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Case study: ‘you have to stay right there until he’s finished!’

Working on a ward at Nottingham Children’s Hospital, we asked a nurse if it was appropriate to play for the very young baby she was caring for. She said ‘yes of course’. We could see that she was feeding the baby through a feeding tube.

As we played, the nurse interacted with the baby, soothing him through touch and gentle tapping.  The ward sister came along and asked the nurse if the baby had calmed down. The nurse said he had since we had arrived. The ward sister then said ‘you have to stay right there until he’s finished!’

Richard asked the nurse if he’d been very distressed and she explained that he’d been struggling feeding with the tube, then getting angry and being sick, so losing the feed.  This had caused him to be hungry and the cycle had then repeated.

We continued playing and the baby was still slightly upset.  Sarah suggested that Richard played the Bodhrán (drum) for the next piece to see if a quiet repetitive rhythm would be soothing.  We played ‘Evelyne’s’, moving into ‘Sailor went to sea’.  We played an extended version, getting quieter and quieter as the nurse finished the feed and cleaned the feeding tube.  She continued to sooth the baby as we played until he fell completely asleep.  She smiled and said ‘he’s gone off’ at which point we finished the piece.

As we left the ward he was still asleep and had kept the feed down. The effect of calm induced by the interplay between the nurse and musicians was observed to continue in the baby until his next feed approximately two hours after the musicians had left the space.

Music Care

OPUS is delighted to be working in partnership with the University of Nottingham and Room 217 Foundation (Canada) to deliver Music Care Training. Music Care Training is for care providers looking to incorporate music into their care practice, and for musicians looking to take their skills into the care context.  

Next Training: 25/26 November 2019, Music Care Level 1, University of Nottingham  

We are also looking forward to presenting at the second ‘Power of Music in Health and Social Care’ conference, to be held at the East Midlands Conference Centre on 4 November 2019

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OPUS Music CIC relies on grants and donations to deliver music-making in healthcare settings.

Please consider supporting our Music and Health practice by donating to our funds.

OPUS Music CIC is a non profit-making organisation, dedicated to ensuring that all donations go directly towards providing music-making opportunities for people most in need in healthcare settings.

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OPUS Music is a Community Interest Company limited by guarantee registered in England no. 07900221

Registered office: 3 Dodgewell Close, Blackwell, Alfreton, Derbyshire, DE55 5BH

Tel: 01773 861630

Drumming in Intensive Care Units

richard kensington 1 300Five years ago, during my initial training as a musician in healthcare settings, one of the first challenges I faced was how to take my specialism of percussion into hospital settings. How could I use percussion instruments, particularly drums, in spaces that I assumed would be very quiet in a way that would enhance that environment? How could I use something as potentially noisy and intrusive as a drum in an a space populated by children suffering from a variety of illnesses or conditions which are unknown to us and doctors and nurses doing a job that required great concentration and accuracy? After having spent 10 years playing in a variety of loud percussion based bands and running drum circles and percussion workshops, I couldn’t see how a drum would do anything other than disrupt a hospital space, over excite or disturb patients and distract doctors and nurses. At that time the thought of taking a drum into a hospital ward seemed like a bad idea and if the possibility of taking one into an intensive care unit had been raised it would have seemed ludicrous.

In the last couple of months I’ve had cause to remember and reflect on my initial thoughts and reactions to drumming in hospital.

The first occasion started with walking into a children’s intensive care unit in a large hospital in the East Midlands. The unit has about 10 beds in it with only a few feet in between each bed to allow access for nurses, parents etc. The feeling on the ward is quite enclosed and cluttered due to the large amounts of medical equipment around each bed and the large numbers of staff attending the patients.

I was working with two colleagues, Sarah on fiddle and Marc on guitar. We had been requested by a parent to come and play music with her little girl who was about two years old. The little girl, who we will call Lisa, had special needs, no speech and had recently had a tracheotomy, so she couldn’t make any sounds at all with her voice.

When we arrived Lisa was sitting up in bed and her mother was at the bedside. Marc started playing a nursery rhyme and her actions and facial expression showed that she was immediately responding positively to the music. Her mother reinforced our reading of this response with positive comments and an increase in engagement with Lisa. We continued to play, with Marc leading the interactions and encouraging Lisa to shake along or engage with the animal toys around her bed. I changed from accompanying a lullaby on ukulele to playing a deep quiet and steady beat on the bodhrán on the next song. As I did so I noticed a shift in Lisa’s focus towards the drum so I asked Marc to make some space so I could get to the bed.

I knelt down at the bedside and asked Lisa’s mother if I could place the drum on the bed so she could see it and hear it more clearly. I continued to tap along on the drum as we sang, just keeping a gentle pulse and as I did so Lisa leant forward and started touching the drum skin. She was exploring how it felt, sometimes tapping it and sometimes just leaving her hands on the skin to feel the vibration as I continued to tap the drum. Sometimes I copied what she did on the drum but she seemed to be getting the most pleasure from experiencing the vibration from the skin as I hit it. She moved from having both hands on the drum, to both hands and one foot on the skin, to putting both hands, one foot and her face pressed against the drum as I continued to gently tap the pulse of the song that was being played and sung by all the musicians.

