By Parker Neils

How much longer can conventional medicine alone deal with a crisis that is killing and crippling nearly half a million infants a year?

Baby Kate is a week-old infant girl in a hospital-issue knit hat. Her body, the size of a small kitten, lies asleep, bundled in pink blankets.

Her tiny universe—a sterile, plastic-and-steel isolette in the corner of the hospital’s neonatal intensive care unit—is as alien to her as if it had been dropped from a distant planet.

Overhead, speakers dispatch routine messages to busy nurses attending 14 other isolettes in the cool, darkened room. Banks of monitors emit their monotonous beeps and blink red and green electronic eyes. Everywhere is hiss, click, buzz and shuffle.

Baby Kate’s eyes suddenly pop open, only to close tightly again. Tiny tubes inserted in her nostrils help keep her walnut-sized lungs inflated. Another tube, her sole lifeline to food and water, snakes down her throat; still another probes her pencil-thin arms. Her tiny chest heaves once, then settles into a steady rhythm. She’s asleep again.

If she survives a month, Baby Kate has only a 50-50 chance, at best, of ever leaving the hospital. The best thing in her favor is the fact that she’s female—premature boys’ lungs simply don’t develop as fast or as well as do girls’.

Even if Kate does make it home, she’ll face nearly one-in-four odds of developing crippling disorders, from cerebral palsy and mental retardation to chronic lung disease and problems with her hearing and sight. All because nature didn’t give her nervous system the time it desperately needed to knit itself together before greeting the world.

Every day, roughly 1,350 Baby Kates, along with their male counterparts, are born in the U.S.—that’s about 6 out of every 100 live births. Not all of these premature babies (“preemies,” in hospital talk, technically defined as babies born before they’ve spent at least 38 weeks in the womb) will require long stays in neonatal units, but many will. The cost for hospital care for these too-young infants is staggering: $13.6 billion annually, according to figures released last year by the March of Dimes. The national charity is trying to call attention to what it says is the number-one crisis in neonatal health care in the country.

In 2004, the March of Dimes rolled out a five-year, $75 million campaign to raise public awareness of the dramatic rise in premature births in the U.S. over the past two decades. Figures show that since 1981, the U.S. has seen a 29 percent increase in premature births overall. In 2002, that computed to 480,812 preemies running up average hospital and doctor bills of $75,000 each. Officials contrast that sum with $1,300, the average cost of a hospital stay for a full-term baby with no complications.

Exactly what’s causing this rapid rise in the nation’s premature birth rate isn’t clear, say scientists. Roughly half the cases of premature births happen without any apparent medical reason; the other half apparently has a strong association with mothers’ racial and economic status.

Pre-term birth is a phenomenon that strikes women of all races and social classes, but in the U.S., pregnant black women are about 50 percent more likely to deliver pre-term and twice as likely to have “low-weight” babies (technically, newborns weighing less than five-and-a-half pounds) than are non-Hispanic, white moms. Researchers speculate that socioeconomic factors play the largest role in this racial disparity. Poor women, no matter their age, tend to get less prenatal care and social support than other women; too often are malnourished; are recognized as being more exposed to known prematurity risk factors, such as smoking and abuse of alcohol and illegal drugs; and generally lead more stressful lives than other women. The Centers for Disease Control names prematurity as the number-one killer of black infants and blames 80 percent of this mortality on a variety of infectious diseases that target women’s reproductive tracts.

No matter its causes or its primary targets, prematurity is one of a handful of frustrating medical conditions that creates a large wake of victims. For all their suffering, preemies themselves are hardly the only ones to feel the pain of prematurity—the phenomenon takes an immeasurable emotional and physical toll on parents, relatives and loved ones, as well as on hospital medical personnel who must deal with this web of trauma every working day.Faced with the rising frequency of premature and low-weight births, the quest for effective (and always cost-effective) ways to deal with the phenomenon on a medical level is ramping up in hospitals coast to coast.

Interestingly, the most encouraging approach to the crisis may be coming from places far outside the traditional walls of medicine.

The Music Alternative

Today, the standard medical procedure for dealing with premature infants—from the time they’re born until the time they die or are released—is pretty much a cut-and-dried routine straight out of ER medicine: intense intervention with machines and drugs to keep the babies breathing long enough for their vital signs to move into the healthy range.

