Through the analysis of selected musical material the health and wellbeing of
those with neurodegenerative symptoms was understood. Descriptions of musical material
represented symptoms of dementia and their role in creating experiences of
internal/external
After grouping these qualities of connection/disconnection, it was discovered that they
were created (or not) from the musical experiences of one’s relationship to one of three
distinct symptoms of dementia:
The musical analysis of this particular research provided the means to understand and
articulate how health became a portrait of musical connection that also reflected an
experience of mindfulness. Mindfulness represents a healthy way of being and existing
that applies to all domains of human health as it involves attention, awareness,
openness, and compassion. As discussed in the literature review by (
| Neurodegenerative Boundary | Musical Value | Mindful Quality |
|---|---|---|
| Reality/Time Orientation | Musical Awareness |
Focus and Attention |
| Communication | Musical Mutuality |
Sharing and Novelty |
| Meaning | Musical Attunement |
Acceptance and Compassion |
Each selected musical segment underwent its own individual improvisation analysis, and
it is not the point of this study to devalue the individual differences that the
subjective experience of music creates. Despite wide structural differences, these
specific musical elements represented three broad experiences that became the foundation
of this research. The following sections will present these broad experiences of ‘music
as health’ (
The most apparent and frequently occurring characteristic of dementia portrayed in
musical interactions was the idea of reality/time disorientation. Frustration,
agitation, self-doubt, confusion, and exhaustion are extremely common ways of
being that were often present in sessions. This influenced the concept of being
dissociated from a present moment focus over musical time as Thaut (
In many musical examples, the fragile nature of musical connection often blurred
moments of musical focus and awareness in present time and reality. The analysis
of many segments, including this first reflective example, revealed a lost sense
of musical organization and form
Snippets of clear rhythmic cells would often become lost as confusion took over;
anxiety and agitation dominated a willingness to play after an initial musical
sound; and self-doubt and extreme tentativeness erased any wish to engage. The
musical environment then became the context in re - structuring these experiences
so that confusion became clarity, anxiety became manageable, and insecurities
became willingness. In these situations, it was common to search for a rhythm or
sound that could create a point of mutual focus for the client and therapist to
orient towards. As a result, musical ideas were created, but often lost and left
behind as a new or altered idea was found to recreate another moment of fleeting
yet mutual musical focus. Aldridge (
As Hick (
The idea of a continuous settled and unsettled musical movement reflects the sensitive paradox of the participant’s willingness to continue and their ever present vulnerability of confusion and self-doubt (among others). Sustaining a moment of focus in time became the challenge and this often resulted in a sense of musical instability. Thus these experiences are better described as a musical balance between exploration and centring.
During one specific musical example the participant was playing the cymbal and
chimes. Her rhythm on the cymbal matched the beat of the drone in the bass of
the piano. However, at times her playing became unclear as she struggled to
maintain the beat. The therapists playing in the right hand was exploratory
which matched the less distinct sounds the participant was creating with the
chimes. The therapist experimented with short melodies in the upper register
using small intervals and descending lines. Despite the focused nature of the
simple tonic and dominant pedal, there was still a sense of exploration as
there was an attempt to find a musical sound that could allow both individuals
to maintain a sense of time and yet develop other musical elements and timbres.
This was represented by the inconsistent main beat as well as the wandering
quality of the melodic figures in the right hand of the piano. In this example
it appeared the participant was grasping her sense of time from the consistent
beat of the drone. Musical segments that embodied this concept of musical
exploration, allowed the therapist to understand the impact in offering (in
these situations) a centred and clear temporal dynamic in which the participant
and therapist can share.
Through the analysis of many similar segments, musical centring is described as
a way of focusing the therapist and participant towards a shared temporal
structure. The idea of musical focus should not belittle the quality of music
that is being offered, which is why the word minimalism has been chosen, a
sophisticated way of using minimal musical material. From an expansive and
exploratory state of temporal incoherence in music, it often became apparent
when the participant and therapist discovered something musical to orient
towards. In retrospect, the therapist missed many of these small musical cues
in sessions. When discovered however, the music seemed to scale down to the
very sound the client and therapist were able to focus on. Whether on the piano
or using percussion instruments (the choices available at the facility), rhythm
often became the element of clarity. This makes sense as many neurological
sources, including Thaut (
Repetition - Participants often offered a basic beat or simple/small rhythmic cell that they could only reproduce a few times. A repetitive beat or rhythmic cell often reoriented the participant and often provided the structure for them to maintain their beat/theme.
