Archive for category Music/Music therapy

[WEB PAGE] Mozart may reduce seizure frequency in people with epilepsy

June 10, 2020. Source: University Health Network


A new clinical research study has found that a Mozart composition may reduce seizure frequency in patients with epilepsy.

A new clinical research study by Dr. Marjan Rafiee and Dr. Taufik Valiante of the Krembil Brain Institute at Toronto Western Hospital, part of University Health Network, has found that a Mozart composition may reduce seizure frequency in patients with epilepsy.

The results of the research study, “The Rhyme and Rhythm of Music in Epilepsy,” was recently published in the international journal Epilepsia Open. It looks at the effects of the Mozart melody, “Sonata for Two Pianos in D Major, K. 448” on reducing seizures, as compared to another auditory stimulus — a scrambled version of the original Mozart composition, with similar mathematical features, but shuffled randomly and lacking any rhythmicity.

“In the past 15 to 20 years, we have learned a lot about how listening to one of Mozart’s compositions in individuals with epilepsy appears to demonstrate a reduction in seizure frequency,” says Dr. Marjan Rafiee, lead author on the study. “But, one of the questions that still needed to be answered was whether individuals would show a similar reduction in seizure frequency by listening to another auditory stimulus — a control piece — as compared to Mozart.”

The researchers recruited 13 patients to participate in the novel, year-long study. After three months of a baseline period, half of the patients listened to Mozart’s Sonata once daily for three months, then switched to the scrambled version for three months. The others started the intervention by listening to the scrambled version for three months, then switched to daily listening of Mozart.

Patients kept “seizure diaries” to document their seizure frequency during the intervention. Their medications were kept unchanged during the course of the study.

“Our results showed daily listening to the first movement of Mozart K.448 was associated with reducing seizure frequency in adult individuals with epilepsy,” says Dr. Rafiee. “This suggests that daily Mozart listening may be considered as a supplemental therapeutic option to reduce seizures in individuals with epilepsy.”

Epilepsy is the most common serious neurological disorder in the world, affecting approximately 300,000 Canadians and 50 million people worldwide.

Many experience debilitating seizures. The treatment is often one or more anti-seizure medications. But for 30 per cent of patients, the medications are not effective in controlling their seizures.

“As a surgeon, I have the pleasure of seeing individuals benefit from surgery, however I also know well those individuals for whom surgery is not an option, or those who have not benefitted from surgery, so, we are always looking for ways to improve symptom control, and improve quality of life for those with epilepsy,” says Dr. Taufik Valiante, senior author of the study and the Director of the Surgical Epilepsy Program at Krembil Brain Institute at UHN and co-Director of CRANIA.

“Like all research, ours raises a lot of questions that we are excited to continue to answer with further research and support from the epilepsy community.”

While these results are promising, the next step is to conduct larger studies with more patients, over a longer period of time.

Story Source:

Materials provided by University Health NetworkNote: Content may be edited for style and length.

Journal Reference:

  1. Marjan Rafiee, Kramay Patel, David M. Groppe, Danielle M. Andrade, Eduard Bercovici, Esther Bui, Peter L. Carlen, Aylin Reid, Peter Tai, Donald Weaver, Richard Wennberg, Taufik A. Valiante. Daily listening to Mozart reduces seizures in individuals with epilepsy: A randomized control studyEpilepsia Open, 2020; 5 (2): 285 DOI: 10.1002/epi4.12400

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[Abstract] Safe and Sound: meta-analyzing the Mozart Effect on epilepsy


  • Our meta-analysis supports music therapy as a complementary intervention for epilepsy.
  • Mozart music may improve seizures and EEG after both short- and long-term music treatment
  • The therapeutic potential of music and the most effective protocols need further definition.



The use of music-based neuro-stimulation for treating seizures and interictal epileptiform discharges (IED) (the so-called “Mozart effect”) remains a controversial issue. We have conducted an updated meta-analysis in order to systematically review literature evidence and provide further insights about the role of the Mozart effect in epilepsy.


Following the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines, we searched three bibliographic databases from their date of inception to January 2020. Nine meta-analyses were performed according to both music stimulation protocols and outcome measures. We applied the Cochrane Q-test and the I2-index for heterogeneity evaluation, and either fixed-effect or random-effect models to compute mean differences and pool data.


Of 147 abstracts, 12 studies were included and grouped according to stimulation protocols and outcome measures. The nine meta-analyses showed significant reductions in seizures and IED frequencies after long-term music treatment, and in IED frequency during and after a single music stimulus.


