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The Graduate School
2004
The Effect of Music on Non-Responsive
Patients in a Hospice Setting
Sarah E. Kerr
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THE FLORIDA STATE UNIVERSITY
SCHOOL OF MUSIC
THE EFFECT OF MUSIC ON NON-RESPONSIVE PATIENTS IN A HOSPICE
SETTING
By
SARAH E KERR
A thesis submitted to the
School of Music
in partial fulfillment of the
requirements for the degree of
Master of Music
Degree Awarded:
Spring Semester, 2004
The members of the Committee approve the thesis of Sarah E. Kerr defended on
March 30, 2004.
________________________
Jayne Standley
Professor Directing Thesis
________________________
Clifford Madsen
Committee Member
________________________
Diane Gregory
Committee Member
Approved:
____________________________________________________________________
Jon Piersol, Dean, School of Music
The Office of Graduate Studies has verified and approved the above named
committee members.
ii
I dedicate this thesis to my parents, George and Elaine Kerr. Also, I dedicate this thesis
in loving memory of my grandfather, George Kerr, who was a hospice patient in my
hometown. There is no doubt that he would have benefited from music therapy services.
I love you!
iii
ACKNOWLEDGMENTS
I would like to begin by thanking my parents who continually provided support
and encouragement throughout the thesis process. Special thanks to Dr. Jayne Standley
for whose expertise and guidance I am ever grateful. Thanks to Dr. Dena Register who
helped guide me in setting up a study at Big Bend Hospice. Finally, to Melanie Harms
and the music therapy staff at Big Bend Hospice, I am grateful for your referrals and
support as well as the patients who participated in my study.
iv
TABLE OF CONTENTS
List of Tables………………………………………………………………. vi
Abstract……………………………………………………………………. vii
INTRODUCTION………………………………………………………… 1
METHOD…………………………………………………………………. 9
Participants………………………………………………………... 9
Design …………………………………………………………….. 9
Procedure………………………………………………………….. 10
RESULTS…………………………………………………………………. 11
DISCUSSION……………………………………………………………... 14
APPENDIXES…………………………………………………………….. 15
Appendix A: Raw Data……………………………………………. 15
Appendix B: Informed Consent……………………………………. 19
Appendix C: Approval Letter……………………………………… 20
REFERENCES…………………………………………………………….. 21
BIOGRAPHICAL SKETCH………………………………………………. 25
v
LIST OF TABLES
1. Subject Demographics………………………………………………………….. 9
2. Table of Means: Heart Rate by Type of Music……….………………………... 11
3. Results of 2-Way Repeated Measures ANOVA for HR by Music Type.…….... 11
4. Table of Means: Respiration Rate by Type of Music..…………………………. 11
5. Results of 2-Way Repeated Measures ANOVA for RR by Music Type.…….…12
6. Table of Means: Heart Rate by Day……………….………………………….…12
7. Results of 2-Way Repeated Measures ANOVA for HR by Day.………………. 12
8. Table of Means: Respiration Rate by Day.……………………………………... 13
9. Results of 2-Way Repeated Measures ANOVA for RR by Day.………………. 13
vi
ABSTRACT
The purpose of this study was to evaluate the effects of music on non-responsive
patients in a hospice setting. Non-responsive was defined as those patients who were
comatose or whose terminal illness had progressed to the point that the patient did not
respond to verbal stimuli. A total of 10 subjects participated in the study on two
consecutive days. Data were collected on subject’s heart rate and respiration rate at the
beginning of each visit, after 10 minutes of silence, and then again after 10 minutes of
music. Each subject listened to a classical selection and a new age selection but only one
selection was played each day. A two-way repeated measures ANOVA revealed
significant differences for both HR and RR across trials but not for type of music. Heart
rate and respiration rate data were also analyzed by day 1 vs. day 2. Again, both
physiologic measures were significantly lowered following music with no significant
differences by day. Results of this study support the continued use for music therapy
with hospice patients who are verbally non-responsive.
vii
INTRODUCTION
Music is a powerful tool that can be used in a variety of ways to reduce anxiety,
decrease pain perception, and change a person’s mood--all of which benefit an
individual’s quality of life. It has been expressed that each person on this earth has a
theme that is his/her identity and a repertoire of being that each uses to adapt biologically
and existentially. Like a piece of jazz music, we are constantly improvised to meet the
internal and external demands of our daily lives. Music therapy can help facilitate this
improvisation by extending an individual’s repertoire to meet life’s challenges (Aldridge,
1998).
