Archive for category Music/Music therapy

[Infographic] MUSIC & THE BRAIN

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[Music] I Will Survive – Gloria Gaynor: with Lyrics (on screen) – YouTube

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[WEB PAGE] Why include music therapy in a neuro-rehabilitation team?

By Wendy L Magee

Abstract

Interdisciplinary neuro-rehabilitation programmes can be enhanced by including music therapy as music interventions can incorporate a patient’s goals across behavioural domains. Neurologically, music is intrinsically motivating, drives motor function and elicits emotional responses. Incorporating live music delivered by trained and qualified professionals ensures interventions are tailored to patients’ needs and goals, assisting with engagement and adherence to treatment. The evidence for the effects of music therapy in neuro-rehabilitation is reviewed, with reference to a recent Cochrane Review.


Summary

  • Music therapy with neurological populations typically engages the patient in active music-making, with the therapist playing live music and adapting musical components moment-by-moment to both meet patient needs and challenge the patient to reach goals
  • In neuro-rehabilitation, interventions range across song-writing to address psychosocial needs, singing and vocalising exercises to target communication goals, and playing instruments or moving to music to meet motor goals
  • Neurologically, music is intrinsically rewarding and motivating, activating neural networks throughout the brain that influence non-musical behaviours, and resulting in changes to brain structures

Music therapy: what is it and what is involved?

The rationale for including music therapy as part of an interdisciplinary rehabilitation programme may not be immediately obvious: unlike other professions that address function within a more clearly defined domain (e.g. physiotherapy for movement disorders; speech and language therapy for speech/language disorders; psychology for cognitive disorders) music therapy addresses function across domains. As defined, music therapy is the clinical and evidence-based use of music interventions to accomplish individualised goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy programme.1 A common misconception is that music therapy is passive listening to recorded music. However, when delivered by a trained professional, music therapy typically actively engages the patient in live music-making, targeting active health goals, with the therapist adjusting musical parameters (tempo, dynamic, rhythm, pulse, melody, harmony) moment-by-moment in immediate response to the patient’s functioning.

Internationally, professionals trained as music therapists are required to adhere to professional standards and codes of conduct: in the UK, music therapists are registered with the Health and Care Professions Council. Music therapy interventions are distinguishable from recreational activities, as they are individually tailored to the individual, goal directed and planned by a health professional. Interventions vary considerably, even when targeting goals within the one domain (i.e. motor; psychosocial; communication) but fall into two broad categories: active or receptive methods.2 Active methods used in neuro-rehabilitation include: song-writing; music-making using acoustic or digital MIDI instruments; movement to music including gait training to rhythmic music or metronome; and singing or vocalising. Receptive methods include: music listening to live or recorded music; and imagery to music. Dosage for effective music interventions vary widely in terms of the number and frequency of contacts, the duration of individual contacts and course of therapy, and the mode of delivery (individual or group).2 Dosage is dependent on the targeted outcome, stage of rehabilitation and setting, so standard recommendations cannot be made.

Why include music therapy in a neuro-rehabilitation team?

The theoretical rationale for using music in neuro-rehabilitation centres upon music’s innate competencies within humans, its cross-cultural purpose for social bonding across cultures, and its neurological capabilities in both healthy and neurologically damaged populations. Music is a universal phenomenon that exists in all known human societies and is considered distinctive to the human condition.3 Cross-culturally, humans engage in musical activity through singing and instrument playing as part of creative play and within ritual. So music is a familiar, meaningful activity with many inherent associations, even for those who are musically untrained. Music is also a social activity, a medium for engaging with others in meaningful collective practices4 and assists with managing social relationships.3 Thus, it facilitates social bonding and interaction as music-making is rarely a solitary activity. In western societies, music-making is realised through singing in choirs and ritual practices and playing instruments in bands and orchestras. Group singing is conducive to social bonding5 and has been found to be a stress-reducing activity as measured through reductions of adrenocorticotropic hormone,5 cortisol and cortisone.6

However, the strongest argument for including music therapy in neuro-rehabilitation lies in its neurological benefits. Neurologically, music is intrinsically rewarding as it activates brain regions involved in reward, motivation, emotion, and arousal.7 Cortical changes in brain damaged patients during music interventions indicate activation of bilateral networks across the frontal, temporal and parietal lobes, cerebellum and limbic areas, stimulating cognitive, motor, and emotional processes.8-10 When integrated with repetitive rehabilitation exercises and drills, music that is tailored to an individual’s performance can enhance the motivation to sustain engagement and may improve patient mood and enhance motivation.11

