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Nancy Haider, BME 1450 Midterm Assignment, Oct 28, 2003
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Music Therapy
An application of systems biology
Maria Haider
Abstract:
M
usic therapy is used to alleviate certain mental,
physical and emotional ailments. A certified
music therapist provides the personalized services to the
patients. A wealth of literature is available which proves that
music therapy has positive effects on patients with neurological
impairment. Music provides a good model for studying the
complex interactions taking place in the brain on systems
level. Sophisticated brain imaging technologies present today
has enabled scientists to study how music affects the activity of
brain in mentally impaired patients. It has been shown to help
patients suffering from Alzheimer’s disease for which no cure
has yet been discovered. With further research and
development in this interdisciplinary field integrating music
therapy, imaging technology, music development systems,
computer software and medical information, it might become
possible to cure untreatable mental disorders such as
Alzheimer’s disease and autism and Parkinson’s disease with
music therapy. Among other cures, music therapy provides
relaxation, reduces anxiety/depression and treats insomnia
without depending on medicines by using “brain Music”. If the
present extensive research continues, there is a possibility that
the future treatment of these complex disorders would change
from capsules to music therapy.
Key Words:
Alzheimer’s disease, Autism, Brain Music, Music
Therapy, Music Therapist, Parkinson’s disease.
Introduction:
The study of brain and music, with all its
interdisciplinary complex integrative nature, for
identifying and modeling the key components, complex
interactions and pathways that can be manipulated to
discover new ways of treating diseases and disorders
comes under the domain of systems biology.
“Music therapy is the skillful use of music and
musical elements by an accredited music therapist to
promote, maintain, and restore mental, physical,
emotional, and spiritual health. Music has nonverbal,
creative, structural, and emotional qualities. These are
used in the therapeutic relationship to facilitate contact,
interaction, self-awareness, learning, self-expression,
communication, and personal development [3]”.
Music therapy encompasses various techniques
such as singing, dancing, listening to music, or
composing, or playing music. Listening to music helps to
develop cognitive skills such as attention and memory,
influence emotions and creates an environment for self
expression and is employed to treat patients with
dementia. Singing technique is used to treat patients
with speech impairment by enhancing articulation,
rhythm and breathe control. Singing and listening to
songs helps elderly people to remember significant
events of their lives. To improve motor coordination in
patients, instrument playing is employed. Rhythmic
movement or dancing helps to cure muscle and joint
ailments. Composing music is used to facilitate
cooperative learning. Music Therapy has been applied
successfully for cure in a number of health problems
including dementia, speech and hearing impairment,
Parkinson disease, autism and other developmental
disabilities, depression, insomnia and many more.
Hearing about music having medicinal qualities
evokes an urge to question the integrity of such
discipline. Today, ample evidence is available proving
that music is effective medically. An important finding of
neuroscience in regard to music is that many parts of the
brain takes part in perceiving and experiencing music.
Research has revealed that human brain have
distinct circuits for perceiving and processing music [1].
According to the neuroscientists behind these
researches, a neurological study of music processing
provides an ideal model for studying the way brain works
[1]. While processing musical sound, brain has to
integrate complex perceptual and behavioral tasks [1].
The sensory organs deliver all the gathered information,
directly to a certain specialized areas within the temporal
lobes of the cerebral cortex [1]. But responding to music
requires much more: a working memory, likely located
towards the rear of frontal lobes [1]-[2]. Bits of music are
stored here while the brain makes sense of the whole
tune[1]. The emotional response to music is processed
Nancy Haider, BME 1450 Midterm Assignment, Oct 28, 2003
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in a set of structures distributed more widely throughout
the brain[1].
Fig 1:
Neural Structures
utilized in Music
Processing [1]
Auditory cortex, a structure present in each of
the temporal lobes with in a fold of tissue called lateral
sulcus, is thought to contain perceptual skills. This area
is divided into three hierarchical levels, according to the
complexity of the processing task. The primary cortex
receives input from the ear from a structure called
Thalamus, which can identify the fundamental elements
of music such as pitch or loudness. The secondary
cortex focuses on harmonic, melodic and rhythmic
patterns and the tertiary cortex integrates these
patterns into overall perception of music. For playing
music, this information is integrated with signals from
another area of the brain called motor cortex.
A number of cognitive abilities are required for
the perception of music. In this process, a musical piece
is stored in the memory, it is differentiated into different
part which are then put in order and interrelated.
Conclusions in holistic context are made and are
compared with already stored musical experiences. In
doing so, the brain is actively storing, ordering,
abstracting, concluding, comparing, planning, expecting
and learning, thus performing very complex integrative
functions [6].
