Friday, May 11, 2012

Horn Therapy

As a hospice volunteer I've been working with an elderly male in end stage Alzheimer's. He's both non-verbal and non-ambulatory and his wife, with the help of a caregiver, is caring for him at his home. Until recently I've been using very rhythmic guitar playing and singing to catch his attention and get feet tapping and an occasional smile or wink. 

Last month, however, that no longer worked and he didn't rouse up and open his eyes when I played for him. It seemed to me (more intuitively than emprically) that it was some combination of him not being able to hear as well and/or able to process music. So for the last two sessions I've taken the French horn and played hymns, thinking that it's both louder and less complicated musically than guitar and singing - and it has worked.

Both times while warming up he has opened his eyes and looked around to see what's going on, and then looked directly at me while I was playing and given me some full face smiles, which is the best response we can get at this point. 


  1. If the patient has a churchgoing background going back to childhood, then the hymns sung in childhood will be very deeply embedded memories, for two reasons. One is that they will be very old memories, and people with dementia tend to retain old memories better then recent ones. The other is that music memories (as I think you mentioned in a previous blog) get stored in a very distributed way all over the brain, and this seems to help retention.

    So, playing hymns or singing hymns may well be a good way to get through to him. Ask his relatives if they know of any hymns that are his particular favourites.

    When my father was almost permanently unconscious with dementia right at the end of his life, the one thing that woke him up was my sister playing Christmas carols on her violin. He even tried to sing along to the chorus of "O Come all ye Faithful".

    I think you've hit on a good idea with hymns.

  2. Jonathan - What a wonderful story about your dad. With my hospice volunteering I've seen that a number of times, nearly always with hymns. Your use of the word "distributed" is a very concise way of talking about how musical memories are stored - and I'll probably steal it ;-)

    In this case I knew what his favorite hymn was and had tried singing it back when I first started working with him, but got no response. What worked were catchy, rhythmic tunes (his wife had also told me he'd often done little percussive things when listening to music). So "Down By the Riverside" got a response, but his favorite, "Nearer, My God, To Thee", didn't.

    What's changed now is that the disease has advanced and the guitar and voice weren't getting through, but the horn - either because it's much louder or because it's just that single line and easier to process, or both - is getting through. It may be the same thing I was talking about in that diary - for me, at least, the horn sound has a larger tactile component than any other instrument I've played - you feel it as well as hear it.

    They use harps a lot in hospice work as well, and that's another instrument where I feel the vibrations as well as hear them, and my guess is that's why they work so well when sensory/processing abilities are waning.

    As to hymns - the response we get in the little country churches we play in to those old hymns all the denominations seem to be culling out for theological reasons, or just in pursuit of novelty, is very strong amongst the older generation. People always come up and thank us for playing them.