Archive | NICU Infants RSS feed for this section

International Summit for Music Therapy in the NICU, Brief Report

By on August 5, 2010 in NICU Infants

A little bookkeeping first: If you emailed me requesting the score for Introducing Lady Gaga to Boomwhackers, I’ll be sending those out on Monday. Thanks for your patience! Now, back to the post:

I’m enjoying my plane trip from New York City to San Diego by blogging. (I’m online, 30,000 feet up in the air, and actually sitting in seat 14E right now, a middle seat… not so conducive to healthy circulation for a rather tall person. But I am happy that the flight is nonstop.) I spent the last 5 days in NYC: 2 days gallivanting around, and 3 days at the International Summit for Music Therapy in the NICU.

Here are my presentation points from the Summit:

I was blown away by the depth of knowledge, insight, and experience shared from each participant at the summit. Unfortunately, to recount all of the thought-provoking discussions and perspectives would take an entire blog site, so I’ve boiled it down to the presentation titles only.

Here are some interesting topics that were covered:

  • Program design and implementation in Europe (Germany)
  • Noise, Music, and the Environment in the NICU (USA)
  • Music Therapy as a Semiotic System of Communication (Spain)
  • Interplay with the Medically Fragile Infant (Australia)
  • Development of a Trauma-Informed NICU Music Therapy Treatment Model (USA)
  • Wordless Melodies: Sounds of Eden (Israel)
  • The Pacifier Activated Lullaby: From Theory to Practice (USA)
  • NICU Palliative Care: Anticipatory Grief & Bereavement (USA)
  • Guided Imagery and Music with a Bereaved Parent: Case Study (USA)
  • Live Infant-Directed Singing and Instrumental Music for Expression and Interaction (USA)
  • Heather on Earth Multi-Site Research Study (USA)
  • Music and Maternal Sounds in the NICU (USA)
  • Neurological Development to Inform Music Selections in the NICU (USA)
  • Analysis of Music Therapy Contributions (Spain)
  • Relational Psychophysiology: Lessons from Mother-Infant Interaction (USA)
  • Pain, Songs of Kin and Sedation (USA)

The experience was very rich and diverse as each of us got an opportunity to peek inside practice in NICUs of 10 different countries.

The countries represented at the Summit included (alphabetically listed):

  • Argentina
  • Australia
  • China
  • England
  • Germany
  • Ireland
  • Israel
  • Spain
  • Sweden
  • United States

Special thanks to Joanne Loewy and the staff at Beth Israel Medical in New York for making the International Summit possible! Support for the summit came from the Heather on Earth Music Foundation, Remo, and the Louis Armstrong Educational Foundation.

Oh, and my gallivanting about NYC included:

  1. Getting lost for three hours on the way from the airport to the hotel after a red-eye, all because one of the subway lines was closed.
  2. Walking.
  3. Eating *amazing* food.
  4. Catching Rock of Ages 80s Musical and Stomp on Broadway. Rock of Ages was AWESOME.
  5. People-watching.
  6. Figuring out how to be “city savvy.”
  7. Seeing Maestro Moses Josiah play the musical saw in the subway:

Photo above courtesy of Dino De Luca.

Comments { 2 }

A Warm Welcome into the World: NICU Music Therapy Article in Therapy Times

By on June 17, 2010 in NICU Infants

I wrote an article that was recently published in Therapy Times, a multidisciplinary online resource featuring topics for nursing, nutrition therapy, occupational therapy, speech therapy, physical therapy, respiratory therapy, and music therapy. You may view the full article, but first here is an excerpt ~

“(Music) is as powerful as any medicine. It has a unique way of accessing the brain and the nervous system.”
—Oliver Sacks, neurologist and author

According to the March of Dimes, the number of babies born preterm in the nation increased by 7 percent between 1994 and 2004. Unfortunately, the acoustical environment of most NICUs is not sensitive to the needs of the infants because of crowded spaces, closely spaced infants beds, machinery sounds, and sound-generating adult activities in open rooms surfaced with hard, reflective materials. In fact, noise levels in the NICU are usually well above the American Academy of Pediatrics recommended decibel level. Read the full article…

Thanks to m_bartosch for the image above.

Comments { 0 }

Music Therapy in the NICU: An RN’s Perspective

By on March 11, 2010 in NICU Infants

I recently asked Shelley Frazier, RN, BSN, IBCLC, what she thought about music therapy. She is the Lactation Consultant, Discharge Planner, and Education Coordinator for the Newborn ICU at Tallahassee Memorial Hospital in Florida. Shelley also helps facilitate the National Institute for Infant & Child Medical Music Therapy at Florida State University. The research in NICU music therapy program at Shelley’s hospital has been established since the early 1990s.

**

What do you notice that music therapy does for the infants, and what criteria do you use for referrals?

