Clinical Psycology Developmental Neurorehabilitation

Question: Discuss about the Clinical Psycology for Developmental Neurorehabilitation. Answer: Introduction Music is an imperative part of our lives- we find it to be attached to all stages of our life from childhood till the end of life. The manner in which music impacts our life and how we respond to music is found to be varying across the different phases of life (Chlan et al., 2013). Research has indicated that music helps to fill a fundamental human need. This need is referred to a desire to belong to a group where individuals have a common purpose (Zhao Kuhl, 2016). There is a rich pool of evidence highlighting the benefits music has for healthy older adults. Improvements in self-esteem, psychological well-being, a decrease in pain and depression, relief from stress and improvement in life satisfaction are the wide-ranged benefits by which music is found to be having a positive impact on individuals (Ho et al., 2016). Steele et al., (2016) state that some quantitative research indicates that playing a musical instrument have a good influence on an older adult. Playing instruments li ke guitar and piano throughout their lifetime, especially at an older age, can effectively reduce age effects on human functioning, like tasks requiring perceptual speed and memory. A positive attitude regarding taking part in musical activities are to be built up in individuals with the aim of bringing improvement in their quality of life. Favouring music programs enables older adults to favour positive activities like comedy and trivia. Older adults consider music to be a new hobby. It may also be considered as a scope to learn again some long forgotten skills that can perhaps help them to achieve satisfaction and contentment. The already existing literature has indicated the connection between psychological well-being in old age and cognition abilities. However, few research studies have put the focus on the actual benefits of music on the older population. There is a lack of quantitative studies that have researched on this topic. Almost no literature has attempted to address rigorously how music, as an intervention, can impact memory and cognitive decline occurring with ageing. The proposed research is designed suitably to fill this highlighted major gap in literature through the identification of impact that music has on cognitive functioning among adults later in their lifespan. The study specifically aims to highlight what the impact of learning to play a musical instrument is on the well-being of healthy adults. Research question What is the influence of learning to play a music instrument later in life on the cognitive functioning and well-being of healthy seniors? The hypothesis of the proposed research is that participants under experiment would have improved cognitive functioning, memory and psychological well-being as compared to participants in the control group. Literature review According to Gerdner McBride (2015) music is known to be eliciting physical, emotional and cognitive responses for people off all age groups. Moreover, music has the capability to engage individuals effectively in social experiences. Such social experiences are known to give meaning to life. Individuals can be helped to form social relations, friendships, encouraged to take up lifelong learning and give an essence of accomplishment through music. Cheung et al., (2016) support this idea by stating that music can enhance the psychological well-being of adults in old age. Music can give valuable information about the human condition. As stated by Liesk et al., (2015) it is music that enables individuals to express their feelings and structure their thoughts. A sense of self is in built within individuals along with feelings of self-esteem. Group-identity, wholeness, and healing are the things conveyed effectively through music that words fail to express. Lastly, music can integrate bod y, spirit, and mind. Sung et al., (2012) studied the importance and personal meaning of music as perceived by older adults. The inferencess of the study highlighted that music could provide older adults with means of connecting with society as well as other individuals. Individuals are also given means of understanding self-identity, expressing spirituality and maintaining well-being, and establishing associations with memory. Particularly, music can be considered as a forum for sharing and interacting with others, thereby enhancing a positive feeling. Age-related physical changes that an individual faces can have a profound impact on the way older adults take part in various activities. However, the physical changes are not always successful in generating undefeatable obstacles hindering older persons to develop a new interest (Srkm et al., 2014). A large section of the older population may have the desire to learn to play a musical instrument, to develop any musical skill, learn to sing or re-learn musical skills that are long forgotten. Regardless of the talent or skill, music goes on to amplify wellness in all individuals (Hegde, 2014). Bright (2014) opined that music contributes significantly to a positive ageing process as older adults can feel competent, maintain a sense of self-esteem and independence. People can steer clear of having feelings of loneliness and maintain a balance between intellectual, spiritual and emotional aspects of life. Several research studies tout the advantages of active music participation for older adults. Music making has proven to bring improvements in socialisation, psychological wellbeing and to aid in satisfaction (Hakvoort Bogaerts, 2013). Bower et al., (2014) suggest that getting involved in a musical performance reduces the risk of suffering from dementia. By playing