Dr Shashikant's Integrated Mind Body Yoga Therapies Vikram Hospital Bangalore www.vikramhospital.com drshashikantsk@gmail.com 08497877818

1. Clinical Use of MusicClinical Use of Music
TherapyTherapy
Dr Shashikant S K
MBBS, MD ( Yoga and Rehabilitation)
Msc applied Psychology
drshashikantsk@gmail.com 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
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46. Thanks for your attentionThanks for your attention
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