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Clinical use of_music_therapy dr shashikant


Dr Shashikant's Integrated Mind Body Yoga Therapies …

Dr Shashikant's Integrated Mind Body Yoga Therapies
Vikram Hospital Bangalore

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  • 1. Clinical Use of MusicClinical Use of Music TherapyTherapy Dr Shashikant S K MBBS, MD ( Yoga and Rehabilitation) Msc applied Psychology 1
  • 2. Outline • Introduction • Mechanism of music therapy • Indication and contraindication of music therapy • Clinical practice • Clinical evidence of music therapy • Summary • References 2
  • 3. IntroductionIntroduction •Definition •History review •The purpose of this seminar 3
  • 4. Definition • American Music Therapy Association (AMTA), 1998 Music therapy is allied health profession in which music is used within a therapeutic relationship to address physical, psychological, cognitive, and social needs of individuals 4
  • 5. History review • 1931~1940 – Music Educator’s National Conference (MENC) – National Music Council (NMC) • 1950 – National Association of Music Therapy (NAMT) • 1971 – American Association of Music Therapy (AAMT) • 1980 – Certification board of music therapy • 1998 – American Music Therapy Association (AMTA ) 5
  • 6. The purpose of this seminar • The brain – The brain is no more puzzle box J. D. Watson • Whole person-centered approach • Interdisciplinary integration – specific education – long-term care 6
  • 7. The purpose of this seminar • Linking between motor and cognition Factors motor cognitive emotional internal external ※motor-skill complexity D.J. Serrien et al 2007 7
  • 8. Mechanism ofMechanism of music therapymusic therapy •The Mozart effect •The adaptive behavior in evolution •Characteristics of music •Neural network of music processing 8
  • 9. The Mozart effect • The “Mozart Effect” refers to an enhancement of performance or a change in neuro-physiological activity associated with listening to Mozart music. – Subjective: 36 undergraduates group 1 : listened to Mozart K448 music group 2 : listened to a relaxation tape group 3 : sat in silence 9 FH Rauscher et al 1993
  • 10. The adaptive behavior in evolution While people experienced musical chills, cerebral flow changes occurred in several brain areas, including: 1. Dorsal midbrain 2. Ventral striatum ( which contains the nucleus accumbens ) 3. Insula 4. Orbitofrontal cortex Blood & Zatorre, 2001 10  Processing emotions induced by music
  • 11. The adaptive behavior in evolution • The “ chills “ effect - Music experience is intimately related to its emotional appeal. - Melodies evoke strong emotions because their skeletons resemble digitized templates of our species’ emotional calls. Steven Pinker 1997 11
  • 12. The adaptive behavior in evolution • Music and language • Auditory scene analysis • Emotional calls • Habitat selection • Motor control • Resonance in brain-body-world 12 Steven Pinker 1997
  • 13. Characteristics of music • Music structure – elements of spatial-temporal construction  Pitch 、 Gesture  Time (duration) 、 Meter 、 Rhythm  Timbre  Form 13
  • 14. Characteristics of music •Production system of music structure 1. Grouping structure 2. Metric structure 3. Reductional structure 14
  • 15. Characteristics of music • Grouping structure 15 Stanzas, movements, and pieces→ Lines or section → Phrases → Motifs →
  • 16. Characteristics of music •Metric structure Beat perception leads to the perception of a metrical organization corresponding to periodic alteration between strong and weak beats. – The strong beats generally correspond to the spontaneous tapping of foot. 16
  • 17. Characteristics of music •Reductional structure (1) time-span reduction (2) prolongation reduction 17
  • 18. 18 Tonal Center Pitch Class Clusters Pitch Class Pitch Spectral Representation Object/ Source Timbre Characteristics of music ↑ ↑ ↑ ↑ ↑ ↑ Domains of Acoustic Structure Domains of Affect and Motion Tension/ Relaxation Leap (interval) Spatial Location Anxious Attention Etc.  Acoustic codes→ representation codes
