by Krista Winter, MA, MT-BC, Neurologic Music Therapist
Winter is slowly turning into spring, snow into rain, and that means the ground will soon be coming back to life. Trees and grass will once again turn green, flowers will be blooming, the joy of Spring! Not so fast, because for some this means struggling to breathe and being wary of the ever increasing pollen count. You might be thinking allergies, but that is a secondary issue to a chronic illness that affects a large percentage of children (and adults), Asthma.
I work at Barton County Memorial Hospital (BCMH), and as of March 8, 2011 we are now certified as an Asthma Ready Hospital—only the 2nd hospital in Missouri to receive this designation. We have 2 Certified Asthma Educators (AE-C), another rarity seeing as there are under 3,000 total in the United States. This all exists in a small rural 24-bed hospital. You might not think this is relevant to you and your practice, but statistically it is very likely that you have at least 1 (probably more) client who suffers from Asthma. According to the Centers for Disease Control and Prevention (CDC), approximately 7.1 million children are diagnosed with asthma, which is just around 10% of the pediatric population. The Asthma and Allergy Foundation of America states that not only is asthma the “most common chronic illness in children” but it is also one of the leading causes of school absenteeism AND hospitalizations of children.
In other words, this is a serious problem and many of our clients will be affected, both children and adults. Asthma occurs out of sight in the persons’ airways, which become constricted and swollen when triggered by external (and at times internal) factors. It can look like someone is just “out of breath” when in reality the air cannot get through the airway and could become a serious life-threatening problem. Unfortunately due to its outward “invisibility” many people do not take it seriously, and children suffer humiliation by coaches, peers, even parents. The good news is, although asthma cannot be cured, it CAN be controlled (American Lung Association). Between the physical manifestations of asthma and the emotional affect, Music Therapy can provide great benefits.
First of all, for any Music Therapist looking to work with the asthma population or related issues such as COPD, I recommend reading “Music, the Breath and Health: Advances in Integrative Music Therapy” edited by Ronit Azoulay and Joanne V. Loewy. Second, educate yourself on Asthma itself. I have attended the nationally certified 6-hour workshop, “Becoming an Asthma Educator”, and borrowed resources from Certified Asthma Educators (who are also Respiratory Therapists). Fortunately I work with two AE-C’s and have gleaned great information from listening closely and collaboration.
The main themes within Asthma Education include teaching students to identify symptoms and triggers, the 3-Step process (I will explain in a moment), and how to properly use the various medication devices (which can be very confusing). The 3-step process is what students need to do when they are having an asthma attack. 1) Stop and sit down, 2) Tell and adult, 3) Take medication. There are many sub-topics that are addressed with students within these topics, but once the student gains this knowledge they are much more likely to be successful in controlling their asthma.
Ways to implement Music Therapy in treating clients with asthma. At BCMH we have incorporated Music Therapy into the Asthma Education program in 3 ways:
1) Inpatient services
2) School assemblies (for all students) and 3-week education (asthma students)
3) Educational Presentations (for caregivers including parents, teachers, daycares)
*Currently the AE-Cs do home visits that do not include Music Therapy; however we are discussing the possibility of Outpatient referrals specifically for participants in the Asthma Education program who have severe anxiety and psychosocial problems.
Goals for inpatients with asthma include increasing respiratory efficiency, teaching age appropriate relaxation skills (which also addresses proper breathing techniques), providing accurate age developmental stimulation if the patient is long-term, and providing opportunities for expression and identification.
Since music is so closely related to breathing and respiration, I have written a few songs that mirror “belly breathing” (or diaphragmatic breathing) lyrically, melodically, spatially, and rhythmically. Interestingly, during one of our sessions, the Asthma Educator was teaching two young boys how to properly use a spacer with their inhaler, it takes breathing coordination, and when I added a simple melodic support on the glockenspiel that mirrored the appropriate action, the boy immediately improved. Since there were two boys I had the boys take turns playing the glockenspiel while the other practiced using the spacer so they were helping one another.
Another favorite song I adapted to a familiar tune uses egg shakers:
“Shake, shake, shake out my ________ insert specific stressor or anxiety of client (3X)
And…stop shaking egg shakers…take in a big deep breath.”
It is a simple song but it incorporates two important elements: naming the client’s trigger and deep breathing techniques for symptom control and relaxation.
Using wind instruments: recorders, harmonicas, slide whistles are also great ways to improve breathing techniques, increase client confidence over asthma symptoms (as reported in several research studies). Using scarves also provides a great age-appropriate way for younger children to see the effects of their breathing as they blow to make the scarf “fly” to a song such as “Somewhere Over the Rainbow” or musical improvisation.
These are a few ways I have implemented Music Therapy in the treatment of asthma, and it has been a very successful addition to the BCMH Asthma Education program. Most importantly, make sure you are “Asthma Ready” for any clients you might serve who could possibly have asthma.
I would love to hear your comments and suggestions as I expand my knowledge in this area. Feel free to contact me at krista.winter@bcmh.net.