The Contribution of Music Therapy to Quality of Life

11th Congress of the EAPC/Meet the Expert Vienna, May 2009
The Contribution of Music Therapy
to Quality of Life in Older People
– Music as a Pharmacon?
Günther Bernatzky, Michaela Presch
University of Salzburg, Faculty of Natural Sciences, Departm. of Organism Biology
Content
Introduction
Physiological Effects of Music
Research Studies
Summary
Enhance the
Quality of Life !
Content
Introduction
Physiological Effects of Music
Research Studies
Summary
Enhance the
Quality of Life !
QUALITY OF LIFE
.... alleviate ... stress
physiological,
psychological,
social,
spiritual,
Improving comfort
Enhance the
Quality of Life !
QUALITY OF LIFE
INTEGRATED
INTERDISCIPLINARY
APPROACH!
yes
?
?
Most Common Symptoms
in Patients with Cancer
Pain
70 - 84%
Shortness of breath (Dyspnea)
25 - 50%
Nausea and Vomiting
25 - 30%
Depression/Anxiety
~ 30%
Weakness/Cachexy
45 - 100%
Fatigue
~ 75%
(Lymphatic) Oedema
~ 30%
Agitation/Confusion
20 - 80%
Walsh, Donnelly, Mercadante 2000; David Cella: Jahrestagung der Gesellschaft für Hämatoonkologie 10/2003
Multimodal Therapy
for Treatment of Fatigue
Elements of the therapy:
Relaxation techniques
cognitive stress management group therapies
medical training therapy
Onkologie 2003;26:607-608 und Cancer 2001; 92 (Suppl.6)
Desires/Wishes of Palliative Patients
• NO PAIN
• TIME, LONG LIFE
• RELAXATION, WELL-BEING
• HOPE
• EMPATHY, COMFORT, SOLACE
• SINCERITY
• RELIABILITY, SAFENESS
• DIRECTNESS, FORTHRIGHTNESS
• INFORMATION, EXPLANATIONS
Complementary Therapies
300 randomly selected hospices
Most popular methods:
Massage and Music Therapy
Demmer C. (2004): A survey of complementary therapy services provided by hospices,
J Palliat Med: 7:510-516
History of Music Therapy
Roger Bacon (c. 1214-1294 ) called attention to the
"delay of aging's symptoms" through music, and
demanded that all doctors have a thorough knowledge
of music.
Music as a “fountain of youth”.
Paracelsus (1493-1541) practiced “musical medicine“ he introduced a vibration method into medical
practice, a method that used art, music in particular,
as a remedy.
Number of papers
Scientific Publications on Music Therapy
Year
Abbildung: Veröffentlichungen zur Musiktherapie in Fachzeitschriften pro Jahr – Überblick
(Quellen: Psyndex, PsychInfo, MedLine 1950 -2005)
Content
Introduction
Physiological Effects of Music
Research Studies
Summary
Enhance the
Quality of Life !
How Music Affects the Brain
further literatur for figures:
www.biologie.de, www.auric.de
Acoustic signals are
signal
translated into neuronal
activity in the
cochlea and progressively
transformed in the
auditory brainstem
How Music Affects the Brain
thalamus
primary
auditory cortex
• pitch height
• timbre
• roughness
• intensity
medial orbitofrontal
cortex
amygdala
• emotions
• control of emotional behaviour
a-c: pos. corr. with incr.
chills intensity
Amygdala is switched of less fear
a l. dorsom. midbr.; r. Thal., bilat. Cereb.
b l. ventr. striatum, bilat. Insula
c r. orbitofr. cortex
You don’t have
to be a musical
genius to have
music running
through your
head!
MUSIC promotes/regulates …
MUSIC promotes…
… physical relaxation
… power of concentration
… social behaviour
… capacity of memory
MUSIC regulates …
affective,
cognitive and
sensorimotoric components – via:
•
•
•
•
•
emotion
cognition
attention
behaviour
communication
Luisa Lopez: Music Therapy: The Long Way to Evidence-Based Methods - Pending Issues and
Perspectives. Ann. N.Y. Acad. Sci. 1060:269-270 (2005); doi: 10.1196/annals.1360.064
* Hillecke T, Nickel A, Bolay HV: Scientific Perspectives on Music Therapy. Ann. N. Y. Acad. Sci. 1060:
271-282 (2005); doi:10.1196/annals.1360.020
How the body reacts to music
MUSIC
VITALISATION
cognitive integration
of musical- and nonmusical information
emotional reactions
bodily reactions
(tensioned or relaxed)
autonomic nervous
system
heart rate
electrodermal activity
How the body reacts to music
immune system
premotor
motor activity
activity
overlap between neural
activities of the late
stages of perception &
those related to the early
stages of action
positive effects
variations of (salivary)
IgA concentrations
heard pieces of music
activate
music perception
movement induction
social functions
MAKING MUSIC
perception
memory
emotion
cognitive processes
social cognition
action
learning
cognition
Content
Introduction
Physiological Effects of Music
Research Studies
Summary
Enhance the
Quality of Life !
