Computer aided music therapy evaluation: Testing the Music Therapy Logbook prototype 1 system

Research indicates that music therapists are likely to make use of computer software, designed to measure changes in the way a patient and therapist make use of music in music therapy sessions. A proof of concept study investigated whether music analysis algorithms (designed to retrieve information from commercial music recordings) can be adapted to meet the needs of music therapists. Computational music analysis techniques were applied to multi-track audio recordings of simulated sessions, then to recordings of individual music therapy sessions; these were recorded by a music therapist as part of her ongoing practice with patients with acquired brain injury.The music therapist wanted to evaluate two hypotheses: one, whether changes in her tempo were affecting the tempo of a patient's play on acoustic percussion instruments, and two, whether her musical interventions were helping the patient reduce habituated, rhythmic patterning. Automatic diagrams were generated that gave a quick overview of the instrumental activity contained within each session: when, and for how long each instrument was played. From these, computational analysis was applied to musical areas of specific interest. The results of the interdisciplinary team work, audio recording tests, computer analysis tests, and music therapy field tests are presented and discussed.     

The sound of music: differentiating musicians using a fast, musical multi-feature mismatch negativity paradigm

Musicians' skills in auditory processing depend highly on instrument, performance practice, and on level of expertise. Yet, it is not known though whether the style/genre of music might shape auditory processing in the brains of musicians. Here, we aimed at tackling the role of musical style/genre on modulating neural and behavioral responses to changes in musical features. Using a novel, fast and musical sounding multi-feature paradigm, we measured the mismatch negativity (MMN), a pre-attentive brain response, to six types of musical feature change in musicians playing three distinct styles of music (classical, jazz, rock/pop) and in non-musicians. Jazz and classical musicians scored higher in the musical aptitude test than band musicians and non-musicians, especially with regards to tonal abilities. These results were extended by the MMN findings: jazz musicians had larger MMN-amplitude than all other experimental groups across the six different sound features, indicating a greater overall sensitivity to auditory outliers. In particular, we found enhanced processing of pith and sliding up to pitches in jazz musicians only. Furthermore, we observed a more frontal MMN to pitch and location compared to the other deviants in jazz musicians and left lateralization of the MMN to timbre in classical musicians. These findings indicate that the characteristics of the style/genre of music played by musicians influence their perceptual skills and the brain processing of sound features embedded in a musical context. Musicians' brain is hence shaped by the type of training, musical style/genre, and listening experiences.     

Musicogenic Epilepsy: Review of the Literature and Case Report with Ictal Single Photon Emission Computed Tomography

Summary: Purpose : We report a case of musicogenic epilepsy with ictal single photon emission computed tomography (SPECT) study and discuss the findings of this patient in the context of 76 cases with musicogenic epilepsy described in the literature and seven other cases followed in Zurich.
Methods : We analyzed the 83 patients according to the precipitating musical factors, type of epilepsy, presumed localization of seizure onset, and demographic data.
Results : Fourteen of 83 patients (17%) had seizures triggered exclusively by music. At time of examination, music was the only known precipitating stimulus in 65 of 83 patients (78%). Various characteristics of the musical stimulus were significant, e.g., musical category, familiarity, and instruments.
Conclusions : Musicogenic epilepsy is a particular form of epilepsy with a strong correlation to the temporal lobe and a right-sided preponderance. A high musical standard might predispose for musicogenic epilepsy. Moreover, the majority of cases do not fall into the category of a strictly defined "reflex epilepsy", but appear to depend on the indermediary of a certain emotional reaction mediated through limbic mesial temporal lobe structures.     

Music therapy for dementia and higher cognitive dysfunction: a review

Music is known to affect the human mind and body. Music therapy utilizes the effects of music for medical purposes. The history of music therapy is quite long, but only limited evidence supports its usefulness in the treatment of higher cognitive dysfunction. As for dementia, some studies conclude that music therapy is effective for preventing cognitive deterioration and the occurrence of behavioral and psychological symptoms of dementia (BPSD). In patients receiving music therapy for the treatment of higher cognitive dysfunction, aphasia was reported as the most common symptom. Many studies have been conducted to determine whether singing can improve aphasic symptoms: singing familiar and/or unfamiliar songs did not show any positive effect on aphasia. Melodic intonation therapy (MIT) is a method that utilizes melody and rhythm to improve speech output. MIT is a method that is known to have positive effects on aphasic patients. Some studies of music therapy for patients with unilateral spatial neglect; apraxia; hemiparesis; and walking disturbances, including parkinsonian gait, are available in the literature. Studies showed that the symptoms of unilateral spatial neglect and hemiparesis significantly improved when musical instruments were played for several months as a part of the music therapy. Here, I describe my study in which mental singing showed a positive effect on parkinsonian gait. Music is interesting, and every patient can go through training without any pain. Future studies need to be conducted to establish evidence of the positive effects of music therapy on neurological and neuropsychological symptoms.     

