Archive for category Music/Music therapy

[WEB SITE] Brains Tend to Work in Sync During Music Therapy, Study Suggests

Published on 

MusicTherapyDocUke

 

The brains of a patient and therapist become synchronized during a music therapy session, a breakthrough that could improve future interactions between patients and therapists, researchers suggest.

The research, published in the journal Frontiers in Psychology, was carried out by Professor Jorg Fachner and Dr Clemens Maidhof of Anglia Ruskin University (ARU).

In the study, they used a procedure called hyperscanning, which is designed to record activity in two brains at the same time, allowing them to better understand how people interact.

During the session documented in the study, classical music was played as the patient discussed a serious illness in her family. Both patient and therapist wore EEG (electroencephalogram) caps containing sensors, which capture electrical signals in the brain, and the session was recorded in sync with the EEG using video cameras, a media release from Anglia Ruskin University explains.

Music therapists work towards “moments of change,” where they make a meaningful connection with their patient. At one point during this study, the patient’s brain activity shifted suddenly from displaying deep negative feelings to a positive peak. Moments later, as the therapist realized the session was working, her scan displayed similar results. In subsequent interviews, both identified that as a moment when they felt the therapy was really working.

The researchers examined activity in the brain’s right and left frontal lobes where negative and positive emotions are processed, respectively. By analyzing hyperscanning data alongside video footage and a transcript of the session, the researchers were able to demonstrate that brain synchronization occurs, and also show what a patient-therapist “moment of change” looks like inside the brain.

“This study is a milestone in music therapy research,” says lead author Jorg Fachner, Professor of Music, Health and the Brain at Anglia Ruskin University (ARU), in the release.

“Music therapists report experiencing emotional changes and connections during therapy, and we’ve been able to confirm this using data from the brain.

“Music, used therapeutically, can improve well-being, and treat conditions including anxiety, depression, autism and dementia. Music therapists have had to rely on the patient’s response to judge whether this is working, but by using hyperscanning we can see exactly what is happening in the patient’s brain,” he continues.

“Hyperscanning can show the tiny, otherwise imperceptible, changes that take place during therapy. By highlighting the precise points where sessions have worked best, it could be particularly useful when treating patients for whom verbal communication is challenging. Our findings could also help to better understand emotional processing in other therapeutic interactions,” he concludes.

[Source(s): Anglia Ruskin University, Science Daily]

 

via Brains Tend to Work in Sync During Music Therapy, Study Suggests – Rehab Managment

, , , , , ,

1 Comment

[WEB PAGE] Music Therapy Improves Symptoms and Behaviors of Palliative Care Patients

—Music therapy interventions have led to improved outcomes for patients with a number of common conditions. The effects of patient characteristics, goals, and interventions on outcomes aren’t fully understood, however. A recent study was designed to get some answers.

Does music truly have the power to heal? A recent study, published in American Journal of Hospice and Palliative Medicine, suggests that it does. According to the authors, music therapy improves a host of symptoms, including pain, anxiety, depression, and shortness of breath, among others.1

image

Music therapy, an evidence-based practice, involves addressing patients’ individualized goals through a therapeutic relationship with a board-certified music therapist (MT-BC),2 who can help patients address their physical, social, emotional, psychological, and spiritual needs.3Interventions include playing instruments, listening to music, choosing songs, singing, songwriting, music-assisted relaxation/imagery, and improvisation.

Previous studies have reported improved outcomes with music therapy; however, the effects of patient goals, patient characteristics, and music therapist interventions haven’t been investigated in-depth.

Research that strikes a chord

“Our study looks more in-depth at music therapy interventions and their effects on symptoms,” explains Lisa M. Gallagher, MT-BC, of the Cleveland Clinic Arts & Medicine Institute, in Lyndhurst, Ohio. “We also had the opportunity to utilize a database of over 1500 patient records and were able to obtain statistically significant results with the largest number of patients researched to date—293 who met all study inclusion criteria.”

