Nursing Homes	Other Care Facilities
Nursing Homes Rehab (PT,OT& ST) Recreation therapists	Hospitals/Acute Care Assisted Living SCUs PACE Sites & ADCs

Benefit	Measure	Cost Effect
Reduced Yelling	Less yelling frequency & volume	Rent adjacent bed, reduce aide requirements
Improved Eating	Weight gain, time spent eating	Reduced labor, medical fees & violation fines
Less isolated dining	More group, less assisted eating	Reduced labor (can eat with others in room)
Less Sleep Problems	Time/nights reported out of bed	Reduced labor, improved sleep & health
Less resident stress	Less infections/comorbidities	Reduced meds titration, less violations/fines
Less unsafe wandering	Less fall reports	Reduced risk, medical costs & time out of facility
Increased sociability	# & quality of communications	Less 1 on 1, better family relations & activities
Reduced sundowning	Fewer resident sundowning	Labor use, less resident/staff stress (turnover)
Less incident reports	Reduced ER visits	Less labor, ambulance, medical/medication cost
Less neuroleptic meds	Reduced polypharmacy & ADRs	Reduced labor, staff stress, resident medical cost
Less resident isolation	More activities/communications	Less labor, better family relations, marketability
Reduced aggression	Reduced incident reports,	Reduced workers comp, residents medical costs
Improved esprit de corp	Reduced tardiness, call-offs	Reduced overtime expense & agency fees
Reduced staff turnover	Reduced staff turnover	Reduced recruit/hire/screen/training expense
Empowerment of staff	Increased # aide interventions	Fewer nurse interventions (more time managing)
More staff knowledge	Pre-post tests on dementia	Improved survey (know how to respond)
Less staff depression	Pre-post depression testing	Better job performance, reduced health claims
More staff solidarity	Pre-post employee climate test	Less agency fees or recrui/hire/screen/expense
Improved overall health	Longer average resident stay	More revenue/resident, less marketing expense
Gain innovator image	More referrals, longer waiting list	Increases occupancy/revenue, less marketing

Intervention	Behavioral Explanation	Prescription
Gait Training	Large muscle, depth perception losses + inactivity, poly pharmacy,psycho drugs inrease fall potential	Use implicit learning for patient to learn to tie heavily entrained beat to even gait
Range of Motion	Abbreviated conscious attention span + memory impairment make ROM participation rates low	Same songs on graduated beat CDs increases patient pace for improved aerobics  & ROM
Neuromuscular re-education	Cognitive losses can create pseudo losses in coordination and muscle control, need switch to implicit	Music provides background & sung instructions for patient to “learn” ADL procedurally + Montessori
Pain Management	Unexplained pain shorten attention span, distracts wounded conscious	Used to distract patient from pain generated by ROM or elevated pace
Wound Care	Chronic confusion -> stress which depresses immune system	Relaxation reduces cortisol, improves healing and immune response
Improve strength & endurance	Patient easily distracted by pain and confusion which inhibits activity & exercise participation	Music increases participation rate and extends exercise/dance/sing time as it maintains focus (graduated beat CDs)
Orthotic/prosthetic	Loss of conscious processing makes following steps difficult. Need to build procedural memory for activity	May be used as an understood cue to trigger physical exercise e.g. marching, dancing, singing
Functional mobility skills	Habilitation requires greater demands on attention/cognition than Patient normally can gather	Music uses entrainment to raise patient attention span, cognition and short term retrieval
Injury prevention	Loss of muscle control, judgment, & memory lead patients to do things with increased patient risk	Retrain patient to make non -conscious decisions avoiding risks using auditory & prosthetic devices

Intervention	Behavioral Explanation	Prescription
ADLs	Short/long term memory & attention span losses make sequencing through multi-step activities difficult	Patients relearn an ADL using music & or singing to cue ADL steps. Lyrics cue next steps
Adaptive equipment	Earphones may be used to focus attention, tune out other stimulation & accommodate more active patients	Use of earphones to reduce need for stimulation & dangerous activities such as wandering
Safety Management	Patient has a need to self stimulate, move toward or away from stimulation	Use of sensor triggered music to distract patient from unsafe behavior e.g. elopement
Cognition management	Patient neural/chemical deficits decrease coordination of messages and coordination of cognition	Exploit entrainment (Mozart effect) to generate short lived cognitive improvement
Upper extremity, fine muscle control	Patient “forgets” conscious how to consciously control muscles or that extremity is in fact theirs	Use music to make it easier for patient to “learn” steps in muscle/coordination exercise
Contracture management	Some muscle contracture may be induced though chronic fear/anxiety	Use music to reduce stress induced withdrawal or contracture
Job analysis/modification	Patient retains motor memory from over practiced motions/activities but activating them can be difficult	Use music to provide a background on which the patient learns cues to ADLs or therapy routine
Bathroom safety	Fear of overlit, industrial, cold & threatening bathroom or safety tub causes patient to avoid bath/toilet	Use battery operated CD player in bathroom, to reduce confusion and avoid stress

Intervention	Behavioral Explanation	Prescription
Verbal/written expression	Questioning, testing or any activity with fear/failure potential inhibits remaining cognitive/memory ablities	Use type of music for mood management and to reduced “performance” stress
Auditory comprehension	Attention/memory deficits make expressing/understanding verbal communications increasingly difficult	Use music to sing instructions for improved communications and comprehension
Reading comprehension	See above	Use music to reinforce read lyrics  sing along
Cognition management	Over stimulation, environment or schedule change create confusion stress & diminish remaining ability	Use entrainment to improve attention span and temporary cognitive
Alternative communications	See above (auditory & reading comprehension) which can cause emotional liability or profanity	Use sung communications to improve patient comprehension and participation
Swallowing/dysphasia	Confusion generated by wounded conscious processing of swallowing process inhibits swallowing process	Engineered music hijacks wounded consciousness processing; frees procedural swallowing memory
Sensory Integration	Reduced conscious attention span decreases ability of patient to integrate multiple sources of sensory stimulation	Engineered music may be used to facilitate the introduction of other sensory stimulation and prolong patient exploration and enjoyment
Dysarthia	Muscle atrophy and/or aphasia (e.g. DFL) make speaking difficult or impossible	Use song lyrics for exercise and for regaining speech ability for problems not associated with neural loss
Apraxia	Inability to follow instructions may, relearn/learn new activities actions particularly in Parkinson's or LBD	Some relearning can take place through Montessori techniques or in relation to engineered music