The role of music therapy in rehabilitation: improving aphasia and beyond

Music is part of the human nature, and it is also philogenically relevant to language evolution. Language and music are bound together in the enhancement of important social functions, such as communication, cooperation and social cohesion. In the last few years, there has been growing evidence that music and music therapy may improve communication skills (but not only) in different neurological disorders. One of the plausible reasons concerning the rational use of sound and music in neurorehabilitation is the possibility to stimulate brain areas involved in emotional processing and motor control, such as the fronto-parietal network.

In this narrative review, we are going to describe the role of music therapy in improving aphasia and other neurological disorders, underlying the reasons why this tool could be effective in rehabilitative settings, especially in individuals affected by stroke.     

Reduced body cell mass following severe head injury in children: implications for rehabilitation

Statement of purpose: Increased proteolysis, muscle catabolism and altered body composition have been well documented after severe head injury, but the extent of these effects in children, and whether they extend into rehabilitation, have not been studied. This study determined nutritional status and body composition, with particular reference to the body cell mass (BCM), of head injured children at entry into a rehabilitation programme, and compared body composition analysis with anthropometric nutritional assessment. Methods: Nineteen head injured children (nine males, 10 females, mean age 9:1=4:3 years range 1.2-15.1 years) were measured for height, weight and total body potassium (TBK, a measure of body cell mass) on referral to rehabilitation after the acute phase (mean 38.1 days post-injury). Data was compared with expected normative data derived from healthy age and gender matched children. Nutritional status was determined by two separate criteria based on either anthropometric or body composition methods. Results: The mean percentage of expected TBK for height was 84:4=15%, significantly below the clinically acceptable level for body cell mass (90% of expected). Using the anthropometric definition, only 1/19 was undernourished, whereas 12/19 had poor nutritional status using body composition (chi2=7:58, p=0:006). Conclusions: The data revealed a significant depletion in the metabolically active BCM in the presence of normal anthropometry, suggestive of significant muscle wasting. These findings have important pathophysiological and clinical implications in the rehabilitation of children following major head trauma.     

Resting energy expenditure of children attending a rehabilitation programme following head injury

Statement of purpose: Increased resting energy expenditure following head injury is well documented, but whether this increase extends into rehabilitation and whether this is affected by changes in body composition have not been studied. The aim of this study was to determine whether children attending a rehabilitation program following head injury had altered energy expenditure and body composition. Methods     

儿童孤独症康复治疗的研究进展

儿童孤独症起病早,以语言障碍、社会交往（人际关系）障碍、兴趣狭窄及行为重复刻板为主要临床表现,多数伴有智能落后。由于孤独症是一种全面的发育障碍,其不仅严重影响患者的生存质量,还给患者家庭带来沉重的心理和经济负担。由于孤独症致病因素众多,目前尚无特异的治愈手段,如何有效治疗孤独症仍是世界难题。多年来国内外学者探索性的治疗成果提示积极的康复治疗能有效提高孤独症儿童的生活质量。现将近年来康复治疗取得的进展综述如下。     

农娱治疗在精神分裂症患者社会功能康复中的作用

目的 探讨农娱治疗在精神分裂患者社会功能康复中所起的作用。方法 治疗组315例,采用药物治疗结合农娱治疗;对照组300例,使用单纯药物治疗。对以上两组的治疗结果,经住院慢性精神分裂症社会功能评定量表测查,对测查结果进行统计学处理。结果 治疗组与对照组的社会功能恢复程度存在显著性差异。结论农业治疗结合体娱治疗,对精神分裂症患者的社会功能康复,有一定的促进作用。     