The objectives of the study included the following:

  • To describe patient characteristics, patient goals, and interventions used by the music therapist
  • To assess the impact of music therapy sessions on outcomes
  • To identify which patient characteristics, goals, and interventions had an effect on outcomes

This retrospective study included data obtained from music therapy sessions held between September 2000 and May 2012. “Sessions were conducted with patients and any family members present,” Gallagher says. “These included addressing any symptoms such as pain, anxiety, depression, shortness of breath, and mood, while also working on other goals, such as coping and relaxation. We had patients rate the level of their symptoms before and after the sessions, and we were able to investigate the level of change that occurred.” Moreover, therapists examined changes in vocalization, facial expression, and body movement.

Interventions were classified according to 6 main categories, including music-assisted relaxation, music listening, verbal/emotional participation (verbal processing, lyric analysis, etc.), verbal/cognitive participation (music discussion, songwriting, etc.), vocal participation (singing and humming), and physical participation (clapping, foot-tapping, playing instruments). In the majority of the sessions, the MT-BC used more than 1 intervention.

The database included 5970 music therapy sessions spread among 1570 patients who were at least 18 years old and reported a minimum of 1 incidence of depression, anxiety, mood, pain, or shortness of breath before and after their session. For patients who participated in more than 1 session, only data from the first session was included.

What the study revealed

The final analysis included 293 patients with complete data on all primary outcome measures. Of these patients, most (67%) were women, with a median age of 61 years and a cancer diagnosis (93%). Lung cancer, hematologic cancers, breast cancer, and gastrointestinal cancer were the most common. The most frequent reasons for referral to music therapy were enjoyment (23%); relief of anxiety (16%), pain (13%), or depression (12%); and support (7%).

Significant improvements in the mean scores from pre- to post-session were reported for pain, depression, anxiety, shortness of breath, mood, facial expression, and vocalization. No significant improvement was reported for body movement. Positive verbal responses were recorded for 96% of patients; 4% had ambivalent responses or no response. (Demographics and cancer diagnosis did not impact outcomes.)

“We found that vocal and emotional interventions were the two most effective interventions for improving symptoms,” Gallagher says. “Perhaps the only surprise was the level of response—for instance, that 96% had a positive response to their experience and that both clinical and statistical significance were demonstrated.”

Ending on a high note

In this study, the greatest percentage of patients achieved clinically relevant improvements in mood, vocalization, and facial expression. These results also demonstrate that, going forward, no intervention changes are required based on age, gender, or diagnosis.

Limitations of the study included the use of observational behavioral data and the potential for reporting bias. Furthermore, data were missing for patients who experienced severe pain or high anxiety, had fallen asleep, were actively dying, or participated in sessions that were interrupted.

“There are a few other questions that we would like to investigate,” says Gallagher. “These include the cost-effectiveness and duration of music therapy; the validation of scales for mood, anxiety, and depression; and a more in-depth look at specific interventions used to address goals with patients and families.”

“I knew at a gut level that music therapy was effective,” Gallagher continues, adding that the current study helped to demonstrate that. Music therapy is an evidence-based profession that provides value-based healthcare to a wide variety of patients, including palliative medicine patients.”

Published: March 01, 2018

via Music Therapy Improves Symptoms and Behaviors of Palliative Care Patients

, , , ,

Leave a comment

[Infographic] The Effects of Music on the Brain

, ,

Leave a comment

[BLOG POST] Mozart and epilepsy: the rhythm beats on

 

I can’t seem to get away from the theme of Mozart and epilepsy. When I first looked at this, in a blog post titled Mozart and seizures? The links between epilepsy and music, I took the topic rather lightly, more a subscript than a headline you may say. But I have since learnt to take the links between epilepsy and music more seriously.

By Barbara Krafft – The Bridgeman Art Library, Object 574471, Public Domain, Link

 

The major trigger for my ‘road to Damascus’ conversion is a 2018 paper titled Study of the Mozart effect in children with epileptic electroencephalograms, published in the journal Seizure. The paper was an eye-opener because it gave a very helpful comprehensive context to the broader beneficial effect of music…not just in epilepsy, but in other neurological disorders such as Parkinson’s diseasedementia and sleep disordersThe authors, Elyza Grylls and colleagues, started on the established premise that Mozart’s music has a beneficial effect on epilepsy. What they wanted to know was if other forms of music have a similar settling effect on epilepsy, or if only Mozart’s music carries the magic touch. The authors therefore played Mozart’s Sonata for two pianos in D major (K448) to 40 children with epilepsy who were undergoing an EEG (electroencephalogram, or electrical brain wave test). They then compared this with the effect of playing other types of music. Remarkably, they found that only Mozart’s Sonata led to a significant reduction in EEG epileptic discharges.

