The Last Iris:
A Mother’s Day Tribute

By Jane Twohey (of the Room 217 Foundation) with Rory Taillon

The special bond between grandson and grandma is evident as Rory discusses his friendship with his Grandma, Doris Taylor. “I was a bit of the odd ball…you know a free spirit.” says Rory.  “She was kind of like that too so we had a special bond.”

Recognizing Rory’s musical talent at a young age, both mom and Grandma encouraged Rory to take singing lessons. His mom, Anne Marie, also a musician and singer, leads the choir and worship in their local church.  “Grandma always gave me crap if I didn’t sing in church,” laughs Rory. Anne Marie adds, “It was on the way home from church when I first knew that Rory had talent. At six years old he belted out, Holy, Holy, Holy in perfect pitch. I immediately enrolled him in singing lessons.”

Diagnosed with esophageal cancer, Grandma Doris was bedridden in her final days. Her love of music was evident even when too weak to eat. Rory would visit her often, “Grandma had all of the Room 217 CDs and she played them all the time. She played them constantly. Her favorite CD was the one with Eagles Wings on it.”

“I spent a lot of time with her and just sat with her. She was weak but still there. She wanted me to play and sing for her. She always wanted to hear Irish songs.  She loved the old Irish tunes like Black Velvet Band and When Irish Eyes are Smiling.  She also loved Hallelujah and House of the Rising Sun by the Animals.” Doris passed away at home on December 23, 2010.

About a month after Doris died, Rory turned to songwriting to help put words to his loss. He penned The Last Iris as a tribute to his Grandma and friend. The iris was Doris’ favorite flower.  “Writing the song helped deal with my pain. I was having trouble dealing with her death and it seemed like a good idea. I started playing my guitar and wrote the lyrics. I miss her, she was my confidant. I would come to her when I needed to talk.” Rory’s loss is evident in the lyrics of The Last Iris:

I sat and held you close
You told me you were ready
And you were proud
And that you loved me

Rory wrote a follow up song about Doris called Closure. “The Last Iris is my perspective on her passing. Shortly after that, I wrote Closure with a friend of mine, which is more about what I perceive her take on death to be.”

And I will be there to guide you from above
And I will lead you through the fog
You must be brave, Your soul cannot be won
And your fears you’ll overcome; no more need for tears
The darkness will soon be gone and peace will overcome

Every Mother’s Day in church, Rory plays guitar and sings his mom’s favorite song Ave Maria.  It is dedicated to his ‘two moms’ and to all mothers across the generations.

For more information on Rory Taillon, how to purchase his music and where he is performing next, visit www.rorytaillon.com

A Music Resource for Relaxation, De-Stressing and Pain Distraction

Music and Relaxation

Studies that focused on music and relaxation highlight the biological and neurological effects that music has on the body and the brain. Fried (1990) discussed decreasing heart and respiratory rates initiated by changes in the autonomic nervous system activity when relaxing music is played, and changes that occurred in paradoxical arousal patterns that were contrary to those in cognitive function and anxiety, which is a positive result showing how music was used to create physical relaxation symptoms that are opposite of physical symptoms experiences during anxiety.

Significant decreases in state anxiety were found in college students when listening to preferred, relaxing music (Davis & Thaut, 1989). In a broader study Robb (2000) found music relaxation and progressive muscle relaxation were the most effective in eliciting changes in anxiety and perceived relaxation when listening to music and participating in various relaxation techniques, but that state and trait anxiety did not differ among treatments.  A meta-analysis of 22 studies that focused on using music to decrease physiological arousal due to stress found that music and music-assisted relaxation significantly decreased arousal due to stress, and the amount of stress that was reduced was dependent on the client’s age, type of stress, musical preferences, and the type of music utilized (Pelletier 2004).

What is Guided Imagery and Music?

Guided Imagery and Music (GIM) is a technique used by specially trained therapists to help clients achieve a greater self-understanding and gain insight into their life problems. The Bonny Method of Guided Imagery and Music (BMGIM) was developed by Helen Bonny, who defines it as a “music centered exploration of consciousness which uses specifically sequenced music programs to stimulate and sustain a dynamic unfolding of inner experiences” (AMI, 2000). Music and imagery work together as therapeutic agents to expand a client’s awareness, resulting in major therapeutic benefits (Burns & Woolrich, 2004).