„20 Minutes of Mozart mutes OA Pain“
RCT examining the influence of music as a nursing intervention
on osteoarthritis pain in elders (n = 66)
Measurement of differences in pain perceptions over 14 days
Results
Those who listened to music for 20 minutes daily
(experimental group) had less pain, when compared with those who sat
quietly and did not listen to music (control group).
Listening to music was an effective nursing intervention for the reduction
of chronic osteoarthritis pain
• Andantino für Flöte, Harfe und Orchester, KV 299;
• Ouvertüre von „Le nozze di Figaro“ KV 492;
• Beginning of Sonate Symphonie No. 40
significant decrease in pain
R McCaffrey, E Freeman: Effect of music on chronic osteoarthritis pain in older people.
Journal of Advanced Nursing 2003, 44(5), 517-524.
Listening to music can reduce chronic pain by up
to 21 % and depression by up to 25 %. It can
also make people feel more in control of their
pain and less disabled by their condition:
n=60; 2 groups (mu,con); painful conditions (osteoarthritis, disc
problems, rheumatoid arthritis....6,5 yrs)
1 h music/day/week reported improved physic., psychol.
symptoms compared to Contr.
Sandra L. Siedlecki, Cleveland Clinic Foundation, Ohio, Journal of Advanced Nursing. Vol. 54,5, pg.553-562
TAKE HOME MESSAGE
Music and Music guided imagery
have shown to be an ideal adjuvant
combination with other standard
therapeutical methods.
www.schmerzinstitut.org
Music therapy not only reduces pain
BUT
also addresses associated
psychological
distress in a positive way.
Nickel AK, Hillecke T, Argstatter H, Bolay HV: A Step on the Long Road to an Evidence-Based Treatment.
Ann.N.Y.Acead.Sci.1060:283-293 (2005)
How does it work – Music?
MUSIC MAY ALTER COMPONENTS
OF THE TOTAL PAIN EXPERIENCE –
IT DECREASES THE PERCEPTION OF PAIN !
Pain and Quality of Life
Pipam W, Likar R, Klocker J, Bernatzky G, Platz T, Sittl R, Janig H. Results of a poll of cancer patients
with respect to pain and quality of life; Schmerz. 2002 Dec; 16(6): 481-9.
Russell E. Hilliard (2005)
Music Therapy in Hospice and Palliative Care: a Review of the
Empirical Data. eCAM 2005; 2(2)173-178
PURPOSE: Review of empirical studies found in the literature and to
document the emergence of an evidenced-based approach to the
use of music therapy in hospice and palliative care.
METHOD: Total of 11 studies are reviewed: 6 show sign. differences
support the use of music therapy.
RESULT: The methodological quality of these small, short-term studies
was generally poor, as was the presentation of results. No useful
conclusions can be drawn.
The need to create an evidence-based approach to
hospice and palliative care music therapy is articulated,
and future researchers are empowered to continue to
conduct investigations among this population.
Empirical studies in hospice/palliative care music therapy
Author
Year
Publication type
Research design
Randomization
n
Dependent variables
Curtis
1986
Journal
Altering treatment
Yes
9
Pain relief and relaxation
Whittall
1989
Conference
proceedings
Pilot study;
pre/post test
No
8
Heart and respiratory rate,
extremity temperature
Calovini
1993
Master’s thesis
Pre/post test
No
11 State anxiety
Longfield
1995
Master’s thesis
Quasiexperimental
pre/post test
No
8
Abbott
1995
Master’s thesis
Pre/post test
No
28 Quality of life
Gallagher
2001
Journal
Pilot study ex
post facto
pre/post test
No
90 Pain, mood, anxiety,
shortness of breath
Mood and pain
Hilliard EH. Music Therapy in Hospice and Palliative Care: a Review of the Empirical Data. Advanced Access
Publication 2005, 2(2): 173-178.
Empirical studies in hospice/palliative care music therapy
Author
Year
Publication type
Research design
Randomization
n
Dependent variables
Krout
2001
Journal
Pre/post test
No
80 Comfort, pain, relaxation
Hillard
2003
Journal
Clinical trial
Yes
80 Quality and length of life,
time of death
Wlodarcyk
2003
Master’s thesis
ABAB, counterbalance
No
10 Spirituality
Batzer
2003
Master’s thesis
Experimental
Yes
15 Discomfort behaviours
Hilliard
2004
Journal
Ex post facto
No
80 Time and duration of MT
provided, needs treated
by MT
ABAB, session A consisted of cognitive-behavioural music therapy (30 min) and session B consisted of a nomusic visit (30 min)
MT, music therapy
Hilliard EH. Music Therapy in Hospice and Palliative Care: a Review of the Empirical Data. Advanced Access
Publication 2005, 2(2): 173-178.
