Seeing Music?

Source: Schutz, Michael and Scott Lipscomb. "Hearing gestures, seeing music: Vision influences perceived tone duration." Perception 36 (2007): 888-897.

Summary

Michael Schutz and Scott Lipscomb created this study to settle the debate among percussionists: does the length of the striking gesture have any direct impact on the length of the resulting tone? They found that the stroke height used in playing a note on the marimba had no effect on the acoustic length of the note. However, gesture and visual information played a large role in the perceived length of notes, even when the acoustic properties between so-called "long" and "short" notes were indistinguishable. They concluded that "music is only music within the mind of the listener" and observed that effective musical performances must rely on both auditory and visual information. Performances heard in contexts such as recorded radio broadcasts and blind auditions rob "both the performer and audience of a significant dimension of musical communication."

Reflection

I was frequently reminded of this topic after hearing Michael Schutz speak at the Colloquy for Music Psychology and Neuroscience. As performers of any instrument, we need to consider every aspect of the musical performance from the audience perspective. While many pianists will protest at the notion that the piano is a percussion instrument, it is undeniable that the basic operation mechanisms of the the instrument are similar to those of some percussion instruments. Many issues of performance are based on the fact that piano tones decay immediately. For example, in passages where composers write a crescendo under a long held note, my students often have trouble imagining that the note is growing louder.

The solution to this is partly further development of the inner ear, but this type of phrasing could also be understood through the use of a physical gesture. I can remember the first time I encountered this problem as a student. My teacher asked me to sing the phrase, noticing how my physical gestures mirrored the character of the long note. This demonstration was very helpful when I returned to the piano; the way I used my breath and arms to conduct the note made it much easier to shape the long note at the piano.

Beyond the basic level of duration of notes, gesture can also enhance other musical events. While preparing for a concerto competition in which I performed the same concerto as three other pianists, I was advised to use physical gestures to set myself apart from the others. Rather than simply playing a quick passage note-perfectly, she guided me in using an arm motion that would assist in communicating the effect of soaring, both musically and visually. Of course, my performance had to be technically sound and expressive in order for these visual "extras" to have any effect.

There are those who would dismiss this approach as purely virtuosic and lacking in artistic depth. Indeed, without a solid performance, visual displays merely distract the audience. Yet the findings of this study clearly show that visual cues act as an aid to audiences, influencing the way in which we respond to auditory information. Perhaps what is needed is a fine balance of both audio and visual cues. "Virtuosos are masters at shaping the musical experience, which in this case means using visual information to accomplish that which is impossible 'in reality'."

The structural neuroanatomy of music emotion recognition: Evidence from frontotemporal lobar degeneration

Reference:

Rohani, Omar, Susie M.D. Henley, Jonathan W. Bartlett, Julia C. Hailstone, Elizabeth Gordon, Disa A. Sauter, Chris Frost, Sophie K. Scott, and Jason D. Warren. "The structural neuroanatomy of music emotion recognition: Evidence from frontotemporal lobar degeneration." Neuroimage 2011, June 1; 56(3): 1814-1821.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092986/?tool=pmcentrez

Summary:

Despite growing interest in the neurobiology of music, the brain mechanisms that are critical for processing emotion in music remain incompletely understood. Music is universal and highly valued for the powerful emotional responses it engenders: indeed, music activates brain circuitry associated with pleasure and reward and musical emotion judgments and brain responses are consistent amongst members of a musical culture. Certain music can specifically induce an intense arousal response in normal listeners, and this response is mediated by brain structures such as the amygdala and insula that have been implicated in other kinds of salient emotional stimuli. Deficits of musical emotion comprehension have been reported following focal damage of these same structures, located in the medial prefrontal and anterior temporal lobe.

Frontotemporal lobar degeneration (FTLD) is the name for a group of clinically, pathologically and genetically heterogeneous disorders associated with atrophy in the frontal lobe and temporal lobe of the brain. In the over 65 age group, FTLD is probably the fourth most common cause of dementia after Alzheimer’s disease, dementia with Lewy bodies and vascular dementia. Patients with FTLD frequently exhibit derangements of complex social and emotional behaviour. From a clinical perspective, investigation of musical emotion processing and its cerebral associations in FTLD has the potential to improve the understanding of the disease’s phenomenology, and the intrinsic network connectivity in the working brain.

A human brain showing frontotemporal lobar degeneration.

The idea behind this research was to investigate critical neuroanatomical associations of emotion recognition from music using FTLD as a disease model of brain network breakdown. The research included 26 patients with FTLD and 21 healthy control subjects with no history of neurological, or psychiatric illness. Recognition of four emotions (happiness, sadness, anger, and fear) from music, facial expressions and nonverbal vocal sounds was assessed using a procedure in which subjects were required to match each target stimulus with the most appropriate verbal emotion label in a four-alternative-forced-choice model. The music stimuli were short (approx. 11 s) non-vocal (orchestral and chamber) excerpts drawn from the Western classical canon and film scores. MR brain images were acquired in all FTLD patients at the time of behavioural testing, as well as voxel-based morphometry, a neuroimaging analysis technique that allows investigation of focal differences in brain anatomy.

