SingFit: Music Therapy for Dementia & Mood with Andy Tubman

SPEAKER_00 0:00

Welcome to Ask Dr. Mia, Answers on Dementia Caregiving. I am your pocket geriatrician and memory specialist. When I was helping my mom with her cancer journey, I knew I wanted to be her advocate and her care partner, but I didn't expect to have to rehash old patterns of communication like a teenager. Combining my knowledge as a specialist for older adults and my own experience as a sandwich generation care partner, I am here to empower you to take practical steps to not only care for the older adult in your life, but also take good care of yourself. Welcome. In this episode of Ask Dr. Mia, I had the pleasure of talking with Andy Tubman, who is a music therapist who developed along with his sister a technology called seeing fit. Seeing as in seeing and fit as in fitness. There are very few music therapists around the country. Andy and I really talked about how music is a tool for use with people who are living with Alzheimer's disease and related dementias. One thing that is unique about seeing fit is that it really can be done at a way of one motivating someone with dementia to do certain tasks, and can certainly be an opportunity and a tool for caregivers to emotionally connect with their loved ones. Technology could certainly be used at home, but also could be used in senior care, retirement communities, or even memory care. I've had the chance to try out the SingFit app for 30-day free, which is available for everyone. And sometimes I even use music to motivate myself to get out of bed in the morning. And this is a fun way to use music, and the app makes it easy to identify the goal of music, whether it's to uplift someone when they're sad, energize someone to get them started on the day, or calming someone down when they're feeling anxious and agitated. Hope you enjoyed this episode and check out Sing Fit for yourself. Welcome back to Ask Dr. Mia podcast. Today I am excited to talk with Andy Tubman. Andy is a musical therapist and he is the co-founder and chief clinical officer at musical health technologies, also called SingFit. He has been a board-certified music therapist for over 20 years and developed innovative techniques that help clients achieve their goals as well as train other healthcare professionals internationally. I'm excited to hear more about SingFit, the technology, and how it may help people who are living with dementia and caregivers who are taking care of them. So welcome to the podcast, Andy.

SPEAKER_01 3:21

Cheers. Thank you so much.

SPEAKER_00 3:22

Thank you. Well, I know many of us have heard have seen those viral videos where people with dementia seem to really come alive when they hear their favorite music. Can you tell us a little bit about what is SingFit and how does it differ from just playing someone's favorite music?

SPEAKER_01 3:40

Yeah. So the the thing is, is it Singfit is an active music making process. It it gives you, it speaks the words, it gives you a word cue. So it literally tells you the words to sing in the song. And what that does is it engages everything that singing and the research says happens when you're singing, right? And so it gets people singing, language centers, timing centers, motor centers, planning centers, right? Short-term, long-term memory, everything is rocking, the respiratory system. And so it's this active process that differentiates SingFit from simply a listening process. Because within the active process, you are also listening to your favorite song while you're producing the music as well. Right. And so the thing is, is when when people are like, yeah, yeah, my grandmom lights up when she hears our favorite Sinatra song. And I'm like, that is absolutely beautiful. But my question is, is what do you do with it? How do you turn it into some improvement of quality of life on a regular basis and consistently? Right. And so I think what we've found is that it is much more consistent in terms of mood elevation and building relationships and everything if you are actively singing together.

SPEAKER_00 4:59

Interesting. Yeah. And I think that that that makes me think about seeing karaoke, where the words are given to you and you don't have to memorize the words, and word finding is such a big problem for a lot of people living with dementia, and also a problem for people who don't know the song. Like, you know, if I were to sing some songs with, say, my parents, I wouldn't necessarily know the words to the songs that they like to sing.

SPEAKER_01 5:24

That's right. Exactly. And, you know, the difference here, again, is that karaoke, first of all, is really fun in bars and fun for people that can easily read, right? But the challenge here is that when you have zero design for somebody that has cognitive challenges or visual challenges, and you add the academic process of reading on top of it, you create a situation that you know you're setting someone up for failure, right? And so from my point of view, you eliminate the visual where it becomes an academic process where you have to then process what you're reading and then synchronize it to music and then add respiratory system and add tonality and perform, right? You eliminate that process. You just hear the words and repeat them. And so I think it just creates a much more successful scenario when someone can, you know, if someone's joining in and spontaneously singing, even if you're not using SingFit, that gives you the words. But if you just repeat the chorus with somebody that they might already know and have memorized in their system because they've been singing that song for 70 years, right? That repetition of chorus between folks is a very powerful tool.

SPEAKER_00 6:46

Yeah, absolutely. Transitioning a little bit in and just talking about what is a music therapist who would typically see a music therapist. Obviously, you just in your answer so far, you've thought a lot about the different type of cognitive, motor, pulmonary systems that all have to be on board just to sing. Tell us a little bit more about, you know, what a music therapist does.