Dependent variables positively affected
by music therapy (Review)
Pain
Physical comfort
Fatigue and energy
Anxiety and relaxation
Time and duration of treatment
Mood
Spirituality and quality of life
Cochrane Database of Systematic Reviews
Vink AC, Birks JS, Bruinsma MS & Scholten RJ (2003)
Music therapy for people with dementia.
Objectives: To assess the efficacy of music therapy in the treatment of
behavioural, social, cognitive and emotional problems of older people
with dementia.
Results: 5 studies included (354 studies-254). Randomised controlled
trials that reported clinically relevant outcomes associated with music
therapy in treatment of behavioural, social, cognitive and emotional
problems of older people with dementia.
Conclusion: The methodological quality and the reporting of the
included studies were too poor to draw any useful conclusions.
More rigorous studies are needed to establ.
whether music therapy may play a role in the
treatment of older people with dementia.
Wirkung von individualisierter vs. klassischer
Musik auf Unruhe bei Alzheimer
• Frequenz der Unruhe
während der Baseline,
klassischer und
individualisierter Musik
• Individualisierte Musik
war assoziiert mit einer
signifikant größeren
Abnahme des erregten
Verhaltens verglichen mit
klassischer Musik
L.A. Gerdner (2000): Effects of individualized versus classical "relaxation" music on the frequency of
agitation in elderly persons with Alzheimer's disease and related disorders. Int Psychogeriatr. 12(1): 49-65.
Cochrane Database of Systematic Reviews
Maratos AS, Gold C, Wang X, Crawford Mj (2008)
Music therapy for depression.
Objektives: examine the efficacy of music therapy with standard care
compared to standard care alone among people with depression and
compare the effects of music therapy for people with depression
against other psychological or pharmacological therapies.
Results: Analysis of 5 studies (RCTs): 4 studies: reduction in symptoms
of depression; 1 study: no significant change in mental state; dropout
rates from music therapy conditions low in all studies.
Conclusion: small number and low methodological quality
of studies mean that it is not possible to be confident
about its effectiveness
High quality trials evaluating the effects of
Music therapy on depression are required.
Klinische Evidenz von Musiktherapie
für verschiedene Krankheitsbilder
Gewichtung der
Evidenz
Richtung der
Evidenz
Schwerwiegende
Sicherheitsbedenken
Alzheimersche
Krankheit
0
Ja
Angstzustände
0
Nein
Depression
0
Nein
Übelkeit und
Erbrechen
0
Nein
0
00
000
gering
mittel
hoch
eindeutig positiv
unklar
tendenziell positiv
Eindeutig negativ
Ernst E.: Praxis Naturheilverfahren – Evidenzbasierte Komplementärmedizin. Spinger Medizin Verlag, 2001
MUSIC STIMULATION
IN PEOPLE WITH PARCINSON
Music, Rhythm and Motor Rehabilitation
What would you think if you saw a person unable to take a step on his own
walk independently while listening to a rhytmic beat?
They cannot plan movements on their own - however they may still have the ability
to move, and this ability is unlocked by music.
Outcomes:
• Motion initiated in parts of the body that have limited movement
• Movement maintained in affacted extremeties
• Increased range of motion
• Repertoire of exercises built up – resident can perform indipendently with
confidence
• Motivation to participate in daily activities
• Increased neuromuscular control
http://www.bethabe.org/MT_and_Motor_Rehabil220.html
MLS - RESULTS
AIMING - Fehlerdauer - rechte Hand
Interaktion zwischen Gruppen- und Messwiederholungsfaktor
AIMING - Fehlerdauer
0,6
0,6
rechte Hand: F(1,19)=7.253; p=0.015
linke Hand: F(1,19)=0.399; p=0.535
F(1,19)=5.254; p=0.033
0,5
0,4
Fehlerdauer (sec)
Fehlerdauer (sec)
0,5
0,3
0,2
0,1
0,4
0,3
0,2
0,1
0,0
0,0
rechte Hand
linke Hand
Parkinson-Gruppe (n=11)
VOR Musik
NACH Musik
rechte Hand
linke Hand
Kontroll-Gruppe (n=10)
Parkinson-Gruppe (n=11)
Kontroll-Gruppe (n=10)
VOR Musik
NACH Musik
G. Bernatzky, P. Bernatzky, H.P. Hesse, W. Staffen, G. Ladurner (2004): Stimulating music increases
motor coordination in patients afflicted with Morbus Parkinson. Neuroscience letters 361: 4-8.
