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Music as medicine 110118

A lively discussion of how the power of music can influence health and disease.

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MUSIC AS MEDICINE
OR
“LISTEN TO TWO JAZZ RIFFS
AND CALL ME IN THE MORNING”
Randy M Rosenberg MD FAAN FACP
Associate Professor of Neurology
Lewis Katz School of Medicine at Temple University
Principle Flutist of the Warminster Symphony
IS MUSIC AS MEDICINE A NEW IDEA?
MUSIC MEDICINE
The Chinese character for
medicine comes from the
character for music
OLDEST MUSICAL INSTRUMENTS IN
THE WORLD
Age: 7,000 – 9,000 years old
Country of Origin: Jiahu, Yellow River
Valley, China
Material(s) Used: Red-Crown Crane wing
bones
Age: 42,000 – 43,000 years old
Country of Origin: Geisenklösterle Cave,
Blaubeuren, Germany
Material(s) Used: Mute Swan bone and
Mammoth Ivory
Geisenklösterle
Flute
Jiahu Flutes
THE ANCIENTS AND MUSICAL RELIEF
• Egyptian papyri, over 2,600 years old, refer to incantations as cures for
infertility and rheumatic pain.
• In the Bible, David played the harp to lift Saul’s depression (1000-600 BC)
• 1 Samuel 16:16 (NKJV) Let our master now command your servants, who are
before you, to seek out a man who is a skillful player on the harp (probably
lyre). And it shall be that he will play it with his hand when the distressing spirit
from God is upon you, and you shall be well.
• The ancient Greeks (800-600 BC) believed music had the power to heal the
body and soul. They used the flute and the lyre for gout and sciatica.
• Paeans were a classification of ancient Greek songs that cured specific illnesses.
For example, when the plague hit ancient Greece, they played a specific song
with the frequencies and rhythmic patterns thought to halt the illness.
ANCIENT GREEK MUSIC

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Music as medicine 110118

  • 1. MUSIC AS MEDICINE OR “LISTEN TO TWO JAZZ RIFFS AND CALL ME IN THE MORNING” Randy M Rosenberg MD FAAN FACP Associate Professor of Neurology Lewis Katz School of Medicine at Temple University Principle Flutist of the Warminster Symphony
  • 2. IS MUSIC AS MEDICINE A NEW IDEA?
  • 3. MUSIC MEDICINE The Chinese character for medicine comes from the character for music
  • 4. OLDEST MUSICAL INSTRUMENTS IN THE WORLD Age: 7,000 – 9,000 years old Country of Origin: Jiahu, Yellow River Valley, China Material(s) Used: Red-Crown Crane wing bones Age: 42,000 – 43,000 years old Country of Origin: Geisenklösterle Cave, Blaubeuren, Germany Material(s) Used: Mute Swan bone and Mammoth Ivory Geisenklösterle Flute Jiahu Flutes
  • 5. THE ANCIENTS AND MUSICAL RELIEF • Egyptian papyri, over 2,600 years old, refer to incantations as cures for infertility and rheumatic pain. • In the Bible, David played the harp to lift Saul’s depression (1000-600 BC) • 1 Samuel 16:16 (NKJV) Let our master now command your servants, who are before you, to seek out a man who is a skillful player on the harp (probably lyre). And it shall be that he will play it with his hand when the distressing spirit from God is upon you, and you shall be well. • The ancient Greeks (800-600 BC) believed music had the power to heal the body and soul. They used the flute and the lyre for gout and sciatica. • Paeans were a classification of ancient Greek songs that cured specific illnesses. For example, when the plague hit ancient Greece, they played a specific song with the frequencies and rhythmic patterns thought to halt the illness.
  • 7. JUST HOW POWERFUL IS RHYTHM?
  • 8. “THE BEAT”: A CRITICAL PART OF MUSICAL RHYTHM What allows to do snap your fingers, tap your foot and DANCE! Every culture has music with a beat Ancient-throughout history Very early part of the human machinery Perception of the beat ties to motor systems
  • 9. BEAT BASED PROCESSING TIES IN WITH LANGUAGE Accurate perception of temporal patterns is crucial to hearing, speech, motor control, and music. Beat perceptions requires: Predictability Flexibility Man is the only primate that can process the beat…with exceptions Beat processing is tied into a specialized network that includes motor activity including the movement in speech Therefore beat processing and the neural connections allow us to be vocal learners with which we acquire language
  • 10. THE BEAT AND OTHER VOCAL LEARNERS
  • 11. RHYTHM: AS A POTENT TRIGGER FOR MUSICAL MEMORY Queen: We Will Rock You Michael Jackson: Billie Jean Benny Goodman: Sing Sing Sing The Knack: My Sharonna Pink Floyd: Money
  • 12. DOES MUSIC IMPROVE SCHOLARSHIP AND LEARNING?