Musical Space – The above concept was often complimented with static harmonic ideas on the piano; open fifths in the bass (and other open intervals), octaves, one consistent chord/drone or even a single tone. If present, melodies often contained only a few intervals, were repetitive and rhythmically steady.
Musical Clarity – These musical qualities constructed the small structural themes that often captured the attention of participants. They offered structure through clear thematic statements in which both the therapist and participant could orientate towards. This often became the structure in bringing the improvisation to further musical places, while maintaining orientation and awareness.
In learning from moments of musical exploration, the next musical example represents a focus of musical material. Musical space was given to a participant who was hesitant on playing and had been presenting herself as confused and agitated. This space was created through the alteration of silence and the use of two dominant seventh chords in F major on the piano along with a simple vocal melody. Slowly, the participant played the cymbal within the structure of the musical material presented by the piano. These cues are small but have been the result of musical simplicity, space and patience.
Through the idea of musical centring, participants’ rhythms that were once
imprecise and inconsistent (or became this way), became clear and continuous.
The reconstruction of a lost rhythm was a subtle indicator of the client’s
awareness to the present musical moment. Those that lost a sense of music
making (or had difficulty producing in the first place) often predicted the
simplicity of certain musical material and perhaps allowed them to feel
grounded and safe enough to finally enter into the music. Schwarz (
The following example (Figure 1) is another portrait of musical awareness through the rhythmic utilization of open fifths. This participant had trouble physically finding the drum and keeping a beat for longer than a measure. In this minute segment, a consistent rhythm was repeated by the therapist on the drum, and this was supported by three open fifth intervals in the bass of the piano. A simple vocal line was used and repeated. The participant struggles at times to maintain the rhythm but is actively focused towards the beat and the groove of the music This example represents a repetition of simplistic musical material within an aesthetic setting in which the participant can experience awareness.
Musical Excerpt 1
Within this experience of improvisation, the observations of
Two qualities of dementia that influenced the manifestation of music in this
research were monotony/sensorial behaviours and self-doubt/hesitancy.
Consequently, these inhibited the potential communicative experiences of
improvisation. Some participants could go through phases of musical searching
before discovering a strong musical focus, which remained stable, while others
immediately engaged in a strict and stable musical pattern. Regardless, it was
important to enhance moments of individual awareness with musically mindful
moments of communication and creativity/novelty. In this way, it was possible to
breakdown the boundaries of sensorial motions and self-hesitancy to be creative
and communicative in music. Aldridge (
Referring again to
Music became the experience that could reconstruct focused, yet unconscious and pervasive motions into communicative and creative playing. In these instances the musical environment turned into a landscape of accompaniment where the participant could go back and forth between moments of musical awareness/repetition and musical dialogue and creativity. Musical dialogue enabled tentative and gentle playing to be encouraged and also allowed metronomic players to become aware of another form of rhythmic experience. Pushing the boundaries of musical creativity enabled participants to play beyond a basic beat and truly explore their capacity for musical climax. However, despite these more extreme experiences, musical awareness was extremely important in the continuity and resolution of such vulnerable and often fragile moments in music.
In many musical segments musical invitations and responses were clear and overemphasized, while the musical space left in response for participants demanded time and patience. The embellishment of musical dialogue comes from two distinct ways in which dementia influenced the participant’s personalities in music, despite the presence of temporal orientation. The first seemed to be a manifestation of frailness, feelings of worthlessness, and hesitation, common characteristics found with each participant in their uncertain musical rhythms and melodies. The therapist’s exaggerated musical ideas were often simple and remained tonally unresolved as an invitation to continue. Occasionally, the therapist had to repeat this idea a number of times before participants were willing to continue. This patience was often imperative and at times, sudden motions or swells of music would diminish any motivation that had been potentially cultivating. When participants did engage in a response/dialogue the therapists timing in acknowledging this sometimes demanded a sense of musical delicacy. Musical acknowledgments to their responses were usually immediate and met their sound. Leaving too much space and ambiguity in musical answers often gave participants a reason to become overcome by their hesitation and uncertainty again. The following (Figure 2) is an example of a gentle yet expressive and clear dialogue in music from the data.
Musical Excerpt 2
In the analysis it was written:
Another example of how clear musical communication manifested itself was with participants who played in a metronomic manner. In some cases the therapist utilized different tempos and rhythmic ideas to interact with someone who became fixated on a steady beat. Whereas some participants enjoyed this steady sensation while being aware of the musical environment, others became completely lost in the motion and the aim was to bring them into a musical interaction. This phenomenon highlighted the potential ambiguity behind an apparent demonstration of musical focus and the fragility of music in offering specific musically-cognitive experiences to participants.
