Music for a While – Blog 7

Music for a While BLOG
BSO Associate – Neil Valentine
Entry 7, 29/10/15

One of my favourite activities to do as part of Music for a While is called Passing Instruments. This is essentially selecting instruments and passing them around a circle of participants giving each person an opportunity to play them.

Key to this is space and time. It takes time to explore something new until you are satisfied with it, and this activity needs time for each person and space so that they can be free to explore. Each person has their own protected time to explore the instruments, and for music this means that it is just one person trying something out at a time.

This is very important. Music is sound, and sound travels. If it were art then each person could try out their red pen at the same time. If everyone tried out an instrument at the same time, they would not experience their own sound the way you would if you all had a red pen and you all tried colouring at the same time.

To experiment fully you need to space and focus to do this, and we provide this. Each person is focused on, listened too, appreciated, encouraged and congratulated as they explore the instrument, however they choose to do this. There are no right or wrong answers in this, and sometimes the instruments are tasted rather than played, or used in a new and creative way (intentionally or not). This is fine, although we do encourage and lean them towards a more efficient technique.

I always begin with a small purple shaker. I like the colour, its vibrant and fun. Its light and easy to handle, and most importantly it makes a very good quality sound that is loud and clear for the effort needed. You can move it the smallest of amounts and it will produce a loud and exciting sound. Perfect for this work when some of the patients really struggle with fine motor skills.

I choose a two-tone wood block next. This is another instrument that is exciting to look at, it can be played multiple ways and is very loud for the energy needed. It is also light and can be played easily or with assistance.

I may say ‘I have this shaker, here, listen to this’ and then ‘David (insert name) would you like a go? here, try it, it’s great fun’. David may have a go, we appreciate, encourage, but not too loud, and then it is passed on and around.

Occasionally someone will not want to give it a go, which is fine. This leads to another use of this exercise. I will say ‘that is fine, no problem at all! Can you take the shaker from Doris and pass it on to David? That’s really helpful, thank you’.

This will encourage them to just take the instrument and pass it on. They have already held it then, had an instrument in their hand, which is one less barrier to getting them involved again the next time round.

This also promotes social bonding between the group, as they have to engage with each other to make sure the instrument is passed around the whole group.

A very fun, ice-breaking and musically useful opening activity.

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Music for a While – Blog 6

Music for a While BLOG
BSO Associate – Neil Valentine
Entry 6, 20/10/15

Music for a While – A session in a While…

During set up today I was approached by one of the specialist nurses who has been particularly enjoying the music sessions. One of the patients who had enjoyed a previous session didn’t want to come this week to the group. So I decided to take the music to him. This patient is a classical music fan, and although his speech is hard to understand and he has a dementia diagnosis he made it very clear he enjoys music.

After a whistle stop tour of Radetzky March, some of Bach’s Cello Suite no. 3 and Rondo all Turca he told me his favourite composer is Chopin (not quite ideal for solo viola, but a project to think about…) and clearly said ‘Thank you for the Music, I enjoyed it’.

He still wasn’t interested in the group however. The nurse suggested that it was the collaborative nature that he struggled with. He likes performance of music, being performed to but struggled with the group percussion and the ‘noise’ that comes with this. Which is fine, not everything is for everyone, but I hope that I will be able to persuade him to come down again, perhaps with some Chopin…

On returning to the group room patients were arriving and my normal method is to play music in the background whilst arrivals continue and tea and biscuits are served. This is always a crucial part, as I try to gauge who is in the room. I meet the patients and check in with the staff and hope I can get a sense of who and where we are together. I play a variety of repertoire and see the reactions.

The start was a little delayed so I decided to pass round some of our laminated lyric sheets. After a nice rendition of My Bonnie Lies Over the Ocean (a Music for a While classic) and Skye Boat Song we were ready to officially begin.

We are sat around a large table with tea in china cups and open packs of biscuits, patients either sat in wheelchairs or transferred to regular chairs, nurses, a couple of volunteers, all surrounded by mobility equipment that is used on the wards.

