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The Magic of Music

Publication: Case Management Journal

Author / Writer: Mindy R. Toran

 

When you hear a song you like on the radio, your entire mood lightens. You sing along, hum the chorus, or snap your fingers. Listening to a tape or CD of your favorite artist help you relax or feel more energized. You may even use music to practice yoga or meditate.

In fact, a recent study conducted by Roper Starch Worldwide, a New York based marketing research and consulting firm, found that listening to music is the number one stress-buster for more than half of the world (56%). The survey, “Roper Reports Worldwide: Global 2000 Consumers Study,” was based on interviews with 1000 consumers in 30 countries. “When you think of music’s cost and availability through radio, TV, personal CD players, the Internet, and so many other new channels of individualized distribution and communication, it’s not surprising that more than half the world listens to music to relax,” says Tom Miller, group senior vice president of Roper Starch Worldwide and director of the global consumer study.

Music and Medicine

It should come as no surprise that music is crossing over into the world of medicine. Music Therapy – the restorative use of music to address patients’ physical, psychological, cognitive, and social functioning – has been used successfully with individuals of all ages and disabilities for more than 50 years. Its recognition has grown during the past 20 years or so and seems to be gaining acceptance as the medical community learns more and understands it benefits.

“Music can help address emotional and spiritual issues when dealing with chronic illness,” says Kathy Murphy, MMT, MT-BC, music therapy manager at the Hospice of Palm Beach County in West Palm Beach, Fla. Music therapy can assist in pain management, decrease anxiety, aid in relaxation, or help people cope with hospitalization and illness. “Often patients with conditions that are difficult to treat respond to music, which can serve as a means for stimulating discussion and expressing emotions, provide comfort, or even help develop functional or motor skills. There are so many applications for music therapy, all of which are determined on an individual basis.”

Music therapy can benefit patients with respiratory ailments, neurological problems, chronic pain, diabetes, brain injuries, cancer, dementia and Alzheimer’s disease, and numerous other conditions. Research has shown that music can decrease pain perception, reduce anxiety and depression, increase relaxation, improve mobility for victims of stroke and Parkinson’s disease, reduce the need for anesthesia in childbirth, and enhance communication with autistic children.

“Music is a catalyst [that] patients respond to. It often speaks to us where words don’t work,” says Mary Helen Ekstam, MT-BC, director of clinical and community services at the Rehabilitation Achievement Center in Chicago and owner of Music Therapy Associates, a private practice. “Music therapy can help patients adjust their injury or illness; gain ground with fine motor, oral motor, and communication skills; and aid in their psychosocial adjustment. We focus on their spiritual, psychological, emotional, cognitive, and physical needs.”

Music therapists use both instrumental and vocal music activities to facilitate medical improvements. Similar to case management, music therapy programs are based o individual assessment, treatment planning, and ongoing program evaluation. Music therapists often function as members of an interdisciplinary team and implement programs on a group or individual basis to address a variety of outcomes, including pain and anxiety reduction, stress management, communication, and emotional expression.

Deforia Lane, PhD, MT-BC, is the director of music therapy at the Ireland Cancer Center with the University Hospitals Health System in Cleveland, Ohio. She says, “We assess a patient’s needs, interview the individual to determine performance objectives and goals, work closely with treatment team, document results, and follow up as necessary. There are a multiplicity of ways to involve everyone in the therapeutic process, including the patient, family members, and the treatment team. The goal is to reduce anxiety, increase relaxation, decrease pain perception, increase communication, and help the patient regain a sense of normalcy and positive self-image.”

Because each case is different, there is no “typical” music therapy session. The therapist may work with the patient using guided imagery, listening, songwriting, or performance. Sessions can last from 15 minutes to an hour, depending on the patient’s needs and abilities.

“We may begin a session by singing a song, using instruments such as the omni chord to help patients create their own melodies, encouraging them to sing to help open their chest muscles, helping them write a song to relax or express their feelings, or developing guided imagery programs that we can put on tape to give the patient something to take home,” explains Barbara Reuer, PhD, Mt-BC, owner of MusicWorx of California in San Diego, who works with Scripps Health Care System and serves as director of the music therapy program at Stevens Cancer Center at Scripps Memorial Hospital in La Jolla, Calif.

“The nature of the session depends on the patient. I often work in subacute care units, with oncology patients, in alcohol and substance abuse programs, and with long-term care and vent patients,” Reuer continues. Additional settings may include intensive care units, pre- and post-op surgery, cardiac care, obstetrics, pediatrics, physical rehabilitation, and outpatient rehab. “Nurses, social workers, cancer care coordinators, and physicians may refer patients to music therapists for help with anxiety, depression, pain management, stress management, etc.” Music therapists draw from their individualized experiences to assess, treat, and evaluate patients.

Music Therapist Training

Currently, more than 5,000 music therapists are practicing, and 70-plus colleges and universities in the United States and Canada offer music therapy degree programs. Although music therapists are not licensed, graduates are eligible to take a national certification examination. Those who pass become board certified and hold the MT-BC designation, demonstrating entry-level skills in the profession. Other recognized professional designations include registered music therapist (RMT), certified music therapist (CMT), and advanced certified music therapist (ACMT).

The American Music Therapy Association (AMTA), the national organization based in Silver Spring, Md., was founded in 1998 as a result of the unification of the American Association for Music Therapy (established in 1971) and the National Association for Music Therapy (begun in 1950).  The group aims to advance public awareness of music therapy’s benefits and increase access to quality services. AMTA establishes criteria for the education and clinical training of music therapists, and members adhere to a code of ethics and standards of practice in their delivery of services. Through the Journal of Music Therapy, Music Therapy Perspectives, and other AMTA publications, research findings and clinical studies relevant to the practice of music therapy are highlighted.

“In the past 5 to 10 years, we’ve seen a gradual move from music therapists employed in institutions like state hospitals and psychiatric facilities to more contractual arrangements,” says David Smith, PhD, MT-BC, an associate professor at the School of Music at Western Michigan University in Kalamazoo, Mich., and AMTA president from 1997-1999. “We’re beginning to see greater interest in music therapy in a number of settings – not just in the medical arena. The use of music therapy is growing in geriatric facilities, schools, and rehabilitative settings.”

Reimbursement

Greater acceptance of the practice has led to more reimbursement for music therapy services. Currently only about 20% of music therapists receive third party payments, but that trend is beginning to change. Music therapy is a reimbursable service under Medicare’s Partial Hospitalization Benefit-Eligibility and Scope of Service, according to a June 1995 program memorandum released by the Health Care Financing Administration (HCFA). Reimbursement for other services still is handled on a case-by-case basis.

“We’re mainly reimbursed by the agencies we work with,” says Celeste Behnke, MT-BC, owner of The Music Works, a private music therapy practice in Sacramento, Calif. Fortunately, insurance companies are beginning to recognize the advantages of covering music therapy services, and some insurers are reimbursing as long as the appropriate CPT codes are used, she notes.

“Case managers can help us identify which therapies are approved and help us to determine which CPT codes our services can be billed under,” says Ekstam of Music Therapy Associates. “In return, we need to educate case managers about the clinical effect of music on clients’ progress and other intangible benefits.”

Behnke emphasizes, “Music gives control back to the patients and adds value to their lives. Because music is expressive, it has an impact on all individuals, not just children, on some level. Our practice is outcome-driven, not discipline-driven, and our goal is to focus on the whole person and help him or her to heal.”   [ end ]

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