Deborah Howell (Host): Music, it can lift moods, decrease anxiety, and even be used as an effective form of treatment. Music therapy is the clinical and evidence-based use of music by a credentialed music therapist. And its therapeutic use can positively impact hormone release and pain perception, helping patients cope and adapt.

Host: Today, Courtney Rosewall, a board-certified music therapist at Le Bonheur, is here to tell us more about how music therapy is having a positive impact on patients and their treatment. And to help us understand, here's a little taste of what a music therapy session sounds like.

Music therapy sample: Feeling down like you just can't win. Days are long and nights just won't end. You can't seem to shake the heavy weight on your heart. It's like the world's just falling apart.

Don't you worry, Harmony. Just keep singing this song with me. Keep holding on. You are not alone. You'll be feeling better before too long.

Hold on tight. I'm here to say, "Harmony. I'm just one call away." Let's find the joy in the little things. You and I will be singing in the spring.

Don't you worry, Harmony. Just keep singing this song with me. Keep holding on. You are not alone. You'll be feeling better before too long.

Your family's here with so much love to share. Here at Le Bonheur, you are getting so much care.

Don't you worry, Harmony. Just keep singing this song with me. Keep holding on. You are not alone. You'll be feeling better before too long. Keep holding on. You are not alone. You'll be feeling better before too long.

Host: Welcome, Courtney.

Courtney Rosewall: Hi. Thanks, Deborah, for having me here today.

Host: That was so, so wonderful to be a part of, to just listen in on one of your sessions with one of your patients. I'm very moved at what you do.

Courtney Rosewall: Yes, that is probably one of my highlights of my time here at Le Bonheur. That is right there at the beginning when I was able to start following with our trauma team and being able to help that sibling process, the trauma that her sibling had experienced, but also she was experiencing and their family was experiencing in that moment. And so, being able to support her was so beautiful. And we ended up with a song at the end.

Host: I just love it. It's so heartwarming. Let's talk about the types of things you do as a music therapist at Le Bonheur. What interventions do you do with your patients and how do you work with other members of the patient's medical team?

Courtney Rosewall: So as far as interventions go, they are endless. But some of the ones that I use the most here at work are instrument playing, music composition like songwriting or lyric adaptations; music and movement, so dancing, maybe doing Itsy Bitsy Spider; singing with patients, listening to music with patients. Also, we do heartbeat recordings here as well as multimodal neurologic enhancement in the NICU, guided imagery; things to help with relaxation, like progressive muscle relaxation as well. So, those are daily interventions that I use.

And when it comes to working with other members of our medical team, you can find Taylor and I collaborating with members of our child-life team, like our child-life specialist, or our hospital educators or our activity coordinators, to just work on doing more normalizing and legacy-building experiences. You might find us co-treating with members of our rehab team, such as physical therapist, occupational therapist or our speech therapist to help support developmental and fine and gross motor skills. You might see us co-treating and collaborating with social work, our family assistance program or our trauma mental health counselors to support patients and families with their psychosocial or socio-emotional, and then also with nurses and doctors providing procedural support and helping when it's assessment and care time. So, you can see us working with anybody and collaborating with anybody here in the hospital.

Host: I love it, as it should be. Now that we have an understanding of the kinds of tools you employ, maybe we can dive in a bit deeper into the science behind music therapy. How does music therapy affect the brain and body?

Courtney Rosewall: So, music therapy is an evidence and research-based practice where music therapists will utilize music as a tool to stimulate the brain for mental, physical, emotional and also personal goals and wellbeing. And through research and studies, it's been found that music therapy can influence vital signs, increase patient engagement in their care, and also provide a distraction and increase coping while they're here in the hospital.

Host: Now, what happens actually in the brain when we create and hear music?

Courtney Rosewall: Yeah. So, music is a multisensory experience and engages the brain. And so because of the way music is processed, music therapists will use patient-preferred music to elicit the most engagement and benefits for our patients. So, music can invoke different emotions and memory recall, and music can trigger a release of dopamine and serotonin and oxytocin. And those are considered like your mood enhancers or pleasure neurotransmitters. So, music can also drive plasticity and create new and more efficient connections between neurons, and that's also kind of known as what sometimes we call like rewiring in the brain. And so, someone who maybe has had a traumatic brain injury, speech is processed differently than music and singing. And so, we might use music and singing to help build those neurons and rewire to help them find a way to get back to having that communication through music.

Host: I know this is all medical, but it's all very magical as well, right?

Courtney Rosewall: I love getting to talk about the way music affects the brain. It is so fascinating to me.

Host: And let's talk about outcomes. How does music therapy affect physical patient outcomes?

Courtney Rosewall: Music therapy can be used for pain management. Music therapists also utilize a method known as iso-principle, and it is a method for mood management where the music therapist provides music that matches their client's mood. And then, we'll gradually change the music to help the client shift to a different mood. And this can have an influence, like I mentioned before, on the patient's vitals, which is like their respiration rate, their heart rate, their blood pressure. Music therapy research also shows that it can aid in the overall patient satisfaction and also decrease the length of a patient's hospital admission.

