Published on April 22, 2016

Music as a balm for hospice patients

Music as a balm for hospice patients

Joy Indomenico is a healer who uses a balm rare in the bustling realms of hospitals and doctor offices: music.

In her tiny West Barnstable office, she is surrounded by her therapeutic tools: harp, tone chimes, shakers, clave rhythm sticks, keyboard, several different drums, including an hour-glass African djembe; and a Latin instrument resembling a wooden slinky, called a kokoriko.

As a certified music therapist, she travels the Cape, using music to connect with hospice patients and those with conditions such as autism, speech disorders, or dementia.

Indomenico, who believes she is the only certified music therapist on the Cape, studied music therapy techniques abroad and in this country. For her clients here on the Cape, she plays accordion, violin, harp, keyboard, bowed psaltery, and clarinet.

In her career, she has worked with the blind and the developmentally disabled and was recently hired part-time by the Visiting Nurse Association of Cape Cod, to work with hospice and adult day care clients.  She goes to day care programs and visits clients in their homes or skilled nursing facilities, often bringing along her 12-pound lap harp.  Sometimes it’s as simple as playing music and trying to get the patient to engage through singing or playing a rhythm instrument.

“I’m not a performer as much as I use my music to get someone else to play along with me,” she said.

Indomenico’s manner is warm but slow and mindful; as if she were mentally on tip toe, a breath of calm in what might be tense or frightening moments for her clients.

“I can be the human touch,” she said. “The vibration of live music is energy that connects with someone who is ill.”

History of Music Therapy

Music therapy first became known in this country after World War II when therapists worked with soldiers suffering from physical and mental trauma, said Jacqueline Birnbaum, administrative coordinator and a senior therapist at the Nordoff-Robbins Center for Music Therapy  at New York University in Manhattan.

Music is a way to communicate with those who might otherwise be isolated, such as autistic children or those with developmental delays, she said.

“It’s about finding ways to participate meaningfully with other people. Music can be a common ground.”

Music engages many different parts of the brain, according to the late physician and author Oliver Sacks.  He even describes humming the “The Volga Boatman’s Song” to help him inch down a mountain with a badly injured leg.  Music may help stroke patients regain damaged neural pathways or create new ones and regain the ability to speak, he writes.  And when live music is played or sung for premature infants, it seems to help regulate heart rate and encourage the sucking reflex, based on studies published in the journal Pediatrics.

Nordoff-Robbins, founded by Paul Nordoff and Clive Robbins to incorporate a humanistic approach based on improvisation and live music, is one of several institutes where music therapists can train. They have to be musicians as well as therapists, Birnbaum says, to be able to sing and play basic instruments such as keyboard and guitar. They are then certified through the national Certification Board for Music Therapists.  In some states, Medicaid covers music therapy for certain patients.

“My mother was happy to have Joy come.”

For the last few weeks, Indomenico has been visiting with Meg Pappas’ 91-year-old mother, Theo, who is in hospice care at Epoch of Brewster.

“What’s nice about her visits, she’ll be playing music and songs that my mother knows,” said Pappas. “She says, ‘Oh, I know that song.’ …From the very first time, my mother was happy to have Joy come.”

Indomenico’s visits have helped Pappas, as well, she said, particularly on days that are stressful with her mother.

“By the time she leaves, everyone is smiles and happy.”

There are times when Indomenico uses music as more tool than salve.  For example, she uses tone chimes about the size of a shoebox to work with clients struggling with speech issues.  By striking the chimes, which play the tones of a five-note pentatonic scale, she helps clients re-learn how to speak by singing instead of speaking a phrase.

“The musical part of the brain has nothing to do with speech,” she said. “Stutterers can sing with no stutter.  People who can’t speak after a stroke can oftentimes sing, depending on what part of the brain was damaged.”

Few Side Effects From Music

In a 2009 interview, Oliver Sacks said “there are few, if any, bad side effects of music, and music can often work where no medications can.”

For clients such as Pappas, it brings peace. Her mother, an artist and knitter and avid reader, is wearing out and has memory problems.

“She’s tired of living, I know that. She’s ready to go,” Pappas said. But Indomenico and her music seem to soothe the savage beast of age.

“From the very first time Joy came, my mother was happy to have her come. Out of the blue sometimes my mother would say, ‘I wonder if she’s coming again?’”