by Sabine Bilnik-Clauss

 Sabine Bilnik-Clauss

Born 1960, a social worker and a registered nurse. She has trained in the Peter Hess-sound massage, relaxation therapies (BTB) and aroma care, among others.

She has overseen various management activities in the field of nursing homes and is now a lecturer at the Niederrhein University / Department of Social Work. Since 2000 she is self-employed within the areas of consulting, seminars, lectures and moderation in all aspects of work with the elderly people. Sabine provides consulting, projects and seminars in your own premises with the topics of dementia, sound and other relaxation methods.

For those concerned with the effects of Dementia, it is of utmost importance to understand the use of singing bowls on people with this disease.

Dementia – circumstances of those affected and impact of the disease

The term “dementia” does not refer to a specific disease, but a wide range of symptoms. The broad category of dementia includes many diseases with the characteristic defects of the brain performance. It is a loss of mental ability, that is, memory and thinking disorders. The advance of the disease exacerbates symptoms, so that all normal activities of everyday life are affected.

The affected people are suffering from a progressive loss of memory. Something “just said” is immediately forgotten, as they can’t save any new information in their short-term memory. Also a long-term memory is affected by forgetting. There are problems in thinking and limitations of judgment, speech disturbances and cognitive uncertainties, for example in the use of everyday life objects.

The stages of dementia

To give the reader an idea of the disease progression and the escalation of symptoms, I briefly described the stages of dementia below.

Mild forgetfulness is in the foreground of the early stages of dementia. Affected people noted that, many times and over a long period, they postponed things repeatedly, they often seek for words in conversation, their concentration diminishes and they increasingly find themselves in an unfamiliar surroundings and can no longer find their way. This slowdown in orientation and feeling of performance degradation result in amplified uncertainty, hectic and anxious behaviour in everyday life.

The person concerned rather goes out of his way to withdraw from an unfamiliar or complex situations. The mood is rather anxious, depressed but also irritated or angry. At this stage the disease often result in the person mislaying important objects and thus accuse others of, for example, having taken this object.

The middle stage with moderate impairments, e.g. the lack memory retention is characterised by temporal and spatial disorientation. But the language ability distinctly varies. The ill person always loses the real issue in conversation and may not finish his sentences. The sentence structure is no longer maintained and little by little the concentration is lost. Gradually, the social ability to start a conversation would deteriorate and contacts with the environment are going to be more and more difficult.

This results in a retreat into a different periods of life (past), stored in the long-term memory in attempt to achieve security in the situation of forgetting the present. Restlessness and need to move and search for security very clearly describe the image of this stage and the situation of the individual. In addition, hallucinations, a disturbed circadian rhythm and a frequent change of mood occur.

A severe dementia at an advanced stage with a very extensive and physical impairments fundamentally changes daily lives of those affected. Due to the disturbances in coordination, gross and fine motor skills and balance, the sufferers are increasingly dependent on help and support of others. Unsteady gait, often stooped posture and ever increasing restriction of total mobility for the most part impede the independent living. The control of bladder and bowel movements no longer exists and the communication on a verbal level is almost impossible. Delusions and hallucinations can be mutually reinforcing, but also a retreat into their own inner world, so apathy or apparent apathy can be observed.

In addition to a more and more restricted physical situation, eating and swallowing difficulties come and that leads to the complete dependence on care of others.

Access routes to dementia affected people, one might perhaps think, can’t be achieved as the person ill with advanced stage dementia no longer or only little perceives their surroundings.

Everyone has different levels of strengths and abilities. We do not always need all of this capacity, but in the situation of people affected by dementia, here lie an unfamiliar and unusual potential to remain in contact with their environment.

Habits, routine actions, rituals, humour, but also understanding of the music and always at least parts of the long-term memory are some of the attainable accessibility options.

