and “music therapy”

Musicoterapia in ambito neurologico
Alfredo Raglio
Dipartimento di Scienze Biomediche e Chirurgico-Specialistiche
Sezione di Clinica Neurologica – Università di Ferrara
alfredo.raglio@unife.it
Dr. Alfredo Raglio
A.A. 2012-2103
NECESSITA DI DEFINIRE LA MUSICOTERAPIA… Dr. Alfredo Raglio
A.A. 2012-2103
9 th WORLD CONGRESS
OF MUSIC THERAPY:
Music Therapy:
a global mosaic
many voices, one song
WASHINGTON, D.C., 1999
Dr. Alfredo Raglio
A.A. 2012-2103
La Musicoterapia è ...l'uso della musica e/o dei suoi elementi
(suono, ritmo, melodia e armonia) per opera di un musicoterapeuta qualificato, in un rapporto
individuale o di gruppo, all interno di un processo definito, per facilitare e promuovere la
comunicazione, le relazioni, l'apprendimento, la mobilizzazione , l'espressione
l organizzazione ed altri obiettivi terapeutici degni di rilievo, nella prospettiva di assolvere i
bisogni fisici, emotivi, mentali, sociali e cognitivi.
La Musicoterapia si pone come scopi di sviluppare potenziali e/o riabilitare funzioni
dell'individuo in modo che egli possa ottenere una migliore integrazione sul piano
intrapersonale e/o interpersonale e, conseguentemente, una migliore qualità della vita
attraverso la prevenzione, la riabilitazione o la terapia .
(8 th WORLD CONGRESS OF MUSIC THERAPY, AMBURGO, 1996)
Dr. Alfredo Raglio
A.A. 2012-2103
Dr. Alfredo Raglio
A.A. 2012-2103
Clinical Psychology Review 29 (2009) 193–207
Contents lists available at ScienceDirect
Clinical Psychology Review
Dose–response relationship in music therapy for people with serious mental
disorders: Systematic review and meta-analysis
Christian Gold a,⁎, Hans Petter Solli b,c, Viggo Krüger b, Stein Atle Lie a
a
Unifob Health, Bergen, Norway
“…Music therapy is University
a special type of psychotherapy where forms of musical interaction and communication are used alongside verbal of Bergen,
Norway
Diakonale Hospital, Oslo, Norway
communication. It Lovisenberg
has been defined as “a systematic process of intervention wherein the therapist helps the client to promote health, using music experiences and the relationships developing through them as dynamic forces of change” (Bruscia, 1998). The types of ‘music experiences’ can include a rused t i cin l emusic i n ftherapy o
a b s tfree r a acnd t structured improvisation, other types of active music-­‐making by patients, and listening to music. Improvisation is perhaps the most prominent form of musical interaction in music therapy. It has been Article history:
Serious mental disorders have considerable individual and societal impact, and traditional treatments may
Received
30 any June 2008
described as central in m
music therapy models. lient(s) and therapist n musical instruments hey have chosen, showClimited
effects.
Music
therapy mayimprovise be beneficial inopsychosis
and depression,
includingttreatmentReceived in revised form 6 January 2009
resistant
cases. Theoaim
of
this review was t
toheme. examine the
benefits
of music therapy
for speople
with serious
playing together freely o
r w
ith a
g
iven s
tructure o
r a
m
usical r n
on-­‐musical M
usic t
herapists a
re pecifically trained to Accepted 12 January 2009
mental disorders. All existing prospective studies were combined using mixed-effects meta-analysis models,
intervene therapeutically within the medium, for eallowing
xample to support by pofroviding rhythmical or pre-post
tonal study),
grounding, to clarify, to confront to examine
the influence
study design
(RCT vs. CCT vs.
type of disorder
Keywords:
(psychotic
vs. non-psychotic),
and number
of sessions.
Resultsm
showed
therapy,
when added toin music therapy Psychosis
or to challenge the client's expression in the music (Bruscia, 1987; Wigram, 2004). Other odes that
of music
music experiences standard care, has strong and significant effects on global state, general symptoms, negative symptoms,
Depression
include playing composed singing aanxiety,
nd wfunctioning,
riting or and
improvising songs (Baker dose–effect
& Wigram, 2005), and listening to musical engagement.
Significant
relationships
were
Psychotherapy music on instruments, depression,
identified for general, negative, and depressive symptoms, as well as functioning, with explained variance
Dose–effect relationship
music (Grocke & W
igram, 2006). Songs may be used by clients as a Mixed-effects meta-analysis
ranging from 73% to 78%. Small effect sizes for these outcomes are achieved after 3 to 10, large effects after 16
safe, structuring and socially acceptable form in wtohich they The
can express hich might be helps
too people
overwhelming to 51 sessions.
findings
suggestfeelings that music w
therapy
is o
antherwise effective treatment
which
with
psychotic
and
non-psychotic
severe
mental
disorders
to
improve
global
state,
symptoms,
and
functioning.
express. Music listening may be helpful to bring up and make available therapeutically relevant issues (emotions, associations, Slight improvements can be seen with a few therapy sessions, but longer courses or more frequent sessions
memories, identity issues). are needed to achieve more substantial benefits.
© 2009 o
Elsevier
Ltd. All rights reserved.
All these different modes of ‘music experiences’ become therapeutic by being used in the context f a therapeutic relationship. Verbal discussions, reflections, or interpretations connected to the music are important to help clients explore the potential meaning of an experience, and to Contents
relate a new experience within therapy to situations in the client's life. The degree to which the music experience itself, versus the verbal reflection 1.
Introduction
. . c
. onnected . . . . . . . .to . i. t, . i. s . s.een . . . a.s . the . . .active . . . . a
. gent . . . . o. f . c.hange . . . . .m
. ay . . v
. ary . . . b.etween . . . . . .m. odels . . . . o
. f m
194usic therapy Music therapy
in mentalH
health.
. . . t
. reatments . . . . . . . . t.hat . . .rely . . .solely . . . . o
. n . .the . . .d.irect . . . e
. ffects . . . . .o.f .m. usic . . . a
. lone, . . .
194
(Garred, 2004), as well 1.1.
as between clients. owever, which do not 1.2.
Music therapy—the evidence to date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
195
“involve or depend upon rocess of intervention nd change 1.3. a p
Research
questions
addressed in thisareview
. . . . .w
. ithin . . . . a. c
. lient–therapist . . . . . . . . . . . .relationship” . . . . . . . . . .(“auxiliary . . . . . . . .level”, .
195 Bruscia, 1998, p. Method T
. he . . .term . . . .‘music . . . . .m
. edicine’ . . . . . . i. s . s. ometimes . . . . . . . .u.sed . . t
. o . d
. istinguish . . . . . . . . s. uch . . . t.reatments . . . . . . . .from . . . .m
. usic .
196therapy.”… 195), are not music t2.herapy. Dr. Alfredo Raglio
A.A. 2012-2103
b
c
2.1.
Criteria
2.1.1.
2.1.2.
2.1.3.
2.1.4.
2.1.5.
for selecting studies
Study design . . .
Study quality . . .
Participants . . . .
Interventions . . .
Outcomes. . . . .
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196
196
196
196
196
196
after initiation of trazodone, and the headache disaped
when the
the agent
agent was
was discontinued.
discontinued. The
The temporal
temporal
d when
onship suggested
suggested that
that the
the headache
headache could
could be
be the
the adverse
adverse
onship
t of
of trazodone
trazodone use.
use. The
The possibility
possibility of
of the
the headache
headache caused
caused
rotonin syndrome
syndrome is
is not
not likely
likely due
due to
to the
the lack
lack of
of clinically
clinically
rotonin
ciated
findings of
of mental
mental status
status change,
change, autonomic
autonomic hyperhyperiated findings
ity
or neuromuscular
neuromuscular abnormalities.
abnormalities.
ty or
he
most common
common side-effects
side-effects that
that lead
lead to
to discontinuation
discontinuation
e most
azodone for
for treatment
treatment of
of insomnia
insomnia are
are sedation,
sedation, dizzidizziazodone
2
and
psychomotor
impairment.
2 To our knowledge,
and psychomotor impairment. To our knowledge,
are few reports of severe headache as an adverse effect
are few reports of severe headache as an adverse effect
d to trazodone use. In 1992, Workman et al. reported
d to trazodone use. In 1992, Workman et al. reported
a 35-year-old patient who possessed a genetic predisa 35-year-old patient who possessed a genetic predision toward migraine suffered from severe migraine
ion toward migraine suffered from
severe migraine
ache after trazodone treatment.3 The mechanism of
ache after trazodone treatment.3 The mechanism of
done-induced headache is not clear. Serotonin-releasing
done-induced headache is not clear. Serotonin-releasing
r and serum serotonin increase during headache attacks
r and serum serotonin increase during headache attacks
cerebral vessels are highly innervated by serotonin fibers
cerebral vessels4,5are highly innervated by serotonin fibers
raphe nuclei. Workman et al. indicated that migraine
raphe nuclei.4,5 Workman et al. indicated that migraine
ache may be evoked by trazodone through its active
ache
may be evoked by trazodone through its active
bolite, m-chlorophenylpiperazine, which is a potent
bolite,
is a potent
elective m-chlorophenylpiperazine,
serotonin receptor agonist.which
In addition,
this
elective serotonin receptor agonist. In addition, this
Received 14 June 2011; revised 8 August 2011;
accepted 23
23 September
September 2011.