MUSIC STIMULATION
IN PEOPLE WITH STROKE
Music and Speech Rehabilitation
What would you think if you met a person who had lost her ability to speak
after having a stroke, but who could sing with perfect clarity?
Speech and singing use different areas of the brain to complete their tasks – MT
allows people to reconnect with their voices & exercise vocal.
People who have not been able to talk for many years are slowly learning to sing, to
communicate, and finally to talk to others. Everyone can use singing to promote
vocal support, organize conversational speech & improve communication skills – the
focus is language & speech improvement, not professional musical achievements.
Outcomes:
• Conversational phrases are embedded into familiar song phrases to support
speech
• Improved Communication Skills: improved clarity and fluency, increased
expressive speech and vocal range and volume.
• Increased confidence in communication attempts
• Enhanced expression
http://www.bethabe.org/MT_and_Speech_Rehab221.html
MUSIC STIMULATION
IN PEOPLE WITH STROKE
How Can Music Therapy Help Stroke Survivors?
Particular areas of benefit include:
•
•
•
•
•
•
•
•
•
•
•
•
•
Movement and Muscle Control
Speech and Communication
Cognition
Mood and Motivation
Playing a drum to increase range of motion in the arm
Exercising to up-beat music
Timing music to match your natural walking rhythm
Exercising muscles of the mouth
Setting a phrase to music, first singing the words, then
transferring these words to speech
Rhyming, chanting, or rapping
Creating a song with lyrics containing important information
Conducting or performing in a band
Rhythm repetition games
http://www.bethabe.org/MT_and_Stroke170.html
P < 0,01
P < 0,05
Särkämö T, Tervaniemi M, Laitinen S, Forsblom A, Soinila S, Mikkonen M, Autti T, Silvennoinen HM,
Erkkilä J, Laine M, Peretz I, Hietanen M: Music listening enhances cogntive recovery and mood after
middle cerebral artery stroke. Brain (2008), p 1 - 11
p < 0,05
p < 0,1
p < 0,05
p < 0,1
Särkämö T, Tervaniemi M, Laitinen S, Forsblom A, Soinila S, Mikkonen M, Autti T, Silvennoinen HM,
Erkkilä J, Laine M, Peretz I, Hietanen M: Music listening enhances cogntive recovery and mood after
middle cerebral artery stroke. Brain (2008), p 1 - 11
Cancer
RCTs show that music therapy, compared with usual
care, improves quality of life1 or reduces odd
disturbance in cancer patients2.
RCT (n = 60) suggested that procedural pain and
anxiety are not influenced by music therapy when
compared with simple distraction3.
RCT (n = 8) showed that music therapy plus guided
imagery improved mood and quality of life of
cancer patients, compared with no additional
treatment
1 Hilliard RE. The effects of music therapy on the quality and length of life of people diagnosed with terminal
cancer. J Music Therap 2003, 40: 113-137.
2 Cassileth BR, Vickers AJ & Magill LA. Music therapy for mood disturbance during hospitalization for
autologous stem cell transplantation. Cancer 2003, 98: 2723-2729.
3 Kwekkeboom KL. Music versus distraction for procedural pain and anxiety in patients with cancer. Oncol
Nurs Forum 2003, 30: 433-440.
Multiple Sclerosis
2 small RCTs of active music therapy showed positive
trends for respiratory muscle strength 1 or selfesteem, depression and anxiety in MS patients 2
The effects failed to reach statistical significance –
possibly because of too small sample size
1 Wiens ME, Reimer MA & Guyn HL. Music therapy as treatment method for improving respiratory muscle
strength in patients with advanced multiple sclerosis: a pilot study. Rehabil Nurs 1999, 24: 74-80.
2 Schmid W & Aldridge D. Active musc therapy in the treatment f multiple sclerosis patients: a matched
control study, J Music Ther 2004, 41: 225-240.
How do the elderly benefit
from music therapy ?
… ENHANCEMENT OF
QUALITY OF LIFE
How do the elderly benefit
from music therapy ?
Better awareness and concentration
Enhances interest levels and social
interaction
Improves memory and recall
Happier outlook on life and higher
self-esteem
How do the elderly benefit
from music therapy ?
MT increases mobility and coordination
MT diminishes pain and improves
recovery time
MT reduces tension and promotes
relaxation
Was ist zu beachten?