改良森田疗法对精神分裂症康复疗效的观察

目的 探讨改良森田疗法与康复疗法对精神分裂症康复疗效的比较。方法 改良森田疗法和康复法,都以文娱、体育、工艺、书法绘画等作业内容为基本手段。改良森田疗法在相对卧床期、轻作业期、重作业期和康复期中,运用森田疗法的理论指导患者明确各期的目的和行为准则,通过实施达到预期的康复目标。康复疗法则以组织指导患者积极参与作业活动来达到训练提高社会功能的目的。结果 改良森田疗法组与康复疗法组治疗前后IPROS分量表及总分值对照均有显著差异(P<0.01);两组相互对照,改良森田疗法组康复效果更显著(P<0.01)。两组治疗前后BPRS量表总分及因子分自身对照均有显著意义;治疗后改良森田疗法组的焦虑忧郁和缺乏活力因子分的减分率更明显(P<0.01)。治疗前后两组自知力恢复自身对照均有显著意义(P均<0.01);治疗后两组对照,改良森田疗法组的自知力恢复比康复疗法组更显著(P<0.01)。结论 改良森田疗法和康复疗法对协助临床改善精神分裂症的部分精神症状、自知力的恢复和社会功能的提高均有效,两者比较,改良森田疗法的疗效更显著。     

The use of music therapy to promote attachment between parents and infants

The promotion of attachment behaviours between parents and infants through music-based interventions is an emerging specialism in music therapy practice. The theoretical formations and research to support this work are increasingly being elaborated, and the work of music therapists with clients throughout the lifespan increasingly draws on this rich theoretical base.This paper provides an overview of the theoretical underpinnings that inform the work of qualified music therapists in promoting healthy and secure attachment between parents and infants where disruption to a secure relational bond has occurred, or is vulnerable in some way. Characteristics of the innate musicality of the very young infant are considered, and the mutual regulation potentials of music making between caregivers and their developing infants is presented.Recognising the musicality of early parent-infant interactions allows for a deeper theorising of the effects and benefits of music therapy for this population as well as a unique insight into how sensitive responding through shared timings and synchrony builds capacity for the essentials of emotional intimacy for the developing couple. For the purposes of this review the definition of infant used is the broadest possible: from birth until 3 years and 11 months of age.     

Recovery of educational skills following paediatric traumatic brain injury

Academic success in the classroom is often dependent upon a child's ability in the areas of literacy, such as reading and spelling, and arithmetic. Following traumatic brain injury these skills are often compromised. The present study examined the recovery of educational skills (reading accuracy, reading comprehension, spelling and arithmetic) over 24 months post-injury, in a group of children who had sustained a mild, moderate or severe TBI. Results showed that the severe TBI group exhibited greater deficits on reading comprehension and arithmetic, while the moderate and severe TBI groups performed similarly in the areas of reading accuracy and spelling. Future research is required to further investigate predictors of educational outcome post-TBI.     

Music technology usage in music therapy: A survey of practice

The purpose of this study was to determine (a) how many music therapists use music technology in their clinical work, (b) trends regarding music technology usage related to gender, age, and/or geographical location, (c) how music therapists acquire knowledge and/or training in music technology, (d) barriers to using music technology in clinical work, (e) types of music technology music therapists currently use, and (f) why music therapists do or do not use music technology in their clinical practice. Participants (N = 600) completed a 27-question survey with a 95% completion rate. The return rates for participants by country were: (a) US 27%, (b) Australia 6%, (c) Canada 9%, and (d) UK 9%. Both quantitative and qualitative analyses of the data were conducted. A majority of the music therapists surveyed (71%, n = 443) reported using music technology in the clinical setting. Differences in technology usage were found according to age and gender of the participants. Most of the participants reported to be self-taught (61%, n = 464). Results of this study indicated that more training in music technology related to clinical practice is needed, with attention given to ways to make more technology accessible to a variety of learners.     

Complementary/alternative medicine in chronic paediatric diseases-prevalence and parental psychological factors

Seventeen children aged 5-16 years old ( M = 11.3, SD = 2.97, Range= 6.25-16.00) were assessed between 4-5 years post-severe closed head injury, using the Wide Range Assessment of Memory and Learning (WRAML). Compared to age and sex matched controls, this group demonstrated deficits in the ability to learn new information, particularly their rate of learning. Deficits were more apparent with verbal than visual material. There were no indications of differences in delayed recall as measured by the amount of information lost nor in recognition memory. Results indicate that retrieval deficits may be an important component of memory difficulties in severe closed head injury. Educational implications are considered.     