If a team of new medical therapists now working at a Tallahassee hospital has its way, practitioners of neonatal health care nationwide soon will be singing a remarkably different tune. Since 1999, a program in medical music therapy—the only one of its kind in the country—has been quietly winning the hearts and minds of medical professionals over the still-controversial issue of applying music to healing.

In this extraordinary case, premature infants born at Tallahassee Memorial HealthCare—a large public hospital based near FSU’s campus—get treated with music as a matter of course. Depending on what they need most—help in learning how to suck from a bottle or soothing relief from the daily stress of living with malformed bodies, and in a strange new world on top of that—these babies are eligible for a medley of musical services, from recorded lullabies to live guitar performances by highly trained music therapists.

It’s all standard operating procedure within the Infant and Child Medical Music Therapy Institute, designed and run by researchers based in FSU’s music school and partnered with the administration of Tallahassee Memorial. Now into its second full year, the institute is the result of two decades of research at the hospital, where patients of all ages participated in tests designed to gauge the value and versatility of music as medical therapy.

Jayne Standley, the architect of FSU’s medical music therapy outreach program, talks about an idea that has grown to become a model for revolutionizing neonatal health care—if not hospitalization for all ages—in the world.

“We set out to be the international demonstration project for showcasing the benefits of music therapy for hospital patients,” she says. “And now, we’re generally recognized as the pioneer for using music therapy with premature infants. There’s a great deal of national interest in what we’re doing.

”Standley speaks from a level of professional training in music therapy that by all accounts has few peers. Florida State’s School of Music is home to the nation’s third oldest degree-granting programs in music therapy (behind the first, founded in 1944 at Michigan State, and a program at the University of Kansas), a field that now is only in its fifth decade as an established health profession.

Standley began her career in music therapy as an FSU undergrad in 1962. She began graduate work in 1968, working with FSU’s Clifford Madsen, a renowned music educator who is credited as being a pioneer shaper of music therapy as a bona fide profession. A prolific scholar with dozens of books and journal articles on music education and therapy, Madsen is still a force within FSU’s music school.

In the early 1960s, Madsen devised a system for standardizing training for students interested in careers as music therapists. His ideas caught on, and today there are at least 69 degree-granting programs in music therapy on university campuses around the U.S. plus programs in a dozen foreign countries. Certified practitioners are represented by a 5,000-member American Music Therapy Association, the field’s pre-eminent professional organization. Standley, who edits the association’s journal, enjoys a reputation as one of the profession’s foremost researchers.

“We like to think our program here is the top program in the country, certainly the top medical music therapy program in the U.S.”

She’s careful to make the distinction between FSU’s specialty—applying music therapy directly to patients in a real hospital setting—and what most other programs do, which is to primarily emphasize work with emotionally and mentally disturbed children in homes and schools and with the elderly, typically those suffering from Alzheimer’s disease.

“We’re the only degree-granting music therapy program in the country that runs a medical program. We do the most research in the field of music therapy and most of the medical research (in the field), too. We combine student training, research and clinical services together—that’s what makes us unique.”

Music Stat!

When she began working with Tallahassee’s only large public hospital in the mid-1980s, Standley figured she’d be facing a protracted, uphill battle to convince doctors and nurses that music has the power to heal. Reflecting on that experience today, she says she started “with doctors who had no idea of what we’d be doing,” and now her staff and students enjoy a profoundly different working environment at the hospital.

“We now have doctors who make ‘stat’ (hospitalese for now) referrals on the loud speaker system for music therapists. It never occurred to us that the doctors would get it so well, but they have.

”Music therapy has indeed become an integral part of Tallahassee Memorial’s services, says Paula Fortunas, president of the hospital’s foundation, who described the music therapy collaboration between TMH and FSU as “the country’s finest.” Today, the hospital welcomes Florida State music therapists into almost every walk of medical care under its roof, from the neonatal ward to its physical rehab center. As a result, FSU’s young program, which has only two full-time staffers, four interns and about 10 students each semester, is stretched thin trying to keep up with demand for their services.

Aside from their highly specialized work with preemies, FSU-trained music therapists cover the field, or try their best to, Standley says. It’s common for TMH cancer patients, pre- and post-operative patients of all ages, anxious children facing various medical procedures or even Alzheimer’s and psychiatric patients to be treated with guitar-wielding therapists at some point during their hospital stays.