Music-based neurostimulation may improve the clinical outcome of individuals with epilepsy, by reducing the frequency of seizures and IED. Further and stronger evidence will allow defining its potential in the different forms of epilepsy, and the most effective stimulation protocols.


Music therapy should be considered as a complementary, non-invasive approach for treating epilepsy and epileptiform discharges.

via Safe and Sound: meta-analyzing the Mozart Effect on epilepsy – ScienceDirect

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[Music] Few of my favorite things – Julie Andrews – The sound of Music


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[Music] Don’t Worry, Be Happy – Bob Marley

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[WEB SITE] Music Therapy Boosts Stroke-Recovery Rates, Aids Memory

Bridging Sound and Science: Music’s Role in Healing

Health experts explore how a song could become the prescription of the future

Choir Helps Stroke Survivors Regain Their Voice

Randy Kernus was not expected to live. Nine years ago the then 51-year-old was headed to work near his home in Northern Virginia when a tangle of abnormal blood vessels on his brain started to bleed.

He doesn’t remember anything from that day — neither the rush from one hospital to the next nor the diagnosis that followed: a massive hemorrhagic stroke that required a major operation to remove the cluster of vessels that caused the bleeding.

Kernus survived the trauma, beating the experts’ initial predictions. But the stroke left him partially paralyzed and nearly speechless from Broca’s aphasia, a common stroke-associated injury that affects one’s ability to produce words, even though language comprehension typically remains intact.

After several weeks of routine rehabilitation therapies, the paralysis went away. Kernus’ speech, however, was slow to return. More than a year after the stroke, he still wasn’t speaking in complete sentences, and that terrified his wife, Laura Obradovic.

“His neurologist had told us, ‘Wherever he’s at 18 to 24 months after the stroke, that’s probably the best he’s going to be,’ ” Obradovic recalls.

Refusing to accept her husband’s stalled progress and stunted sentences as their new normal, Obradovic enrolled in a nearby support group for stroke survivors and their caregivers, hoping to learn about other interventions from those who were going through the same thing.

That’s where they met Tom Sweitzer.

Survivors who sing   

Standing over a keyboard at the front of a beige conference room on a satellite college campus in Loudon, Virginia, Sweitzer, a music therapist, addressed the dozen or so adults seated in front of him. Some were joined by caregivers; others came solo. Everyone held sheet music.

“Let’s start by telling us one of your favorite Thanksgiving traditions,” Sweitzer said.

The group, a choir of stroke survivors that goes by the name Different Strokes for Different Folks, had just finished a more traditional vocal warm-up. But this next exercise wasn’t for the voice; it was for the brain.

The singers went around the room and traded stories of food and family. When it was Kernus’ turn, he told the group, “Pumpkin pie is one of my favorites. But on top of that, obviously, it’s football for me.”

Nothing about his sentence was incomplete.

“It’s just really, really impressive,” Obradovic says about her husband’s progress since joining the stroke choir five years ago, despite having no previous experience or even an interest in singing. “Randy has come leaps and bounds from where he was” when doctors predicted he would likely not see further improvements in his speech.

The Different Strokes for Different Folks stroke choir practices for an upcoming performance in Loudoun County, Virginia.


The Different Strokes for Different Folks stroke choir practices for an upcoming performance in Loudoun County, Virginia.

The breakthroughs Kernus has experienced since joining the stroke choir are not unique. Music therapist Skylar Freeman, who works with Sweitzer and the stroke choir, sees progress like his all the time. When she joined the group, three years ago, Freeman says, it was “really difficult” to understand what many of the members were trying to communicate. Sentences were short and often incomplete, and pauses between words stretched several seconds.

“And now it’s like full sentences — very quick, super responsive,” she says. “Some people say that it’s like magic. I don’t think it’s like magic; it’s like music. That’s just really what it is.”

Drop the melody, but keep the words

Researchers and therapists have long known that people who can’t speak after a brain injury, including stroke, usually can sing. For the majority of the population, words and music are produced in similar ways but on opposite sides of the brain — speech on the left and song on the right — explains Kathleen Howland, a music therapist, speech therapist and professor of music therapy at Berklee College of Music in Boston.

“And what is so fascinating about music and the brain is when speech goes down, music typically does not,” Howland says.

But speech and music also share a network. And studies have found that singing can help rebuild speech pathways. This is one reason why Sweitzer and a team of therapists from his Middleburg, Virginia, nonprofit, A Place to Be, work with stroke survivors on singing everyday phrases, including what they want to eat and how they feel in a particular moment. The goal: One day they’ll drop the melody but keep the words.