Public Domain, Link

The authors concluded that there was indeed an anti-epileptic effect of Mozart’s music, the so-called  ‘Mozart therapy’. But what is so special about K448? They speculate that it has to do with the structure of Mozart’s music, containing as it does, long periodicities. Interestingly, the music of Yanni, which is similarly structured, has somewhat a similar effect on brain wave activity. On the contrary, and sorry to Beethoven fans, Fur Elise doesn’t have this effect.

By W.J. Baker (held the expired copyright on the photograph) – Library of Congress[1]Contrairement à une erreur fréquemment répandue le buste a été réalisé par Hugo Hagen, non pas à partir du masque mortuaire mais, comme de nombreux autres, d’après le masque réalisé en 1812 par Franz Klein pour un buste qu’il devait réaliser ensuite., Public Domain, Link

So what does the structure of Mozart’s music do to the brain? One suggestion is that Mozart’s music enhances the body’s parasympathetic drive; this reduces the heart rate, and thereby inhibits the brain’s propensity to epileptic seizures. The suppression of this parasympathetic drive is of course the theory behind using vagus nerve stimulation (VNS) to treat drug-resistant epilepsy. For more on VNS, see my previous blog, Vagus nerve stimulation: from neurology and beyond!

By Bionerd – MRI at Charite Mitte, Berlin (used with permission), CC BY 3.0Link

You have surely wondered by now if K448 is the only one of Mozart’s compositions to have an anti-epileptic effect. It doesn’t matter if you have not, because the authors of another interesting paper did. They titled their study, published in 2018, Mozart’s music in children with drug-refractory epileptic encephalopathies: comparison of two protocols. Published in the journal Epilepsy and Behaviour, the authors, Giangennaro Coppola and colleagues, compared the effect of K448 with a set of his other compositions. Intriguingly they found that the composition set actually had a greater effect in epilepsy than K448…by a wide margin of 70% to 20%! Furthermore, the set was better tolerated by the children; they were less irritable and had a better nighttime sleep quality.   

https://www.publicdomainpictures.net/en/view-image.php?image=76907&picture=dog-amp-child-painting

It therefore appears as if it all rosy in the garden of music and the brain. But it is not! As every rose grows on a thorny tree, so do some forms of music trigger epileptic seizures. This so-called musicogenic epilepsy is well-recognised, and two recent culprits are the music of Sean Paul, discussed in the journal Scientific American , and the music of Ne Yo, explored by NME. Therefore you should craft your playlist wisely.

By CLASSICNEYO – Own workCC BY-SA 4.0Link

So, is it time for neurologists to start prescribing music?

Or is it too much of a double-edged sword?

Music is #SimplyIrresistible. Luca Florio on Flickr. https://www.flickr.com/photos/elle_florio/29516744480

via Mozart and epilepsy: the rhythm beats on – The Neurology Lounge

, , , , , , , , , , , ,

Leave a comment

[Abstract] Nuanced effects of music interventions on rehabilitation outcomes after stroke: a systematic review

Background: Music is affordable and easily integrated in rehabilitation exercises, and has demonstrated different effects on the brain. We hypothesized that music interventions could improve rehabilitation outcomes after stroke.

Objective: the aim of our review is to determine the effectiveness of different types of music interventions according to the rehabilitation objectives after stroke.

Method: A systematic review of randomized controlled trials, clinical controlled trials and cross-over design performed on PubMed and PEDro in May 2018. All of these studies focus on acute, sub-acute or chronic stroke rehabilitation with music or rhythmic auditory stimulation intervention in adults during clinical outcomes. Two independent reviewers extracted the data and assessed the risk of bias before bringing it together.

Results: Twenty-seven studies were included and analyzed. Our review found positive effects on physical status (upper-limb activity; gait parameters, balance), on cognition (neglect, attention, communication) and mood. The analysis of the quality of the evidence showed that a majority of the studies had a high risk of bias.