On neuropsychological evaluation, patients with FTLD showed deficient recognition of canonical emotions (happiness, sadness, anger and fear) from music as well as emotional signals conveyed by facial and vocal expressions compared with healthy control subjects. Impaired recognition of emotions from music was specifically associated with grey matter loss in a distributed cerebral network including insula, orbitofrontal cortex, anterior cingulate and medial prefrontal cortex, anterior temporal and more posterior temporal and parietal cortices, amygdala and the subcortical mesolimbic system. This network of the brain is essential for recognition of musical emotion that overlaps with brain regions previously implicated in coding emotional value, behavioural context, conceptual knowledge and theory of mind. The study also found that amygdala damage was associated with impaired emotion recognition only from music, as opposed to emotion recognition of facial and verbal expressions.

Reflexion:

The ability that music has to affect and manipulate emotions and the brain is undeniable, and yet largely inexplicable. This research identified regions of the brain associated with music emotion recognition, including insula, orbitofrontal cortex, anterior cingulate and medial prefrontal cortex, anterior temporal and more posterior temporal and parietal cortices, amygdala, and striatum. Identifying the neural mechanisms of musical emotion helps us understand how the brain codes emotional value, and how emotional signals acquire meaning.

Following a similar idea, Petr Janata, associate professor of psychology at UC Davis' Center for Mind and Brain, mapped the brain activity of a group of subjects while they listened to music, and found that the region of the brain where memories of our past are supported and retrieved also serves as a hub that links familiar music, memories and emotion. His research may help to explain why music can elicit strong responses from people with Alzheimer's disease. The hub is located in the medial prefrontal cortex region — right behind the forehead — and one of the last areas of the brain to atrophy over the course of the disease.

In Rohani & al.’s study, subjects with frontotemporal lobar degeneration did not respond well to recognition of emotion in music, unlike Alzheimer’s patients in Janata’s study. This was caused by grey matter loss, including the medial prefrontal cortex region, which is linked to memories and emotion. Does memory affect music emotion recognition, or is it just contained in the same medial prefrontal cortex region as is emotion? How does music succeed in prompting emotions within us? And why are these emotions often so powerful?

Images of Sonic Objects

Source:
Godøy, R. I. (2010, April). Images of sonic objects. Organised Sound, 15(1), 54-62. Cambridge University Press. Retrieved October 10, 2011, from Scholars Portal Journals
http://resolver.scholarsportal.info.myaccess.library.utoronto.ca/resolve/13557718/v15i0001/54_ioso

Summary:
Largely based on the theories of Pierre Schaeffer in his Traité des objets musicaux (1966), but also drawing on more recent evidence from the study of musical imagery and support from the theory of embodied cognition, Rolf Inge Godøy, Professor at the Department of Musicology, University of Oslo, argues that the “sonic object” is the most significant timescale of music with regard to human’s ability to form stable memory images of music (sonic images) from continuous sound.

First, Godøy gives some useful background information on musical imagery, which is defined as the “mental capacity for imagining musical sound in the absence of a directly audible sound source”. Placing musical imagery in the broader context of mental imagery, he explains that there is generally a “functional equivalence” between real-world perception and action and imagined perception and action. (For example, recalling the last verse of a song would take longer than the first verse because people usually scan through the song from the beginning.) Furthermore, neuroscientific research shows that mental imagery and real perception and action share much of the same neural substrate. Of particular interest in musical imagery is that auditory and motor imagery seem to be bidirectionally linked. (For example, when professional pianists listen to piano music, the motor areas of the brain are also activated. Vice versa, when the pianists see silent piano performance actions, they also mentally hear the music associated with those actions.) Then, putting musical imagery in the perspective of embodied cognition, which sees perception and cognition as intimately linked with sensations of movement, Godøy argues that body movements are integral to music and that sound-events should be “understood as included in some kind of gesture trajectory”.

All of the above background information helps to prepare the reader for Godøy’s ideas about the nature of sonic objects, which he defines as “holistically perceived fragments of sound, typically with durations in the 0.5 to 5 seconds range”. He justifies this timescale by citing research that shows that listeners can generally recognize salient musical features, such as style, rhythm, texture/timbre, modal/tonal features, and expressivity, within this 0.5 to 5 seconds range. He then points out that theories of memory support the idea of sonic objects as coherent chunks of sound that are perceived and imagined in the present moment (in a series of “now-points”). In this way, an entire piece of music is basically a chain of sonic objects perceived and imagined chunk-by-chunk, moment-by-moment. Godøy describes three types of sonic objects: 1) Impulsive, meaning abrupt attack followed by decay, 2) Sustained, and 3) Iterative, meaning a quick series of fluctuations (e.g. tremolo). Given the integral sound-gesture link in the embodied perspective, he remarks that the three types of sonic objects correlate well with impulsive, sustained, and iterative body gestures. And given the bidirectionality between motor and auditory imagery, Godøy believes the “kinematics and dynamics of sound-related actions can create images of sonic objects”, which carries the implication that action imagery can actually enhance musical imagery and, therefore, can potentially be applied in various contexts, such as musical practice, research, and education.

