PSYCHOSOCIAL FORUM
Editor
Marion Doctor, LCSW
Denver, Colorado
Guest Editor
Christine Tuden, MS, MT-BC
Galveston, Texas
Management of pain for burn patients during debridement is
a challenge for all clinicians working within the burn care
team. Applying the gate control theory of pain, Prensner takes
a systematic approach to address the “chronicity and intensity”
of procedural pain by developing specific music therapy pro-
tocols. Prensner contends that the structure and innate qual-
ities of music make it a versatile therapeutic modality, which
can affect both the physiologic and psychological aspects of
the pain experience. She clarifies the value of music therapy as
another strategy for pain management that can enhance con-
ventional treatment approaches offered by the burn care team.
Prensner makes numerous valid assertions on the benefits
of music therapy in pain management, but primarily takes a
cognitive-behavioral approach in discussing the music thera-
pist’s role in assisting patients in this area. In addition to this
theoretical orientation, attention can also be given to the role
of the patient in the music therapy process. As an adjunct to
Prensner’s article, I encourage the reader to keep in mind that
a concern in working with any patient in the medical setting is
the need to involve the patient actively in the therapeutic pro-
cess. It is important to remember that only the patient fully
understands his or her own pain experience. When defining
music therapy, both the therapeutic relationship and music
exist simultaneously within the healing process. In addition,
we need to consider situations where using music may be
inappropriate or counterproductive to the patient’s needs. In
these cases where music may be overstimulating, the therapist
needs to rely on the therapeutic alliance to assist the patient
through the difficult or painful period.
In one case example Prensner describes a female patient
who coped with pain by singing during her dressing change, a
technique the patient used with the music therapist on the
previous day. This scenario clearly illustrates the therapist’s
ability to help patients identify their individual strengths and
coping skills and achieve a level of increased independence.
Some patients cope better by singing familiar songs, and some
may need to participate in creating music, whereas other pa-
tients respond better to passive music listening with imagery.
Regardless of the therapeutic intervention, the patient should
always be encouraged to participate actively in the assessment
process. Once coping skills are identified and further devel-
oped, the most successful interventions are those where pa-
tients learn and use the techniques on their own.
There is a multitude of strategies used by music therapists to
cope with pain and anxiety. In her article Prensner defines 4
82
specific music therapy interventions that have been developed
as effective music therapy for pain management. These tech-
niques are well explained and provide a clear understanding
and rationale for music therapy in burn care. Prensner also
describes the use of multiple therapy protocols during a treat-
ment session and uses several case examples to demonstrate
application of the protocols. By using both physiologic and
psychosocial outcome measures, the author is able to provide
a holistic determination of intervention effectiveness. Al-
though an elaboration on the assessment process for deter-
mining which protocol to implement would have been a use-
ful addition, this section does invoke the reader to consider
different scenarios. For example: How actively were patients
involved in the process? Did most patients receive individual
music therapy sessions before the procedure? Further, could
the frequency or number of music therapy interventions dur-
ing debridement influence patient outcome? The answers to
these questions would certainly provide a more in-depth un-
derstanding of the approach used by the author.
When using specific music therapy protocols, Prensner’s
approach is to divert the patient’s attention away from the
painful stimulus. The author uses the words, “redirect and
distract,” to describe methods of coping. Although these tech-
niques can be successful, it should be noted that in some
instances using music as a means of assistance and integration
could be more empowering for the patient. Prensner’s state-
ment that interventions should “engage the patient’s atten-
tion as much as possible” is an important concept. In an en-
vironment such as the debridement room, where loss of
control is a critical issue for all patients, active music engage-
ment techniques offer patients the chance to regain control
over their pain and discomfort. Developing techniques that
involve and engage patients through the process can foster a
sense of self-control and independence. In addition to Pren-
sner’s protocols, another technique to consider is drumming
in combination with deep breathing. Rhythmic drumming is
alternated with deep breathing exercises, in which the patient
takes a deep breath and then beats on the drum as loudly as
possible while exhaling. This action allows the patient to have
a physical release for the pain he or she is experiencing. When
patients have an increased awareness of their physiologic and
emotional responses to pain, they can begin to alter their re-
sponses and regain control.
