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NICU Music Therapy

Introduction to Music Therapy in the NICU at Mount Sinai Beth Israel

Image: Louis Armstrong

The fetus is part of a system, dependant upon the physiological condition and emotional states of another human being. From both medical and music therapy perspectives, working within the meter of respiratory and cardiac rates of both mother and fetus within the context of entrainment may have important synchronous medical implications. The life rhythm of the heart is the first sound that a developing fetus hears in the womb. The significance of a steady pulse has been noted as a primary means of awareness, as in the concept of basic beat (Nordoff-Robbins, 1975), and has been an indicant of neurological functioning in older adults (Tomaino, 1999; Clair et al, 1995). Complementary medicine programs have incorporated aspects of rhythm and breath work into specific methods that have enhanced relaxation in pregnant women. Breath attunement has been effectively influenced through music therapy. Since the body actively uses respiratory mechanisms to play wind instruments and to sing or tone, the use of these applications can be efficiently monitored and physiologically served through music therapy when the fetus is in the womb, as well as when the infant is outside the mother's body. Purposeful sustenance of the musical aspects of this environment can provide continuity, thus sustaining the rhythmic, flowing components.

NICU Music Therapy: The Role of Attachment
Bonding and the role that the emotional status or the mother and father play in the development of bonding may be at risk when the infant is hospitalized. Music can normalize the relationship and enhance feelings of closeness during an otherwise seemingly confined period.

Although the music therapy NICU literature has recognized the value of mother's voice, neonatal clinicians and music therapists have not investigated the impact of mother's emotional status upon the neonate. This would include an assessment of how music therapy treatment might be most effectively pursued for both parent/caregiver and baby. An avoidance of this evaluation could pose significant threats to the fragile baby and growing relationship. If mother has not recognized and addressed her own feelings of anxiety associated with having an infant prematurely, an infant who may be dangerously ill, her provision of music could be contraindicated. Themes of anxiety and separation tend to usurp the premature baby's parents' bonding abilities (Harris, G., 1994).

Two European music therapists introduce this important topic in an introductory way. Nocker-Ribaupierre (2004, 1998) studied the short- and long-term effects of the maternal voice on the behaviors of very-low-birth-weight infants in conjunction with their mothers and how this affected the bonding process. Lenz (1998) looked at interactional disorders in terms of aspects of bonding between mothers and infants. The Beth Israel referral form provides a mechanism for psychosocial needs. Therapists will be alerted to specific psychotherapeutic needs which are identified by staff in the comment section. Loss of a twin, previous birth trauma, drug use, domestic violence and first time parent/s are common referral criteria identified in this domain.

There are several studies that recognize the importance of mother's voice and the infant's ability to recognize both mother's and father's voice (Coleman, et al, 1998, Rock et al, 1999). The literature is missing clinical work with mothers and fathers from a music psychotherapy perspective, which preempts working with the parent-child dyad. Clearly, the field of music therapy will benefit from more case studies and illuminated methods of how music therapy can impact the bonding process. When applicable in this study, we will include in the assessment how music therapy may address the parent/caretaker's anxiety, and how it may affect the implementation of parenting/bonding. The referral/assessment, which includes a parental/family assessment and consultation with the social worker and nurses who provide data on parental intervention of music, will be imperative in the intervention. Such data collection is a primary modality of treatment prior to the music therapist working with the infant, and/or the infant and parent together. The music provided for the infant is most beneficial when we can address the music maker and how effective he/she is in creating an environment of homeostasis for the dyad.

Music Therapy: A Risk-Free Intervention
The use of music therapy in the treatment of infants that are premature is a safe modality. Since music is an acoustic modality, the infant can be held and then gradually moved to the isolette or bassinette, while the therapist provides a continuous momentum and feeling of motion, through musical phrasing. This can induce a sense of homeostasis for the infant in virtually a very short period of time. Such an effect is achieved through principles of entrainment (Loewy, et al, 2005, Bradt & Dileo, 1999, Rider, 1997). The premise that premature infants seek rhythmic stimulation is not new to the medical literature. Thoman, et al, 1991, studied the effects and the experience of entrainment and how it facilitated neurobehavioral development. The study was reviewed in the Journal of Developmental Behavioral Pediatrics. Entrainment was achieved through the use of a breathing bear device that reflected the infants' breathing patterns. Eventually, the infants with this devise in their bassinettes demonstrated more regulated breathing patterns and improved oxygenation. 