Aggression in music therapy and its role in creativity with reference to personality disorder

This article describes a project that explored the relationship between aggression and creativity in music therapy. It examines the role of aggression in psychological growth and how music therapy might have a unique role in channelling aggression. An exploratory qualitative study included a mixed methods approach of a case study and thematic analysis of interviews. It included three interviews with three experienced music therapists who were asked about their experience of aggression in music therapy. The case study supports the evidence gathered in the interviews, and describes short-term individual music therapy treatment with a man with a personality disorder diagnosis and a history of extremely aggressive behaviour. The study suggested a strong link between aggression, affect and body movement. Gathered information and results from interview analysis showed that aggression and creativity share important similarities in areas of mastery and control, affect and emotion, and action and intention. Conclusions of the study showed that music therapy can sometimes provide a context for safe exploration of aggression and deeper feelings. It can also enable the individual to sublimate negative emotions through appropriate expression.     

Assessment of speed of processing after paediatric head trauma: need for better norms

The neuropsychological test scores of 47 children with traumatic head injury (THI), aged 9-14 years, were evaluated to determine the relative contributions of severity of injury (length of coma) and age on performance. Stepwise regression analyses revealed that age consistently explained a statistically significant proportion of the variance on the Trail Making Test (TMT) and Finger Tapping Test (FTT), even after accounting for injury severity. However, logistic regression analyses indicated that currently available age-based norms for these tests did not improve classification of mild-moderate vs. severe injuries, as compared to a system based exclusively on raw scores. It is concluded that, whereas age is an important consideration when assessing children with THI, available age-based norms for some common paediatric neuropsychological tests do not appear to be sufficiently stratified or robust to fully capture these age effects. It is suggested that more comprehensive age-referenced norms, based on larger and more adequately stratified samples, are needed. In addition, some practical implications of these findings are discussed.     

Effect of a combined dance/movement and music therapy on young adults diagnosed with severe autism

Current literature is scarce on the potential effects of combined dance/movement and music therapy on adults diagnosed with severe autism, particularly in distinguishing these effects on different areas of psychopathological disorders. We set two goals: first, to assess the effectiveness based on the score the participants obtained from the Revised Clinical Scale for the Evaluation of Autistic Behavior (ECA-R) after a series of dance/movement and music therapeutic procedures on adults with severe autism; second, to contrast the differences in effectiveness in concrete areas defined by subscales of the ECA-R, especially in its defined 2 factors and 12 functions. An overall of 36 one-hour sessions were carried out during 17 weeks on a sample of 8 participants with severe autism (approximately 2 sessions per week). During the treatment 8 measurements were taken (1 every 3 weeks) from this sample and from a control sample, which was also comprised of 8 subjects who were equally monitored at the same care center by two independent psychologists. Our experimental study seems to suggest that combined dance/movement and music therapy could be effective if used regularly for the improvement of autistic symptoms in adults diagnosed with severe autism.     

A woman's voice: The politics of gender identity in music therapy and everyday life

In contrast to a comparative model of gender that implies that gender is something you have, a performative model of gender points towards gender as something that is construed in relationship and in context. From this perspective music therapy can be understood as an arena for performance and negotiations of gender. In this process, music therapy can conceal a range of socio-cultural and political dimensions significant in how people manage their sense of self, health, and well-being. This article explores how gender and sexuality are located through singing as a musical act and cultural gesture, and how the social presence of the voice is implicated in sexual politics. Using the experiences of a young woman in music therapy as a point of departure, this article examines the notion of interrupted voices in everyday life and therapy.     