Music therapy is a 2-fold modality, in which the music and
the rapport developed between therapist and patient play
Journal of Burn Care & Rehabilitation
Volume 22, Number 1 Prensner et al 83

complementary roles. Consequently, a greater emphasis on
the role and the importance of the therapeutic relationship
would have been a useful addition to Prens-
ner’s discussion. Although the protocols are well developed
and explained, the patient will not respond well to them unless
trust and rapport are established. Certainly, it is a component
that should not be considered secondary in the treatment
process.
The latter part of the article briefly describes some prelim-
inary research findings using 3 interventions. These data pro-
vide good insight into the benefits of these therapeutic inter-
ventions. I certainly look forward to the future publication of
more detailed and specific information on a number of addi-
tional factors, including the age range, TBSA burn percentage,
and frequency and duration of sessions for the subjects
involved.
Prensner’s article does propose the need for further study
of the processes and benefits of music therapy with burn
patients. Certainly, it would be desirable to expand on our
current research base and determine whether music therapy
interventions are most effective before, during, and/or af-
ter the debridement process. Further, for patients with se-
vere burns and for whom debridement can last several
hours, coping skills can be severely tested or become inef-
fectual. Identifying effective music therapy protocols for
patients with severe burns (⬎50% TBSA) deserves much of
our attention. Another area to investigate is that of care-
giver involvement in pain management. Ample research
opportunities remain. I commend Prensner for taking this
important preliminary look into this developing area of mu-
sic therapy and highlighting the need for further
examination.

Music Therapy for Assistance with Pain and Anxiety

Management in Burn Treatment
Jennifer D. Prensner, BM, MT-BC,*† Charles J. Yowler, MD,* Lori F. Smith, BS, MT-BC,†
A. Louise Steele, MMEd, MT-BC,† Richard B. Fratianne, MD*
Cleveland, Ohio

The management of pain is one of the primary issues in burn care. Pain is not only a physiologic
experience, but a psychological one as well. With this in mind, the treatment of burned patients
must incorporate a holistic view of pain management and healing. Cognitive, behavioral, and
pharmacologic interventions all have a role in pain management. Studies, as well as clinical expe-
rience, have shown that musical intervention has been helpful in assisting patients with pain
management in a variety of medical settings. Music is an element of normal life that can be eas-
ily adapted for the needs of individual patients and their current environment while providing a
means for self expression and for normalizing the environment. This article examines the ratio-
nale for using music therapy with burned patients, describes several protocols that have been
adapted to meet the specific needs of burned patients, and summarizes our preliminary find-
ings, which demonstrate significant response to music therapy protocols employed on our
patients. (J Burn Care Rehabil 2001;22:83– 88)

Pain is one of the most prevalent issues confronting
the burned patient. Pain sensation is the experience of
pain as reported by a patient, whereas pain behavior is
From the *Burn Center, MetroHealth Medical Center, Cleveland, OH,
and †The Cleveland Music School Settlement, Cleveland, Ohio.
Reprint requests: Richard B. Fratianne, MD, Department of
Surgery, MetroHealth Medical Center, 2500 MetroHealth
Drive, Cleveland, OH 44109-1998.
Copyright © 2001 by the American Burn Association.