2011.
accepted
Neurology
Issue
When music
music becomes
becomes music
music therapy
therapy
When
doi:10.1111/j.1440-1819.2011.02273.x
doi:10.1111/j.1440-1819.2011.02273.x
Psychiatry and Clinical Neurosciences 2011; 65: 679–683
S
CIENTIFIC LITERATURE PROVIDES evidence of the
CIENTIFIC LITERATURE PROVIDES evidence of the
unquestionable effects of music both in pathological coneffects
of music
boththerapeutic
in pathological
conIunquestionable
personally
that
music
embodies
potentialion the
texts
and uponsee
individuals
generally
speaking.11 Also
Also on the
texts
and
upon individuals
generally speaking.
ties
as
suggestive
–
but
not
scientifically
proven.
physiological, neurophysiological, biological and neurochemiphysiological,
neurophysiological,
biological
and neurochemiexample,
‘Mozart’s
music’
is an
concept:22
calFor
levels,
confirmation
of such
effects
hasinsufficient
been forthcoming.
cal
levels,
confirmation
of suchoreffects
hasfrom
beenDon
forthcoming.
which
Mozart?
The
Requiem
an
aria
Giovanni?
Empirically, all individuals can experience well-being and
Empirically, all individuals can experience well-being and
positive
emotions
when
that has
parWhy Mozart
and not
thelistening
Beatles ortoB.music
McFerrin?
Andsome
addresspositive emotions when listening to music that has some particular
significance
forwhat?
them,How?
or can derive pleasure from
ing
whom?
Producing
ticular significance for them, or can derive pleasure from
socializing
a musical
experience
(making
or listening tomusicmusic
With these
queries
in mind,
the international
socializing
a musical
experience
(making
or listening
to music
Psychiatry
and
Clinical
2011;
65:
679–683
together
with
others), Neurosciences
buthas
allintroduced
the above,
while
emphasizing
the
therapeutic
community
–
as
an
essential
comtogether
with others),
but
all therefers
above,
while emphasizing
the
potentialities
of music,
usually
to momentary
effects that
3,4
ponent
of
therapy
by
music
–
the
concept
of
‘relationship’.
potentialities
of music,
elude therapeutic
logic.usually refers to momentary effects that
Thetherapeutic
above thoughts
elude
logic. can help re-model music-therapeutic
I personally
see that music
potentialipractices
by introducing
theembodies
followingtherapeutic
aspects (Evidence
Based
tiesMusic
as suggestive
but not
scientifically
proven. 5,6 musical and
Therapy–and
Evidence
Based Practice):
For example,
‘Mozart’s
music’
is an insufficient
relational
training
of music
therapists,
presence of concept:
a therapeu011 The Authors
which
Mozart?
The
Requiem
or
an
aria
from
Giovanni?
011 The Authors
tic setting, a theoretical/methodological Don
background,
aims
hiatry and Clinical Neurosciences © 2011 Japanese Society
of Psychiatry
andBeatles
Neurology
Why Mozart
and not the
or B. McFerrin? And addressoriented
to
the
achievement
of
stable
and
longlasting
hiatry and Clinical Neurosciences © 2011 Japanese Society
of
Psychiatry
and
Neurology
ing whom? Producing what? How?
improvements
(according
to type
gravity of pathologies
With these queries
in mind,
theand
international
musicconsidered),
content
(active
and/or
receptive
techniques)
therapeutic community has introduced – as an essential
com3,4 the
facilitating
intra-by and
inter-personal
with
ponent
of therapy
music
– the conceptrelationships
of ‘relationship’.
patient/client
and rigorous
assessment
The above thoughts
can help
re-modelcriteria.
music-therapeutic
practices
by introducing
the following
aspects
Based
I believe
that neither
music nor
the(Evidence
sonorous-musical
5,6
musical
and if
Music
Therapy
andtoEvidence
Based
Practice):
element
can fail
keep these
concepts
in due
consideration
relational
of music
therapists,
presence
of aIn
therapeuthey aretraining
to assume
a potential
therapeutic
value.
therapeutic
tic applications
setting, a theoretical/methodological
aims
it is of essential importancebackground,
that the individual’s
oriented
to the
achievement
of stable
longmusicality
and musical
potential
shouldand
emerge:
thislasting
can only
improvements (according to type and gravity of pathologies
happen through the relationship between the music therapist
considered), content (active and/or receptive techniques)
and the patient/client
mediated by the
power of music.
This is
facilitating
intra- and inter-personal
relationships
with the
what definesand
therigorous
therapeutic
specificity
of music and contextupatient/client
assessment
criteria.
I believe that neither music nor the sonorous-musical
element can fail to keep these concepts in due consideration if
they are to assume a potential therapeutic value. In therapeutic
applications it is of essential importance that the individual’s
musicality and musical potential should emerge: this can only
happen through the relationship between the music therapist
and the patient/client mediated by the power of music. This is
what defines the therapeutic specificity of music and contextu-
Letters to the Editor 683
alizes the various possible interventions through music. Music
can be the source of deep pleasure, it can stimulate relationships and attentive and cognitive functions, but it becomes
therapeutic practice only in the presence of the essential components mentioned above.
REFERENCES
Letters to the Editor 683
Psychiatry
and Clinical Neuroscience
1. Sacks O. The power of muisc. Brain 2006; 129: 2528–2532.
2. Koelsch S. Towards a neural basis of music-evoked emotions.
Trends
Cogn.possible
Sci. 2010;
14: 131–137.
alizes the
various
interventions
through
Music
Volume
65,itIssue
7, music.
(/doi/10.1111/pcn.2011.65.issue-7/issu
C. All those
things
with music
J. Music
can 3.beGold
the source
of deep
pleasure,
can(Editorial).
stimulate Nord.
relationTher.attentive
2009; 18:and
1–2.cognitive functions, but it becomes
ships and
, Kruger
et alInformation
. Dose-response
relationship
4. Gold practice
C, Solli HP
therapeutic
only
in theVpresence
of the essential
com- in
Additional
muisc
therapy above.
for people with serious mental disorders: systemponents
mentioned
atic review and meta-analysis. Clin. Psychol. Rev. 2009; 29: 193–
207.
How to Cite
REFERENCES
5. Vink A, Bruinsma M. Evidence based music therapy. Music
1. Sacks
O. The
power
of 4:
muisc.
Brain
2006; 129:
Ther.
Today
2003;
1–26.
Available
from2528–2532.
URL: http://www.
2. Koelsch S. Towards a neural basis of music-evoked emotions.
musictherapyworld.de
(last
accessed
4
JulyWhen
2004). music becomes music therapy. Psy
Raglio,
A. (2011),
Trends Cogn. Sci. 2010;
14: 131–137.
6. Edwards J. Possibilities
and
problems
for evidence-based prac3. Gold C. All those 683.
things with
music
(Editorial). Nord. J. Music
doi:
10.1111/j.1440-1819.2011.02273.x
in music
therapy. Arts Psychother. 2005; 32: 293–301.
Ther.tice
2009;
18: 1–2.
4. Gold C, Solli HP, Kruger V et al. Dose-response relationship in
Alfredo
Raglio,
MA (Music
Therapy)
muisc therapy for people with serious
mental
disorders:
systemSospiro
Foundation,
atic review and meta-analysis. Clin.
Psychol.
Rev. 2009;Cremona,
29: 193– Italy
207.
Email: raglioa@tin.it
M. Evidence
based
therapy.
Music2011;
5. Vink A, BruinsmaReceived
25 July
2011;music
revised
22 August
Ther. Today 2003; 4: 1–26. Available from URL: http://www.
accepted 23 September 2011.
musictherapyworld.de (last accessed 4 July 2004).
6. Edwards J. Possibilities and problems for evidence-based practice in music therapy. Arts Psychother. 2005; 32: 293–301.
Author Information
Sospiro Foundation, Cremona, Italy, Email: raglioa@
Publication History
Alfredo Raglio, MA (Music Therapy)
Cremona,
Italy 19 DEC 2011
1. Sospiro
IssueFoundation,
published
online:
Email: raglioa@tin.it
Article
first 22
published
online: 19 DEC 2011
Received 2.
25 July
2011; revised
August 2011;
accepted 23 September 2011.
http://onlinelibrary.wiley.com.bibliosan.cilea.it/doi/10.1111/j.1440-1819.2011.02273.x/fu
Dr. Alfredo Raglio
A.A. 2012-2103
Differences between “music” and “music therapy” interventions in dementia.
(Raglio & Gianelli, Current Alzheimer Research, 2009, 6, 293-301).
MUSIC
MUSIC THERAPY
Presence of a professional of the music area
Presence of a professional of the musictherapeutic area with specific relational and
musical competences
Absence of a specific therapeutic setting
Presence of a structured therapeutic setting
Absence of a specific intervenion model
Presence of a music-therapeutic referential
model grounded on theoretical and
methodological criteria
Aims: temporary well-being, improving mood,
promoting socialization, memories and
stimulation of frames of mind, relaxation, etc.
Aims (aspiring to become stable and longlasting over time): attenuation of behavioral and
psychiatric symptoms and prevention/
stabilization of complications; increase in
communication and relationship skills
Contents: structured musical initiatives
(rhythmic use of instruments, singing,
movement associated to music, etc.) and
listening to music (classical music, favourite
music, etc.)
Contents: sonorous-musical improvisation;
listening activities that involve verbal and
elaborative competences (preferably at initial
stages of dementia)
Dr. Alfredo Raglio
A.A. 2012-2103
Altri interventi con la musica
in ambito clinico…
!   ATTIVITA’ DI PRODUZIONE MUSICALE
!   ASCOLTO MUSICALE INDIVIDUALIZZATO
!   BACKGROUND MUSIC
!   MUSICA E MOVIMENTO
!   …
QUALI OBIETTIVI? IN QUALE AMBITO CLINICO?
QUALI CONTENUTI? QUALI PROFESSIONISTI?
Dr. Alfredo Raglio
QUALI MODALITA’ DI VERIFICA?...