Host: Wow, that is truly incredible. I know you can feel it. You come in from a day crashing around, I'll throw in a little spa music and I can actually feel my heart rate decreasing.

Courtney Rosewall: Yes. Just last week, I was in a patient's room and the parents were concerned with the patient's heart rate being elevated. And within three songs, the patient's heart rate had decreased, was back within normal limits. And the patient was just kind of lying in their bed, looking and smiling, and then just closed their eyes and went to sleep. And they had just calmed right on down.

Host: That's so special. The other part of your day I want to talk about, because it is incredibly special, you spend a lot of time with your NICU patients. How does music therapy specifically benefit babies and toddlers?

Courtney Rosewall: So Taylor, she is our other music therapist here at Le Bonheur. We both have received additional education and training regarding providing music therapy services within a NICU. And our brains are just so remarkable. And at such a young age, they can identify and process music. And this is why our infants and toddlers here at the hospital benefit so greatly from music therapy.

So, some of the common goals we may work on with this population is increasing their tolerance to various stimuli. And all that's going to do is really normalize what going home is going to be like after they discharge. And hearing what an infant would typically hear is lullabies and nursery rhymes while at home. And also, we work on increasing developmental skills and fine and gross motor skills. So, that might look like grasping and holding a baby rattle. It might also look like we have this phenomenal tool called a PAL, which is a pacifier-activated lullaby. Within the music therapy world, Taylor and I are working with our speech therapist to work on getting some here, but it will use music to encourage infants to suck on a pacifier. And that only builds their suck-swallow reflex to be able to take from a bottle when it's time to do that. And so being able to utilize music as a reward to increase their ability to eat and being able to co-treat with speech therapists in that capacity is also amazing. So, our patients, our infants and toddlers, they benefit so much from music therapy.

Host: This is all so wonderful. Taking the next step up, how does interaction with music promote child development?

Courtney Rosewall: When you think about the brain, we have the frontal lobe and we have the temporal lobe. And that's where movement, thinking, decision-making, language processing, speech, emotions, they're all controlled there. And music can stimulate all of those functions as well as other functions within our brain and other locations. And so, music therapy goals within infant and toddler populations is to work towards increasing that cognitive function, the communication, coping, developmental, fine and gross motor skills, and those are all normal things that those patients would be experiencing and learning outside of the hospital setting. So, getting to do that with them here and have more normalizing experiences and not experience that developmental delay because they may be here at the hospital not getting those outside.

Host: Sure, I understand. Now, you also work with mental and behavioral health patients. How does music therapy affect these patients?

Courtney Rosewall: This is a population that is so near and dear to my heart and music therapy provides a space for these patients to process and express thoughts and emotions musically through listening, music-making, songwriting or composition. It teaches coping skills, it increases self-awareness, self-expression. And it can help decrease anxiety and increase that patient's autonomy and control and encourage them to be more engaged and take a more active role in their care while in the hospital.

Host: So many benefits. What are your overall goals as a music therapist at Le Bonheur and what are you most proud of?

Courtney Rosewall: So goals-wise, Taylor and I both have a shared goal to start a music therapy student program and have students come in and shadow and observe us. We want to serve as a practicum placement site. We would also be hopeful to move towards being an intern placement site in the future. And we are actually looking forward to this goal coming to fruition soon because the University of Memphis is getting ready to launch their music therapy program. And I am so excited about that.

And then, I would love to see us not only hire more music therapists, but to hire more creative arts therapists, such as art therapists or dance and movement therapists. And as great as I think music therapy is, there are other creative arts therapists out there that can kind of just really help fulfill all the patients and their family's needs here.

Host: Well, Courtney, you are a bringer of joy. Thank you so, so much for being with us today. What you do is very special. We really thank you for shining a light on everything music therapy can do for those we love. And I hope you reach your goals and get other kind of therapists in there with you and all working together to create better lives for these patients.

Courtney Rosewall: Yeah, thanks. I would like to share some of the things that I've been proud of here. I know you had asked earlier, and I got so excited about sharing my goals. But there are two things that I am really proud of here. And one thing I'm the most proud of is the work that I've been doing alongside with our trauma team here at Le Bonheur, just being able to serve with this team has been amazing and seeing how they truly exemplified patient and family-centered care and being able to see the family as a whole and not just solely focusing on the patient and as you heard in the song earlier, you know, being able to support that sibling through processing what their family had just experienced.

And I just really love the work that I get to do alongside those members and also, being able to collaborate with our child-life specialist that's down in the emergency room to support those behavioral and mental health patients during their hospital stay. And something I am really excited about is Le Bonheur has this new grant and it's going to fund the Hope Journey Program. And so, I am excited to see how music therapy can partner along with that Hope Journey Program and see where we can even further support those patients with behavioral and mental health needs.

Host: The whole journey sounds incredible. Best of luck to you. And if you'd like to learn more, please go to lebonheur.org/news-events/podcast. This is the Peds Pod by Le Bonheur Children's Hospital. I'm Deborah Howell. Thanks for listening and have yourself a great day.