a musical instrument, one can delay the initiation of dementia. Playing an instrument can aid in exercising fingers, arms and hands thereby augmenting physical health. As music helps in establishing social connections, one can live longer and stay healthy. Active engagement in music making can promote cognitive performance and skills, directly influencing the formation of memory and retrieval of memory (Im Lee, 2014). Therapeutic benefits that music brings along are well recorded. The advantages of music listening and playing musical instruments can improve patterns of sleep, relieve stress, boost immunity, decrease depression and reduce chronic pain. Patients with Parkinsons disease and dementia are greatly benefited (Nombela et al., 2013). Music therapy can be defined as the evidence-based and clinical utilisation of music interventions for accomplishing goals related to therapeutic relations. Music therapy is largely referred to the systematic process wherein the music therapist aids in helping the patient to promote his health (Vstfjll et al., 2012). Ekholm et al., (2016) argued that from the viewpoint of biology and neuroscience, one can find numerous factors for understanding that music therapy has a reflective impact on physiological as well as psychological health. Still, there are only a handful of studies that have previously tested and undertaken a systematic investigation of such refle ctive and philosophical impact. The challenge is to explore this arena and give new insights into the topic. Literature has the clear demonstration that music can be considered as a strong modality for bringing positive change in people belonging to all age groups, particularly older people. Research articles extensively examine the impact of music therapy on patients with retarded cognitive functioning. However, there exists a deficiency of substantial quantitative articles regarding the impact of music on non-institutionalised and healthy adults. Therefore, it can be concluded that at the fundamental level that there lies a gap in the previous literature that discusses how and to what extent music influences older adults. Research methodology The aim of the proposed study is to determine the extent to which learning to play musical instruments at an older age impacts cognitive functioning as well as psychological well-being of older adults who are non-institutionalised. The proposes research would use an experimental design for evaluating the effectiveness of a 8-week hand chime music intervention. This intervention would be applied on the cognitive functioning of older adults. A 2x2 (treatment group x time of measurement) design would be utilised for addressing the research question. Participants would be randomly assigned to one group among control group and experimental group. The cognitive function would be evaluated using the Choir Chime Study Questionnaire and cognitive well-being assessments. Procedure Participants to be included in the study would be community-dwelling people aged 60 and above, having a special interest in music. Inclusion criteria would be as follows: Having normal strength in arms and normal physical function Capable of extending forearms Capable of holding hands steady and grasping the chimes Usually enjoying music Capability to converse Having adequate hearing capability Ability to read English Ability to follow all forms of visual and verbal instructions and cues Not taking any form of music lesson Selection of the participants would be done on the basis of their verbal reports of the criteria. Moreover, participants need to obtain a score minimum 23 when adjudged on the Mini Mental State Examination (MMSE). 12 participants would be selected randomly, 6 for each of the two study groups. Consequently, 3 control and experimental groups would be planned with 12 members in each group. This would include 36 participants in total. Participants who would be selected to take part in the study would be given the Choir Chime Study Questionnaire and Ryffs Scales of Psychological Well-Being for completing and handing back at a time of the follow-up appointment. The Choir Chime Study Questionnaire is supposed to be a music and health questionnaire that would be made particularly for this proposed study. The aim would be to gather music background and demographic data for the participants. Ryffs Scales of Psychological Well-Being was developed by Ryff in 1989 for assessing psychological well-being. The scale measures Environmental Mastery, Autonomy, Personal Growth, Purpose in Life, Self-Acceptance and Positive Relations with others (Ryff, 2013). At a time of the second meeting, the participants would bring back the completed measures that would be then reviewed for clarification and accuracy. The location for the intervention would depend on the location accessibility and availability. Participants would be assigned to either wait-list control groups or experimental group. The participants included in the experimental group would participate in one of three chime playing groups. At the instance of completion of 8-week music intervention, the participants would require to complete Ryffs Scales of Psychological Well-Being and assessments of cognitive functioning. Participants included in the wait-list control group and the participants from the group of experimental condition would have the same time of assessment. However, after assessment, they would be asked to wait for 8 weeks. The assessment would be done after 8 weeks again. They would then receive the 8-week intervention. Intervention The interventions would consist of two 90 minutes sessions in a week for a time frame of 8 weeks. Songs that would be used for the training sessions would include popular music that be from the young years of the