It’s not uncommon for babies in the neonatal intensive care unit, or NICU, at DCH Regional Medical Center to weigh less than three pounds, or little more than a bottle of water. With infants less than 28 weeks of age, their lungs aren’t fully developed, and the very thing keeping them alive—breathing machines that force oxygen into their lungs—can also cause significant damage over time to their lung tissue and vision. Lowering supplemental oxygen levels even slightly can have tremendous positive effects on these babies.
How do you lower supplemental oxygen? By increasing the amount of oxygen that these babies absorb. How do you do that? In some cases, play music.
Time and again, Dr. Andrea Cevasco-Trotter and her students have seen music therapy’s immense power to improve outcomes for premature babies as well as for dementia patients, the terminally ill, and traumatized adolescents. One of Cevasco-Trotter’s research studies, conducted in the NICU, showed that infants who received music therapy went home 14 days earlier than infants who didn’t receive music therapy.
Reducing the Stress of the NICU
Board-certified music therapists use music in ways that are scientifically proven to help people of all ages with motor, cognitive, communicative, social, and emotional needs, Cevasco-Trotter said. The same is true in the NICU, but the stakes are much higher.
“When you look at images of premature infants’ brains, they look like Swiss cheese because the babies’ brains are still developing,” Cevasco-Trotter said. “They literally have holes in parts of their brains where cells haven’t migrated yet. This is a problem because the NICU is a stressful environment, and every time a baby is stressed, cortisol floods the brain and stops brain development.”
Fluorescent lights, wires, dinging monitors, and other babies wailing intensify the effect.
A professional certification is required for music therapists to work in these high-risk NICUs. The University of Alabama is one of only 10 universities in the nation that offers this NICU certification through the National Institute for Infant and Child Music Therapy at Florida State University.
“Students love it because most undergraduates do not get to go into neonatal intensive care units as part of their clinical training,” Cevasco-Trotter said.
UA students who are trained to conduct music therapy in the NICU learn about the consequences of adding to premature babies’ stress levels, to recognize the signs of stress, and how to respond to those signs during the therapy session. As Cevasco-Trotter said, the NICU is stressful enough, and music therapy shouldn’t make it worse.
With just a few minutes of singing and strumming a guitar, they’ve seen babies’ heart rates drop from a near-alarm-dinging 190 to a manageable 170. Scrunched up fingers and faces also relax, another sign that the babies are no longer stressed.
“We have found that heart rates stay down and oxygen levels stay up after we finish, even when we sing to the babies for just a few minutes,” she said. “For some babies, music therapy doesn’t make a huge difference in their heart rates, but even small changes over time can have huge long-term benefits.”
The greatest benefits, according to her research study, have been in babies with very high heart rates.
“For babies whose heart rates were over 200, the ones who were inconsolable, screaming, and crying and whose monitors were dinging when we arrived, their heart rates were significantly different before, during, and after receiving music therapy,” she said. “Long-term is harder to track, but we’ve seen significant differences overall.”
Music for the Ages
Concurrently, Cevasco-Trotter is working on two studies involving older adults. One investigates music preferences for different age groups, breaking up music by decade. Though it’s widely known in music therapy that patient-preferred music works best, this presents a challenge when music therapists work with large groups of people, which is often the case at veterans’ hospitals and nursing homes.
“We know from previous research that music from our young adult years is music that we like across the entire lifespan,” she said. “But another music therapist and I recently did a study of top songs recommended by music therapists for older adults, and we found that more music therapists are using songs from before their patients’ young adult years, standards from the early 1900s like ‘Let Me Call You Sweetheart,’ ‘You’re a Grand Old Flag,’ and ‘Take Me Out to the Ball Game.’ We decided to investigate how music preferences change over time and see what decades of music work best for older adults.”
Though they are still gathering and analyzing data, preliminary results show that older adults are unique regarding their thoughts on music from their young adult years.
“People in their 80s and 90s tend to really dislike music from the 1960s, and they also don’t show much interest in music from the 1950s,” she said. “People in the 70s tend to like all of it, including songs from the 1900s.”
For music therapists who work primarily with large groups at retirement centers, dementia units, and assisted living units, her research has profound implications.
“You could use songs from the 1940s, ‘30s, ‘20s, and ‘10s, and everybody will enjoy it, which will have the most impact,” she said.
The second study she is working on compares the benefits of music, recreational, and reminiscing therapies for older adults with dementia. Specifically, she is comparing participants’ cognition, stress, and participation levels for each therapy type.
Preliminary data has shown differences in cognition.
“Participants in the music therapy group are maintaining or have had fewer declines in cognition compared to those in the reminiscing group,” she said. “It’s interesting because both groups were structured very similarly with very similar activities. For example, the music therapy group exercised with music whereas the reminiscing/recreational group exercised without music. We were able to control other variables to isolate the effects of music therapy programming. Other studies have shown similar positive results for music therapy groups.”
Interact, Engage, Respond
In all cases, Cevasco-Trotter said she most enjoys interacting with patients.
“People often think that music therapy is just listening to music, and for some patients—those in hospital beds, those experiencing extreme amounts of pain, or those experiencing extreme anxiety—music therapy may only involve listening to music,” she said. “But oftentimes it’s actual engagement and interaction that make music therapy a beneficial experience.”
A former student, for instance, analyzed anger, stress, and depression in teenagers living in a juvenile detention center. The student found declines in all three emotional states in the teens who participated in music therapy.
“They were engaged,” Cevasco-Trotter said. “Those kids exercised to music. They played instruments. They wrote songs. They practiced relaxation techniques to music. It’s very meaningful when kids realize that they can accomplish something, that they can rap or express themselves through music in a way that someone else understands. That interaction allows us to reach them on a different level.”
Interaction also drew Cevasco-Trotter to music therapy. When she started her bachelor’s degree at UA undecided on a major, she hadn’t considered studying music therapy because she thought it merely involved playing music for older adults.
“I switched once I realized all that it encompassed,” she said. “Music therapy impacts so many different ages and populations of people with different needs. I loved that it wasn’t just playing an instrument, but that it involved interacting and engaging with people and using music as a tool to help them.”
At Florida State University, where she earned her doctorate, she used music therapy to help new mothers bond with their premature infants, helping them to write, sing, and record lullabies that she played when the moms couldn’t be in the NICU.
She suspects that what was true for her is also true for her students—clinical work often solidifies a student’s decision about their chosen field.
“You can read about music therapy, but when you experience it, it comes together,” she said. “To be able to see it in action, that’s when students learn and when they realize this is what they want to do.”