0273-8481/2001
the set of observable behaviors that indicate a patient
is experiencing pain. Emotional factors, such as anx-
iety and depression, can have an effect on both pain
sensation and behavior.1 Psychological issues that can
affect the perception of pain may include: fear of
complications or sequelae of the injury, coping with
environmental factors, fear of the unfamiliar stimuli
encountered, stress related to the injury and hospital-
ization, and outside stressors seemingly unrelated to
the actual illness.2 Additional contributing factors in-

84 Prensner et al
clude: the nature of the illness, its degree of severity,
the nature of the response to pain by the individual,
and the individual’s history of previous physical and
mental ailments.3 The close relationship between
physical pain and contributing psychological factors
necessitates that both be managed simultaneously in
the treatment of patients with burns.
BACKGROUND
The gate control theory of pain perception is one of
the more widely accepted theories for the control of
perceived pain.4 The main premise of this theory is
that if a pain intervention can stimulate the larger-
diameter sensory nerve fibers, it acts as a diversion, or
closes the gate, of the smaller, slower-conducting fi-
bers which transmit pain to the brain.3 Pain percep-
tion has 3 main components: 1) sensory-discrimina-
tive; 2) motivational-affective; and 3) cognitive-
evaluative. The cognitive-evaluative factors affect
pain perception by the level of anxiety, the situation in
which trauma occurs, attention and distraction levels,
and competing sensory stimuli.5 Cognitive strategies
employed in pain and anxiety management may be
classified as 1) imagery; 2) self-statements; and 3)
attention-diversion devices.6 Imagery strategies in-
volve envisioning events that are inconsistent with
pain. Attention-diversion deals with redirecting at-
tention from the pain to another event, passive or
active, in an effort to distract oneself from the pain.1
Music therapy incorporates all of these cognitive
strategies and can be effectively adapted for a wide
range of cognitive and physical function levels.
Music exists as one of the few sources of needs
satisfaction that can follow people into the hospital
and can be made available in virtually any setting.7
The use of music to assist with pain and anxiety man-
agement can be defined as the combination of “au-
dioanalgesia” (the use of sound or music to reduce
pain), and “anxiolytic music,” (the use of music or
sound to reduce anxiety). The application of one or
both of these concepts is referred to as music assisted
relaxation (MAR).
Music therapy has been proven effective with pain
and anxiety management on a variety of levels.
Bolwerk8 found that music incorporating simplistic
repetitive rhythms was found to decrease anxiety in
patients with myocardial infarction. Music in combi-
nation with several relaxation techniques was also
found to decrease the mean amplitude of corticoste-
roid levels as well as increase reentrainment of circa-
dian rhythms in the subjects studied.9 Radziewicz
and Schneider10 and Locsin11 found that music sig-
Journal of Burn Care & Rehabilitation
January/February 2001
nificantly affected musculoskeletal and verbal pain re-
actions in postoperative obstetric and gynecologic pa-
tients. Additional evidence of the combined effects of
music and relaxation techniques on physiologic as-
pects of pain has been acquired using electroencepha-
lography,12 finger temperature,13 and electromyo-
graphy.14 Music has also been observed to affect both
the sensory and affective aspects of pain perception in
cancer patients.10,15,16 During dental procedures,
music was found to suppress pain in 90% of the sub-
jects tested.17,18
MUSIC THERAPY IN THE BURN
CENTER
MetroHealth Medical Center is the county hospital
serving residents of Cuyahoga County and serves as a
campus of the Case Western Reserve University
School of Medicine. MetroHealth operates a Level I
Trauma Center for children and adults and a verified
burn center serving Northeast Ohio. The Compre-
hensive Burn Care Center at MetroHealth comprises
both an inpatient unit and a 24-hour ambulatory
burn treatment clinic. The music therapy service at
MetroHealth is provided by a contractual arrange-
ment between the Burn Center and The Cleveland
Music School Settlement. The music therapist is as-
signed full time to the medical center with service
primarily to the Burn Center.
One of the most prominent problems faced by
burned patients is the chronicity and intensity of their
pain. This pain often leads to problems with compli-
ance in treatment.19 Furthermore, management of
pain is very difficult because of the variability in the
intensity of pain experienced both minute to minute
and during the prolonged course of the healing pro-
cess. Overmedication can result in sedation that limits
physical and occupational therapy. As a result, alter-
nate methods to redirect and distract patients from
their suffering are often used.20
In the treatment of burns, several nonpharmaco-
logic treatments for pain and anxiety have been used.