Music and epilepsy: a critical review

The effect of music on patients with epileptic seizures is complex and at present poorly understood. Clinical studies suggest that the processing of music within the human brain involves numerous cortical areas, extending beyond Heschl's gyrus and working within connected networks. These networks could be recruited during a seizure manifesting as musical phenomena. Similarly, if certain areas within the network are hyperexcitable, then there is a potential that particular sounds or certain music could act as epileptogenic triggers. This occurs in the case of musicogenic epilepsy, whereby seizures are triggered by music. Although it appears that this condition is rare, the exact prevalence is unknown, as often patients do not implicate music as an epileptogenic trigger and routine electroencephalography does not use sound in seizure provocation. Music therapy for refractory epilepsy remains controversial, and further research is needed to explore the potential anticonvulsant role of music. Dopaminergic system modulation and the ambivalent action of cognitive and sensory input in ictogenesis may provide possible theories for the dichotomous proconvulsant and anticonvulsant role of music in epilepsy. The effect of antiepileptic drugs and surgery on musicality should not be underestimated. Altered pitch perception in relation to carbamazepine is rare, but health care professionals should discuss this risk or consider alternative medication particularly if the patient is a professional musician or native-born Japanese. Studies observing the effect of epilepsy surgery on musicality suggest a risk with right temporal lobectomy, although the extent of this risk and correlation to size and area of resection need further delineation. This potential risk may bring into question whether tests on musical perception and memory should form part of the preoperative neuropsychological workup for patients embarking on surgery, particularly that of the right temporal lobe.     

Aspects of psychotherapies. Music therapy and its specificity]

Musicotherapy, associating art and science, concerns a sensorial approach, in a therapeutic aim, through sound and music, to psychological difficulties, of numerous somatic and psychosomatic troubles, as well as neurotic and psychotic disease. Music therapy is one of the art-therapy methods, all of them dealing with mediation in reference to Winnicott, leading the patients to active and creative participation and being most of the time shorter than classical verbal therapies. It may be considered as being related to the main theories of modern psychotherapies, and refers either to Psychoanalysis or to behaviour therapies, or to cognitive therapies, or to humanistic therapies ... but, whatever its main basic theory, musicotherapy shows its specificity. Its specific features are: the variety and complexity of its techniques; the specificity of the therapeutic relation; patient, music, and therapist are united through a triangular relationship; transference is of a special quality; the way the therapist answers the patient and helps him may be either verbal or musical. Practising music and listening to music must not be considered as a therapy. Music is not therapeutic in itself. It becomes so when music is used in techniques organised in a therapeutic aim. Musicotherapy may be necessary for a patient who suffers, who asks to be helped and who finds through music a way of expression and communication. The therapeutic aim has nothing to do with musical training. Musicotherapy concerns children as well as adults and elderly people, but requires different techniques adapted to the category of patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Neurophysiology and neurobiology of the musical experience

Music, a universal art form that exists in every culture around the world, is integral to a number of social and courtship activities, and is closely associated with other creative behaviours such as dancing. Recently, neuroimaging studies have allowed researchers to investigate the neural correlates of music processing and perception in the brain. Notably, musical stimuli have been shown to activate specific pathways in several brain areas associated with emotional behaviours, such as the insular and cingulate cortex, hypothalamus, hippocampus, amygdala, and prefrontal cortex. In addition, neurochemical studies have suggested that several biochemical mediators, such as endorphins, endocannabinoids, dopamine and nitric oxide, may play a role in the musical experience. A growing body of evidence also indicates that music therapy could be useful in the clinical management of numerous neurological and psychiatric disorders. Indeed, music therapy could be effective in patients with neurodegenerative disorders, such as Alzheimer's dementia and Parkinson?s disease, as well as in psychiatric illnesses, such as schizophrenia, depression, anxiety and autism spectrum disorders. Unfortunately, there is still a shortage of rigorous scientific data supporting the clinical application of music therapy, and there is thus a need to confirm and expand the preliminary findings regarding the potential and actual effectiveness of music therapy. This need should be addressed through prospective, randomized, controlled, single-blinded investigations of the short- and long-term effects of music therapy in diverse clinical conditions.     