Research articles have proven that music communicates, motivates, soothes,
calms, alleviates pain and anxiety, and lifts the spirit, and sometimes gets to the heart of
deeply perplexing emotional, spiritual, and interpersonal problems, thereby releasing
energies for healing (Brown, 1992). Music is a holistic medium, basic to our existence
(Starr, 1999). According to Aldridge (1998), our very human being is symphonic,
coordinated not like a mechanism but rather like a piece of chamber music coordinates its
very instrumental voices. What links the performance of music and the performance of
health is the element of participation.
A classic example of how music influences a person’s health can be found in the
Bible. Three thousand years ago, a young musician named David was able, through
music, to counter the dismal episodes of melancholia which beset King Saul. These
moods were so intense, that they completely debilitated the King. The only effective
remedy was music. It is noteworthy that in this ancient account, the patient participated
in his own plan of treatment and issued the order for a highly skilled musician to be
found to relieve his terrible plight (I Samuel 16:14-23). Music nurtures us with its
beauty; it feeds the soul; it “soothes the savage beast” (William Congreve). It is called
the universal language (Starr, 1999). Hans Christian Anderson said it best, "When words
fail, music speaks” (Brown, 1992).
The fact that “music speaks” to reduce pain perception has received some
attention in the medical field. Although scientists find it difficult to define pain, it is
associated with a stimulus that causes physiologic changes such as faster heart rate,
1
higher blood pressure, greater secretion of epinephrine into the blood stream, increased
blood sugar, dilated pupils and sweating (Luciano, Sherman, and Vander, 1978).
Although some define pain as a sensory experience which yields an emotional reaction,
the International Association for the Study of Pain (1986) defines pain as “an unpleasant
sensory and emotional experience associated with actual or potential tissue damage, or
described in terms of such damage.”
Several research studies have been completed to determine if music can affect a
person’s perception of pain. Everyone experiences pain but each person experiences pain
differently due to their individual physiology. The most influential theory concerning
pain perception is the Gate Control Theory proposed by Ronald Melzack and Patrick
Wall in 1965. This theory states that pain impulses transmitted from nerve receptors
through the spinal cord to the brain can be altered in the spinal cord, brainstem, and
cerebral cortex. Regardless of the intensity of the pain, the neural activity in the spinal
cord acts like a gate which can increase or decrease the amount of nerve impulses from
the receptors to the central nervous system. Increased activity by the larger, fast
conducting nerve fibers of the central nervous system can inhibit the passage of painrelated impulses, thus partially or totally decreasing the sensation of pain. Larger fiber
stimulation closes the “gate” for the smaller, slower-conducting fibers.
In addition to nerve fiber types, Melzack and Wall (1965) suggest that pain
experience also consists of three major psychological dimensions: (a) sensorydiscriminative, (b) motivational-affective, c) cognitive-evaluative. Cognitive or higher
central nervous system processes associated with thinking influence the intensity and
quality of pain experiences through “expectation, suggestion, level of anxiety, the
meaning of the situation in which injury occurs, attention distraction levels, competing
sensory stimuli, and other psychological variables” (Melzack, Sprague, & Weisz, 1963).
Thus pain perceptions and pain behaviors are created by the interaction of
physiological and psychological factors of the individual. In addition, the psychic and
physical factors that determine the sensation of pain are important components of the
pain perception phenomenon. The manipulation of any or all of these factors will affect
the quality and intensity of pain perception. Because pain is subjective and personal,
many different types of pain management techniques have been designed to alleviate pain
2
and one such technique is that of music therapy.
The use of music in the relief of pain has been incorporated into the practice of
music therapy over the past several decades. Research reviews the use of music in both
acute and chronic medical conditions and relief is usually attributed to the distraction and
relaxation factors of music. Both music and pain have similar ancient roots (Eagle and
Harsh, 1988) as both are derived from the same root word “aio.” The psychoneurological
processing of both is similar as both have measurable characteristics in frequency and
amplitude of signals being neurologically processed with the potential for one to affect
the other. Neurologically, experimental and clinical studies show that fluctuating or
pulsed mechanical vibrations such as those found in music are effective in pain
modulation and in raising the thresholds of pain tolerance (Chesky and Michel, 1991).