Brandon Hassan, a music therapist who works with the choir, demonstrates this by tapping his leg and slowly singing, “I’m feeling sad.” All too often, he says, people with aphasia resort to words or phrases that come easily, and “I’m good” is one of the phrases he hears regularly.

“Someone could be very upset in a moment, but that’s the phrase that’s easy to put out there into the world,” he explains. “So we can work on that emotional vocabulary and help provide those phrases that are functional so that we don’t always just have to say ‘I’m good’ because it’s the easiest thing to say.”



At their weekly rehearsals, the singers are challenged to fill in missing lyrics to familiar songs, which may be top of mind but not tip of tongue. For example, the therapists will sing “All you need is …” and wait, no matter how long it takes, for someone to say “love.” The group also writes original songs, which requires members to come up with, and remember, words to an unfamiliar melody.

“People who stutter after their stroke, they don’t stutter when they sing,” Sweitzer notes. “When something inside of your brain dies, the simplest beat … and a simple sound can open up your brain to want to grow again.”

And figuring out how those “simple sounds” trigger healing pathways in the brain is exactly what one of the world’s leading biomedical research institutes has set out to do.

Synching science with song 

In June 2015, National Institutes of Health Director Francis Collins found himself at a dinner party with “a rather distinguished group of people,” just outside the nation’s capital.

Supreme Court justices Anthony Kennedy, Antonin Scalia and Ruth Bader Ginsburg were in attendance, and the mood was “tense,” to say the least. The dinner took place the same week the court had issued its ruling on gay marriage, “and there was not full agreement amongst those three Supreme Court justices about whether they got it right,” recalls Collins, a physician who is known for his work on the Human Genome Project.

In an effort to lighten the mood, the geneticist and amateur musician grabbed his guitar — Collins admits he “sometimes” brings it to social events — and jumped onstage with the bluegrass band that was there entertaining the guests. World-renowned soprano Renée Fleming, who was also at the dinner, joined him.

“The whole evening changed. People began to sort of relax out of their tension zones,” Collins says. “Antonin Scalia — smoking a cigar, raising his glass of brandy — lustily sang along as we joined together for a rendition of the Bob Dylan anthem ‘The Times They Are A-Changin,’ which seemed particularly appropriate. And, I confess, I chose it for that reason.”

The impromptu performance by the scientist and the soprano not only saved the fate of the fete but also prompted the duo to launch a joint research endeavor between the NIH and the John F. Kennedy Center for the Performing Arts to explore the link between music and health, called the Sound Health Initiative, in partnership with the National Endowment for the Arts. In September the NIH announced a $20 million investment to fund the initiative’s first round of studies.

“You wouldn’t, at this point, say music therapy is a well-worked-out science,” despite a small body of research showing its effectiveness, Collins says. But newer technologies and a better understanding of how the brain works are making it easier for scientists to home in on how music affects the brain.

“And we know it affects you,” Collins adds. “When you hear a piece of music that’s particularly important to you, it makes you stop where you are. You might get a chill or some other experience. It’s really getting in there, in your brain circuits, and having a profound effect.”

“Some people say that it’s like magic. I don’t think it’s like magic; it’s like music.

–Music therapist Skylar Freeman

Some of the NIH-funded projects are looking at how music may be able to help improve walking ability in people with Parkinson’s disease. Another looks at the potential for music to reduce the likelihood that patients in intensive care will develop delirium — a common complication in hospital care, especially among older adults. There’s also a study underway examining music’s potential to improve physical and mental health in older adults with cardiovascular disease.

It will be a few years before the results from the Sound Health Initiative research come to light, but once they do, Collins expects that the field of music therapy will “really gather momentum.” And with more “solid evidence,” Collins is hopeful that music therapy will become a standard treatment for many common health conditions — one that physicians prescribe and third-party payers cover.

“Wouldn’t it be great if for pain, music was the first prescription before you get to any kind of pain relievers?” Fleming, the soprano, adds.

That might not be too far from reality.

Music taps into memory

Zoe Gleason Volz was packing up her collection of maracas, bells and tambourines after leading a music therapy session at an assisted living facility in Manassas, Virginia, when one of the adults leaving the room suddenly burst into song.

“We’re off to see the wizard,” the woman, in her 80s, sang.

Volz whipped around and joined in: “The wonderful wizard of Oz!” The two continued through the next several lines of the song. Just a few minutes earlier, the woman belting out the famous Judy Garland tune struggled to piece together details from everyday life. The words to the song from the 1939 film, however, flowed naturally.