PRIMÄR
• Bildung, Hörerfahrung und Herkunft
prägen den Musikgeschmack
• Selbstwertgefühl muss erhalten
bleiben; persönlicher Geschmack,
Präferenzen miteinbeziehen!
• Musikerfahrungen, die in Jugend
gemacht werden, sind in lebhafter
Erinnerung
SEKUNDÄR
• Optimale Tonwidergabe
• Altersgebrechen
(Schwerhörigkeit)
• Technikumgang
Durch aktives Musizieren, Musikhören & Singen erfolgt eine
Stärkung der Kommunikations- und Kontaktfähigkeit und
des Selbstvertrauens.
Einer Isolation und Vereinsamung wird so entgegengewirkt.
Standardisierte Musiktherapien
Welche Musik hat bei
welchen Menschen
unter
REZEPTIVE
AKTIVE
welchen Bedingungen
welche Wirkung?
ZIEL:
Enhancement of
quality of life
How do the elderly benefit
from music therapy ?
AKTIVE MUSIKTHERAPIE
• nicht für jeden alten
Menschen geeignet, da
Energie aufgewendet
werden muss.
• setzt Lebens- und
Spielfreude und Mut zum
Improvisieren voraus
• es muss möglich sein nur
ruhig zuzuhören, die
Gruppe zu verlassen …
REZEPTIVE MUSIKTHERAPIE
• für alle alten Menschen
geeignet
• Gespräche, die dem Hören
folgen, sind sinnvoll.
• setzt leicht handhabbare
Technik voraus!
AKTIVIERENDE oder
BERUHIGENDE Musik ?
Indications for music therapy
in palliative medicine (1)
communication disorders
stress / other psychological
problems
pain
neurological disability
Ernst E. et al. (2006): The Desktop to Complementary and Alternative Medicine –
An Evidence-based approach. Mosby,Elsevier
Indications for music therapy
in palliative medicine (2)
Pain/Anxiety
Extreme muscle contractions of body
Insomnia
Breathing problems
Introversion, depression
Deficits with acceptance of life situation
Delhey M. (1997): Musiktherapie. In: Aulbert E, Zech D. (Hrsg.):
Lehrbuch der Palliativmedizin. Schattauer, Stuttgart, 916-922
Content
Introduction
Physiological Effects of Music
Research Studies
Summary
Enhance the
Quality of Life !
Effects of Music Therapy for
Older People
PYSIOLOGICAL (pain, shortness of breath)
PSYCHOLOGICAL (depression, anxiety, anger, fear,
frustration)
SOCIAL (isolation, loneliness, boredom)
SPIRITUAL (lack of spiritual connection, need for spirituallybased rituals)
COGNITIVE (neurolog. impairments, disorient., confusion)
Enhance the Well-Being – Reduce Stress and Suffering
Promote the quality of life !
RESEARCH
Lack of controlled studies with large
sizes that would allow for generalization.
Need for studies with higher levels of
control and randomization of subjects.
Guidelines for future studies should be
established.
LIMITATIONS
MUSIC SHOULD NOT
EXCEED 90 dB AS THIS MAY LEAD TO
HEARING IMPAIRMENT
Standardisierte Musiktherapien
Welche Musik hat bei
welchen Menschen
unter
welchen Bedingungen
welche Wirkung?
MUSIC AT HOME
Musiktherapie – Definition
Musiktherapie ist die
wissenschaftlich fundierte,
diagnosespezifische Nutzung
von Musik oder von musikalischen
Elementen zu Heilzwecken.
Sie bedient sich entweder der
Musikrezeption (REZEPTIVE MUSIKTHERAPIE)
oder der musikalischen Aktivität des Patienten
(AKTIVE MUSIKTHERAPIE),
wobei jeweils sowohl Einzel- als auch
Gruppenverfahren möglich sind.
formuliert von H.P.Hesse, 1980
Universität Salzburg, Naturwissenschaftliche Fakultät
Fachbereich für Organismische Biologie
Arbeitsgruppe für „Neurodynamics & Neurosignaling“
ALLTAGSERFAHRUNGEN
1. Musik aktiviert Körper und Psyche,
versetzt in Stimmung,
regt zum Mitsingen/zur Bewegung an.
Beispiel Klarinette: ...........
Beispiel Klavier: W.A. Mozart, Sonate A-Dur, KV 331,
Alla turca
Der therapeutische Einfluss erstreckt sich
in Abhängigkeit vom Charakter der
verwendeten Musik in folgende Richtungen:
• AKTIVIERUNG
…
Körper & Psyche
körperliche Aktivierung,
emotionale Neuorientierung (Stimmungsveränderung)
Ouvertüren & Märsche regen an und zerstreuen negative
Gedanken.
• ENTSPANNUNG ...