GIM is based on theories from two schools of psychology: humanistic and transpersonal. Humanistic psychology deals with a person’s growth as they move from fulfilling basic to complex human needs, and to ultimately achieve self-actualization (Maslow, 1968). Transpersonal psychology aims to expand awareness through imagery and dreams to in order to understand one’s greater connection to life (Vaughan, 1979). GIM aims for both self-improvement and self-transcendence.

The Music Programs

The music programs in the BMGIM provide structure and direction in the session. The therapist chooses a type of music that is most appropriate for the client’s situation. Specific programs have been developed for different purposes, including Caring, Peak Experiences, Imagery, Grieving, and Relationships. The programs are based on classical music and are mainly instrumental (Bonny, 1978). The music that tends to be the most effective for a particular client has enough structure and predictability to provide comfort, but also has enough variation and ambiguity to create interest and evoke reactions in the form of feelings and images  (Summer, 1993).

So How Does It Work?

While the client is completely relaxed, the music helps to evoke different feelings, emotions, thoughts, memories and images (Bonny & Pahnke, 1972). These images can be dream-like, and may contain mythical and archetypal figures or symbols released from the unconscious (Vaughan, 1979). The therapist acts as a guide, heightening the client’s awareness and helping them navigate the experience.

How Does A Session Unfold?

A BMGIM session unfolds in four stages (Bonny, 1978). The first stage is an opening conversation between client and therapist to find a focus for the session. The second phase is a relaxation induction. The therapist guides the client through relaxation exercises to relax the body and move to a state of consciousness conducive to focused imagination. The therapist then describes a scene to open the client to the imaging process. The third phase is the music-imagery experience, which lasts about 30-40 minutes. The therapist plays a specifically designed program of classical music while the client describes images that come to mind. The therapist dialogues with the client, supporting and encouraging their spontaneous imaging and attempting to heighten awareness. The fourth stage is called the return and post-talk. The therapist helps the client return to an alert stage of consciousness and they discuss the experience, trying to make sense of the images and relate them to the client’s life. The therapist does not make interpretations for the client, but prompts them to come to their own realizations.

Who Benefits?

GIM has been used with a wide range of clients, although it is not recommended for people with serious mental disorders. It can be helpful for those seeking assistance with a variety of issues such as relationship problems, career changes, health issues, stress and anxiety, depression, grief and loss, addiction, different forms of abuse, clarity about life experiences, or spiritual and existential questions.

Final Thoughts

GIM is a unique therapeutic technique that uses the powers of music and imagery to gain deeper self-understanding. Music has the ability to bring about memories, feelings and images, which become even more vivid when the mind is completely relaxed and the imagination is focused. A client’s GIM experience is a personal journey through an exploration of their unconscious. With an expanded awareness, clients can discover inner issues, themes and feelings and work through life’s problems with a new level of insight.

References

Association for Music and Imagery [AMI]. (2000). Welcome. Retrieved from ami-bonnymethod.org/the-bonny-method-2

Bonny, H. (1978). Facilitating GIM sessions. Salina, KS: Bonny Foundation

Bonny, H., & Pahnke, W. (1972). The use of music in psychedelic (LSD) psychotherapy. Journal of Music Therapy, 9, 62-87.

Burns, D. & Woolrich, J.W. (2008). The Bonny method of guided imagery and music. In Darrow, (ed.) Introduction to approaches in music therapy. U.S.: American Music Therapy Association Inc.

Davis, W., & Thaut, M.H. (1989). The influence of preferred relaxing music on measures of state anxiety, relaxation, and physiological responses. Journal of Music Therapy, 26(4), 168-187.

Fried, R. (1990). Integrating music in breathing training and relaxation: I. Background, rationale, and relevant elements. Applied Psychophysiology and Biofeedback, 15(2), 161-169.

Maslow, A. H. (1968). Toward a psychology of being.  New York: Van Nostrand Reinhold.

Pelletier, C.L. (2004). The Effect of Music on Decreasing Arousal Due to Stress: A Meta-Analysis. Journal of Music Therapy, 41(3), 192-214.