We begin with the hello song, I strum this on my viola and sing hello to each person. It gradually catches on as the words are learnt through repetition. We are all singing and every time we sing to the next person a smile greets us. This is a very common reaction. Patients who are seemingly elsewhere or unengaged suddenly light up and focus in on the singing and their name. It is a way into their reality and also being sung to is just very nice.

I then like to pass a selection of instruments around the circle from one to another, giving time and space to try out some sounds. Returning patients know what is coming and you might think that varying the start would be useful, but this is such a ice breaking exercise that I stick with it. One lady says ‘I know this, it’s a shaker’. It allows someone to try it out, much like you would different colours if you were painting and get to grips with making some sounds. It is amazing how much patience is shown and space given with encouragement and appreciation shown amongst the participants. Shakers, drums, chime bars, wood blocks, bells all feature and all present different challenges. This also gives me a chance to see who gravitates to which instruments and who has particular physical challenges that may suit a shaker or a drum.

Whilst trying out chime bars, a lady said ‘This sounds like Do-Re-Mi’ and starts singing the famous song. It was fortunate as I had a lyric sheet for that song, which was a great connection. Its these kind of connections that can really validate someone, give them confidence and feel like they have contributed. This is a long song, but all we are really interested in is singing ‘Doe, a deer, a female deer….’ etc. I add in the intro just for context, then we sing around then chorus a few times. Smiles and laughter.

Then we are back to instruments and a game called ‘Start/Stop’. It is as it sounds, someone says ‘Start’ and we all start, sometimes they count in too to give a speed, and then when they feel like they place their hands up and say ‘Stop’ as clear as they can. I try to facilitate rhythmic and melodic playing, hopefully supported by someone who has a strong rhythmic sense on a drum which then can drive the music.

It is amazing how quickly the group catch on to this. This applies to those with varying degrees of dementia and confusion. Music starting and stopping is very clear and deliberate. Strongly rhythmical music seems to build around and inside the group. Whether playing in time or not, participants become part of what is happening, and then when we stop suddenly, the change is unmistakable. Eyes lift up, gazes look round, smiles are exchanged, we did something together! There are lots of looks to me seemingly saying ‘was that ok?’. Of course it was, it always is ok, better than ok in fact, it was perfect.

This time we passed the conductors baton around as a symbol of power. Just a symbol really as to most people a baton is a mythical thing that men with white hair and a serious face wave around whilst wearing a black suit and facing the wrong way. But to some it meant a symbol of responsibility, which is enough.

Before reprising the Hello Song as a Thank you Song we had a go at ‘I do like to be beside the seaside’, which is great fun all round, especially when instruments are added.

Closing a session with the same format and melody as the start, I find, bookends the session nicely, brings us to a familiar point that is always a nice place to end. I then played some more music as the group dispersed, with the amazingly enthusiastic staff taking them back with smiles and in good humour.

I have been asked to play Chopin twice this week so that is my next challenge. Watch this space.

Music for a While – Blog 5

Music for a While BLOG
BSO Associate – Neil Valentine
Entry 5, 15/10/15

BSO Associate Neil Valentine is working acute older peoples wards in Poole, Portsmouth and Hampshire Hospitals. He will be visiting the each ward once a week for 6 months.This is a collection of his thoughts, feelings, impressions and experiences.

Music and Delirium

This post recounts the most intense experience of Music for a While so far.

I was in the day room working with a couple of patients, we had a nice time, some fun singing and exploring of instruments. Smiles were around and eyes brightening up.

They went back to their beds and I entered the ward to play to a few gentlemen who were unable to make the trip to our session. This was lots of fun, one patient was singing and clapping along, the others smiling and enjoying. I had been warned that one particular gentleman was a little unsettled and to be aware of this. My colleague from the BSO, who was there to observe, sat with him, and had a great time laughing and joking.