“Sometimes you stumble into these really wonderful areas where you trigger a memory,” says Volz, a music therapist at Neurosound Music Therapy in Fairfax, Virginia, who often works with older adults who have memory issues. “After this session, a lot of the time, many individuals will continue to tell me stories. … So you’ve definitely hit something, and the brain is awake and active.”

Music therapist Zoe Gleason Volz leads a music therapy session with a group of older adults at an assisted living center in Northern Virginia.


Music therapist Zoe Gleason Volz leads a music therapy session with a group of older adults at an assisted living center in Northern Virginia.

Music’s effect on memory is another area of study being funded by the NIH. Specifically, scientists are looking at how memories are triggered by music and how music may help consolidate memories.

Research shows that music may provide relief from some symptoms associated with memory loss. Listening to music can reduce anxiety and agitation in people with Alzheimer’s disease, for example. It may also lessen their need for antipsychotic and antianxiety medications.

And similar to stroke recovery, music can be an effective way to communicate with people who have cognitive complications, explains Kelsi Yingling-Tafaro, a music therapist and executive director of Neurosound Music Therapy.

Some of the adults she works with don’t always process verbal instructions. “But if you sing the directives, they are very compliant. They understand what you are saying, and they are able to communicate with you through singing,” she says.

Other studies have found that music can help with memory recall and enhance people’s awareness of their current environment. This may be because musical memories are stored in a part of the brain that remains relatively undamaged by Alzheimer’s, researchers suggest.

“There’s something about music that taps into who you are,” the NIH’s Collins says. “It allows people who’ve kind of gotten lost back in the fog to come back out again with a familiar song and interact and experience enjoyment again.”

What’s more, music allows people to experience that sense of enjoyment with others.


More than medicine 

It was the day of the annual holiday concert — a performance the Different Strokes for Different Folks choir had spent months working toward. The singers, dressed in festive holiday attire, sat onstage at a local school in a row of chairs arranged in an arch, waiting for the program to start.

Everyone was there — that is, everyone except Kernus.

Suddenly, his face appeared on a large screen, stage right. The show was ready to start. Kernus no longer lives in Northern Virginia, where the stroke choir is based. He and his wife moved to North Carolina in October of 2019, to be closer to the beach — a retirement dream they pushed up once Kernus showed significant progress in his stroke recovery.

But despite the distance, Kernus is very much still an active member of the choir. He can’t imagine leaving, so each Wednesday he dials into practice through videoconferencing and participates in performances the same way. And it doesn’t seem strange to anyone involved.

The sense of community among the choir members is unlike anything Sweitzer has seen. Along with singing together, the group watch movies, go horseback riding and schedule walks, he says. They’ve helped one another overcome seemingly impossible obstacles and have been a source of comfort during times of devastating loss.

“Many of these individuals, they don’t live like they used to live,” Sweitzer explains. “Many of them will never drive again; some of them have actually lost their spouse through their episode with their stroke. So feeling isolated in a world where maybe other people might not understand the challenges that you have every day, and then coming into a social situation where there are people just like you … they call each other a family.”

And experts say that might be yet another key to music therapy’s success.

“Wouldn’t it be great if for pain, music was the first prescription before you get to any kind of pain relievers?”

–Renée Fleming

Social isolation and loneliness have been linked to several health problems, including high blood pressure, heart disease and Alzheimer’s disease, according to research from the National Institutes on Aging. And being cut off from communicating with others because of stroke-related aphasia can trigger feelings of isolation, music therapist Hassan says.

“The common theme that all of them said they experienced was the feeling of being alone in the world,” Hassan observes. “To have this group is huge for them, because they can come together and know that everyone is on the same page as them. … Everyone has context and knows what they’re going through.”

But music’s connective power may also be what keeps music therapy from being a routine part of medical care. “I think we wonder, How can something that is so emotional and so spiritually moving … how can that really attach itself to clinical and scientific outcomes?” Sweitzer says.

That’s where the Sound Health Initiative comes in. Collins says the goal of the project is to merge two fields that have been traveling in parallel, so that everyone involved can learn more about how music fits into medicine.

“The sparks that fly” when two seemingly opposite fields come together “is really the way new discoveries happen,” Collins says. “I’m counting on that happening here, and we’re already starting to see some evidence for that.”

