Enhancing Dementia Care Through Music Therapy: Insights from a Clinical Practice Model for Persons with Dementia
Caring for individuals with dementia requires a thoughtful and person-centered approach. Dr. Alaine E. Reschke-Hernández's model, featured in Music Therapy Perspectives, provides a robust framework for improving the well-being of individuals with dementia. This evidence-based model emphasizes personalized care and interdisciplinary collaboration to foster meaningful engagement and connection.
Understanding Dementia: A Holistic Perspective
Aging changes biological and psychosocial functioning, categorized as primary aging (natural declines like reduced memory capacity) and secondary aging (illness-related changes, such as dementia). Dementia is an umbrella term used to describe changes in memory and other areas of cognition related to underlying neurological conditions. Late-onset Alzheimer’s disease, a specified type of dementia, impacts up to 80% of individuals with dementia. Significant and progressive memory impairments, cognitive declines, and diminished communication skills characterize this disease. These changes demand a therapeutic approach that considers the neurological aspects and the person’s unique life experiences.
Key Components of the Clinical Practice Model
Dr. Reschke-Hernández's model focuses on enhancing social interactions, mood, communication, and autonomy for individuals with dementia. Here’s a breakdown of it’s key elements:
1. Comprehensive Assessment and Interview
The foundation of this model lies in a holistic understanding of the individual. Therapists should interview and observe to assess the cognitive, emotional, and physical well-being of the person, considering their history, preferences, and strengths. This ensures interventions align with their unique needs.
2. Individualized Goal Setting
Specific, measurable, attainable, relevant, and time-bound (SMART) goals are designed to reduce agitation, improve mood, and foster social connections. For example, to enhance memory recall, a client may be tasked with recalling three memories or key elements during a session by the end of four weeks. This goal is specific and easily understood, even by those not directly involved in the session. It is measurable, aligning with the client’s current cognitive abilities, and achievable with appropriate support. The goal is relevant, focusing on improving the client’s well-being, fostering connections, and stimulating meaningful memory recall. Setting a four-week deadline ensures a timely reassessment of the client’s progress and allows for necessary adjustments. This approach ensures therapy sessions are guided by impactful, goal-oriented strategies.
3. Personalized Interventions
The model advocates for flexible, person-centered activities that leverage the individual’s functional skills and preferences. Music therapists and other non-pharmaceutical providers should use interventions that prioritize psychosocial responses - fostering engagement, mood regulation, and social connection. For instance, selecting music that resonates with the person’s cultural background and past experiences enhances its therapeutic effectiveness.
4. Themes of Therapeutic Techniques
Cognition: People living with dementia have unique cognitive needs that require personalized support to maintain memory, attention, communication, and problem-solving abilities as their condition progresses. Musical Executive Functioning Training (MEFT)® would be a great technique to utilize with this population as individuals could practice decision-making skills involving the creative process, social interaction patterns, or the structure of the activity. During implementation, therapists should simplify communication and allow extra processing time to help individuals engage more effectively.
Attention: As dementia progresses, individuals may also develop specific needs for attention, as it involves focusing, managing distractions, and engaging meaningfully in daily activities. Musical Attention Control Training (MACT)® would provide a structured activity where the individuals could practice utilizing sustained, selective, divided, and alternating attention via musical elements cueing different responses. Therapists should reduce distractions in the environment, such as games or television noise, and use varied musical elements to sustain focus and motivation.
Familiarity: Familiarity is crucial for individuals with dementia, as they may perceive environments, even familiar environments, as unknown, making consistent routines and familiar sensations essential for providing comfort, reducing confusion, and helping maintain their connection to their memories and identity. Singing a familiar song via Therapeutic Singing (TS)® will not only facilitate the initiation of speech but may also elicit an emotional response and lead to further social interactions.
Audibility: Auditory perception is vital for those affected by dementia, as difficulties in hearing can exacerbate communication challenges, leading to frustration and social withdrawal, which may further contribute to feelings of isolation. If goals with a client involve maintaining their hearing capability, Auditory Perception Training (APT)® could be a useful technique to practice discriminating and identifying different components of sound during musical exercises. However, overall, therapists should utilize strategies like clear speech and vibrotactile input when working with this population to address hearing challenges, ensuring the individual fully benefits from the session.
Structure: For individuals with dementia, the structure may provide a predictable routine that reduces anxiety, supports memory retention, enhances their sense of security, and helps them navigate daily activities more independently despite the cognitive challenges they may face. Though there are many ways to provide structure to your session, it is recommended to have a set beginning and end routine when working with a repeated client or group. By routinely using a particular song or introduction activity, the therapist may use Musical Sensory Orientation Training (MSOT)® to orient the individual to the session and provide them with a sense of ease as they know what to expect.
Autonomy: As dementia progresses, those impacted may experience lessened autonomy as cognitive decline impairs their ability to make decisions, manage daily tasks, and navigate their environment independently. This theme may be achieved through Therapeutic Instrumental Music Performance (TIMP)® where the playing of musical instruments is used to exercise and stimulate functional movement patterns. The individual is accomplishing and exercising skills that may enhance their range of motion, endurance, strength, coordination, etc., which can aid in their independent engagement in activities of daily living.
5. Ongoing Evaluation and Adaptation
Continuous monitoring ensures interventions remain effective and evolve with the person’s changing needs
Importance of Model and Application to Music Therapy
Psychosocial outcomes are the heart of this model, emphasizing how social, cultural, and environmental factors shape an individual’s experiences. By incorporating a holistic understanding of the individual into the building of their goals and interventions, the model ensures comprehensive, consistent care tailored to each person. By addressing the multifaceted needs of individuals with dementia, music therapy is identified as a vital tool for fostering engagement, connection, and joy, improving their quality of life.
For a deeper dive and furthering your education in this framework, explore the full article here: https://doi.org/10.1093/mtp/miab006. Whether you are a music therapist, caregiver, or healthcare professional, this approach offers invaluable insights for creating meaningful, person-centered care.
