Research

Research: Past Projects

Use of Voice and Singing in Palliative & Cancer Care Music Therapy

Clements-Cortés, A. (2017). Singing and vocal interventions in palliative and cancer care: Music therapists’ perceptions of usage, Journal of Music Therapy,54 (3), 336-361. https://doi.org/10.1093/jmt/thx010.

The objective of this study was to assess music therapists’ perceptions on how they use singing and vocal interventions in palliative and cancer care environments. Eighty credentialed music therapists from Canada and the United States participated in this two-part convergent mixed-methods study that began with an online survey, followed by individual interviews with 50% (n = 40) of the survey participants. In both palliative and cancer care, singing client-preferred music and singing for relaxation were the most frequently used interventions. In palliative care, the most commonly addressed goals were to increase self-expression, improve mood, and create a feeling of togetherness between individuals receiving palliative care and their family. In cancer care, the most commonly addressed goals were to support breathing, improve mood, and support reminiscence. Seven themes emerged from therapist interviews: containing the space, connection, soothing, identity, freeing the voice within, letting go, and honoring. Conclusions: Music therapists use singing to address the physical, emotional, social, and spiritual goals of patients, and described singing interventions as accessible and effective. Further research is recommended to examine intervention efficacy and identify factors responsible
that contribute to clinical benefit.


Buddy's Glee Club

Buddy’s Glee Club: Singing for Health and Wellness, Multi-Phase Studies

Buddy's Glee Club Three is currently underway. The purpose of this study is to examine the effects of choral singing with residents of a long-term care facility, diagnosed with Alzheimer’s disease, dementia, or cognitive impairment, and their caregivers. 

Buddy's Glee Club Two: examined physical, social, and emotional dimensions of wellness for older adults participating in a singing program facilitated by two music therapists. The participants included 16 older adults who were cognitively intact and those diagnosed with dementia. Self-report, observational, and interview data were collected: Likert scale ratings of mood, pain, anxiety, happiness, and energy were completed at the beginning and end of each choral session; participant behaviour and interactions were recorded in weekly observation notes; and semi-structured interviews about the choir were completed with participants as well as staff and volunteers who assisted with the choir. For all participants, average weekly pre- and post-session scores for happiness and mood increased each session; energy increased for 14 of 16 sessions; pain decreased for 14 of 16 sessions, and anxiety decreased for 11 of 16 sessions. T-test analyses, two-tailed with aggregated sessions data, indicated that changes were statistically significant (p < .01) for four indicators: increases in mood, energy, and happiness, and a decrease in pain. The observed decrease in anxiety did not reach statistical significance at conventional levels (p = .06) but is noteworthy given the small sample. Qualitative data led to the identification of nine major themes (community building/making friends; special moments; climate of positivity; music is therapy; singing makes me feel well/keeps me going; no anxiety at Glee; increased mood, energy and alertness; I can do it; and I love to sing) as well as recommendations for music therapists facilitating choral programs with this population.  This study has been published.

Clements-Cortes, A. (2014). Buddy’s Glee Club two: Choral singing benefits for older adults. Canadian Journal of Music Therapy, 20(1), 85-109.

Buddy’s Glee Club One:took place with cognitively intact and cognitively impaired older adults attending an adult day care program. Five main themes emerged from this study: friendship and companionship; simplicity; happiness and uplifting and positive feelings; relaxing and reduced anxiety; and fun. This study has been published.

Clements-Cortes, A. (2013) Buddy's Glee Club: Singing for Life, Activities, Adaptation & Aging,37, 4, 273-290, DOI: 10.1080/01924788.2013.845716


Amy on green screen

Sing-A-Long of the 1930s

This study investigated the utilization of an original sing-a-long DVD and activity package titled Sing-A-Long of the 1930’s to engage older adults’ participation in singing and therapeutic recreation activities. The method included the participation of 25 nursing or retirement homes and adult day care centres across Canada in a DVD sing-a-long and activity program for 5 weeks, followed by individual interviews with participants and/or focus groups. The results focused on participant, caregiver, and DVD facilitator’s perceived benefits and indicate the DVD was successful in engaging older adults with cognitive impairment in social interaction and discussion, participation in meaningful activity, reminiscence, sensory stimulation, and quality of life in aging.