“We are desperately looking for hope, desperately looking for healing,” Sweitzer adds, pointing to a lack of medical cures for Alzheimer’s and so many other diseases that haunt humanity. “And I think science is finally opening the door to the power of music.”


via Music Therapy Boosts Stroke-Recovery Rates, Aids Memory

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[Infographic] Music & The Brain


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[WEB PAGE] ‘Alternative’ Rehabilitation approaches – Online Neurology Journal ACNR

‘Alternative’ Rehabilitation approaches

Posted in Rehabilitation Articles on 17th Feb 2020

In the rehabilitation section of this edition we have chosen to focus on ‘alternative’ therapeutic approaches utilising music or animals. This reflects a growing interest in the importance of providing a stimulating therapeutic environment for patients as they undergo rehabilitation. There is evidence that patients undergoing inpatient rehabilitation are bored1 and inactive.2 Patients treated in ‘enriched’ environments show greater levels of physical activity, social interaction and cognitive activity.3

Importantly, in the current financial climate, this was achieved without increasing staffing numbers; it is a change in mindset and also having availability of resources to support these interactions. Environmental enrichment can include provision of equipment to enhance activity away from the bedside e.g. iPads, books, puzzles, newspapers, games, music and magazines. It can also include provision of daily group sessions, with a varied focus, for example: self-management education, emotional support, communication, physical activities. Some of the interventions in studies on stroke units may already be occurring on rehabilitation wards e.g. communal mealtimes, but there is still scope to look at relatively easy and cheap changes that could enhance a patient’s rehabilitation journey and potentially improve rehabilitation outcomes and reduce length of stay. It is essential that rehabilitation environments enable people to continue to participate in meaningful activities and supporting interaction with family members as this can facilitate the transition to living with what is often a long term disability. Being hospitalised following an acquired brain injury entails many losses – loss of function, loss of independence, loss of role within family and society and a loss of identity. Physiological losses are compounded by a physical separation from family and also in some cases a virtual separation (the single most common complaint on our ward used to be the lack of WiFi signal). Loss of access to hobbies and cognitive stimulation from work often compounds the boredom. Hobbies and activities that interest people are intrinsically more rewarding and motivating than therapist-driven exercises. Diane Playford at the recent BSRM meeting spoke about the importance of ‘play’ or non-structured activity during rehabilitation and encouraged us to think of ways of incorporating more opportunities for play within our units. I hope these two articles will continue to stimulate that discussion.

Emily Thomas, Rehabilitation Editor

1. Kenah et al. Disability and rehabilitation. 2018;40(22):2713-22)
2. Janssen et al. Clin Rehabil. 2014;28(1):91-101. doi: 10.1177/0269215512466252. Epub 2012 Nov 28).
3. Rosbergen et al. 2017 Clinical Rehab

via ‘Alternative’ Rehabilitation approaches – ACNR | Online Neurology Journal ACNR | Online Neurology Journal

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[WEB SITE] How Music Helps Your Mental Health

How Music Helps Your Mental Health

Music is medicine for your mind.

There are very few things that stimulate the brain in the way it does. It’s one of the most demanding cognitive and neural challenging activities. Music requires complex and accurate timing of multiple actions in your brain because of the structural, mathematical, and architectural relationships between the notes. Although it may not feel like it, your brain is doing a lot of computing to make sense of all the incoming stimuli. It’s one of the few activities that activate almost every part of your brain.

The effects of music are cognitive, psychological, social, behavioral, and emotional. Research has shown that listening to musical pieces can reduce anxiety, blood pressure, and pain as well as improve sleep quality, mood, mental alertness, and memory. Active engagement with music has lasting brain benefits, such as improving concentration, memory, self-discipline, and confidence.  The cognitive benefits of music education extend from early childhood to old age. Some studies show that it can make you smarter. It may even help ward off the effects of brain aging.Music is a total brain workout.


Music Evokes Mental States

Listening to, singing, playing, composing, and improvising music evokes and allows you to express mental states and feelings. New research has determined that the subjective experience of music across cultures can be mapped to at least 13 common feelings, including:

  • amusement,
  • joy,
  • eroticism,
  • beauty,
  • relaxation,
  • sadness,
  • dreaminess,
  • triumph,
  • anxiety,
  • scariness,
  • annoyance,
  • defiance, and
  • feeling pumped up.

Researchers came up with a very cool interactive map, in which musical samples are plotted along the 13 dimensions of the emotional experiences determined. In the map, each letter corresponds to a musical track. You can hover over a letter to play it. Check out the map here.

How Music Helps Your Mental Health
Graphic by Alan Cohen.

Potential applications for these research findings range from informing psychological and psychiatric therapies designed to evoke certain feelings to helping music streaming services like Spotify adjust their algorithms to satisfy customers’ audio preferences or set the mood.