SPEAKER_01 7:11

So at this point, there's about approximately, and it is really hard to nail down, but approximately 10,000 board-certified licensed music therapists in the US. I am one of them. And then you have to think about they specialize, similar to like a doctor, right? And so some are working in school systems, some are working in private practice with kids on the autistic spectrum, some are working in hospice, some are working in palliative or cancer hospitals, right? And so there's a very finite number of music therapists, and they're working in these different settings. Some are working in senior care communities, right? And, you know, they are tasked with a variety of tasks. From if somebody comes out of surgery and their heart needs support and stabilization in terms of its beat and its groove, a music therapist might actually use music, either live or programmed music, to help stabilize that heartbeat, right? In interacting with the person or having them listen to the music and help to stabilize that heart. That's called entrainment. Whereas a music therapist working in a senior care community, if the senior care community is progressive and well-funded, the therapist might work one-on-one with a dementia, with someone with dementia who tends to be agitated, right? Because a music therapist, in theory, should have those skills to come in and bring a toolbox of musical processes to really help ground and organize that person and get them focused and back into their normal day. So music therapists could do the deeper work with the fragile patients, or often in a senior care community, music therapists are tasked with singing with people, right? Playing music and singing to them. So it it var it there's a quite a spectrum of what music therapists are doing. Some some are doing like my first job, my first job was actually working in traumatic TBI, traumatic brain injury rehab, right? Where it's it's a very focused process on figuring out what musical processes are going to help find motor planning, let's say, right? That might be piano playing, that might be something else. But like, you know, that's that you know, that that could be like like very, very deep kind of brain neurological work to, you know, playing songs for somebody. So it it varies quite a bit.

SPEAKER_00 9:51

Yeah, it's it's similar to a geriatrician where we could be everywhere and nowhere. Um, and it sometimes it makes it hard to pen down what does a geriatrician do? What does a music therapist do? Yeah. Um, but I wanted to go back and ask because I don't think I realized the power of music. You said that a music therapist can stabilize the heart rate using music. How does that work?

SPEAKER_01 10:15

I would say support, right? Not just stabilize. But let's let's say that that someone's respiratory system or their heart is having some challenges and they're on different kinds of meds to try to help this. If there's a technique in music therapy called entrainment, and and really the very basic of it is that if there's irregular heart rates or irregular beats, a music therapist might take the tempo, the mean tempo of that heart rate, right? So meaning like what's around where the main tempo is, right? If it's a little erratic here, but it's steady here, what's that main optimal heart rate? And then either play live to that tempo that we're going for, or have programmed music. And then either by the person listening consciously, unconsciously, possibly even participating in some sort of simple tapping physiologically. But if they're in that state, they might not be ready to do active process, right? So it might be more of a receptive process at that point. But there is a phenomenon that is called entrainment, where the body starts to regulate to what is being fed to them in terms of music. And yeah, so it can help to to to stabilize respiration and and heart rate.

SPEAKER_00 11:37

Yeah, that reminds me of babies, newborn babies who are skin to skin with their parents and they hear the sound of a parent's heartbeat. I I I feel like that I'm guessing that might be a similar process where what you hear gets transmitted physiologically into, say, your heart rate.

SPEAKER_01 11:55

Absolutely. Well, the the the first the first groove that a baby hears is while in utero and is his mother's, you know, their mother's heart, right? And and that that that steady rhythm is a real feeling of security for all of us, quite frankly. And so that that is innate in a living being, right? And so that that's true for, I don't know, every, maybe not on the amoeba level, right? But but most beings are are first exposed to that, you know, that that at least the human is first exposed to to that heartbeat of the mom as as as the groove and the organizing rhythm.

SPEAKER_00 12:37

Yeah, it's it's amazing. Um tell so I know SingFit has a number of platforms online, and I'll include the website to Singfit in the show notes, but if you can tell us a little bit about SingFit Studio Caregiver, because I know that's the one that probably our audience would be most interested in.

SPEAKER_01 12:59

Yeah, so I I think you're right. Like the the Caregiver uh is is simply an app and it's you can download it on iOS or you know, any kind of Android or iOS platform device. And what it does is well, it it has a variety of features, quite frankly, but the the core of it is that it provides songs with a word cue. So in other words, it literally we literally put a spoken word as an extra track on top of the singer and the music. So it might sound you might hear the music and then you would hear the word cue, fly me to the moon, and then the music would be playing, and you'd hear the singer, fly me to the moon, let me play among the stars, let me. And so the tracks are, you know, have this word cue and a guide singer baked into it. And so that means that the person, the caregiver, or even the person, like they don't need to be able to sing, they don't need to know the songs, they don't need to know the words, right? And even for people who are, you know, not having cognitive challenges, who want to do preventative, right? If they do some song learning, it's just a beautiful way to exercise that that brain and that respiratory system, especially songs they don't know. But when it comes to our dementia folks, folks with dementia, we want that app is going to help serve up those familiar songs and what what I call preferred songs, right? That's cut not me, that's a music therapy term, where where the app serves up preferred music so that the person with dementia is familiar and it's the app is feeding the words so that there's a higher integration of language into the process, but without feeling like it's a big task and a lot of work, right? So it's like hopefully this spontaneous, fluid singing process that both the caregiver and the the participant can engage in. I mean, there's more features to the app that I can explain, but but that's the core of it.