A number of studies suggest that behavioral ap-
proaches can be effective in assisting burned patients
in managing their pain and anxiety. However, scientific
data substantiating these interventions is limited.20
Numerous music therapy protocols have been used
to assist in different facets of burn treatment with
particular attention to related pain and anxiety needs.
Music therapy protocols are used to assist with spe-
cific routine procedures, including dressing changes,
range of motion exercises,21 and intravenous (IV)
line placements. Music therapy may also provide
emotional support, reality orientation, and sensory
Journal of Burn Care & Rehabilitation
Volume 22, Number 1 Prensner et al 85

stimulation as well as opportunities for self-expression
and the acquisition of age-appropriate cognitive and
expression skills. Several traditional music therapy
protocols have been used to assist patients with pain
and anxiety management, including various imagery
strategies with music listening and muscle relaxation
with music (Table 1).
In the MetroHealth Burn Center, the music ther-
apist is accessible to all patients. Patients are seen
individually, in small groups, and in cotreatment with
other therapies, as appropriate. The music therapist
determines which protocols to use based on initial
and ongoing assessments of patients and weekly
meetings with the burn team. The Burn Center uses
several sets of clinical pathways specific to the learning
and treatment needs of both acute and intensive care
patients.24 The pathways emphasize the importance
of a continuum of care and incorporate music
therapy.
Adapted Music Therapy Protocols Effective
with Burned Patients
Since incorporating music therapy as part of its treat-
ment program in 1998, the Burn Center has identi-
fied several music therapy protocols as being particu-
larly effective in its treatment of burned patients. The
effectiveness of the music therapy protocols is deter-
mined by measures that include self-report of pain
and anxiety, heart rate, pulse rate, verbal feedback
from patients and their families, and behavioral ob-
servations by staff of patients’ tension levels. Proto-
cols are selected and adapted to fit rehabilitative
needs, while engaging the patient on as active a level
as possible. Because of the fact that burn pain is con-
stant and often very intense, it is important that music
therapy protocols engage the patient’s attention as
much as possible and thereby assist the patient in
redirecting attention from pain and anxiety onto the
music. At this burn center, selected protocols have
been used which incorporate facets of traditional pro-
tocols but which have been adapted or modified to
meet the specific needs of this population. The fol-
lowing protocols incorporate both traditional and
original material and are adapted for effective use with
burned patients based on the music therapist’s
experience.
Song Phrase Cued Response (SPCR) is defined as
having the patient listen to a song in order to provide
a specific response at a designated time in the song.
This protocol is designed to assist the patient with
focusing attention on the music and away from the
painful stimulation. The tasks required of the patient
necessitate concentration, but are simple enough not
to cause undue frustration. SPCR is usually used in
conjunction with other protocols, either as a facilita-
tor or a catalyst. For example, SPCR assists with fo-

Table 1. Music-assisted relaxation protocols

Protocol Active/Passive Main Strategy Description

Music-assisted progressive muscle
relaxation
Music listening
Music vibroacoustic therapy
Entrainment
Music-elicited imagery
Music and directed imagery
Music and guided imagery
Music and biofeedback
Active Tense/release muscle Systematic tensing/releasing of muscle groups, following
groups verbal directives (Jacobson,22 1938) with music
selected to foster effectiveness.
Passive Listen Listening to carefully selected music matched to patient’s
preferences and needs (Maranto,23 1991).
Passive Listen/tactile Applying low frequency pitches of carefully selected
music directly to the body, incorporating patient’s
needs/limitations (Maranto,23 1991).
Passive (can be Alter physical rhythms Altering a specific physical rhythm/mood by matching it
active) with music, then gradually adjusting it toward the
therapeutic goal (Maranto,23 1991).
