Tuesday, October 28, 2014

What new research findings have developed in using music to alleviate the symptoms of Parkinson’s Disease patients?

          In his book, Music, The Brain, and Ecstasy: How Music Captures Our Imagination, Robert Jourdain describes the malady of Parkinson’s Disease (PD) as a malfunction of the substantia nigra in the basal ganglia, leading to impaired movement and motor functions. The book explains Dr. Oliver Sacks’ discovery that many PD patients responded to music through listening and were able to temporarily move again. However, the stipulation is that the patient must be in the right mood with their preferred type of music. In some PD patients, the mere thought of music, by mentally “playing” through compositions, generated normal EEG (Jourdain, 1997). However, as the music comes to a halt, so too does the freedom from impaired movements. It is clear that music creates a sense of flow in the brain, permitting for a higher degree of integration, thereby allowing patients to move with more fluidity. Although these findings have been significant, newer scholarly literature has been produced since Jourdain’s book was published in 1997. This essay aims to update Jourdain’s research on music and PD patients by investigating the effects of vibroacoustic therapy (VAT) and singing. 
          VAT is a useful approach that uses audible to create mechanical vibrations applied directly to the body by a vibrating surface such as a mattress, chair, or table. Vibrations have been used for many years across several cultures to restore mental, physical and emotional balance. Within the medical field, it has been used in ultrasound technology, to treat tissue contractures, and to break kidney stones (Boyd-Brewer, 2004). There are many benefits to VAT such as alleviating pain, reducing anxiety, inducing relaxation, and stimulating blood flow. 
          In PD patients, VAT has been shown to reduce motor symptoms, as it resets abnormal neural rhythms, initially caused by a loss of dopamine. King, Almeida, & Ahonen (2009) found improvements in all motor symptoms listed on the Unified Parkinson’s Disease Rating Scale (UPDRS). In particular, there was a significant decrease in tremor and rigidity and a significant increase in step length and speed in the upper limbs. Although PD is usually treated with drugs, the effects usually wear off over time and patients develop a range of physiological and psychiatric problems. VAT, therefore, proves to be a noninvasive, nonpharmacologic method that holds promising results. Furthermore, no negative effects have been reported with VAT. 
          When VAT is combined with music, it can produce powerful results as it allows the patient to experience VAT physiologically (through the applied vibrations) and psychologically (through music listening). Music that has been composed for VAT uses particular timbres, textures, and frequencies, resulting in a range of instrumentation and sound. Tactile sensations which are interspersed and felt throughout the surface are created through strategic use of dynamic accents, volume levels, and pitch changes. When music VAT is combined with a low frequency of 40 Hz, improvements can be seen in motor abilities and daily living tasks such as chopping food or making the bed (Vincente, Manchola, & Serna, 1997).
          Approximately 80% of PD patients are diagnosed with voice and speech problems, greatly affecting their quality of life. These include difficulty initiating speech, loss of volume, range, pitch and intonation of the voice, difficulty conveying emotions in speech, breathiness, uncontrolled rates of speech, slurred speech, and stuttering (Wan, Ruber, Hohmann, & Schlaug, 2010). Although traditional speech therapy and pharmacological techniques are often pursued, they have produced inconsistent results (Wan et al., 2010). It is clear that other alternatives are needed to alleviate the symptoms of PD. 
          It has been known that music listening can have remarkable effects on emotional and cognitive functioning, especially on individuals with neurological conditions. Active music making can have an even more profound effect, as it requires more of the nervous system at work, and involves perception and action, linked to motor, sensory and multimodal integrative areas throughout the brain. These networks overlap with mirror neurons which play an essential role in the observation and execution of actions (Wan et al., 2010). Singing is a useful medium because it involves an auditory-motor feedback loop in the brain more intensely than other music making activities such as instrumental playing (Wan et al., 2010, p. 287). 
          Given that speaking and singing share behavioral and physiological similarities, singing has proved to be an effective way of treating many of the speech abnormalities that PD patients experience, as it directly stimulates the musculature associated with respiration, articulation, phonation, and resonance (Wan et al., 2010). Since singing requires regulated breathing, inspirations, and expirations, it calls for much more vocal control and intensity than speaking. As a result, PD patients may increase respiratory muscle strength which can lead to positive, long term results in the pulmonary and cardiovascular systems. In fact, Bonilha, Onofre, Vieira, Prado & Martinex (2009) found that patients experienced improvements in dyspnea after only two minutes of vocal exercises and overall had increased inspiratory and decreased expiratory volumes compared to a control group. 
          Singing can also decrease the frequency of stuttering by an astounding 90%. This is due to the fact that music simply cannot exist without rhythm. In the same way that a metronome produces external timing cues, the act of singing involves an internal representation of rhythm which administers internal timing cues for the initiation of each syllable (Alm, 2004, p. 330). According to Stager, Jeffries, & Braun (2003) who compared the activation of speech with singing through PET brain imaging, speech was activated in the left hemisphere while singing was activated in the right hemisphere. Although there was activity in the left dorsal putamen during speech, neither the left or right putamen was activated during singing. These findings support the idea that while speech requires timing cues from the left basal ganglia system, singing uses a different procedure for the timing of syllables, resulting in its success to help those who stutter.
          PD is a progressive disorder that can be physiologically, physically, and psychologically damaging. Although the use of pharmaceutical drugs such as Levodopa have been wide spread as it improves motor functions of PD, many patients eventually develop movement complications within five to ten years. Despite that 80% of PD patients develop speech and voice abnormalities, only 3-20% have consulted a speech and language therapist (Di Benedetto, Cavazzon, Mondolo, Fugiu, & Peratoner, 2009). As a result, many PD patients are left feeling defeated and hopeless about the future. There is much room then, for music as a means to alleviate motor and speech symptoms of PD. Although Jourdain has explained some of the ways that music can help, much literature has been published since then that offers new ways of using music, such as VAT and through singing. It is clear that these are excellent alternatives for PD patients as these methods are noninvasive, nonpharmacologic, cost effective and therapeutic.