Körper & Psyche
Lösen von körperlicher Verspannung, Beseitigung
von psychischen Spannungen (z.B. Angst)
Entspannungsmusik entspannt Körper und Geist und hat
konzentrationsfördernde Wirkung.
1. AKTIVIEREND
Anregung
–
2. BERUHIGEND
Entspannung
Möglicher therapeutisch nutzbarer Einfluss
von Musik
• Einwirkung primär über den Körper
• Aktivierung des Körpers (z.B. Tanz)
• Beruhigung des Körpers (z.B. Wiegenlied)
Lösung von körperlicher Anspannung
• Einwirkung primär über die Psyche
• Emotionale Aktivierung (Stimmung)
• Befreiung von Ängsten und Lösung von angstbedingten
Spannungszuständen
?
?
(Claudio Abbado, geb. 1933)
„Musik ist die beste Medizin. Mehr als jede Behandlung
hat mir die Musik geholfen, diese schwierigen Monate
zu überstehen.“
Musikalische Hausapotheke = Musikament®
AKTIVIERUNG
+
Mozart: „Eine kleine
Nachtmusik“
Universität Salzburg, Naturwissenschaftliche Fakultät
Fachbereich für Organismische Biologie
Arbeitsgruppe für „Neurodynamics & Neurosignaling“
Starke Opioide +/Nicht-Opioide
+/- Adjuvant.
Schwache Opioide und
Nicht-Opioide
+/- Adjuvant.
Nicht-Opioide
+/- Adjuvant.
„Radetzky-Marsch“
„Walzer“
„L.v. Beethoven
Rondo a capriccio“
Koanalgetika
„Bobby McFerrin
Don`t worry...“
„Music from
the Coffee lands“
SCHMERZ: BIO-PSYCHO-SOZIALE EINHEIT
Universität Salzburg, Naturwissenschaftliche Fakultät
Fachbereich für Organismische Biologie
Arbeitsgruppe für „Neurodynamics & Neurosignaling“
ALLTAGSERFAHRUNGEN
Beispiel Klarinette: ........
Beispiel Klavier: W.A. Mozart, Sonate A-Dur,
KV 331, Var. V
2. Musik entspannt (beruhigt) Körper und
Psyche,
löst Erinnerungen und Assoziationen aus,
regt zum Träumen an.
Musikalische Hausapotheke = Musikament®
ENTSPANNUNG
-
MOZARTMUSIKAMENT®
+
Mozart: Hornkonzert Kv447
Universität Salzburg, Naturwissenschaftliche Fakultät
Fachbereich für Organismische Biologie
Arbeitsgruppe für „Neurodynamics & Neurosignaling“
Starke Opioide +/Nicht-Opioide
+/- Adjuvant.
Schwache Opioide und
Nicht-Opioide
+/- Adjuvant.
Nicht-Opioide
+/- Adjuvant.
„Bruder Jakob: Happy Baby Guten Morgen“
„Ade zur guten Nacht. Abendlieder HappyBaby“
„Baby Dreams: Close your eyes“
„Entspannung
bei Schmerzen.“
„Mentalis Verlag
Traumreise“
„Mentalis Verlag
Echoes of Silence“
„Schumann:
Träumerei“
Koanalgetika
„Franz Liszt:
Liebestr. Nr. 3“
„Enya“
SCHMERZ: BIO-PSYCHO-SOZIALE EINHEIT
EMOTIONALE REAKTIONEN AUF MUSIK
„Schneller Rhythmus und Stakkato“ (meistens Dur)
Fröhlichkeit ... stärkeres Atmen ...
Freude wird durch hohe Frequenz, große Intervalle,
hohe Lautstärke und hohe Stimmlage ausgedrückt.
Bsp.: Joseph Haydn: Symphony No. 70 D major, Classical
Johann Strauss II: Tausendeine Nacht,Romantik
Georges Bizet: Carmen Suite No. 1. 2nd movement:
Musette de Choisy, Classical
(G. Kreutz et al., 2008)
G.B. 2001
Juslin PN (2001) Cue Utilization in Communication of Emotion in Music Performance:
Relating Performance to Perception: J. Exp. Psych. 26:1797-1813
EMOTIONALE REAKTIONEN AUF MUSIK
„Langsamer Rhythmus und Legato“ (überwiegend
Moll)“ Traurigkeit ... Puls, Hautwiderst., Htemp.