Still, the program’s biggest successes have come from work with premature infants, generating a remarkable track record in research that led to the creation of the aforementioned infant/child institute. Dr. Rick McArthur, a thoracic surgeon and chief medical officer at TMH, said he’s watched how music therapists work within the hospital for several years but has highest praise for what he’s seen in the neonatal unit.

“The music therapists are very busy people here, but the most dramatic results I’ve seen so far have been in the NICU (neonatal intensive care unit),” he told Research in Review. “Overall, I’ve become very appreciative of it.”

Music as Medicine

What Standley and her students witness first-hand in neonatal units—desperately fragile infants who respond, eagerly, to music’s mysterious touch—seems almost magical.

Babies too young to know anything about their worlds, too neurologically immature even to grasp such babyhood basics as sucking, swallowing and even breathing in a healthy rhythm, hear music and often within minutes, begin picking up clues for doing what most babies do naturally.

As FSU’s researchers and others have proven (Johannes Brahms springs to mind) even the youngest of humans respond positively to music. But music’s effect on adults has been known and pondered for thousands of years. Ancient Greek philosophers touted music’s restorative powers. The great mathematician Pythagoras even preached about its ability to cure diseases and promote spiritual growth.

Music’s uncanny ability to invigorate, stimulate and motivate humans is legendary. Some religion scholars even credit music with being the primary driving force in more than a few religious traditions around the world. Not inconsequently, for better than a century now, modern marketers have successfully used music to sell everything from religion to running shoes.

An entire generation of so-called “New Agers” professes belief in music’s power to cure both the mind and the body of a host of ills. And since 1998, the federal government has formally recognized music as a legitimate, alternative (or complementary) therapy for treating medical conditions ranging from Alzheimer’s disease to autism. (see box, page 16).

Yet for all this fascination with music and its intriguing connections with human behavior, scientists still have no clear picture of how music works its magic on us, even though they’ve learned volumes about how the brain breaks down and processes music signals. Brain scientists say that music acts in many ways just like a drug, lighting up the brain’s “pleasure centers” in much the same way that eating chocolate, sniffing cocaine or even having sex does. Many different regions of the brain are involved in breaking music down into its various components—e.g. tone and tempo—but exactly how this processed music impacts emotions, much less influences other brain functions related to behavior, is unknown.

One of the most curious phenomena known about music and the brain is that music is processed almost entirely by parts of the brain that apparently have little if anything to do with processing language and speech. Consequently, some people who can’t talk at all can sing.

An entire vein of music therapy—called neurological rehabilitation—has grown up around this and other curious ways the brain handles music in relation to other stimuli, Standley says.

“Your brain picks up rhythm and responds to it in a special way. For physical therapy, for example, we can speed up a patient’s (exercise) by changing the tempo of the music they’re hearing.

“If you need to move an arm, you’ll do that much more freely if you’re beating on drums. The rhythm helps your brain coordinate the movement.”

Mouth Music

Baby Kate still has her eyes closed, but she’s quite busy. She’s sucking on an odd-looking pacifier and seems to be enjoying herself.

The tiny infant is now 3 weeks old, but still weighs a life-threatening 4 pounds—only 12 ounces more than her birth weight. So far, all her food has been delivered by tube because Kate, like most preemies, was born before she had the ability to suck from her mom’s breast or a bottle. That’s all about to change.

To her caregivers’ delight, Baby Kate is rapidly learning to do what comes naturally to most newborns—suck and breathe at the same time. If all goes well, she’ll soon be weaned from her “odd-looking” pacifier to a nippled bottle full of formula. Her feeding tube—no match for feeding by mouth when it comes to putting weight on an infant—can then be phased out.

Kate is one of hundreds of preemies around the U.S. lucky enough to be treated with PAL, an acronym for pacifier-activated lullaby, a technology developed by Standley during her work at TMH in the early 1990s (see box, page 20). Still in the testing stage in 50 other medical settings around the country, PAL devices demonstrate the innate power of music over the most instinctual of human behaviors.

With PAL, infants quickly learn that something very pleasant happens—lullabies—when they suck. Interestingly, the infants are responding to music as their sole reward for sucking, with no association with food. The system’s pacifiers are hooked up only to music control devices, not to bottles of formula.

