The use of music therapy to assist children who have severe burns

Australian Journal of Music Therapy, Annual, 1994 by Jane Edwards

Abstract:

Music therapy is a valuable tool in distracting children with severe burns for the pain experienced in daily debridement baths. Music therapy allows choice, facilitating the child's sense of being in control, and provides an atmosphere of safety and comfort.

This paper reports on the role of music therapy in assisting children aged from eighteen months to five years during daily debridement procedures in the burns unit of a children's hospital. Songs of the child's choice were sung by the therapist. accompanied by guitar. The observations of the therapist indicate that music therapy, presented in this way can offer relief from anxiety prior to the bath and is helpful in comforting and distracting children during the bath.

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The pain which accompanies treatment procedures following a severe burn is often viewed, by adults, as more stressful and painful than the injury itself (Achterberg and Kenner. 1988). Pharmacologic intervention offers some relief but it has been argued in the case of children that their level of pain is often underestimated (Knudson-Cooper and Thomas, 1988 cited Adler, 1989). Attempts to alleviate pain can therefore be inadequate to the needs of the child.

The research literature pertaining to the use of music therapy in daily debridements is limited. So too is information on the provision of assistance in psychological preparation and support during the experience for people of all ages who undergo daily debridements. The research literature available, however, indicates that techniques are available which can assist in management of pain experienced in debridement.

Distraction techniques have been used successfully to focus children's attention away from physical pain and onto an object or activity (Kelley, 1984: Fowler-Kerry and Lander. 1987 and Rasco. 1992) so reducing levels of pain experienced. Music is an effective distraction medium. It is a structured and engaging medium which may have positive associations with events and contexts outside the hospital, such as family, home and school, facilitating an environment of safety and support.

Fowler-Kerry and Lander (1987) assessed the value of music distraction and suggestion on the experience of pain reported by children receiving routine immunisation. 200 children aged from 4.5-6.5 years were involved in the study. Music distraction was found to significantly reduce pain. Suggestion did not reduce pain and there was no significant difference found between the group which received suggestion with music distraction and the music distraction group.

Rudenberg and Royka (1989) report the benefits of music therapy in addressing the needs of the child with severe burns. They support the role of music therapy in promoting psychological preparation for painful procedures. These techniques include teaching relaxation techniques for use prior to treatments with discussion and songwriting used as a means of exploring feelings relating to the experience of treatment. There is, however, no mention in their report of the role of music during debridements.

Schneider (1983). in a study involving burned children who were receiving dressing changes, suggests pain intensity is greater with decreases in health and locus of control and increases in anxiety. Therefore. the degree of pain experienced is person-specific and is impacted by a group of factors. A reduction in anxiety can contribute to pain reduction.

Ward (1987) used music and relaxation techniques to assist five burned patients receiving daily debridements. The people in the study were aged 13-96. They acted as their own controls receiving music with progressive muscle relaxation. or no music with every second debridement over 14 days. Heart rate was recorded before and after the debridement. Without music, heart rates increased significantly after debridement. Where music was used in the debridement, heart rates stayed the same as before. This indicates that music may have assisted in reducing anxiety associated with the experience.

A similar study by Achterberg and Kenner (1988) compared the effect of relaxation, relaxation and mental imagery, and relaxation, imagery and thermal biofeedback using psychological and physiological indicators of pain and distress. Their study observed 149 adults undergoing daily debridements. Each person received six sessions. The three experimental groups received benefit with the relaxation group showing the least positive effects. The group receiving relaxation, imagery and biofeedback received the greatest benefits but the researchers recommend that the extra equipment and personnel required to use biofeedback in treatment is not warranted by the small increase in benefits in comparison to positive effects received from relaxation and imagery. It is therefore concluded that mental control during the debridement assists in managing the pain associated with the experience.

A bath for debridement purposes can range in time from 10 minutes to longer than 45 minutes depending on the size of the area of damaged skin. Before the bath, the child has all dressings removed and following the bath has dressings replaced. The entire procedure can take up to an hour or longer and can be exhausting and distressing for the child as each aspect of the procedure can be painful or at least cause discomfort.