Music composed of ever-changing frequencies and amplitudes delay the onset of
adaptation, fatigue, and habituation in the Pacinian corpuscles and their related neural
processes. Pain is certainly a multidimensional phenomenon which requires a
multidimensional approach in treatment, and music has been shown to be effective in
several types of pain coping strategies.
Music has been used to control pain since ancient history. The Persians and
Hebrews used music as therapy for several illnesses; the early Greeks used music to alter
psychological and physiological states; the tribal medicine men of Africa used music as a
primary tool to enhance their healing powers. From the Renaissance to the present day,
music has and is still being associated with medicine (Brown, Chen, & Dworkin , 1989).
One of the most popular applications of music in the medical field came from
Gardner and Licklider (1959) for their use of music in dental procedures, thus coining the
term “audioanalgesia,” the use of auditory stimulation (music and/or noise) as an
analgesic agent. In this study, patients were given a remote volume control box and told
to increase the auditory stimulation to mask the sound of the drill and/or if they felt any
sensations of pain. Gardner and Licklider (1960) reported that out of 1000 patients, 65%
had complete suppression of pain, 25% had suppression enough that no analgesia was
required, and 10% had less than adequate relief.
Instead of raising the pain threshold in patients, some researchers suggest that
music sound stimulation affects tolerance levels (Davenport & Robson, 1962).
3
MacClelland (1979) reported that music provided a diversion and distraction from the
strange sights and treatments in the operating room and when carried over into the
recovery period, patients experienced shortened, more pleasant post-operative recovery.
Likewise, Herth (1978) reported a 30% drop in the use of pain medication by hospitalized
patients who listened to music when experiencing pain. Another study of post-operative
abdominal surgery patients showed positive reduction in patient’s musculoskeletal
reactions, pain-relieving medications, and verbal pain reports (Locsin, 1981). Music was
administered for the first 48 hours after the surgery.
In addition, Matejek, Mulik-Kolasa, and Stupnicki (1996) reported on the effect
of music listening in presurgical patients awaiting non-orthopedic surgery. The day
before surgery arterial pressure, heart rate, cardiac output, skin temperature, glucose
count, and blood samples were taken. The patients were then told about the surgical
procedure and all measures were taken every 20 minutes for one hour. The music
listening group mean values for each variable returned to the initial value while the
control group values remained at the stress induced level. Strauser (1997) reported
similar results with patients receiving chiropractic intervention. Music listening groups
showed significantly less anxiety and tension although there were no significant
differences in physiological measurements across conditions.
Likewise, Bonny (1983) reported the effectiveness of programmed taped music in
reducing stress for the patients in an intensive coronary care unit. Data were collected
over a period of 10 months with 26 patients in intensive coronary care. Patients were
given a choice of tapes, three of which were classical and one tape which included
examples of folk, country, jazz, and swing. Tapes were 25-35 minutes in length and
selections varied from three to five minutes each. Results of the study included
decreased heart rate, greater tolerance of pain and suffering, decreased anxiety and
depression in patients.
An individual can exert control over the sensory-discriminative component of
pain by such means as physical and mental relaxation, including slow, deep breathing
(Melzack, 1973). Music facilitates this physical and mental relaxation process by
providing reinforcing cues, such as slow tempos and constant rhythmic patterns. A music
therapy training program was incorporated with the Lamaze technique for expectant
4
mothers to use during labor and childbirth. Hanser, Larson, and O’Connell (1983) used
the music therapy to cue rhythmic breathing, to assist the woman in relaxing by
prompting positive associations with the music and to focus attention on the music,
diverting attention from discomfort and extraneous hospital sounds which might signal
anxiety. Results yielded that 100% of the mothers displayed fewer pain responses when
the music was played during labor as compared to patients who had no background music
within the same environment.
