Look out; here she comes again.
 
I think this article formed some of the background to my Feb 15
posting re cognitive therapy etc.
 
This caught my eye, especially because music is so important to me. If
I'm in the throes of depression, I lose interest in playing music,
which probably only compounds the problem...  I'm also finding it
interesting that therapy concepts that would have been written off as
'flakey' in the not so distant past, are now coming into their own.
 
Janet
 
who is spending too much time digging through the ever increasing
wonders of the internet
 
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JAMA Medical News & Perspectives - January 24/31, 1996
 
Leaving Concert Hall for Clinic, Therapists Now Test Music's 'Charms'
 
USING MUSIC as treatment for psychological or physical disorders is an
idea that has existed in many forms, in many cultures, and for many
centuries. But its application as a specific means of therapeutic
intervention is a development largely of the mid 20th century.
 
Essentially, music therapy is the building of a relationship between
patient and specially trained therapist using music as the basis
for communication. The therapist does not teach singing or playing an
instrument; rather, the instrument and the voice are used to explore
the world of sound and create a common musical language with the
patient. Both therapist and patient take an active part in the therapy
sessions through playing, singing, or listening.
 
Music therapists work in a variety of settings, including hospitals,
rehabilitation centers, special schools, and hospices. Their patients,
or clients as they prefer to call them, include children and  adults
of all ages and intelligence levels with learning disabilities,
physical handicaps, autism, sensory impairments, emotional
disturbances, psychiatric illnesses, brain injury, or terminal
illnesses.
 
However, those practicing music therapy and treating patients have
almost entirely limited their publications to single case studies,
occasional reports of small groups of patients, and anecdotal
accounts. The result has been that any beneficial effects have not
made much of an impression on clinical medicine.
 
Need to Assemble Evidence
 
There are signs that this is beginning to change. At the annual
meeting of the National Association for Music Therapy (NAMT), held in
Houston, Tex, several speakers addressed the need to assemble the
evidence that, as Michael H. Thaut, PhD, put it, "will allow us to
break into the mainstream of acceptance." Thaut is  professor of music
and biomedical engineering at Colorado State University, Fort Collins.
 
Thaut's point was echoed by Gerald C. McIntosh, MD, a neurologist and
adjunct professor of music therapy at Colorado State, who said, "We
now have to show that something is cost-effective  as well as
clinically useful. This is a new challenge."
 
Music therapists have been reluctant to subject their work to
scientific study, noted Heather Purdie, MSc, MMus, a music
therapist at Woodend Hospital in Aberdeen, Scotland. She suggested
that this reluctance may stem from the expressive, creative nature of
the medium. But like her colleagues, Purdie recognizes the need to
provide evidence of the efficacy to secure professional credibility
and validity. "It is increasingly urgent for music therapists to be
able to demonstrate that the intervention they offer is both effective
and efficient in a competitive market."
 
There are indications that music therapy is gaining greater
acceptance. One was noted by Bryan C. Hunter, PhD, the NAMT's
president from 1993 to 1995, who said that the Health Care Financing
Administration now includes music therapy as a reimbursable service
under certain conditions in Medicare's partial hospitalization
policies. Obtaining universal third-party reimbursement for their
members' services has been one of the association's goals for at least
3 years, he said. Hunter is associate professor and coordinator of
music therapy at Nazareth College in Rochester, NY.
 
"If you take a poll of physicians at random, they may not have even
heard of music therapy," Hunter said in an interview. "If they have,
they probably think of it as a sort of fringe thing. But among
physicians who have had some experience, who have received the
services of a good, competent music therapist in treating patients, I
think you would find strong support for music therapy."
 
A development that will ultimately facilitate the expansion of music
therapy in clinical practice is a reorganization of the two
professional groups of music therapists, which include many of the
estimated 5000 music therapists practicing in the United States, into
a single body. The NAMT has about 3200 members, and the American
Association for Music Therapy has just over 500 members. Many
therapists belong to both groups.
 
The governing boards of these associations have endorsed a proposal to
take effect in January 1998 that will merge the groups as the American
Music Therapy Association. The step, says Hunter, will  enable
advocates of music therapy to speak with one voice. "We will never
realize our full potential as long as there are two associations whose
missions cause them to compete with each other and confuse the public,
third-party payers, government agencies, and our clients," he said.
 
Use in Stroke, Parkinson's
 
But gaining acceptance of the clinical value of music therapy by
mainstream medicine will still depend on hard evidence from
controlled studies. One example, presented at the meeting, came from
Colorado's McIntosh and Thaut. They reported on the effects of
rhythmic auditory stimulation in improving the mobility of patients
with stroke or Parkinson's disease.
 
The rhythmic stimulation, or cuing, is delivered by metronome pulses
embedded in the music, which is recorded on audiotapes and listened to
over headphones. Patients choose the music they like. Results do not
seem to be related to the kind of music chosen, Thaut said.
 
The Colorado group first studied rhythmic cuing in normal people to
obtain baseline data. Even normal individuals have wide variations in
their walking patterns, McIntosh noted, but when those in the
experiment were given the rhythmic cuing, stride variability was
reduced. "People walked better to music than they did without."
 
In the stroke study, 10 patients, half with left hemiplegia and half
with right hemiplegia, were given rhythmic auditory stimulation
30 minutes a day for 3 weeks. At the end of this time, the patients
had improved their cadence, stride, and foot placement compared with
patients who had not been given auditory stimulation.
 
In addition to measuring patients' walking patterns, the Colorado
group takes surface electromyographic readings of the muscles used in
walking--including the gastrocnemius, tibialis anterior, and vastus
lateralis--before and after auditory stimulation to document the
timing and magnitude of changes in the patients' gait.
 
