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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 --------------------------------------------------------------------- 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 --------------------------------------------------------------------- Janet Paterson - 48 - 7 - [log in to unmask] - Bermuda <---- End Forwarded Message ----> Janet Paterson - 48 - 7 - [log in to unmask] - Bermuda <---- End Forwarded Message ----> Janet Paterson - 48 - 7 - [log in to unmask] - Bermuda