Music Therapy and Promoting Self Expression for People with Neurodegenerative Disorders

Music therapy students must complete practicum experiences as part of completing a degree in music therapy. Even at the master’s level, I had to do a certain amount of hours for advanced practicum. For most, practicum at the undergraduate or master’s equivalency levels are the first time a music therapy student gets to actually practice music therapy.

In my experience and knowledge, students will typically have 4-5 practicum placements during their schooling. My practicum placements included: co-leading music therapy groups at my university’s child development center, individually leading groups at schools for children with varying disabilities (different practicums at different schools), co-leading a group at a nursing home, and individually leading 1:1 sessions at a nursing and rehab facility.

I have fond memories of all these experiences that include many song parodies and planned sessions. The moment that remains most vivid to this day is my time with a woman I will call O. I choose this letter because the song I associate with her most is “Oh Happy Day.” O lived at the nursing and rehab facility I visited for my fourth practicum. She had a neurodegenerative disease, so she remained in bed during our sessions. O received oxygen through a trach collar. She was very thin. In the beginning I was very unsure of how music therapy was going to happen with O. My supervisor said that the nurses would tell me she could not talk. My supervisor also said that if you gave her time, she could respond. I learned that she loved hymns and gospel music and my supervisor suggested “Oh Happy Day” and eventually it became a duet every single session with me starting the call “Oh Happy Day” and O responding “Oh Happy Day” like the song has in its structure. It was such a simple interaction but such a meaningful one. We connected in that moment. O was able to shine her light, be seen, be heard, have a happy moment. I learned to be more present. During that time, I also learned several other standard hymns and gospel tunes that benefited my song repertoire.

I am so appreciative of that experience because I have met several others in a similar situation, so I was prepared to be patient. I know there is someone in that body wanting to be acknowledged. Music becomes that common time and space.

In my work today, I have found similar experiences working with people whose hospice diagnosis in Parkinson’s Disease, another neurodegenerative disease. Often people remain cognitively intact, but their body’s experience tremors and other mobility issues. During music, especially instrument play, the “tremors” or repetitive movements they experience become more purposeful when they are playing a drum or shaking a tambourine.

Parkinson’s also effects the physical facial expressions that typically help express emotions. So they might have a flat affect when they are really feeling happy or sad. Music can become an extension of how they might really want to express themselves.

I worked with someone who’s family really wanted their loved one to engage more in general. Whenever we sang their favorite songs they maintained eye contact, continuously participated in the visit, and presented with words of enjoyment and appreciation. The music brought the person and their spouse into a shared experience. The music sparked emotional responses and supported their spiritual expression as well.

Another person had been a life long singer. They were bed bound and overtime had a slow decline of cognitive functioning. For most of the time we worked together, we would sing his favorite songs. They often provided harmony. It helped bolster is identity as musician. Singing was their life and I was going to make sure they had an essence of that until the end. At times, they would become emotional just from the beauty of the music, but at times it might have been some frustration with themselves due to the cognitive decline. Yet, even when they were very tired, they always welcomed music at the bedside.

Music therapy, especially at end of life, can help support the autonomy of someone who is losing their independence. It can give them a sense of purpose because it provides an accessible way to continue participating in life. As a music therapist, I can adapt the music in a way that supports them throughout the physical, emotional, and cognitive changes they might experience.