MUSIC THERAPY TAKES CHARGE:
Of the “Big Four”, Why Music Therapy Works Best for Covid19 Patients

Michael Sokoloff

University of the Pacific

4/30/20

Author Note

Michael Sokoloff, Graduate of Department of Music Therapy, University of the Pacific

Michael Sokoloff, MT-BC, MNA is CEO of Coronavirus Music Therapy a Board Certified Music Therapist (# 15458), and Bay Area Representative of the California Association of Music Therapy

Correspondence concerning this article should be addressed to Michael Sokoloff,
657 – 25th Avenue, San Francisco, CA 94121. Contact: michael@coronavirusmusictherapy.com

Michael Sokoloff gives written permission to use previously published text; test; or portions of tests, tables, or figures.

Abstract

The following is a white paper detailing why Music Therapy is positioned to “Take Charge” in modern medicine’s battle against coronavirus covid19. This white paper explains why, of the “Big Four '' rehabilitation therapies (Physical Therapy, Occupational Therapy, Speech Therapy and Music Therapy), Music Therapy works best for treating coronavirus covid19 patients, their families & frontline healthcare workers.  Please note that it is not my goal in this white paper to say that Music Therapy is a superior rehabilitation therapy to Physical Therapy, Occupational Therapy or Speech Therapy.  My goal is to show that the wide range of clinical domains that can be treated by Music Therapy make it uniquely suited to help patients with covid19, their families and frontline healthcare workers.  

Keywords: AMTA, CAAMT, MA, MNA, MT, MT-BC, OT, PT, RT, SFSU, SFSU MSP, ST, UOP, UOP Music Therapy, USF, american music therapy association, california association of music therapy, masters, masters degree, masters nonprofit administration, nonprofit administration, music therapy, music therapist, board certified music therapist, occupational therapy, occupational therapist, physical therapy, physical therapist, rehab therapy, rehab therapist, rehabilitation therapy, rehabilitation therapist, san francisco, san francisco state university, multimedia studies program, san francisco state multimedia studies program, speech therapy, speech therapist, university of the pacific, university of the pacific music therapy, university of san francisco, assisted living, hospice, hospital, nursing home, skilled nursing facility, alzheimer’s disease, memory care, white paper, bay area, victorian, Michael Sokoloff, dr. feilin hsiao, dr. eric waldon, karen moran

MUSIC THERAPY TAKES CHARGE: Of the “Big Four”, Why Music Therapy Works Best for Covid19 Patients

I. Introduction

Note: This article contains the following abbreviations: MT for both Music Therapy and Music Therapist. PT for Physical Therapy and Physical Therapist, OT for Occupational Therapy and Occupational Therapist, ST for Speech Therapy and Speech Therapist, and RT for Rehabilitation Therapy and Rehabilitation Therapist.  

Of all the types of rehabilitation therapies, I define the “Big Four” as PT, OT, ST and MT (Physical Therapy, Occupational Therapy, Speech Therapy and Music Therapy). These were the four most common rehabilitation therapies employed for patient treatment when I worked full time on my music therapy internship in a Skilled Nursing Facility in San Francisco,

My goal in this white paper is to show why, of the “Big Four'' rehabilitation therapies (PT, OT, ST, and MT), Music Therapy works best to treat coronavirus covid19 patients, their families & frontline healthcare workers.  Please note that it is not my goal in this white paper to say that Music Therapy is a superior rehabilitation therapy to Physical Therapy, Occupational Therapy or Speech Therapy.  My goal is to show that the wide range of clinical domains that can be treated by Music Therapy make it uniquely suited to help patients with covid19, their families and frontline healthcare workers.   

II. The “Big Four” of Rehabilitation Therapy

If PT, OT, ST and MT were considered quadruplets born of the same mother (Mrs. Rehab Therapy), it is easy to imagine Physical Therapy as being the eldest child, Occupational Therapy as the 2nd born, Speech Therapy as the third born and Music Therapy as the baby of the family. Physical Therapy formed its first professional association in 1921 (“APTA History,” 2017). Occupational Therapy became a profession in 1917 (“History of Occupational Therapy,” 2020). Speech Therapy became a profession in 1926 (“The History of Speech Language Pathology,” n.d.). Music Therapy became a profession in 1944 (“History of Music Therapy,” 2020). Even though in this chronology, the profession of Occupation Therapy is older than Physical Therapy, Physical Therapy has the largest US Market Size of the Big Four, amounting for an estimated 53% of the US Market of the big four, compared to 37% of the US Market for Occupational Therapy, so we’ll keep Physical Therapy as the eldest child in our metaphor. Note: Percentages of the US Market Size of the Big Four are hypothetical due to a lack of data about the Music Therapy US Market Size in 2020.  