The sensory awareness opens up world of the senses. For through seeing, hearing, smell, taste and touch, we understand what is happening around us and can react to it. At this level, in all life situations until death, people need stimulation to perceive their surroundings. Inspiring a more pleasant sensations can therefore lead to greater alertness and increased responses to the direct living environment. It promotes personal contact, thus leading to a “significant” communication.

The emotional memory stores the feelings that connect us to an experience. This responsiveness to the emotional level is always open and creates a direct access to people suffering from dementia. I guide them with those positive memories into the most serene environment possible.

The atmosphere in which the individual lives, is one of the main ways to support and give a protected space for these positive feelings, as well as strong emotions such as rage and anger. To promote peace and relaxation and to incorporate appropriate opportunities into everyday life, are the important tasks in car

Perhaps the memory of the respective event is no longer comprehensible and can no longer be verbalised, but the feelings that were associated with it, are always noticeable to the sufferers.

So emotional memory plays an important, perhaps the most important role in the experience of the person concerned and his attendants.

Sound massage as a sound-relaxation with people suffering from dementia

Why can the sound-relaxation be effective and supportive for people with forms of dementia?

As described, those affected by the change in their symptoms are always on the lookout for something familiar, something that gives them a break in their state of forgetting, that is safety, security and basic trust.

Since sounds act on the whole body, it can favourably influence an imbalance on the increasingly important emotional level. In sound experience, no cognitive performance is expected, not thinking but the Feel is at the forefront and thus enhances the self-esteem of sufferers.

Unlike other methods of relaxation, the simplicity of the sound range does not overpower the sufferers. Often this needs linguistic guidance implemented (for example, Progressive muscle relaxation according to Jacobson) and a separate “training” to be practiced over a certain period. It shows him his existing capabilities and facilities in his own world, in a part of their own personal history. Sound accompanied us from the beginning of humanity. Early prenatal memories of sound, for example, the voice of our mother, but also oscillation and vibration are the feelings familiar to us. They can be felt at all levels and reach somewhere those affected for sure.

Based on the reactions during and after a sound-relaxation, mostly non-verbal, for example, through facial expressions, changes in breathing or muscle tone, an often very clear communication can be achieved. In this way we do not lose direct contact and remain so in a harmonious connection, ever with more extensive impairments as the disease progresses.

Encounter the sound, once carefully perceive it with all your senses, hear and feel, even without direct physical contact. The bowls  can be arranged around the bed or wheelchair. They can be used on the sound massage also as “musical” support. Experience with sounds music. Are reminiscent of the origin, the basic trust a meaningful supply and slow to adapt to a very unusual offer.

In order not only to take into account the spiritual but also the physical abilities, Peter Hess® therapy singing bowls are not put on like the classic sound massage on the body, but positioned close to the body. This allows for an intensive emanation of the oscillations of the bowls placed on on the bedspread, the positioning pillows, a rug or a small cushion in the wheelchair. The sound offering can be done with the universal bowl, but also with the additional small pelvis bowl or completed still with the supplementary heart bowl.

To strike the singing bowls very carefully and gently, because the effect can be felt more than heard. The waves of sound are sent through the body gently massaging and are perceived by the patients at all levels. The result is again ‘order’ and inner balance.

The position of Peter Hess® therapy bowls is chosen based on the classic Peter Hess-sound massage.

Starting with the joint, or universal bowl at the foot, the small pelvis bowl in the area of the buttocks to the chest area. It is important in this case also, if possible, both sides of the body to beklangen. Even though the heart bowl is used, this should rather far from the body may be placed in the shoulder head area on a small table or shelf. Here I was always observe for a sensitivity into the acoustic perception of “high” tones into the vicinity of the ears.

In the seated position, the (universal)joint bowl is placed at the feet on the floor and tried the small pelvis bowl on a pillow or a folded blanket on the thighs. At the head and shoulder area, the heart bowl can, set by the side or around the wheelchair, be used continually.