Music therapy interventions in neuro-rehabilitation: practice and evidence

Music boosts cognition in the brain damaged patient, with reported effects on arousal, attention, orientation, memory, executive function, spatial neglect, and mental flexibility. For patients with Disorders of Consciousness (DOC), maintaining arousal is a significant problem and can interfere with optimal engagement in rehabilitation. Using music that is salient to the patient has been found to promote behaviours indicative of arousal and selective attention12, increase behavioural responses that indicate discrimination13 and awareness.14 Music therapy within interdisciplinary care may prime patient responsiveness in DOC,15 which is particularly useful when part of co-treatment: a music therapist will play live music that is personally salient to the patient, adjusting musical parameters to help the patient achieve and maintain an optimal state of arousal so as to engage in treatment sessions. Music has also been found to improve orientation for patients in post-traumatic amnesia.16 Following middle cerebral artery stroke, music interventions have been shown to be superior in enhancing cognitive recovery, more specifically verbal memory and focused attention, when compared to a language intervention (patient selected audio book listening) or a control condition (standard rehabilitation).8 Similar results have been found with mild traumatic brain injury patients, where music training in the form of eight weeks of piano tuition resulted in significantly improved results in executive functions related to attention, learning strategies and memory retrieval.17 Thus, music interventions have demonstrated positive effects across the spectrum of brain damage.

Of all behavioural domains with neurological populations, the strongest evidence for music interventions is with motor disorders. Motor regions within the cortex are sensitive to and driven by auditory stimuli as the auditory system processes temporal information rapidly and precisely, creating entrainment between a rhythmic signal and movement.18 In healthy subjects, movement to music results in superior physical performance: running for longer, lower perceived exertion, and slower exhaustion.19 These beneficial effects are increased when agency is incorporated into a workout, that is, that the physical movements result in musical sounds.20 These observations support the growing body of research examining the influence of music with a strong beat on gait disorders and upper limb function in adults with stroke and acquired brain injury. A Cochrane Review examined the effects of rhythmic auditory stimulation (RAS) on gait velocity, cadence, stride length, stride symmetry, gait and balance.2 RAS is a therapeutic intervention using rhythmic pulse to improve gait or gait related aspects of movement. Using live music, the therapist can embed the rhythmic pulse into the music for the patient to move to, or a metronome alone can be used. Based on 10 randomised controlled studies (n=298) the meta-analysis found beneficial effects for RAS on gait velocity, stride length, gait cadence and general gait in people with stroke, although the degree of improvement across studies was inconsistent.2 Subgroup analyses indicated that RAS interventions using live music with the beat embedded in the music may be more effective than using a metronome alone in addressing gait velocity and cadence. These findings highlight that although RAS can be implemented within interdisciplinary rehabilitation by non-music professionals using a metronome, the inclusion of a music therapist in the rehabilitation team using live music may enhance the intervention’s benefits. Music provides an intrinsic motivational reward, and using live music enables components (such as tempo, dynamic tension, harmonic tension and resolution, melodic direction) to be adapted in the moment to the patient’s movements, driving these movements to goal attainment.

Music interventions are used to rehabilitate upper limb function following stroke, measuring outcomes such as timing of movement, strength, hand function, manual dexterity, range of motion and elbow extension angle2 and often in co-treatment with occupational therapists. Interventions typically involve the patient playing strategically placed musical instruments in live music making: the therapist commonly manipulates rhythm and tempo in the accompanying music to guide the patient’s movements, but harmonic and melodic tensions are also used. A number of studies have examined neural reorganisation during these interventions, noting coupling between the motor and auditory cortices.11 The benefits for involving music therapy in team treatment include motivation and adherence to treatment of motor disorders.21

