TOLEDO, Ohio — Nine-year-old Hannah Gorham loves to sing.
She loves Carrie Underwood and reading Fancy Nancy books, and she adores Bear-y, the tattered stuffed animal blanket she has had since birth.
Her hero is Calysta Bevier, the 16-year-old ovarian cancer survivor from Hannah’s hometown of Grand Rapids, Ohio, who advanced to the semi-finals on the popular NBC show America’s Got Talent.
And Hannah’s therapeutic savior might just be music.
In ProMedica Toledo Children’s Hospital since Aug. 31 for severe migraines, Hannah was introduced recently to music therapy, a growing practice for hospitalized children and those with developmental or physical disabilities.
Operated through the hospital’s Child Life program, music therapy helps children and their families cope with stresses related to a child’s illness and the adjustment of a hospital stay. David Putano, a music therapist who owns a private practice in Toledo, visits children like Hannah at the hospital for weekly one-on-one musical sessions.
“When you expose people to music they love, the feeling of success, of hopefulness, reminds them of things they love,” Putano said. “At a hospital, we sometimes get away from things at home that we love, things that are beautiful.”
On this particular Friday, surrounded by stuffed tigers, monkeys, and dolls, Hannah, a quiet, petite blonde with glasses, finds her place on the keyboard and joins Putano in making music. The pair first coordinate musical notes to a preprogrammed rhythm (this, time, they choose one reminiscent of an epic space movie; Putano often uses movie references to get students in the right creative frame of mind). As Putano plays the guitar, Hannah finds her happy place on the keyboard and joins in.
“OK, start going slower, we are going to sneak up on the ending,” Putano prompts. “When I count to three, you play one more note.”
Twice, the session is interrupted so that Hannah can take medication. Then, it’s back to the beat.
Hannah watches intently as Putano searches for the perfect hip-hop beat on the keyboard. She clutches Bear-y as he explains to the young girl that there are 12 notes in music and helps her find the A note on the keyboard.
“Play whatever you want … Atta girl!” he encourages.
“You can tell when someone is really wired for music. You do really well,” he says to his tiny student as they finish up.
She smiles. Quietly.
“My favorite part was doing this with David. It made me happy,” Hannah said after the lesson. “It feels good.”
Hannah was diagnosed two years ago with Chiari malformation, a congenital defect in which part of the skull at the back of the head is too small for the brain.
“She started stuttering; she would trip over things and there would be nothing there,” said her grandfather, Rick Tolles, also of Grand Rapids.
Her mother, Heather Gorham, was optimistic that music therapy would help.
“Heck, it’s worth a shot. All of this medication is hard on her little body, but if something like this would work, that would be fantastic,” she said.
The young girl had been getting migraines for about a year, but a week into fourth grade, they became severe, Tolles said. Now, when she gets a migraine, Hannah runs to her grandfather and hides in the crook of his arm to shield herself from the light.
“I think the biggest thing is the music. It makes her rest easier— I can get her to close her eyes,” he said. “I haven’t found much else that helps.”
Music is considered to be a primary cognitive experience, meaning as human beings, we have no control over the emotions we feel when we experience it, Putano said.
“If we can identify music that a patient loves, music they have positive associations with . if we can engage them in playing music that they really like a lot, we can instantly have them experience those positive emotions,” he said.
Researchers have found that music therapy provides a diversion from negative feelings and helps manage the pain of not only adults but of children with developmental, physical, behavioral, and neurological disabilities, said Al Bumanis, a certified music therapist and now the spokesman for the American Music Therapy Association. Continued research with music shows effects on the subjects’ vital signs: blood pressure goes down, the heart rate slows, body temperature goes up; it calms and relaxes but also motivates.
Boston Children’s Hospital has an expansive music therapy program involving four music therapists.
Dozens of clinical trials found that music therapy helped stabilize premature newborns’ breathing rate during their time in the neonatal intensive care unit. In 2012, Jennifer Canvasser created the Micah Smiles Fund to help expand the C.S. Mott Children’s Hospital Music Therapy Program after daily music therapy made her son smile every day of his short, 10-month life.
The profession first gained ground after World War II, when soldiers returned home with Post Traumatic Stress Disorder, Bumanis said.
“People who cared for them noticed it was more than a diversional activity, that it could be incorporated into the overall treatment,” he said.
Today, there are more than 6,000 music therapists working in the United States, and the association works consistently to move toward a profession that is recognized by insurance companies as a benefit, Bumanis said. Currently, he said the association’s surveys show that about 25 percent of clients get health care reimbursements.
“Physical therapy, occupational therapy, we are years behind them, but we are catching up, When (hospitals) are asked, ‘Do you want to pay for medication or music therapy … It is a long-term process, but the trend is moving in the right direction,” he said.
