How Music Unlocks Muscle Memory

It’s the 1980s and a woman sings Men of Harlech, a traditional and stirring Welsh folksong. Nothing unusual about that you might think. Sung by choirs, on battlefields, and in rugby crowds, it’s a song that’s deeply embedded in the Welsh psyche. But 80-year- old Hilda’s rendition was extraordinary. Hilda, you see, was living with advanced dementia.

I remember the event as if it was yesterday. We were working together on an art project and in the background Men of Harlech began to play. As soon as the introduction started, to our astonishment Hilda rose from the sofa, clasped her hands in front of her and sang the lyrics all the way through perfectly in Welsh.

What was most remarkable was that usually Hilda appeared to be completely disengaged from her surroundings. She spent all of her days sitting on the sofa with her eyes closed, and I had never heard her speak. My belief was that Hilda was unable to do anything – but how wrong I was.
UNLOCKING MEMORIES

What I learned that day was that If you find the right prop – it becomes the key to unlock the memories that may have seemed lost forever. That ‘key’ doesn’t have to be music, but it is a particularly effective tool to access meaningful moments. Why? Because music is processed and stored in so many different parts of the brain.

Most activity providers know that, if we know an individual’s musical preferences and history of any particular songs and tunes that relate to specific times, we can selectively use music to stimulate those memories as a reminiscence activity and so enhance self-identity. But music can do so much more.

Many of you will have seen the recent social media posting of a Prima Ballerina in her 90’s who is living with dementia. As she listens to Swan Lake, her movement memory is stimulated and she performs again with beauty and grace. https://www.youtube.com/watch?v=6-j5yeRDBaU

Or perhaps you saw the recent item which featured Paul Harvey, an 80-year-old former composer, living with dementia. Against all odds, Mr Harvey retained his innate ability to play music and remember compositions. He was able to do so due to muscle memory.

THE POWER OF PROCEDURAL MEMORY

This ability to still be able to complete well-rehearsed movement is called procedural memory and results in what is known as a skill. So, when we know that a person has a skill, be it playing a musical instrument or dancing a classical ballet, providing the right music and the opportunity will unlock that potential.

Music is particularly empowering as it not only supports a sense of self, but also stimulates physical health – from providing rhythm for movement to providing rhythm for the heart rate. Even this knowledge can enable care providers to think carefully about the music that is available to support individuals; not only selecting the genre to suit individual preferences but even choosing music with the beat to stimulate either relaxation or alertness. I have often noticed that calm, relaxing music is being played in care home dining rooms when, actually, some- thing with a faster beat would support more active dining

One of the most important observations I have made over my many years of working with people with dementia is that, whilst music itself can unlock the potential of individuals, it is often the accompanying social interaction that helps to reconnect the person with others. The joy of sharing music by singing or humming together, dancing together, playing an instrument together or simply tapping along or swaying to the beat – it is the togetherness that enhances the mood and nurtures the spirit.

OTHER ACTIVITIES THAT UTILISE MUSCLE MEMORY

But it is not just music-related activities that provide a ladder to seemingly lost memories. Any pursuit which bypasses the brain and utilises muscle memory – such as knitting for example – can deliver the same remarkable results.

I believe that learning through muscle memory, while widely known in dementia circles, could be more extensively utilised. Take the design of a care home bedroom, for example. If you think of a person moving into one, he or she will be used to the set-up of their bedroom at home. They will know from repeated movement around the room, the exact location of the wardrobes, the chest of drawers, the bathroom, the light switches and the plug sockets from muscle memory. And this stops them from getting lost and confused.
MAKING THE MOST OF MUSCLE MEMORY IN A CARE HOME

So why not recreate as similar as possible an environment for those living with dementia in their care home? While it might not be possible to create a room which is a carbon copy of a care home resident’s bedroom at home, it is certainly possible to replicate some furniture positions to enable them to navigate their way around the room using the same muscle memory that they would use at home.

But of course it is not as simple as that. Dementia is a very complex and nuanced condition and those living with dementia have different levels of functional ability. The question is, how do you integrate the science of muscle memory into the culture of a care home while accommodate all abilities?

The answer lies in the QCS PAL Instrument, which provides a highly effective framework to help professionals assess the level of functional ability of clients with cognitive impairments. The instrument assesses those living with dementia on four levels. But what are the different levels and what do they mean?

‘Planned’ means that a person with dementia is capable of carrying out a task by themselves, although they may need help with activities that need high-level thinking such as problem solving. At a PAL Exploratory level, they would need guidance, which is broken down into multiple stages. Those operating on a PAL Sensory level, require the carer to demonstrate each step one at a time, while at a PAL Reflex level, the person needs extensive support from their carer.

The QCS PAL Instrument supports care givers to understand the level of ability of the person. At a Planned Level, the person will be able to factually learn the new information about their room, for example, that the toilet door is right of the wardrobe. Identifying those at an exploratory and a sensory level will be important to understand that they will learn best through practising the repetition of movement, which enhances muscle memory.

On this note, I’ll always remember the story of lady, who was living with advanced dementia at a home I worked in. She had become very anxious after not being able to find the way back to her room. We decided to teach her how to find her way by using muscle memory. Firstly, we taught her how to get to her room by using the lift. That meant she needed to know which button to press. We practised and practised, together and before long, her muscle memory kicked in, and she knew how to get to her floor. Afterwards, by constantly repeating the short journey from the lift to her room, she was able to get there unattended. It took time, but it was a liberating experience for everyone involved, and demonstrated the extraordinary power of muscle memory.
QCS POLICIES

Back to music, which first alerted me to the remarkable capability of muscle memory, QCS has several policies in place, including a care plan and risk assessment for use when considering the use of meaningful music in every day activity, for example while helping the person to get dressed or to dine, as well as to support recreational activities. The National Activities Providers Association (www.napa-activities.co.uk) have some great ideas for supporting music based activities and the Royal College of Occupational Therapists, Living well through activity in care homes: (https://tinyurl.com/5wpaa38w) the toolkit offers some great ideas for integrating activities and music.

I will always be grateful for my experience in North Wales. Most of all it taught me about the magical effect that music can have on us all. It is liberating in the way it unshackles the mind, body and spirit. And most of all, as demonstrated in this article, it provides an accessible gateway to unlock learning through muscle memory. It has had an indelible effect on my life and can do on yours’ and your service users too. Why not give it a try?