  • 19. Neural network of music processing •Auditory system 19 Cochlea Auditory n. Brainstem nuclei (1) lateral superior olivary nucleus (2) lateral lemniscus (3) inferior colliculus Thalamus Auditory cortex Eardrum sets
  • 20. Neural network of music processing • Music processing cannot be ascribed wholly to one cerebral hemisphere. • Unlike speech, music is not associated with a fixed semantic system, although it may convey meaning through other systems, such as emotional analysis and associative memories ( to retrieve contextual information ). 20
  • 21. Neural network of music processing • Melody and temporal structures are processed independently. 1. Pitch-based ( melodic ) – right temporal cortex 2. Time-base ( temporal ) – widespread and bilateral neural networks • Neural modules involving motor and perceptual timing of tasks 1. Cerebellum 2. Basal ganglia 3. Supplementary motor area 4. Premotor cortex 5. Parietal cortex 21
  • 22. Indication andIndication and contraindicationcontraindication of music therapyof music therapy •Indication •Contraindication and Precaution 22
  • 23. Indication • Music therapy can be used or four special needs – Social aspect – Psychological aspect – Cognitive aspect – Physical aspect 23
  • 24. Indication- Social aspect 1. To reintegrate them who isolated and withdrawn into social relationships 2. To experience themselves as something orderly and subjective 3. To establish a meaningful relationship between the inner rhythms of body, outer rhythms of personal interaction and broader patterns of cultural activity 24
  • 25. Indication- Psychological aspect 1. Mood improvement 2. Encouraging self-expression 3. Temporal coherence 4. Disease related stress
  • 26. Indication- Cognitive aspect 1. To improve communication 2. To improve spatial-reasoning 3. To improve memory 4. Increasing status of arousal 5. Improving executive function 26
  • 27. Indication- Physical aspect 1. Sensory stimulation 2. Motor integration 3. Mood-related physiologic response such as: heart ate respiratory pattern blood pressure peripheral and renal perfusion 4. Decreasing pain 5. Other : nausea, vomiting 27
  • 28. Indication • Client – Music therapy can be applied to a broad type of subjects, including subjects with: 1. mental retardation 2. psychiatry and psychotherapy, such as schizophrenia, emotion and behavior disturbance 3. vision or hearing impairment 4. physical and speech disorder 5. pain control 6. cancer or palliative care 7. geriatric care 28
  • 29. Contraindication and Precaution • Acoustic induced epilepsy • Post-traumatic stress disorder 29
  • 30. ClinicalClinical practicepractice •Equipment and apparatus modality •Approaches of music therapy •The place to service 30
  • 31. Equipment and apparatus modality • Therapeutic room • Observation room with one way mirror – Sound Insulation , the ceiling height must not be too low • Cabinets – for instrument admission • Real musical instruments • Music CD 31
  • 32. Approaches of music therapy • After music therapist collect client’s data from chart or interview, they will approach their client. Included: – Subject’s data – Problem and requirement – Client’s capacity of music 32 Bruscia 1991
  • 33. Approaches of music therapy • Listening or receptive – Relaxation, meditation, song-discussion, Bonny Method of Guided Imagery and Music, and Live review with music • Re-creating – Process-oriented & Product-oriented – Melodic Intonation Therapy • Improvising – Nordoff-Robbins Music Therapy (Creative Music Therapy) • Composing – Song-writing • Other 33 Bruscia 1991
  • 34. Approaches of music therapy 34 Client Method Almost all of the clients who needs music therapy Nordoff-Robbins Music Therapy (Creative Music Therapy) Alcoholic, drug addict, psychotic disorder Bonny Method of Guided Imagery and Music Aphasia, apraxia Melodic Intonation Therapy Seriously communicative disturbance Modified Melodic Intonation Therapy Autism, dyslexia, attention deficit hyperactivity disorder(ADHD) Auditory Integration Therapy Parkinson’s disease, stroke, traumatic brain injury(TBI), Huntington’s disease, CP Rhythmic Auditory Stimulation Schizophrenia and psychotic disorder Gestalt Approach Music Therapy Schizophrenia and psychotic disorder Psycho-dynamically Oriented Music Therapy