Once Lisa had become used to the sensation she decided she wanted to find out more about this object so she started to try and move it around. I responded to her attempts to move the drum, moving it for her in the direction that she was trying to get it to go. She turned the drum around and put her hands inside it. She tapped inside the drum and left her hands on the skin as I played the other side. This continued for at least 5 minutes after which time Lisa started to get tired which she showed by simply disengaging from the drum and leaning backwards onto her bed.

All the way through the interaction was accompanied by beautiful music and songs from Marc and Sarah. As Lisa was exploring the drum and interacting with me, a group of nurses and doctors had gathered to look at what was happening. From their comments and faces they all seemed to be really enjoying the opportunity to see their little patient behaving like a normal child enjoying her exploration of her environment.

The second instance of drumming in ICU was in a different large hospital in the East Midlands. This time a nurse said it would be ok if we went into a side room where a young toddler, we’ll call him Mohammed, was standing in his cot. His mum was in the room with him and the TV was on with the volume turned up. After saying hello to them both we checked with the boys mum if they would like us to play. They had already seen us playing in the main part of ICU so we felt like they would understand what we might be offering. When Mum agreed we asked if we could turn the TV off. Once we had done this we had Mohammed’s full attention.

As soon as we started playing he was jiggling around to the music and wiggling about holding onto the bars on his cot. He also had a tracheotomy and was attached to oxygen through that. I was surprised at how much energy he had and how little the tracheotomy and the oxygen tube hindered his enjoyment or compulsion to move. He was really grooving and smiling. We gave him a shaker and he quickly learnt the ‘throwing the shaker out of the cot’ game so I approached him with my drum. His response was very similar to Lisa’s. His hands were immediately on the skin and again rather than his focus being on hitting the drum himself he seemed to be enjoying feeling the vibration through the skin. Mohammed too was intent on exploring the drum, constantly turning it around and around so he could feel it inside and out. The drum must have seemed enormous to him, as he was only just taller than it’s diameter. Once he got the hang of how to get a sound from the drum he started really enjoying the loudness of the instrument and as we were in a side room I was able to allow him to really get into this, knowing that the volume outside the room wouldn’t be distressing to other patients and staff. As he started to lose interest in the interaction I refocused my playing of the drum to join back in with the tune that Sarah had been playing throughout the interaction and so we were able to leave the room in a musical way with Mohammed having played his part in some great interactive music making while learning about and experiencing a person sized drum!

In order to use a bodhrán in hospitals I’ve had to develop my technique so that I can play very quietly whilst maintaining accuracy and positivity. I’ve also had to develop and change my musicality to think about how I use the drum to accompany song. Traditionally the drum is used to add drive to tunes and to bring out the rhythm and shape of tunes. There can be a lot of ornamentation used in bodhrán playing and I often choose to strip much of this away so that I focus on the essence of the rhythm of the song or tune, focusing on groove more than the shape of a tune. I always try and keep in mind that my focus is on playing for the space and the person rather than for my own enjoyment. The drum I have has a very rich bass end and even the top end is mellow sounding. This enables me to play with a variety of dynamics without bringing in any harshness to the sound. It has been my experience that choice of instrument is very important when using percussion in hospitals. My preference is for warm sounding drums that can be played to obtain a variety of pitches. The other factor that I’ve had to consider is the weight of the drum. The bodhrán is often played sitting down, so walking around a hospital for a day carrying the drum also presented problems. I fitted a strap to my drum and this has helped a great deal.

When using the drum for interactions there are number of things to bear in mind, not least of all the potential volume of the instrument and the impact that this can have on the space around. There is a lot of satisfaction and a sense of power to be gained by a child when they hit a drum hard and get a loud sound in response. It’s a great thing to allow this but the musician also has a responsibility to their surroundings and the other people in the space. Sometimes it’s not a problem to allow a child to make a lot of noise, sometimes it’s ok once or twice but then the volume needs to be managed. Other times a loud noise is not appropriate. I dampen the drum with my hand, use explicit verbal instructions or offer beaters with softer heads in order to manage the volume of the drum. If volume is becoming an issue I also try to refocus onto rhythm, pattern or copying.

I’ve come to realise that there is no problem with bringing and playing drums into the most sensitive of environments. My skepticism at the start of my training was rooted in the way I was seeing drums, thinking about them and relating to them at the time. The power of drums to transform mood, empower people, to facilitate communication and connection and to bring joy seems consistent in all situations. This power is not constrained to the volume or complexity of what is played. It’s up to the drummer to learn and then decide how to best use the drum to the maximum benefit in any given circumstance. Working with drums in hospitals has given me a great faith in the efficacy of what I do as percussionist and inspires me to explore the huge potential of drums still further.

Richard Kensington, OPUS Musician

Reflections on Practice: Partnerships with Doctors

oli matthews 1 300We entered the ward as a group of three musicians. As soon as we entered though the doors we were noted by a doctor in the second bay down who had a group of 7 junior doctors with him.

