For as long as mankind has walked the earth, music has been integral to its existence, a primal expression inspired by the natural rhythms in its environment. Whether a whistled imitation of a birdcall, a primitive drumming imitating a heartbeat, or a chant to soothe a crying infant, music appears to have been a constant companion from the infancy of the species.

Built on this prehistoric basis, music therapy has now become an established health service. Goal areas of music therapy include motor skills, social/interpersonal development, cognitive development, and self-awareness. While promoting relaxation and stress reduction, music therapy has also been shown to affect sleep patterns, improve the memories of stroke patients, and even decrease the amount of painkiller medication for some patients.

Although music therapy programs, along with writing and visual art therapy, have recently taken a blow with the movement toward managed healthcare practices at large hospitals, several notable facilities are spearheading movements to put music therapy back on the front line of patient rehabilitation. Facilities, such as the New York City-based Louis Armstrong Center for Music and Medicine, are setting a new precedent for the beneficial role that music therapy plays in multiple patient rehabilitation programs.

The Sound of Changing Times

A fixture at the Beth Israel Medical Center since 1994, the music therapy program was begun by music therapist, Joanne Loewy, DA, MT-BC, LCAT, with a generous contribution from the Louis Armstrong Educational Fund. Named the Louis and Lucille Armstrong Music Therapy Program, it supported research and clinical music therapy services for infants, children, and families who have been hospitalized at Beth Israel. Additional funding from the Charles Lawrence Keith and Clara Miller Foundation, as well as the Grammy Foundation grants and tremendous support from hospital trustee Richard Netter, would expand the program to also treat outpatients and patients with HIV.

Under Loewy’s direction, music therapy became incorporated into the programs and services in Beth Israel’s nationally renowned Department of Pain Medicine and Palliative Care, as well as the neonatal intensive care unit (NICU), The Department of Family Medicine, and the hospital’s intensive care units.

In 2005, with contributions from the David B. Kriser Foundation and additional support from the Louis Armstrong Educational Foundation, Beth Israel opened the Louis Armstrong Center for Music and Medicine, intended to use cutting-edge music therapy techniques to complement medical treatment for children, teens, and adults with asthma and chronic obstructive pulmonary disease (COPD).

Looking to expand their services further, the Center has become affiliated with some of the top facilities in mind-body therapeutic services, including New York City-based New York University, Hahnemann Creative Arts in Therapy Program at Drexel University in Philadelphia, and the American Music Therapy Association.

“When I started in 1994, it was just me and the unit for many years, then we grew a nice internship program, and we’ve maintained that,” says Loewy. “We also have international training, where students from Spain and Scandinavia and Taiwan come and train with us. We have a two-day orientation and observation (O&O) program. Anyone can come in for two days; they pay a small fee, and hear from all our staff. They get an idea of what music therapy truly is. Usually, people encourage folks to enroll in a program. But with our O&Os, you get a small but full appetizer first – a hands-on experience – of what it would be like to be a music therapist.”

A Helping Hand from an Old Friend

Among the specialized programs highlighted at the Center for Music and Medicine is the Music and Health Clinic, which caters to hospitalized musicians and performing artists. These patients have specific medical needs related to the unique physical, mental, and emotional demands of their profession – therapists need to account for the psychological strain that musicians endure, especially the pressure to return to full range of function. For example, a performer can be impeded by overuse injuries, scar tissue from surgical procedures, and even side effects of medication, such as tendon inflammation.

“Areas of frequent relevance in the artist population include depression, anxiety, substance abuse, insomnia, emotional trauma, narcissistic styles, repetitive strain injuries, soft-tissue ailments, advanced chronic diseases, pain syndromes, voice difficulties, and pulmonary diseases,” says Stephan Quentzel, MD, JD, MA, medical director of the Music and Health Clinic.

He continues, “Diagnostic and treatment attention in the form of medical and psychiatric avenues are given, as expected, and so is music therapy. We are using music to help musicians, because often the music is both part of their glory and their suffering – there is frequently a love/hate relationship with the music. Music therapy offers a language of psychotherapy to explore the artist’s relationship with music.”