Conclusion: Focusing on high to moderate level evidence, our review highlighted that rhythmic auditory stimulation has a positive effect on gait and balance; that receptive music therapy improves mood as well as some cognitive functions; that there is not enough evidence to determine the effectiveness of active music therapy and melodic intonation therapy. High-quality trials with large samples would be necessary to further assess and/or recommend these interventions.

via Nuanced effects of music interventions on rehabilitation outcomes after stroke: a systematic review: Topics in Stroke Rehabilitation: Vol 26, No 6

, , , ,

Leave a comment

[WEB SITE] How does music therapy work? Brain study sheds light

Published 

Music therapy works, but no one is really sure how. Now, a novel type of brain scan may provide key insight.

man listening to music

Music is a powerful thing. In fact, it forms the basis of a type of therapy, the aptly named “music therapy.”

During sessions, a music therapist attempts to form a bond with their client in order to enhance well-being and improve confidence, communication skills, awareness, and attention.

There are several types of music therapy. Some involve simply listening to relaxing music while talking. Others involve making music with instruments, which can be particularly effective for those who struggle to communicate verbally.

One type, known as the Bonny Method of Guided Imagery and Music (GIM) aims to facilitate discussion. The therapist plays music and asks the client to describe the images that come to mind.

Trials have found benefits to music therapy, but how it works remains unclear.

Using GIM as their focus, a team led by two experts from Anglia Ruskin University, in the United Kingdom — Prof. Jörg Fachner and Clemens Maidhof, Ph.D. — set out to find the answer. Their findings appear in the journal Frontiers in Psychology.

Discovering important moments

The goal of a music therapist is to reach a “moment of change” in which they can strengthen their connection with their client. Therapists and clients often describe feeling in sync, and now there is evidence to prove it.

In the current study, the researchers used hyperscanning — a procedure that can simultaneously record two people’s brain activities — to study a music therapist’s session with a client.

The method, says lead author Prof. Fachner, “can show the tiny, otherwise imperceptible, changes that take place during therapy.”

The therapist and client wore EEG caps to record the electrical signaling in their brains, and the session was filmed. Ultimately, the researchers hoped to learn more about how the individuals interacted.

“Music, used therapeutically, can improve well-being and treat conditions including anxietydepressionautism, and dementia. Music therapists have had to rely on the patient’s response to judge whether this is working, but by using hyperscanning we can see exactly what is happening in the patient’s brain,” says Prof. Fachner.

Once the recordings were complete, the researchers asked the therapist, client, and two other GIM therapy experts to watch the video and each note down three moments of change, as well as one unimportant moment.

A clear connection

The team examined their answers for overlap to see whether any points were of interest to all four participants. A couple of moments fell into this category.

With that knowledge, Prof. Fachner and Maidhof examined the EEG readings from those moments. They paid particular attention to the areas of the brain that process positive and negative emotions.

Surprisingly, they came up with an image that illustrates a moment of change inside the brain.

When the client’s brain switched from negative emotions to positive ones, their EEG recording clearly showcased this. A few moments later, the therapist’s brain showed the exact same pattern.

Both the therapist and client later identified this moment as a point when they felt that the session was working. Not only were their thoughts in sync, but their brain activity, too.

The researchers also noted increased activity in both participants’ visual cortexes during these moments of change.

More effective therapy

It is unlikely that other case studies will provide the exact same results, due to the personalized nature of therapy. But more research will need to go into therapist-client relationships before the synchronicity can be confirmed.

Still, Prof. Fachner described the study as “a milestone in music therapy research.”

Music therapists report experiencing emotional changes and connections during therapy, and we’ve been able to confirm this using data from the brain.”

Prof. Jörg Fachner

He adds that the study has further implications than just proving a point. He explains, “By highlighting the precise points where sessions have worked best, it could be particularly useful when treating patients for whom verbal communication is challenging.”

The findings could also make music therapy more effective by exposing when and how a therapist should intervene for maximum efficacy.

And, as Prof. Fachner notes, studies such as this may “help [researchers] better understand emotional processing in other therapeutic interactions.”