The idea is that once infants learn to suck, then they’re soon ready to start feeding themselves by mouth. Once they get the sucking part down, they’re ready for the next steps—first learning to swallow, then to breathe before taking another suck. Babies born before their 34th week in the womb simply can’t handle such a coordinated activity. The PAL system with its musical treat is immensely helpful to infants struggling to grasp the fundamentals of feeding themselves by mouth, Standley says. She hopes some day to see the devices, patented by FSU, as common in neonatal units as heart monitors.

Music to Little Ears

Even though exasperated moms have praised the contribution of Brahms to domestic sanity for more than a century, serious academic research into the effect of music on infants and children is a comparatively young field of study.

Only in the past 30 years have researchers documented the positive impacts music therapy has had in reducing stress and anxiety in infants and young children, raising levels of saturated oxygen in infants’ blood streams, and—as Standley’s work with premature infants has shown—helped fragile infants gain weight and neurologically adjust to their new worlds.

In the mid-1970s, researchers first demonstrated the remarkably healthful affinity that newborns have to music. A group of 127 infants ranging from 183 to 230 days gestation was divided into two groups. One listened to their mothers’ voices while the other listened only to recorded lullabies. The study found that the group hearing lullabies gained weight faster than those hearing their moms.

Working with her Florida State colleague Cliff Madsen, in 1982 Standley set out to determine at which points during infancy babies demonstrate a preference for music, their mother’s voice or silence. The answer amazed them, and it’s framed Standley’s research ever since.

Standley’s infant research subjects—ranging in age from one to eight months—were outfitted with Velcro strips on one foot, connected to a mercury switch activating a tape recording of their mother’s voice on the right or music on the left. They could simply move their leg left to hear mom, right to hear music.

“We found that the smaller infants preferred the mother’s voice,” Standley says. “Around four or five months of age, the babies began to listen to the music, although they’d keep going back to their mothers just to make sure her voice was still there. But by the time they were 6 to 8 months old, they clearly preferred to listen to the music.

”What was particularly surprising in the study was that the 1-month-olds learned the trick just as fast as the 8-month-olds did. On average, it took Standley’s baby subjects only two-and-a-half minutes to master the task.

In 1991, a graduate student of Standley’s, Janel Caine, wondered what effects music might have on premature and low birth-weight infants struggling in hospital intensive care units. Caine chose 52 infants at Tallahassee Memorial for the study.

Caine evenly divided the group into an experimental and a control group, each balanced by gender—11 boys and 15 girls in each group. One group got daily, half-hour doses of lullabies and other children’s music delivered by tape recorders; the other group got none. Caine found that the control group—the babies that heard no music—remained in the hospital an average of a week longer than the experimental group. Her music group showed a marked reduction in stressful behavior and a much better appetite and therefore faster weight gain than the infants in the control group.

During a follow-up study with those same babies six months later, Standley found that the parents of the babies who’d had music reported they were easier to calm and put to sleep at night with a simple lullaby than were the control babies.

“So we felt there was some evidence that the babies who had benefited from music very early on were calmer babies, both in the hospital and at home,” she says.

This finding was particularly notable, Standley says, since one of the most prevalent characteristics of premature infants is that they tend to be irritable, hyperactive and difficult to calm for many months after they leave the hospital. Music therapy for preemies can translate into therapy for harried parents, in other words.

A Balm in Babyland

Calming infants and young children is one of the great, universal challenges for hospital staff no matter the medical setting.

Preemies are typically hypersensitive to any kind of stimulus—from noises in the intensive care unit to the gentle touch of a parent or caregiver. Older kids often are terrified of any routine procedure—especially anything involving a needle. Medical personnel can fairly measure the anxiety levels of children by counting the number of people it takes to hold them down for some procedures such as intravenous (IV) injections. Also, such diagnostic exams as MRIs and CAT scans demand that patients be perfectly still—a virtual impossibility for many kids.

In the case of older children, sedation is often the only solution. Current standards hold that whenever a child is sedated, a registered nurse must be present for two hours to watch for side effects. Not uncommonly, children are so scared that even drugs don’t work and the procedure has to be rescheduled.

In the mid-1990s, Standley and her students wondered if music therapy might help calm children enough to avoid sedation altogether. They devised an intervention technique whereby children first get treated to lively, boisterous music involving puppets and lots of laughter. This active session then gradually phases into a slower, quieter presentation designed to lull the children to sleep.

“All it took was a single demonstration and the nurses were believers,” Standley recalls.