Quentzel, who specializes in integrative medicine and psychiatry, blends a medical/biological/musical approach to address ailments unique to performing artists and musicians. The accompanying music therapy team is trained in complementary approaches, such as music-assisted relaxation, guided visualization, and stress management, which are used to alleviate pain and anxiety.

Other clinical services offered to performers include:

• Music ergonomic-posturing: Adjusting and/or altering the way music is played and the musical environment in which one plays may reduce the overuse that contributes to repetitive strain injuries.


• Vibration: Instruments, such as the gong and tone bars, and the use of toning can alter the perception of pain and/or anxiety.

• Breath Entrainment: Tension, fatigue, and fear tend to cause physical constriction and emotional contraction in the body and mind. Wind-playing provides a medium for elongation of musical phrases through melodic and harmonic entrainment, which can extend and increase the volume and capacity to breathe.

“Music therapy offers a psychotherapy sensitive to the need to integrate the true inner self of the performer with their false public face,” says Quentzel. “Great psychic conflict can develop in the musician, resulting from the tension between their inner and outer personas. All people have a schism between the inner life and the image shown to the world, but this seems amplified in performers, as the public face can rise destructively to dominate over the private face.”

He adds, “Music can serve the false self or the true self, depending on how it develops and is used. Therein lies the true potential of music therapy – to help the artist integrate his inner and outer selves, and to reestablish his love of the music for personal reward rather than public accolade.”

Not Just Child’s Play

While musicians hold a special place in Center’s services, the NICU is equally renowned as an environment where music therapy has developed strong roots. Approximately 12 percent of babies in the United States are born prematurely each year – a staggering figure considering complications from premature births include cerebral palsy, chronic lung disease, gastrointestinal problems, mental retardation, as well as vision or hearing loss.


As a Level 3 neonatal intensive care unit, the NICU at Beth Israel Medical Center provides advanced services for prematurely born infants and full-term infants who are otherwise medically compromised. An interdisciplinary team consisting of doctors, nurses, medical specialists, physical therapists, patient-care representatives, and music therapists works together to address the varied needs of the parent/child entity, as well as the immediate medical needs of the infant.

“A pronounced area of challenge in NICU music therapy lies in addressing the toxicity of the NICU acoustic environment,” says Kristen Stewart, MA, MT-BC, LCAT, the clinical director of Louis and Lucille Armstrong Music Therapy Program.

“The American Academy of Pediatrics has reported that this sound environment is hazardous to preterm development, and sources in the literature abound as to how the exposure to such noxious sound stimuli as alarms, infant crying, and elevated speaking levels due to the high volume of people on the unit impact the preterm infant during their NICU stay, as well as later in life.”

Fetal-hearing capacity has been noted to develop after approximately 19 weeks, granting a secondary perception of its environment beyond touch. The fetus absorbs sounds, such as the mother’s heartbeat and the movement of fluids and blood through the placenta, and these become hardwired into its developing brain, providing a basis for further developmental changes. Infants who leave the womb prematurely find this link cut short and present problems sleeping and/or breathing properly.

To counter this effect, music therapists utilize live sound and music to replicate the auditory environment found in the womb. By replicating this atmosphere, music therapists have been shown to deepen infant sleep-state, support infant self-regulation, and assist in the stabilization of breathing and heart rates. Also, with parents or caretakers participating, music therapy enhances parent/infant bonding, soothes irritability, re-enforces feeding rhythms and weight gain, and promotes a sense of safety during examination procedures.

“Music therapy treatment techniques at Beth Israel are designed to match the developmental stage of the infant and recommended intervention parameters. Music and sound that replicate the constancy and rhythmicity of the womb environment are used at Beth Israel through live music intervention that interactively incorporates the moment-to-moment responses of the infant. Also, strategies that emphasize the use of parent’s voices, and facilitate parent-infant bonding are favored,” says Stewart.

She continues, “These techniques are carefully executed to contain and organize the potentially overwhelming experiences NICU patients and families are exposed to, facilitating a connection to safety and security that allows patterns of resiliency and healing to emerge.”

Both Stewart and Loewy are currently leading clinical trials in eight NICUs in the Northeast, looking at the effect of live music in breathing, heart rate, stability variation, and attachment issues. These trials are made possible thanks to support from the Heather on Earth Music Foundation.