More pages on NICU Music Therapy at Beth Israel:

Attia, J., Amiel-Tison, C.,Mayer, N., Shnider, S., &Barrier, G. (1987). Measurement of postoperative pain and narcotic administration in infants using a new clinical scoring system. Anesthesiology 67: A532.

Bradt, J. & Dileo, C. (1999). Entrainment, Resonance, and Pain-Related Suffering. In C Dileo (ed) Music Therapy & Medicine: Theoretical and Clinical Approaches, pp.181-206. Silver Spring, MD: The American Music Therapy Association.

Clements, A. (1996). New sense out of old sense. In R. Pratt & Groke, D. (eds.) Musicmedicine 3: Expanding Horizons , pp101-119. Melbourne, Australia: University of Melbourne.

Courtnage, A., Chawla, H., Loewy, J. & Nolan, P. (2002). Effects of live infant directed singing on oxygen saturation, heart rate, and respiratory rate of infants in the neonatal intensive care unit. Pediatric Research 51, (4).

Liebman, S. (1989). The effects of music and relaxation on third trimester anxirty in 3rd trimester anxiety in adolescent pregnancy. Unpublished doctoral thesis. Miami.

Linquist, R. (1985). The role of GIM in the birthing process. Unpublished fellows paper. Institute for music and consciousness. Townsend, WA.

Loewy, J. Hallan, C., Friedman, E. & Martinez, C. (2005). Sleep/Sedation in Children Undergoing EEG Testing:  A Comparison of Chloral Hydrate and Music Therapy. Journal of Perianesthesia Nursing, 20 (5), 323-31.

Loewy, J.V. (2004). A Clinical Model of Music Therapy in the NICU. In M. Nocker-Ribaupierre (ed.), Music Therapy for Premature and Newborn Infants (Susan Weber, Trans.). Gilsum, N.H.: Barcelona Publishers.

Loewy, J.V. (2003). Aufbau eines Musiktherapieprogramms fur neugeborene Kinder - Einfuhrung und Quellen-NICU Music therapy. In M. Nocker-Ribaupierre (Hg.), Horen - Brucke ins Leben, Musiktherapies mit fruh - und neugeborenen Kindern, Forschung und klinische Praxis. Gottingen, Germany: Vandenhoeck & Reprecht.

Loewy, J. V. (2000) Music Therapy in the NICU. NY, NY: Satchnote Armstrong Press.

McKinney, C. (1990). Music therapy in obstetrics: A review. Music Therapy Perspectives . 8: 57-60.

Nordoff, P, Robbins, C. (1975) Creative Music Therapy. New York: Samuel Day.

Ribaupierre, M.N. (2004). Music Therapy for Premature and Newborn Infants. Gilsum, N.H.: Barcelona Books.

Pratt, RR. (1999). Music and infant well-being. In R.R. Pratt & D Grocke, (Eds), MusicMedicine 3-Expanding horizons. Melbourne, Australia: University of Melbourne.

Stewart, K. & Schneider, S. (2000) Environmental Music Therapy. In Loewy J. V. (Ed) Music therapy in the NICU. NY, NY : Satchnote Armstrong Press.

Thoman, E.B., Ingersoll, E.W. & Acebo, C. (1990) Premature infants seek rhythmic stimulation and the experience facilitates neurobehavioral development. J. of Developmental and Behavioral Pediatrics, 12(1), 11-18.

Tomaino, C. (1998). Music On their minds: A qualitative study of the effects of using familiar music to stimulate preserved memory function in persons with dementia. Doctoral Thesis: New York University.

Winslow, G. (1986). Music therapy in the treatment of anxiety in hospitalized high-risk mothers. Music Therapy Perspectives, 3:29-33.

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