Called to watch as a 3-year-old child, anxiously awaiting an IV hook-up, was captivated by the musical antics of Standley’s students, a group of RNs were amazed to see the child gradually submit to the procedure without restraints or tranquilizers.

For at least four years now at Tallahassee Memorial, all children’s IVs, MRIs, CAT scans and electrocardiograms start with music therapy—it’s standard operating procedure throughout the hospital. Most of these procedures are done within 15 minutes and involve no sedatives, no nurses and no restraints—just therapeutic music, Standley says. Using the technique, hospital staff report a 98 percent success rate with electrocardiograms, an 84 percent success rate with CAT scans and a 97 percent success rate with IVs.

But preemies—Standley’s specialty—require extra patience and a more carefully executed plan. Because pre-term infants come into the world deprived of a fully developed nervous system, they are easily startled by even the slightest sound, movement, touch or change in the heat, light or air pressure around them. A 1997 study by the American Academy of Pediatrics found that noise, for example, causes stress responses in infants and affects normal brain-cell division. Over-stimulation may be the main cause for the language and other developmental problems so common in children born pre-term, the study concluded.

For caregivers in neonatal intensive care units, a supreme challenge is to avoid over-stimulating their tiny charges while gradually increasing their tolerance for what lies ahead—a world with endless and ever-changing stimulation. Considering the extreme frailty of these infants, that’s like walking on eggshells.

Standley designed a step-by-step procedure to tackle the problem. First, music therapists began calming preemies by humming to them until they were pacified. This was followed by gentle massage, then a nice session in a device that has served parenthood well for ages—a rocking chair. This “multi-modal” procedure, designed to teach babies to tolerate changing stimuli, worked beautifully, Standley says.

“We found that the babies who had this procedure went home a week sooner than the babies who did not.” The procedure is now a standard clinical service in Tallahassee Memorial’s neonatal intensive care unit.

Tallahassee Training

Baby Kate grasps a small bottle of formula in her tiny hands. Wide-eyed, she sucks greedily at the nipple. At five weeks, she’s grown to nearly 6 pounds. She’s improving, but her doctor is still worried. Something about the sound of her heartbeat isn’t right.

Still, Kate is a lucky girl to have made it this far. Two preemies born on her birthday in the same unit weren’t so lucky.

This afternoon, Kate will be lulled into a nap by the dulcet chords of “Frčre Jaques,” sung by a young woman finger-picking a guitar at her bedside. The instrument is the number-one tool used by FSU music therapists at Tallahassee Memorial, as it is for music therapists everywhere.

Versatile and easily portable, the guitar is the tool of choice for the professional music therapist. At FSU, being proficient in guitar is not only a handy talent for students training to be music therapists—it’s required.

In fact, the program—which offers one of the few Ph.D.s in music therapy in the Southeast—offers three levels of guitar training. Students also train in keyboards, voice and other instruments.

“In this field, versatility is essential,” Standley says. “If there’s a patient in pain, and he or she is a fan of country music, for example, a music therapist can provide that music to a way that can be powerfully pleasurable.

“If you like hymns, the same thing; if you’re a baby, a lullaby. A good music therapist is adept at bringing all kinds of music to all age ranges and often on a moment’s notice.

”But aside from being accomplished musicians, students also must have an appreciation for the medical, psychological and social aspects of working with patients, says Standley. The FSU program thus requires in-depth coursework in such disciplines as child and family psychology, sociology, social work, physiology and anatomy.

At this juncture in its already distinguished history, Standley says FSU is trying to strengthen its position as being one of the country’s premier centers for music therapy training. One of the ways it’s going to do that, she believes, is transforming the new child/infant institute at Tallahassee Memorial into the nation’s central supplier of certified music therapists for neonatal intensive care units. Right now, only about seven hospitals in the nation have music therapists working in their NICUs, says Standley, and the need is critical.

By March of this year her year-old program at TMH had trained only 20 people, a group made up of music therapists, pediatric nurses and nutritionists who heard about the emerging program. Later this year, thanks to a special training diploma she negotiated with the American Association of Music Therapy, Standley sees the institute expanding to be able to accept at least 100 trainees a year.

“If all goes well, eventually everyone in the nation who wants a certificate in NICU (music therapy) training will have to come through Tallahassee,” she says.