SPEAKER_00 15:05

So do the caregiver or the person with memory problems, did they see something on the app that cues them? No, it's it's just sounds like a lot of it.

SPEAKER_01 15:15

It's an auditory cue. That's right. It's a spoken word auditory cue. And and then one of the main features that um our smart algorithm creates is that a caregiver would put in a profile. So let's say someone, their loved one is born in 1945, and the app is a smart app and says, okay, they're born in 1945, they have MCI and they love rock and roll. And then that profile is set up, and the app starts thinking and populating the songs that are going to match this musical preferences, unless the person already knows those musical preferences and you can put them in the profile. And then what happens is let's say that the person, the participant is feeling anxious, right? And the caregiver knows this. Well, then they would open up the app, the app would say, What's the goal today? And it would be reduce anxiety. And the app would say, How anxious is the person today? Right. And you put in, you do like two, three pre-questions. And then with all that information, the app says, okay, Mia is a bit anxious. She's in a little she's in a bit of a high energy state. And so the app is going to match your rock and roll preferences with a bit of a high energy song. And then the app is going to serve up five other songs that move away from that energetic state into a more organized state while giving the caregiver cues on how to talk about and facilitate the music. So it's really a guide through a singing process.

SPEAKER_00 16:46

Wow. That's fascinating. I I think that's really taking taking this music as a way to, as a tool to help regulate our mood, but but make it more consistent and less dependent on people who know already know how to do it. Training to people who don't have any experience doing it and may not even know what kind of music, you know, say my parent will like and and having that be available. So is it something that typically the caregiver does with the person with the disease, or is it possible for the person by themselves to sing without a caregiver?

SPEAKER_01 17:25

It it's both, but it it's probably if if the person is comfortable with technology historically and they have maybe MCI, like they're not that far along on their dementia journey, they could possibly sing independently at this point. But the design of the algorithm is really more for input. And so so they can put do their input, what their goal is that day, but it's also really designed for a caregiver to put that input to open up the app and to facilitate that process, like you're pointing out, that it's really a guide for that caregiver. But yeah, I've like people that are not so far along on the journey could do it independently as well. And there are some other other features in there that every everybody wins. This is this is this is my saying, not uh not a music therapy saying, but everybody wins if if you're singing for you know, like consistently singing on a regular basis. And so you can use the algorithm. A caregiver can be very comfortable in using the algorithm because the basically the caregiver is guided through what to say and how to introduce a song and everything. But the other side of that is that if you you can also just build the person's favorite playlist, right? And if you know that that, you know, when the saints go marching in is going to get that person to the bathroom in time, you pull up that walking playlist and you hit when when the saints go marching in to get that person to the bathroom. And so they're singing, they're walking, they're they're they're you know being supported in that ADL, in that activity of daily living, and in that task, everybody wins, right? So you can use the algorithm, but you could also use specific songs for different kinds of functions through the day. And and I think that that's that's you know, a win-win situation where you could do really nice singing process, but you can also use songs to support different tasks.

SPEAKER_00 19:22

That's fantastic. Um I really appreciate uh yeah. I mean, I'm curious how did you design the platform? Did you design it with people who are caregivers or people who are living with dementia?

SPEAKER_01 19:37

Yeah, so we we started with the idea. Actually, my father was an opera singer, and he years and years ago, would, you know, there uh get in the car and think to himself, man, I really would love to learn the words in the libto, just like because back in the day they had an opera prompt, right? And this was a person that would stand behind a shell and have the libretto in front of them and feed the words to the singers that were forgetting the lyrics, right? So he's like in the car, he's like, I wish I had that opera prompter in the car so I could learn the words as I'm driving. And so this set him on trying to figure this out for years. And once I found out that this cueing idea was evidence-based speech therapy and music therapy practice, and the app economy, as you you were talking about Apple before we started recording, the app economy became ubiquitous. You know, I went to my sister who was a technologist, and I was like, hey, you know that idea dad has? And she was like, Oh no, we have to do it, right? And so that's kind of where this was born. And then we started, we got some funding and we started building the word queuing system. We started in a group process using the word queuing system and figuring out how to group how it would work in a group, and then that evolved into the app that I'm describing, the Caregiver app with the algorithms and and the playlists, abilities, and things like that.