Music medicine involves integration of a wide
array of fields, professions and technologies.
Collaboration between music professionals and medical
professionals is essential in achieving the desired goal.
Only music professional can design, develop and
control music for medical purposes and then design and
implement the therapy session according to individual
needs. Professional music therapists are responsible
for providing efficient treatment. According to the Music
Therapy standards of practice, the music therapist is
responsible for assessing, designing and implementing
music therapy treatments, monitoring the patient’s
progress and reformulating the therapy depending on
the patient’s response and new developments in the
field. On the same time, it is impossible to study how
brain is affected by music without the help of
researches proficient in medical fields.
Advancement in brain imaging technology has
enabled scientists to gather information about the
structure of brain and how it is activated by music.
Neural circuits that process music has mostly been
studied by using the brain imaging techniques of
positron emission tomography (PET) and functional
magnetic resonance imaging. These techniques can
help to determine the anatomical location of activity
within
the
brain.
Other
methods
include
electroencephalography
(EEG)
and
magnetoencephalography (MEG), which respectively
measure electrical and electromagnetic activity of
neurons within the cerebral cortex [1].
Fig 2: Data from MEG study of processing of
music [8]
In addition to the medical imaging devices,
music therapy requires a sophisticated music system
and music instruments. Now a days, systems with high
quality sound and functionality is available, which
makes it possible to test different sound techniques in a
study. It is now possible to affectively compose a piece
of music that would provide beneficial effects to a
particular patient without much hassle with the help of
Nancy Haider, BME 1450 Midterm Assignment, Oct 28, 2003
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musical instruments integrated with computer software
technology [15].
Nancy Haider, BME 1450 Midterm Assignment, Oct 28, 2003
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Review:
Music has been proved to be a tonic for the
patients of dementia. Alzheimer’s disease is the most
common form of dementia, in which the brain, its
cognitive functioning and memory is affected. It is a
degenerative disease with a slow onset and a
continuous decline in cognitive abilities. Personality
changes along with social and occupational loss occur
during the course of disease [7].The prevalence of
dementia increases with age, therefore elderly
represents the largest population suffering from this
disease [5]. Currently four million Americans are
experiencing effects of this disease [7]. It is estimated
that 12 to 14 million people will be affected by the year
2040 unless a cure is found [5].
The responsiveness of patients with dementia,
specifically Alzheimer’s disease, to music is well
documented [4]. Multiple cases prove the fact that
people with dementia, despite memory loss, are able to
remember and sing old songs and dance to old tunes
[5]. Musical therapy interventions have been used with
dementia patients to improve cognitive, physical and
emotional skills such as reorientation, exercise,
maintenance of social behavior, language skills, anxiety
reduction, memory retention and self expression [5].
Structured musical activities helps to maintain and even
re-attain the social and emotional skills and therefore
helps to delay the withdrawal of the patient from the
society [5]. Neuro-musical case studies prove that
music apparently can influence the person suffering
from dementia by providing sense of accomplishment,
stimulating and energizing, helping remember past
events and soothes both the patient and the caregiver
[6]. At present there is no known cure for dementia but
neurological studies suggests that cognitive processes
related to music processing may be preserved even in
the latest stages of the disease [5].
A study conducted on nuns about 10 years ago
by Dr. Snowdon at University of Kentucky, revealed that
the more one uses brain, less chance there is of
acquiring Alzheimer’s disease in old age [11]. The
concept of “use it or lose it” has been proved
consistently in many studies. Perceiving and playing
music involves highest cognitive, motor and emotional
abilities [6]. Thus the people who experience music
might be using their brains more than others.
Research shows that music therapy helps to
practice maintaining attention [12], improve moods [13],
motivates for participation in exercise and movement
activities (dancing) [7] and improves speech (singing) in
neurologically impaired patients.
Dementia is usually diagnosed and its
progression is assessed through a cognition test, the
mini mental state examination (MMSE). Based on
questions and activities, this test evaluates functional
capabilities of the patient. This test fails to discriminate
minor language deficits and lack of assessment of
fluency [4]. The use of dynamic musical play of music
therapy may be used to stimulate cognitive function and
elicit some response which MMSE fails to evaluate [5].
In some studies, brain imaging data show that
the auditory cortex in the left hemisphere of the brain of
musically trained subjects is larger than that of
untrained subjects [9]. The same study also showed
that the effects were greater for those who started
music training at relatively younger age especially age 7
[10]. Although this finding proves that music affects the
brain structure, practicing mathematics or playing chess
might also show the same results. It is not yet
ascertained that music education may improve
performance in other modes of cognition.