Robb, S. (2000). Music assisted progressive muscle relaxation, progressive muscle relaxation, music listening, and silence: a comparison of relaxation techniques. Journal of Music Therapy, 37(1), 2-21.

Summer, L. (1993). Melding musical and psychological process: The therapeutic musical space. Journal of the Association for Music and Imagery, 4, 37-48.

Vaughan, F. (1979). Awakening intuition. New York: Doubleday.

Technologies to Assist Older Hearing Impaired Patients

For the elderly or ill patient, who may be confined to bed rest, there is a need to optimize communication opportunities with medical or support personnel, as well as family members. These moments of communication often are very important. Fortunately, most hearing losses can be treated with hearing aids. The goal of amplification in hearing aids is to boost all speech sounds so the hearing impaired person can hear clearly. While hearing losses vary from one person to the next,  hearing aid technology allows for a very precise adjustment of the sound delivered to the listener’s ear, so that speech is easy to understand and also comfortable.

Tuning in to a radio, or listening to music can be stimulating, soothing, and can sometimes help with recovery and healing. Music can increase your overall sense of well-being, improve mood and focus and relieve stress. In recent years there have been a number of studies showing the benefits of listening to music, and also learning music (e.g., Nat Rev Neurosci 2010;11[8]:599).

For all of the reasons mentioned above, it seems a worthwhile goal to try to make music available to older patients. So, how can we optimize music listening for the client in a hospital room, or in a room shared with others?

The technology today allows us to deliver sound from a radio, personal music player, or even a television, directly to the patient’s ears through hearing aids or earphones. The volume of the signal can be adjusted using a small remote control. What this means is that the listener can enjoy an audio signal of choice wirelessly, and without interrupting others in the same room. Many of these systems are available as a package with the purchase of hearing aids from an Audiologist. Bluetooth or infrared headsets also are offered at stereo or electronic specialty shops.

MCC 2013 – Saturday November 9, 2013 – Toronto, ON

The Room 217 Foundation’s Music Care Conference will be returning to the University of Toronto on Saturday November 9, 2013 in partnership with the Music and Health Research Collaboratory, Toronto Alzheimer’s Society, Baycrest Hospital and founding partner Laurier Centre for Music in the Community.

Speakers include:

NEW THIS YEAR!

Music Medicine Research Symposia presented by MaHRC:
3 Thematic Symposia on Implications of Research for Practice

Music Medicine and Neurodeficits – Friday November 8, 1:00-5:00
Music Medicine and Quality of Life – Sunday November 10, 9:00-12:00
Music Medicine and Pain – Sunday November 10, 1:00-5:00

For more information call 905.852.2499

EARLY BIRD REGISTRATION OPENS June 1, 2013

9 PRACTICAL COMMUNICATION TIPS

Presbycusis generally presents itself with complaints of difficulty hearing in the presence of background noise, having to ask people to repeat themselves, having to increase the volume on the television or radio, and sometimes ringing in the ears.

On top of a measurable hearing loss, older individuals begin to experience a decline in the ability to process speech information with the same speed and accuracy. The quicker the rate of speech the more challenging due to the overlap of speech sounds. Deficiencies in the auditory system are the direct result of an impaired sound intake system (in other words, the sensory hair cells of the cochlea).

The very first step in addressing a presbycusic hearing loss is to treat with hearing instruments. This will allow speech information to be detected clearly, at a normal loudness level. This step in treatment is important to pursue earlier rather than later, as hearing aids require patience and a certain period of acclimatization. Older adults sometimes have trouble adjusting to such a physical, and psychological change.

Even with amplification treatment, however, hearing in everyday listening environments can present some degree of challenge. This is especially true when the talker is at a distance, or where there is background music or noise. Following are some practical tips for communicating with an individual with hearing loss.

• Face the individual with whom you are talking.
• Make sure you have the listener’s attention before speaking. You might tap them on the shoulder or wave if they are not aware that you are addressing them.
• Do not shout. Speak slowly, and clearly. Do not over- articulate.
• Avoid chewing gum or food while speaking. Do not obscure your mouth in any way.
• Sit within three to six feet of the listener.
• Ensure that there is sufficient lighting in the room, so that your face is visible. This will make speech reading possible.
• Find a quieter environment within which to communicate, preferably where there is carpeting.
• Watch the listener’s face for clues on whether or not they are able to understand what you are saying. If needed, you might try to rephrase what you have said, rather than repeating the exact same way.
• Ask the listener what you can do to help them hear better so they are able to better participate in the conversation.