After a sound-relaxation the sufferers should also have time to consider. The important thing is to observe for a while to perceive any reaction of relaxation. This is done via the communication by the breathing, muscle tone and nature of changes in the skin. Sound relaxation can also activate, excite, make the new order conscious. Often the effect depends on the starting state, rather sleepy, introverted or restless with strong urge to move.

From practice:

Project “Touching support” – contact for people with severe dementia

To be able to undergo the described hereinafter experience in working with sound, requires the potential of an intense and understanding cooperation.

The project “Touching support” exists since the fall of 2007 in the Joachim-Neander—House in Diakonie in Dusseldorf / Benrath. It is designed for people with severe dementia at an advanced stage and is regularly offered by me as an external associate. It’s an individual support, linked to the biography of each resident. Focus of those sessions through variety of impulses through whichever medium, is to stimulate senses and promote relaxation and well-being.

I would like to describe some encounters with residents as part of this project, in which sound is used as a supporting element for relaxation and wellbeing.

Meeting with Mrs. D.

I meet Mrs D. today. She was lying on her side in the bed of her hospital room. She opened her eyes and looked at among others, pictures on the wall and the wallpaper. I can contact her by softly speaking, initial contact on the right shoulder and direct eye contact. She seemed to recognise the situation and moved her mouth into a smile.

Mrs. D. is permanently bedridden and very limited in her communication options. Her body builds great tension. Her arms are bent, her fists clenched, her back hard and  palpable with tension, the head often shows a slight hyperextension. The sound-relaxation leaves Mrs. D. in an obvious state of relaxation and wellbeing.

The gentle, but rhythmic decline of the singing bowls sound in the proximity of the feet and on both sides of her body around hip and heart area (wherever the placement is possible) firstly causes a basic relaxation and promotes a peaceful atmosphere of contact. The primary focus of this session is a touch by bodily contact, but also a touch by the sound.

In particular, touch by the hands, leaves Mrs D with noticeably less tension during the sound. The steady sound of the singing bowls carry on the sense of safety and security. This also is gradually noticeable to Mrs. D. and changes the overall impression of her situation. A deepened breathing also release tension from other areas of the body, e.g. the back becomes softer. Mrs. D. may allow more and more direct physical touch and indicate through her facial expression, especially around the mouth, well-being, tranquility, but also an active interest in her surroundings.

With the end of the sound-relaxation I stay in physical contact for a little while, holding her hands, soft now, gently stretching previously clenched palms, rubbing carefully with calm movements. This part of the session can also be supported by a quiet, relaxing background music and I can say goodbye until next time.

Mrs. D. is very relaxed, her eyes closed, breathing quietly, her face is soft and her mouth opens a little. The hands and fingers are loose and spread out or under her blanket and a smile can be seen on her face.

Another meeting with Mrs M.

Mrs. M. can spend a few hours of her day in a wheelchair. I pick her up at her table and go with her to a quieter lounge area. We sat together here a few times already and I can put a chair opposite. I brought for her a Universal bowl and three Bengali singing bowls (triad).

Mrs. M. is at a stage of the illness where she experiences a lot of self-motion. Her body as a whole, but above all hands and arms, always appear to move. This hardly leaves time to pause and strongly affects her facial expressions. Her eyes are wide open and she verbalises through silent, but in a response often, a louder groan.

Even today, she is restless and movements, mainly of the right arm, take all her attention. I touch her hands and she holds them fixed for a moment. I try to establish a direct contact with the eyes and to approach her with my face. She comes towards me very close and puts her cheek against mine. Her arms and hands are on my shoulders and I can pause  for a moment.

She then leans back in her wheelchair, closes her eyes and her arms and hands are placed on the armrests. I now put a small pillow on her knees and thighs and offer her the sound of the Universal bowl.

The movements of the arms continue, but slowly, with pauses, stop and she briefly closes her eyes. The gentle decline of the singing bowls sound has also a calming effect on her trembling legs. More and more she comes to the rest, her face looks relaxed and she verbalises quietly. Her breathing deepened and she may sit back and  relax even longer. Her hands encircle the singing bowl so she can also experience direct physical contact through sound.