Active Imagery Experiencing and/or discussing improvised images
elicited by specifically selected music (Maranto,23
1991).
Active Imagery Using specially selected music and suggestion with a very
relaxed person to foster progression toward the
therapeutic goal (Maranto,23 1991).
Active Imagery Using specially selected music and suggestion with a very
relaxed person to explore issues related to or causing
the condition (Maranto,23 1991).
Active Biofeedback Utilizing music carefully selected to elicit/cue relaxation
(Maranto,23 1991).

86 Prensner et al
cusing attention, providing a structure to range of
motion exercises with instruments, and providing an
actively engaging alternate focal point during adver-
sive situations. If a patient seems inattentive to a mu-
sic therapy intervention, SPCR can be used to assist
the patient in focusing on the therapist and gradually
increasing interaction. The outcome of this protocol
is measured by the level of the patient’s participation
in the protocol; ie, does the patient demonstrate the
ability to attend to the task, interact with the thera-
pist, respond on cue, provide appropriate responses,
etc.
Adapted Progressive Muscle Relaxation (APMR) is
the organized and systematic relaxation of muscle
groups to music, adapted to avoid causing additional
pain through physical tension. The patient is in-
structed to visualize small lights of a specially selected
color. The color is selected by the music therapist to
elicit the desired temperature sensation for the pa-
tient’s current comfort needs. This visualization aids
the patient in focusing attention by providing a sim-
ple specific subject to concentrate on. Furthermore,
contrary to traditional progressive muscle relaxation,
this adaptation avoids the physical tensing of muscles
which may be painful for burned patients because of
the tissue damage and tight dressings. Structure for
deep breathing is provided by cues from the therapist
and repetitive rhythmic accompaniment. Through-
out the protocol’s application, the tempo of the mu-
sic (and volume, if desirable) are gradually decreased,
to assist patients in slowing their respiratory rates.
This protocol can be recorded on cassette tape, and a
tape player can be provided for the patient’s use dur-
ing their hospital stay. The recording allows the pa-
tient to use the technique in other settings (such as
before surgery or during outpatient visits) to assist
deep breathing and emotional regrouping. The effec-
tiveness of the protocol is determined by the patient’s
participation: observable signs of muscular relaxation,
relaxed affect, decrease in eye movement, positive
verbal feedback, or falling asleep.
Music Based Imagery (MBI) provides a relaxation
experience specifically designed for the individual pa-
tient. Due because of a large amount of aversive stim-
ulation faced by burned patients, traditional relax-
ation and imagery techniques are inadequate. MBI
uses familiar images described by patients as the fo-
cus, which assists them in concentrating as well as
evoking pleasant memories involved in the scenario.
Because the patient must describe and focus on the
images, MBI requires that he be able to clearly com-
municate with the music therapist and not be cur-
rently involved in an acute episode of reality-distort-
ing psychosis. MBI begins by having the patient
Journal of Burn Care & Rehabilitation
January/February 2001
identify a special place and describe it to the music
therapist. The patient is then instructed to concen-
trate on his special place and try to imagine what it
would be like to be there. The images are sung by the
music therapist as improvised lyrics integrated with
cues for rhythmic deep breathing and APMR. Tempo
and volume are gradually decreased. The patient’s
individualized MBI music can be recorded on cassette
tape and left with the patient for independent use.
MBI’s effectiveness is determined by the patient’s
participation: observable signs of muscular relaxation,
relaxed affect, decrease in eye movement, positive
verbal feedback, or falling asleep.
The Relaxation Response Elicitation (RRE) is de-
signed to assist with relaxation or regulation of vital
rhythms or both while providing therapeutic interac-
tive musical stimulation to patients who are able to
give minimal overt responses to auditory stimulation.
