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Florida State University Libraries Electronic Theses, Treatises and Dissertations The Graduate School 2004 The Effect of Music on Non-Responsive Patients in a Hospice Setting Sarah E. Kerr Follow this and additional works at the FSU Digital Library. For more information, please contact [email protected] 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 REFERENCES Aldridge, D. (1998). Life as Jazz: Hope, Meaning, and Music Therapy in the treatment of Life-Threatening Illness. Advances in Mind-Body Medicine, 14, 271-282. Aldridge, D. (2000). Music Therapy in Dementia Care. London: Jessica Kingsley Publisher. Axen, K., Distenfeld, S., & Haas, F. (1986). Effects of Perceived Musical Rhythm on Respiratory Pattern. Journal of Applied Physiology, 61(3), 1185-1191. Bailey, L. M. (1983). The Effects of Live Versus Tape-Recorded Music on Hospitalized Cancer Patients. Music Therapy, 3(1), 17-28. Bailey, L. M. (1984). The Use of Songs in Music Therapy with Cancer Patients and their Families. Music Therapy, 4(1), 5-17. Bailey, L. M. (1986). Music Therapy in Pain Management. Journal of Pain and Symptom Management, 1(1), 25-27. Barker, K., Burdick, D., Stek, J., Wessel, W., & Youngblood, R. (Eds.). (1995). Bible. Grand Rapids, MI: Zondervan Publishing House. Bason, B., & Celler, B. (1972). Control of the Heart Rate by External Stumuli. Nature 4, 279-280. Bonny, H. L. (1983). Music Listening for intensive Coronary Care Units: A Pilot Project. Music Therapy, 3(1), 4-16. Brown, J. (1992). When Words Fail, Music Speaks. American Journal of Hospice and Palliative Care, 9(2), 13-16. Brown, C. J., Chen, A. C. N., & Dworkin, S. F. (1989). Music in the Control of Human Pain. Music Therapy, 8(1), 47-60. Chesky, K. S., & Michel, D. E. (1991). The Music Vibration Table (MVT): Developing a Technology and Conceptual Model for Pain Relief. Music Therapy Perspectives, 9, 32-38. Clair, A. (1990). A Preliminary Study of Music Therapy for Severely regressed Persons with Alzheimer’s Type Dementia. Journal of Applied Gerontology, 9(3), 299311. 21 Curtis, S. L. (1986). The Effect of Music on Pain Relief and Relaxation of the Terminally Ill. Journal of Music Therapy, 23(1), 10-24. Davenport, H. T., & Robson, J. G. (1962). The Effects of White Sound and Music Upon the Superficial Pain Threshold. Canadian Anaesthetists’ Society Journal, 9(2), 105-108. Eagle, C., & Harsh, J. (1988). Elements of Pain and Music: The Aio Connection. Music Therapy, 7(1), 15-27. Ellis, D. S., & Brighouse, G. (1952). The Effects of Music on Respiration and Heart Rate. American Journal of Psychology, 65,39-47. Frank, J. J. (1985). The Effects of Music Therapy and Guided Visual Imagery on Chemotherapy Induced Nausea and Vomiting. Oncology Nursing Forum, 12(5), 47-52. Gardner, W. J., & Licklider, J. C. R. (1959). Auditory Analgesia in Dental Operations. The Journal of the American Dental Association, 59, 1144-1149. Gardner, W. J., Licklider, J. C. R., & Weisz, A. Z. (1960). Suppression of Pain by Sound. Science, 132, 32-33. Hanser, S. B., Larson, S. C., & O’Connell, A. S. (1983). The Effect of Music on Relaxation of Expectant Mothers during Labor. Journal of Music Therapy, 20 (2), 50-58. Herth, K. (1978). The Therapeutic Use of Music. Supervisor Nurse, 9, 22-23. Hilliard, R. E. (2003). The Effects of Music Therapy on the Quality and Length of Life of People Diagnosed with Terminal Cancer. Journal of Music Therapy, 40(2), 113-137. International Association for the Study of Pain. (1986). Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. Pain, Supplement 3, 217-221. Kerkvliet, G. J. (1990). Music Therapy may help Control Cancer Pain News. Journal of the National Cancer Institute, 82(5), 350-352. Krout, R. E. (2001). The Effects of Single-Session Music Therapy Interventions on the Observed and Self-Reported Levels of Pain Control, Physical Comfort, and Relaxation of Hospice Patients. American Journal of Hospice and Palliative Care, 18(6), 383-390. Krout, R. E. (2003). Music Therapy with Imminently Dying Hospice Patients and their 22 Families: Facilitating Release Near the Time of Death. American Journal of Hospice and Palliative Care, 20(2), 129-134. Lane, D., & Wilkins, R. (1994). Music as Medicine: Deforia Lane’s Life of Music, Healing, and Faith. Grand Rapids, Michigan: Zondervan Publishing House. Locsin, R. (1981). The Effect of Music on the Pain of Selected Post-Operative Patients. Journal of Advanced Nursing, 6, 19-25. Luciano, D. S., Sherman, J. H., & Vander, A. J. (1978). Human Function and Structure. New York: McGraw-Hill. MacClelland, D. (1979). Music in the Operating Room. AORN Journal, 29(2), 252-260. Magill-Levreault, L. (1993). Music Therapy in Pain Management. Journal of Palliative Care, 9(4), 42-48. Matejek, M., Miluk-Kolasa, B., & Stupnicki, R. (1996). The Effects of Music Listening on Changes in Selected Physiological Parameters in Adult Presurgical Patients. Journal of Music Therapy, 33(3), 208-218. McMillan, S. C. (1996). Quality of Life of Primary Caregivers of Hospice Patients with Cancer. Cancer Practice, 4(4), 191-198. Melzack, R. (1973). The Puzzle of Pain. New York: Basic Books. Melzack, R., Sprague, L. T., & Weisz, A. Z. (1963). Stratagems for Controlling Pain: Contributions of Auditory Stimulation and Suggestion. Experimental Neurology, 8, 239-247. Melzack, R., & Wall, P. D. (1965). Pain Mechanisms: A New Theory. Science, 150, 971-979. O’Callaghan, C. C. (1996). Complementary Therapies in Terminal Care: Pain, Music Creativity, and Music Therapy in Palliative Care. American Journal of Hospice and Palliative Care, 13(2), 43-49. Starr, R. J. (1999). Music Therapy in Hospice Care. American Journal of Hospice and Palliative Care, 16(6), 739-742. Strauser, J. M. (1997). The Effects of Music Versus Silence on Measures of State Anxiety, Perceived Relaxation, and Physiological Responses of Patients Receiving Chiropractic Interventions. Journal of Music Therapy, 34(2), 88-105. Thompson, J., & Vincent, S. (1929). The Effects of Music on the Human Blood 23 Pressure. Lancet, 1 (March 9), 534-537. Whittall, J. (1989). The Impact of Music Therapy in Palliative Care: A Quantitative Pilot Study. In J. A. Martin (Ed.) The Next Step Forward: Music Therapy with The Terminally Ill. Bronx, NY: Calvary Hospital, 69-72. 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