Getting your Groove

 

Clements-Cortes, A. (2014). Getting your groove on with the Tenori-on. Music Technology and Education 7(1), 59–74, doi: 10.1386/ jmte.7.1.59_1

The purpose of this study was to assess the use of the Yamaha Tenori-on instrument in clinical music therapy sessions with a variety of clients across the lifespan ranging from children with ADHD and learning disabilities to older adults with cognitive impairment. In addition, the study sought to evaluate if the accompanying written guide for music therapists on the Tenori-on authored by the P.I. and Dr. Lee Bartel was helpful and useful in implementing musical interventions and working towards goals with a variety of populations. The Tenori-on is a digital instrument on which persons can play or compose music. Participants in the study included music therapists and music therapy interns/students who received a Tenori-on to assess its application in their clinical work. Feedback was obtained through interviews and surveys on their experiences using the Tenori-on with a variety of populations and their assessments of the instrument’s ability to address communication, emotional, social, and motor goals in individual and group settings. Participants described the instrument as fun, engaging, motivating, having sensory appeal, being well suited for improvisation and easy for non-musicians, but also complicated to master.


Relationship Completion

Clements-Cortes, A. (2009). Episodes of Relationship Completion Through Song: Case Studies of Music Therapy Research in Palliative Care. VDM-Verlag Publishing, Germany.

Episodes of Relationship Completion

For my doctoral thesis I looked at “What is the experience of a dying person engaged in a specific music therapy treatment program intended to facilitate relationship completion?” This study involved a presentation of four narrative case studies of palliative care patients and their immediate relations. The clinical music therapy sessions were based on the model of relationship completion as outlined by Dileo & Dneaster (2005). This model includes three levels of practice: supportive (palliative end-of-life symptoms like pain, comfort, quality of life); communicative/expressive (i.e., launching and reflective techniques, musical autobiographies, improvisation); transformative (i.e., life review, resolve conflicts and feelings, address spiritual issues). Emerging themes from the case studies were analyzed and there is also a cross-case chapter. I provide recommendations to music therapists and health care professionals and a summary of what I learned. A unique component in the study is the use of artistic pieces that I crafted to represent and highlight the emotions that were present in music therapy sessions. I conclude the dissertation with a reflection of what it was like to engage in this research study. The study has been published in book format. I was the successful recipient of the Hy and Bertha Shore and Harry and Sara Gorman Award which provided partial funding for the accompanying CD that was produced.

As a further means of communicating and expressing the results of this research study, I recorded a CD titled Episodes of Relationship Completion. This collection of songs is an artistic portrayal of the research study's results and thematic analyses. You can purchase the CD in the online store.

The book Episodes of Relationship Completion Through Song: Case Studies of Music Therapy Research in Palliative Care is now available to buy on Amazon.com. Follow this link to purchase.


Loss, Grief, Relationship Completion

As I began to write more about the use of music to facilitate the expression of emotions with clients in palliative care, I became quite interested in the technique of song writing and how powerful it was for many clients to express their emotions and thoughts in a song. I embarked on a pilot study looking at whether or not song writing was an effective or useful tool in working through issues of loss and grief. That study involved in depth case studies with several palliative care clients. In this study I also began to use narrative methods to express the research results and have since become very interested in narrative methodology. I have presented this research study several times including at the World Congress on Music Therapy in 2008 in Argentina.


Physical Pain in Palliative Care

Clements-Cortes, A. (2011). The effect of live music vs. taped music on pain and comfort in palliative care. Korean Journal of Music Therapy, 13(1), 105-121.