When an injury occurs, the natural rhythms of the
body are interrupted, and the body’s healing process
often further taxes the systems through elevated vital
rhythms. In order to reduce the stress put on these
physiologic systems, the music therapist selects a vital
rhythm to address (usually heart rate), based on the
patient’s current ability to respond. The speed of
the vital rhythm selected is closely approached or
matched by the tempo of the music. Over the course
of the session, the tempo is gradually adjusted, incor-
porating principles of entrainment to assist in using
the rhythm of the music to adjust therapeutically the
patient’s targeted vital rhythm. The rhythm of the
music can be reinforced, if desired, by rhythmic tap-
ping on a drum or patient’s bedrail to emphasize the
tempo and increase response. Contrasting musical
styles and tempos can be alternated to foster re-
sponse, elicit attention, and avoid habituation to the
musical stimulation. If the patient’s responses be-
come more overt, the emphasis of the session can be
adapted to engage the patient more actively. RRE’s
effectiveness is determined by successful entrainment
of the vital rhythm tracked, decrease in observable
signs of tension, and increase in observable positive
responses.
PILOT STUDY
Because of the perceived successful application of Re-
laxation Response Elicitation, Adapted Progressive
Muscle Relaxation, and Music Based Imagery, a pilot
study was conducted with 63 burned inpatients who
received 1 of the 3 protocol interventions. The ses-
sions were conducted in the patients’ rooms by the
music therapist. Baseline data was collected before
music therapy intervention for those protocols com-
Journal of Burn Care & Rehabilitation
Volume 22, Number 1
paring vital rhythms or observable tension levels. Vi-
tal rhythms or tension levels were tracked throughout
the intervention and the progression, and end results
were compared with baseline. Verbal feedback from
the patient or family was provided either spontane-
ously during the session or at the conclusion of the
protocol. The findings of the pilot study are shown in
Table 2.
CASE EXAMPLES
Music therapy is effective with a wide variety of age
groups and function levels. At times the responses can
be quite dramatic, as the following cases demonstrate.
A 6-year-old male with burns totaling approxi-
mately 30% TBSA was admitted to the inpatient unit
after a scald accident. During a visit by the occupa-
tional therapist, the patient refused to range his fin-
gers and arms. However, when the music therapist
used a familiar children’s song with finger play, the
patient completed range of motion exercises indepen-
dently. On another day, while attempting to place an
IV, the medical staff met with difficulty because of
edema in the extremities. Consequently, the patient
was very agitated, which elicited great concern from
the patient’s mother. The therapist requested time to
assist the child with relaxation, before the procedure
was resumed. As the therapist played and sang famil-
iar children’s songs, the tempo of the music was grad-
ually slowed to foster relaxation. After approximately
10 minutes the pediatrician returned to attempt again
to place the IV. The child opened his eyes and con-
tinued to remain totally calm until the procedure was
resumed.
A 7-year-old male was admitted after a flash flame
to the upper body, approximately 24% TBSA. The
patient participated in a combination of the MBI,
SPCR, and music listening before, during, and after
his dressing change. During the course of treatment
with music therapy intervention, the child demon-
strated a marked decrease in pulse rate, a more natural
trend in pain and anxiety levels, and lower tension
levels. His individual MBI session was taped and was
used at other times of high stress, including before
surgery. A few days after surgery, while heavily se-
dated, the patient demonstrated an elevated heart
Table 2. Responses to adapted music therapy protocols
Protocols
Relaxation Response Elicitation
Adapted Progressive Muscle Relaxation and/or Music Based Imagery
Prensner et al 87
rate. Using RRE, the music therapist was able to de-
crease the heart rate markedly.