Music’s Mental Health Benefits

Reduces Stress

Research shows that listening to certain melodies can lower the stress hormone, cortisol. In one study reviewed, patients about to undergo surgery who listened to music had less anxiety and lower cortisol levels than people who had taken drugs.

Listening to music triggers the brain’s nucleus accumbens, responsible for releasing the feel-good neurochemical dopamine, which is an integral part of the pleasure-reward and motivational systems and plays a critical role in learning. Higher dopamine levels improve concentration, boost mood, and enhance memory. Dopamine is the chemical responsible for the yummy feelings you get from eating chocolate, having an orgasm, or a runner’s high.

Decreases Depression

Science shows that music can help alleviate depression and help a person feel more hopeful and in control of their life. There is even evidence that listening to music can aid in rewiring trauma in the brain. Creating harmonies with others or enjoying live music, like at a concert, gets the brain hormone oxytocin flowing increasing feelings of connectedness, trust, and social bonding.

A study appearing in the World Journal of Psychiatry found that musical therapy successfully reduced depression and anxiety in patients suffering from neurological conditions such as dementia, stroke, and Parkinson’s disease. Researchers also noted that the therapy had no negative side effects and was a safe, low-risk treatment tool. Other research showed that musical therapy significantly improved depressive symptoms.

How Music Helps Your Mental Health

Boosts Mood

One study found that people who listened to upbeat tunes could improve their mood and boost happiness levels in just two weeks. In the experiment, one group was instructed to try to improve their mood with music. The other participants were told to listen to music but were not guided to try to intentionally elevate their mood. When participants were later asked to describe their happiness levels, those who had purposefully tried to improve their moods reported feeling happier after just two weeks.

Not surprisingly, another study found that different types of music had different effects on mood. Researchers determined that classical and meditation scores offered the greatest mood-boosting benefits. Heavy metal and techno were found to be ineffective and in some cases, detrimental. Surprisingly though, even sad music can bring most listeners pleasure and comfort, according to one study.

While listening to music can bring multiple mental and physical health benefits, creating it can be therapy, too. Singing in a choir has many mood-boosting and mental health benefits. Of course, playing a musical instrument has advantages for both your mental wellbeing and physical brain health.

Increases Motivation and Enhances Performance

There’s a good reason why exercise classes blast the beats or runners have tunes playing in their earbuds. Research shows that listening to fast-paced music motivates people to work out harder.

In one experiment, 12 healthy male students pedaled stationary bikes. The participants rode for 25 minutes in three sessions and listened to six songs. Unbeknownst to the bikers, the researchers were altering the tempos and measuring performances. For example, the songs were played at a normal speed, increased by ten percent, or slowed by ten percent.

The researchers discovered that speeding up the tracks resulted in increased performance in terms of distance covered, the speed of pedaling, and power exerted. Interestingly, listening to faster-paced songs not only caused exercisers to work harder during their workouts; they also reported enjoying the music more. Conversely, slowing down the tempo led to decreases in all of the variables.

Strengthens Social Bonds

In a 2013 review of the research on music, Stefan Koelsch, a music psychologist at the Freie University Berlin, determined the mechanisms through which music allows us to connect with one another. It impacts brain circuits involved in empathy, trust, and cooperation. This might explain how it has survived in every culture of the world. Music is one of the few activities where people around the globe respond in a common way. It connects all kinds of people across a myriad of cultures, traditions, and practices all over the world.

The article, Four Ways Music Strengthens Social Bonds, explains that music helps people feel connected in four ways:

  1. It increases contact, coordination, and cooperation with others.
  2. Music causes your brain to release oxytocin.
  3. It strengthens our “theory of mind” and empathy.
  4. Music increases cultural cohesion.


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[Abstract] Music Therapy Enhances Executive Functions and Prefrontal Structural Neuroplasticity after Traumatic Brain Injury: Evidence from a Randomized Controlled Trial

Traumatic brain injury (TBI) causes lifelong cognitive deficits, particularly impairments of executive functioning (EF). Musical training and music-based rehabilitation have been shown to enhance cognitive functioning and neuroplasticity, but the potential rehabilitative effects of music in TBI are still largely unknown. The aim of the present crossover randomized controlled trial (RCT) was to determine the clinical efficacy of music therapy on cognitive functioning in TBI and to explore its neural basis.