  • 13. THE ”MOZART EFFECT” Rauscher et al. reported that listening to ten minutes of Mozart’s music briefly increased the abstract reasoning ability of college students The effect is limited to spatial– temporal tasks involving mental imagery and temporal ordering. (predicting paper shapes) In 2010 a larger meta-analysis of a greater number of studies again found a positive effect, but that other kinds of music worked just as well but only if you enjoy it. In 1998 Zell Miller, the Governor of the state of Georgia, asked for money to be set aside in the state budget so that every newborn baby could be sent a CD of classical music. ThanksZell!!
  • 14. DOES LISTENING TO PREFERRED MUSIC IMPROVE READING COMPREHENSION PERFORMANCE? Students who revised study material in quiet environments performed more than 60% better in an exam than their peers who studied while listening to music that had lyrics.  Students who revised classwork while listening to music without lyrics did better on later testing than those who had revised to music with lyrics. It made no difference if students review or revised classwork and notes while listening to songs they liked or disliked. Both led to a reduction in their test performance. Students who revised or did homework in silence rated their environment as less distracting and accurately predicted that this would lead to better performances in subsequent tests. Applied Cognitive Psychology 28: 279-284 2014
  • 15. LANGUAGE AND LITERACY THROUGH MUSIC A 2014 study published in The Journal of Neuroscience found that children who took music lessons for two years didn’t just become better at playing an instrument—they became better at processing language. Harmony project in low income neighborhoods with drop out rates of 50% 3 years of participation=97% high school completion with many going on to college Language and music share the elements of pitch, timing, and timbre. As children become more familiar with pitch, timing, and timbre through musical instruction, their language-processing skills also improve—enabling them to distinguish nuances in speech more easily Music enhances vocabulary and verbal understanding (short sentence interpretation) Repetition, rhyme and melody Leads to enhanced memory, learning, Reinforces language patterns
  • 16. DIANA DEUTSCH “SPEECH TO SONG ILLUSION” The neural circuitries underlying speech and song are at some point distinct and separate They can accept the same input, but process the information in different ways so as to produce different outputs This illusion is in line with what philosophers and musicians have been arguing for centuries… strong linkages must exist between speech and music. SHORT TERM PLASTICITY LONG TERM CHANGES The perception of speech as song requires isolation and repetition
  • 17. CAN MUSIC BE AN ANALGESIC?
  • 18. PAIN IS A CONSEQUENCE OF ILLNESS AND PRACTICALLY INESCAPABLE
  • 19. MUSIC THERAPY FOR THE TREATMENT OF PAIN For acute pain patients, especially post-operative: The hypotheses that patients in the music group will need less analgesic, have a shorter length of hospital stay, and experience less adverse effects than those in the control group were not supported by the data A number of studies suggest that there is a benefit but these are poorly controlled and variable in outcome measures For chronic pain patients: Music may be beneficial as an adjuvant as it reduces self-reported pain and depression. Importantly, the analgesic effect of music appears higher with self- chosen over researcher-chosen music. But…as my grandmother wouldsay…”It couldn’t hurt.”
  • 20. IS MUSIC A ”HEALTH SUPPLEMENT” FOR AN AGING BRAIN?
  • 21. • “Anatomists today would be hard put to identify the brain of a visual artist, a writer or a mathematician, but they would recognize the brain of a professional musician without a moment’s hesitation.” -Oliver Sachs MD • “Ah, music. A magic far beyond all we do here!” • Albus Dumbledore • Headmaster Hogwarts School
  • 22. ANATOMICAL CHANGES IN A MUSICIAN’S BRAIN • Studies using prospective longitudinal designs have found that children who receive musical training show changes in structural brain development compared to those who do not ( Habibi et al., 2017;Hyde et al., 2009), • Suggests that musical training may contribute to, rather than simply correlate with, neural plasticity ie changing the structure of the brain • ?Bigger brain=?Better brain
  • 23. MANY NEUROSCIENTIST ACCEPT THESE CONCEPTS… Musicians have stronger auditory cognitive skills across the life span. Playing an instrument improves working memory hearing speech in noise neural speech-sound processing across the life span. A lifetime of playing an instrument protects musicians from age-related neural declines. Adults who played an instrument as a child still reap neural benefits even 40 years after stopping lessons. Even older musicians with hearing loss have superior hearing in noise and auditory cognitive skills.
  • 24. SO WHAT IS THIS I HEAR ABOUT NEUROLOGICAL MUSIC THERAPY?
  • 25. FIVE BASIC DEFINITIONS ARTICULATE THE MOST IMPORTANT PRINCIPLES OF NEUROLOGIC MUSIC THERAPY It is defined as the therapeutic application of music to cognitive, sensory, and motor dysfunctions due to disease of the human nervous system. It is based on neuroscience models of music perception and the influence of music on changes in non-musical brain functions and behavior. Treatment techniques are based on data from scientific and clinical research and are directed toward non-musical therapeutic goals. Flexible treatment techniques are adaptable to a patient’s needs. Practitioners are educated in the areas of neuroanatomy and physiology, brain pathologies, medical terminology, and rehabilitation of cognitive, motor, speech, and language functions.
