Harp and Voice at Meir Hospital

by Sunita Staneslow
published by The Harp Therapy Journal

The medical article about this study was published by hospital staff from Meir Hospital in the journal 'Birth' and can be downloaded here.

During 2004 and 2005 I participated in a study on the impact of live music on newborns at Meir Hospital in the town of Kfar Saba where I live in central Israel. Together with colleague, singer and percussionist Eliana Gilad 100 hours were spent playing in the Newborn Intensive Care Unit. This is the story of our hospital experience.

Kfar Saba is about 20 minutes northeast of Tel Aviv and just two miles from the border of the West Bank. Meir Hospital serves the local Jewish and Arab communities between Tel Aviv and Netanya about 20 miles to the north. Hospitals are one of the few places in Israel where Arabs and Jews meet as equals. Muslim, Christian and Jewish doctors and nurses work side by side with both Arab and Jewish patients. This unique opportunity to service equally the Arab and Jewish communities with peaceful music captivated a small Jewish family foundation in California that agreed to fund the study.

Eliana was introduced to a member of the family foundation after she performed in Los Angeles during 2003. This woman was so touched by Eliana’s music that she encouraged her to immediately submit a proposal because the family was about to make a decision for the next year’s funding. The foundation subsequently agreed to fund the project for two years. Unfortunately we lost a large part of the funds both to hospital bureaucracy and taxes because we were not registered as a non-profit.

Before playing regularly at the hospital, Eliana and I needed to convince the entire NICU staff that our music would be beneficial. Our formal presentation to the staff included handouts of published studies and a live sample of our music. One of the head physicians, Dr. Shmuel Arnon, neonatologist, is also a trained cantor (Jewish liturgical singer) and took a special interest in having live music in the unit. It was Dr. Arnon who led the study and supported us every step of the way. But, it took several months of bi-weekly playing to build confidence and support from the entire staff. Live music in the Newborn Intensive Care Unit was a new idea and we were entering a highly sensitive part of the hospital. But, it really didn’t take too long for us to feel welcomed and completely comfortable. The nurses dimmed the lights as soon as we arrived and spoke in softer voices. Just the idea of having music in the NICU was calming and the staff said that it changed the atmosphere for the rest of the day.

We were funded to play for 100 hours at the hospital, including the time for the study. Eliana and I played for two hours at each session, usually from around 10am-12noon. We would move to different sections of three rooms depending on the need and if the mothers requested our music.

Eliana and I purposefully mixed traditional Eastern rhythms with Western harmonies. Eliana sang without words and played softly on a Turkish frame drum using Eastern rhythms. Sometimes she used a chain of small bells and other times only sang. I know that the drum is very controversial in this situation, but it was played very gently and to me it sounded like the closest thing to a heartbeat. By not singing in any language, the music was not defined as either Arabic or Jewish. Being inclusive to both cultures was one of the reasons we were there in the first place. A very important element regarding the rhythm was that Eliana often used the medical equipment and monitors as guides. If a monitor started beeping loudly, Eliana would stop playing the drum and use the tone and rhythm of the machine as a guide until the machine became quite. Rhythms used on the frame drum were often: Sofyan -Turkish 2/4, Semai- Eastern 10/8, Semai Darej-Turkish 3⁄4.

On the harp, I usually played in a major or minor key and improvised except when we played a traditional Turkish lullaby. I would follow the rhythms set by Eliana and also keep an eye on the monitors. The idea was to be as calm, steady and soothing as possible so that the babies would not cry, but sleep. I played on a harp built by Jack Yule of Scotland. It has 34 strings, which are all folk-gague gut except for the bass, which is wound wire.

The study was designed to test the difference in reaction between live, recorded and no music for newborn babies and was conducted over a period of several months. We needed to have healthy babies born after 32 weeks and weighing at least 1500 grams. So, the timing of the study was dependent on the supply of newborn babies. We played the same way whether we were in the study or not, but were more conscious of keeping a consistent volume and form to the music.

During the study we were in a closed room with dimmed lights, just after the babies were fed and played for 30 minutes. We then stayed in the room and sat quietly for another 30 minutes. I think that it was very important that we stayed in the room after we played. There was a soothing energy in the room that was not broken by the noise of leaving and doors opening.

The sentences in quotations are taken from the abstract of the study written by Dr. Arnon. The full study will soon be published in the nursing journal, “Birth”. It should be noted that although it is called ‘music therapy’ in the abstract, neither Eliana nor I are trained music therapists. Music therapy is a relatively new field in Israel and ‘music therapy’ was used for lack of a better definition.

Hypothesis: “Music stimulation has been shown to provide significant benefits to preterm infants. We hypothesized that live music therapy is more beneficial than recorded music and may improve physiological and behavioral parameters of stable preterm infants in the Neonatal Intensive Care Unit.”

Methods: “Thirty-one stable infants randomly received live music, recorded music, and no music therapy over three consecutive days. Each therapy was delivered for 30 minutes.” The babies were all born weighing more than 1500 grams, could hear and were healthy. “Heart rate, respiratory rate, and oxygen-saturation and a behavioral assessment were recorded, every two minutes, before, during, and after therapy, allowing 30 minutes for each interval.” “The infant's state was given a numerical score as follows: 1- deep sleep; 2-light sleep; 3- drowsy; 4- quiet awake or alert; 5- actively awake and aroused; 6- highly aroused, upset, or crying; and 7- prolonged respiratory pause >8 seconds. The volume range of both music therapies was from 55 to 70dB.

Results: Live music therapy had no significantly effect on the

physiological and behavioral parameters during the 30 minute therapy; however, at the 30-minute interval after the therapy ended, it significantly reduced heart rate (150 ± 3.3 beats per minutes before therapy vs.127 ± 6.5beats per minutes after therapy) and improved the behavioral score (3.1 ±0.8 before therapy vs. 1.3 ± 0.6, after therapy, p < 0.001). Recorded music and no-music therapies had no significant effect on any of the tested parameters during all intervals.”

Conclusion: ”Live music therapy is associated with a reduced heart rate and a deeper sleep at the 30 minutes after therapy. Both recorded and no-music therapies had no significant effect on the tested physiological and behavioral parameters.”

In retrospect, I think that 30 minutes was too short a time to measure the effects of live music. I believe there would have been a change in behavior during an hour-long session of music. But, those were the parameters of the study that were chosen. A short questionnaire was completed by the parents participating in the study and there was an overwhelming positive response to the music. The music was calming for the staff, parents and babies. Eliana and I were honored to have taken part in the first study using harp music and voice in a hospital in Israel.

Sunita Staneslow graduated from the Manhattan School of Music and her books of harp arrangements are sold around the world. She is a founding member of the non-profit harp organization NEVEL which is building a network of harp therapists in Israel.

Eliana Gilad, founder of Voices of Eden, is an internationally renown sound healer.Gilad has performed with Bobby McFerrin and Dr. Emoto of What the Bleep -a water crystal photo of her music appears in the film. www.voicesofeden.com

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Harp and Voice at Meir Hospital