References 

Alm, A. A. (2004). Stuttering and the basal ganglia circuits: a critical review of possible relations.       Journal of Communication Disorders, 37(4), 325-369. http:// simplelink.library.utoronto.ca/url.cfm/450679

Bonilha, A.G., Onofre, F., Vieira, M.L., Prado, M.Y. A., & Martinex, J. A. B. (2009). Effects of singing classes on pulmonary function and quality of life of COPD patients. International Journal of Chronic Obstructive Pulmonary Disease, 4, 1-8. http://www-ncbi-nlm-nih-gov.myaccess.library.utoronto.ca/pmc/articles/ PMC2672787/pdf/copd-4-001.pdf

Boyd-Brewer, C. (2004). Vibroacoustic therapy: Sound vibrations in medicine. Alternative and Complementary Therapies, 9(5), 257-263. http://dx.doi.org/ 10.1089/107628003322490706

Di Benedetto, P., Cavazzon, M., Mondolo, M., Rugiu, G., & Peratoner, A. (2009). Voice and choral singing treatment: a new approach for speech and voice disorders in Parkinson’s disease. European Journal of Physical and Rehabilitation Medicine, 45(1), 13-19. http://myaccess.library.utoronto.ca/login?url=http:// search.proquest.com.myaccess.library.utoronto.ca/docview/67423449? accountid=14771

Jourdain, R. (1997). Music, the brain, and ecstasy: How music captures our imagination. New York, NY: HarperCollins Publishers.

King, L. K., Almeida, Q. J., & Ahonen, H. (2009) Short-term effects of vibration therapy on motor impairments in Parkinson’s disease. NeuroRehailitation, 25(4), 297-306. http://simplelink.library.utoronto.ca/url.cfm/450495

Stager, S. V., Jeffries, K. J., & Braun, A. R. (2003) Common features of fluency-evoking conditions studied in stuttering subjects and controls: an H215O PET study. Journal of Fluency Disorders, 28(4), 319-336. http:// resolver.scholarsportal.info.myaccess.library.utoronto.ca/resolve/0094730x/     v28i0004/319_cfofcsacahps.xml

Vincente, P. C., Manchola, I. F., & Serna, E. T. (1997). The use of vibroacoustics in idiopathic Parkinson’s disease. In T. Wigram, B. Saperston, R. West (Eds.), Science therapy: A handbook (125-131). Newark, New Jersey: Harwood Academic Press. 


Wan., C. Y., Ruber, T., Hohmann, A., & Schlaug, G. (2010). The therapeutic effects of singing in neurological disorders. Music Perception, 27(4), 287-295. http:// search.proquest.com/docview/89184449?accountid=14771

1 comment:

Samuel Silva said...

Veronica,

While studying a little about the relevance of the basal ganglia for music-making, I also became interested in the benefits of music to PD patients. I remembered the case showed in class, of PD patients recovering their normal movements while dancing to music. That was impressive. Moreover, your blog post helped increase my interest in this topic; so, thank you.