● Physical Therapy US Market Size in 2018 = $34.5 bn

● Occupational Therapy US Market Size in 2020 = $24.3 bn

● Speech Language Pathologist in the US Market Size in 2020 = $4.2 bn. 

● Music Therapy US Market Size in 2020 = $X bn

There is a lack of data regarding Music Therapy’s US Market Size in 2020. For the sake of creating a pie chart, we will estimate Music Therapy US Market Size in 2020 = $2.0 bn. 

* Note: Music Therapy US Market Size is an Estimate. Also, percentages of the US Market Size of the Big Four are hypothetical due to a lack of data about the Music Therapy US Market Size in 2020.  

Also, please note, per Stephenson (2018), that there are seven rehabilitation therapies. In addition to the “Big Four”, there is also Respiratory Therapy, Cognitive Rehabilitation and Vocational Rehabilitation. Even though Respiratory Therapy and Vocational Rehabilitation may be effectively used with covid19 patients, the goal of this whitepaper is to concentrate on the “Big Four” of rehabilitation therapies. 

III. Music Therapy’s Clear Advantage Treating Covid19 Patients

Music Therapy has a clear advantage in treating covid19 patients among the “Big Four” rehab therapies. In scientific research studies, Music Therapy has been shown to provide individualized clinical benefits to patients in a wide variety of clinical domains. “Board Certification Domains” 2015 identifies eight clinical domains for music therapy services: 1) Cognitive. 2) Communicative, 3) Emotional, 4) Musical, 5) Physiological, 6) Psychosocial, 7) Sensorimotor, 8) Spiritual. This shows how wide of a net of clinical domains Music Therapy covers. In my own private music therapy practice, Coronavirus Music Therapy, I specialize in working with covid19 patients, their families and frontline healthcare workers. For these three target groups, scientific research has shown that Music Therapy can improve immune systems (Dixon, 2018), relaxation (Abrahams, 2006) and sleep (Liu, Gao & Hiu, 2019). And in the terrible situation where a covid19 patient is given a fatal diagnosis, Music Therapy can work as a hospice service to provide life review (O’Callaghan, 2013), family bonding and family bereavement. Music Therapy is a clinical profession that is suited to treat a wide variety of clinical domains. That means that Music Therapy is uniquely positioned to be able to provide services in the widest range of clinical domains to covid19 patients, their families and to frontline healthcare workers of any of the “Big Four” rehabilitation services (PT, OT, ST or MT).  Please note that it is not my goal in this white paper to say that Music Therapy is a superior rehabilitation therapy to Physical Therapy, Occupational Therapy or Speech Therapy.  My goal is to show that the wide range of clinical domains that can be treated by Music Therapy make it uniquely suited to help patients with covid19, their families and frontline healthcare workers.  According to the American Music Therapy Association in “What is Music Therapy?,” (2020). “Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.”

For the clinical professions of physical therapy, occupational therapy and speech therapy, all of these therapies work extremely well on accomplishing goals within one specific clinical domain. According to Stephenson (2018), physical therapy “...works to improve movement dysfunction. Therapists work with patients to restore movement, strength, stability and/or functional ability and reduce pain via targeted exercise and a range of other treatment methods.”. Physical therapy can help a patient improve gross and fine motor skills. It accomplishes this work effectively and professionally. But as a clinical profession, it does not in itself have the ability to provide a covid19 patient and family with hospice services such as life review, family bonding or family bereavement. It is too limited in scope. Whereas Music Therapy can easily and naturally provide these hospice services.