I was then asked to play from outside a side room to a particularly distressed patient. This lady had come in for a fall, but in hospital had developed some severe delusion and paranoia, probably related to an infection.

Her speech was full of fear and anxiety. Determined to tell us about a disaster that was happening for her. Words were repeated as she tried to convey her distress. She had flooded the room and all her bedding needed changing, but this was nigh on impossible due to her distress.

I decided that playing from outside the room made me (and probably her) feel like I was just watching her, peeking in rather than trying to be present and to engage. So I went in and for the next 45 minutes I played non-stop, her own private concert so to speak.

During this time she focused on me and whilst I played she tried to tell me about the disaster that was her reality. Whilst focused on me, the amazing nursing staff were able to change her bedding, clear up the water and get her into bed.

I played my full repertoire of relaxing and calming melodies and songs, all aimed at bringing the level of anxiety down. I brought the volume and intensity down, thinned out my tone but kept up the sense of emotion through vibrato and expressive phrasing.

The dementia specialist nurse sat with her, stroked her hair as I played. Occasionally she sat up, distressed, but then lay down again. She was made comfortable and began to speak with less distress, quieter and calmer.

It was quite an experience for me. Determined to play constantly, smoothly, beautifully, no shocks or sudden changes, just calm and sustained. A bed of sound that had the possibility to help her calm down and feel safe. It had the added bonus of masking sounds from the ward, many of which can be intrusive. Trolleys clashing, doctors and nurses talking about patients, drugs being administered, other patients talking or shouting. The music created a sound buffer for her in the room, allowing the room to be protected, door almost closed, light off and sounds not penetrating from outside.

There got to a point when the lights were off that she would open her eyes, look around and see me. When she saw me she had something to focus on and the distress increased. When this happened I realised that what she needed was to be able to sleep, not more music. It had reached the point where her delusion had been calmed and reduced, and a person standing in her room (playing beautifully or not) would now be a focus for this delusion and anxiety.

So I slipped out of the room.

Later I was told she had slept well and had a much calmer night.

This is the first time I have experienced someone with such a vivid expression of an alternate reality to my own. Yes we all see our own version of the world, and in the wards I have met many patients who are confused or unsure about their reality. But not to this level.

On my way out a Junior Doctor thanked me saying “that was magic”.

No hocus-pocus I’m afraid but it certainly put my recent whinging about a sore wisdom tooth in perspective.

Neil Valentine
BSO Associate

Music for a While – Blog 4

Music for a While BLOG
BSO Associate – Neil Valentine
Entry 4, 08/09/15

BSO Associate Neil Valentine is working acute older peoples wards in Poole, Portsmouth and Hampshire Hospitals. He will be visiting the each ward once a week for 6 months.This is a collection of his thoughts, feelings, impressions and experiences.

Finding the right music

One thing that has become clearer over the course of the project so far is the need to find the ‘right’ music as often as possible. When the aim is to make connections and engage with someone through music you need to establish a common ground. In musical terms this means meeting their expectations to some degree if possible.

Often I have had requests for music that is special to a person or a family. In some cases I have been able to source the music and play it quite quickly, but only if I have an idea of what the music sounds like, its style, the singer or composer. And in these cases the standard of the playing is not as high as I would like, seeing as I have quickly learnt some music using my phone or laptop to download a score or picture.

Sometimes it is fortunate as I know the music, and if they are able to sing the first few notes then the rest of the song can follow relatively easily. But this is not often not the case. The questions I have taken to asking when appropriate are 1: Do you have any types of music that you particularly like? and 2: Would you like music that is upbeat and exciting or calm and relaxing?

The answer to the first question seems to always be ‘Not really, I like a bit of everything’. But by the way they answer, it gives an opening to prod further if you think it’s appropriate or take that as your answer and choose yourself.

