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A Model for Music and Health Science Collaboration

By Stefan Fiol and Rhonna Shatz

Introduction

Facilitating connection by validating the dignity of each person is the goal of the service learning course “Dementia and the Arts,” offered as a collaboration between Dr. Stefan Fiol (Professor of Ethnomusicology, College-Conservatory of Music), Dr. Rhonna Shatz (Director of the Cognitive Disorder Clinic, College of Medicine), Rachel Tomsic (Neurological Social Worker, UC Health), and Betsey Zenk-Nuseibeh and Christina Weber, two community-based music therapists. The course draws upon the generative, connective power of the arts to create intergenerational learning opportunities for students across colleges and for individuals and care partners in our community who are living with neurodegenerative disease (NDD). For people suffering from NDDs, which includes Alzheimer’s disease, Lewy body/Parkinson’s disease, Frontotemporal neurodegeneration, and Primary Progressive Aphasia, musical engagement serves as more effective and life-affirming alternative to pharmacological interventions often used for treating behavior and mood complications of NDDs. While the course is centrally concerned with neurodiversity, it also forges community between individuals who are diverse in terms of age and cultural, racial, and gender identity.

‘Dementia and the Arts’ is intended for students who are curious about incorporating arts-based learning into medical or allied health contexts. It is a one-credit service learning course open to all UC students, undergraduate (CCMS 5115) and graduate (CCMS 6015), as well as fourth-year medical students. During some semesters, the service-learning component has been combined with didactic material to create a three-credit graduate seminar and an undergraduate Honors seminar. The course has been supported by a UC Forward mini-grant in Academic Year 2020-21 and a UC Health Pathways seed grant in Academic Year 2021-22, , and a University Research Council (URC) Faculty Research Pivot Award for AY 2022-23. Forty percent of students and eighty percent of community participants have enrolled in the course for more than one semester, attesting to its success in filling a vital need for intergenerational social connection, creativity, and meaning.

[A Quintet consisting of Sarah Wagner, CC Vasan, and Bridget Watson Connie and Bob Wilson show their joy by making heart symbols for each other during an online session.]

Course Structure and Goals

Stigma and isolation characterize the aging process, and the limitations of our health care system place a disproportionate burden on spouses and family members as care providers. There are few opportunities for students and elders to engage creatively with each other. The intention of this course is to create conditions where people can feel whole in themselves and whole in community, where they can stretch themselves creatively without fear of failure. Care Partners and persons with an NDD are motivated to be part of an educational space in which dementia is destigmatized and they can support learning. Most music programs cater to residential care settings and either include just the individual with NDD or their care partner; our course is unique in serving individuals with NDD still living at home and in supporting the relationship that they have with their care partner. And we have been gratified to hear that they have discovered new ways to connect with each other through music and mindfulness after the conclusion of the course.

After several weeks of online and synchronous training in facilitation and creative aging, students are matched with a person with NDD and a Care Partner. These four individuals form a “Quartet” that meets for 45 minutes per week for a minimum of eight weeks. Students facilitate the sessions within a structure consisting of a check-in (5-7 minutes), a moment of mindfulness (5-7 minutes), a co-regulation activity involving synchronous movement and/or sound (10-15 minutes), a co-creative activity that stretches cognitive functioning (10-15 minutes), and a moment to celebrate connection and the unique gifts of each group member (2-3 minutes). See the following video for an illustration of this structure using excerpts from Quartet sessions. Students have weekly meetings with a course supervisor to reflect on their experiences and harvest learning from past sessions. Students in the course also submit weekly reflections about their collaborations, thereby charting their development and learning process. These reflections take the form of 1) a weekly fieldnote, distilling and summarizing key learnings and questions, that is reviewed by the supervisory team only; and 2) a collaborative reflection space for students in the course to share ideas with each other.

This course provides safe containers (the Quartet and the classroom) for students to forge human connections and try out different kinds of arts-based techniques and facilitation strategies. While offering oversight and tools, we seek to emphasize student agency over their own learning process. This is a “failure-free” zone. If students develop a strategy that is not connecting with their partner with NDD, they need to be creative, adaptive, and resilient. Students will also learn to listen more openly, to use observation and feedback to become more responsive in the moment and to handle the problems that people are bringing to them. These are useful skills in personal and professional life, whether one aspires to be a practicing physician or a musician seeking to connect in the moment with different audiences.  The communication and creative skills demonstrated in these sessions also ultimately serve as positive models and platforms for care partners to adapt in their daily life with persons with NDDs, providing students with real world experience as teachers and mentors. Moreover, this course can open up professional pathways in medicine, music therapy, neurology, psychology, wellness, and related fields of health and education. It also offers an opportunity to hone skills in musical composition, improvisation and performance. Above all, community participants have communicated that they value being part of an learning environment for students, and students in medicine and music have told us that this course gives them a sense of purpose in their educational pursuits, and that they value being able apply their skill set in service to others.