音乐疗法对应激性失眠易感人群唤醒度的影响

目的探讨应激性失眠易感人群的高唤醒机制及音乐疗法对其唤醒度的影响。方法选择中国康复研究中心北京博爱医院的健康医护人员33人,根据福特应激失眠反应测验量表中文版(FIRST-C)中位值(17分)分为易感组(16人)和非易感组(17人),采用加拿大Thought Technology公司生产的多参数生理指标监测系统采集一般生理指标(包括指端脉搏血容振幅、皮温、皮肤电传导、呼吸频率和波幅、心率)以及脑电波[包括δ波、θ波、低波幅和高波幅α波、α波、感觉运动节律(SMR)、低波幅和高波幅β波]。结果与非易感组相比,易感组受试者治疗前后皮肤电传导升高(P=0.003,0.001)、SMR波幅升高(P=0.015,0.031)和低波幅β波波幅升高(P=0.000,0.001),仅治疗后高波幅β波波幅升高(P=0.004);与治疗前相比,治疗后两组受试者指端脉搏血容振幅降低(P=0.000)、皮温升高(P=0.000)、呼吸频率增加(P=0.008)、心率减少(P=0.000),以及易感组皮肤电传导降低(P=0.001)、呼吸波幅降低(P=0.032)、高波幅α波(P=0.017)和低波幅β波(P=0.013)波幅降低,非易感组皮肤电传导降低(P=0.039)、低波幅(P=0.035)和高波幅(P=0.031)α波波幅降低、α波波幅降低(P=0.044)、低波幅β波波幅降低(P=0.015)。结论平静状态下应激性失眠易感人群生理和皮质均表现出高唤醒趋势;音乐疗法可以降低其高唤醒机制,尤以生理指标改善显著,可以作为健康管理手段,预防应激性失眠易感人群进展为慢性失眠。     

The rehabilitation of brain injured children: the case for including physical exercise and virtual reality

Whilst substantial advances in rehabilitation programmes for brain injured children have been made, there is still a fundamental need to improve understanding of the rehabilitation process and how this can be incorporated into practice. It is argued here that taking a neurological approach to improving cognition, mood and social functioning is likely to be of great benefit to the patient. Theoretical reasons are outlined as to why activities such as interactive exercise can improve both the structure and function of the brain, and it is recommended that further research is carried out to establish the effectiveness of these types of activities.     

The role of mood and personality in the perception of emotions represented by music

Neuroimaging studies investigating the processing of emotions have traditionally considered variance between subjects as statistical noise. However, according to behavioural studies, individual differences in emotional processing appear to be an inherent part of the process itself. Temporary mood states as well as stable personality traits have been shown to influence the processing of emotions, causing trait- and mood-congruent biases. The primary aim of this study was to explore how listeners’ personality and mood are reflected in their evaluations of discrete emotions represented by music. A related aim was to investigate the role of personality in music preferences. An experiment was carried out where 67 participants evaluated 50 music excerpts in terms of perceived emotions (anger, fear, happiness, sadness, and tenderness) and preference. Current mood was associated with mood-congruent biases in the evaluation of emotions represented by music, but extraversion moderated the degree of mood-congruence. Personality traits were strongly connected with preference ratings, and the correlations reflected the trait-congruent patterns obtained in prior studies investigating self-referential emotional processing. Implications for future behavioural and neuroimaging studies on music and emotions are raised.     

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.     

A discussion of evidence-based music therapy to facilitate feeding skills of premature infants: The power of contingent music

Due to neurologic immaturity, premature infants must be fed by tube until approximately 34 gestational weeks and many have subsequent problems with transition to oral feeding. In the United States, infants whose only problem is ineffective feeding remain in the Neonatal Intensive Care Unit at an average cost of $2000/day until independent nippling with regular weight gain is achieved. This is a serious and prevalent problem that increases medical costs and risk of developmental delays. Research shows that infants generally thrive more in the home with home-based nursing support and medical monitoring than in the hospital and the earliest possible discharge date is preferred.     

Rehabilitation of everyday memory deficits in paediatric brain injury: Self-instruction and diary training

Memory problems that interfere with everyday living are frequently reported in children who have sustained acquired brain injury (ABI), but their nature and rehabilitation is under-researched. This study aimed to (1) determine neuropsychological correlates of everyday memory deficits in children with ABI, and (2) investigate the effectiveness of a newly developed programme for their rehabilitation. We assessed everyday memory, verbal memory, attention and behaviour in 15 children with ABI. The children attended the everyday memory rehabilitation programme: six weekly sessions that involved diary training, self-instruction training and case examples. At the onset we found that everyday memory problems were related to impaired attention and behavioural difficulties. On completion of the programme there was a significant increase in children's abilities to perform daily routines that demanded recall of information and events. In addition, children used diaries more frequently. Moreover, significant secondary gains were found in attention and mood (anxiety and depression). In conclusion, the results provided preliminary evidence that our six week programme could be effective in reducing everyday memory difficulties and improving psychological well-being in children with ABI.