Communication outcomes are frequently targeted with music following stroke and traumatic brain injury, as it has long been noted that people with severe non-fluent aphasia have greater success when singing lyrics than speaking the same words.10 Although speech and music are neurologically distinct, they share pitch, timing and timbre cues to convey information at an acoustic level and at a cognitive level both demand complex cognitive skills: memory, attention, and the ability to integrate acoustic events and perceive these according to rules of syntax are required by both.22 Music, like language, has structural rules for production suggesting a deep connection between the two within the brain. Intensive music interventions to address language production with people with severe non-fluent aphasia have resulted in neuroplastic changes to connections across brain regions.10 The acts of speech and singing additionally share musculature for respiration, phonation, articulation and resonance.23 Music therapy interventions address communication goals through singing and vocalising, often in co-treatment with speech and language therapists. Singing interventions address non-fluent aphasia, dysarthria, dyspraxia, dysprosody and dysphonia measuring outcomes such as words produced, speech intensity, naturalness and intelligibility, rate control, articulation, phonation and prosody.2,24 Melodic intonation therapy is an intervention frequently used to target language production in expressive aphasia, engaging right-hemispheric structures through tapping of the left hand and intoning words in a melodic contour that imitates speech prosody.10 Numerous case reports describe the benefits of a number of music interventions to improve communication, supported to some extent in research suggesting benefits to overall communication, naming and repetition.2 Further research would consolidate these findings and improve the widely varying protocols that have been reported.

Lastly, music therapy interventions are reported to improve psychosocial functions such as behavioural outcomes, emotional needs, mood, well-being, social skills and quality of life.2 Psychosocial sequelae are integrally related following brain injury: communication or behavioural difficulties impact upon social relationships, risking feelings of isolation and depressed mood, reducing quality of life. Music therapy can reduce agitation in patients with post-traumatic amnesia.16 The intersectional nature of psychosocial subdomains can be addressed through therapeutic music-making as a meaningful social experience that enhances social bonding3 and stimulates emotional experiences. Music therapy will typically use active music interventions such as song-writing, improvisation and song-singing to address mood, identity reconstruction and emotional expression in neuro-rehabilitation.2 These can be powerful interventions when delivered in groups and may also incorporate members of the patient’s social support network. Individually tailored music listening programmes in the acute recovery phase post-stroke have resulted in less depressed and confused mood states than standard rehabilitation.8 More research is needed examining the effects of music interventions on all aspects of psychosocial functioning.

Conclusions

Music provides a familiar salient stimulus that activates widespread neural activity and has the potential to be harnessed to improve functioning across all the behavioural domains, including motor, cognition, communication and psychosocial. Thus, music therapy is well-placed as an intervention in neuro-rehabilitation. Music is also ubiquitous and easily accessible with the swipe of a screen, but its use is not without risk, particularly the possibility of triggering strong emotional reactions. The application of music interventions in neuro-rehabilitation thus requires planned and careful application with vulnerable populations by professionals trained in its use.