SPEAKER_00 21:08

Wow. That is fascinating. Yeah, I'm sure it takes it's taken a long time to get here.

SPEAKER_01 21:15

Yes.

SPEAKER_00 21:15

Yeah. And you guys have just partnered with AARP, and that this is also offered at a discounted rate for ARP members, and you guys offer a free monthly webinar that can help caregivers, you know, use this technology as well.

SPEAKER_01 21:34

That's right.

SPEAKER_00 21:35

Anything, yeah, that's that's fascinating. Because I think for people who are maybe not quite sure or less adventurous with their technology, it would be helpful to have, you know, some guidance besides just playing around on the Absolutely.

SPEAKER_01 21:50

Um and I I think, you know, what what I do enjoy about doing the webinars is that it it it it does kind of support the app itself. Although, you know, we have a nice um support system at Singfit, right? Where if someone does have questions, we have a whole team of folks that can help people through the technology and and even the buying of the app, depending on what your level of comfort is with the tech, right? So we have a team of folks that can um help with that. And but the other part of the the webinars that I that I do enjoy is is not just about how to use SyncFit the app, but also coming up with really functional ways of of integrating different types of musical process in caregiving and in uh your life for for health and and quality of life. So we kind of depending on the webinar, we'll be break we'll break down, you know, what are some different ways to use music.

SPEAKER_00 22:49

What would be some examples of different ways of using music? I'm a music novice in many ways. So when you say different modalities of using music, I don't think I've ever thought about using music to get someone to go to the bathroom. I think the only way I've thought about it is like, you know, as potentially a calming or enjoyable thing to do.

SPEAKER_01 23:09

Yes, exactly. No, but I I I think that uh, you know, we we we like so big picture, I kind of always explain that there's a difference between the passive receptive process, right, and then the active music making and what those bring to the table, right? And what why would you use one and not one at one point and then another at another point. And so it's just like you're saying, I appreciate you saying, like I I'm a music novice, it seems like it's a nice relaxing thing. It's exactly the point that if you start having an understanding of like this this active music making is is like you know, is going to because because my my my dad is like anxious and want and walking around and can't sit down and can't focus. Well, Andy said, don't play mellow chopin, because that could actually make him more anxious and more agitated. What I should do is get him singing and rocking and then connect with him musically, right? Music making. And he's like, I found my thrills. And he feels connected and heard and and and organized and connected with you. And then so this is what you know, I'm we're starting to explain the the core of this, and then providing some simple ways, like sing fit, but if you are a dancer and and he's and it's safe for him to dance, put on that song and move and dance with them and and sing. That's active as well, right? So there's different ways. A passive receptive scenario that we would touch on is like if someone's far along on their dementia journey, excuse me, it might be around mealtimes where the goal is to support calorie intake and eating, and you you you know what kind of music in general somebody likes, but it's if you put on sleepy music, right? That's not necessarily going to help them intake calories. But if you put on up like energetic music with a vocal focused, with big Tony Bennett singing or something like this, right? A big vocal, that also can pull their ear and distract them from underst from being able to differentiate a fork from a spoon. So, you know, we'll talk about how to match the energetic level of the meal with nonverbal music, right? Or non-vocal centered music, right? And to use music as a tool, as a support system.

SPEAKER_00 25:47

Wow. That is all very fascinating. And I think we could talk forever about the different ways that music can help support your loved one. I would like to encourage people to check out Sing Fit for themselves, and I will link the show notes for Sing Fit's website, or you can just search Sing Fit S-I-N-G fit. That makes sense in terms of using Singing for Fitness.

SPEAKER_01 26:12

Yes, exactly. Exactly. And it's easy if you want more information, just info at SingFit. And we have uh, like I said, a nice team that will get back to you and help walk through or answer questions or connect you to a music therapist.

SPEAKER_00 26:24

That's fantastic. Thank you so much for coming on to the podcast, Andy.

SPEAKER_01 26:28

Yeah, thank you. And nice questions. I appreciate you uh having me on.

SPEAKER_00 26:31

Thank you. If you've enjoyed listening to this episode, feel free to share with someone who might also enjoy it. If you can also leave me a review on Apple Podcasts or Spotify or wherever you listen to this podcast, as that is the way how other people can find my podcast. Thank you and talk to you next time. Thank you so much for listening to this episode. Please click the follow button on your favorite podcast platform. Please remember that this is educational content and that do talk to your own doctor if you have specific questions. Original music by Grant Willis. The podcast is edited by Builder Librarian. And finally, please repeat after me by taking care of myself, I can better care for the older adult in my life.