As it turns out variety is very appreciated. Even when a particular style is requested, varying the music does not put patients off from engaging. The common thread here is my instrument, me and the way I approach the music. Music played well and beautifully tends to be appreciated, engaged and enjoyed. Which is why it seems that unrequested music I have had a chance to practice and feel comfortable with is more enjoyed than music that is requested but thrown together in the moment.

This is not a hard and fast rule. Sometimes working out a piece of music with a patient so you both rediscover it together can be lots of fun. This happened recently with a patient who was a keen singer, and together we were able to work out ‘Abide with Me‘ and ‘Jerusalem‘.

After writing this, finding the right music now appears to be about attitude. Being open and honest, and presenting what I can to the best of my ability. I cannot always present the perfect music, but I can have enough ideas, enough improvisation skill and enough repertoire to be able to adapt something to the presented situation. So maybe the statement from the opening paragraph should be: One thing that has become clearer over the course of the project so far is the need to find the right outlook or attitude as often as possible.

Music for a While – Blog 3

Music for a While BLOG
BSO Associate – Neil Valentine
Entry 3, 25/07/15

BSO Associate Neil Valentine is working acute older peoples wards in Poole, Portsmouth and Hampshire Hospitals. He will be visiting the each ward once a week for 6 months.This is a collection of his thoughts, feelings, impressions and experiences.

In one setting we have been getting a regular group meeting  together, sometimes with the same patients and other times with different ones. The main thing that is great here is that the level of staff allows us to see what is happening. I am often so involved in musical interactions that I am unable to step back and notice small and subtle changes and developments. But with the right experience some of the Staff from the hospitals can do just that.

One particular conversation with a Dementia specialist nurse has stuck with me. We were talking about the ways in which you can diagnose dementia and its different stages. We also discussed how it can be confused and difficult as there are often multiple conditions manifesting at the same time. For instance a patient may have Parkinson’s, or literacy may be an issue, or perhaps English is not a first language so can often a barrier.

She spoke so passionately and clearly about when, during a musical interaction, she was able to see new things going on. A new movement, or a movement not seen for many weeks. A new behaviour, or a change of behaviour. Or perhaps the same behaviour despite a particularly involving musical passage when you would expect a change in reaction.

One particular patient struggles with the English language, is almost completely illiterate and repeats the same stories over and over. These factors make diagnosis of her dementia very difficult. But during the musical interaction, which is to say a new stimulus was presented directly to her, one would expect a variation of behaviour (however subtle) that would let a trained person see that the level of cognition was at a particular stage. However with this patient, despite this quite direct and powerful musical interaction there was no variation in behaviour. It was put to me that it was lack of change in behaviour that confirmed she was stage 3 dementia. Had she been able to process this musical interaction and engage with it she would be diagnosed as stage 2.

It appears that the right musical interaction might allow a trained person to see a patient in a different way To see them interact on another level that is not based on conversational or physical tests. As most methods of dementia diagnosis are based on talking or cognition based activities, music may takes them outside of this and onto a different path. It might allow them to be observed in a new place and in this case produced a window into the patient and helped the dementia nurse to be surer of her diagnosis.

Music for a While – Blog 2

Music for a While BLOG
BSO Associate – Neil Valentine
Entry 2, 25/07/15

BSO Associate Neil Valentine is working acute older peoples wards in Poole, Portsmouth and Hampshire Hospitals. He will be visiting the each ward once a week for 6 months.This is a collection of his thoughts, feelings, impressions and experiences.

Making Connections – Jigs, Songs and a Slow Dance.

From my previous experience working with patients suffering from Dementia, making connections has been the key motivation. Finding a new way to connect with someone who may be operating on a different level to you. Finding a musical language in that moment that can connect you together. In a closed session this is possible as you find your space, your safety and you can open up and begin to find some expression. But on the wards the distractions and uncertainties make this very hard to achieve. So the primary method is for me to play, to perform, and try to make connections through this rather than a directly, two-way, musical conversation.