  • 35. The place to service • Hospital • School • Clinic • Early Intervention Center • Nursing home • Hospice • Personal workroom 35
  • 36. Clinical evidenceClinical evidence of Music Therapyof Music Therapy • Studies of music therapy in rehabilitation • “ Mozart effect “ or “ Albinoni effect “ ? 36
  • 37. Studies of music therapy in rehabilitation 37
  • 38. Study 1 Study 2 Author Ilana Schlesinger, M.D. et al, 2009 Lesley A. Brown, PhD et al, Disorder or Symptom Parkinson’s disease tremor (moderate to severe) Parkinsonian gait Sample n = 20 PD = 20 (HI: Ⅱ~Ⅲ), Health = 10 Intervention Five part: •Baseline period (0.5hr) •Relaxing music period (15 min) •Self relaxation period (15min) •Relaxation guided imagery (RGI) (10-15 min) •Post relaxation period (30min) Subjects walked at a self-selected pace along on unobstructed walk way in 4 differing test condition •No music, no task •Music, no task •No music cognitive task •Music cognitive task (N=24trials, 4x6) Instruments MicroMini Motionlogger actigraph (a small wrist worn dervice, resembling a watch, conting an accelermetier) Subjects were asked to walk the length of an unobstructed 10M walking. Three-diamension kinematic data were collected at 120Hz by using a 6-canera motion analysis system. Outcome measure RGI dramatically decrease tremor, Music decrease, too. But RGI > music. Self-relaxation no effect. Mean gait velocity, stride length, percentage of the gait cycle spent in double- limb support. Gait among the PD patients was adversely by concurrent music. In contrast, gait performance in the control subject show no significant difference 38
  • 39. Study 3 Study 4 Author L. Jing. W. Xudong, 2008 Teppo Sarkamo et al 2008 Disorder or Symptom Exercise- induced fatigue Cognitive recovery and mood after MCA stroke Sample n = 30 health male college student n = 60 Intervention Music= 15, no music= 15 On the initial subjects performed a graded exercise test on a cycle ergo-meter to determine blood lactic acid threshold. Then the exercise intensity was set as 80-85% of blood lactic acid threshold until fatigue. Then music group: 15min, no music group: 15min; in supine. • 3 group: music group (n=20); language group (n=20); control group (n=20) • Duration: 2 months • All patients received standard medical care and rehabilitation. • 54 patients complete the study (music: 19; verbal: 19; control: 17) • Music & verbal > 1hr/ day Instruments Heart rate, jump height, blood glucose, blood lactic acid, urinary protein, simple reaction time & ratings of perceived exertion (RPE) • MRI (2wks & 6 mo after stroke) • Neurophysiology assessment: (1) cognitive tests; (2) mood & quality of life questionnaire. One week (baseline); 3 months; 6 months after stroke Outcome measure Heart rate, urinary protein & RPE decreased significantly after the application of relaxing music (p < 0.01), and these decrease were greater then these without music. • Verbal memory, focus attention improved significantly more in the music group than verb & control group • The music group also experienced less depression and confused mood than the control group. 39
  • 40. Study 5 Author Michael Schauer et al, 2003 Disorder or Symptom Gait of hemiparatic stroke patients. Sample n = 23 (walk 20min without any assistive device) ( control group v.s. test group) Intervention 1. Control group received 15 sessions(20m) of conventional gait therapy 2. Test group received 15 therapy sessions(20m) with musical motor feedback (5 days per week) 3. parameters: (1) Gait velocity, (2) step duration, (3) gait symmetry, strike length (4) foot rollover path length (hell- on- toe- off distance) Instruments MMF device consist of sensor insoles that detect the group contact of the heels & a portable music player compatible with the MIDI standard. The music was played at an adjustable speed which was estimate from the time internal between two consecutive heel-strikes. Outcome measure The test group showed more mean improvement than control group •The stride length increased 18% v. s. 0% • Symmetry deviation decreased 18% v. s. 20% •Walking speed increased 27% v. s. 4% •Rollover path length increased 28 v. s. 11% 40