 

via How does music therapy work? Brain study sheds light

, , , , , , , , ,

Leave a comment

[Abstract] The SonicHand Protocol for Rehabilitation of Hand Motor Function: a validation and feasibility study

Abstract

Musical sonification therapy is a new technique that can reinforce conventional rehabilitation treatments by increasing therapy intensity and engagement through challenging and motivating exercises. Aim of this study is to evaluate the feasibility and validity of the SonicHand protocol, a new training and assessment method for the rehabilitation of hand function. The study was conducted in 15 healthy individuals and 15 stroke patients. The feasibility of implementation of the training protocol was tested in stroke patients only, who practiced a series of exercises concurrently to music sequences produced by specific movements. The assessment protocol evaluated hand motor performance during pronation/supination, wrist horizontal flexion/extension and hand grasp without sonification. From hand position data, 15 quantitative parameters were computed evaluating mean velocity, movement smoothness and angular excursions of hand/fingers. We validated this assessment in terms of its ability to discriminate between patients and healthy subjects, test-retest reliability and concurrent validity with the upper limb section of the Fugl-Meyer scale (FM), the Functional Independence Measure (FIM) and the Box & Block Test (BBT). All patients showed good understanding of the assigned tasks and were able to correctly execute the proposed training protocol, confirming its feasibility. A moderate-to-excellent intraclass correlation coefficient was found in 8/15 computed parameters. Moderate-to-strong correlation was found between the measured parameters and the clinical scales. The SonicHand training protocol is feasible and the assessment protocol showed good to excellent between-group discrimination ability, reliability and concurrent validity, thus enabling the implementation of new personalized and motivating training programs employing sonification for the rehabilitation of hand function.

via The SonicHand Protocol for Rehabilitation of Hand Motor Function: a validation and feasibility study – IEEE Journals & Magazine

, , , , , , , , , ,

Leave a comment

[WEB SITE] The Benefits of Playing Music Help Your Brain More Than Any Other Activity

Learning an instrument has showed an increase resilience to any age-related decline in hearing.

The brain-training is big business. For companies like BrainHQ, Luminosity, and Cogmed, it’s actually a multimillion dollar business that is expected to surpass $3 billion by 2020. But, do the actually benefit your brain?

 

Research doesn’t believe so. In fact, the the University of Illinois determined that there’s little or no evidence that these games improve anything more than the specific tasks being trained. Luminosity was even fined $2 million for false claims.

So, if these brain games don’t work, then what will keep your brain sharp? The answer? Learning to play a musical instrument.

Why Being a Musician Is Good For Your Brain

Science has shown that musical training can change brain structure and function for the better. It can also improve long-term memory and lead to better brain development for those who start at a young age.

Furthermore, musicians tend to be more mentally alert, according to new research from a University of Montreal study.

 

“The more we know about the impact of music on really basic sensory processes, the more we can apply musical training to individuals who might have slower reaction times,” said lead researcher Simon Landry.

 

“As people get older, for example, we know their reaction times get slower. So if we know that playing a musical instrument increases reaction times, then maybe playing an instrument will be helpful for them.”

 

Previously, Landry found that musicians have faster auditory, tactile, and audio-tactile reaction times. Musicians also have an altered statistical use of multi-sensory information. This means that they’re better at integrating the inputs from various senses.

 

“Music probably does something unique,” explains neuropsychologist Catherine Loveday of the University of Westminster. “It stimulates the brain in a very powerful way, because of our emotional connection with it.”

 

Unlike brain-games, playing an instrument is a rich and complex experience. This is because it’s integrating information from senses like vision, hearing, and touch, along with fine movements. This can result long-lasting changes in the brain. This can also be applicable in the business world.

Changes in the Brain

Brains scans have been able to identify the difference in brain structure between musicians and non-musicians. Most notably, the corpus callosum, a massive bundle of nerve fibres connecting the two sides of the brain, is larger in musicians. Also, the areas involving movement, hearing, and visuospatial abilities appear to be larger in professional keyboard players.

 

Initially, these studies couldn’t determine if these differences were caused by musical training of if anatomical differences predispose some to become musicians. Ultimately, longitudinal studies showed that children who do 14 months of musical training displayed more powerful structural and functional brain changes.

