ابزارهای دوسویه برای ترویج خلاقیت موسیقی در افراد مبتلا به زوال عقل

Dementia is a growing problem that affects the lives of those diagnosed and caregivers, with symptoms having an effect on memory, communication, the ability to learn new skills and problems with behaviour, such as aggression, agitation and depression. Participation in activities can improve quality of life for people with dementia, reducing behavioural problems and aiding relaxation. Research has established that people with dementia can be both artistically and musically creative, and have an appreciation of music even in the latter stages of the disease. The symptoms of the disease, however, mean that supporting music making activities with this group of people is challenging. This paper describes a prototype system designed to enable people with dementia to create music, using a touch screen interface to control a system which utilises chords to create pleasant-sounding music regardless of any prior musical knowledge. Results of usability studies suggest the system is easy to use, and that pleasant-sounding music can be created with it. Participants, including people with dementia, appeared actively engaged during use of the system, many reporting they enjoyed the experience. Future testing will establish the degree to which people with dementia could be musically creative using such a system.

Dementia currently affects over 27.5 million people worldwide (Wimo, Jonsson, & Winblad, 2006), and with the aging population steadily increasing, the number of people with dementia is expected to rise. Ferri et al. (2005) estimate that the number will double every 20 years and will exceed 81 million in the year 2040. Given the problems associated with the condition, such an increase in the number of people with dementia is likely to have far-reaching consequences on families and available community resources. Dementia, a condition that more commonly affects older people, encompasses a range of brain disorders that progressively damage extensive areas of the brain, eventually leading to cerebral failure. The main symptoms of dementia are memory impairment, a decline in cognitive function, and problems with executive functioning (affecting the ability to use imagination, organise and forward plan). Normal everyday functioning is affected because of this damage, and an individual’s condition will deteriorate over time (LoGiudice, 2002). Although finding a cure for such a debilitating condition is important, researchers also recognise the need to provide a better quality of care for people with dementia with facilities that enhance day-to-day living. There are various ways in which the safety and care of people with dementia can be improved, for instance by training and educating caregivers (Jacques and Jackson, 2000 and Kitwood, 2005) and using assistive technology (Astell, 2005). Another successful strategy is to provide meaningful activities that people with dementia can participate in on a daily basis. These activities should reflect both what individuals would like to do and what they are able to do. Volicer and Bloom-Charette (1999, p. 8) believe the provision of meaningful activities for people with dementia ‘is the most important factor, but the hardest to achieve’. Their investigations, involving people with dementia who also had a diagnosis of depression, found a 90% improvement in mood when participants were involved in meaningful activities. Although there are benefits associated with participation in activities, the symptoms of the condition make it difficult to devise activities that are accessible. This is caused by the person’s problems with short-term memory, communication difficulties, decreased concentration levels and their inability to learn new skills. Research is therefore being carried out to develop novel and interesting activities for this group that are nevertheless failure-free – that is, activities for which there is always a successful outcome. If effectively implemented, such activities could enhance the lives of people with dementia and improve their social interaction and day-to-day living (Alm et al., 2005). Research has established that people with dementia have the capacity to continue to participate in a variety of activities and tasks. It has been suggested that they can retain existing and develop new creative skills, both artistically and musically, despite the dementia (Miller et al., 2000 and Miller et al., 2005). It has been thought for some time that music can be experienced and enjoyed by people with dementia, and recent research suggests this is evident even in the latter stages of the condition (Clair et al., 2005 and Cuddy and Duffin, 2004). However, without a specialist music therapist present, musical activities provided by caregivers tend to be passive, i.e. listening to music or to others singing. Where music therapists provide active music making sessions, they often opt for simple percussion instruments for basic rhythm making (Vink, 2002). This is because the use of traditional musical instruments for this group would be impractical, not only because the symptoms of the condition would make it difficult to learn to play such an instrument, but also because playing musical instruments successfully usually requires prior training. Thus, although there are recognised benefits associated with the provision of musical activities, caregivers lack the resources and possibly the skill to support active music making sessions. There is thus a need to develop a novel instrument that could make creative music making accessible to people with dementia. This research explored the development of a system that could enable people with dementia to be creative through active music making, whether they had pre-existing skills or not. The system was designed to be easy for caregivers to support, providing an engaging and enjoyable activity for those participating, with the added potential to increase social interactions if used in pairs or groups. It was hoped that the quality of life for people with dementia and caregivers could be improved through this creative musical activity.

The study with people with dementia established that they were able to use the system to create pleasant-sounding music, and that with minor adjustment, the system could provide an easy way to bring active music making to people with dementia, whether for use at home, in residential housing or in day care centres. Using the system to play music to two other people provided a positive experience for participants, and, if the prompting system is made more effective, the system could provide an activity for individual use, as well as for use in pairs or groups. As Holmes, Knights, Dean, Hodkinson, and Hopkins (2006) showed, live music is received particularly well by people with dementia, and this system could give a sense of empowerment to users if playing for others, as well as the potential benefits for those listening. This system has been shown to be easily supported by carers, which confirms its potential as a regular activity for people with dementia. These studies suggest that carrying out evaluations with healthy older adults may be a useful way to gather information when designing for people with disabilities of the same age. Observations may also highlight similarities in behaviour between both groups, and although this does not help designers establish if their systems for creativity and leisure activities are usable, they may be able to use this information to gain an insight into how their target group might react. Further evaluations will be used to establish whether people with dementia can use the system to be musically creative. If this is shown to be the case, further selections could be added to future versions. This could include providing options to select music style as well as mood, for example sounds that portray classical, country or jazz genres. A variety of instrument sounds, screen colours and shapes could be provided, enabling the system to be fully customisable for individuals. Additional information gained from further evaluations will focus on the potential of people with dementia to communicate emotion through music, leading to future research to develop a tool that could enable people with dementia who have severe communication difficulties, to express their feelings. These investigations have suggested that active music making could be used as a means for people with dementia to be creative, a way for them to be empowered by sharing their musical creations with others, and potentially as a means for those with language problems to communicate emotion to others.