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Nancy Haider, BME 1450 Midterm Assignment, Oct 28, 2003 1 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 2 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 3 musical instruments integrated with computer software technology [15]. Nancy Haider, BME 1450 Midterm Assignment, Oct 28, 2003 4 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 5 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] Abbot, A., “Neurobiology: Music, maestro, please!,” Nature , vol. 416, 2002, pp. 12 – 14. Zatorre, R. J., Evans, A. C. & Meyer, E. J. Neurosci, vol. 14,1994, pp.1908–1919. Canadian Association for Music Therapy, Canada Annual General Meeting, Vancouver, British Columbia, www.musictherapy.ca, 1994, (accessed Oct 20, 2003). Aldridge, D., Aldridge, G. “Two epistemologies: Music therapy and medicine in the treatment of dementia,” The arts in psychotherapy, vol.19, 1992, pp. 243-255. Brotons, M., Kogger, S. M., Pickett-cooper, P., “Music and Dementias: A review of literature,” Journal of Music Therapy, vol. 34,4,1997, pp. 204-245. Rosch, P., Koditz, H., “Music and brain:Medical perspective,” www.musicandbrain.com (accessed: Oct 27,2003). Cevasco, A. M., Grant, R. E., “Comparison of different methods for eliciting exercise-to-music for clients with Alzheimer’s disease,” Journal of music therapy, vol. 40-1, 2003, pp. 41-56. Patel, A. D., “Language, music, syntax and the brain,” Nature Neuroscience, vol. 6 no. 7, 2003, pp. 674-681. Hodges, D. A., “Music and brain research: Sweater music all the time,” The Education Digest, vol. 66 no. 33, 2000, pp.49-54. Hodges, D. A., “Implications of music and brain research,” Music Educators Journal, vol. 87 no. 2, 2000, pp. 17-22. Snowdon, D., “The Nun Study,” University of kentucky, www.mc.uky.edu/nunnet, updated: Sep 30, 2003. (Accessed: Oct 27, 2003). Gregory, D., “Music listening for maintaining attention of older adults with cognitive impairments,” The journal of Music Therapy, vol. 39 no. 4, 2002, pp. 244-264. Magee, W. L., Davidson, J. W., “The effect of music therapy on mood states in neurological patients: A pilot study,” The Journal of Music Therapy, vol. 39, no. 1, 2002, pp.20-29. “Music therapy and autism” The music Therapy association of British Columbia, http://www.mtabc.com/autism.html , 2002, (Accessed: Oct 27, 2003). Whiteside, J. “Musical interlude helps improve sleep quality, research shows”. University of Toronto, http://www.newsandevents.utoronto.ca Aug 12, 2002. (Accessed: Oct 27, 2003) Schrag, B., Commentary on “Music Therapy: Research on human subjects with Mental Disorders”, The online ethics centre for engineering and science at CASE Western Reserve University. onlineethics.org/reseth/appe/vol4/music1.html, (Accessed: Oct 23, 2003)