Putano got his music therapy degree from Eastern Michigan University in 1991. Eastern Michigan is one of about 75 universities in the country with such programs and one of three in Michigan along with Western Michigan University and Michigan State University. In Ohio, music therapy degrees are offered at Baldwin-Wallace, Ohio University, the College of Wooster, and the University of Dayton.
He has worked for Child Life since 1999. Weekly, he visits with children undergoing procedures from emergency appendectomies to chemotherapy for cancer. He recently started therapy for patients in hospice and also teaches music therapy for autistic children at the School for Autistically Impaired Learners, or S.A.I.L., in Toledo.
For those with specific developmental challenges, like autism, specific goals are targeted. But for a child with a physical illness, music therapy is an augmentation.
“I’m not sitting in on treatment meetings,” he said. “What I do with them is therapeutic. We complement what the doctors are doing. We complement what the medical experts are doing. It might be because they are having anxiety for a surgical procedure. (My session) is 40 minutes they might not be focused on that procedure.”
When Putano begins a therapy program with a patient, he starts by getting to know what kinds of music they have been exposed to. He usually uses a keyboard to introduce them to playing. He might have them dramatize a popular TV show or movie, similar to the “space movie” Hannah worked with.
He encourages self-expression.
“We end up making beautiful music with each other right on the spot,” he said. “Before we know it, we are jamming just like recording a record.”
If the child catches on, the sessions become more structured. A guitar and some percussion instruments, are brought in. Parents, siblings, and friends get involved. If the therapist discerns that the child may want to write, pen and paper comes out and they try their hand at songwriting. Children have written about their dogs, their turtles, going to camp, or better yet— going home.
“It’s great, whether it’s something pertinent about going home, worrisome stuff, or something wonderful,” he said. “Once we have words, we go toward putting music to it. Then I record it for them.”
Children get a copy of their recording.
“Johnny” is a 16-year-old patient who wasn’t able to focus on much. His cancer treatments were harsh, but Putano’s arrival for a music session gave him a boost.
“He sees me go by and he lights up,” the therapist said.
The pair has had more than half a dozen sessions together, and the teen now has two guitars. Putano sends him copies of their sessions so he can go over them himself.
“A lot of times, with a lot of things, it feels like we don’t have control,” Putano said. “This gives him a feeling of control. He can be successful. He can practice. He can control when he starts and stops (a session).”
Toledo Hospital has expanded its music therapy program to create relaxing diversions for children in another part of the hospital.
With the help of a $7,500 grant from the American Hospital of Radiology Administrators, music therapy has been introduced this year to the hospital’s imaging department.
In rooms where X-rays, gastrointestinal testing, and other radiological testing is done, paintings of musical instruments adorn the walls— a saxophone, maracas, tambourines, a guitar —surrounded by songbirds and musical notes. They remind small patients they can relax, that things will be over soon and they can go home, said Heather Heebsh, the interventional technologist at ProMedica Toledo Hospital.
To accompany the art by Beth Covert of Temperance, Putano helped put together a playlist on an iPad that dishes out anything from Disney tunes, VeggieTales, and Wiggles for the smaller children to classic rock, country, and nature sounds for older kids. Kids can choose Christian music, holiday melodies, and classical songs. A lighting system that puts stars and moons on the ceiling offers a visual distraction, she said.
“This is all to reduce stress,” said Heebsh. “They are coming in and they don’t know what to expect, and it’s scary. They aren’t thinking about the needle anymore.”
The music therapy program has other benefits. A distracted child means radiology techs can get images much more quickly, reducing the amount of radiation that has to be used. Additionally, they may not have to use sedation while little Johnny or Mary are listening to their favorite Disney characters sing, said Joan Kirch, administrative director for imaging.
“We have heard some of the techs saying, ‘Well, we don’t have to do that,’ ” she said.
Heather Heebsh had been reading up on the benefits of music therapy ever since she made a campus visit with her son to Eastern Michigan and saw all of the new students who were interested in getting music therapy degrees.
“They were doing it for autistic children; I thought, why not do it for all children?” she said.
The program made a believer out of Jenny Pienta, an X-ray technician at the hospital, who originally was skeptical that the program would make a difference.
“Then this kid came in and he started dancing and pointing up to the pictures on the wall,” she said.
Another time, a woman brought her 3-year-old in to have upper gastrointestinal procedures done.
“The whole time we were walking in, she had this frown. As soon as we picked out music she liked, she quieted right down. I’m OK to admit that I was wrong,” Pienta said, shrugging her shoulders.
Information from: The Blade, http://www.toledoblade.com/