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Harmonicas in Music Therapy: Research and Clinical Programming
Lee Anna Rasar
Music Therapy Clinical Practice – Historical Review
- motivation factor increases percentage of people who follow through with pulmonary exercises as well as amount of time engaged in therapeutic programming – increase in frequency of as well as length of practice and in amount of energy invested in practice
- relatively cheap – is accessible to most people - can easily secure donations for those who can’t afford harmonicas
- easy to learn – can adapt music reading system and teach to play by ear if needed
- music is produced while inhaling as well as when exhaling
- outcomes in research studies show equal to and better results when compared with other pulmonary programming
Music Therapy Clinical Practice – Historical Review:
1970s and 1980s – Children’s Hospitals in Galveston, Miami, and New Orleans
- Pre- and post-surgery – results were equal to or better than outcomes from use of incentive spirometry
- Harmonicas were used in individual therapy sessions to target a variety of goal areas ranging from pulmonary to social/emotional
1980s – outcomes:
- Found that harmonica playing led to productive coughing
- Specific improvement noted in: peak flow, total lung volume/vital capacity, and inspiratory and expiratory forces
- Used in Rehab with Pulmonary patients and Orthopedic patients who were paralyzed (pulmonary problems main cause of death for patients with paralysis), protocols developed for surgery patients for use pre- and post-surgery
Pulmonary patients included those with asthma and cystic fibrosis – harmonica was used for general pulmonary exercise/maintenance - Used in feeding groups with children who had difficulty swallowing to develop rhythmic tongue thrust – musical selections: Cindy, Cindy; Brandenburg concertos
- Used to develop lip closure for patients in occupational and speech therapy – sequential progression from slide whistle to kazoo to harmonica was effective
- Used to assess potential for successfully weaning off ventilation for patients from state schools – severe/profound MR/DD (now termed IDD) and those with multiple handicaps, including deaf/blind – if could learn pre-surgery, could anticipate cooperation post-surgery with protocol needed; deaf patients able to feel vibrations from harmonica playing and respond
- Harmonicas used in conjunction with: exercise to music and dance programs, playing other wind instruments, singing, use of Orff tone bars as form of CPT to loosen secretions, upper body strengthening (examples: conducting and dancing with weights), breathing and blowing exercises
- Fenestrated trachs enabled harmonica playing for patients with trachs
- Integration with school music programs post-hospitalization and community re-integration
- Standards of Clinical Practice – American Music Therapy Association – motor, cognitive, language, social, emotional, spiritual
Since 2000:
- Use of Passy Muir valves enable harmonica playing
- Use with patients with Parkinson’s – target tongue thrust and initiation/continuation/control of movement – and also with patients with ALS and stroke patients in feeding groups
- Use with nursing home resident with dementia who taught himself to play harmonica – had never played before and had not engaged in music performance before – grew to love singing and harmonica playing and taught and encouraged others to become involved
- Adapted homemade neck holder to use to easily transport harmonica
Presentation of concerts for family, friends, nursing home residents and special programs
- OMREX – Oral Motor and Respiratory Exercises – NMT (Neurologic Music Therapy) techniques which have become widely used internationally – Medical Coding and Records Manual : Neurologic Music Therapy by Suzanne Oliver, Michael Thaut, and Kimberly Sena provides research documentation for use of medical code billing
- Use of harmonicas in conjunction with harp therapy programming for active and passive harp work
Case study with home health patient – increased peak flows and ultimately decreased amount of oxygen needed – development of chordal accompaniment system for playing and reading music
The Effects of Harmonica Playing on Pulmonary Rehabilitation – Feb. – May 2008 – Luther Hospital and Sacred Heart Hospital in Eau Claire, WI
Range of conditions from restrictive disease to chronic obstructive problems
Inspiratory and expiratory values smaller in restrictive disease; Fev1 larger and FVC smaller in obstructive disease – patients could exhale air for much longer periods of duration
Patients instructed in inspiratory and expiratory breathing techniques to maximize breath duration and control – music therapy students provided guitar and harp accompaniment tapes made individually for each patient to use in home practice
Patients with restrictive disease made the most gains. Patients who practiced more than 4 days weekly and who consistently practiced and were present at sessions made the most gains. One patient more than doubled the number of seconds she could sustain tones on harmonica when exhaling while playing (from 7 to 14) and almost quadrupled the number of seconds she could sustain tones on harmonica when inhaling while playing (from 4 to 15). All patients made gains in the numbers of seconds they were able to sustain tones on harmonica. Pulmonary Function Tests which were individualized in content were used pre- and post- data run for all patients. Specific functions addressed for individual patients improved for the patients who consistently attended sessions and practiced at home. Weather conditions (humidity, extreme temperatures, and barometric pressure) affected results. Personal status also affected results – difficulty sleeping, being sick, walking long distances. Access to program location presented barriers which necessitated moving location of program when one hospital undertook a construction project. Some patients participated in physical rehab immediately prior to sessions, and others did so immediately after sessions. Comparison of these groups would provide interesting data for future research.
Comparison of Oxygen Levels in Music and Non-Music Conditions during Physical Therapy Exercises Completed by Coronary Artery By-pass Graft Patients – November 2005 – Bloomer Medical Center – Bloomer, WI
Post-surgery CABG patients had pulmonary measures taken immediately prior to exercise and then 15 minutes into exercise program on step-down unit. If the exercise caused the oxygen level to drop too low, exercises were stopped. On days that music therapist was present and provided music to facilitate the exercises, the oxygen levels increased despite the engagement in the physical exercise. Neurologic Music Therapy techniques were used.
Assessment of Effects of Musical Respiratory Interventions for Patients on Ventilator Support – Lakeside Nursing and Rehabilitation Center – May – August 2003 - Chippewa Falls, WI – (update: This setting is now a regional Ventilator unit.)
Part of a series of grants with Dr. Mark Lindsay – Harmonica playing was examined along with singing and breathing and blowing exercises as tools to improve general medical status, including quality of life. The individual medical status of the patients affected the results of the grant. Individual responses of patients did yield positive results in all categories. People with developmental disabilities and multiple physical disabilities including paralysis were included in harmonica playing. In addition to addressing the physical respiratory goals, patients set social and emotional goals for their work and presented several concerts which were attended by friends, family, staff, and community members. Need for physical assistance to set up harmonicas and neck holders impacted ability of patients to independently follow through on practice.
Research Finding of Interest - Recommendations/Precautions for Musical Notation Use in Harmonica Programming in Pulmonary Rehabilitation:
Do NOT include number cues on the same page with the I and O coding for inhaling or exhaling while playing harmonica for patients who are playing harmonica for pulmonary rehab purposes. Playing by reading notes from number cues is actually harmful to these patients because it encourages them to take short breaths, and it also results in a cognitive focus on note reading instead of in a respiratory focus on deep, slow breathing. Once the patient has learned to use the I/O method of playing harmonica and has established a practice routine, then the patient may be rewarded by getting to play the melody notes on one song at the end of the practice time and after the last data measure is taken. Be sure to caution the patient not to practice with the melody note playing style but instead to focus on sustaining long tones through the chordal accompaniment method of note reading.