This study examined the effects of live music versus taped music on palliative care patients’ perceived degree of pain relief and physical comfort. Pain was assessed by the short-form McGill Pain Questionnaire, and physical comfort, the second dependent variable, was assessed by a VAS. The pain and physical comfort assessment instruments were administered in a pre- and post-test fashion. In total there were five scores yielded by the pre- and post-tests for each of the two sessions for each participant. Five regression analyses were run on the post scores as a function of pre score and session. Participants were inpatients of the Palliative Care unit of Baycrest Hospital, diagnosed with a terminal illness and were referred to the study by members of the interdisciplinary team. Participants had to be experiencing pain and taking a scheduled analgesic/pain medication as a result of their illness. Each subject was randomly assigned to the live or taped music group, and received treatment once on each of two days. Results indicated that both live and taped music were statistically significant in reducing pain perception and enhancing physical comfort, with the live music being more effective than taped. The results of this study were published in July 2011.


Burnout in Music Therapists Working in Palliative Care

Clements-Cortes, A. (2006). Occupational stressors among music therapists working in palliative care. Canadian Association for Music Therapy Journal, 12(1), 30-60.

The purpose of this study was to investigate the role of music therapists working in inpatient palliative care, and the occupational stress they face during the course of their work. Four music therapists were interviewed in an effort to: identify factors and stressors they experience in their work environment that may lead to “burnout and compassion fatigue” as described by the literature; identify coping strategies; and, provide general recommendations to reduce and cope with stressors. Data gathered from the interviews was coded, clustered, and synthesized and themes were highlighted. Lack of understanding by health care professionals of the role of the music therapist, ongoing loss, differing palliative care philosophies among members of the interdisciplinary team, difficult referrals, over-identifying with clients, and lack of appropriate space were the stressors specifically listed by participants. Furthermore although not specifically stated as stressors by participants, feelings of helplessness, juggling multiple roles, advocating for music therapy, not feeling valued or appreciated, and relationships with other interdisciplinary team members were also sources of stress.


Songs of Our Lives

Statistics Canada predicts that by 2056 people aged 65 and older will make up more than 25% of the population. As we age we experience cognitive difficulties and degrees of memory loss either from the natural processes of aging or more profoundly as a result of dementia. Throughout our lives music and song surround us. These songs and melodies are the backdrop against which we live our lives. They are melodies that are sung to us as young children and that we hum and sing along to as we age. They are not only the cultural wallpaper against which we carry out day to day transactions, but also act as markers for significant events that make up the life story for each of us individually. They accompany and anchor important events in our lives and often trigger memories when these same pieces of music are re-encountered.

This study is a collaboration between Bernie Warren, School of Dramatic Art, University of Windsor and myself in which we seek to explore the use of Significant Songs as a stimulus for the recall of life events. The proposal builds on the artistic, pedagogical and research expertise of the investigators. This proposal is predicated on the notion that Significant Songs, those that are attached to life events and have specific meaning for an individual, may be used to help trigger an individual’s memory. The purpose of this study is to examine the benefits of participating in workshops facilitated by a drama instructor and music therapist on the benefit and usefulness of investigating the significant songs of older adults to facilitate the writing of life story and future reminiscence opportunities. This study focuses on older adults who are cognitively intact. The first workshop took place at the Miles Nadal Jewish Community Centre in Toronto, Ontario in August 2011.

The purpose of this study was to assess the use of the Yamaha Tenori-on instrument in clinical music therapy sessions with a variety of clients across the lifespan ranging from children with ADHD and learning disabilities to older adults with cognitive impairment. In addition, the study sought to evaluate if the accompanying written guide for music therapists on the Tenori-on authored by the P.I. and Dr. Lee Bartel was helpful and useful in implementing musical interventions and working towards goals with a variety of populations. The Tenori-on is a digital instrument on which persons can play or compose music. Participants in the study included music therapists and music therapy interns/students who received a Tenori-on to assess its application in their clinical work. Feedback was obtained through interviews and surveyson their experiences using the Tenori-on with a variety of populations and their assessments of the instrument’s ability to address communication, emotional, social, and motor goals in individual and group settings. Participants described the instrument as fun, engaging, motivating, having sensory appeal, being well suited for improvisation and easy for non-musicians, but also complicated to master. The study has been accepted for publication in the Music, Technology and Education Journal (2014).