An interactive tool to promote musical creativity in people with dementia

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Abstract

Dementia is a growing problem that affects the lives of those diagnosed and caregivers, with symptoms having an effect on memory, communication, the ability to learn new skills and problems with behaviour, such as aggression, agitation and depression. Participation in activities can improve quality of life for people with dementia, reducing behavioural problems and aiding relaxation. Research has established that people with dementia can be both artistically and musically creative, and have an appreciation of music even in the latter stages of the disease. The symptoms of the disease, however, mean that supporting music making activities with this group of people is challenging. This paper describes a prototype system designed to enable people with dementia to create music, using a touch screen interface to control a system which utilises chords to create pleasant-sounding music regardless of any prior musical knowledge. Results of usability studies suggest the system is easy to use, and that pleasant-sounding music can be created with it. Participants, including people with dementia, appeared actively engaged during use of the system, many reporting they enjoyed the experience. Future testing will establish the degree to which people with dementia could be musically creative using such a system.

Introduction

Dementia currently affects over 27.5 million people worldwide (Wimo, Jonsson, & Winblad, 2006), and with the aging population steadily increasing, the number of people with dementia is expected to rise. Ferri et al. (2005) estimate that the number will double every 20 years and will exceed 81 million in the year 2040. Given the problems associated with the condition, such an increase in the number of people with dementia is likely to have far-reaching consequences on families and available community resources. Dementia, a condition that more commonly affects older people, encompasses a range of brain disorders that progressively damage extensive areas of the brain, eventually leading to cerebral failure. The main symptoms of dementia are memory impairment, a decline in cognitive function, and problems with executive functioning (affecting the ability to use imagination, organise and forward plan). Normal everyday functioning is affected because of this damage, and an individual’s condition will deteriorate over time (LoGiudice, 2002).

Although finding a cure for such a debilitating condition is important, researchers also recognise the need to provide a better quality of care for people with dementia with facilities that enhance day-to-day living. There are various ways in which the safety and care of people with dementia can be improved, for instance by training and educating caregivers (Jacques and Jackson, 2000, Kitwood, 2005) and using assistive technology (Astell, 2005). Another successful strategy is to provide meaningful activities that people with dementia can participate in on a daily basis. These activities should reflect both what individuals would like to do and what they are able to do. Volicer and Bloom-Charette (1999, p. 8) believe the provision of meaningful activities for people with dementia ‘is the most important factor, but the hardest to achieve’. Their investigations, involving people with dementia who also had a diagnosis of depression, found a 90% improvement in mood when participants were involved in meaningful activities.

Although there are benefits associated with participation in activities, the symptoms of the condition make it difficult to devise activities that are accessible. This is caused by the person’s problems with short-term memory, communication difficulties, decreased concentration levels and their inability to learn new skills. Research is therefore being carried out to develop novel and interesting activities for this group that are nevertheless failure-free – that is, activities for which there is always a successful outcome. If effectively implemented, such activities could enhance the lives of people with dementia and improve their social interaction and day-to-day living (Alm et al., 2005). Research has established that people with dementia have the capacity to continue to participate in a variety of activities and tasks. It has been suggested that they can retain existing and develop new creative skills, both artistically and musically, despite the dementia (Miller et al., 2000, Miller et al., 2005).

It has been thought for some time that music can be experienced and enjoyed by people with dementia, and recent research suggests this is evident even in the latter stages of the condition (Clair et al., 2005, Cuddy and Duffin, 2004). However, without a specialist music therapist present, musical activities provided by caregivers tend to be passive, i.e. listening to music or to others singing. Where music therapists provide active music making sessions, they often opt for simple percussion instruments for basic rhythm making (Vink, 2002). This is because the use of traditional musical instruments for this group would be impractical, not only because the symptoms of the condition would make it difficult to learn to play such an instrument, but also because playing musical instruments successfully usually requires prior training. Thus, although there are recognised benefits associated with the provision of musical activities, caregivers lack the resources and possibly the skill to support active music making sessions. There is thus a need to develop a novel instrument that could make creative music making accessible to people with dementia.

This research explored the development of a system that could enable people with dementia to be creative through active music making, whether they had pre-existing skills or not. The system was designed to be easy for caregivers to support, providing an engaging and enjoyable activity for those participating, with the added potential to increase social interactions if used in pairs or groups. It was hoped that the quality of life for people with dementia and caregivers could be improved through this creative musical activity.

Section snippets

Dementia

Dementia is caused by widespread disorders of the brain. There are over seventy conditions that cause dementia, with each one having a ‘particular pattern of cognitive change that may be accompanied by physical signs’ (LoGiudice, 2002). Alzheimer’s Disease (AD) is the most prevalent of these causes, accounting for 60% of cases, with Lewy body variant (of Alzheimer’s Disease) accounting for 20% of cases, frontotemporal dementia (FTD) (including Pick’s) 5%, vascular dementia (VaD) 5% and the

Research question

This research concentrated on developing technology to support people with dementia in their participation in musical activity. The aim of this research was to provide an activity currently unavailable – the creation of meaningful musical compositions. The intention was to develop a system that would enable people with dementia to create music without the need for prior musical or instrumental skill, via a user-friendly, intuitive, failure-free system. If this can be achieved using technology

Evaluation

Three pilot studies were carried out to test the usability of the system using a functional prototype. The tests provided qualitative data through observations and video recordings, and a questionnaire in the second Pilot Study provided quantitative data. Due to ethical issues in research involving people with dementia, initial evaluations were performed with users who did not have dementia. Once it was ascertained that the system was working sufficiently well to be introduced to people with

Discussion

Pilot Study 1 suggested minor changes be made to the interface, and these were implemented. Pilot Study 2 provided data from participants who were the same age as the target user group. Experience of playing a musical instrument did not appear to affect the amount of time participants in Pilot Study 2 used the system, with the six previous players using it for an average of 9 min 50 s, and the five non-players, an average of 6 min 33 s. Quantitative results, together with analysis of video

Conclusions

The study with people with dementia established that they were able to use the system to create pleasant-sounding music, and that with minor adjustment, the system could provide an easy way to bring active music making to people with dementia, whether for use at home, in residential housing or in day care centres. Using the system to play music to two other people provided a positive experience for participants, and, if the prompting system is made more effective, the system could provide an

Acknowledgements

Special thanks go to all the participants taking part in the pilot studies, and especially to the clients and carers at Alzheimer Scotland in Dundee, Scotland. This research was funded by the Engineering and Physical Sciences Research Council.

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