Music Perception and Cognition: A Review of Recent Cross‐Cultural Research

Experimental investigations of cross‐cultural music perception and cognition reported during the past decade are described. As globalization and Western music homogenize the world musical environment, it is imperative that diverse music and musical contexts are documented. Processes of music perception include grouping and segmentation, statistical learning and sensitivity to tonal and temporal hierarchies, and the development of tonal and temporal expectations. The interplay of auditory, visual, and motor modalities is discussed in light of synchronization and the way music moves via emotional response. Further research is needed to test deep‐rooted psychological assumptions about music cognition with diverse materials and groups in dynamic contexts. Although empirical musicology provides keystones to unlock musical structures and organization, the psychological reality of those theorized structures for listeners and performers, and the broader implications for theories of music perception and cognition, awaits investigation.     

A musical assessment of psychiatric states in adults

In music therapy, joint musical improvisation of therapist and subject provides the framework for a spontaneous and intimate, non-verbal interaction. This study shows that such an interaction can be used to reveal the subject's capacity for emotional contact with another person, the nature of this contact and how well it is sustained. We examine the musical interaction in first music therapy sessions using a model of analysis specially developed for this study. A comparison between 15 schizophrenics, 15 depressed patients and 15 clinically normal controls revealed significant differences. The findings, which take into account subjects' musical background and perceptual functioning, have implications for the diagnostic use of music therapy in adult psychiatry.     

The Music of Silence: Part I: Responses to Musical Imagery Encode Melodic Expectations and Acoustics

Musical imagery is the voluntary internal hearing of music in the mind without the need for physical action or external stimulation. Numerous studies have already revealed brain areas activated during imagery. However, it remains unclear to what extent imagined music responses preserve the detailed temporal dynamics of the acoustic stimulus envelope and, crucially, whether melodic expectations play any role in modulating responses to imagined music, as they prominently do during listening. These modulations are important as they reflect aspects of the human musical experience, such as its acquisition, engagement, and enjoyment. This study explored the nature of these modulations in imagined music based on EEG recordings from 21 professional musicians (6 females and 15 males). Regression analyses were conducted to demonstrate that imagined neural signals can be predicted accurately, similarly to the listening task, and were sufficiently robust to allow for accurate identification of the imagined musical piece from the EEG. In doing so, our results indicate that imagery and listening tasks elicited an overlapping but distinctive topography of neural responses to sound acoustics, which is in line with previous fMRI literature. Melodic expectation, however, evoked very similar frontal spatial activation in both conditions, suggesting that they are supported by the same underlying mechanisms. Finally, neural responses induced by imagery exhibited a specific transformation from the listening condition, which primarily included a relative delay and a polarity inversion of the response. This transformation demonstrates the top-down predictive nature of the expectation mechanisms arising during both listening and imagery.SIGNIFICANCE STATEMENT It is well known that the human brain is activated during musical imagery: the act of voluntarily hearing music in our mind without external stimulation. It is unclear, however, what the temporal dynamics of this activation are, as well as what musical features are precisely encoded in the neural signals. This study uses an experimental paradigm with high temporal precision to record and analyze the cortical activity during musical imagery. This study reveals that neural signals encode music acoustics and melodic expectations during both listening and imagery. Crucially, it is also found that a simple mapping based on a time-shift and a polarity inversion could robustly describe the relationship between listening and imagery signals.     

The use of music therapy with pediatric patients undergoing cardiac catheterization

This paper describes a technique which was developed while working with pediatric cardiac catheterization patients. Observations were made as to whether music might be useful as: (1) a supportive, nonthreatening aid in preparing pediatric patients psychologically for cardiac catheterization: (2) providing a means of relaxation during the cardiac catheterization procedure for these patients. Comments of patients and their parents were taken into account along with a questionnaire which the catheterization staff answered upon termination of the music therapy program in the laboratory. Although more research is needed, these comments and questionnaire results seemed to indicate that the use of music as a nonthreatening and relaxing supportive aid may be of value in preparing pediatric patients for catheterization as well as during the catheterization itself.     

