The auditory stimulus was the NICU ambient noise, and the music stimulus was recorded lullaby music. Physiological monitoring included heart rate and oxygen saturation. The infant's behavioural state was classified using the Six Derived States of Behaviour classifications (Thoman, 1990). A Restricted Maximum Likelihood (REML) model was used to analyse the physiological and behavioural responses. There were no significant effects of maternal presence on physiological or behavioural outcome measures in either group over time. The Experimental group had consistently lower heart rate than the Control group. There was a significant difference in oxygen saturation (p< 0.05) between the Mother Present and Mother Absent periods in the Experimental group and infants responded to music with more Quiet Sleep and higher oxygen saturation in the presence of the mother. Findings from this study suggest that maternal presence had a positive effect on premature infant physiological and behavioural status during music and no music periods and a significant effect on oxygen saturation. This finding is worthy of more substantial investigation.
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ItemThe impact and effect of group music therapy on anxiety, depression, quality of life and coping with women with breast cancer: a mixed methods study( 2011)This mixed method study investigated the impact and effect of group music therapy on anxiety, depression, coping and quality of life, and the experience of music therapy for women with breast cancer. Four groups of women received 6 weekly music therapy sessions that incorporated various music therapy methods. Eighteen women at different stages of the disease trajectory took part in the study. A decision tree was developed to determine the most appropriate intervention to use each session. The pre and post program measures were the Depression Anxiety Stress Scale (DASS), the Coping Orientation to Problems Experienced Inventory (COPE), the European Organisation for Research and Treatment for Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the European Organisation for Research and Treatment for Cancer Quality of Life Questionnaire Breast Cancer Module (QLQ-B23 (breast cancer). Visual Analogue Scales (VAS) measured mood, anxiety, coping and quality of life, pre and post each session. Qualitative data was gathered through focus group interviews which were held post music therapy program. A statistically significant improvement was found on one item of the EORTC QLQ-B23 (breast cancer) inventory, but there were no other notable changes. There were trends on two items of the COPE inventory, but no other changes, and no detected changes on the DASS. Statistically significant improvement was found on all four items on the VAS across all four groups, indicating that the music therapy sessions had a significant impact during the course of the six week program. The themes emerging from the qualitative analysis evolved from discussions about the music therapy sessions, the group experience and living with breast cancer. These were: a) music was heard and appreciated differently, b) the sessions allowed reflection, c) playing the chord harp was a voyage of discovery, d) songwriting was meaningful, e) listening to songs, singing and song writing were very moving experiences, f) confusion over the questionnaires, g) experiencing challenging moments, h) not enough time in the sessions and there were too few people, i) sharing experiences, j) it was a special space, k) the feeling endured, l) appreciation of the music therapist, m) it was a discrete experience, n) wanting to join a choir, o) the need to discuss the effects of treatment, p) silence of breast cancer, q) the impact on others of the diagnosis, r) seeing the funny side, s) it was a dual process coping with many things, and t) travelling similar but different paths. Individual distilled essences were generated from the focus group data, depicting the women’s distinctive experiences. Group essences were also developed from the data, illustrating the different group experiences. This study is one of only a few to examine a group music therapy model for women with breast cancer. Even though the study was small the findings make an important contribution to the research literature on the effect of group music therapy for women living with breast cancer.
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ItemMusic therapy for a 10-year old child experiencing agitation during posttraumatic amnesia: an intrinsic mixed methods case study( 2010)A mixed methods case study was developed to explore the use of music therapy for children, aged 2-14 years, experiencing agitation during the posttraumatic amnesia phase of recovery following severe traumatic brain injury. The study developed pragmatically within a real world research context, and was undertaken in the Children’s Neuroscience Centre at The Royal Children’s Hospital Melbourne (Australia). The collection of qualitative data was embedded in a quantitative protocol, and data was collected concurrently. During the recruitment phase of the study, only one participant met the full eligibility criteria. The study subsequently evolved as an intrinsic case study. Data collection took place every day (excluding weekends) for the first ten days of posttraumatic amnesia. Data collection included the participant being video recorded pre, during, and post each daily music therapy intervention. The music therapy intervention involved the music therapist-researcher singing familiar songs. The aim of the quantitative data collection and analysis was to measure the effect of music therapy on agitation, and included two independent reviewers viewing the video data and rating the participant’s agitation pre, during, and post each music therapy intervention using the Agitated Behavior Scale (Corrigan, 1989). These ratings were then analysed statistically. The analysis of qualitative data aimed to explore the responses of both the participant and the music therapist-researcher during the music therapy interventions, and was an emergent process undertaken using Morse and Pooler’s (2002) tri-tiered method of analysis for videotaped data. The participant (a 10-year old girl) sustained an extremely severe traumatic brain injury as a result of a transport accident. Severe cognitive impairments and a significantly reduced level of consciousness resulted in the participant presenting with only Islands of Awareness during the music therapy interventions. Analysis of the quantitative data yielded inconclusive results as to the effect of music therapy in reducing agitation during and post each music therapy intervention. Micro-description and analysis of the qualitative data revealed that the participant displayed four distinct categories of behaviours during the music therapy interventions: Neutral, Acceptance, Recruitment and Rejection. The final three categories of participant behaviours were responses to the familiar songs. Further, the music therapist-researcher responded to the participant’s behaviours in four distinct, corresponding ways; Holding, Affirming, Enticing, and Containing. The interpretation of these categories of behaviours and responses was that through offering a consistent musical holding for the participant’s behaviours, and adaptation of the familiar songs in a contingent manner in response to the participant, the music therapist-researcher offered an Environment of Potential to maximise the participant’s Islands of Awareness. The Environment of Potential maximised early stimulation to optimise the participant’s early recovery of consciousness and cognitive abilities.