A 28-year-old female was admitted for inpatient
care after a house fire with scattered burns totaling 7
to 8% TBSA. She participated in music therapy to
assist with pain and anxiety management during her
dressing change. The patient demonstrated excellent
participation in MBI before and after her dressing
change. However, during the wound treatment the
patient demonstrated reluctance to participate audi-
bly in the music-making process. Therefore, the mu-
sic therapist used verbal SPCR to encourage active
participation by the patient. While engaging in
SPCR, the patient began singing, instead of stating,
the desired word or phrase. The length of the pa-
tient’s responses continued to increase. The patient
continued to sing entire songs with the therapist
throughout the remainder of her dressing change.
On the following day the patient did not have music
therapy intervention, but the medical staff reported
that the patient sang to herself during her dressing
change. An analysis of the data collected indicated
that with music therapy intervention, the patient ex-
hibited a more stable pulse rate, lower anxiety levels,
and a steady decrease in tension.
A 48-year-old male was admitted for treatment fol-
lowing an industrial flash flame electrical source burn
to the upper body and face, covering approximately
5% TBSA. During the course of the patient’s treat-
ment, the patient participated in a number of music
therapy protocols, including Song Adaptation, Ther-
apeutic Instrument Play, Therapeutic Singing, and
MBI. The protocol that the patient responded to
most effectively was MBI, particularly after wound
dressing changes. The patient stated that MBI as-
sisted him by taking the edge off of his pain. The
patient also stated that Therapeutic Singing assisted
him with pain management during dressing changes.
Furthermore, as an outpatient, this patient encour-
aged 2 fellow patients to contact the music therapist
and obtain tapes of an MBI session to assist with their
pain management.
An 83-year-old male was admitted for inpatient
care after a scald to his lower extremity. This patient
fully participated in the MBI protocol administered
before and after his dressing change, and SPCR, Song
Total Not Fell Percent
Patients Successful Neutral Successful Asleep Success
35 14 N/A 21 N/A 60
28 0 1 22 5 98

88 Prensner et al
Choice, and Therapeutic Singing during his dressing
change. The next day, medical staff related that dur-
ing debridement, the patient requested music ther-
apy, stating that it “makes this go easier!” In analyz-
ing the data, this patient demonstrated lower pulse
rates, lower pain and anxiety levels, and reduced ten-
sion levels during the dressing change with music
therapy intervention.
SUMMARY
Music therapy has long been recognized for its effec-
tiveness in assisting patients in dealing with significant
aspects of pain and anxiety. In the past 10 years, re-
search has demonstrated the positive impact of music
therapy’s effectiveness in a diversity of settings. Al-
though scientific research is limited, clinical observa-
tion suggests that music therapy is beneficial in the
treatment of burned patients regardless of age or se-
verity of burn. The trained music therapist can adapt
protocols to the patient’s limitations while capitaliz-
ing on their strengths and addressing needs in a pleas-
ant, personally affirming way. Additionally, music
therapy protocols can continue to be modified to sup-
port the patient’s rehabilitative progress, both physi-
cally and emotionally.
Clinical experience in the MetroHealth Burn Cen-
ter indicates that music therapy protocols that require
active involvement are more supportive of patient
needs. This form of active alternate engagement as-
sists patients in shifting and maintaining their focus
away from aversive stimulation. The ability of appro-
priately selected and therapeutically administered
music to engage the patient increases its usefulness in
procedures such as dressing changes and range of
motion exercises. Engagement in music therapy can
also promote compliance with procedures, assist with
general pain and anxiety management, offer an op-
portunity for needed self-expression, and affirm the
individuality of the patient.
Burned patients present a unique and difficult chal-
lenge in pain and anxiety management. Several music
therapy protocols have been specifically adapted for
burned patients. A pilot study of the responses of 63
patients receiving one of the adapted protocols indi-
cated that Adapted Progressive Muscle Relaxation
and Music Based Imagery plus Music Assisted Relax-
ation (combination of APMR and MBI) were effec-
tive. We are currently engaged in a randomized, pro-
Journal of Burn Care & Rehabilitation
January/February 2001
spective study to evaluate Adaptive Progressive
Muscle Relaxation and Music Based Imagery.
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