This article is submitted by Judy Keith, MSc, Aud(C), Reg. CASLPO. Judy is Owner and Operator of Chemong Audiology and Hearing Centre in Bridgenorth, ON and Hearing Unlimited in Peterborough ON. She has been providing audiology services in the Peterborough area for more than twenty years.

The Room 217 Foundation, with the generous support of the GlaxoSmithKline Foundation, has recently

1.       For release, closure and comfort
Spirit Wings was played while staff sat with a client overnight – she was soothed by the music and she died while Footprints was being recited.  All of the staff members who experienced this individually spoke to me afterwards and explained how powerful this experience was.  As the resident was dying they encouraged her to “let go” and they guided her to focus on the songs that were very meaningful to her. The music brought some ease and comfort to a very difficult night.

2.       For reminiscence and enhancing communication
Volunteers have found the Room 217 CDs very useful in communication with clients facilitating discussions around memories triggered as they listen to the music.

3.       For soothing relaxation
One elderly gentleman, who was at end of life, very much enjoyed the CDs. He and his wife said they helped to take the worries away. They were able to sit and hold hands and quietly let the music soothe them. Another bereavement client enjoyed several of the CDs as she sat quietly at home by herself. She said they brought her much comfort and relaxation. 

4.       For companionship on the journey
Loneliness was eased by a dying patient who was semi-comatose and alone.  The only physical response was noted on repositioning.  We brought Room 217 CDs to her and noticed her toes tapping to Gentle Waters.   We changed the CD over to Old Chestnuts and her hands kept time to the beat despite severe apnea. We asked if she liked the music and she nodded yes.  She lived three more days with music as her companion.

5.       For sleep  promotion
Hugs and Kisses was played in the evening for a pediatric client at bedtime to promote a calm relaxed environment for sleep – allowing him to be rested in the morning and an increase in energy throughout the day.  Staff noticed an increase in his energy when he wakes in the morning after a long restful sleep. 

 6.       For distraction
One client became very obsessed related to his diagnosis with the shopping channel and was buying everything that was advertised so we were blocking that channel. Then he would become very agitated with commercials. We suggested to his family that we could put on the Recollections DVD which brought him much comfort and peace at the end of his life as he was very involved in his life in nature. His family was very grateful and he would often look at the DVD in the last week of his life.

In another situation, one of the clients (pediatric) was going through a medical situation causing insomnia, pain and an increase in seizures.  The music was put on for him which allowed him to rest (unfortunately unable to sleep) and redirect his attention to the music and off the pain and discomfort he was experiencing. 

7.       For program support i.e. bathing
We have implemented the Room 217 music care resources in our bathing program for our day hospice clients and they really enjoy it.  They state it helps relax them and get in to a peaceful space.

8.       For de-stressing caregivers
One Program Director plays the Room 217 music in her office while completing bereavement follow up calls. She finds it very calming and has noticed a difference in her experience when making the calls. 

9.       For regulated breathing
The client was in advanced stage of palliative care. I played live music for him which helped regulate his breathing. I setup the client’s son with a couple CDs from the Room 217 collection that would be comparable to the live music I played. The client’s son stated that he noticed a difference in his father’s breathing.

 10.   For reflection and meditation
Spirit Wings supported meditation. The music is instrumental for deeper reflection.

Happy Valentine’s Day from Room 217

Pablo Casals, the great cellist said “the capacity to care is the thing that gives life its deepest meaning and significance.” As a virtuoso, Casals was acquainted with care, the kind that brings precise fingering, bowing, and flexibility, demonstrating virtuosity, seasoned over years of skillful, mindful practice and performance.

He suggests that care is not merely technique, but rather quintessential to human purpose. Significance in life comes from the extent of one’s ability to care. If that is true then the pursuit of increasing stamina to care yields compelling dividends.

Caring for people implies concern, kindness, love, warm affection and approval. It may also suggest oversight or charge for the safety, well-being and prosperity of a loved one.