One participant became so captivated by a musical beat that it seemed habitual, despite changes in a larger musical context. The therapist attempted to match the participant’s strong beat at first, using a repetitive rhythmic pattern with thick chords in a descending A minor chord progression. Despite the building of tempo, the therapist decided to leave this idea behind and play sparse and slow chords. The participant disregarded this aesthetic alteration and continued with the strength and vigour that had been established. It is through this experience one could understand how this participant was fixed with a musically metronomic experience. It was also learned (as you will see in the next musical example) how one could acknowledge this groove yet also allow the participant to experience rhythm in a different musical context.
Within the data, focusing on a dialogue through changes in groove became an
important experience in allowing participants to hear another and react with
them in music. This involved tempo changes, emphasis on the offbeat, rhythmic
phrases with rests, using polyrhythms and changing the emphasis of beat (half
time/double time). In an improvisatory dialogue G. Aldridge (
Musical Excerpt 3
The idea of a shared creative encounter is often ambiguous and subjective. However, this particular experience was sculpted by the symptoms of dementia and how music was able to push their communicative limits. These ‘limits’ were different for each individual, some only being able to achieve a level of extended musical focus with minimal musical material. However, there were distinct (though not as common) experiences of musical climax and creative exploration where a reciprocal expression was shared between the participant and therapist. In this context, communication can be seen in a creative light of novel exploration with another. These moments often occurred when participants were willing to creatively express themselves in a spontaneous musical environment but needed the context and movement of the music to allow them to be a part of this. Fatigue, the comfort of musical monotony, and tentativeness often inhibited this experience for some participants. Yet others, if strategically and musically encouraged, could enter into this world. This type of musical participation was able to offer a clear experience of mutual creation, trust in the present moment, and the confidence to be a part of a spontaneous musical moment, which is again reflected in the qualities of mindfulness. These moments were sometimes fleeting and easily lost, especially to fatigue. Moments of musical flourishes were often contrasted by strong resolutions of predictable and stable musical patterns that the participant could foresee. Also, a predictable musical element, such as a consistent rhythm or tonal centre, was often present throughout moments of musical ambiguity. Taking a participant to a heightened musical state for too long, without a sense of musical grounding, often resulted in a loss of musical orientation. This was a result of the uncertainty, confusion and sensitivity that dementia can create.
Musical figures of ‘creativity’ were sometimes represented through atonal implications, rhythmic ambiguity, flourishing melodic figures and strong musical pushes towards a climax (through dynamics, tempo and texture). Atonality was a rare occurrence in sessions, as some participants seemed to engage more when music was more tonally and formally clear. The hidden structural implications of atonality were often confusing for participants and this provided the therapist with valuable information in offering this novel musical experience. Perhaps for some participants their musical focus and awareness were influenced by the clear audition of changing musical structures. Thus, if more obscure musical figures were being used, incorporating a consistent familiar musical element offered something for individuals to musically focus on and grasp. The times atonality was implicated in the therapists musical contributions were when participants were engaged melodically (using the piano) and their production had a wandering quality. In early attempts to match the resulting chromaticism, the therapist’s atonal figures lacked structure and the ensuing musical sound was one of uncertainty (which resulted in a loss of musical engagement). However, once the therapist employed a clearly audible repetitive rhythmic pattern/basic beat or a strong and revisited fundamental tone, cohesion was often restored and a musical structure of focus was available for participants.
This phenomenon was congruent with obscured rhythms, flourishing melodic
patterns, and intense climaxes in the music (through the building tension of
texture, dynamics, and tempo). A free sense of timelessness often resulted in
an immediate experience of musical disconnect, but there were ways in which
this ‘timeless’ feeling could be experienced while keeping a theoretical sense
of time. Polyrhythms and different accents of beat were two elements in the
data that were used most frequently. In hindsight, the use of different meters
(7/8 and 5/8) and frequently changing meters provided this experience as well.
Following a short period of rhythmic ambiguity in the data, the therapist would
often fall back into a strong basic beat. Climaxes of melodies, texture, tempo
and dynamics were frequently contrasted by simple and repetitive musical
structures, often initiated by the participant, which reintroduced predictable
musical material. These rhythmical and tonal resolutions demonstrated the
participants’ understanding of musical process and form and the ever constant
need of temporal cohesion. These descriptions of musical tension and release
are inherent in most natural musical formations, but it is the analysis of
these moments in therapy that allow therapists to understand potential
experience of musical community and expression. The following is a personal
reflection
Through the participants’ involvement in a climactic musical phrase, therapists
are able to offer them a novel and creatively spontaneous interaction.