The babies love the music therapy!  We do several different kinds here. They enjoy when we take them out of the isolette and gently touch them and sing softly to them. So often touch in the ICU is harsh and disturbing to the baby. Rolling them over, sticking them for labs, putting nasogastric tubes down their noses. The touch from music therapy is kind, soft and gentle. The babies love it. We also do the music therapy where they suck on a pacifier to turn on the music, and I have found that this is helpful for getting the ready to suck/swallow/and breathe babies ready to eat. They will suck to hear the music and music gives them pleasure and the longer they suck the better it is. It helps to increase their endurance for sucking and in the long run helps them to be ready to feed.

The criteria is not really in hard print. A baby needs to be intermediate care status. In an isolette or open crib. Not having a lot of apneic episodes. Stable on an oxygen source or on room air. Not an irritable BPD baby.  Someone that can benefit from suck endurance. Around 31 weeks gestation or more.

Does music therapy overstimulate infants?

We watch the babies closely for when they are physiologically ready for music therapy. Everything kind of has to fall into place for the individual baby to receive Music Therapy….and stay in place. In other words, a baby can qualify one week, start to feel bad the next week, and we will need to postpone the therapy until later. We really don’t start music therapy until the kids are ready to start getting a bit of stimulation. Music therapy is also a way to teach parents about the right kinds of stimulation for their baby (e.g. gentle though, quiet voices).

How does music therapy change the general NICU environment?

I feel that music therapy is very helpful to the parents as a calming tool, something they can do/ be trained to do with their baby. It is something that they can continue to do at home after the baby is discharged. It can lend some “normalcy” to an otherwise very high tech environment. As for the babies, they love it. They respond well to it, and it can also be a continuation of activities at home. It can lower their heart rate and assist them with becoming accustomed to touch and sound in our world.

How does music therapy change parents’ attitudes, visitations, and/or behaviors in the NICU?

Some parents are very receptive to outsiders working with their babies, and some are not. I do find that a very stubborn difficult parent to an NICU nurse/RT/doctor, can be sweet and kind to the music therapist. The parents can have some control with music therapy. I have found that if you prearrange a time with parents, they love to visit during music time.  A large percentage of our parents are from out of town and have a lower socioeconomic status and are unable to visit frequently, but if they live in town and have a car they will visit during music time.

For more information about NICU music therapy, please see the following posts:

9 Research-based Effects of Music in the NICU
 45 Hospitals around the World that Provide NICU Music Therapy
 Does Music Therapy in the NICU Overstimulate Infants?
 NICU Music Therapy Overview (video)
 Book Review: Bella’s Blessings

Let me know you thoughts, comments, and/or questions about music therapy and babies.

Comments { 3 }

Does music in the NICU overstimulate infants?

By on March 3, 2010 in NICU Infants

Dr. Jayne Standley explains how, why, and when to use music therapy in the neonatal intensive care unit (NICU) in her book Music Therapy with Premature Infants: Research and Developmental Interventions. But, my blog’s title question comes up often, and understandably so! Especially when the medical goal is to promote baby from the “survival/pacification phase” to the “HOME with family phase” as gently and smoothly as possible. So, the question stands: Does music in the NICU overstimulate infants? When music is used improperly, then the answer is a resounding yes. When a radio program or CD plays continuously for hours at a time over a loud speaker, or when musicians play in a NICU with neither NICU music therapy training, nor knowledge of sound level recommendations, then yes, music can be detrimental to the infants’ neurological development. Also, when an infant is in the survival phase, then he/she is not ready for a developmental treatment such as music therapy.

However, music therapy can be beneficial to an infant who is medically stable, during and beyond the cautious stimulation phase. When the medical team decides that baby is ready for developmental stimulation, the occupational therapists and music therapists cautiously provide sensory stimulation, and document observations of infant behaviors. If baby exhibits any signs of overstimulation, then treatment is paused or terminated, according to the research-based protocol. But when baby is tolerating stimuli, then music therapy is a great way for baby to gain practice self-regulating during multi-modal stimulation (MMS), a common NICU music therapy intervention. Deanna Hanson-Abromeit has shown how music therapy interventions produce similar results to NIDCAP (Newborn Individualized Developmental Care and Assessment Program), a widely used and accepted, research-based program for NICU environment and care delivery. Music therapists work together with the medical staff as part of the team. Check out the list of 35 hospitals that already use music therapy in the NICU. Here are some criteria we use when treating infants in a NICU with music therapy:

  1. Minimum weight of approximately 3 lbs.
  2. Clinical stability
  3. Readiness for developmental stimulation

Additionally, referrals can be based upon any of the following infant needs:

  1. Irritability, agitation, behavioral distress
  2. Sedation, sleep, pain
  3. Self regulation
  4. Respiratory difficulties
  5. Feeding, sucking, weight gain
  6. Parent/family bonding
  7. Lengthy hospitalization

A couple of weeks ago, I wrote an easy-to-read list of NICU music therapy research-based effects. Keep in mind that music is acoustically different than noise. Accumulation of sounds in the NICU consists of machine-generated and human-generated noise. Noise in the NICU is unpredictable, disorganized, unfamiliar, with an extremely wide range of frequencies. Music in the NICU provided by a music therapist who has specialized NICU MT training is predictable, familiar, organized, with form and a very narrow range of frequencies. This quality of sound elicits calm behaviors. NICU music therapists first assess the patient, devise a treatment plan, implement the treatment plan in conjunction with other therapies (e.g. physical, occupational, speech), document patient progress, evaluate, and modify the treatment plan to stay on target with patient goals. Also important to take note is that NICU music therapists use culturally-specific, familiar, live music for baby. (For example, if the baby comes from a Spanish-speaking family, the NICU music therapist will probably include Spanish lullabies in the treatment.) Research shows that infants respond preferentially to their native language.