Caregiving is the act of extending oneself to share the burdens of others. Family members care by virtue of relationship (i.e. mother, grandparent). Professional caregivers have dedicated training in specific caregiving skills (i.e. nurse, therapist, PSW). Volunteer caregivers have some training and knowledge and give of their time to come alongside others to share in care.

Compassion lies at the heart of giving care. Empathy, shouldering and presence come from qualities of the heart, often prompted by personal experiences. One learns to care by receiving care and then is more able to pass it on.

Regulations and litigations are well-intentioned efforts that can impede our capacity to come alongside and offer personalized attention due to increased reporting, system compliance and political correctness. How do we strengthen our capacity to care working in medical or educational systems that seem to mitigate against it?

Here are 5 ways to encourage our caring capacity.

1. Show up. Even when it is tempting not to, time spent journeying alongside another person is an act of care.
2. Be present. Give up your own agenda for a while and give mindful attention to the needs of the other.
3. Listen attentively. Listening is not just hearing the spoken word. Loud messages may be unspoken. Pay attention.
4. Attend details. We care about the details of what is important to us. What are the details that are important to the other?
5. Be replenished. Genuine care comes from your heart and soul. We need spiritual inspiration and refreshment.

On Valentine’s Day, we celebrate love for those we care about. Care well. Love deeply. As Casals said, that is where we will find the most profound meaning of life.

Recently, I came across a user-friendly resource for health care providers, family and volunteer caregivers of persons with dementia, who want to more effectively integrate music into their care. Written by music therapist Robin Rio, she intends the book to be used as “an interactive tool in creating a musical atmosphere for time shared with someone who has dementia.”

Her passion and experience with the dementia population is evident through personal anecdotes and through practical tips for caregivers. For example, she offers 10 ways to make a melodic connection, 15 ways to make a rhythmic connection. And you don’t have to be musician to use music. She says “it’s not the level of musicianship or the quality of your voice that makes for the most meaningful interactions. It’s a sense of fun and engagement”. 

Rio recommends live music-making “sessions” which provide optimal connection. Sessions may last 15-30 minutes including an opening song, instrument playing, movement, singing. She coaches the caregiver on a variety of responses and reactions that may be encountered and how to evaluate them.

She also recommends core songs and includes a song list prepared by the American Association of Music Therapy (Jackert et al, 2003). This list was compiled by a group of music therapists with extensive experience doing music in the eldercare population and includes a table of frequently requested songs.

One of the key tips Rio offers the caregiver is to look for songs that were popular in the decade when the person with dementia was a teenager and young adult. According to research, most older adults show preference to music at this time in their lives (Peters, 2000).

Another important tip she cites (Clair, 1996) is this: singing in a lower key with music that has been slowed down makes it much easier for the person with dementia to be able to participate.

And this advice by Rio particularly caught my attention reflecting the compassionate and practical help you will receive  from this book:

Even if someone is unable to respond, unless there is profound hearing loss, he is still hearing your voice. Even with a hearing loss, leaning in close to someone and singing to him will generate warm feelings and enhance the mood and environment. There are vibrations produced when we sing which can be felt in the body of both the singer and the listener. The only time it’s important to not sing is if the music-making seems to disturb or distress the person you are caring for in any way.

References:

Clair, A.A., (1996). Therapeutic Uses of Music with Older Adults. St. Louis, MO: MMB Music.

Jackert, L. et al, (2003). Music Therapy and elderly Persons: Innovative Approaches. American Music Therapy Association Pre-Conference Institute Publication. Silverspring, MD: AMTA

Peters, J.S., (2000). Music Therapy: An Introduction. Springfield, IL: Charles C. Thomas

This blog entry is submitted by Noreen Langdon, Executive and Artistic Director for the Atlantic Health Arts Society.  For more information or to contact someone in your area about Health Arts Societies, visit www.healtharts.org or www.samsante.org

The Health Arts Societies/Société pour les arts en milieux de santé is a national group of seven registered charities that arranges live musical concerts for Canada’s under-served seniors, and offers paid professional engagements for our nation’s talented musical artists.

Since it was founded in 2006, the Health Arts Societies/Société pour les arts en milieux de santé has held over 7,000 concerts across the country for under-served seniors. The Concerts in Care program provides a venue for an enriched intergeneration experience to seniors in care, and has engaged the services of more than 17,000 Canadian artists paid at professional rates.