Returning to a comprehensive quote by Aldridge (
The following section originates from a unique perspective surrounding the
experiences of acceptance and compassion with those living in long term care. As
discussed, a sense of personal and social meaning was often created through
musical interactions and connection. In addition to these encounters, the
therapist also searched for others ways in which they could offer this experience
when a physical interaction in music seemed inappropriate or impossible.
Throughout such work in long-term care, the therapist has been able to verbally
communicate with participants about their experiences of acceptance and compassion
within their environments. However, during moments where no words were spoken, a
personal opinion is the only source of perspective. While an objective stance can
be taken through musical manifestations of focused and opened experiences, one can
only speculate on non - verbal and hypothesized moments of acceptance and
compassion. However, these opinions are necessary in presenting a complete picture
of the experiences of music that arose from the data. This section of descriptive
musical encounters represents Aldridge’s (
An experience of acceptance and compassion in a musical interaction involves a
semiconscious stream of musical choices based on one’s sense of another in an
empathetic and vulnerable environment. In relation to mindfulness, Hayes,
Strosahl, and Wilson (1999) stated
that these concepts involve a “conscious decision to abandon one’s agenda to have
a different experience and an active process of ‘‘allowing’’ current thoughts,
feelings, and sensations” (
The settings in which these participants have been placed often take away the
opportunity for individuals to mindfully
In many musical segments, it was difficult to create a meaningful yet physically
active musical interaction. Upon reflection, it was apparent that the participant
was fatigued, needed space, or was being a part of the musical environment in a
reflective manner. When we understand the diagnosis of dementia, this makes sense.
Consequently, their “being” in music was not directly open and it was important to
not modify these boundaries in such a straightforward manner. At these times, the
music became more emotionally informed to create feelings of connection and care
for those who needed to “just be” as Aldridge (
The following (Figure 4) is an example of a participant who had been engaged in an interactive dialogue for an extended period of time. She became fatigued and was unable to consistently hold her body up in her wheelchair. She continued to play during these moments of fatigue, and the music was mutually paradoxical. In this example, the piano support utilized the Phrygian mode in C, acknowledging the participant’s fatigue with minor elements and falling intervals of the mode, and acknowledging her bursts of energy to play with more major elements and open intervals.
Musical Excerpt 4
The participant ended up rising and falling with the music (however, we can only subjectively assume who is influencing whom). A musical landscape was created where she could utilize her passion to play but also rest when needed. The use of the Phrygian mode at this time was intuitive. The therapist had consistently practiced within this mode and had come to understand the heaviness yet beauty that was inherent in its intervallic make up.
On a contradictory note, there were numerous examples where the therapist continued
to ‘encourage participation’ to ‘reach’ the non – musical aims of social engagement
and improvement of motor skills. In hindsight, these attempts seem superficial and
ignore the immediate emotional portrait of the participant within the music. While
there were no prescriptive formulas for emotional musical construction, the emphasis
on one’s musicological responsibility as clinical improvisers becomes magnified.
While therapists cannot generalize what musical qualities mean to others, there are
inherent universal qualities that they need to practice to understand what they can
The next example represents particular moments when participants appeared to relate
to the musical experience in a receptive manner, indicating their presence through
body language, gestures, and vocalizations. These individuals were more isolated and
withdrawn, and it was important to enhance interaction in subtle ways. In these
moments the idea of emotionally informed music was significantly intensified again
and the idea of musical simplicity and space became important. Musically pushing or
overwhelming those who needed space became detrimental in attaining a form of
physical connection. At times, the music often took a concentrated stance to create
moments of physical intimacy; an experience that is represented in the following
reflection
This final experience of music with these participants balanced musical space and focused musical intuitions. The effect was often a connection through intimacy created with body language and the space to rest and reflect. These reflections came from direct requests from participants as well as spontaneous moments of nostalgia that were discussed afterwards. The resulting experience has been viewed as a musical landscape that reflects individuals and allows them to be in a realistic environment of care and truth. When constructed, in a musical sense, a space was created that allowed participants to enter a form of connection, in active or receptive ways. Musical construction, in this context, is the conscious construction of musical material used with a direct intention of achieving a particular feeling or atmosphere. It is these musical experiences that emphasized the true vulnerability and emotional strength inherent in those affected with dementia.
Sabat (