One of my favorite places to facilitate music-making and foster growth and social interaction is at an Alzheimer's center or assisted living community. As a music therapist I bring a different perspective and methodology to the group experiences at these locations than the usual invited entertainers or activity leaders. I have been asked to come back to visit the Alzheimer's center based on the fact that I involve the residents in active music-making and encourage interaction and self-awareness. Given these reactions, I want to explore and recommend some of the strategies I use when approaching a group of older adults with dementia or Alzheimer's disease.
I say that these groups are some of my favorite clients to work with mainly because of the dramatic change in demeanor that occurs during the music activities. When I walk into a room full of thirty to forty residents and all I hear is the sound of silence, it is sometimes intimidating. In my experience it is kind of like being in a doctor's office waiting room where nobody talks to each other! This is a very sad situation for the residents because they see each other every day but just don't remember who their neighbor is or even where they are or why they are doing a certain activity. Then the "miracle" occurs during the music-making...
The residents literally begin stirring, lifting their heads, looking around, and moving their hands and feet to the rhythm of the music. Suddenly several people start singing words to the music and others begin playing tambourines and maracas that were laying in their laps. Smiles abound and laughter filters through the crowd. I love to see the recognition on faces when some of the residents realize that they are sitting next to someone, or when they are invited to dance by a caregiver! These events are short-lived, but I think incredibly powerful injections of humanity into a place and people that time forgot.
I keep the following ideas and strategies in mind when facilitating these groups:
1. Use a microphone -- I do not have a loud voice, so it is even more important that I use amplification, not only for my voice, but also for my guitar. Even with a microphone there will still be some who complain that they cannot hear very well. The sound of the live accompaniment should be strong and supportive whether it is from a guitar or a piano. I do not recommend using a digital keyboard, but a digital piano is just fine.
2. Use songs and music from the resident's young adult years -- Research with people who have Alzheimer's has shown that memory loss happens generally in retrograde fashion. It also seems that most people tend to have a connection with music especially from their teenage and young adult years. I currently use much music from the 1930's very successfully with my groups (i.e., Alexander's Ragtime Band, Side by Side, etc.)
3. Use song cards -- Make song cards with pictures on the front and the lyrics on the back. The song cards are a good visual to help cue the group about what they are singing. The song cards are also perfect for facilitating choice-making by individuals or the group.
4. "Pass the plate" -- Use something that necessitates interaction with your neighbor. I have used a big beach ball, a treasure box, or some other object that relates to a theme. Think of an item that is good for a show and tell. Pick a song or some recorded music that indicates that the object should move around the room. When the music stops, the person holding the item can choose a song or share a memory or story that comes to mind.
5. Themes -- Group activities built around thematic ideas are a perfect way to encourage reminiscing and discussion. Consider using holidays, seasons, news events and local traditions as the basis for the songs and music selections. One of my favorites is using the sun, moon and stars as a theme whenever the space shuttle takes off or there is an eclipse or meteor shower in the news. There are many songs that talk about the sun, moon or stars that the residents know and love!
6. Have a drum circle -- Community drum circles are appropriate for all ages and adaptable to almost any situation. The drum circle promotes group interaction and allows for individuals to be creative while participating at their ability level. Some clients will feel self-empowered by being drum circle facilitators. Please see my posts under the categories section for "drumming" for an extensive set of articles about how to use drum circles with groups who have disabilities.
7. Go with the flow! -- This concept may take some trial and error and experience, but planning is the key. Try to arrange the activities for the group experience into a contour of activity that begins and ends with less energy and has increased energy in the middle of the music session. The residents need time to wake up and begin feeling the music stimuli before they will be willing to dance and play instruments. It is also appropriate to help them return to a normal mental, emotional and physical energy state before stopping the group activities.
8. Shakers, drums and bells, oh my! -- Use as many different types of small percussion instruments that you can find so that everyone has something to make music with. Active music making is very important and cannot be left out. Playing instruments immediately changes the passive listener to a more focused participant who will be more likely to answer questions, make choices and provide spontaneous feedback.
9. Dance! -- Movement to music can also include dancing while sitting down. Props like scarves, ribbons, gloves and costume pieces are useful in cuing movement to music. Using recorded music for the activity can provide valuable time for you to personally interact with the group members.
10. Have fun! -- It will show, and your energy and excitement will be contagious.
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