Effects of music therapy on positive and negative affect and pain with hospitalized patients recovering from a blood and marrow transplant: A randomized effectiveness study

Due to the extensive procedures surrounding treatment, cancer patients often experience a variety of physical and psychological symptoms and side effects that negatively impact their quality of life and ability to cope with and manage an illness. Providing a choice of music during a receptive music therapy session may not only distract the patient from negative affective states, but also may provide a sense of autonomy and control over a patient's immediate environment. The purpose of the study was to determine whether receptive music therapy can improve two general dimensions of emotional experience and pain in a single session for hospitalized patients recovering from a blood and marrow transplantation (BMT) procedure. The guiding research question was: Will participants experience improved positive and negative affect and pain immediately following a patient-preferred live music therapy session? Participants (N = 32) were randomly assigned to experimental or wait-list control conditions and completed the Positive and Negative Affect Schedule (Watson, Clark, & Tellegen, 1988) Short Form version and a Likert-type Pain Scale as a pre- and posttest within a single-session design. In an attempt to provide support, autonomy, and distraction, patient-preferred live music was used in receptive music therapy sessions as previous music therapy researchers indicated patient-selected live music is preferred and can be effective. There were no between-group differences at pretest. Concerning posttest analyses, there were significant between-group differences in positive and negative affect and pain, with experimental participants having more favorable scores than control participants. From the results of this randomized effectiveness study, it seems that a single receptive music therapy session can be an effective intervention concerning positive and negative affect and pain for hospitalized BMT patients. As higher levels of patient engagement may result in stronger treatment effects, future research encouraging hospitalized BMT patients to engage in different types of active music therapy interventions is warranted. Limitations of the study, implications for clinical practice, and suggestions for future research are provided.     

Music therapy and neuropsychology: a proposal to music therapy based on the cognitive processing of music

In the last decade, a considerable number of studies have been made on the cognitive processing of music. A patient with pure amusia due to the infarction of anterior portion of bilateral temporal lobes revealed the disturbance of the discrimination of chords. Using positron emission tomography, these regions were activated when musically naive normal subjects listened to the harmony compared to the rhythm of identical music. So, we concluded that anterior temporal portion might participate in the recognition of chords. Several articles reported that the musician's brain was different from nonmusicians' functionally and anatomically. This difference was considered to be caused by the musical training for a long time. Recent studies clarified that the reorganization might occur by musical training for a few months. Melodic intonation therapy (MIT) is a method aimed to improve speech output of aphasic patients, using short melodic phrase with a word. The literatures of mental processing of music suggested that right hemisphere might participate in the expression of music, namely singing and playing instrumentals. So, it was supposed that MIT utilized the compensational function of right hemisphere for damaged left hemisphere. We also reported that mental singing improved the gait disturbance of patients with Parkinson's disease. Music therapy is changing from a social science model based on the individual experiences to a neuroscience-guided model based on brain function and cognitive processing of the perception and expression of music.     

The perception of musical phrase structure: a cross-cultural ERP study

Electroencephalography (EEG) was used in a cross-cultural music study investigating phrase boundary perception. Chinese and German musicians performed a cultural categorization task under Chinese and Western music listening conditions. Western music was the major subject for both groups of musicians, while Chinese music was familiar to Chinese subjects only. By manipulating the presence of pauses between two phrases in the biphrasal melodies, EEG correlates for the perception of phrase boundaries were found in both groups under both music listening conditions. Between 450 and 600 ms, the music CPS (closure positive shift), which had been found in earlier studies with a false tone detection task, was replicated for the more global categorization task and for all combinations of subject group and musical style. At short latencies (100 and 450 ms post phrase boundary offset), EEG correlates varied as a function of musical styles and subject group. Both bottom-up (style properties of the music) and top-down (acculturation of the subjects) information interacted during this early processing stage.     

Effects of music and music therapy on mood in neurological patients

Mood disorder and depressive syndromes represent a common comorbid condition in neurological disorders with a prevalence rate that ranges between 20% and 50% of patients with stroke, epilepsy, multiple sclerosis, and Parkinson’s disease. Notwithstanding, these conditions are often under-diagnosed and under-treated in the clinical practice and negatively affect the functional recovery, the adherence to treatment, the quality of life, and even the mortality risk. In addition, a bidirectional association between depression and neurological disorders may be possible being that depressive syndromes may be considered as a risk factor for certain neurological diseases. Despite the large amount of evidence regarding the effects of music therapy (MT) and other musical interventions on different aspects of neurological disorders, no updated article reviewing outcomes such as mood, emotions, depression, activity of daily living and so on is actually available; for this reason, little is known about the effectiveness of music and MT on these important outcomes in neurological patients. The aim of this article is to provide a narrative review of the current literature on musical interventions and their effects on mood and depression in patients with neurological disorders. Searching on PubMed and PsycInfo databases, 25 studies corresponding to the inclusion criteria have been selected; 11 of them assess the effects of music or MT in Dementia, 9 explore the efficacy on patients with Stroke, and 5 regard other neurological diseases like Multiple Sclerosis, Amyotrophic Lateral Sclerosis/motor neuron disease, Chronic quadriplegia, Parkinson’s Disease, and Acquired Brain dysfunctions. Selected studies are based on relational and rehabilitative music therapy approaches or concern music listening interventions. Most of the studies support the efficacy of MT and other musical interventions on mood, depressive syndromes, and quality of life on neurological patients.     