The therapists have also studied rhythmic auditory stimulation in
patients with Parkinson's disease and have obtained similar
improvement in walking patterns compared with controls. "Two different
pathologies, one hemispheric damage and the other damage to the brain
stem basal ganglia, yet both respond to the same treatment," Thaut
noted.
 
Thaut said the metronome beat excites and shapes activity in the motor
system of the brain, which helps organize and integrate complex
movement. The primary clinical importance of music is not its
emotional or motivational value, he said, but the neurological effects
that improve motor control. When muscle activity is synchronized to
auditory rhythm it becomes more regular and efficient.
 
"The brain is organized in a complete pattern. Stride length, step
cadence, symmetry, posture, everything, is centrally, not segmentally,
related. So when one improves on one of these parameters, everything
else comes into place. This fits in very well with modern theory about
motor control," he explained.
 
Not only do patients walk better with auditory stimulation, but the
effect lasts. The Colorado group has studied their patients after they
have completed the treatment and finds that they retain the walking
pattern they acquired during rhythmic training. Patients can reliably
reproduce their new walking pattern without further rhythmic cuing.
 
There is, said Thaut, an "entrainment effect": auditory rhythm is
extremely efficient for entraining movement frequencies. The most
exciting aspect, he said, is that this entrainment model holds
true for people who have damaged motor systems. "We're enhancing a
normal mechanism in the brain that's been damaged by the stroke."
 
A study reported by Scotland's Purdie was also designed to show the
effects of music therapy on stroke patients. It involved 40 long-term
institutionalized stroke patients randomly assigned to music therapy
or standard care. It was designed as a feasibility study, to show that
a randomized controlled trial of music therapy was possible.
 
Purdie reported that, after 12 weeks of music therapy involving
sessions of about 40 minutes per day, treated patients showed some
signs of being less depressed, less anxious, more emotionally stable,
more interactive, and more motivated to cooperate and communicate than
did a control group. Psychosocial tests were used to measure the
various parameters.
 
Purdie also spoke of the need to address the low self-esteem that
characterizes many stroke patients, relieve their isolation, improve
motivation, and develop their confidence, because "inactivity and
fatigue are common after stroke, complicated by sensory and motor
impairments." Regardless of the severity of the impairment, patients
do respond to music, such as by tapping the foot, she said.
 
Purdie noted that although the small numbers of patients in her study
do not permit drawing firm conclusions, the findings suggest that
music therapy may have contributed to improvements in behavior,
communication, and psychological state.
 
Rock-a-bye Neonate?
 
Other reports at the NAMT meeting included the use of music therapy
during childbirth. Hope E. Young and Karen E. May, music therapists in
Austin, Tex, have set up a service that provides music to give birth
by. At the beginning of the third trimester, before setting up a
program for a woman, the therapists work with her obstetrician at the
hospital where the delivery is planned to make sure no complications
are expected. They also require their clients to take childbirth
education classes because they "feel this enhances the effectiveness
of music therapy."
 
The prospective mother and her partner select the kind of music they
like and that correspond to the stages of labor. "We use tapes of all
types of music--classical, rock and roll, country, blues of all kinds,
and played on a wide variety of instruments--piano, guitar, winds,"
Young said. Throughout labor, the woman uses a remote control device
to regulate the volume of the music, "which gives her a sense of
control," said Young. In the early stages of labor the music is slow,
relaxing, and calming, with little variation in tempo or volume. In
the later stages, when physical exertion is required, the music has a
definite steady beat. To listen to after delivery, the couple may
choose an especially meaningful song or piece of music.
 
In their report at the meeting, Young and May said that half the women
who listened to music during delivery did not require anesthesia.
"Music stimulation increases endorphin release and this decreases the
need for medication. It also provides a distraction from pain and
relieves anxiety," said Young. They have  used music therapy in about
30 deliveries.
 
Special Use in Children
 
At the Ireland Cancer Center of the University Hospitals of Cleveland,
Ohio, the director of music therapy, Deforia Lane, PhD, who is known
for her work in the physical and psychological rehabilitation of
cancer patients, has studied immune function in children given a
single 30-minute music therapy session. In 19 subjects, a significant
(P=.01) increase in salivary IgA occurred after the music session. In
17 controls, there was a small but not significant decrease in IgA
levels. The finding indicates that music therapy plays a positive role
in recovery, Lane said.
 
"Music speaks to the entire human being," said Clive E. Robbins, PhD,
director of the Nordoff-Robbins Music Therapy Center at New York (NY)
University. Robbins is one of the pioneers of modern music therapy. He
originally worked in England with mentally retarded, autistic, and
physically disabled children and, in painstaking sessions with his
former partner Paul Nordoff, has demonstrated how music can bring an
autistic child out of isolation, fear, and anxiety.
 
The "music" that emerges between the therapist on the piano and the
child on a drum is an improvised exchange. The child beats the drum
and the pianist responds. "When you have a child who is unable to
relate to life successfully, cannot endure human relationships, or has
communication difficulties, this improvisation be very effective,"
said Robbins. "It's a way of reaching into the child's mind."
 
Robbins likened this improvised exchange between the autistic patient
and the therapist to everyday conversation. "As we speak, we
improvise. You ask a question, I respond. So it is with music. It can
be used as flexibly as we use speech to reach children with language
problems. It bypasses those difficulties," he said.
 
"Neurologic research is discovering that the brain comes into
synthetic activity in response to music," Robbins said. "Some say
the brain is fundamentally programmed so that the organic connections
are symphonic rather than mechanistic."
 
--by Charles Marwick
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Janet Paterson  -  48  -  7  -  [log in to unmask]  -  Bermuda
 
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