In the spring of 2012, through the generous sponsorship of BMO Financial and in partnership with several performing arts organizations, the Health Arts Societies held a Concert in Care festival across Canada. Seventy-three thousand elders and others in long-term care enjoyed first-class music by over 4,000 artists in 1,835 concerts across the country, spanning all ten provinces and the Northwest Territories.

The Concerts in Care program builds on the work of hundreds of performing artists, and on a philosophical foundation that live, interactive music provides immediate and positive engagement for all residents in care who participate. The positive response of these seniors, many suffering in the midst of their journey with dementia, is interesting and exciting for everyone involved.

Much has been written about the way music provides people with ways of understanding and developing their own identity, connecting with other people, maintaining their well-being and experiencing and expressing spirituality. People also associate music strongly with the memories of their own lives. The Concerts in Care program offers music as a source of entertainment, but also as a forum to share and interact with others.

The Health Arts Societies are witnessing broad acceptance of the value of Concerts in Care in the LTC sector. There is increasing recognition in Canadian society that the aging audience is as important to serve as any other enjoying the work of professional performers. Concerts in Care have been received with joy and gratitude across the country. Here are some comments from health care settings across Canada about Concerts in Care:

• The musicians were wonderful. Their selection was fabulous with such a variety of music. I heard about the music for the rest of the day.” We have a couple of ‘fiddlers’ as Residents and they stated “You know, that’s not my type of music but I liked to hear them play” “Boy, you sure could tell that they enjoy playing music”. Another comment by a dignified gentleman who listens to classical music all the time stated “It’s been so long since I’ve been to the symphony, it’s so nice to hear them again”. Marny Warner, The Birches, Musquodoboit Harbour, NS
  
•  I was very moved as I observed the residents absolutely mesmerized by the performance. They were absolutely transfixed. On so many occasions some of the residents have such a short attention span that they are up and out within a few minutes. There must have been at least 75 residents there and they all stayed for the performance. I was hearing comments from residents like “That was wonderful,” “This was the very best,” “When will we have some more?” “I am still vibrating” The performers were breathtaking! Their generosity of time, supplies and kindness will not be forgotten. It was a powerful performance and made a tremendous impact on our residents and all fortunate to hear the concert. Vija Mallia, Residence Director, Castleview Wychwood Towers, Toronto, ON
  
•  It was absolutely wonderful. We had residents reminiscing who rarely speak any more. We do have entertainment here on a regular basis, but this was a very rare opportunity for our residents- the chance to hear truly first class, professional music. Janet Eggert, Director of Programs and Services, Covenant Health, St. Joseph’s Edmonton, Alberta

Delivering Room 217 resources to Hospice Palliative Care in Canada

The Room 217 Foundation has decided to take a proactive role in the delivery and use of its music care resources to Hospice Palliative Care (HPC) facilities and programs across the country. Based on Room 217’s mission to produce and deliver music care resources to those in complex care and life threatening situations and based on Room 217’s experience, it is patients and families in HPC that have the greatest need for resources and strategies to enhance their quality of life.

Early in 2012, Room 217 designed the Room to Room (R2R) program for the controlled delivery and accessibility of its resources to HPC facilities and programs. With the generous financial support of the GlaxoSmithKline Foundation, Phase I of R2R was started in August of 2012 and is currently being introduced and monitored into more than 40 participating HPC facilities in towns and cities across Canada.

Proposed outcomes of the R2R program include awareness of the importance of music in care in participating HPC programs and facilities, as well as improve quality of patient care for people who are dying in Canada by:

• Improving quality of life
• Assisting in relationship completion
• Decreasing feelings of isolation and fear
• Helping to meet psychosocial and spiritual needs
• Providing pain distraction

For more information on the R2R program, please contact Debbie Devitt, Program Facilitator at R2R@room217.ca

The GlaxoSmithKline Foundation is dedicated to improving quality of life with a focus on health and wellness. The GSK Foundation remains committed to the continued evolution of GSK employees’ “cause of choice,” the hospice palliative care movement in Canada. They believe that all Canadians have the right to die with dignity, free of pain, surrounded by loved ones in the setting of their choice.