Discrepancy between musical ability and language skills in children with Williams syndrome

BackgroundChildren with Williams syndrome (WS) show a marked interest in music, a characteristic often explored in clinical settings. However, the actual musical abilities of patients with WS remain debatable due to some of the relevant data being derived from experimental tasks that require a verbal response, despite the known language impairments in WS. The present study aimed to examine musical ability in children with WS using a newly invented pitch discrimination task with minimal involvement of language and clarify its relationship with language skill.MethodsEleven children with WS participated in the study. We used a novel pitch discrimination task that required minimal language use. Two piano tones were presented sequentially, and children were asked to give a non-verbal response as to whether the second tone was higher than, lower than, or the same as the first tone.ResultsPitch discrimination performance in children with WS was lower than the level predicted for their chronological age (CA), even in the non-verbal task. Pitch discrimination ability and verbal mental age (VMA) were shown to be dissociated, such that children with WS with a lower skill level for language showed an unexpectedly higher level of pitch discrimination ability and vice versa.ConclusionsOur results indicated reduced musical ability with respect to CA in children with WS. The dissociation between musical ability and language skills may indicate unique developmental relationships that differ from those in normal children. These findings provide new evidence to support the importance of assessing actual musical ability in WS prior to implementing interventional music therapy.     

Constructing a grounded theory of young people's recovery of musical identity in mental illness

Musical identity is a highly relevant, yet little researched area within mental illness. In this study, the researchers explore how 11 young people's musical identities changed during their experiences of, and recovery from mental illness. The researchers use a constructivist grounded theory approach to collect and analyse in-depth interviews with young people attending a music therapy programme at a youth mental health service. Findings are presented as a constructivist grounded theory of young people's recovery of musical identity. This interpretation illustrates how aspects of these young people's pathology presents as ‘musical symptoms’ during acute illness and the ways in which young people engage in processes of ‘bridging’ and ‘playing out’ musical identity in the community. The role of music therapy in supporting young people's recovery from mental illness is presented, and the need to consider community-based music services is discussed.     

Psychotherapeutic facilitation of musical creativity.

The distinction between musical composition and performing is an historical artifact. Both activities have creative components, expressed by composers through the originality of their scores, and by performers through their unique and stirring interpretations. Music represents an artistic refinement of biologically driven activities, serving the need for communication, self-orientation, social contact, and emotional expression through soundmaking. Developmental factors--attachment to a soundmaking object, parental influence, the role of teachers, and supportive environments--have been reviewed in connection with the choice of music as career or avocation, and in the assessment of talents and handicaps presented by musical patients. Some historical examples serve to show that psychotherapy has traditionally been modified to fit the special needs of musicians. Familiarity with the musical culture and community can be helpful in treating these patients, and special clinics or health programs for performing artists have been established over the past few years. Three case examples are presented, based on experience with musician-patients in San Francisco, to illustrate different ways of providing psychotherapy that enhances musical creativity.     

The musical life of an autistic boy

A hyperactive 8-year-old autistic boy who had exceptional musical ability and absolute pitch but who was unable to read music was given training in several aspects of music in individual lessons two or three times a week during a four-year period. He now reads piano music moderately well and can read melodies and accompany himself with chords at the piano. His behavior improved steadily as he became more competent in musical activities, and his ability to concentrate improved as he was brought to read music and perform it in rhythm without letting his attention wander. His comprehension of music was aided considerably by practice in taking dictation and learning to write the notes of the melodies with the correct rhythmic values.     

A case of musical agraphia

Damage to the left upper parietal lobule causes pure agraphia. However, we experienced a patient who exhibited musical agraphia following such a lesion after the agraphia improved. The patient was a 53-year-old female piano teacher. After surgery, she exhibited agraphia and musical agraphia. There was no expressive amusia, receptive amusia, aphasia, agnosia or apraxia. Fifteen months post-surgery, when her agraphia had resolved, her abilities to read, write, and copy music were evaluated. She could read and write single notes and musical signs, but her ability to write a melody was seriously impaired. Furthermore, the salient impairment was in writing rhythm rather than pitch. She could copy music, but only slowly. We consider her a case of pure musical agraphia.