There is significant use of music in cancer therapy and pain management in
hospice care. Music therapy is used to promote relaxation, to reduce anxiety, to
supplement other pain control methods, and to enhance communication between cancer
patients and their families (Bailey, 1983 and 1984). Music therapy influences the
psychological state of cancer patients thus enhancing quality of life. Kerkvliet (1990)
found that music was effective as a means of relaxation and distraction during
chemotherapy sessions, and Frank (1985) reported that music reduced nausea and
vomiting in cancer patients during these chemotherapy sessions.
Music therapy is the skilled use of music by a certified music therapist to meet the
physical, psychological, spiritual and social needs of patients and their families. It has
been an integral part of hospice care since 1970 when the first hospice was established in
this country. Focus of hospice is on comfort and quality of life for terminally ill patients
and their families (McMillan, 1996). Music therapy is a complementary treatment
modality which is being recognized as an adjunct service with hospice care and palliative
organizations who treat terminally ill patients (O’Callaghan, 1996). Music therapists are
an integral part of the support team at Big Bend Hospice in North Florida where the
mission is to provide compassionate care to individuals with a terminal illness, comfort to
their families, and emotional support to anyone who has lost a loved one.
Research has shown the music center of the brain to be the most primitive and last
to deteriorate (Clair, 1990). It is believed that a patient in a coma can still hear, a point
illustrated by Starr (1999) in a case study of a young cancer patient. A thirteen year old
cancer patient in a coma was unresponsive until he heard his mother singing Spanish
hymns. Somehow connected physiologically, the patient opened his eyes and responded
to a question about how much he liked the music. His response was, “Yes very much,”
5
that he liked the music (Starr, p. 741). When the music was finished the patient drifted
back into the non-responsive state
Krout (2001) noted the effectiveness of single-session music therapy interventions
with 80 patients served by an established hospice program in Florida. By way of
behavioral observation and subject’s self reporting, data were collected. Results showed
patients in the study exhibited increased control over pain, more physical comfort and
increased relaxation during both data-collection scenarios. Single session music therapy
appeared highly successful in the study.
Similarly, Lane and Wilkins (1994) studied the effects of single session music
therapy on 40 hospitalized children with cancer. By measuring the immunoglobulin-A in
the saliva of the patients in pre-post test situations, it was concluded that the use of
single-session music therapy statistically reduced the level of this stress hormone in the
patient’s saliva. In addition, the patient evaluations indicated that the sessions had a
positive effect on patient attitude.
In support of music therapy for pain control of patients in hospice and palliative
care, Magill-Levreault (1993) writes, “Music can engage, activate and alter affective,
cognitive, and sensory processes through distraction, alteration of mood, improved sense
of control, the use of prior skills and relaxation . . . The diverse qualities of music
potentiate its effectiveness as a medium to be used to soothe pain and ease suffering.”
Results from 465 cancer patient responses reinforce previous findings of reduction of
pain, improvement in mood and communication (Bailey, 1986).
Further support of palliative music therapy’s role in pain reduction was noted by
Curtis (1986). Measurement of patient’s perceived pain relief, physical comfort,
relaxation, and contentment scores after listening to recorded music pointed to the
effectiveness of music. The results were derived from the graphical analysis of 17
terminally ill patients. Numerous case studies are evidence of the reduced pain and
increased relaxation when listening to music (Krout, 2003; O’Callaghan,1996; Starr,
1999). Furthermore, Hilliard (2003) offers support for the use of music therapy in
palliative care. Studying terminally ill cancer patients at Big Bend Hospice in North
Florida, Hilliard notes that music therapy sessions increased the quality of life while
patients were becoming more ill. Music therapy can influence a patient’s quality of life
6
even though physical health declines and patients become imminent. The mean of the
groups studied also indicated that those receiving music therapy lived longer by an
average of 12 days than those without music therapy intervention. Data were collected
from 80 subjects in the study.
In addition to the studies of music to control pain and improve quality of life, it
has also been studied for its effect on heart rate and blood pressure. As early as 1929,
Vincent and Thompson attempted to study such effects with gramophone and radio
music. In general they found a slight rise in the listener’s blood pressure while listening
to music. Further study by Bason and Celler (1972) found that the human heart rate
could be varied over a certain range by entrainment of the sinus rhythm with external
auditory stimulus. An audible click was played to the subjects at a precise time in the
cardiac cycle. Within a critical range, heart rate could be increased or decreased up to
12% over a period up to three minutes. When the auditory stimulus or click was not
within the range of the cardiac cycle, no change in heart rate was noted. This study is
important for supporting the proposition of music therapists that meeting the tempo of the
patient influences their musical playing and is the initial key to therapeutic change
(Aldridge, 2000).
