Written by Dr Artur Jaschke (PhD/ScD)
Music-based therapies and interventions in the Neonatal Intensive Care Unit
“The intra-uterine sound environment, although beyond conscious recall, may leave a wordless and amorphous memory trace which serves as a template for all future rhythmic response and provides us with a lifelong sound and rhythmic symbolic image of security, thereby providing for continuity between intra- and extra-uterine life.”Isenberg-Grzeda, 1995, p. 145
[…] At around 16 weeks, while still inside the mother’s womb, the child can hear sounds, however, it cannot yet interpret these as sounds. From approximately 26 weeks’ gestation, preterm infants will have the capacity to react to auditory stimuli. Within the womb, a foetus hears their mother’s heartbeat, breathing and gait and shows recognition to the mother’s voice and, in some circumstances, the father’s voice as well (Perin et al., 2022, Blencowe et al., 2012). From 30 weeks onwards, the infant is able to distinguish between varying speech tones and timbres and is also able to process complex auditory sounds. This point likely marks the start of speech and language development. This shows us that the sonological or auditory environment in the womb is as important as its warmth, safety and nutrition 9Berg, Chavez and Serpanos, 2010; Bertch et al., 2020).
When a child is born preterm, and is placed into an incubator, the incubator keeps the child alive as it creates a warm and secure environment where medical procedures can be administered. The noises inside and outside the incubator, however, do not resemble the sounds of the womb. In recent research it has been shown that music in the form of individual notes or sounds, provided by a specially trained music therapist, has beneficial effects on brain development, stress levels and overall health of a child born preterm. It stimulates the growth of the brain network and, furthermore, adds to the bonding process between parents and child, where parents feel connected with the infant through music (Loewy & Jaschke, 2020). The therapist can incorporate any unwanted sounds, like the beeps, peeps and hissing of the air supply and heating apparatus, into individually chosen notes. Without such a therapeutic approach, the noise within the incubator could be harmful to the child. Some parents have reported that once at home their child could not fall asleep unless the hoover or hair-dryer was running; the sonic environment of the incubator has been imprinted onto the child’s memory.
To avoid this, active noise cancelling (ANC) technology can be used. This is very similar to state-of-the-art headphones. It is a sound system based on a high performing algorithm that actively reduces noise inside the incubator, creating a quieter and more comfortable environment. It works continuously over a broad range of frequencies adapting to various predictable and unpredictable sounds.
Unwanted vibrations, which turn into unwanted noise, are recorded and counteracted within milliseconds by an advanced AI algorithm. The vibrations and unwanted noise one would hear in the incubator are met with an opposing sound wave transmitted through the speakers. Microphones inside and outside the incubator record the sounds and contribute to enhancing the counter signal, thus creating a precise noise cancelling signal enabling a much quieter environment. Through directed speakers inside the incubator, the infant can be positioned in a sound-controlled circle; this is not a physical space but is created through the sound waves played from a transducer above the infant. This can be compared to standing in a shower cubicle, where the projected stream of water only hits a particular radius, allowing a person to be either wet or dry, depending on where they stand in the cubicle.
NEOSound is a music-based therapeutic intervention incubator (Jaschke & Bos, in press). It is a breakthrough in therapy for preterm infants and a wonderful example of augmented intelligence, where human intelligence and machine learning come together to work side by side. It is a controlled music therapy environment that monitors the child as well as creating a quiet environment, away from disturbing sounds both inside and outside the incubator and, at the same time allowing positive sounds, like voices and music, to be introduced to the infant. Hearing speech is important for the child to develop their own language abilities. Administering NICU music-based therapies and interventions allow for brain development, as well as minimising unwanted and potentially harmful noises, which add to the well-being and recovery of the neonate (van Dokkum et al., 2020, 2021; Span et al., 2021; Bos et al., 2021).
This is the point where both interventions and natural sonological surroundings come together, within a clinically implemented artificial framework, to reproduce the environment of each individual womb with controlled external inputs, such as the recorded womb sounds of the mother, the parents’ voices, and music-based therapeutic interventions. Machine-learning algorithms, together with motion capture video recording, will help monitor the baby and support clinical care (Jaschke & Bos, in press).
Imagine NEOSound as a small-scale, physical metaverse, where the musical intervention is based around the experience of the child in the incubator, rather than the incubator simply being a space to keep the child alive. Transferring the immersive experience of the womb to the incubator could potentially have significant health recovery benefits. In turn, it would close the gap between cognition and movement and how these relate to each other, reviving the discussion around embodied cognition. Investigating neonates in the incubator through movement, and the relationship between movement and cognitive development, shows us that embodied cognition is something innately linked to human development (Kraft et al. 2021, Loewy & Jaschke, 2020)
Learning from this controlled environment could lead to a significant breakthrough for our experience in the metaverse but, more importantly, to the revival of music and music-based therapies and interventions as a means of understanding our emotions, behaviour and cognition at the crossroads of artificial intelligence (Werger, Groothuis & Jaschke, 2021).
Before we translate this into a digital space, we have to first immerse ourselves in the physical world, understanding what the arts and music bring to it, how they influence our thinking and our behaviour. We do not need to turn our backs on technological evolution, but neither should we take it for granted, as it is our innate ability to be creative and to improvise that will allow for the next leap in the evolution of human knowledge and intelligence. […]
Excerpt from Mind the Music: on improvisation, Music and the Brain – (expected autumn 2023): HetMoet-Menard Press Amsterdam: London
Together with the Cambridge Centre for Music Therapy Research, The School of Medicine Chelmsford, University College Hospital London and the University of Cambridge, we are organising a Music Therapy in the NICU content day in 2024 (date tba). This session is meant to bring together national experts and health care professionals to present the benefits of Music-based therapeutic Interventions on health and well-being of both neonates and parents in paediatric care.