Wind Talkers

The same security and comfort that premature infants respond to in music therapy can also be applied to those with chronic illnesses, who use music as a medium to progress in rehabilitation. Chronic obstructive pulmonary disease (COPD) includes lung conditions such as emphysema, chronic bronchitis and chronic asthma that involve breathing difficulty, wheezing, fatigue and chronic cough. Amid the inhaled steroids are used to suppress lung inflammation and antibiotics used during flare-ups of infections, many patients suffering from COPD are looking to music therapy for another option.

“When patients enroll in cardiac or pulmonary rehabilitation, they receive information on the music therapy programs,” says Ronit Azoulay, MT-BC, LCAT, from the Music for AIR (Advances in Respiration) and Music for CAIR (Cardiac Advances in Rehabilitation) programs. “In addition, every patient in cardiac and pulmonary rehabilitation is scheduled for four music therapy groups with the option to sign up for continuing music therapy.  On the inpatient units, the doctors and nurses fill out referral forms or call us to refer patients. We also attend rounds and may gather referrals at these interdisciplinary meetings.”

Through a joint effort with the Center for Cardiac and Pulmonary Health at Beth Israel Medical Center, music therapy is offered as a complementary approach to achieving treatment goals and wellness in the Music for AIR program, as well as Music for CAIR. In these programs, supported by a grant from the Johnson & Johnson Society for the Arts in Healthcare, music therapists utilize techniques to help patients breathe and cope with symptoms, such as dyspnea, as well as provide psychosocial support for people coping with chronic illness.

The services offered through this program include:

• Music-assisted relaxation and guided imagery that influence heart rhythms, optimize breathing, and support stress management


• Group music-making, using simple wind instruments, to provide gentle pulmonary exercise, tension release, and creative expression

• The “Sing-A-Lung” chorus, which draws on the therapeutic benefits of singing and songwriting from a variety of musical genres to enhance breath, voice, and spirit.

“The chief complaint of both groups of patients is usually shortness of breath, which can have a debilitating impact on all activities of daily living, from being able to walk up a flight of stairs to go grocery shopping or perform household chores,” says Azoulay.

She adds, “Patients with COPD may experience hyperinflation of the lungs due to air-trapping. Typically, these patients are advised to use a technique called ‘pursed lip breathing’ to assist in expelling stale air that is trapped in the lungs. In music therapy, we may whistle, play a recorder or harmonica, or sing to mimic pursed lip breathing while creating a musical tone. For patients with cardiac problems, the work may focus more on entraining heart rhythms, mind-body techniques to modulate heart rate and blood pressure, which may involve group drumming and a rhythmic focus at times.”

The Road Ahead

“There is a growing body of evidence that reflects the far-reaching benefits of music therapy,” says Stewart. “Disseminating this information in professional arenas continues to bridge the gap of awareness that remains among some medical professionals. There are still some who are committed to older models of care, but there are also clear trends in medicine that emphasize an integrative approach to treatment, which includes music therapy.”

In addition to launching several outpatient services in clinics and schools, including its two innovative programs, Music for AIR and Music for CAIR, the Center’s Asthma Initiative Program (AIP), intended to help children and teens with asthma using music visualization and wind instruments, has also broken new ground for music therapy in the hospital setting.

In the AIP program, Brian Harris, MA, MT-BC, LCAT has coordinated schoolchildren in the Bronx to receive group music therapy as part of their weekly routine. He uses a Native American flute and works to ease their breathing. Harris also encourages long breaths through clinical improvisation on recorders, which were donated by Yamaha.

Through these successful music programs experiences, the Louis Armstrong Center for Music and Medicine has created a powerful basis for the usage of music therapy in a hospital setting. No longer intended as only a sedative experience for patients with chronic pain, music therapy is now clinically recognized as contributing significantly to medical care, providing psychological and physical comfort to patients with various needs.

The work of facilities, such as Center for Music and Medicine, are paving the way for music therapists to work in a variety of therapeutic setting, including patient rehabilitation programs.

“We’ve been at the cutting-edge of music therapy and medical research for the past decade and, for me, it’s been an honor to grow amongst a team of music therapists who are as eager to train, learn, and research as I am,” says Loewy.

    — Bob Stott is a staff writer for Therapy Times. Questions and comments can be directed to bstott@therapytimes.com.