erniedrigt
typisch mittlere Aktivierung, Kleinschrittigkeit der
Melodie und fallende, sequenzierende Abschnitte
Bsp.: Tomaso Albinoni, Adagio, G minor, Baroque
John Dowland, Dances from Lachrimae: Semper
Dowland Semper, Dolens, „Goe Nightly Cares“
W. A. Mozart: Piano concerto no. 21, KV 467, C minor,
2nd movement: Andante
Classical
(G. Kreutz et al., 2008)
G.B. 2001
Juslin PN (2001) Cue Utilization in Communication of Emotion in Music Performance:
Relating Performance to Perception: J. Exp. Psych. 26:1797-1813
MUSIK UND EMOTION
MUSIKALISCHE CHARAKTERISTIK UND
DEREN KÖRPERLICHE WIRKUNG BEI SPRACHE/MUSIK
FREUDE
TRAUER
(PRESTOTYP)
(ADAGIOTYP)
GRUNDFREQUENZ,
TONHÖHE
hoch
tief
VARIABILITÄT
(MELODIE)
stark
gering
SPRECHTEMPO
schnell
langsam
LAUTSTÄRKE
gross
gering
TONHÖHENVERLAUF
auf/ab
abwärts
KLANGFARBE
hell, strahlend
weich,dunkel
SCHERER (1982); EIBL-EIBELSFELD (1984)
MUSIK UND EMOTION
MUSIKALISCHE CHARAKTERISTIK UND
DEREN KÖRPERLICHE WIRKUNG BEI MUSIK
FREUDE
TRAUER
(PRESTOTYP)
(ADAGIOTYP)
TEMPO
schnell, mit Accelerandi
langsam, mit Ritardandi
RHYTHMUS
punktiert, synkopiert,
abwechslungsreich
konturlos, mit Tendenz zum
„Stehenbleiben“
LAUTSTÄRKE/KLANGF. laut, hell, strahlend
leise, dunkel, verschmelzend
MELODIK
großer Ambitus, sprunghafte Intervalle, aufwärtsstrebende Motive
geringer Ambitus, kreisend
schrittweise fallende
Motive
HARMONIK
einfache Harmonien,
Betonung der Diskanttöne
komplexe Harmonik mit
komplizierten Akkordfortschreitungen
SCHERER (1982); EIBL-EIBELSFELD (1984)
Music examples
Wolfgang A. Mozart
Klarinettenkonzert A-dur, KV 622, 2. Satz: Adagio
Edvard Grieg
Peer Gynt, Suite Nr. 1 op. 46, 1. Satz: Morgenstimmung
Peter Tschaikowsky
Konzert Nr. 1 für Klavier u. Orchester b-moll op. 23,
2.Satz, mehrsätzig
Antonio Vivaldi
Die vier Jahreszeiten; Konzerte für Violine, Streicher und
Basso continuo op. 8, Nr. 1-4
ALLTAGSERFAHRUNGEN
Schmerztherapie: multimodales Konzept
adjuvante
&
pharmakologische Basistherapie
Starke Opioide
+/- Nicht-Opioide
+/- Adjuvant.
Physikalische,
psychologische,
physiotherapeutische
Verfahren:
- Musik
Koanalgetika
Schwache Opioide
Nicht-Opioide
+/- Adjuvant.
- TENS
- Biofeedback
- Akupunktur
Nicht-Opioide
+/- Adjuvant.
SCHMERZ = BIO-PSYCHO-SOZIALE EINHEIT
MUSIK HAS ENOUGH
POWER TO INCREASE
QUALITY OF LIFE AND SHOULD
BE SEEN/USED LIKE A
PHARMACON !
MUSIC AS A PHARMACON ?
PHARMACOKINETIC/DYNAMIC
DOSIS/MAX/MIN
INDICATION/CONTRAINDICATION
SIDE EFFECTS
APPLICATION (ACTIVE/RECEPTIVE)
Enhance the
Quality of Life !
Musik und Gehirn
GLÜCK
TRAUER
p<0.01
p<0.01
p<0.05
n.s.
ZORN
FURCHT
ZORN
p<0.01
p<0.01
J. Panksepp, G. Bernatzky: Emotional sounds and the brain: the neuro-affective
Foundations of musical appreciation, Behavioural Processes 60 (2002) 133-155
QUALITY
OF LIFE
MUSIC
Fotos: O. Anrather (Salzburg) Musik: Mozart
Klarinettenkonzert, KV 447 („Mozarteffekt“)
Thank you !