Sour Note: The Sound of Money

This week, roughly 9,300 premature infants will be born in the U.S.—more than 500 of them in Florida.

If music therapy could help just one of these babies in every hospital to check out only a single day earlier than they would otherwise, the cost savings to hospitals and government Medicaid budgets would be huge. This is the kind of thinking that advocates like Standley must use to convince a still-skeptical medical establishment to fully embrace music therapy as a profession worthy of a dedicated place in hospitals nationwide.

The average, daily cost of a bed in Tallahassee Memorial’s NICU is about $2,000, Standley says. Her research has documented two different music therapy procedures that can cut preemies’ hospital stays by a week. This spring, she is finishing a book that presents a detailed cost/benefit analysis of medical music therapy as practiced now for 10 years in the hospital.

She doesn’t have to convince Dr. Todd Patterson, director of the hospital’s NICU, either about the effectiveness of music therapy treatment with pre-term infants or about any cost-saving that might come from it. Although the hospital can’t yet put a figure on how much premature births are costing it every year (he said a new cost-accounting policy should soon provide that) Patterson knows it’s a pricey enterprise.

Most of the women who deliver pre-term at TMH are poor and have no medical insurance, which means they pay nothing for their neonatal services, he says. The hospital bills Florida’s Medicaid program for the full cost of each pre-term delivery, but the state typically pays “maybe 25 percent or less” of these costs, Patterson says. Tallahassee Memorial picks up the rest of the tab—and passes it on to its paying customers.

Patterson has watched what music therapists do in his unit for two years. He’s seen babies’ breathing become more regular, seen infants sleep and feed better, watched their heart rates tick down to normal and overall, seen the calming effect that music therapy has not just on patients but on staff and parents as well.

For all that, though, he’s not optimistic that music therapy will be fully integrated into neonatal and pediatric care in hospitals outside Tallahassee anytime soon.

“Funding is just so tight these days,” he told Research in Review. “Most people still view music therapy as a luxury, not a necessity. In a perfect world, it would be standard procedure everywhere, but it’s a tough time to even talk about introducing new programs in health care.

”Standley has heard all this—and more—before, and knows what she faces. She believes the main obstacle standing in the way of an open-arms embrace by the medical profession of music therapy as medicine is a lack of awareness.

“Awareness, that’s the key. We have to make the medical community aware of the benefits and to show them the research that proves it.

”Advocates for medical music therapy need not worry about being thwarted by tightened hospital budgets—without research to back up their claims, they’re dead in the water as far as the medical community is concerned, Standley says. She’s frustrated that much of her latest research at TMH still awaits publishing, caught up in a two-year backlog at professional journals.

And then there’s the built-in problem of inertia. Dealing with premature infants necessarily means taking immediate, even desperate steps to keep them alive—and in traditional medical training that typically means heavy reliance on drugs and technology. In such drama, the surgical intervention of music as medicine gets overlooked. Standley laments this mentality.

Too often, medical personnel don’t think in terms of teaching the child to adapt; they instantly think of giving a child a tranquilizer.

“Regardless of the application, whether working with confused Alzheimer’s patients or with surgery patients, with young children or young adults, a music therapist can come in and provide an alternative procedure without medications, avoiding side effects or interactions with other drugs.

“So, we have to teach doctors to think about music therapy in a different way.”

On the Upbeat

Lying on her back, legs up, Baby Kate is grinning at her mom. She doesn’t know it, of course, but she’s going home.

Kate has survived an ordeal that newborns shouldn’t have to face. Luckier by a long shot than most preemies, she’s got two committed parents who love her to pieces. She still faces forbidding challenges—her doctor predicts she’ll need open-heart surgery within nine months—that most kids will never know. But for now, Kate’s rough start in life has taken a sharp turn toward a healthy future.

Despite the long road ahead for music as an accepted complement to traditional medicine in hospitals and clinics, Standley is optimistic. Ten to 15 years from now, she sees her profession sitting as a welcomed guest at the nation’s grand health care table.

“I think we’re on a reasonable timeline. There’s a huge interest today in more complementary medical techniques, proven alternatives to just another drug,” she says, offering a prediction.

“One day music therapy (in hospitals) will be as standard as occupational and physical therapy are today. I see music therapists at the ready to step into any number of procedures in the hospital—from pre-operative anxiety to post-operative care—for any age group.

“And then we’ll wonder why it took so long to get there.”