Academic journal article Australian Journal of Music Therapy

The Use of Extemporizing in Music Therapy to Facilitate Communication in a Person with Dementia: An Explorative Case Study

Academic journal article Australian Journal of Music Therapy

The Use of Extemporizing in Music Therapy to Facilitate Communication in a Person with Dementia: An Explorative Case Study

Article excerpt

Communication and dialogue

According to pragmatic communication theory it is impossible for human beings not to communicate (Watzlawic et al., 1967). Even when silent or turning away (or reading this text) you are intentionally or non-intentionally communicating with others. In this understanding, a condition like aphasia, is not equivalent with being non-communicative, although, in a highly verbal and visual (Western) culture, being unable to put thoughts into words may easily be considered as being non-communicative, and in worst case; non-existing.

The Latin word communicatio means message, and communicare to share. Sharing a statement, an expression or an act is a joint action and therefore being interactive. When communication is coupled with an emotional component, this combination is based on vitality dynamics between people (Stern, 2010). Hence, communication is essential to social bonding and is much more than a linguistic message in also including nonverbal and paralinguistic expression (Ridder, 2003). Nonverbal expression is communication through body language, gesture, mimic, and eye contact, for example, by nodding, pointing, or clapping. Paralinguistics is about vocal expression and non-speech sounds. These sounds may be described with a range of musical components such as pitch, volume, tempo, melodic contour, timing, dynamic, and intonation. In paralinguistics the concept of prosody is essential and reflects not what is said, but how it is said. The ancient Greek understanding of the word prosody is "song sung to music" which supports the importance of an intrinsic "communicative musicality", a term proposed by Malloch (1999; Malloch & Trevarthen, 2009).

Active communicative acts are maintained in dialogues by components such as turn-organization, flow and timing. One communication partner may give turn-yielding and turn-maintaining cues with the other showing turn-requesting or turn-denying cues (Holck, 2004; Knapp, Hall & Horgan, 2014). Both communication partners are unconsciously timing their way of expressing themselves to each other, and mostly only when the flow is broken or disconnected, it becomes evident how critical timing is to maintaining communication. Such mis-synchronization is challenging, and it demands focus and abstract thinking to repair mis-synchronization and maintain dialogue. From a social-pragmatic viewpoint, the purpose of communicating is not only to convey a logical understanding of something, but also a psychological and pragmatic understanding. Therefore it is imperative to relate to paralinguistic and nonverbal expression in communication with people where the semantic meaning of language is afflicted, e.g. due to dementia and/or aphasia (Ridder, 2003).

Initiating and maintaining communication with others is a highly complex task, however vitally necessary. Children who are neglected and adults who are isolated show the same profound and devastating reactions to social deprivation. Social exclusion from taking part in cultural life and developing relationships makes it difficult to benchmark normality and may lead to stigmatization and health risks (Hobcraft, 2002; Pettigrew, Donovan, Boldy, & Newton, 2014). People who are unable to engage in communicative interactions due to dementia or cognitive neurodegeneration may be critically exposed to social isolation, even if they are surrounded by other people.

Dementia and social isolation

Dementia is a neurocognitive disorder caused by various brain illnesses that affect perception, cognition and motor function. This biomedical and psychological disability poses complex challenges to global health and economy (Moniz-Cook et al., 2011). The number of people living with dementia worldwide is currently about 47.5 million with 7.7 new cases every year (World Health Organisation, 2015). The World Alzheimer Report 2014 estimated that the global societal economic cost of dementia exceeded 600 billion USD (Alzheimer's Disease International, 2014). …

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