He turned to us, introducing us to his group as a regular team that come into the Children’s wards each week, playing music for and with the children, parents and staff.

As the junior doctors were currently doing some observations on a small child at the time, we asked if it was appropriate to play some music at this time and the doctor (trainer) welcomed the opportunity to see how the junior doctors dealt with the situation and how they could use the music as an aid to their work.

We then played a gentle version of ‘Wind the bobbin up’ on Melodeon, Fiddle and Ukulele, adding vocals to act as a distraction to the small child whilst the junior doctors listened to her breathing through a stethoscope.

The child and her mum instantly recognised the song and joined in with the actions, singing along very happily. The junior doctor was instantly able to listen to the child’s breathing without any fuss from her, as she was far more interested in the music and joining in with us.

It wasn’t just the parent and child that enjoyed our music, as very quickly all junior doctors joined in the singing and actions too, much to the child’s delight.

Oli Matthews, Musician, OPUS Music CIC

Reflections on Apprenticeship: Joe Danks

Dancing in Hospital Corridorsjoe danks b&w

Jim knew that he wasn’t much of a singer or dancer, and to him, a public display of singing and dancing implied he thought himself and expert. The villagers just stared at Jim and said, “What do you mean you don’t sing?! You talk!” Jim told me later, “It was as odd to them as if I had told them that I couldn’t walk or dance, even though I have both my legs.” Singing and dancing were a natural activity in everybody’s lives, seamlessly integrated and involving everyone. The Sesotho verb for singing (ho bina), as in many of the world’s languages, also means to dance; there is no distinction, since it is assumed that singing involves bodily movement.’

This Is Your Brain On Music – Daniel Levitin 2006

To some people, making music is an activity reserved for the elite. This is no more apparent than in the UK’s concert halls, with their ritual flower bouquets and coughing breaks. This is the same for dance, an art form most commonly seen at the wedding disco. So where does that leave us, stone cold sober in the harshly clinical environment of a hospital corridor, bobbing up and down in time to ‘Wind The Bobbin Up’?

I love dancing. As a child my role in my parent’s band was to be the first on the dance-floor and to encourage others to join me. Im still doing that now! I’ve pogoed and shuffled and bopped and moshed and salsa danced to all kinds of music and I hope I always will. However, most of my dancing has been with others doing the same thing in a dimly lit venue. Using movement in my music in healthcare practice has been a relatively new exploration for me. Its important to recognise that the young people we’re working with are often dancing, and we should positively reinforce this engagement with our music.

I do this sometimes by mimicking the movement of a young person, and sometimes by responding to their movement with music too. An example of this happened in a corridor, with a young person en route somewhere with his mother. He boogied along to the music we were playing in the adjacent ward, and his mum stopped and the both stood and watched. I turned away from the ward and noticed them. The child started, slowly at first bobbing up and down with the music. I joined in, naturally! This lasted for a minute or so. The music came to a natural conclusion, and I started improvising gently around a G chord, just to keep the music and dancing going. The rest of the musicians started to join in, not only with the music but with the movement too. Dave then led us into ‘Round and Round the Village’, an English Childrens song, and we all marched!

I think this highlighted the point to me that we are only embarrassed about dancing because we are told to be, and often children are yet to feel that embarrassment. I am now as confident in using movement in the hospital ward as I am singing and playing, and I feel that it is becoming an integral part of my practice. Its useful for making people laugh, making people dance and keeping people engaged; definitely not something to be embarrased about! Perhaps we all need a little more ‘Ho Bina’ in our day to day lives?

Reflections on Apprenticeship: Marc Block

marc blockJames and I had been playing for a while with B (a boy of around 5 with Down’s), who had been enthusiastically playing on the xylophone. We played through a song and brought it to an end, and B carried on playing, so we picked up his tempo and played chords along to him until another piece of repertoire emerged and we played that through, B focussed intently all the while on his playing. There came a point where B very clearly stopped and gave the beaters to his mum, who remarked how impressed she was that we were able to play in such a way that made B the musician and us his accompanists, and that we played something really good that he was taking a leading part in. This felt like a ringing endorsement, that what she described is EXACTLY what we’re aiming for.

Three of us had played to a whole bay, where I had offered a teenage lad with cerebral palsy a shaker – a bit tentatively as I was not sure if he would be able to hold it and I knew his motor control would be limited. His face, however, was such a beaming welcome of the music that it felt right. He did hold the shaker and was able to move it from side to side and played exactly on the rhythm. The song ended and he handed it back. The others said their goodbyes and made to go, but I was having a strong feeling that the lad could happily play more. I decided to go with that and, rather than be led by the others, said we could do more and went back to him with the xylophone. He struggled a little with the beater (we need a thick-handled one!) but clearly enjoyed being able to make sounds as Rich played and we sang along, and his brother came along and helped him with it. Meanwhile, across the bay, Sarah had engaged a mother and child in more play with the glock. It seemed very much the right thing that I had followed my instinct there and gone back to him, and the others agreed. At this point in the apprenticeship (very few sessions left) I’m pleased to be taking a lead in this way.