Using an AB/BA design, 40 patients with moderate or severe TBI were randomized to receive a 3-month neurological music therapy intervention either during the first (AB, n = 20) or second (BA, n = 20) half of a 6-month follow-up period. Neuropsychological and motor testing and magnetic resonance imaging (MRI) were performed at baseline and at the 3-month and 6-month stage. Thirty-nine subjects who participated in baseline measurement were included in an intention-to-treat analysis using multiple imputation. Results showed that general EF (as indicated by the Frontal Assessment Battery [FAB]) and set shifting improved more in the AB group than in the BA group over the first 3-month period and the effect on general EF was maintained in the 6-month follow-up. Voxel-based morphometry (VBM) analysis of the structural MRI data indicated that gray matter volume (GMV) in the right inferior frontal gyrus (IFG) increased significantly in both groups during the intervention versus control period, which also correlated with cognitive improvement in set shifting. These findings suggest that neurological music therapy enhances EF and induces fine-grained neuroanatomical changes in prefrontal areas.


via Music Therapy Enhances Executive Functions and Prefrontal Structural Neuroplasticity after Traumatic Brain Injury: Evidence from a Randomized Controlled Trial | Journal of Neurotrauma

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[ARTICLE] Musical Sonification of Arm Movements in Stroke Rehabilitation Yields Limited Benefits – Full Text

Neurologic music therapy in rehabilitation of stroke patients has been shown to be a promising supplement to the often strenuous conventional rehabilitation strategies. The aim of this study was threefold: (i) replicate results from a previous study with a sample from one clinic (henceforth called Site 1; N = 12) using an already established recording system, and (ii) conceptually replicate previous findings with a less costly hand-tracking system in Site 2 (N = 30), and (iii) compare both sub-studies’ outcomes to estimate the efficiency of neurologic music therapy. Stroke patients in both sites were randomly assigned to treatment or control groups and received daily training of guided sequential upper limb movements additional to their standard stroke rehabilitation protocol. Treatment groups received sonification (i.e., changes in musical pitch) of their movements when they moved their affected hand up and down to reproduce a sequence of the first six notes of a C major scale. Controls received the same movement protocol, however, without auditory feedback. Sensors at the upper arm and the forearm (Xsens) or an optic sensor device (Leapmotion) allowed to measure kinematics of movements and movement smoothness. Behavioral measures pre and post intervention included the Fugl-Meyer assessment (FMA) and the Stroke Impact Scale (SIS) and movement data. Bayesian regression did not show evidence supporting an additional effect of sonification on clinical mobility assessments. However, combined movement data from both sites showed slight improvements in movement smoothness for the treatment group, and an advantage for one of the two motion capturing systems. Exploratory analyses of EEG-EMG phase coherence during movement of the paretic arm in a subset of patients suggested increases in cortico-muscular phase coherence specifically in the ipsilesional hemisphere after sonification therapy, but not after standard rehabilitation therapy. Our findings show that musical sonification is a viable treatment supplement to current neurorehabilitation methods, with limited clinical benefits. However, given patients’ enthusiasm during training and the low hardware price of one of the systems it may be considered as an add-on home-based neurorehabilitation therapy.


Stroke survivors frequently suffer from severe disabilities. Stroke may lead to impairments in motor and sensory systems, emotion regulation, language perception, and cognitive functions (Morris and Taub, 2008). Impaired arm function caused by gross-motor disability is also a common consequence of stroke immensely affecting quality of life in a considerable number of patients. In this case, regaining control over body movements is one of the crucial components in post-stroke recovery. There is an urgent need for effective motor rehabilitation approaches to improve quality of life in stroke survivors. Different therapeutic approaches such as Constraint Induced Movement Therapy (CIMT), mental practice, robot-aided therapy, electromyographic biofeedback, and repetitive task training have been applied to improve arm function after stroke (Langhorne et al., 2009). Of note, in a recent review it has been suggested that neurologic music therapy might be more effective than conventional physiotherapy (for a recent review see Sihvonen et al., 2017).

Motivational factors seem to play an important role for the beneficial effects of neurologic music therapy. From the patients’ informal descriptions of their experience with music-supported training, it appears that this is frequently highly enjoyable and a highlight of their rehabilitation process, regardless of the form of auditory stimulation, be it piano tones, or sonification of movement with other timbres [for a review see Altenmüller and Stewart (2018)]. However, effects of music supported therapy in stroke rehabilitation are not always consistent. In a recent review, seven controlled studies that evaluated the efficacy of music as an add-on therapy in stroke rehabilitation were identified (Sihvonen et al., 2017). In these studies, training of finger dexterity of the paretic hand was done using either a piano-keyboard, or, for wrist movements, drum-pads tuned to a C major scale. Superiority of the music group over fine motor training without music and over conventional physiotherapy was evident in one study after intervention comprising five 30-min sessions per week for 3 weeks (Schneider et al., 2010). The beneficial effect seen in the music group could be specifically attributed to the musical component of the training rather than the motor training per se, since patients practicing with mute instruments remained inferior to the music group. Here, the Fugl-Meyer Assessment (FMA) was applied before and after 20 sessions of either music supported therapy on a keyboard or equivalent therapy without sound. FMA scores of the motor functions of the upper limb improved by 16 in the music group and by 5 in the control group, both improvements being statistically significant although to a lesser degree in the control group (p = 0.02 vs. p = 0.04; Tong et al. (2015)).