Also with Mrs. M., after the end of the sound session, I stay a short time in order to support the effect of the relaxation. The decline of the Bengali singing bowls on the table is this sessions finishing touch and again leads to a relaxed and musical sound experience.

Meeting with Mrs S.

I also meet Mrs. S. in her room. She is completely bedridden and lies on her back in a slightly elevation position. The head is a little overstretched and she looks at the ceiling. Colourful ribbons or the image of a coloured light projector stimulate her visual senses. Her arms are bent and her hands constantly in motion – fast and restless. She fixed on me for a brief period of quiet speech and initial touch on her right shoulder.

Here, I have option to use all three Peter Hess® Therapy Singing Bowls. The (universal)joint bowl at the foot and pelvis bowl at hip and rib cage are supported in their position by a small positioning cushions. I place the small heart bowl at the shoulder/head height on the bedside table or a shelf.

A basic relaxation is achieved after the first sounds and Mrs. S. pays attention to the sounds and vibrations. She looks around, her hands stop and it seems as if they want to adjust the rhythm of the sounding.

As I begin first on her feet, it takes some time, until all three bowls resonate in succession. Now Mrs. S. is watching quietly. Her hands are soft, the arms loose, their movements continue. She reached with her hand to her forehead and then re-connect both hands at the level of her sternum. Her breathing is deep and I can now touch her forehead, hold my hand quietly and stroke from the eyebrows to above her hairline. Mrs. S. enjoys this contact and can also close her eyes. This mood holds on for a while until the bowls are all faded away again. She is relaxes, the face is softened (her forehead smooth, her eyes closed, her mouth slightly open) and she breathes again from the very deep.

Conclusion

The encounters in this project do not only affect the sufferers themselves. I always experience a very strong sense of connectedness in a sound-relaxation. The communication on an emotional level through sound helps to maintain contact with each other.

Colleagues in the field of nursing repeatedly confirm long-lasting periods of relaxation that they can observe with the residents following the sound sessions. It brings a positive change in many areas of care, e.g. it facilitates the regular break for partially bedridden sufferers, which can make life more gentle and enjoyable for the sick person.

Also, the feedback of the relatives who temporarily are able to observe the session or be integrated on request, is very positive. To experience the sufferer in the relaxed state, or themselves make contact intensified through sound, is often a new, but important experience. Often at a time of “voicelessness”, allows to reach those affected even closer and more intensely where they can stay in touch, without language, at the level of tangible emotions.

However, the experiences described presuppose also to have dealt with the life story (biography work) of the patient and thus be able to build on positive events.

The importance of sound experience in people with forms of dementia • • •

• Sound may touch – it is a companion, also in difficult life situations.
• Sound reaches the people on the level, which is always open for a direct contact with its environment.
• Sound is a more mindful way, especially in the described situation with people suffering form brain disorders. Be mindful of yourself, be mindful of others, do not overwhelm, have no expectations, have no right to the outcome, let it happen and enjoy the incoming diversion.

The sessions described above make these principles clear. The objectives; an improvement of the general condition, visible well-being, safety, joy and connecting with each other, are usually achieved in a short time.

The different life and illness circumstances always indicate the direction. The dementia patient is directing – to recognise those signals and to provide a customised session for this moment, requires a great deal of empathy, but also a wealth of experience with other relaxation techniques, media and methods to promote awareness and a sense of relaxing atmosphere.

Dealing precisely with the diseases and their different symptoms, but also being able to evaluate nursing situations allows the sound-relaxation session to be a positive experience for the person concerned.

The emotional memory will let such positive feelings be felt always at every sound, because we remain receptive to feelings till the end of life, and thus through sound we always remain connected.

©Translation and edit: Alex Andrzejewski (Maranta Sound Academy)