 

These studies prove that learning a musical instrument increases grey matter volume in various brain regions, It also strengthens the long-range connections between them. Additional research shows that musical training can enhance verbal memory, spatial reasoning, and literacy skills.

Long Lasting Benefits For Musicians

Brain scanning studies have found that the anatomical change in musicians’ brains is related to the age when training began. It shouldn’t be surprising, but learning at a younger age causes the most drastic changes.

 

Interestingly, even brief periods of musical training can have long-lasting benefits. A 2013 study found that even those with moderate musical training preserved sharp processing of speech sounds. It was also able to increase resilience to any age-related decline in hearing.

 

Researchers also believe that playing music helps speech processing and learning in children with dyslexia. Furthermore, learning to play an instrument as a child can protect the brain against dementia.

“Music reaches parts of the brain that other things can’t,” says Loveday. “It’s a strong cognitive stimulus that grows the brain in a way that nothing else does, and the evidence that musical training enhances things like working memory and language is very robust.”

Other Ways Learning an Instrument Strengthens Your Brain

Guess what? We’re still not done. Here are eight additional ways that learning an instrument strengthens your brain.

 

1. Strengthens bonds with others. This shouldn’t be surprising. Think about your favorite band. They can only make a record when they have contact, coordination, and cooperation with each other.

 

2. Strengthens memory and reading skills. The Auditory Neuroscience Laboratory at Northwestern University states that this is because music and reading are related via common neural and cognitive mechanisms.

 

3. Playing music makes you happy. McMaster University discovered that babies who took interactive music classes displayed better early communication skills. They also smiled more.

 

4. Musicians can process multiple things at once. As mentioned above, this is because playing music forces you to process multiple senses at once. This can lead superior multisensory skills.

 

5. Musical increases blood flow in your brain. Studies have found that short bursts of musical training increase the blood flow to the left hemisphere of the brain. That can be helpful when you need a burst of energy. Skip the energy drink and jam for 30 minutes.

6. Music helps the brain recover. Motor control improved in everyday activities with stroke patients.

7. Music reduces stress and depression. A study of cancer patients found that listening and playing music reduced anxiety. Another study revealed that music therapy lowered levels of depression and anxiety.

 

8. Musical training strengthens the brain’s’ executive function. Executive function covers critical tasks like processing and retaining information, controlling behavior, making, and problem-solving. If strengthened, you can boost your ability to live. Musical training can improve and strengthen executive functioning in both children and adults.

 

And, wrap-up, check out this awesome short animation from TED-Ed on how playing an instrument benefits your brain.

 

via The Benefits of Playing Music Help Your Brain More Than Any Other Activity | Inc.com

, , , , ,

Leave a comment

[ARTICLE] The Use of Rhythmic Auditory Stimulation to Optimize Treadmill Training for Stroke Patients: A Randomized Controlled Trial – Full Text

Abstract

The use of functional music in gait training termed rhythmic auditory stimulation (RAS) and treadmill training (TT) have both been shown to be effective in stroke patients (SP). The combination of RAS and treadmill training (RAS-TT) has not been clinically evaluated to date. The aim of the study was to evaluate the efficacy of RAS-TT on functional gait in SP. The protocol followed the design of an explorative study with a rater-blinded three arm prospective randomized controlled parallel group design. Forty-five independently walking SP with a hemiparesis of the lower limb or an unsafe and asymmetrical walking pattern were recruited. RAS-TT was carried out over 4 weeks with TT and neurodevelopmental treatment based on Bobath approach (NDT) serving as control interventions. For RAS-TT functional music was adjusted individually while walking on the treadmill. Pre and post-assessments consisted of the fast gait speed test (FGS), a gait analysis with the locometre (LOC), 3 min walking time test (3MWT), and an instrumental evaluation of balance (IEB). Raters were blinded to group assignments. An analysis of covariance (ANCOVA) was performed with affiliated measures from pre-assessment and time between stroke and start of study as covariates. Thirty-five participants (mean age 63.6 ± 8.6 years, mean time between stroke and start of study 42.1 ± 23.7 days) completed the study (11 RAS-TT, 13 TT, 11 NDT). Significant group differences occurred in the FGS for adjusted post-measures in gait velocity [F(2, 34) = 3.864, p = 0.032; partial η2 = 0.205] and cadence [F(2, 34)= 7.656, p = 0.002; partial η2 = 0.338]. Group contrasts showed significantly higher values for RAS-TT. Stride length results did not vary between the groups. LOC, 3MWT, and IEB did not indicate group differences. One patient was withdrawn from TT because of pain in one arm. The study provides first evidence for a higher efficacy of RAS-TT in comparison to the standard approaches TT and NDT in restoring functional gait in SP. The results support the implementation of functional music in neurological gait rehabilitation and its use in combination with treadmill training.