References

  1. American Music Therapy Association. Definition and Quotes about Music Therapy [Internet]. Silver Spring MD: American Music Therapy Association; n.d. [cited 2019 July 15]. Available from https://www.musictherapy.org/about/quotes/https://www.musictherapy.org/about/quotes/ .
  2. Magee WL, Clark I, Tamplin J, Bradt J. Music interventions for acquired brain injury. Cochrane Database of Systematic Reviews. 2017(1). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006787.pub3/abstract
  3. Trehub SE, Becker J, Morley I. Cross-cultural perspectives on music and musicality. Philosophical Transactions of the Royal Society B: Biological Sciences. 2015 Mar 19;370(1664):20140096. https://royalsocietypublishing.org/doi/full/10.1098/rstb.2014.0096
  4. Dissanayake E. An ethological view of music and its relevance to music therapy. Nordic Journal of Music Therapy. 2001 Jul 1;10(2):159-75. https://www.tandfonline.com/doi/abs/10.1080/08098130109478029
  5. Keeler JR., Roth EA, Neuser BL, Spitsbergen JM, Waters DJM, Vianney JM. (2015). The neurochemistry and social flow of singing: bonding and oxytocin. Frontiers in human neuroscience. 2015;9:18.
  6. Fancourt D, Aufegger L, Williamon A. Low-stress and high-stress singing have contrasting effects on glucocorticoid response. Frontiers in psychology. 2015:6;1242.
  7. Blood AJ, Zatorre RJ. Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion. Proceedings of the National Academy of Sciences. 2001 Sep 25;98(20):11818-23.
  8. Särkämö T, Tervaniemi M, Laitinen S, Forsblom A, Soinila S, Mikkonen M, Autti T, Silvennoinen HM, Erkkilä J, Laine M, Peretz I. Music listening enhances cognitive recovery and mood after middle cerebral artery stroke. Brain. 2008 Feb 20;131(3):866-76. https://academic.oup.com/brain/article/131/3/866/318687
  9. Särkämö T, Tervaniemi M, Huotilainen M. Music perception and cognition: development, neural basis, and rehabilitative use of music. Wiley Interdisciplinary Reviews: Cognitive Science. 2013 Jul;4(4):441-51.
  10. Schlaug G, Norton A, Marchina S, Zipse L, Wan CY. From singing to speaking: facilitating recovery from nonfluent aphasia. Future neurology. 2010;5(5):657-65.
  11. Street AJ, Magee WL, Odell-Miller H, Bateman A, Fachner JC. Home-based neurologic music therapy for upper limb rehabilitation with stroke patients at community rehabilitation stage—a feasibility study protocol. Frontiers in human neuroscience. 2015;23;9:480. https://www.frontiersin.org/articles/10.3389/fnhum.2015.00480/full
  12. O’Kelly J, James L, Palaniappan R, Fachner J, Taborin J, Magee WL. Neurophysiological and behavioral responses to music therapy in vegetative and minimally conscious states. Frontiers in Human Neuroscience. 2013;25:7:884.
  13. Castro M, Tillmann B, Luauté J, Corneyllie A, Dailler F, André-Obadia N, Perrin F. Boosting cognition with music in patients with disorders of consciousness. Neurorehabilitation and neural repair. 2015;29;(8):734-42.
  14. Verger J, Ruiz S, Tillmann B, Ben MR, De MQ, Castro M, Tell L, Luauté J, Perrin F. Beneficial effect of preferred music on cognitive functions in minimally conscious state patients. Revue neurologique. 2014;170(11):693-9.
  15. Magee WL. Music in the diagnosis, treatment and prognosis of people with prolonged disorders of consciousness. Neuropsychological rehabilitation. 2018;17;28(8):1331-9.
  16. Baker F. The effects of live, taped, and no music on people experiencing posttraumatic amnesia. Journal of Music Therapy. 2001;38(3):170-92.
  17. Vik BM, Skeie GO, Vikane E, Specht K. Effects of music production on cortical plasticity within cognitive rehabilitation of patients with mild traumatic brain injury. Brain injury. 2018;16;32(5):634-43. https://www.tandfonline.com/doi/full/10.1080/02699052.2018.1431842
  18. Thaut MH, Abiru M. Rhythmic auditory stimulation in rehabilitation of movement disorders: a review of current research. Music Perception: An Interdisciplinary Journal. 2010;1;27(4):263-9.
  19. Terry PC, Karageorghis CI, Saha AM, D’Auria S. Effects of synchronous music on treadmill running among elite triathletes. Journal of Science and Medicine in Sport. 2012;1;15(1):52-7.
  20. Fritz TH, Hardikar S, Demoucron M, Niessen M, Demey M, Giot O, Li Y, Haynes JD, Villringer A, Leman M. Musical agency reduces perceived exertion during strenuous physical performance. Proceedings of the National Academy of Sciences. 2013;29;110(44):17784-9.
  21. Street AJ, Magee WL, Bateman A, Parker M, Odell-Miller H, Fachner J. Home-based neurologic music therapy for arm hemiparesis following stroke: results from a pilot, feasibility randomized controlled trial. Clinical rehabilitation. 2018;32(1):18. https://journals.sagepub.com/doi/full/10.1177/0269215517717060
  22. Kraus N, Chandrasekaran B. Music training for the development of auditory skills. Nature reviews neuroscience. 2010;11(8):599.
  23. Wan CY, Rüüber T, Hohmann A, Schlaug G. The therapeutic effects of singing in neurological disorders. Music perception: An interdisciplinary journal. 2010;1;27(4):287-95.
  24. Tamplin J, Baker FA. Therapeutic singing protocols for addressing acquired and degenerative speech disorders in adults. Music Therapy Perspectives. 2017;17;35(2):113-23.

Wendy L Magee, PhD, is a Music Therapist Clinician and Researcher, working with adults with complex needs from acquired brain injury and neuro-degenerative disorders since 1988. Her published research covers: evidence-based music interventions in neuro-rehabilitation including a Cochrane Review; measurement; Disorders of Consciousness; identity following disability; and new and emerging music technologies in healthcare.

via Why include music therapy in a neuro-rehabilitation team? | ACNR | Online Neurology Journal

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[Infographic] MUSIC & THE BRAIN

 

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

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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

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[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

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[Infographic] The Effects of Music on the Brain

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[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

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[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

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

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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

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