  • 41. “Mozart effect” or “Albinoni effect” 41
  • 42. “ Mozart effect “ or “ Albinoni effect “ ? 1. To have access to client’s past 2. To be able to focus attention solely on present 3. To comfortable enough to give up control over the outcome of the task to experiment during the session 4. To recognize the significance of accidental expression Phillips 1988 42 • Important qualities of clinical practice
  • 43. 43 “ Mozart effect “ or “ Albinoni effect “ ? • Subjects – group 1: Mozart ( happy ) group 2: Albinoni ( sad ) group 3: silence Thompson et al 2001
  • 44. SummarySummary 44
  • 45. References• Aldridge D. Music therapy research: A review of references in the medical literature. P1-32. • Azizi SA. Brain to music to brain!. Neuroscience Letters 2009; 459: 1-2. • Benzon, W. Beethoven's Anvil: Music in Mind and Culture. 2001. Basic Books. New York. • Bharucha JJ, Curtis M, Paroo K. Varieties of musical experience. Cognition 2006: 100: 131-172. • Brown LA, Bruin N, Doan JB, Suchowersky O, Hu B. Novel Challenges to Gait in Parkinson’s Disease: The Effect of Concurrent Music in Single- and Dual-Task Contests. Arch Phys Med Rehabili 2009; 90: 1578-1583. • Bruscia, K. E.. Defining research and theory. 1998. In Bruscia K. E.: Defining music therapy. Glisum, NH: Barcelona. p.239-248. • Campbell D. The Mozart Effect: Tapping the Power of Music to Heal the Body, Strengthen the Mind, and Unlock the Creative Spirit. 1997. NY, U.S.A.. Avon books. • Deleo, C. Introduction to music therapy and medicine: definitions, theoretical orientations and level of practice, In Deleo, C (Ed.), Music therapy and Medicine: Theoretical and Clinical Association. 1999. Maryland: American Music Therapy Association, Inc. P1-10. • Elkins, A. K.. AMTA Member Sourcebook 2003. Maryland: American Music Therapy Association, Inc. P203-222. • Hughes JR. Review The Morzart Effect. Epilepsy & Behavior 2001; 2: 396-417. • Jing L, Xudong X. Evaluation on the effects of relaxing music on the recovery from aerobic exercise-induced fatigue. J Sports Med Phys Fitness 2008; 48: 102-106. • Peretz I, Robert JZ. Brain Organization for Music Processing. Annu.Rev. Psychol 2005; 56: 89-114. • Peretz T, Zatorre RJ. “The cognitive Neuroscience of Music” 1st ed. 2003. U.S.A.: Oxford University Press. P430-448. • Rauscher FH, Shaw GL, Ky KN. Listening to Mozart enhances spatial-temporal reasoning: towards a neurophysiological basis. Neuroscience Letters 1995; 185: 44-47. • Sarkamo T, Teraniemi M, Laitinen S, Forsblom A, Soinila S, Mikkonen M, et al. Music listening enhances cognitive recovery and mood after middle cerebral artery stroke. Brain 2008; 131: 866-876. • Schauer M, Mauritz KH. Musical motor feedback (MMF) in walking hemiparetic stroke patients: randomized trials of gait improvement. Clinical Rehabilitation 2003; 17: 713-722. • Schlesinger I, Benyakov O, Erikh I, Suryaiya S, Schiller Y. Parkinson’s Disease Tremor is Diminished with Relaxation Guided Imagery. Movement Disorder2009; 24(14): 2059-2062. • Serrien DJ, Ivry RB, Swinnen SP. The missing link between action and cognition. Progress in Neurobiology 2007; 82: 95-107. • Styns F, Noorden L, Moelants D, Leman M. Walking on music. Human Movement Science 2007; 26: 769-785. • Summins F. Rhythm as an Affordance for the Entrainment of Movement. Phonetica 2009; 66: 15-28. • 中華民國應用音樂推廣協會作者群。音樂與治療。初版。台北縣。星定石文化出版有限公司。 2004 年。 • 張乃文著。兒童音樂治療:台灣臨床實作與經驗。初版。台北市。心理出版社股份有限公司。 2004 年。 • 心智探奇 • 科學人大腦怎麼聽音樂 45
  • 46. Thanks for your attentionThanks for your attention 46