With regard to the neurophysiological mechanisms of neurological music therapy, it was demonstrated that patients undergoing music supported therapy not only regained their motor abilities at a faster rate but also improved in timing, precision and smoothness of fine motor skills as well as showing increases in neuronal connectivity between sensorimotor and auditory cortices as assessed by means of EEG-EEG-coherence (Altenmüller et al., 2009Schneider et al., 2010).

These findings are corroborated by a case study of a patient who underwent music supported training 20 months after suffering a stroke. Along with the clinical improvement, functional magnetic resonance imaging (fMRI) demonstrated activation of motor and premotor areas, when listening to simple piano tunes, thus providing additional evidence for the establishment of an auditory-sensorimotor co-representation due to the training procedure (Rojo et al., 2011). Likewise, in a larger group of 20 chronic stroke patients, increases in motor cortex excitability following 4 weeks of music-supported therapy were demonstrated using transcranial magnetic stimulation (TMS), which were accompanied by marked improvements of fine motor skills (Amengual et al., 2013).

In addition to functional reorganization of the auditory-sensorimotor network, recent findings have reported changes in cognition and emotion after music-supported therapy in chronic stroke patients. Fujioka et al. (2018) demonstrated in a 10-week-long randomized controlled trial (RCT), including 14 patients with music supported therapy and 14 patients receiving conventional physiotherapy, that both groups only showed minor improvements. However, the music group performed significantly better in the trail making test, indicating an improvement in cognitive flexibility, and furthermore showed enhanced social and communal participation in the Stroke Impairment Scale and in PANAS (Positive and Negative Affect Schedule, Watson et al., 1988), lending support to the prosocial and motivational effects of music. In another RCT with an intervention of only 4 weeks, Grau-Sánchez et al. (2018) demonstrated no superiority in fine motor skills in the music group as compared to a control group, but instead an increase in general quality of life as assessed by the Profile of Mood states and the stroke specific quality of live questionnaire. Despite growing evidence, the neurophysiological mechanisms of neurological music therapy remain poorly understood.

Most of the existing studies on music-supported therapy have focused on rehabilitation of fine motor functions of the hand. Much less evidence exists on post-stroke rehabilitation of gross motor functions of the upper limbs. In a previous study we thus developed a movement sonification therapy in order to train upper arm and shoulder functions (Scholz et al., 2015). Gross movements of the arm were transformed into discrete sounds, providing a continuous feedback in a melodic way, tuned to a major scale (i.e., patients could use movements of their paretic arms as a musical instrument). In this way, sound perception substituted for defective proprioception. In a first pilot study in subacute stroke patients we were able to demonstrate that musical sonification therapy reduced joint pain in the Fugl-Meyer pain subscale (difference between groups: −10; d = 1.96) and improved smoothness of movements (d = 1.16) in comparison to movement therapy without sound (Scholz et al., 2016). Here, we extend these findings by comparing the effects of the established musical sonification setup (Scholz et al., 2016) with a newly developed, less expensive sonification device in a group of subacute stroke patients with upper limb motor impairments. The only apparent differences between both data acquisition methods were the improved sound quality and the loss of need to strap sensors to patient limbs. In order to further elucidate the neurophysiological underpinnings of musical sonification therapy we simultaneously recorded EEG and EMG data from a subset of patients to analyze cortico-muscular phase coherence during upper limb movements (Chen et al., 2018Pan et al., 2018). According to previous studies (Pan et al., 2018) we hypothesized that cortico-muscular phase coherence increases in the ipsilesional hemisphere after musical sonification therapy. […]


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Figure 2. Experimental setup. (A) three-dimensional space (the Leapmotion controller at Site 2 was placed on the board at the position marked in purple), with axis labels describing qualitative sound changes when the hand was moved relative to the frame (and hence, the body). (B) Xsens sensors as used at Site 1, attached to wrist and upper arm of patient. (C) Leapmotion controller as used at Site 2, with the space axes superimposed. Panel (A) taken from Scholz et al. (2016).

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