A.A. 2012-2103
MUSIC THERAPY MODELS
(WORLD FEDERATION OF MUSIC THERAPY, 1999)
!   CREATIVE MUSIC THERAPY (NORDOFF-
ROBBINS)
!   ANALITICAL MUSIC THERAPY (PRIESTLEY)
!   BEHAVIORAL APPROACH (MADSEN)
!   GUIDED IMAGERY AND MUSIC (BONNY)
!   BENENZON MUSIC THERAPY (BENENZON)
Dr. Alfredo Raglio
A.A. 2012-2103
IN SINTESI…
ORIENTAMENTO
ORIENTAMENTO
UMANISTICO
PSICODINAMICO
↓
↓
VALENZA ESPRESSIVA
VALENZA INTROSPETTIVA
(enfasi sulla componente estetica)
(enfasi sulla componente relazionale)
↓
↓
LA LIBERTA ESPRESSIVA
FACILITA IL FLUSSO
EMOTIVO EVITANDO IL
BLOCCO DEL PENSIERO E
DELLA CREATIVITA
L ASTENSIONE
DALL AZIONE CONTATTA
LE VERE EMOZIONI E
SVILUPPA IL PENSIERO
Dr. Alfredo Raglio
A.A. 2012-2103
Quale musicoterapia?
!   Musicoterapia
!   musicoTerapia
!   MusicoTerapia
Dr. Alfredo Raglio
A.A. 2012-2103
Altri modelli…
!   L’approccio neuroscientifico (ambito neurologico)
Dr. Alfredo Raglio
A.A. 2012-2103
Le principali tecniche…
!   TECNICHE IMPROVVISATIVE
!   TECNICHE RECETTIVE
Dr. Alfredo Raglio
A.A. 2012-2103
Gli ambiti applicativi…
!   PSICHIATRICO
!   NEUROPSICHIATRICO INFANTILE
!   NEUROLOGICO
!   GERIATRICO
!   ONCOLOGICO/CURE PALLIATIVE
!   …
Dr. Alfredo Raglio
A.A. 2012-2103
LA LETTERATURA
SCIENTIFICA…
Dr. Alfredo Raglio
A.A. 2012-2103
LA RICERCA PUO’ ESSERE
INTESA COME
SISTEMATIZZAZIONE
E
VALUTAZIONE
DELL’INTERVENTO
TERAPEUTICO
Dr. Alfredo Raglio
A.A. 2012-2103
Necessità di definire i contenuti degli
interventi (M o MT)e di utilizzare
metodologie di ricerca adeguate
Dr. Alfredo Raglio
A.A. 2012-2103
EVIDENCE BASED MEDICINE ê
EVIDENCE BASED MUSIC THERAPY (Edwards, 2002; 2004; Vink & Bruinsma, 2003; Rolvsjord et al., 2005; Abrams, 2010) Dr. Alfredo Raglio
A.A. 2012-2103
“Evidence Based Music Therapy is a method in which the music therapist, in each decision he or she makes, tries to integrate best available scientific evidence with his or her own experience, combined with the values, expectations and wishes of his or her patient. Evidence Based Music Therapy is based on the principles of Evidence Based Medicine”. (Vink & Bruinsma, 2003) Dr. Alfredo Raglio
A.A. 2012-2103
LEVEL OF EVIDENCE
!
Systematic review that is based on RCT's !   RCT or CCT studies !
Patient-­‐series with or without controls !   Case studies !   Expert opinions
!   Qualitative research Dr. Alfredo Raglio
A.A. 2012-2103
LA RICERCA IN
MUSICOTERAPIA
…
Dr. Alfredo Raglio
A.A. 2012-2103
LETTERATURA SCIENTIFICA
…
Dr. Alfredo Raglio
A.A. 2012-2103
igram T
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Gold C,
Musicoterapia
e…
Depressione (Maratos et al.,
2009)
•  Cure di fine vita (Bradt &
Dileo, 2010)
•  Danno cerebrale acquisito
(Bradt et al., 2010)
•  Autismo (Gold et al., 2010)
• 
Demenza (Vink et al., 2011)
•  Schizofrenia (Mössler et al.,
2011)
• 
ibrary Raglio
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A.A. 2012-2103
Esempi di RCTs in
musicoterapia
Dr. Alfredo Raglio
A.A. 2012-2103
Efficacy Of Music Therapy In The Treatment Of
Behavioral And Psychiatric Symptoms Of Dementia
Raglio A, Bellelli G, Traficante D, Ubezio MC, Gianotti M, Villani D,
Trabucchi M,
Alzheimer Dis Assoc Disor, 2008; 22:158-162
Fondazione Sospiro (CR)
Gruppo Ricerca Geriatrica (BS)
Unità Valutazione Alzheimer, Ancelle della Carità (CR)
RSA Salò (BS)
Fondazione Piccinelli (BG) Dr. Alfredo Raglio
A.A. 2012-2103
Efficacy of music therapy treatment based on
cycles of sessions: a randomized controlled trial.
Raglio A, Bellelli G, Traficante D, Gianotti M, Ubezio MC,
Gentile S, Villani D, Trabucchi M
Aging and Mental Health, 2010, 14, 900-904
Fondazione Sospiro (CR)
Gruppo Ricerca Geriatrica (BS)
Unità Valutazione Alzheimer, Ancelle della Carità (CR)
RSA Salò (BS)
Fondazione Piccinelli (BG)
Fondazione S. Chiara (BG)
IRCCS Don Gnocchi (MI)
Dr. Alfredo Raglio
A.A. 2012-2103
Background: Music therapy has been proposed as a valid approach for behavioral and psychological symptoms (BPSD) of dementia. Dr. Alfredo Raglio
A.A. 2012-2103
Objective: to assess MT effectiveness in reducing BPSD in persons with dementia. Dr. Alfredo Raglio
A.A. 2012-2103
Methods: -­‐  Sixty persons with moderate-­‐severe dementia (CDR 2-­‐4) -­‐ Experimental group (n=30): 30-­‐36 MT sessions (30 min/
session) -­‐ Control group (n=30): educational support or entertainment activities. -­‐ Subjects were randomly assigned to experimental or control group -­‐ multidimensional assessment (MMSE, Barthel Index and NPI) -­‐ Improvisational/intersubjective MT approach -­‐  Music therapists: 5-­‐year training focused on the relational MT approach applied in particular on persons with dementia -­‐  MT evaluation: items taken from MTCS (Raglio et al., 2006) Dr. Alfredo Raglio
A.A. 2012-2103
Main difference between the two studies: -­‐  The first study was based on a continuous treatment: 30 biweekly sessions (16 weeks) -­‐ The second study was based on 3 cycles of 12 sessions each, 3 times a week (36 sessions) and each cycle of treatment was followed by 1 month of wash-­‐out Dr. Alfredo Raglio
A.A. 2012-2103
MAIN RESULTS (first study)
Dr. Alfredo Raglio
A.A. 2012-2103
RaglioDisord
et al
Alzheimer Dis Assoc
Windows. The cognitive, functional, and behavioral 35
scores were submitted to a mixed analysis of variance, 30
25
with 1 repeated (time: before, after 8wk, after 16wk
20
25
**
15
and4wkafterendoftreatment)and1independentfactor
***
***
10
(group: experimental and control). Dementia severity 20
**
5
15
was considered as covariate.
***
***
0
Each NPI item score was submitted to Friedmann’s 10 4 weeks after
Before Treatment After 8 weeks After 16 weeks
end of
analysis of variance for nonparametric data,25 comparing
treatment
5
the variations occurred Experimental
in the 4 differentGroup
surveys (beforeControl Group
the treatment, 8wk and 16wk after beginning of 0 Before Treatment After 8 weeks After 16 weeks 4 weeks after
FIGURE 1. Average NPI global scores in the experimental and
treatment and**P<0.01;
also 4wk after end***P<0.001
of treatment) betweenat t test comparison
end of
control groups
between experimental
groups.group and control group. The agreement
treatment
between 2 independent observers of MT sessions was
Experimental Group Control Group
30
NPI scores
ann’s
aring
efore
g of
ween
ment
was
Cohen
f NPI
miles,
Alzheim2,
er DiApril–June
s Assoc Disord # Volu2008
me 22, Number 2, April–June 2008
Volume 22, Number
35
NPI scores
vioral
ance,
16 wk
actor
verity
#
Dr. Alfredo Raglio
A.A. 2012-2103
Raglio et al
Alzheimer Dis Assoc Disord
"
Alzheimer Dis Assoc Disord # Volume 22, Number 2, April–June 2008
Volume 22, Number 2, April–June 2008
Efficacy of Music Therapy
TABLE 2. Changes in NPI Items Score
Before Treatment
After 8 wk
Windows. The cognitive, functional, and behavioral
scores were submitted to a mixed analysis of variance,
with 1 repeated (time: before, after 8wk, after 16wk
and4wkafterendoftreatment)and1independentfactor
(group: experimental and control). Dementia severity
was considered as covariate.
Each NPI item score was submitted to Friedmann’s
analysis of variance for nonparametric data,25 comparing
the variations occurred in the 4 different surveys (before
the treatment, 8wk and 16wk after beginning of
treatment and also 4wk after end of treatment) between
experimental group and control group. The agreement
between 2 independent observers of MT sessions was
Experimental group
Hallucinations
Delusions
Depression
Agitation
Euphoria
Anxiety
Apathy
Disinhibition
Irritability
Aberrant motor activity
Appetite and eating
Nighttime behavior disturbances
Control group
Hallucinations
Delusions
Depression
Agitation
Euphoria
Anxiety
Apathy
Disinhibition
Irritability
Aberrant motor activity
Appetite and eating
Nighttime behavior disturbances
0.28
3.48
2.07
2.90
0.24
3.00
1.97
0.38
3.66
5.59
0.66
3.21
0.21
2.62
1.07
2.38
0.10
1.28
1.21
0.38
2.79
4.17
0.66
1.14
0.10
3.72
2.69
4.93
0.31
3.34
2.03
0.59
4.24
4.93
0.76
1.72
0.34
3.69
2.93
4.34
0.24
2.93
2.69
0.66
4.55
5.14
0.48
1.10
After 16 wk
35
4 wk After End of Trial
Test di Friedmann (v2)
0.18
2.93
1.21
1.25
0.04
1.21
0.61
0.18
2.18
3.71
0.07
1.07
0.07
2.68
1.57
1.39
0.00
1.50
1.75
0.46
1.61
3.86
0.57
0.64
2.08
9.70*
6.48
17.03***
5.67
20.69***
8.10*
0.83
10.88**
19.60***
2.54
16.59***
0.14
3.72
2.34
3.90
0.24
2.93
1.90
0.62
4.24
5.00
0.79
1.38
0.14
3.31
2.28
3.48
0.31
3.10
2.28
0.48
4.55
5.07
0.69
1.10
1.00
2.94
2.72
14.56**
1.70
0.86
4.05
0.84
1.29
1.44
0.69
12.88*
30
NPI scores
NPI Test
25
20
**
15
10
5
0
***
***
Friedmann test average and score (statistical significance: *P<0.05; **P<0.01; ***P<0.001).