Introduction

About 60% of all stroke patients (SP) have difficulties with walking (). These are often caused by hemiparesis and/or sensory deficits of the lower extremity and/or trunk and are also due to uncoordinated movements. In addition to motor and sensory dysfunctions, symptoms such as spasticity, somato-sensory neglect, and cognitive malfunctioning may further impede walking. Thus, the restoration of gait is often a key focus of rehabilitation efforts, enhancing not only physical activity but also autonomy and participation in everyday life ().

Treadmill training (TT) with and without body weight support has been shown to improve functional gait in stroke patients effectively. A meta-analysis comparing 44 trials (n = 2,658 patients) revealed clear therapeutic effects on gait velocity and walking endurance, the latter only for TT with body weight support (). However, the improvements were identified only for independent walkers while patients who walked with assistance did not show an additional benefit from TT (). Lee’s work () provided evidence that TT with a high walking velocity at the beginning of training is more effective when compared to a stepwise increase in velocity.

Rhythmic-auditory stimulation (RAS) is defined as a therapeutic application of pulsed rhythmic or musical stimulation in order to improve gait or gait related aspects of movement (). It has been demonstrated that SP are able to synchronize their gait pattern to auditory stimulation using music with an embedded metronome (). This led to immediate improvements in stride time and stride length symmetry as well as weight bearing time on the paretic side, while EMG showed a more balanced muscular activation pattern between the paretic and non-paretic sides (). Training effects of RAS for SP were confirmed in a meta-analysis comparing 7 randomized controlled studies (n = 197) that showed improvements in functional gait performance (velocity, cadence, and stride length) (). This work also gave evidence, that a musical stimulation is more effective in improving gait velocity and cadence then the metronome (). Hayden et al. found that RAS became more effective when it is implemented earlier in the rehabilitation program. This provides evidence that the variation in time of the RAS-training during the rehabilitation process may affect the success of the treatment (). The application of RAS on the treadmill (RAS-TT) was evaluated over a 3-week training period by Park et al. In that study metronome stimulation was used for 9 patients with chronic stroke. The results were compared with a group of 10 patients performing over ground RAS walking training (). The RAS-TT group experienced greater improvements in gait velocity ().

While RAS and TT have proven to be effective for gait training in SP, the efficacy of its combination (RAS-TT) in the early course of rehabilitation in SP has not been investigated to date. Therefore, we hypothesized that RAS-TT in the early course of rehabilitation would improve the clinical efficacy of TT for SP. The purpose of the present study was to investigate the functional improvements of gait using a rehabilitation therapy combining RAS and TT in order to assess its clinical efficacy for patients suffering the aftermaths of a stroke.

Materials and methods

Design

The study protocol was approved by the state authorization association for medical issues in Brandenburg, that determined on the 21st of January 2010 that no formal ethics approval was required. Patients gave their informed consent according to the Helsinki declaration.

The study was designed as a prospective, single center three arm clinical study with parallel groups. We enrolled patients who performed either RAS on the treadmill (RAS-TT) or treadmill training alone (TT). A third group that received neurodevelopmental treatment following the Bobath approach (NDT) served as a control group. The patients were randomly assigned to the three training interventions by a person not involved in the study using a block randomization (software randlist). Allocations were placed in sealed sequentially numbered envelopes and were not opened until the actual study inclusion. Thus, the patients, the responsible doctor, the assessing physiotherapist, and study manager were not informed beforehand regarding the group assignment.