Ellis and Brighouse (1952) studied the effects of music on respiration and heart
rates with 36 subjects and three selections of music. Data were collected before, during
and after the musical selections. Statistically significant increases were noted in
respiration rate, but there were no significant changes in heart rate. Another study done
by Haas, Distenfield, and Axen (1986) was to determine the effect of external rhythmical
musical activity on respiratory pattern while keeping motor movements to a minimum.
Of the twenty subjects involved in the study, there was no appreciable change in heart
rate, but there was an appreciable change in respiratory frequency. Following music
therapy interventions, Whittail (1989) noted decreases in blood pressure and heart rate of
eight terminally ill patients. As a result of the noted research, auditory cues then appear
to be important to respiration and other motor activity. According to Aldridge (2000), it
is this aspect of organization of behavioral events that appears to be the important aspect
of music and central to music therapy.
7
Knowing the value of music in alleviation of pain for hospice and palliative care
patients and the fact that music has been documented to affect heart and respiration rates
in subjects, the purpose of this study is to determine if music has an effect on a nonresponsive patient’s heart rate and respiration rate. This study will use two musical
selections to determine if one has a greater effect on heart rate and respiration rate. If
these non-responsive, critically ill patients respond to music, then this would justify
continuation of music therapy for hospice patients in a coma state.
8
METHOD
Participants
This study was conducted with patients of Big Bend Hospice in North Florida.
Big Bend Hospice provides services for terminally ill patients and their families. All
selected subjects (N=10) were identified by a registered nurse, family support counselor,
or music therapist as being non-responsive. Non-responsive is defined as those patients
who are comatose or whose terminal illness has progressed to the point that the patient
does not respond to verbal stimuli. The age of the participants ranged from 40 to 105
with the majority being above 80 years old. Patient diagnoses consisted of failure to
thrive, senile dementia, Parkinson’s disease, HIV, and congestive heart failure.
Table 1
Subject Demographics
Subject #
Diagnosis
Age
Gender
1
Failure to Thrive
77
Male
2
Senile Dementia
84
Female
3
Senile Dementia
84
Female
4
CHF
105
Female
5
Senile Dementia
88
Female
6
Senile Dementia
91
Female
7
Parkinson’s Disease
96
Female
8
Parkinson’s Disease
91
Female
9
HIV Disease
40
Male
10
CHF
82
Female
Design
The design utilized for this study was Day 1: AAB and Day 2: AAB’ where A
indicates no music condition and B/B’ indicates two different music conditions. The 2
music conditions were alternated among subjects. The dependent variables were heart
rate and respiratory rate. Heart rate was calculated by counting the number of heartbeats
9
in fifteen seconds and then multiplying that number by four. The researcher listened to
each patient’s heartbeats with a stethoscope and used a stopwatch to accurately collect for
fifteen seconds. Respiratory rate was calculated by counting the patient’s respirations for
fifteen seconds and multiplying that number by four.
The independent variable was type of music (Classical or New Age). The
Classical selection was an excerpt from The Mozart Effect Night, “Andante Cantabile for
String Quartet in C major, K465”and “Romance from the Grand Partita, K361.” The New
Age selection was “Yoga Dream.” Each subject participated in two sessions that were 20
minutes in length on two consecutive days.
Procedure
This was a two-day study that collected data for twenty minutes per subject each
day. On day one the subject’s heart rate and respiration rate were taken at the start of the
session. After ten minutes with no music the subject’s heart rate and respiration rate were
taken again to collect baseline data. Then, the recorded musical selection was played for
ten minutes. At the end of the music, the subject’s heart rate and respiration rate were
taken a final time. On day two the procedure was the same as day one except the subjects
listened to a different musical selection. Half of the subjects listened to the classical
selection on day one and then listened to the new age selection on day two. The other
subjects listened to the new age selection on day one and the classical selection on day
two.
10
RESULTS
Statistical analysis was calculated using a two-way repeated measures ANOVA
for both heart rate and respiratory rate. There were significant differences for both HR
(Table 3) and RR (Table 5) across trials but not for type of music. Subjects’ physiologic
states (HR and RR) were significantly lowered by both types of music even though they
were verbally non-responsive.
Table 2
Means for heart rate by type of music
Source
Measurement 1
Measurement 2
Measurement 3
Classical
86.4
86.4
84.0
New Age
82.8
82.4
80.0
Table 3
Results for 2- way repeated measures ANOVA for heart rate by type of music
Source
Sum of Squares
df
Mean Square
F
Significance
Music
224.267
1
224.267
.770
.403
Measure
83.733
2
41.867
3.788
.042
Music X
.533
2
.267
.017
.983
282.133
18
15.674
Measure
Residual
Table 4
Means for respiration rate by type of music
Source
Measurement 1
Measurement 2
Measurement 3
Classical
20.4
20.8
19.6
New Age
20.0
20.0
18.4
11
Table 5
Results for 2-way repeated measures ANOVA for respiration rate by type of music
Source
SS
df
MS
F
Significance
Music
9.60
1
9.60
.186
.677
Measure
22.933
2
11.467
8.234
.003
Music X
1.60
2
.80
.403
.674
35.733
18
1.985
Measure
Residual
Heart rate and respiration rate data were also analyzed by day 1 vs. day 2 (Tables 7 and
9). Again, both physiologic measures were significantly lowered following music with
no significant differences by day.
Table 6
Means for heart rate by day
Source
Measurement 1
Measurement 2
Measurement 3
Day 1
86.4
87.2
84.0
Day 2
82.8
81.6
80.4
Table 7
Results of 2-way repeated measures ANOVA for heart rate by day
Source
SS
df
MS
F
Significance
Day
273.067
1
273.067
.954
.354
Measure
70.933
2
35.467
3.552
.050
Day X
13.333
2
6.667
.413
.668
290.667
18
16.148
Measure
Residual
12
Table 8
Means for respiration rate by day
Source
Measurement 1
Measurement 2
Measurement 3
Day 1
19.2
19.2
17.2
Day 2
21.2
21.6
21.2
Table 9
Results for 2-way repeated measures ANOVA for respiration rate by day
Source
SS
df
MS
F
Significance
Day
117.60
1
117.60
2.498
.148
Measure
16.533
2
8.267
4.729
.022
Day X
11.20
2
5.60
2.124
.149
47.467
18
2.637
Measure
Residual
Overall, these results demonstrate that terminally ill hospice patients who are nonresponsive are responsive to music, that both types of music in this study had the same
effect, and that the effect was consistent across 2 days.
13
DISCUSSION
Results of this study support the use of music therapy in hospice and palliative
care for non-responsive patients. After listening to music, patient respiration rates and
heart rates decreased significantly. This was true for both day 1 and day 2 of the study.
Although the results of this study have positive implications for music therapists
in a hospice setting who have non-responsive patients, further studies could be completed
with patient’s preferred music to see if results have an even greater significance.
Subject’s preferred music could be determined while the patient was still verbal or by
family members if the patient was non-responsive.
In addition, the length of time the music is played with the patient could be
increased to see if further changes could be noted in heart and respiration rates over the
longer duration of the music intervention. Not only does the music affect hospice and
palliative care patients, but the study would suggest that music could impact any patient
with a physical impairment or malady.
It is obvious from this study that terminally ill non-responsive patients are
benefiting from music. Lowered heart rate and respiratory rate improve quality of life
during this difficult period. Music therapy is highly recommended clinically for nonresponsive patients and further research is definitely warranted in this area.