18 subjects with Alzheimer disease, comparing listening
to preferred music with no music during 10 bathing
sessions. This study found out that subjects in the
intervention group decreased aggressive behavior, but
the results were devoid of statistical significance. Gerdner27 found that listening to preferred music on 39
subjects with dementia had more efficacy in reducing
Before Treatment After 8 weeks After 16 weeks 4 weeks after
end of
treatment
reading activities. Patients were evaluated with MMSE,
which was not different between the 2 groups at the end
of the study.
Dr. Alfredo Raglio
A.A. 2012-2103
The strength of our study includes the number
of patients enrolled, the duration of the treatment, the
type of MT approach,21–23 and the use of standardized
criteria to assess patient’s behaviors during MT sessions
Experimental Group
Control Group
Raglio et al
Alzheimer Dis Assoc Disord # Volume 22, Number 2, April–June 2008
Windows. The cognitive, functional, and behavioral
scores were submitted to a mixed analysis of variance,
with 1 repeated (time: before, after 8wk, after 16wk
and4wkafterendoftreatment)and1independentfactor
(group: experimental and control). Dementia severity
was considered as covariate.
Each NPI item score was submitted to Friedmann’s
25
comparing
analysis
of
variance
for
nonparametric
data,
that the assessment for increased communication was
done only for the experimental and not for the control
the variations occurred in the 4 different surveys (before
group.
Notwithstanding these limitations, this study supthe treatment,
and 16wktreatment
after beginning
of
ports the assertion
that MT is8wk
an effective
for
BPSD in demented patients. MT is a low cost approach
that NH staff treatment
can introduce
theirafter
everyday
and alsoin 4wk
end of activities
treatment) between
with the aim to reduce agitated behaviors, alleviate
caregivers’ stress and burden of care and to lead to a
experimental
groupof and
control patients
group. Theandagreement
global improvement
in quality
life among
relatives. Future studies are needed to definitely confirm
our conclusions.
between 2 independent observers of MT sessions was
Raglio et al
35
Alzheimer Dis Assoc Disord
!
Volume 22, Number 2, April–June 2008
30
TABLE 3. Changes in Patient’s Behaviors During the 3 Cycles of MT Treatment
First Cycle of MT Sessionsw
EB
n-EB
Smiles
Synchronic body movement
Singing
Mean
SD
Mean
SD
0.30
0.72
0.15
0.11
0.02
0.29
0.31
0.13
0.18
0.04
0.33
0.70
0.15
0.13
0.04
0.27
0.32
0.12
0.17
0.08
NPI scores
Observed Behavior
25
Second Cycle of MT Sessionsz
20
15
Third Cycle of MT Sessionsy
Mean
SD
F
Cohen d
0.49
0.59
0.25
0.29
0.07
0.33
0.28
0.23
0.37
0.10
10.37***
5.55**
8.14***
12.41***
6.98***
0.61
1.8
0.53
0.62
0.62
**
Mean and ratings of the F test (**P<0.01; ***P<0.001) on repeated measures (effect inside the subjects) and effect size (Cohen d).
wThe first 10 MT sessions.
z11th-20th MT sessions.
y21st-30th MT sessions.
10
***
***
5
10. Koger SM, Brotons M. Music therapy for dementia symptoms.
Cochrane Database Syst Rev [database online]. 2000;CD001121.
11. Sherratt K, Thornton A, Hatton C. Music interventions for people
with dementia: a review of the literature. Aging Ment Health.
2004;8:3–12.
12. Vink AC, Birks JS, Bruinsma MS, et al. Music therapy for people
with dementia. Cochrane Database Syst Rev [database online].
2004;CD003477.
13. Goodall D, Etters L. The therapeutic use of music on agitated
behavior in those with dementia. Holist
Nurs Pract.
2005;19:
Dr. Alfredo
Raglio
A.A. 2012-2103
258–262.
14. Svansdottir HB, Snaedal J. Music therapy in moderate and severe
dementia of Alzheimer’s type: a case-control study. Int Psychogeriatr. 2006;18:613–621.
15. Raglio A, Ubezio MC, Puerari F, et al. The effectiveness of the
0
Before Treatment After 8 weeks After 16 weeks 4 weeks after
end of
treatment
Experimental Group
Control Group
MAIN RESULTS (second study)
Dr. Alfredo Raglio
A.A. 2012-2103
Aging & Mental Health
Vol. 14, No. 8, November 2010, 900–904
902 Aging & Mental Health
Vol. 14, No. 8, November 2010, 900–904
A. Raglio et al.
Efficacy35
of music therapy treatment based on cycles of sessions: A randomised controlled trial
This stud
studies (Rag
30
Sospiro Foundation, Cremona, Italy; Interdem Group (Psycho-Social Interventions in Dementia), EU; Alzheimer’s
2006; Vink e
Evaluation Unit, Ancelle della Carità Hospital, Cremona, Italy; Geriatric Research Group, Brescia, Italy; Department of
Psychology and Education Technologies Research Centre, Catholic University, Milan, Italy; Department of Neurosciences,
Tor Vergata University, Rome, Italy
severely deme
25
(Received 6 August 2009; final version received 21 December 2009)
in managing
We undertook a randomised controlled trial to assess whether a music therapy (MT) scheme of administration,
including
20three working cycles of one month spaced out by one month of no treatment, is effective to reduce
Ballard et a
behavioural disturbances in severely demented patients. Sixty persons with severe dementia (30 in the
experimental and 30 in the control group) were enrolled. Baseline multidimensional assessment included
Efficacy
of music
treatment
based onInventory
cycles
randomisedHall
con
demographics,
Mini Mental State
Examinationtherapy
(MMSE), Barthel
Index and Neuropsychiatry
(NPI) of sessions: A Murray,
for all15
patients. All the patients of the experimental and control groups received standard care (educational and
entertainment activities). In addition, the experimental group received three cycles of 12 active MT sessions each,
sucha as those
a,b
c,dEvery cycle of treatment was
e followed
a
three times a week. Each 30-min session included
a group of three patients.
*
**
A.
Raglio
,
D.
Traficante
,
M.
Gianotti
,
M.C.
Ubezio
, S. Gentile
,
G.
Bellelli
by one month of wash-out. At the end of this study, MT treatment resulted to be more effective than standard
care to reduce behavioural disorders. We observed a significant reduction over time in the NPI global scores in
practical poin
10 (F ¼ 9.06, p50.001) and a significant difference between groups (F ¼ 4.84,a p50.05) due to a
d,f
both groups
D.
Villani
and
M.
Trabucchi
higher reduction of behavioural disturbances in the experimental group at the end of the treatment (Cohen’s
cological ap
d ¼ 0.63). The analysis of single NPI items shows that delusions, agitation and apathy significantly improved in
the experimental, but not in the control group. This study suggests the effectiveness of MT approach with
a reducing behavioural disorders of severely demented patients.
working5
cycles in
Sospiro Foundation, Cremona, Italy; bInterdem Group (Psycho-Social InterventionsFurthermore
in Dementia), EU;
Keywords: dementia; behavioural disorders; music therapy treatment
d
Evaluation Unit, Ancelle della Carità Hospital, Cremona, Italy; Geriatric Research Group,
Brescia,MT
Italy; s
of such
0
f
Psychology T0
and Education Technologies
Research
Centre,
Catholic
University,
Milan, Italy;
Department
of
Introduction
MT treatment,
the number
of patients
treated
in the
sessions.
Thi
T2
T1
same period could significantly increase and resources
A growing body of evidence has recently shown that
Vergata
University, Rome, Italy
could be moreTor
correctly
allocated.
music therapy (MT) is effective in the treatment
of
ing new inter
Experimental
group
Control
group
The aim of this randomised controlled study is to
Behavioural and Psychological Symptoms of Dementia
asses the efficacy of a MT treatment based on three
(BPSD) (Casby & Home, 1994; Clark, Lipe, & Bilbrey,
had differen
(Received
August
received
working6cycles
of one2009;
month final
spacedversion
out by one
month 21 December 2009)
1998; Clendaniel & Fleishell, 1989; Denney, 1997;
Figure 1. Comparison of theof no
average
global
scoresin in
treatment onNPI
the behavioural
disturbances
Gerdner & Swanson, 1993; Goddaer & Abraham,
lengths of in
severely
demented
patients.
1994;the
Kogerexperimental
& Brotons, 2000; Raglio
et al.,
2008;
and
control
group
over
time.
Snowden, Sato, & Roy-Byrne, 2003; Svansdottir &
hadscheme
a durat
We undertook
randomised controlled trial to assessDr.whether
music therapy
(MT)
of admi
Alfredo a
Raglio
A.A. 2012-2103
Note:
**p50.001.
Snaedel,
2006; Vink,
Birks,
Bruinsma, & aScholten,
2004). Considering these findings, MT is increasingly
varying
from
including three working cycles
of one
month spaced out by one month of no treatment,
is effective
Materials
and methods
proposed as a useful and low-cost non-pharmacological
approach in various stages of dementia. However,
sample
behavioural disturbances Study
in
severely
demented patients. Sixty persons withLee,
severe Cheong
dementia (
several questions need to be clarified. In particular, a
This study took place from March to November 2007.