According to Stephenson (2018), occupational therapy “...focuses on restoring an individual's ability to perform necessary daily activities. This may mean working to improve fine motor skills, restore balance, or assist patients in learning how to increase their functional ability via use of adaptive equipment, among other potential treatment options.”. Part of OT is sometimes teaching patients how to use “adaptive equipment”. Per Fulton (2015), adaptive equipment refers to “...devices used to assist with completing activities of daily living. Bathing, dressing, grooming, toileting, and feeding are self-care activities that are included in the spectrum of Activities of Daily Living (ADLs). These devices can range from the most James Bond like electronic devices to something as simple as a piece of rope to pull a hatchback shut or an old tennis ball with a hole in it to hold a pen to aid in writing.”,
The strength of occupational therapy lies in treating a few clinical domains professionally and effectively (cognitive, physical, psychosocial).  

Speech Therapy’s strength is also found in treating one clinical domain area (communication), professionally and effectively. According to Stephenson (2018), speech therapy is a “...type of rehabilitation therapy used to address difficulties with speech, communication and/or swallowing.” Since swallowing is technically a motor skill, one could say that Speech Therapy treats two clinical domains: communication and motor skills. But it’s treatment of motor skills is very limited.

 Music Therapy has two clear advantages that make it uniquely suited to treating covid19 patients, their families and frontline healthcare workers.  The first advantage is that Music Therapy services a wider range of eight clinical domains (as previously mentioned: cognition, communication, emotions, musical, physiological, psychosocial, sensorimotor and spiritual).  The second clear advantage is that Music Therapy can easily be used as a hospice service, to help a client and his/her family with life review, family bonding and family grieving in the terrible situation where a patient receives a fatal diagnosis from an MD.  Physical Therapy and Speech Therapy are not designed for hospice services, because the point of PT and ST is to help the patient improve in motor skills (PT) and in communication (ST).  Likewise, Occupational Therapy is not designed to be a hospice service because it is concerned with helping a patient improve ADL (Activities of Daily Living).  In hospice, attempts to cure the patient’s illnesses are stopped.  In this circumstance the goal is not to improve the patient’s motor, communication or ADL skills but to provide comprehensive comfort care for the patient and support for the patient’s family.  Of the “Big Four”, Music Therapy is uniquely suited to provide hospice care support to the covid19 patient and his/her family.  

Music Therapy’s wide range of clinical domain treatments (eight clinical domains) also make it uniquely suited to provide flexible medical support to a patient.  In my own private practice, Coronavirus Music Therapy, I have narrowed the non-hospice Music Therapy goals for covid19 patients to improving immune system, relaxation and sleep.  But if a covid19 patient has other needs at a higher level of acuity, Music Therapy is quite often flexible enough to meet these needs.  

In certain situations, Music Therapy’s wide range of clinical domain treatments can sometimes be detrimental. Since Music Therapy can treat such a wide range of domains, there is the distinct possibility that a Music Therapist working with a patient might wander into treating clinical domains of the patient that are not initially identified as clinical domain areas of client needs and strengths based on the music therapy assessment. The antidote to this problem is to have the Music Therapist take time to review the client’s clinical needs and strengths on a regular basis, to make sure that all the clinical goals and objectives being set through music therapy interventions in the music therapy session are working on helping the client improve on individualized clinical goals in the proper clinical domains. 

However, it is this same wide range of clinical domains that music therapy can treat, that end of making music therapy the rehabilitation therapy service most capable of helping patients with covid19, their families and frontline healthcare workers. In my own private music therapy practice, I have taken the wide range of clinical domains music therapy can treat, and have narrowed it to six specific goals that scientific research has shown music therapy can improve: immune system, relaxation, sleep, life review, family bonding and family bereavement. This assures that music therapy goals and objectives will be targeted to specific areas in which a covid19 patient, their family and frontline healthcare workers can most benefit. 

For frontline healthcare workers, aside from the first three benefits of music therapy (improving immune system, relaxation and sleep), at least one scientific study has shown that if music therapy services are provided to patients in a medical facility, it may be able to alleviate medical staff burnout. Romo and Gifford (2007) state that in a scientific study of hospice staff working for a hospice facility, staff agreed or strongly agreed that: 1) Music Therapy was beneficial to patients (100%), 2) Music Therapy improved hospice staff interactions with patients and their families (100%), 3) Knowing the hospice paid for the Music Therapy program increased their commitment to the agency (80%), 4) Music Therapy program increased their job satisfaction (70%), and 5) Music Therapy improved their working conditions (70%).