The goal of the session is to exchange, inspire, and innovate the field of Neonatology and Music-based therapies and interventions alike.
MT NICU Training
- NeoSound Noise Cancelling Incubator
- Music-based therapies and interventions and Kangaroo Care
- Effects of Music-based therapeutic intervention on neonatal brain development using (f)NIRS
- cybernEthics in Music-based therapies and interventions in the NICU
- Music Therapy for in Paediatric end-of-life care
- Music Therapy for reducing anxiety in hospitalized high risk pregnant women
- The Effects of a Group Music Therapy Program for Mental Distress in Parents of Very and Extremely Preterm Infants
Call for Special Issue (recently launched):
Follow the link to view the call for a special issue on neurohumanities – abstract submission deadlin is 30th September 2023: https://www.frontiersin.org/research-topics/56286/medical-neurohumanities-sharing-insights-from-medicine-neuroscience-and-music-in-pediatric-care
About the Author
Artur Jaschke (PhD/ScD) is Reader (Lector) Music-based Therapies and Interventions and in Ecologies of clinical Neuromusicology: creative AI, Music Sciences and Health Care Applications at the department of Music Therapy at ArtEZ University of the Arts in the Netherlands and Senior Clinical Research Fellow cognitive neuroscience of music at the Neonatal Intensive Care Unit, University Medical Center Groningen and the Cambridge Institute for Music Therapy Research (UK).
Contact: [email protected]
Berg, A. L., Chavez, C., and Serpanos, Y. Monitoring noise levels in a tertiary neonatal intensive care unit. Contemp. Issues Commun. Sci. Disord., 2010, 37, 69–72.
Bertsch, M., Reuter, C., Czedik-Eysennberg, I., Berger, A., Olischar, M., Bartha- Doering, L. and Giordano, V., The ”Sound of Silence” in Neonatal Intensive Care Unit – Listening to speech and music inside an incubator, Front, Psychol., 2020 https://doi.org/10.3389/fpsyg.2020.01055
Blencowe H, Cousens S, Oestergaard M, Chou D, Moller AB, Narwal R, Adler A, Garcia CV, Rohde S, Say L, Lawn JE. National, regional and worldwide estimates of preterm birth. The Lancet, June 2012. 9;379(9832):2162-72. Estimates from 2010.
Bos, M., van Dokkum, N.H., Ravensbergen, A.G., Kraft, K.E., Bos, A.F., Jaschke, A.C., (2021) Pilot study finds that performing live music therapy in intensive care units may be beneficial for infants’ neurodevelopment, Acta Paediatrica, online
Isenberg-Grzeda, C. (1995). The sound image: Music therapy in the treatment of the abused child. In: C. Kenny (Reds.), Listening, playing, creating: Essays on the power of sound (pp. 137-150). State University of New York Press.
Jaschke A.C. & Bos A.F. (in press), NeoSound Noise Cancelling Incubator: A medical Device White Paper, Frontiers in Paediatrics, section Technology.
Hutchinson G, Du L, Ahmad K. Incubator-based Sound Attenuation: Active Noise Control In A Simulated Clinical Environment. PLoS One. 2020 Jul 15;15(7):e0235287. doi: 10.1371/journal.pone.0235287. PMID: 32667931; PMCID: PMC7363066.
Kraft, K.E., Jaschke, A.C., Ravensbergen, A.G., Feenstra-Weelink, A., van Goor, M.E.L., de Kroon, M.L.A., Reijneveld, S.A., Bos, A.F. & van Dokkum, N.H. (2021), Maternal Anxiety, Infant Stress, and the Role of Live-Performed Music Therapy during NICU stay in the Netherlands, Int. J. Environ. Res. Public Health, 18(13), 7077
Loewy, J & Jaschke, A.C. (2020a), Mutual Interplay in Neonatal Development, in Music Training, Neural Plasticity and Executive Functions, eds Alain, Habibi & Colombo, e-book ISBN 978-2-88966-047-6
Loewy, J & Jaschke, A.C. (2020b), Mechanisms of Timing, Timbre, Repertoire, and Entrainment in Neuroplasticity: Mutual Interplay in Neonatal Development, Frontiers in Integrative Neuroscience
Perin J, Mulick A, Yeung D, Villavicencio F, Lopez G, Strong KL, et al. Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet Child Adolesc Health. 2022;6(2):106-15. doi:10.1016/S2352-4642(21)00311-4
Span, L.C., van Dokkum, N.H., Ravensbergen, A.G., Bos, A.F & Jaschke, A.C., (2021), Combining Kangoroo Care and Live-Performed Music Therapy: Effects on Physiological Stability and Neurological Functioning in Extremeley and very Preterm Infants, Int. J. Environ. Res. Public Health, 18(12), 6580
van Dokkum, N.H., Kooi. E.M.W., Berhane, B., Ravensbergen, A.G., Hakvoort, L., Jaschke, A.C. & Bos, A.F., (2021), Neonatal music therapy and cerebral oxygenation in extremely and very preterm infants: a pilot study, Special Issue 13(2): Music Therapy in the Neonatal Intensive Care Unit
van Dokkum, N.H., Jaschke, A.C., Ravensbergen, AG, Reijneveld Sijmen, A., Hakvoort, L., de Kroon, M. L. & Bos, A. F., (2020), Feasibility of Live-Performed Music Therapy for Extremely and Very Preterm Infants in a Tertiary NICU, Frontiers in Pediatrics (8)
Werger, C, Groothuis, M. and Jaschke, AC. Navigating Music Technology: Implementing a practise based application of music technology into music-based therapies and interventions and professional practise, 2021. ArtEZ Press: Arnhem