A. Raglioa,b*, G. Bellellic,d, D. Traficantee, M. Gianottia, M.C. Ubezioa, S. Gentilea,
D. Villania and M. Trabucchid,f
a
b
c
d
e
NPI global scores
f
Downloaded At: 22:48 9 November 2010
7,357
1,51
Mean
Comparisons of the average NPI global scores in the experimental
and control group over time
a
b
c
30
30
30
25
25
25
20
20
20
15
15
15
10
10
10
5
5
5
0
0
0
T0
T1
T1
T2
T3
T4
T5
T5
T6
T7
Time
!"#$%&'$()*+,-%./#
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Dr. Alfredo Raglio
!
A.A. 2012-2103
STRENGTH OF THESE STUDIES:
- the general plan of the studies
(RCTs)
- the number of persons enrolled
in the treatments
- the duration of the treatments
- the description of MT approach
- the use of standardized criteria (i.e., blinded raters, clinical
scales, fixed camcorder, and MTCS) to assess the clinical
outcomes and the MT process
Dr. Alfredo Raglio
A.A. 2012-2103
THE FUTURE…
!   Other RCTs are needed
!   Specific and more sensitive tools of assessment are needed
!   It is important to define the contents of the music/music therapy
interventions
!   On which BPSD and in which stages and kinds of dementia is MT
more effective?
!   Can music and music therapy produce any effect also on cognitive
functions?
!   Is there a difference between music and music therapy approaches
and their effectiveness in the field of dementia?
!   It is important to delve into the relationship dose/effect
and cost/
Dr. Alfredo Raglio
effectiveness
A.A. 2012-2103
Esempio di Case Report
Dr. Alfredo Raglio
A.A. 2012-2103
Raglio A, Bellandi D, Baiardi P, Gianotti M, Ubezio MC, Granieri E. Music therapy in frontal temporal dementia: a case report. J Am Geriatr Soc. 2012 Aug;60(8):1578-­‐9. Dr. Alfredo Raglio
A.A. 2012-2103
Introduction Music therapy (MT) is a widespread non-­‐pharmacological approach in the treatment of Behavioral and Psychological Symptoms of Dementia (BPSD) in dementia. Active MT approach is an important way to communicate with person with dementia also in severe stages of disease. MT has psychological and neuroscientific bases. The sonorous-­‐music relationship allows the person to express and modulate/regulate his emotions and behaviors. The frontotemporal dementia (FTD) generally presents several behavioral disturbances (agitation, irritability, depression, disinhibition, etc.) but also difficulties in the emotional perception and regulation, due to the brain lesions. Nevertheless, the person with FTD shows creative aspects and sensibility to the musical patterns. Dr. Alfredo Raglio
A.A. 2012-2103
Aim To verify the efficacy of active music therapy approach on behavioural disturbances in a patient with Fronto Temporal Dementia Dr. Alfredo Raglio
A.A. 2012-2103
Case Description Mrs. M. is 58 years old and has a diagnosis of FTD (Clinical Dementia Rating=3). An encephalic magnetic resonance imaging scan showed prevalent cortical–subcortical atrophy in the temporal areas, bilaterally; in particular the damage is located in the left frontal region and the temporal pole. The neuropsychological assessment highlighted severe memory and language disturbances (total aphasia). Cognitive evaluation was not possible because Mrs. M. was not able to answer the questions Mini Mental State Examination= n.a.). A behavioral assessment indicted significant disturbances at baseline (Neuropsychiatric Inventory (NPI)=26, Cohen Mansfield Agitation Inventory (CMAI)=40, Cornell Scale for Depression in Dementia (CSDD)=2). In particular, formal caregivers reported agitation, depression, purposeless movements, wandering, and persistent vocalizations. Dr. Alfredo Raglio
A.A. 2012-2103
METHODS The MT approach is mainly based on sonorous music relationship between patient and music therapist . They interact using musical instruments but also voice (singing and vocal improvisation). This approach is based on intersubjective psychological theories. Mrs. M. participated in 50 individual MT sessions (30 minutes each) conducted by a trained music therapist twice a week over 6 months. The NPI, CMAI, and CSDD were administered at baseline, before treatment, after 25 sessions, at the end of treatment, and at 1-­‐month follow-­‐up after treatment to evaluate BPSD, agitation, and depression. Pharmacological therapy was not modified during treatment. During the study, nursing staff monitored the main behavioral disturbances (persistent vocalizations, crying, wandering, purposeless movements) and filled in a chart three times a week reporting absence, partial presence, or presence of the above-­‐mentioned disturbances. An independent observer analyzed the MT process from a qualitative point of view through videotapes of each session. Dr. Alfredo Raglio
A.A. 2012-2103
tions, crying,
wandering,
and purposeless
@)+('<:C7?-"&(-7!
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severe memory and language
disturbances
(total
aphasia).
greatly
improved.
The
effects
of
MT
treatment
are
summaCognitive
evaluation was -/!
not 6)8)/&-"!
possible because
Mrs. M.
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rized in Table 1. The clinical results were consistent with
was not able to answer the questions (Mini Mental State
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the MT
Important changes
were observed
in Mrs.
Examination
available)."/0!
A behavioral
assessment
M.’s <+(<':)$)::!
vocal productions; 8'%)8)/&:1!
she used vocalization
to communi- "/0!
indicted significant
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cate, establishing a dialogue with the music therapist and
atric Inventory (NPI) = 26, Cohen Mansfield Agitation
<)(:-:&)/&!%'7"$-L"&-'/:A!0+(-/,!&?)!:&+0C1!K!&-8):!"!G))VE!F?)!*F!<('7)::!G":!"/"$CL)0!=('8!
discharging her emotional and mental stress. Gradually,
Inventory (CMAI) = 40, Cornell Scale for Depression in
vocalizations and wandering decreased, and interactions
Dementia (CSDD) = 2). In particular, formal caregivers
"!X+"$-&"&-%)!<'-/&!'=!%-)GE!
and communicative behavior toward the music therapist
reported agitation, depression, purposeless movements,
:&*)4#*'
increased (eye and physical contact).
wandering, and persistent vocalizations.
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Results Table 1. Results Summary
Result
Baseline
Neuropsychiatric Inventory total score
Cohen Mansfield Agitation Inventory total score
Cornell Scale for Depression in Dementia total score
Observations of nursing staff, mean ± standard deviation,
Persistent vocalizations
Crying
Wandering
Purposeless movements
a
Beginning of
Treatment
26
24
40
23
2
3
median (interquartile range)a
1.20 ± 1.01, 2 (2)
0.5 ± 0.83, 0 (1)
1.80 ± 0.62, 2 (0)
1.75 ± 0.72, 2 (1)
After 25
Sessions
End of
Treatment
1-Month
Follow-Up
8
10
1
10
10
0
8
7
0
0.93
0.44
1.38
1.26
±
±
±
±
0.91, 1 (2)
0.73, 0 (1)
0.62, 1 (1)
0.63, 1 (1)
0.39
0.13
0.86
0.88
±
±
±
±
0.52, 0 (1) 0.08 ± 0.28, 0 (0)
0.37, 0 (0)
0, 0 (0)
0.38, 1 (0) 0.72 ± 0.45, 1 (1)
0.36, 1 (0) 0.69 ± 0.47, 1 (1)
Weekly evaluations across periods (three assessments per week): 0 = absence, 1 = partial presence, 2 = presence.
!
!
!
!
Dr. Alfredo Raglio
A.A. 2012-2103
Discussion It is hypothesized that the above reported results are strongly
linked to MT. This approach can be an important
nonpharmacological resource in the management of BPSD.
A possible explanation is the psychological effects and the
effect of MT on the brain. In particular, MT showed its
effects on areas involved in emotional processing and
regulation, such as the limbic (e.g., amygdala and
hippocampus) and paralimbic structures (e.g., orbitofrontal
cortex, parahippocampal gyrus, and temporal poles). Music
and MT also play an important role in the activation of
social cognition areas and in the mirror neurons system.
Dr. Alfredo Raglio
A.A. 2012-2103
Conclusion These psychological and neuroscientific implications
could be part of the underlying mechanisms of MT
efficacy on behavioral problems in dementia and in
particular in FTD, indicating that MT can be an
effective intervention for improving symptoms and
quality of life and supporting caregivers in the
management of dementia.
Dr. Alfredo Raglio
A.A. 2012-2103
La ricerca musicoterapeutica in
Italia…
Dr. Alfredo Raglio
A.A. 2012-2103
Punti critici…
non riconoscimento della disciplina (a
livello formativo e applicativo)
- parziale diffusione della disciplina sul
piano istituzionale
- scarsa presenza e continuità delle
esperienze applicative
- scarsa formalizzazione/strutturazione degli
interventi
- scarsa sensibilità scientifica dell’ambito
musicoterapeutico
- scarsità di pubblicazioni scientifiche
Dr. Alfredo Raglio
A.A. 2012-2103
IL CONTRIBUTO DELLE
NEUROSCIENZE…
!   Quali gli effetti prodotti dal suono e dalla musica nel
nostro cervello?
!   Quali possono essere le potenzialità terapeutiche?
!   Perché?
!   Tematiche considerate: musica/emozioni,
musica/apprendimento, localizzazione delle funzioni
cerebrali rispetto alla percezione e produzione
dell’elemento sonoro, musica/riabilitazione
(neurocognitiva, neuromotoria, etc.)