[A Quartet consisting of Afolakemi Akinefron, Jonathan Bowden, and Jo Ann and Nick Komanecky enjoy a moment of mindfulness meditation during an online session]

Components of ‘Dementia and the Arts’ Course

• Background in cognitive functions
• Types of neurodegenerative diseases and their symptoms
• Challenging behaviors and strategies for managing them
• Training session to develop improvisation skills
• Training session to develop mindfulness facilitation skills
• Training session to develop music facilitation skills (co-regulation and co-creation)
• Training session to develop skills in working with Care Partners
• Resource Library
• Visiting Lectures by Researchers and Practitioners in Music Therapy, Neuroscience, Ethnomusicology, Nursing, Social Work
• Course packet with many examples of activities for sessions
• Surveys at beginning, middle and end of course for all course participants
• Weekly individual reflection fieldnotes
• Weekly shared reflections with the class
• Weekly Supervision Sessions with Course Leaders

A Peek Inside One Quartet Session

[view this video for the excerpt described below]

The Quartet activities were not proceeding as smoothly as usual. Dave, an individual with Lewy Body Dementia, had been feeling frustrated that his words were not being understood by others in the group, which included two student facilitators and his care partner and spouse, Kathy. In an effort to encourage communication in another way, Trinity, one of the student facilitators, suggested that he try singing his thoughts. “Do you want to just try singing in a scale some of the words that you have in your mind?,” his care partner Kathy repeated.  “That doesn’t sound like fun,” Dave replied. But with some encouragement and modeling from others, he put his thoughts to a made-up tune. In the words of Trinity, “We tried to encourage him to give the activity a try, and eventually, he made a melody up on the spot which was sprinkled with a few words and vocables, and we used this melody as the theme in our song. This felt like a moment of awe, as the melody he came up with was beautiful, and we were able to use something he didn’t feel too confident [about] in the creation of a song.” The group repeated Dave’s tune until it became a fully-formed melody, and week after week they collectively composed from the collective thoughts, emotions, and music ideas of the group. The result was this song.

[Notation for a song composed by Trinity Lê, Max Kalinowski, and Dave and Kathy McGrew]

Overcoming Challenges

This service learning course is a significant time investment for faculty and students.. For students, the course entails at least six initial training sessions (some synchronous, some asynchronous), followed by a minimum of eight weeks of engagement with community participants. Each week, students lead a 45-minute Quartet session, attend a 30-minute meeting with a course supervisor, and build in time for written reflection. For faculty supervisors, the initial training sessions, supervisory meetings, and team coordination meetings add up to quite a bit more than a typical course. All members of the team have gone above and beyond their workload requirements to be involved. In addition to the one-credit service learning course, we have offered this course as part of a 3-credit seminar (‘Music and Brain Health’), which allows us to dedicate more time and resources.

Cross-college collaborations are rewarding at so many levels, but they also present logistical challenges in terms of handling budgets between business offices and creating an equitable experience for all students. Related to this is the challenge of accommodating the schedules of medical or music students, who are among the most overcommitted of all UC students. This course requires some external funding to support a team that includes community-based music therapists, at least one graduate assistant, and technology needs. Finally we are consistently challenged to ensure that students and families are receiving the support that they need. The course of the neurodegenerative disease is progressive and the abilities of affected individuals can decline, requiring constant reappraisal and pivoting in quartet session facilitation.

In spite of these challenges, it is incredibly rewarding to offer a course that generates community and promotes active learning and agency across diverse populations. It is gratifying to witness how each person within the quartet brings a unique set of assets and skills, and each student develops their leadership and adjusts their facilitation accordingly. The course invites intimacy, requiring that students be in relationship with others along the dimensions of health equity and access. The Quartet meetings have been offered virtually throughout the pandemic period, but we were able to hold one in-person celebration with all of the Quartets (students and families) at the end of Spring 2022. The result was a flooding of emotion from all participants. The depth of connection that had been generated within each Quartet through these music and mindfulness practices was palpable.           

[A Quartet consisting of Maya Gulani, Robin Heft, and Chuck and Melisa Albers enjoy a musical moment during an online session.]

A Model for Music and Health Science Collaboration

‘Dementia and the Arts’ offers an innovative service learning model that integrates arts and humanities-based and health science-based training and goals. Although this course is not currently a requirement for any degree program, we believe that the skills that it promotes need to be at the center of our curricula in medicine and music. Improved communication and leadership, flexibility and improvisation, active listening, and above all, direct engagement with diverse communities, are essential to the training of artists and health care workers. Unfortunately, these skills are not always centered in current curricular models. We envision that the approach outlined here–small-group, arts-based activities fostering social connection between community participants and students across disciplines–can be a scalable and accessible model for others to follow. We hope that this program inspires others to create opportunities for students across the arts sciences to collaborate with each other and to learn alongside underserved community populations.

Author Bios

Stefan Fiol (he/him) is Professor of Ethnomusicology at the University of Cincinnati College-Conservatory of Music. Fiol is a specialist in the music, dance, ritual practice, media and social identities of musicians in the central Himalayas and North India. His first monograph is entitled Recasting Folk in the Himalayas: Indian Music, Media, and Social Mobility (University of Illinois Press, 2017). Emergent areas of research include the role of music and mindfulness in evoking awe and in stimulating cognition; indigeneity and musical repatriation in the Guatemalan highlands; and the spatial and social analysis of Himalayan drumming as a mode of historiographic inquiry.

Rhonna Shatz, DO (she/her) is the Bob and Sandy Heimann Chair in Alzheimer’s Disease Research and Education and Director of the Cognitive Disorders Clinic in the University of Cincinnati Department of Neurology and Rehabilitation.  She is a behavioral neurologist specializing in the diagnosis and treatment of neurodegenerative and cancer related cognitive disorders.  Her research interests include brain health systems programs, cancer related cognitive impairment, and the role of musical awe in the fostering of cognitive reserve.