14
APPENDIX A
RAW DATA
Subject #
HR 1
HR2
HR3
Classical
1
2
3
4
5
6
7
8
9
10
88
76
76
112
112
80
68
64
120
68
96
72
72
112
112
80
68
64
120
68
80
64
68
128
112
80
68
60
112
68
Group #
1=Classical
2=New Age
1
1
1
1
1
1
1
1
1
1
New Age
1
2
3
4
5
6
7
8
9
10
100
72
72
100
92
72
72
64
96
88
100
72
72
100
92
68
72
64
96
88
100
68
68
96
92
64
64
64
96
88
2
2
2
2
2
2
2
2
2
2
15
Classical
New Age
Subject #
1
2
3
4
5
6
7
8
9
10
RR1
24
20
16
36
24
20
16
12
8
28
RR2
24
20
16
40
24
20
16
12
8
28
RR3
20
16
16
40
20
20
16
12
8
28
Group #
1
1
1
1
1
1
1
1
1
1
1
2
3
4
5
6
7
8
9
10
28
20
16
24
20
24
16
12
12
28
28
20
16
24
20
24
16
12
12
28
28
16
16
20
20
20
16
12
12
24
2
2
2
2
2
2
2
2
2
2
16
Day 1
Day 2
Subject #
1
2
3
4
5
6
7
8
9
10
HR1
88
72
72
100
112
80
68
64
120
88
HR2
96
72
72
100
112
80
68
64
120
88
HR3
80
72
68
96
112
80
68
64
112
88
Group #
1
2
2
2
1
1
1
2
1
2
1
2
3
4
5
6
7
8
9
10
100
76
76
112
92
72
72
64
96
68
100
72
72
112
92
68
72
64
96
68
100
64
68
128
92
64
64
60
96
68
2
1
1
1
2
2
2
1
2
1
17
Day 1
Day 2
Subject #
1
2
3
4
5
6
7
8
9
10
RR1
24
20
16
24
24
20
16
12
8
28
RR2
24
20
16
24
24
20
16
12
8
28
RR3
20
16
16
20
20
20
16
12
8
24
Group #
1
2
2
2
1
1
1
2
1
2
1
2
3
4
5
6
7
8
9
10
28
20
16
36
20
24
16
12
12
28
28
20
16
40
20
24
16
12
12
28
28
16
16
44
20
20
16
12
12
28
2
1
1
1
2
2
2
1
2
1
18
APPENDIX B
INFORMED CONSENT
My name is Sarah Kerr, and I am a graduate student under the direction of Professor Dr.
Standley in the music therapy department at Florida State University. I am conducting a
research study to determine the effects of music on non-responsive hospice patients.
The patient’s participation will involve listening to two different types of music over a
two-day period. Each session will last for 20 minutes. During the 20 minutes the
patient’s heart rate and respiration rate will be taken three times. Participation in this
study is voluntary. If you choose for your relative not to participate or to withdraw from
the study at any time, there will be no penalty. The results of the research study may be
published, but names of the participants will not be used. Confidentiality will be
maintained to the extent allowed by law.
There are no foreseeable risks or discomforts if you agree to the patient’s participation in
this study.
A direct benefit of this study could be to lower the heart rate and respiration rate of the
patient and to demonstrate positive effects of music during coma-like states. However, if
there is no direct benefit, the possible benefit of participation in this study would be to
increase research done in a hospice setting.
If you have any questions concerning this research study, please call me at (850) 5442746 or the Office of Human Research at (850) 644-8633.
Sincerely,
Sarah Kerr
I give my consent for the patient to participate in the above study.
Signature_______________________
Date_____________________
19
APPENDIX C
HUMAN SUBJECTS COMMITTEE APPROVAL LETTER
20
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24
BIOGRAPHICAL SKETCH
Sarah Kerr was born in Charleston, West Virginia in 1979. She began studying
instrumental music, playing piano and clarinet during her childhood. Her clarinet playing
earned her several honorable awards and top chairs in bands such as all-county, all-state,
and the Honor Band of America. From fall 1997-spring 2001, she attended West
Virginia University in Morgantown, West Virginia. During this time, she studied music
education. As well as playing music, Sarah also had a passion for twirling and loved
creating and performing to the music. In 1997 she earned a position as one of the feature
twirlers for “The Pride of West Virginia” the Mountaineer Marching Band. She twirled
for the marching band and was a member of the wind symphony throughout her
undergraduate career. Sarah graduated summa cum laude from WVU with a Bachelor of
Music in Music Education in 2001, and entered the graduate program in music therapy at
Florida State University in the fall that same year. She is a Music Therapist, MT-BC,
currently employed by Big Bend Hospice in Tallahassee, Florida.
25