Reflection:
Though slightly difficult for me to digest, I still found this journal article quite fascinating. Having read a chapter titled “Imagined action, excitation, and resonance” by Godøy (2001) in a book called Musical imagery, which argues that “images of sound-producing actions… can enhance [the] capacity for imagining sonorous qualities” (p. 237), I was curious to find out if Godøy has written anything else on this subject more recently. As it turned out, he indeed has, and I chose this article because it offers more up-to-date information on musical imagery, a topic that I am deeply interested in.

First of all, I was not surprised at all to discover that auditory and motor imagery are linked; I can relate well to the experience of having the urge to move my fingers and “play along” when listening to other pianists performing pieces that I am acquainted with. Being a performer, I have absolutely no doubt that body movements are integral to musical experience. But Godøy’s suggestion that there is an important gestural component to sound would still have seemed a little strange to me had I not taken a course in conducting two years ago, which certainly made me much more aware of how gestures can accurately represent various sound qualities (with a lot of practice, of course).

What impressed me the most about this article was the fact that something as private and seemingly unobservable as imagery could be systematically studied and theorized upon so extensively. I think that Godøy backs up his argument about sonic objects convincingly. What I am primarily interested in, however, is whether action imagery would really prove effective in developing musical imagery in the context of mental practice, as his view implies. Up till now, I have rarely employed the strategy of mental practice myself. But I have always been taught that I must first know what kind of sound I want (in my “inner ear”) before I can experiment with various ways of pressing the keys that would get me closer to realizing that sound. So it seems to me that the music should come first and the action subservient to it. Nevertheless, I suppose that after some physical practice, the sound would become inseparable from the action associated with it, and, at this point, action imagery would be effective in bringing forth musical imagery. So perhaps one needs a certain amount of physical practice on a particular piece before action imagery can be used? Or maybe it would simply be best for one to start developing mental practice skills early on in one's training?

Reference
Godøy, R. I. (2001). Imagined action, excitation, and resonance. In R.I. Godøy, & H. Jørgensen (Eds.), Musical imagery (pp. 237-250). Exton, PA: Swets & Zeitlinger Publishers.

Memoirs of an Addicted Brain

Lewis, M. (2011), Memoirs of an Addicted Brain. A neuroscientist examines his former life on drugs. Doubleday Canada, www.randomhouse.ca
ISBN 978-0-385-66925-2

Recently, I heard Dr. Marc Lewis interviewed on CBC. He is a neuroscientist from U of T, now living and teaching in Holland. He was talking about his book Memoirs of an Addicted Brain, not fundamentally about music and the brain although Lewis has an undergraduate degree in music from Berkeley and is an avid sitar player. His personal story of drug addiction and his unusual way of describing the brain’s chemistry compelled me to buy the book. I couldn't put it down. Here is the link to the CBC interview. http://www.cbc.ca/thecurrent/episode/2011/10/10/addicted-mind 

Summary

In Memoirs of an Addicted Brain, Marc Lewis recounts his life as a drug addict. Originally from Toronto, he was shipped as a teenager to Boston to attend a boarding school. Homesick, bullied and missing the warmth and affection of his (extended) family, Lewis began to deal with his pain through cough syrup and alcohol.  He moved to Berkeley, California and became part of the LSD and heroin scene. Then, he joined his family in Malaysia and later Calcutta turning to opium. When he returned to Canada to become a psychologist, he stole drugs from medical clinics and was subsequently arrested. The book chronicles Lewis’ journey with drugs, addiction and healing. Lewis eventually recovered and became a professor of developmental psychology and then a researcher in neuroscience.

This extraordinary narrative is formatted around Lewis’ progressive drug addiction. Each chapter gives colourful and detailed explanation, intertwining  underlying emotional conditions with choices, as well as the prominent drug he was using at the time.  Lewis, an effective storyteller, distinguishes the effect of each drug on the brain: i.e. dextromethorphan hydrobromide (cough syrup), cannabinoids, LSD, PCP, heroin, opioids . The reader learns about brain structures, functions and locations in both healthy and drug-polluted brains. Lewis details healthy neurotransmission and then what happens when dopamine and serotonin are regulated  intrusively with addictive drugs. He relates the VALUE and THRUST feedback cycles, the neurological basis for cravings that can take hold in the mind and in the brain. Lewis shows the reader how the addict’s brain, fertilized by the emotional potency of repeated drug experiences, crystallizes synaptic connections, tightening, rigidifying, constraining the choices (Lewis, 2011).