One challenge that Music Therapy has had as a clinical profession is a lack of awareness of the field among medical professionals, and a lack of understanding of the effectiveness of Music Therapy to treat patients in medical facilities (assisted living, hospice, hospitals, skilled nursing, nursing homes). But since, of the “Big Four” (PT, OT, ST, MT), music therapy works best for treating patients with covid19, this can be a time for a reassessment of the value of clinical music therapy services in a medical environment. As medical facilities treat patients with covid19 in this global pandemic, there is an opportunity for medical professionals and medical facilities to observe the clinical benefits that professional, clinical music therapy can bring to patients with covid19, their families, and to frontline healthcare workers. 

Michael Sokoloff, CEO, MT-BC, MNA is the CEO of Coronavirus Music Therapy (www.coronavirusmusictherapy.com) and a board certified music therapist (MT-BC # 15458) working in the Bay Area, California. Michael is the Bay Area Rep for the California Association of Music Therapy. Michael earned his graduate equivalency in Music Therapy from University of the Pacific and earned his MT-BC (board certified music therapist, # 15458) in 2019. Michael earned a Masters degree in Nonprofit Administration from the University of San Francisco, earned a 2-year Certificate in Web Design & Multimedia through San Francisco State University, and earned a B.A. in Social Sciences at U.C. Berkeley with Dean’s List honors. Coronavirus Music Therapy specializes in providing music therapy services to clients with covid19, their families & frontline healthcare workers. Coronavirus Music Therapy was recently honored to partner with California Health Corps and New York Health Corps to provide music therapy services to battle the covid19 pandemic.
 

References

Abrahams, M. (2006). How Music and Sex Affect the Spit. The Guardian. Retrieved from: https://www.theguardian.com/education/2006/mar/07/highereducation.research2

APTA History (2017). American Physical Therapy Association. Retrieved from: https://www.apta.org/History/

Board Certification Domains (2015). Certification Board for Music Therapists. Retrieved from: https://www.cbmt.org/wp-content/uploads/2019/09/CBMT_Board_Certification_Domains_2015.pdf

Dixon, E. (2018). Can Music Help You Get Over A Cold? Studies Suggest It Can Boost Your Immune System. Bustle.  Retrieved from: https://www.bustle.com/p/can-music-help-you-get-over-a-cold-studies-suggest-it-can-boost-your-immune-system-13231417

Dixon, E. (2018). Music therapy utilizing jazz and dance music has been shown to increase the level of antibodies in listeners' bodies, boosting the efficiency of the immune system. Bustle. Retrieved from: https://www.bustle.com/p/can-music-help-you-get-over-a-cold-studies-suggest-it-can-boost-your-immune-system-13231417

Fulton, C. (2015). Adaptive Equipment. AgeSmart Community Resources.  Retrieved from: http://www.agesmart.org/adaptive-equipment/

Gray, R. (2008). Music Can Help Boost Your Immune System. Telegraph UK.  Retrieved from: https://www.telegraph.co.uk/news/uknews/2569640/Music-can-boost-your-immune-system.html

Hart, E. C. & Parsons H. (n.d.). Cost Effective Solutions for a Changing Health System. American Occupational Therapy Association. Retrieved from: https://www.aota.org/About-Occupational-Therapy/Professionals/EBP/Cost-Effective-Health-Care-Reform.aspx

History of Music Therapy (2020).  American Music Therapy Association. Retrieved from: https://www.musictherapy.org/about/history/

History of Occupational Therapy (2020). Top Occupational Therapy Schools.  Retrieved from: https://www.topoccupationaltherapyschool.com/history-of-occupational-therapy/

LaRosa, J. (n.d.). U.S. Physical Therapy Clinics Constitute a Growing $34 Billion Industry. Market Research Blog.  Retrieved from: https://blog.marketresearch.com/u.s.-physical-therapy-clinics-constitute-a-growing-34-billion-industry