“Autism is a developmental brain disorder that
typically appears during the first three years of life. It
affects brain areas controlling language, social
interaction and abstract thought. Children and adults
with autism typically have deficiencies in verbal and
non-verbal communication, social interactions [14]”.
Music therapy has been proved to be beneficial for the
people and children suffering from autism. It helps to
enhance socio-emotional development and interrupts
isolation and social withdrawal. It facilitates verbal and
non verbal communication in patients and promotes self
expression and emotional satisfaction [14].
Music Therapy may also be employed for the
treatment of insomnia. Researchers at sleep clinic at
University of Toronto and University Health Network's
Toronto Western Hospital are using “Brain Music” to
help relaxation and improve the quality of sleep. They
have studied people’s brain waves to see the rhythmic
and tonal sound patterns that create a meditative
condition in that particular individual. A music therapist
in the team has developed software to create music that
matches the person’s brain waves.
“The brain music appears to alleviate some
psychosomatic symptoms such as anxiety without the
potential to cause dependency that has raised concerns
with some pharmacological treatments for insomnia”,
says psychiatry Professor Leonid Kayumov. "Brain
music therapy, because of its more favorable side-effect
profile, may represent a possible alternative for
therapeutic management of insomnia and anxiety. From
ancient times through to the present, philosophers,
historians and scientists have written and spoken of
music as a therapeutic agent” [15].
Although Music Therapy helps mentally
impaired people and others experiencing insomnia,
Nancy Haider, BME 1450 Midterm Assignment, Oct 28, 2003
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anxiety or depression, it has certain draw backs too.
Music therapy is mostly being used for treating people
with neural disorders. The capacity of such people to
engage in decision making for participating in research
studies is questionable. It is unethical to engage a
person in a study and treatment without informed
consent, which a mentally impaired person cannot give.
Four standards have been developed for determining
the capacity of autonomous decision making. These
are: ability to express a choice, ability to understand
relevant information, ability to appreciate the situation
and its consequences and to manipulate information
rationally [16]. Investigator should consider each
standard separately to determine the decision making
capacity of the patient because recent study has shown
that some participating patients did not fulfill all the
standards.
Another issue that is being raised is that of
confidentiality of diagnoses obtained during the course
of patient participation. Here the question is that
whether the researcher should keep the diagnosis
confidential, if this diagnosis conflicts with that of the
hospital. If the patient or participant is not ensured
confidentiality, it is difficult to get accurate information of
symptoms from him. This may lead to inaccurate results
and undesired errors in the research. If a person with
severe mental disorder such as schizophrenia is being
treated or studied, lack of confidentiality may lead to
adverse relationship with the healthcare team [16].
brain waves or “Brain Music”. Such services should be refined
and made available to public. Although pharmaceutical
companies would get affected by such move, this should be
implemented considering the harmful effects posed by the anti
depressants and sedatives.
The drawbacks associated with doing research
involving mentally impaired participants are certainly present
and should be given a serious thought. If every participant is
chosen carefully, and all the ethical considerations given,
there is no point why human nation should not reap the
benefits offered.
If the present extensive research continues, there is
a possibility that the future treatment of these complex
disorders would change from capsules to music therapy.
References:
[1]
[2]
[3]
[4]
[5]
[6]
[7]
Conclusion:
Music therapy has been proved to alleviate certain
mental, physical and emotional and spiritual disorders. It is
difficult to study the dynamics of brain due to it complexity in
structure and interactions and then model them to predict the
possible outcomes if perturbed by abnormal conditions. Music
provides a good model for studying the complex interactions
taking place in the brain and relating them to the outside world
with which it is interacting. Modern music technology and
sophisticated brain imaging devices present today has
enabled scientists and researchers to study how music affects
the activity of brain in mentally impaired patients. It has been
shown to help patients suffering from Alzheimer’s disease for
which no cure has yet been discovered. With further research
and development in the field of music therapy, imaging
technology, music development systems, computer software
and medical information, it might become possible to identify
the underlying causes of certain mental disorders which have
been considered untreatable as yet. In the patients of
dementia, it is possible only after death, by the examination of
the brain tissue, to diagnose the disease conclusively [5].
Using music as a perturbation and other advanced
technologies it might become possible to find out a technique
for affective diagnosis of this disease.
Music therapy is used for the treatment of a number
of disorders. It reduces anxiety/depression and treats
insomnia by increasing relaxation. This does not require any
drug intervention; rather the music medicine is based on the
[8]
[9]
[10]
[11]
[12]
[13]
[14]
[15]
[16]
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