Just playing is often the most appropriate way of making music, especially in a bay. When I am able to present music in a calm and non-intrusive manner I have only been met with appreciation. That implies that there have been times of ‘non-appreciation’ and yes, I admit, a couple of times I have been informed by a patient that they would rather have their own silence. This is of course fine and is one of the problems with working in bays, where the patients have not chosen to be there. However this has only happened when I have tried to interact with a patient through speech or eye-contact. Mostly when this request has been made of me I have been able to still play in the same room, just away from that particular patient.

A key to making these connections are nursing staff, most of whom are very engaged and invested in their work. This week we have had dancing to Irish jigs with the husband of an elderly patient, slow dances to Elvis, chime bars, shakers, conducting and tears in response to a lady’s gratitude to the nurse for making music with her. Truly beautiful connections.

So connections can go either way, but so far the vast majority have been positive connections. Simply playing live music seems to make people want to open up, to connect, to smile and to enjoy. This was clear when two ladies, both of whom seemed to be ‘feigning’ sleep, started to hum along to my version of My Favourite Things. After singing this twice, followed up by Do-a-Deer, My Bonnie, Skye Boat Song and Daisy, Daisy, they clearly were wide awake, heads up and smiling. It turned out one of them had been in her church choir for 40 years, and she had such an amazing voice. Full and rich. It was the first time I was able to get engagement and real singing in the ward. And it seemed to be due firstly to the music choice. Something about Sound of Music spoke for this lady, and she went with it.

So my challenge is to keep building the repertoire that I can pull out of my head when the situation seems to warrant it. I have had plenty of requests, and I will do my best to learn them and get them into the sessions.

One thing is clear, when you are hoping to make connections, you need common ground, and it seems that music that is recognised is a way to do this. Improvisation will always be a part of what I do, and the ability to extend the feeling of a particular piece or engage or prolong the experience is key, but building the appropriate repertoire, playing it with as little notation as possible and performing it in an inclusive and beautiful manner goes a long way to beginning to make connections.

Music for a While – Blog 1

Music for a While BLOG
BSO Associate – Neil Valentine
Entry 1, 02/07/15

Music and Dementia. BSO Associate Neil Valentine is working acute older peoples wards in Poole, Portsmouth and Hampshire Hospitals. He will be visiting the each ward once a week for 6 months.This is a collection of his thoughts, feelings, impressions and experiences.

First Impressions

Music for a While is now at the end of week 2, and with a week’s gap to contend with, there are some reflections and thoughts that have been constant companions from the start.

Firstly I am blown away by the positivity and generosity of the nurses and staff in all settings. There is a real sense in these wards that real care and compassion for the patients makes a difference. The welcome and space they give visitors and relatives of patients is also very moving to see, and this has allowed me to just slip into ward life, play some nice music, share some instruments and musical games, and leave with smiles on faces.

My first barrier to overcome is how to approach working in a hospital bay, when there may be up to 6 patients with visitors or family around, and I am intending to bring some calm and positivity to the space. Firstly this is often already the case, due to the work of the nurses, but the problem with music is it is made up of sound.

Sound has an annoying habit of just going. It travels, and musicians have difficulty directing it in a specific manner. I cannot take my viola into a patient bay and just play to one patient, the very definition of sound means it goes in all directions it can. And that means everyone can hear it.

So I can play quieter so as not to disturb, or I can play very relaxing and calming music or improvisations that will bring as many people in to my world as possible, and these do work.

But when a patient would like something more upbeat, or perhaps clearly wants to be ‘involved’ in the music making, rather than just being a listener, this is where things can more difficult.

To connect properly you have to meet the audience half way, you have to go where they want you to go, and then be the musician you are in that space. And being this way for multiple people at the same time is very difficult indeed.

So the thought remains, how to effectively make meaningful musical connections in a hospital bay, when the very source of that connection for one person may indeed prevent a musical connection for someone else?

Just something to ponder as we go on.

Music for a While continues second week of July.

BSO Associate Neil Valentine running a session a Poole Hospital

BSO Associate Neil Valentine running a session a Poole Hospital