Liu, H., Gao, X & Hou, Y. (2019). Effects of mindfulness-based stress reduction combined with music therapy on pain, anxiety, and sleep quality in patients with osteosarcoma. Revista Brasileira de Psiquiatria. Retrieved from: http://web.a.ebscohost.com.ezproxy.sfpl.org/ehost/pdfviewer/pdfviewer?vid=4&sid=66b5509a-e77c-4714-8f61-02006de8c4bb%40sessionmgr4006

Loewy, J, Stewart, K., Dassler, A. M., Telsey, A. & Homel, P. (2013). The Effects of Music Therapy on Vital Signs, Feeding, and Sleep in Premature Infants. Pediatrics. Retrieved from: http://pediatrics.aappublications.org/conten7/131/5/902

Major Health Benefits of Music Uncovered (2013). McGill. Retrieved from: http://www.mcgill.ca/newsroom/node/18455

Music Therapy (n.d.). Data USA. Retrieved from: https://datausa.io/profile/cip/music-therapy

Music Therapy Reimbursement (2009). AMTA Pro Blog Archive. Retrieved from: https://amtapro.musictherapy.org/?p=32

O’Callaghan, C. (2013). Music Therapy Preloss Care through Legacy Creation. Progress in Palliative Care. Retrieved from: http://web.a.ebscohost.com.ezproxy.sfpl.org/ehost/detail/detail?vid=26&sid=66b5509a-e77c-4714-8f61-02006de8c4bb%40sessionmgr4006&bdata=#AN=87485124&db=a9h

Occupational Therapists in the US Market Size 2003–2024 (2020). IBIS World.  Retrieved from: https://www.ibisworld.com/industry-statistics/market-size/occupational-therapists-united-states/

On Kei, A. L., Yuet Foot, L. C., Moon F. C. & Wai M. C. (2005). Music and its effect on the physiological responses and anxiety levels of patients receiving mechanical ventilation: a pilot study.  Journal of Clinical Nursing. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2004.01103.x/abstract;jsessionid=29BADB0B5914F37B98595198561DC0EC.f01t01?deniedAccessCustomisedMessage=&userIsAuthenticated=false

Otera, M., Hiroko, H. & Takamasa, S. (2013). Musical life review for the elderly with dementia as spiritual care—Clinical functions and roles of meaningful or memorable songs. Arts in Psychotherapy.  Retrieved from: http://web.a.ebscohost.com.ezproxy.sfpl.org/ehost/detail/detail?vid=11&sid=66b5509a-e77c-4714-8f61-02006de8c4bb%40sessionmgr4006&bdata=#AN=89884384&db=a9h

Physical Therapy Market Overview (2017). Agility Health Investor Presentation. Retrieved from: https://www.slideshare.net/AgilityHealth/ahi-investor-presentation-deck-march-2017

Romo, R. & Gifford, L. (2007). A Cost-Benefit Analysis of Music Therapy in a Home Hospice. Nursing Economics.  Retrieved from: 

http://web.a.ebscohost.com.ezproxy.sfpl.org/ehost/detail/detail?vid=17&sid=66b5509a-e77c-4714-8f61-02006de8c4bb%40sessionmgr4006&bdata=#AN=28521713&db=a9h

Sardari, F. & Mashizi, E. G. (2016). Review of the Impact of Music on the Rate of Salivary Cortisol of Patients during Dental Treatment. International Journal of Pharmaceutical Research & Allied Sciences. Retrieved from: https://ijpras.com/en/article/review-of-the-impact-of-music-on-the-rate-of-salivary-cortisol-of-patients-during-dental-treatment

Speech-Language Pathologists in the US Market Size 2002–2025 (2020). IBIS World. Retrieved from: https://www.ibisworld.com/industry-statistics/market-size/speech-language-pathologists-united-states/

Stephenson, B. (2018). 7 Types of Rehabilitation Therapy. Rehab Select Blog. Retrieved from: https://blog.rehabselect.net/7-types-of-rehabilitation-therapy

The History of Speech Language Pathology, (n.d.). Speech Easy.  Retrieved from: https://speecheasy.com/the-history-of-speech-language-pathology/

What is Music Therapy? (2020).  American Music Therapy Association. Retrieved from: https://www.musictherapy.org/about/musictherapy/

Zannetos, A. (2017). Body in Tune: Music and the Immune System.  Sync Project.  Retrieved from: http://syncproject.co/blog/2017/8/23/music-and-the-immune-system