participants as well as tunes that are well-known. The order maintained for the songs would be varied as per the wish of the participants in order to engage them actively. The participants would be arranged in a semicircle in each of the sessions. They would be made to sit in chairs with straight backs for keeping them adequately engaged. Different seats would be assigned to each participant for every session. The names of the participants would be printed and placed on the chairs prior to the beginning of the 12 sessions. The order to be followed for the sitting arrangement of the participants would be randomised. Particularly, each participant would be required to sit in dissimilar places at the time of each of the sessions. They would also be made to play different chimes at a time of each of the sessions. Chromatic arrangement of the chimes would be done, moving from the left towards right. This would imitate the pattern of keys as found in pianos. It implies that the lowest note would be on the left of the researcher while the highest would be on the right. Participants when sitting on three of the six chairs would be made to play three chimes while when sitting on the rest three chairs they would be made to play two chimes. Both hands would be utilised for playing the chimes. There would be a particular son in case of which a participant given a certain chair and playing three of the chimes would need to play all of the chimes. A verbal cue would be given by the researcher for letting the participants know the time of switching and playing the third chime. This would be done well in advance. All sessions need to be held in closed rooms, and special attention needs to be given so that there are no distractions. The same room would be allotted for all of the groups for all sessions. However, for the wait-list control and first experimental groups, there would be a different room during the individual sessions. A similar format of the interventions would be would be applied for all of the sessions. The sessions need to be videotaped. The participant would first take their seat allocated for the session and then take up their chimes. The participants would then be told about which chime would be considered in case of the song to be played. The chimes would then be placed appropriately. A direct method for cuing would be applied after the first song would start and using the cue it would move around in a semicircle. The participant would be pointed at the time of his chance to play the chime. The chime to be played would be the basis of the researcher pointing to the individu al. All of the 21 songs would be played in the same procedure. For each session, a list of 21 songs, tripod and video camera and Choir chimes would be used. The session duration and a number of chimes required for the individual songs would determine the number of songs. Songs would be played in the different Keys for ensuring variety in what is heard and played. Another reason for using different Keys is that using the same Key for all would not lead to mental stimulation. Cognitive learning would not be therefore promoted. Data analysis A particular participant number would be given to each participant. Data obtained from the Choir Chime Study Questionnaire, Ryffs Scales of Psychological Well-Being, MMSE, and the 10 cognitive assessments would undergo proper recording for the participants. Each assessment would be given before the 8 week intervention and 8 weeks after the intervention. The assessment would be scored and data analysis would be done using the SPSS (v.10) software. SPSS is an accurate statistical data analysis tool (Flick, 2015). Quantitative analysis would include calculation of differences in scores by the conversion of post-test minus pre-test scores and subsequent t-test for samples of each assessment. Ethical considerations Ethical issues are involved in the collection of primary data involving human participants. Principles of ethical contemplations are to be followed for making the research noteworthy (Johnson, 2014). For addressing the ethical concerns, the participants would not be caused harm. The dignity of the participants would be maintained as a priority. Informed consent would be taken from the participants before the research. They would be informed about the purpose of the research and its specific aims and objectives. Privacy of the participants would be maintained by considering the participants comfort level with the place of the session. Confidentiality would be maintained by not sharing the research information with outsiders. Exaggeration regarding the aims of the study would be avoided. Communication with the participants would be done with transparency and honesty would be maintained in due process. No misleading information would be given to the participants (Farrimond, 2016). Gantt chart Week 1 Week 2 Week 3-18 Week 19-20 Week 21 Preparation of Data collection instrument Selection of sample population Intervention Data analysis Report compilation References Bower, J., Catroppa, C., Grocke, D., Shoemark, H. (2014). Music therapy for early cognitive rehabilitation post-childhood TBI: an intrinsic mixed methods case study.Developmental neurorehabilitation,17(5), 339-346. Bright, R. (2014). Music therapy in the management of dementia.Care-Giving in Dementia: Volume 1: Research and Applications, 162. Cheung, D. S. K., Lai, C. K. Y., Wong, F. K. Y., Leung, M. C. P. (2016). The effects of the music-with-movement intervention on the cognitive functions of people with moderate dementia: a randomized controlled trial.Aging Mental Health, 1-10. Chlan, L. L., Weinert, C. R., Heiderscheit, A., Tracy, M. F., Skaar, D. J., Guttormson, J. L., Savik, K. (2013). 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