!   Tendenzialmente gli studi non si riferiscono a setting
terapeutici
Dr. Alfredo Raglio
A.A. 2012-2103
who study music cognition often rely on the
theorist Leonard Meyer, who defined it as
Address for correspondence: Daniel J. Levitin,
Ph.D.,
Department
of
Current Advances
inofthe
Cognitive
a
form
emotional
communication, or on
Psychology, McGill University, 1205 Avenue Dr. Penfield,Neuroscience
Montreal, QC
of Music
H3A 1B1 Canada. daniel.levitin@mcgill.ca
the definition of the composer Edgar Varése,
THE YEAR IN COGNITIVE NEUROSCIENCE 2009
Daniel J. Levitin and Anna K. Tirovolas
212
McGill University, Montreal, QC Canada
The Year in Cognitive Neuroscience 2009: Ann.
N.Y. Acad. Sci. 1156: 211–231 (2009).
!
C
2009 New York Academy of Sciences.
doi: 10.1111/j.1749-6632.2009.04417.x
The study of music perception and cognition is one of the oldest topics in experimental
Annals of the New York Academy of Sciences
psychology. The last 20 years have seen an increased interest in understanding the functional neuroanatomy of music processing in humans, using a variety of technologies
including fMRI, PET, ERP, MEG, and lesion studies. We review current findings in the
context of a rich intellectual history of research, organized by the cognitive systems
underlying different aspects of human musical behavior. We pay special attention to the
perception of components of musical processing, musical structure, laterality effects,
cultural issues, links between music and movement, emotional processing, expertise,
and the amusias. Current trends are noted, such as the increased interest in evolutionary origins of music and comparisons of music and language. The review serves
to demonstrate the important role that music can play in informing broad theories of
higher order cognitive processes such as music in humans.
211
Key words: music; language; emotion; structure; evolutionary psychology; expertise
Introduction
Figure 1.
dress questions about part−whole relationships
in music and melody (Ehrenfels 1890/1988).
The past decade has seen an exponential
The field of music cognition traces its oriincrease
in studies of music cognition. Musigins to the 4th century BCE, long before
the establishment of experimental psychol- cal behaviors that are typically studied include
ogy itself, through the ideas of Aristoxenus, listening, remembering, performing, learning,
an Aristotelian philosopher. Contrary to the composing, and, to a lesser extent, movement
Pythagoreans of that time, Aristoxenus ar- and dancing. The largest paradigm shift has
gued that musical intervals should be classi- been the increased use of neuroimaging and
fied by their effects on listeners as opposed neural case studies to inform theories about
to merely examining their mathematical ra- the brain basis for musical behaviors. A second
tios (Griffiths 2004; Levitin 1999). This notion theme over the past decade has been an inbrought the scientific study of music into the creased interest in the origins of music and its
mind, followed by the first psychophysics exper- connection with language, both evolutionarily
iments at the dawn of experimental psychology, and functionally.
In cognitive neuroscientific studies of lanwhich mapped changes in the physical world
guage,
mathematical ability, or visual perceponto changes in the psychological world (e.g.,
Core
brain
regions
associated
with
musical
activity.
Based on Tramo 2001
of theand updated in
Fechner 1860; Helmholtz 1863/1954). Indeed, tion, one rarely encounters a definition
Dr. Alfredo Raglio
A.A. 2012-2103
capacity
being studied, yet the question of
2006 (from
2006).
many of the earliest studies in experimental
psy- Levitin
chology concerned music, and the Gestalt psy- just what is music (and by implication, what
chology movement was formed in part to ad- it is not) is one that emerges more often in
this field of inquiry than in the others. Those
Strutture limbiche e paralimbiche correlate alle emozioni
Review
evocate dalla musica (Koelsch, 2010)
Dr. Alfredo Raglio
Figure 1. Illustration of some structures belonging to the limbic/paralimbic
system. The diamonds represent music-evoked activity changes in these
A.A. 2012-2103
T
Koelsch, 2010 Figure 2. Schematic representation of anatomical connections of some limbic and paralimbic structures involved in the emotional processing of music (Figure 1 and main text). ACC: anterior cingulate cortex; ant Ins: anterior insula; Am (BL): basolateral amygdala; Am (CM) corticomedial amygdala (including the central nucleus), Hipp: hippocampal formation; NAc: nucleus accumbens; OFC: orbitofrontal cortex; PH: parahippocampal gyrus; Temp P: temporal pole. Connectivity is depicted based on Refs. [37,79–81]. Dr. Alfredo Raglio
A.A. 2012-2103
I pressuposti neuroscientifici
della riabilitazione
neuromotoria
con la musica e la musicoterapia
Dr. Alfredo Raglio
A.A. 2012-2103
music as well as psychological, cognitive associations connected with speof defined
interventions
forway
certain
diseases.
However, even if the corpus of outcom
cific musical
experiences.
In the same
the evocation
of synaesthetic
experiences is often used in music therapy. Musically induced visual imagery contributes to that factor as well as musical imagery itself.29 Music
alwaysScientific
has a subjective
meaning for humans.
It is often
observed that subPerspectives
on Music
Therapy
Address
for
correspondence:
Prof.
Dr.
Thomas
Hillecke, German Center for Music Thera
cultures define themselves by specific musical styles, which are coded as
Research,
Universitylanguage.
of Applied
Sciencesmusic
Heidelberg,
Outpatient
Department, Maaßstraße 2
some kind
of group-specific
Additionally
is used to
alter
THOMAS HILLECKE, ANNE NICKEL, AND HANS VOLKER
BOLAY
37
states of
consciousness
in different
nativeVoice:
cultures.
Music is also fax:
known
D-68123
Heidelberg,
Germany.
+49-6221-4154;
+49-6221-4152.
38
German
Center
for
Music
Therapy
Research,
and
Outpatient
Department,
to facilitate
recall of episodic memories. Cognition modulation is clinithomas.hillecke@fh-heidelberg.de
University
of Appliedsubjective
Sciences Heidelberg,
D-68123and
Heidelberg,
Germany
cally used to change
cognitions
meaning
patterns, and is
39,40
Some music theralso important in music guided imagery techniques.
apists useAnn.
musicN.Y.
to induce
hypnotic
and(2005).
to alter©states
conAcad. aSci.
1060: trance
271–282
2005 ofNew
York Academy of Sciences.
A
BSTRACT: What needs to be done on the long road to evidence-based music
41
sciousness.
doi:
10.1196/annals.1360.020
therapy?
First of all, an adequate research strategy is required. For this pur(4) The fourthpose
factor
is called
behavior
modulation
motoric
behavioral
the general
methodology
for therapy
researchorshould
be adopted.
Addi- factor: The basic
assumption
that
musicof methods
represents
a fields
useful
possibility to
tionally,
music therapyis
needs
a variety
of allied
to contribute
271 without
findings,
including such
mathematics,
natural sciences,
behavioral
and
evoke andscientific
condition
behavior,
as movement
patterns,
the
social
sciences, as will.
well as The
the arts.
Pluralism seems
as welldance
as inevi-is well
necessity of
conscious
association
of necessary
music and
table. At least two major research problems can be identified, however, that
known. Marching
songs are common, and the military offers a great variety
make the path stony: the problem of specificity and the problem of eclecticism.
of militaryNeuroscientific
marches. Neuroscientists,
like the
team
of Michael
Thaut,
research in music is giving
rise to
new ideas,
perspectives,
and point
out that rhythmic
stimulation
influences
timing
processes
in the
methods; they
seem to be promising
prospects
for a possible
contribution
to afrontal
andneural
empiricalstructures
scientific foundation
for musicmusic
therapy.therapy,
Despite theNMT).
brain and theoretical
associated
(neurologic
huge
heterogeneity
of
theoretical
approaches
in
music
therapy,
an
integrative
This factor is used therapeutically in gait rehabilitation of stroke
patients
model of working ingredients in music therapy is useful as a starting point for
and in theempirical
treatment
movement
problems,
for works
example,
Parkinson
studiesofin order
to question
what specifically
in musicin
therapy.
42,43
patients. For this
Music
anda heuristic
auditive
stimulation—known
since working
the time of
purpose,
model,
consisting of five music therapy
(attention
modulation,
emotion
modulation, in
cognition
modulation,
Pavlov—isfactors
a useful
tool in
behavioral
conditioning
general.
The analysis
behavior modulation,
and communication
has been
developed
of the behavioral
component
of patients’modulation)
performing
music
is ofbycentral
the Center for Music Therapy Research (Viktor Dulger Institute) in Heidelinterest in berg.
active
music therapy and important in facilitating the learning of
Evidence shows the effectiveness of music therapy for treating certain
new behaviors.
is the
used
as aoftheoretical
framework
in works
behavioral
diseases,Itbut
question
what it is in music
therapy that
remains music
44,45
therapy. largely unanswered. The authors conclude with some questions to neuroscientists, which we hope may help elucidate relevant aspects of a possible link between the two disciplines.
KEYWORDS: music therapy; therapy research; multidisciplinary approach;
Dr. Alfredo Raglio
pluralistic point of view; working ingredients
INTRODUCTION
A.A. 2012-2103
La musica agisce sulle aree
frontali del cervello…
Dr. Alfredo Raglio
A.A. 2012-2103
mited, thus calling for in- being attributed to neural reorganization.9–11
A different line of studies has shown rapid
abilitation approaches.1–4
ted indicating that repeti- plastic adaptation due to music performance,
which is not restricted to cortical motor areas butReorganization
also involves Underlies
auditory and integrative
Neural
12–15
Improvement in Stroke-induced Motor
auditory–sensorimotor
circuits.
e: Dr. Sabine Schneider, InstituteDysfunction
of
by Music-supported Therapy
cians’ Medicine, University of Mu-E. Altenm
üller,
J. Marco-Pallares,
T. F. Münte,
This
suggests
that
music-making,
even
in
unand S. Schneider
Hohenzollernstrasse 47, 30161 Hanskilled
patients,
might
be
an
effective
means
511-3100574; fax: +49-511-3100557.
to induce plastic changes in the motor system.
r.de
THE NEUROSCIENCES AND MUSIC III—DISORDERS AND PLASTICITY
a
b
b
a
a
Institute of Music Physiology and Musicians’ Medicine, University of Music and Drama
Hannover, Hannover, Germany
b
Department of Neuropsychology, Otto von Guericke University, Magdeburg, Germany
Motor impairments are common after stroke, but efficacious therapies for these dysfunctions are scarce. By extending an earlier study on the effects of music-supported
therapy, behavioral indices of motor function as well as electrophysiological measures
were obtained before and after a series of therapy sessions to assess whether this new
treatment leads to neural reorganization and motor recovery in patients after stroke.