More on the Academy of Pediatrics sound level recommendations, NICU sound level reporting, and modern NICU design is coming up in a blog post soon. Until then, whether you are a NICU music therapist, healthcare professional, or family member, please leave comments if you have any questions or feedback. I’d love to hear your thoughts!

Comments { 0 }

Book Review ~ Bella’s Blessings: A Humble Story of Providence

By on March 1, 2010 in NICU Infants

Share

Book Review
Bella’s Blessings: a Humble Story of Providence by Timothy Ringgold

I’ve never had a baby, not to mention gone through the neonatal intensive care unit (NICU) experience as a parent, so I can’t say “Oh sure, I understand.” There is no way that I can fully comprehend what it’s like to find myself forced to ponder the mortality of my own offspring. I can try to imagine, but I really don’t understand on the deepest level. However, in the memoir Bella’s Blessings: A Humble Story of Providence, Timothy Ringgold gives no choice but to understand, to feel what he feels, to see what he sees, to hear what he hears. The author makes a close and memorable connection with the audience immediately at the start of his riveting story. Timothy recounts his family’s journey with no reservations, no hesitations, heightened intensity, and no preparation. After all, there is no preparation for parents who have a newborn swiped out of their arms and rushed into intensive care, requiring  special medical attention at birth. The condition is Epidermolysis Bullosa (EB) and was completely unforeseen and undetected in obstetrical tests and ultrasounds.

The author has a wonderful wife and two beautiful girls. He owns and operates Sonic Divinity, a music therapy service agency in Orange, CA. In addition, he is a board certified music therapist with specialized training in the NICU setting. In other words, he is qualified and trained to help infants heal faster when hospitalized. Unfortunate fate or divine blessing? Timothy states his case clearly in favor of divine blessing.

The journey of Bella’s Blessings consists of 2 major sections: the first 48 hours and the blog. As soon as the social worker at Children’s Hospital of Orange County introduced the author and his wife to CarePages.com, the author regularly posted blog updates as information came in, as challenges were met, and as inspirations dawned. Bella’s first 3 months are documented. In his journey, the author describes the many trials, tribulations, and solutions that come with a newborn emergency: doing research on the disease, getting in touch with the best professionals, coping with financial issues, settling into a new lifestyle, and bonding with Bella through music therapy techniques. He describes how he and his family come together and get to know Bella using music therapy before she is ready to be held, when she experiences distress, and in those especially difficult moments when he and his wife bathe, feed, and change Bella’s dressings. The most touching and grounding aspects of getting to know Bella is keeping the faith, focusing prayer, and taking note of Every. Little. Piece. Of. Providence.

The author vividly describes the honest and raw human experience as a father, husband, and advocate for his family. His story evokes a broad spectrum of emotions from anger, sadness, denial, shock, and confusion, to confidence, courage, joy, and resolve. Purely authentic and real, Timothy takes it day by day and shares how he relates and does not relate to medical staff, meaningful moments of supporting his wife, strengthening the marriage, “The Good,” “The Bad,” and the big picture. In reading the author’s take on providence (which is expressed in various formats in every blog post), I’m reminded of Byron Katie’s book Loving What Is. As Katie suggests “It’s not the problem that causes our suffering; it’s our thinking about the problem.” Full of wisdom, as well as practical solutions to real problems, Timothy expresses his own personal perspective on “thinking about the problem.”

If you are having trouble finding [the Silver Lining] in any given situation, ask for clues. God will reveal them. Just be willing to deal with the fact that [the Silver Lining] may not be what you originally were looking for.

Because of Bella’s inspiration, the author also sends out occasional requests to readers, offering clarity to those friends and family members who want to support the family. The question from loved ones is often, and sometimes desperately “What can I do?” A perfect example for the power of focused prayer, the Ringgold family’s requests in the blogs are always specific and focused. Any family can learn a great deal from the Ringgolds.

Bella’s Blessings reminds the public of the power of prayer, how equally real the unseen is in our physical plane, how spirituality and faith integrate and manifest into physical outcomes, and the importance of consciously acknowledging signs of providence in every day life.

All along we thought that Bella needed the healing. In reading Bella’s Blessings, she actually heals us, the readers.

Read the author’s blog and see more pictures here http://careforanabella.blogspot.com/

Comments { 0 }