FURTHER INFORMATION:
www.schmerzinstitut.org
guenther.bernatzky@sbg.ac.at
Literature Survey
Art der Musik
Allgemein
Gesang
Aktive
Musiktherapie
Aktive &
Rezeptive
Musiktherapie
Erhobene Parameter & Ergebnisse
Verbales, unruhestiftendes Verhalten sank zu 31%
Verbessertes Selbstwertgefühl und bessere
Lebensqualität
Verbesserung der physischen und kognitiven
Funktionen
Durchgeführte Tests wurden besser ausgeführt
Selbstausdruck, Sozialisation und Rückblick
gefördert
Scheinbar vergessene Assoziationen & Gefühle
können durch Musik als Gedächtnishilfe wieder
gefunden werden
Mentale und physische Anregung
Verbesserung der Fähigkeit zur Namensgebung
Verbesserung der Unruhe
Vor allem rastloses Umherwandern wird reduziert
Autoren
Cohen-Mansfield, 1997
Ellis, 2004
Hagen et al., 2003
Hanser, 1994
Johnson et al., 1992
Sacks & Tomaino, 1991
Sorell, 2008
Carruth, 1997
Choi et al., 2009
Fitzgerald-Cloutier, 1993
Vermehrtes Selbstvertrauen; verbesserte
Kommunikation
Fukamizu et al., 2009
Verbessertes Umfeld; verbesserte Lebensqualität
McCaffrey, 2008
Literature Survey
Art der Musik
Rezeptive
Musiktherapie
Erhobene Parameter & Ergebnisse
Autoren
Entspannende Musik verbessert Unruhezustände
Denney, 1997
Klassische Musik erhöht die Gedächtnisleistung
Mammarella et al., 2007
Entspannungsmusik verbessert die Schlafqualität
und Angstreduktion
Ziv et al., 2008
Verbesserung der Unruhezustände; musikalische
Vorlieben sollten beachtet werden
Gerdner & Swanson,
1993
Verbesserung von Unruhezuständen während der
Mahlzeiten
Goddear & Abraham,
1994
Verbesserung des Sprachgedächtnises von 60%
Särkämo et al., 2008
Teilnehmer präferieren Physiotherapie mit
Musikbegleitung
Johnson et al., 2001
Weniger Arthroseschmerzen
McCaffrey et al., 2003
Vermehrte Bewegung und Aktivität
Olson, 1984
Verbesserung beim individuellen Erkennen und
Reduktion der Angstwerte
Irish et al., 2006
Beruhigende Musik und Handmassage verändern
Umwelt positiv
Remington, 1999
Scientific Publications on Music Therapy
European Pain in Cancer Survey
68% of cancer patients receiving treatment for their pain use
alternative methods – the most popular are massage and vitamins
Base: all who receive
treatment (n=506)
I don't use any other methods
Other
Imagery
Hypnosis
Nerve stimulation or TENS
Alcohol rubs
Cold (ice packs)
Alcoholic drinks
Therapy/counselling
Ointments/creams
Meditation
Relaxation therapy
Change in diet
Support groups
Herbal supplements
Physical therapy
Acupuncture
European Pain in Cancer Survey,
Exercise
European Association of Palliative Care.
Heat (heating pad)
Half of European cancer patients have
Vitamins
moderate to severe pain: one in five patients
Massage
32%
19%
1%
1%
1%
1%
2%
2%
3%
4%
4%
Q52: What, if any, other
methods, remedies or
treatments, apart from
medications have you
ever tried to relieve
your pain we have
been discussing?
does not receive treatment. J pain Palliat
Care Pharmacother. 2007; 21(4):51-3
7%
8%
8%
9%
9%
11%
11%
12%
13%
14%
0%
5%
10%
15%
20%
25%
30%
35%
Depression
RCT of depressed elderly patients (n = 30)
Superior results with music-based therapy (various
therapeutic modalities) than no treatment 1
PCTs with depressed adolescent females who listened
to rock music – control groups received massage 2
or simply relaxed 3
Changes to physiological & biochemical parameters
but not mood or behaviour.
1 Hanser SB & Thompson LW. Effects of music therapy strategy on depressed older adults. J Gerontol
1994, 49: 265-269.
2 Jones NA & Field T. Massage and music therapies attenuate frontal EEG asymmetry in depressed
adolescents. Adolescence 1999, 34: 529-534.
3 Field T, Martinez A, Nawrocki T, Pickens J, Fox NA & Schanberg S. Music shifts frontal EEG in depressed
adolescents. Adolescence 1998, 33: 109-116.
MUSIC STIMULATION
IN PEOPLE WITH PARCINSON
Music, Rhythm and Motor Rehabilitation
What would you think if you saw a person unable to take a step on his own
walk independently while listening to a rhytmic beat?
They cannot plan movements on their own - however they may still have the ability
to move, and this ability is unlocked by music.
Outcomes:
• Motion initiated in parts of the body that have limited movement
• Movement maintained in affacted extremeties
• Increased range of motion
• Repertoire of exercises built up – resident can perform indipendently with
confidence
• Motivation to participate in daily activities
• Increased neuromuscular control
http://www.bethabe.org/MT_and_Motor_Rehabil220.html