The study group comprised 32 stroke patients in a large rehabilitation hospital; they
had moderately impaired motor function and no previous musical experience. Over a
period of 3 weeks, these patients received 15 sessions of music-supported therapy using
a manualized step-by-step approach. For comparison 30 additional patients received
standard rehabilitation procedures. Fine as well as gross motor skills were trained by
using either a MIDI-piano or electronic drum pads programmed to emit piano tones.
Motor functions were assessed by an extensive test battery. In addition, we studied
event-related desynchronization/synchronization and coherences from all 62 patients
performing self-paced movements of the index finger (MIDI-piano) and of the whole
Dr. significant
Alfredo Raglio
arm (drum pads). Results showed that music-supported therapy yielded
improvement in fine as well as gross motor skills with respect to speed, precision, and
smoothness of movements. Neurophysiological data showed a more pronounced eventrelated desynchronization before movement onset and a more pronounced coherence
in the music-supported therapy group in the post-training assessment, whereas almost
Music III—Disorders and Plasticity: Ann. N.Y. Acad. Sci. 1169: 395–405 (2009).
32.2009.04580.x !c 2009 New York Academy of Sciences.
395
A.A. 2012-2103
Fare musica favorisce
cambiamenti plastici del
sistema motorio… migliora la
connettività corticale e stimola
la corteccia motoria …
Dr. Alfredo Raglio
A.A. 2012-2103
Stretto rapporto tra ritmo e
movimento (attivazione aree
motorie – corteccia premotoria,
aree motoria supplementare,
cervelletto, gangli della base –
sincronizzazione, modulazione…)
Halsband et al., 1993; Janata et al., 2003; Peretz & Zatorre,
2005; Zatorre et al., 2007; Chenn et al., 2008; 2009;
Grahn & Brett, 2007; 2009; Schwartze et al., 2011
Dr. Alfredo Raglio
A.A. 2012-2103
ctions, this sysg between perry) and motor
connecting these regions might underlie effects
that outlast the duration of the actual intervention. Nevertheless, the gold standard of proving
the efficacy
of an intervention will be a randomPart VI Introduction
ized clinical
trialMusic
(RCT),
in which participants
Listening
to and Making
Facilitates
Brain Recovery Processes
are
randomly
assigned and a new music-based
ug, M.D., Ph.D., MuGottfried Schlaug
tories, Department of
intervention is tested against a gold standard
er, 330 Brookline Avor an established intervention. Having a scien7; fax: 617-632-8920.
tific
basis
for
the
interventions
and
obtaining
n.com
Emerging research over the last decade has actions (leg, arm/hand, or vocal/articulatory
THE NEUROSCIENCES AND MUSIC III: DISORDERS AND PLASTICITY
Department of Neurology; Music, Stroke Recovery, and Neuroimaging Laboratories, Beth
Israel Deaconess Medical Center and Harvard Medical School,
Boston, Massachusetts, USA
shown that long-term music training and skill actions). Music might be a special vehicle to
can be a strong stimulator for neuro- engage components of this mirror-neuron sysrders and learning
Plasticity:
Ann. N.Y. Acad. Sci. 1169: 372–373 (2009).
plastic changes in the developing as well as adult tem. Furthermore, music might also provide an
c 2009
of Sciences.
9.x !
brain.New
MakingYork
music Academy
places unique demands
alternative entry point into a “broken” brain
on the nervous system, leading to strong cou- system to remediate impaired neural processes
pling of perception and action mediated by sen- or neural connections by engaging and linking
sory, motor, and multimodal integrative regions up brain centers that would otherwise not be
distributed throughout the brain. Furthermore, engaged or linked with each other.
listening to music and making music (“musickThe chapters in this section will demonDr. Alfredo Raglio
A.A. 2012-2103
ing”) provokes motion, improves and increases strate several music-based experimental interbetween-subject communication and interac- ventions whose effectiveness in clinical popution, and is considered to be and experienced lations is demonstrated and whose underlying
372
La musica è uno stimolo
multimodale che attiva varie
aree e funzioni facilitando le
connessioni… provoca il
movimento e stimola
l’interazione…
Dr. Alfredo Raglio
A.A. 2012-2103
L’ascoltare e il fare musica attivano
anche le aree del sistema dei
Mirror Neurons
(Kohler et al., 2002; Keysers et al., 2003; Lahav et al.,
2007; Overy & Molnar-Szakacs, 2006; 2009; D’Ausilio,
2009; Koelsch, 2009; 2010; Wan et al., 2010)
A.A. 2012-2103
Dr. Alfredo Raglio
(Grossman,
1980).
the impaired
musical domain,
damage
to this
production
wereInalso
in recreating
hierarchically
tree structures
by Greenfield
and Schneider
areaorganized
of the posterior
inferiorused
frontal
gyrus can lead
to the
(1977).impairments
In contrast, of
fluent
aphasics,
have hierarchically
conjoint
aphasia
and who
amusia!a
selective
organized
semanticallyand
empty)
speech weremusic
able to
problem
with(but perceiving
interpreting
reproduce the hierarchical structure of the models
(Alajouanine, 1948). Recent evidence has also shown that
(Grossman, 1980). In the musical domain, damage to this
aphasic
patients with syntactic comprehension difficulties in
area of the posterior inferior frontal gyrus can lead to the
language
exhibit
similar syntactic
difficulties
in the domain
conjoint
impairments
of aphasia
and amusia!a
selective
of musical
2005). and interpreting music
problemharmony
with (Patel,
perceiving
Neuroimaging
of language
function
andshown
studiesthat
(Alajouanine, studies
1948). Recent
evidence
has also
aphasic patientsintegration
with syntactic
difficulties
of sensory-motor
havecomprehension
shown evidence
of an in
language
exhibit
similar
syntactic
difficulties
in
the
domain
overlap between the brain regions involved in linguistic
of
musical
harmony
(Patel,
2005).
processing and regions comprising the human mirror neuron
Neuroimaging studies of language function and studies
system
(Rizzolatti and Arbib, 1998; Arbib, 2005). Recent
of sensory-motor integration have shown evidence of an
neuroimaging
studiesthehave
alsoregions
implicated
Broca’s
area
overlap between
brain
involved
in linguistic
andprocessing
its right and
hemisphere
homologue
the mirror
perception
regions comprising
the in
human
neuron
andsystem
representation
human
(Rizzolatti ofandhierarchically
Arbib, 1998; organized
Arbib, 2005).
Recent
neuroimaging
studies
have
also
implicated
Broca’s
behavior (Koechlin and Jubault, 2006; Molnar-Szakacsarea
and2006).
its right
hemisphere
in the
perception
et al.,
Furthermore,
it hashomologue
been proposed
that parallel
consonant
over 2005);
dissonant
and Siebel,
see tonal
Figurecombinations
1. In parallel(Trehub,
with the
developmental literature on action and language, infants
2003).
also proposal
seem toofshow
implicitneural
knowledge
of for
principles
The
a common
substrate
music, of
hierarchical
organization
for
music,
for
example
language and motor functions is supported by evidence they
from are
able
to
distinguish
different
scales
and
show
preferences
studies of language disorders. For example, it has been for
consonant over dissonant tonal combinations (Trehub,
shown
that children with dyslexia exhibit specific timing
2003).
difficulties
in the domain
of music
(Overy
et al., for
2003),
The proposal
of a common
neural
substrate
music,
motor
control
and Nicolson,
1995; by
Wolff,
2002)
language
and(Fawcett
motor functions
is supported
evidence
from
andstudies
language
et al.,
1993; Goswami
et al., 2002)
of (Tallal
language
disorders.
For example,
it hasand
been
children
dyslexia
exhibitcan
specific
thatshown
musicthat
lessons
withwith
dyslexic
children
lead timing
to
difficulties in
the domain
music (Overy
al., also
2003),
improvements
in language
skillsof (Overy,
2003). Itet has
motor
control
(Fawcett
and
Nicolson,
1995;
Wolff,
2002)
been found that patients with severe non-fluent aphasia can
and language (Tallal et al., 1993; Goswami et al., 2002) and
benefit
from Melodic Intonation Therapy (MIT), a highly
that music lessons with dyslexic children can lead to
imitative
speech therapy
technique
singing.
Thealso
improvements
in language
skills based
(Overy,on2003).
It has
technique
has been
shown towith
leadsevere
to speech
improvements
been found
that patients
non-fluent
aphasia can
(Sparks
et from
al., 1974),
coupled
with changes
the neural
benefit
Melodic
Intonation
Therapy in(MIT),
a highly
imitative
speech
therapy
technique
based
on
singing.
resources recruited during speech (Belin et al., 1996; OveryThe
technique
et al.,
2005). has been shown to lead to speech improvements
The Shared Affective
Motion Experience model
(SAME)
(Overy & Molnar-Szakacs, 2006;2009)
and representation of hierarchically organized human
behavior (Koechlin and Jubault, 2006; Molnar-Szakacs
et al., 2006). Furthermore, it has been proposed that parallel
(Sparks et al., 1974), coupled with changes in the neural
resources recruited during speech (Belin et al., 1996; Overy
et al., 2005).
Fig. 1Fig.Model
of theofpossible
involvement
of theofhuman
mirrormirror
neuron
system
in representing
meaning
and affective
responses
to music.
One aspect
of theofexperience
of music
1 Model
the possible
involvement
the human
neuron
system
in representing
meaning
and affective
responses
to music.