  • 27. MELODIC INTONATION THERAPY MIT in Stroke MIT: Present Controversies and Future Opportunities Overall, 14 studies between 1973 and 2011 found positive effects for the use of Melodic Intonation Therapy to improve verbal production in individuals with aphasia. The majority of participants were in the chronic phase of recovery. Further research is warranted as many studies were exploratory case studies or case series pre- and post-test designs.
  • 28. DOES MUSIC HELP HEAL INDIVIDUALS WITH BRAIN INJURIES?
  • 29. PHINEAS GAGE: LIFE WITHOUT A PREFRONTAL CORTEX • On September 13, 1848, 25 year old Phineas Gage was working with a blasting crew • An accidental explosion drove an tamping iron through the left cheekbone, past his eye and out the top of his head, severely damaging he orbitofrontal cortex • Survive but with significant behavioral changes • Crude language and behavior • Marked personality changes
  • 30. TRAUMA TARGETS Brain damage can affect movement and language abilities, having a significant impact on quality of life. An estimated 1.5 million people in the U.S. sustain a traumatic brain injury each year, of whom 80,000 to 90,000 will be left with long-term disability. Damage to the orbitofrontal cortex (OFC) and prefrontal cotex often occurs following traumatic brain injury (TBI) and can lead to complex behavioural changes with a negative impact on the individual’s social outcome.
  • 31. NEUROPLASTICITY • “Neuroplasticity” refers to the brain’s ability to change throughout the lifetime in response to new activity, learning and damage. • Changes might occur in the actual anatomy or to the way that the same anatomy functions. • Motor skill learning: neuroplasticity applied to a specific task e.g. juggling, playing the piano
  • 32. ARE MUSICIANS BRAINS ALWAYS DIFFERENT?  A large body of literature now exists to substantiate the long- held idea that musicians' brains differ structurally and functionally from non- musicians' brains.  There are however many variations in the conclusions drawn  A review of the literature highlights a number of variables that appear to moderate the relationship between music training and brain structure and function Dawn Merrett: Moderating variables of music training-induced neuroplasticity: a review and discussion. Frontiers of Psychology 2013
  • 33. • In 2018 Dykesteen et al Brain Injury, 32:5, 634-643 demonstrated behavioral improvements and functional brain changes after 8 weeks of playing piano on patients with mTBI having attention, memory and social interaction problems. • Present evidence for a causal relationship between musical training and reorganization of neural networks promoting enhanced cognitive performance. • SMALL patient size
  • 34. CAN MUSIC BENEFIT SOMEONE WITH ALZEIMER’S DISEASE OR OTHER DEMENTIA?
  • 35. MUSIC THERAPY (MT) IN ALZHEIMER’S DISEASE • Many articles which have found that MT can reduce the mood symptoms and behavior disorders in dementias, especially depression, anxiety and agitation • Although there are some researches which demonstrate that MT is beneficial for preserving cognition of dementia especially of AD, these are not convincing enough • Combining MT with other adjuvant interventions such as dance, art, video game, physical exercise, and so on, is another area for research and clinical use
  • 36. APPLAUSE SIGN: WHEN ACTIONS WON’T STOP ON THEIR OWN • The ability of the frontal lobes to put a “brake” on motor activity can fail in patients with dementia • Music Therapy with Rhythmic Auditory Stimulation may be useful in reestablishing effective “on-off” function • Disinhibition • Motor perseveration
  • 37. ACTIVATING THE MIND OF SOMEONE WITH ADVANCED DEMENTIA The absolutely miracle of bringing someone back to who they were and resurrecting their spirits
  • 38. HOW DOES MUSIC CHANGE THE CHEMISTRY OF THE BRAIN?
  • 39. MECHANISMS OF REWARDS AND PLEASURE IN MUSIC • Music can reliably induce feelings of pleasure • Preliminary studies have shown that music listening and performing modulate levels of serotonin, epinepherine, endorphins, dopamine, oxytocin, and prolactin • Dopamine liberations: • Released when we make plans and predictions to satisfy wants=appetitive component • Released with goals are met=consummatory component • Blocking μ-opioid receptors with naltrexone appears to cause decrease physiological reactions to music for both positive and negative emotions. • Therefore brain opioid activity appears to moderate the pleasure of music
  • 40. FUTURE DIRECTIONS OF MUSIC AND MEDICINE
  • 41. Autism The Cochrane Collaboration provided evidence that music therapy may help children gain improved function in the core domains of autism: Social interaction, verbal communication, initiating behaviour and social- emotional reciprocity. Improve rhythm sense may help with speech discrimination and interpretation Addiction recovery Schizophrenia Depression Eating disorders
  • 43. MUSIC THERAPY IN PATIENTS WITH SCHIZOPHRENIA  Music Therapy vs Standard Care Effects inconsistent across studies Dependent on number of music therapy sessions and quality of music therapy provided.  Therapy added to standard care superior to standard care for global state  Good effects on negative symptoms (apathy, lack of emotion, poor or nonexistant social functioning)  Some aspects of cognitive functioning and behaviour improved.
  • 44. THANK YOU SO MUCH FOR LISTENING QUESTIONS ARE ALWAYS WELCOME AND APPLAUSE IS NICE TOO