Music in Stroke services

Air Arts Royal Derby Hospital

An 18 month project from March 2015 set up by Air Arts to embed music listening, music participation and music therapy approaches into Stroke Services at the Royal Derby Hospital.  

The project had two main aims:
• To improve patient experience, wellbeing and recovery through use of music through a variety of delivery methods.  
• To train staff to incorporate elements of music listening, therapy and participation into their daily therapy sessions with patients.

Our objectives were:
• To set up a core therapy team from both wards to take part in the sessions and training.
• To deliver a minimum of 10 drumming workshops followed by debrief sessions for the core team
• For core staff to attend a 6 week course with a neurologic music therapist exploring how to incorporate elements of music therapy into other forms of therapy (Speech and Language, Occupational and Physiotherapy)

The project was funded entirely through Derby Hospitals General Charitable funds

Description of the arts activity

20 workshops were delivered in total (10 on each ward) by London based African drummer Richard Olatunde Baker, a highly experienced musician and arts in health practitioner.
Workshops lasted up to 1 hour 30 minutes in duration in the dayroom on the wards.

Richard’s workshops focused on group drumming with a wide range of percussion instruments to suit any level of movement and participation.  Singing and chanting was also a large part of the work and patients were encouraged to take a lead on musical elements; beat, tempo, rhythm, volume, duration of sound, sudden or gradual changes and to improvise or vocalise in response to the music.
Drumming was selected as a well-researched musical genre to encourage group activity in this setting, to encourage initiation of movement and vocalising.  Various percussion instruments used as a relatively straightforward way to produce complementary sounds within a group.

There was an added benefit with Richard’s knowledge of African culture and music, arousing curiosity in unusual instruments, non-English vocalisations and a new sound world.  The fact that workshops could be delivered in a largely non-verbal and non-English way was beneficial in terms of supporting patients with little or no speech, but who could join in with vocalisations without any pressure for linguistic comprehension.

Staff attended in an observational and supportive capacity, identifying patient therapy goals which could be worked on in the sessions.   Time was allocated after each session for staff to identify approaches with Richard which they can could adapt for use with their patients in therapeutic sessions between workshops.

Staff from the core team also undertook a 6 week training course in January 2016 with Neurologic Music therapist Catherine Watkins to understand the benefits of music therapy and how this might be embedded into their daily work with patients to benefit wellbeing and improve recovery.

Alongside the workshops, staff have been compiling playlists to use music listening with patients, to aid physical therapy sessions and to improve mood.  Staff have maintained listening diaries for each patient to demonstrate impact on mood and therapy goals.

Details of the project participants

The work took place in two wards: Acute Stroke and Stroke Rehabilitation from March 2015 to August 2016.

Each workshop had 6-15 participants from each ward.  Participants were recruited through referral by therapy staff and invitation on the day of the workshop.
Most of the attendees were in wheelchairs with varying levels of participation.
Overall, the workshops have been attended by 150 patients.

A team of 12 therapists took part in the training sessions with the music therapist.

Project management

The project was undertaken by Air Arts, the arts charity for Derby teaching hospitals.

Laura Waters, Arts Programme Manager for the Trust managed the project in conjunction with Lead occupational therapist Rose Kershaw, devising a timetable for the work, recruiting staff to the project, collecting data and feedback, buying music resources for the wards.

The work was undertaken within standard guidelines for arts projects with approval from the Trust board and Design, Arts and Wayfinding committee which oversees the arts programme.
No ethics consent was required.

There was no cost to the participants.

Evaluation methods and findings

A report was produced following our pilot work for this project in 2012 on the Neuro rehab ward looking at therapy in context assessing feeling of rehabilitation (alone or together), perception of rehab (positive or negative), feeling (boredom or involved) and mood (positive or negative) – all patients increased on all levels throughout the project.

We have gathered patient and staff comments from the drumming workshops, demonstrating that the workshops improved patient mood and self-reported feelings of wellbeing.

Therapists report they have been using the music listening with 40% of their patients.  Outcomes are positive in terms of relaxed behaviours, or more alert depending on what they are focussing on for the session.

Catherine Watkins (music therapy trainer) reported on the outcomes of the 6 week course which is attached.   The report shows clearly that staff found the training to be relevant and appropriate for their work and experienced an increase in their confidence to deliver music as part of their therapy following the course.  This has been borne out by subsequent meetings where therapists have commented on the change to their practice and interestingly that the work has given them a reason and permission to use music in their work:

‘Therapy seems more likely to be successful when we use music techniques’
‘The course has made it acceptable for us to sing and use music in our work’
‘It’s like having permission to use music, a change in perception’
‘Music listening has been easy to implement’
‘Listening to music in physiotherapy sessions really helps patients with their gait work’
‘It has demedicalised the therapy’
‘It’s important to personalise the music – e.g.  football chants, Frank Sinatra’
‘We are using the instruments more and more in our therapy sessions (especially the tambourine) such a versatile instrument to use that is visual and has a sensory cue for the patients it really has helped to enhance our normal sessions.  whether working on vision, sensory stimulation, motor control of the upper limbs.  The list goes on!’

Supported using public funding by the Arts Council England