One aspect
the experience
of music
involves
the
perception
of
intentional,
hierarchically
organized
sequences
of
motor
acts
with
temporally
synchronous
auditory
information.
Auditory
features
of
the
musical
signalsignal
involves the perception of intentional, hierarchically organized sequences of motor acts with temporally synchronous auditory information. Auditory features of the musical
are processed
primarily
in theinsuperior
temporal
gyrusgyrus
(STG)(STG)
and combined
with with
synchronous
structural
features
of theof‘motion’
information
conveyed
by thebymusical
signalsignal
in thein the
are processed
primarily
the superior
temporal
and combined
synchronous
structural
features
the ‘motion’
information
conveyed
the musical
posterior
inferior
(BA and
44) adjacent
and adjacent
premotor
The anterior
a neural
conduit
between
the mirror
neuron
system
and limbic
the limbic
system,
posterior
inferior
frontalfrontal
gyrusgyrus
(BA 44)
premotor
cortex.cortex.
The anterior
insulainsula
formsforms
a neural
conduit
between
the mirror
neuron
system
and the
system,
allowing
this information
be evaluated
in relation
to one’s
autonomic
and emotional
contributing
a complex
affective
response
mediated
the limbic
system.
allowing
this information
to betoevaluated
in relation
to one’s
own own
autonomic
and emotional
state state
contributing
to a to
complex
affective
response
mediated
by theby limbic
system.
Possible
feedback
mechanisms
influence
the subsequent
processing
the musical
the immediate
and more
long-term
timescales.
The shared
recruitment
Possible
feedback
mechanisms
may may
influence
the subsequent
processing
of theofmusical
signalsignal
at theatimmediate
and more
long-term
timescales.
The shared
recruitment
of thisof this
A.A. 2012-2103
Dr.
Alfredo
Raglio
neural
mechanism
in
both
the
sender
and
the
perceiver
of
the
musical
message
allows
for
co-representation
and
sharing
of
the
musical
experience.
Music
notes
from
neural mechanism in both the sender and the perceiver of the musical message allows for co-representation and sharing of the musical experience. Music notes from ‘The ‘The
Lady Lady
Sings the Blues’ by Billie Holiday and Herbie Nichols.
Sings the Blues’ by Billie Holiday and Herbie Nichols.
…The Shared Affective Motion Experience model
suggests that musical sound is perceived not only in terms
of the auditory signal, but also in terms of the
intentional, organized sequences of expressive motor acts
that are behind the signal. So this model can suggest that
properties of the human Mirror Neuron System allow us to
consider social communication, and more specifically
musical communication, in a new light—less in terms of
pitch/timbre/rhythmic patterns—and more in terms of
action sequencing, goals/intentions, prediction, and
shared representations. In particular I think that this model
can be connected to the active music therapy model in which
the movements and the gestures behind the sound play an
important role.
Dr. Alfredo Raglio
A.A. 2012-2103
Tutte le funzioni del sistema dei
Mirror Neurons sono collegate
alla “social cognition”
(interazione sociale,
comunicazione, empatia,…)
(Overy & Molnar-Szakacs, 2009)
Dr. Alfredo Raglio
A.A. 2012-2103
Ascoltare e fare musica attiva funzioni
sociali (Koelsch, 2010)
!   Contact
!   Social cognition (Steinbeis & Koelsch, 2009;
Koelsch, 2009)
!   Co-pathy
!   Communication (Trehub, 2003; Fitch, 2006)
!   Coordination (Overy & Molnar-Szakacs, 2009;
Patel, 2009; Kirschner & Tomasello, 2009)
!   Cooperation (Rilling et al., 2002; Tomasello,
2005)
!   Social cohesion (Baumeister &Leary, 1995;
Cross & Morley, 2008)
Dr. Alfredo Raglio
A.A. 2012-2103
La musica attiva meccanismi
gratificanti legati al piacere e
alla gratificazione…
(Hillecke et al., 2005; Schlaug,
2009; Koelsch 2009; 2010)
Dr. Alfredo Raglio
A.A. 2012-2103
The neurochemistry of music Mona Lisa Chanda and Daniel J. Levitin Trends in Cognitive Sciences, April 2013, Vol. 17, No. 4 Department of Psychology, McGill University, Montreal, Quebec, QC H3A 1B1, Canada Music is used to regulate mood and arousal in everyday life and to promote physical and psychological health and well-­‐being in clinical settings. However, scientific inquiry into the neurochemical effects of music is still in its infancy. In this review, we evaluate the evidence that music improves health and well-­‐being through the engagement of neurochemical systems for (i) reward, motivation, and pleasure; (ii) stress and arousal; (iii) immunity; and (iv) social affiliation. We discuss the limitations of these studies and outline novel approaches for integration of conceptual and technological advances from the fields of music cognition and social neuroscience into studies of the neurochemistry of music. Box 2. Relevance for therapy (Koelsch, 2010) Music therapy (MT) can have effects that improve the psychological and physiological health of individuals. A heuristic working factor model for music therapy [72] assumes five factors which contribute to the effects of MT. These factors refer to the modulation of emotion, attention, cognition, behavior and communication. Given that music can change activity in brain structures that function abnormally in patients with depression (such as amygdala, hippocampus and nucleus accumbens; see main text), it seems plausible that music can be used to stimulate and regulate activity in these structures (either by listening to or by making music), and thus ameliorate symptoms of depression. However, so far the scientific evidence for effectiveness of MT on depression is surprisingly weak, because of the lack of high-­‐quality studies, and the small number of studies with randomized, controlled trials [73]. Studies on neurological applications of MT have so far mainly dealt with the therapy of stroke patients. Recent evidence suggests that playing melodies either with the hand on a piano, or with the arm on electronic drum pads that emit piano tones, helps stroke patients to train fine as well as gross motor skills with regard to speed, precision and smoothness of movements [74]; it seems likely that an emotional component contributes at least partly to these effects, because this treatment was more effective than a standard rehabilitation. Electrophysiological data suggest that these effects are due to enhanced cortical connectivity and stronger activation of the motor cortex as a result of music-­‐supported movement training [75]. Other studies showed that isometric musical stimuli have the capability of regulating gait and arm control in patients with stroke and Parkinson’s disease, presumably as a result of music-­‐evoked arousal and priming of the motor system via auditory stimulation, as well as a result of entrainment of the motor system to the beat of the music [75,76]. Moreover, positive emotions elicited by preferred music can decrease visual neglect (possibly by increasing attentional resources) [77], and listening to self-­‐selected music after stroke appears to improve recovery in the domains of verbal memory and focused attention (along with less depressed and confused mood) [78]. The neural mechanisms for such effects, however, remain to be specified. Dr. Alfredo Raglio
A.A. 2012-2103
INTERVENTIONS WITH MUSIC IN THE
NEUROLOGICAL CLINICAL SETTING
RELATIONAL MUSIC
THERAPY
• Trained music therapist
• Therapeutic Setting
• Psychological models
• Relationship as the core of
intervention
• Specific active or receptive
techniques
• Aims (aspiring to become
stable and long-lasting over
time): attenuation of behavioral
and psychiatric symptoms and
prevention/stabilization of
complications; increase in
communication and relationship
skills (sometimes improvement
of cognitive and motor
functions)
REHABILITATIVE MUSIC
THERAPY
•  Trained professional/music
therapist
•  Rehabilitative setting
•  Neuroscientific and
neurocognitive models
•  Motor and cognitive exercises
using sonorous-musical
elements (in particular rhythm)
•  Specific techniques
•  Aims (aspiring to become
stable and long-lasting over
time): cognitive and motor
changes (sometimes
psychological changes)
MUSIC—SUPPORTED MOTOR
ACTIVITIES
•  Absence of a Professional of
the music field
•  Absence of a specific
therapeutic setting
•  Absence of a specific
intervention model
•  Using music to support motor
activities
•  Aims: well-being, improving
mood and motivation,
promoting socialization, motor
and cognitive stimulation
Western Michigan University
Kalamazoo, MI
USA
Neurologic Music Therapy
A Research-Based System of Standardized
Clinical Techniques
! Colorado
State University
! Center
for Biomedical Research in
Music and Neurologic Rehabilitation
!
!
!
!
!
Michael Thaut, Ph.D Neuroscience/Music Therapy
Gerald McIntosh, M.D. Neurologist
Ruth Rice, MS PT
PT, Neurologic Rehabilitation
Gary Kenyon, MS
Biomechanics, Mathematics
Corene Thaut, MM
MT, Neurologic Rehabilitation
Thaut, M.H. (1999). Training
Manual for Neurologic Music
Therapy
Neurologic
Basic Definitio
! NMT
is de
applicatio
sensory, a
to neurolo
nervous sy
erapy
f Standardized
versity
al Research in
gic Rehabilitation
oscience/Music Therapy
ologist
Neurologic Rehabilitation
echanics, Mathematics
Neurologic Rehabilitation
aining
Music
Thaut, M.H. (1999). Training
Manual for Neurologic Music
Therapy
Neurologic Music Therapy
Basic Definitions
! NMT is defined as the therapeutic
application of music to cognitive,
sensory, and motor dysfunctions due
to neurologic disease of the human
nervous system.
Thaut, M.H. (1999). Training
Manual for Neurologic Music
Therapy
Therapy
nt
Neurologic Music Therapy
Rhythmic Auditory Stimulation
he frequency of
!
RAS - (Rhythmic Auditory Stimulation)
system determines
of activity in
m. Internal
nal time-keeper)
ore powerful
!
RAS is a specific technique to facilitate rehabilitation of
movements that intrinsically are biologically rhythmical. One of
the most important of these rhythmical movements is gait.
Therefore, the most prominent application of RAS is to gait
disorders, e.g. in stroke patients, Parkinson’s patients, and
traumatically brain injured patients.
tor (metronome or
& Distenfeld, 1986;
96).
Thaut, M.H. (1999). Training
Manual for Neurologic Music
Therapy
3
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