We included stroke patients with a hemiparesis of the lower limb (at least 1 muscle group with muscle strength grade <5 as defined by the British Medical Research Council) or with an unsafe and asymmetrical walking pattern (by assessment of a physiotherapist). The patients had to be able to walk independently with assistive devices if necessary for at least 3 min.

Criteria for exclusion were the following: significantly disturbed language perception (marked by either the Aachener Aphasietest or Token Test), cognitive impairment (Mini Mental Status Test <26), major depression or productive psychosis, adjustment disorder with a need for medical treatment, peripheral arterial occlusive disease with walking distance <100 m, and coronary heart disease (instable angina pectoris).

After having passed the diagnostics patients underwent a screening session on the treadmill. There they had to demonstrate a stable and sufficiently ergonomic gait. Candidates with insufficient quality of gait on the treadmill (multimodal neglect or spasticity as assessed by a physiotherapist) were postponed and re-screened every week (Figure (Figure11).

An external file that holds a picture, illustration, etc.Object name is fneur-09-00755-g0001.jpg

Figure 1
Patient flow chart of study design. RAS-TT, rhythmic auditory stimulation on treadmill; TT, treadmill training; NDT, neurodevelopmental treatment.

[…]

Continue —>  The Use of Rhythmic Auditory Stimulation to Optimize Treadmill Training for Stroke Patients: A Randomized Controlled Trial

, , , , , , , ,

Leave a comment

[WEB SITE] Music Therapy Can Rewire a Broken Brain – Videos

Nothing brings out the grinch in some like the early debut of seasonal music when the season hasn’t even started. Reactions can of course go the other way — people weep with joy at memories attached to a song from their past.
Whatever the reaction, music is powerful. Now, a small company in Massachusetts is trying to harness that power to help people with traumatic brain injuries talk again. And scientists say music is actually rewiring patients’ brains.

It is well documented that those with Alzheimer’s disease can benefit from hearing and singing songs they remember from earlier in life — but research into music’s ability to create new pathways in the brain to combat impairment of language abilities (aphasia), hemineglect, and loss of movement is relatively new. Hemineglect is when brain trauma leads patients to lose the ability to pay attention to one side of space. For example, ask them to draw a clock face and they will only draw half of it, ignoring the other side and leaving it completely blank.

The branch of rehabilitation called Neurologic Music Therapy (NMT) helps patients who have suffered terrible brain injuries regain function — through singing and playing percussive instruments.

When brain injuries affect the left side of the brain, patients can struggle with aphasia because the language function is all held on the left side. Music is different. The fine motor skills necessary to appreciate and make music are a mix of the creative skills found on the right hemisphere, and the mathematical and linguistic aspects found on the left. Playing music has also been shown to strengthen the part of the brain that links between both hemispheres, the corpus callosum. NMT can build a new language area in the right hemisphere, as the late Dr. Oliver Sacks said while speaking about one of the most high-profile brain injury success stories — that of former Rep. Gabby Giffords. “Nothing activates the brain so extensively as music, to be possible to create a new language area in the right hemisphere.”

This is the science that NMT triggers — and that NMT companies like Medrhythms are trying to put to use. It is one of only a handful of neurological rehabilitation companies in the country, created to meet the demand witnessed by its CEO and founder Dr. Brian Harris in the early stages of his career.

Like most of the small number of music therapists in the US, Harris started off as an employee of a hospital working at a stroke and brain injury unit. In fact he was the very first music therapist at Spaulding hospital in New England.

“Within just a few weeks of me being there people were getting better faster, with greater results, and very quickly the demand for these services outgrew our ability to supply them,” he told WhoWhatWhy. He saw an opportunity, and started his company as a way of meeting that need. At first it was a lot of hard, lonely, yet rewarding work.

“It was me, working at the hospital eight hours a day. And then I was going to people’s homes in the evenings and weekends doing in-home care. Then we started hiring some other therapists and we quickly grew.”

Despite there being so few practitioners in this new field it seems as though demand for more NMT therapists will rise as news of its benefits spread.

This week’s videos are a demonstration of a patient’s progress thanks to NMT sessions, and a fun cartoon showing just exactly what happens to the brain when playing music.


 

via Music Therapy Can Rewire a Broken Brain – WhoWhatWhy

, ,

Leave a comment

%d bloggers like this: