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Reflections: Music Therapy and Advanced Dementia

Nobody denies the fact that music ( familiar tunes in particular) plays an important role in a person's life, including that of the person battling dementia. Music brings back memories and experiences; calls into remembrance words that might require more effort to articulate sans music; brings about some fun and lightheartedness in a community setting; represents and hence expresses emotions in a safe way. These are just a few examples of what music can potentially do.

So very often do we see videos and broadcasts of people with dementia responding to music that they used to revel in years before. I appreciate and celebrate these moments shared, although I worry about an overhyped portrayal of the potential of music.

What is often not discussed is the harsh reality that the person with dementia might reach a stage where recollection of the tunes that he/she used to sing is no longer as spontaneous as it used to be. It is the stage where words are absent, functional ability on the rapid decline. However, does that mean that music therapy is no longer beneficial or relevant to them? I would safely say, no.

In the experiences that I had with clients who had severe aphasia; who had limited (if any) responses to familiar music; who had fleeting moments of shared attention; music became a language, in its truest form. The improvised melodic phrases, harmonic rhythms, silences.. all become a way of “speaking”. Sometimes, clients respond to an improvised melodic phrase played on the keyboard with an unexpected spoken word, different facial expressions, and chuckles. It made me want to know, what was the music speaking to them? What did they hear in that pentatonic melody that they respond instinctively with a “ yes?”, a “hmmm” or even a “because”.

I came to acknowledge and embrace these precious moments where they are grounded into a meaningful interaction with the therapist. This interaction could be almost impossible in a world that is governed by spoken language.

The music would meander from one key to another, but somehow, there is almost always a beginning, a development, and an ending. It is almost a very magical and inexplicable process, that goes beyond the singing of “You are my sunshine”. ( Disclaimer: I love the song " You are my sunshine" by the way, and it has brought much joy and laughter in music therapy groups!”)

So to caregivers out there who wonder about the plausibility of music therapy with a patient very advanced in dementia, I would say, just give it a shot. Though they might not be able to play up a storm on the drum kit, though the best they could do with the mallet is to fiddle and examine them, though they might not have that ability to get up on their feet and do a mini rock and roll.. the music could potentially touch them on the inside, and provide them some form of tangible structure and sense of being - something so elusive to them.

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