Music and Multimodal Stimulation as Developmental Intervention in Neonatal Intensive Care

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ABSTRACT: Among developments in neonatal intensive care music therapy clinical services is the music and multimodal stimulation (MMS) procedure established by Standley (1998). The procedure incorporates principles of auditory, tactile, vestibular, and visual stimulation toward the goal of optimizing premature infant development. Since its conception, the procedure has grown into a comprehensive program of developmental intervention, involving not only infants, but also their parents and caregivers. This article includes an explanation of the needs of premature infants in a Neonatal Intensive Care Unit; MMS procedure development, clinical implementation, and benefits; parent and caregiver involvement; and program modifications. Implications for future research are also discussed. Of all infants born annually in the U.S., 11.6% are premature and 7.6% are of low birth weight (LBW). Premature and LBW infants that survive often do so with compromised neurological development (Martin, Hamilton, Ventura, Menacker, & Park, 2002) and usually require lengthy hospitalization (White-Traut, Nelson, Burns, &Cunningham, 1994). Consequently, early intervention begins in the Neonatal Intensive Care Unit (NICU). The environment of the NICU may interfere with the maturation and organization of the infant's central nervous system and fail to meet the infant's developmental needs (White-Traut et al., 1994). Infant neurological development is cephalocaudal and proximodistal, manifested in initially more fully developed receptors of tactile and vestibular stimulation than those of hearing and vision (Owens, 2001). The nature of the NICU can overstimulate the lesser developed distance receptors through continual presence of bright lights and noxious sounds and neglect the more mature tactile and vestibular pathways (White-Traut et al., 1994). Also potentially disrupting to the infant's growth and development are the necessary caregiving and medical procedures (e.g., diapering, bathing, dressing, feeding, assessments of vital signs, lab tests, intravenous line insertions, eye exams, administrations of medications, etc.). Because of restrictions caused by medical needs and staffing limitations, infants in the NICU have minimal opportunity to experience normal cause and effect relationships (e.g., crying to be picked up, fed, etc.) that are vital to cognitive and behavioral development (Vickers, Ohlsson, Lacy, & Horsley, 2000). Research about fetal learning has suggested that the NICU, in addition to providing for the medial needs of the infant, should also provide the necessary requirements for learning through contingent experiences (White-Traut et al., 1994). Appropriate intervention can be effective in promoting growth and development of premature and LBW infants by combating unnatural and potentially stressful environmental factors, and by offering tactile stimulation that would have been provided in the womb (Vickers, Ohlsson, Lacy, & Horsley, 2000). Vickers, Ohlsson, Lacy, and Horsley (2000) compared multiple studies incorporating developmentally based progressions of tactile stimulation, and discovered that infants receiving massage had mean hospitalizations 4.6 days shorter and mean average daily weight gains 5 g greater than those not receiving massage. Motionless touch, on the other hand, appeared to lead to a mean average daily weight loss of 0.2 g. Across multiple studies examined by Field (1995), the provision of separate or combined auditory, tactile, vestibular, and visual (ATVV) stimulation for premature infants has resulted in the following: * increased weight gain * developmental enhancement * lower levels of anxiety and stress hormones * improved overall infant health and immune functioning * more responsive, awake, and active infants * less exhaustion * better state regulation * improved muscle tone * shorter lengths of hospitalization. …