People with Alzheimer’s disease and related dementias (ADRD) face a range of issues related to changes in memory and thinking. These may limit their functionality in many other aspects of life. While there is no magic cure to reverse cognitive decline, one treatment option has the potential to facilitate social engagement and emotion regulation in these patients: music therapy.
Alaine Reschke-Hernández has been recognized with the Graduate College’s 2020 D.C. Spriestersbach Dissertation Prize in the Social Sciences. She focused her time at Iowa on research establishing an effective model of music therapy for patients with ADRD.
Reschke-Hernández completed her program in 2019 with a PhD in Music Therapy, which the American Music Therapy Association defines as the systematic application of individualized music activities for addressing goals within a therapeutic relationship with a credentialed music therapist. Although she found studies examining the effectiveness of such interventions for people with dementia, the research often lacked a theoretical foundation for implementing the music.
The results often did not point to clear conclusions determining how to safely and appropriately apply music in helping these individuals and their families. She realized that prior to conducting another study, a new model was necessary to guide research and advance clinical practice.
“I digested a lot of information from different fields,” says Reschke-Hernández. “I also talked to people from a variety of professions - nurses, physicians, activity directors, and more - what strategies they use that work really well for this population. After cataloguing all of this, I developed a schema for how to use different strategies with this population, why to use each one, and what each one looks like with and without music.”
After developing the initial model, Reschke-Hernández consulted dementia experts from various fields for input. She then conducted a multi-site clinical trial comparing a music therapy group to a verbal-based social group, both of which being grounded in the model.
Reschke-Hernández identified music itself as one of the most important predictors of outcomes. Participants’ emotions significantly improved and their degree of social engagement was significantly better in response to the music therapy sessions compared to the verbal-based format. Her results also suggest the model could be used in designing and implementing activities for behavioral improvements among those with ADRD.
“Not only did these clients engage more with each other and the music therapist during the music therapy sessions, there was more constructive engagement - things like encouraging others in the group to sing or complimenting each other,” says Reschke-Hernández. “They also demonstrated improved moods and self-reported feelings of emotion with the music therapy sessions. These are all socially-appropriate, engaging things that you do not see as often in this population.”
While music therapy does not reverse cognitive decline itself, it can lead to improvements in emotional and social functioning. Reschke-Hernández found that, in response to the intervention, people who normally have limited functionality in their environments were better able to use a variety of skills – such as initiating an interaction or carrying on a conversation. Some care staff noted that these behaviors continued directly after the sessions.
As people with ADRD experience cognitive decline, it can become difficult to identify activities they can engage with. For instance, following a plot can be challenging if they are rapidly forgetting what just happened in the story. When compared to other forms of media, such as having participants watch TV or read newspapers, music is a unique way to engage patients.
“There are so many ways to engage with music regardless of your functional abilities,” says Reschke-Hernández. “It is very hard to lose that ability to engage with music because it’s embedded in so many aspects of human life. That connection with our everyday lives creates an opportunity for people to have a normalized experience where they can engage with family members and staff members.”
Many forms of music engagement can be valuable for individuals with dementia, but music therapy offers several advantages compared to simply playing recorded songs. Music therapists often use live music and are able to gauge clients’ reactions to appropriately modify their delivery. This may include slowing down a song, repeating lines, or changing the selection or type of music activity on the spot. These responsive adjustments help to ensure that participants are processing, engaging with, and reacting to the session in a positive way.
Music therapists must be mindful about the interplay between the music itself and the individual.
“There are a lot of different ways we can adapt music to facilitate desired responses and that is a major part of why music therapy is so effective, but the caveat with any music intervention is that we can also evoke negative responses,” says Reschke-Hernández. “People with memory loss might experience prolonged emotions beyond the memories that caused them. While that could mean they feel good beyond the music therapy session, the danger is that they could also get stuck in a negative loop from the session.”
Music is interconnected with our life experiences. While music tends to evoke a lot of positive memories and feelings associated with those memories, it can also prompt emotions from very difficult and negative events in someone’s life. Many songs have strong connections to religious beliefs and culture as well, so music therapists must be mindful and respectful when selecting music.
“Music therapists have to think about all these things when choosing music and deciding what is right for the moment,” says Reschke-Hernández. “They use their skills as music therapists to watch for those responses and adapt in the moment to best support the individual they are working with.”
While her research provides clear evidence for the efficacy of music therapy and offers a model for clinical practice, Reschke-Hernández is primarily interested in improving best practices within the profession and contributing more knowledge about music interventions.
Reschke-Hernández reflects on her time at Iowa and appreciates the support she received throughout the program – particularly from her advisors, Dr. Kate Gfeller and Dr. Daniel Tranel. Since completing her doctoral degree as a Ballard and Seashore Fellow, she has joined the faculty of the University of Kentucky as an assistant professor in the School of Music. She also continues to work as a board-certified music therapist.
Reschke-Hernández says she was initially surprised to hear that she had won the Spriestersbach Prize but is grateful for the opportunity to shine a light on the benefits of music therapy and the needs of people with dementia and their families. Her outstanding research has also been recognized on the national stage, being chosen as a finalist for the prestigious 2020 Council of Graduate Schools/ProQuest Distinguished Dissertation Award.