Marc Lewis believes that addiction is a corrupted form of learning and warns that the extensive flexibility of our brains is not infinite. Synaptic sculpting, how learning occurs, uses up brain flexibility. He states that synaptic shaping is self-promoting and self-reinforcing and can be accelerated by strong emotions. Addictive drugs are addictive because of the strong emotions they release with meaning,  value and the narrowing in of how the world feels (Lewis, 2011).

Lewis admits that once addiction sets in, the brain never returns to the state that preceded it. He would counsel young people in this way:  Say no in a way that catches and takes hold. Pursue things that are real and have meaning rather than illusions and imagined values.

 Reflection

Memoirs of an Addicted Brain is a valuable resource for understanding neurochemistry and the impact of chemical invaders or mimics. Lewis gives a comprehensive yet accessible explanation of neurological structure, function and location. It was easy to visualize baselines and distortions because Lewis relayed the brain as a functioning neighbourhood with each part interrelated doing its specific task i.e. bridging, gate keeping and because he offered the neuroscientific information cumulatively within the context of his growing need for control.

It is a known fact that many musicians struggle with drug addictions. In fact, yesterday in the Ottawa Citizen, Phil Dwyer, saxophonist/pianist/composer candidly describes how he has struggled with serious addiction and mental health issues. http://blogs.ottawacitizen.com/2011/11/01/the-phil-dwyer-interview-part-iv

One friend who toured with a rock band for many years, admittedly said that the touring lifestyle got boring, predictable and there was lots of waiting around. Alcohol and drugs were a way of making it more bearable.  Music and drugs seem attached –at- the -hip in the rave culture. The dissociations or amplifications with reality may be potentiated through music. Certainly musicians of all genres have died of drug overdose.

Memoirs of an Addicted Brain makes me think about the relationship to music and addiction in another way. As music educators, how addicted do we become to “winning” the music competition. The craving feedback loop which is based on needing control and needing the fix may propel our choices – the wanting, the needing  for our own sake of feeling good and needing control - pushing children at a  young age to competitive, neurotic and even inappropriate goals without the care full nurturing, love, and magical experience of music’s aesthetic and spiritual draw. Do we become addicted to the applause of a performance?

Not for one moment did I need to point the finger at Lewis in his courageous autobiography. The neural activity spoke for itself and potentially lies in each one of us. Addiction is insidious, formed day by day, synaptic rut by synaptic rut,  with habits that are formed by personal choices, ultimately a result of what we deeply think about ourselves. We are all vulnerable.

Your Brain on Improv

Source:

http://www.ted.com/talks/lang/eng/charles_limb_your_brain_on_improv.html

About the Speaker: Charles Limb is an Associate Professor, Otolaryngology, Head & Neck Surgery, and Faculty, Peabody Conservatory of Music. He combines his two passions to study the way the brain creates and perceives music. He's a hearing specialist and surgeon at Johns Hopkins who performs cochlear implantations on patients who have lost their hearing.

(http://www.ted.com/speakers/charles_limb.html)

Overview:

The idea that artistic creativity is a product of the brain has inspired Limb to explore the connections between the two. By having jazz musicians and rappers demonstrate their creativity through improvisation and free-style rapping while in an fMRI scanner, Limb is able to see activity in specific areas of the brain. Most of the experiments took place at Johns Hopkins University while some took place at the National Institute of Health.

Summary:

How is the brain able to be creative?

For this experiment, a 35-key MIDI keyboard designed with minimal interference was used in the fMRI scanner. MIDI signals from the keyboard were sent out through the interface and into the computer for analysis.

This study consisted of three experiments. All three experiments involved memorizing a piece and then improvising immediately afterwards. Brain activity (blood flow increase or decrease) was then observed and discussed.

The first experiment had professional jazz musicians memorizing a particular piece of music and then improvising the same piece using the same chord changes. The results showed an increase in activity in the medial prefrontal cortex (self-expression) while the lateral prefrontal cortex (self-monitoring) had a decrease in activity.

In the second experiment, Limb explored what brain activity occurs when musicians are “trading” music back and forth with a 12 bar blues piece. One jazz musician was in the fMRI scanner having a musical conversation with another musician, Limb himself, in the control room. The results showed that the musician’s Broca’s area, language area, as well as the brain area potentially connected to expressive communication were activated. These results provide some insight to the claim that music is a language.

The third experiment was to think about the connections between free-style rap and jazz. Free-style artists first memorized a rap written by Limb (control conditions). With the help of various cued words, the artists then created their own version of the rap. From a combination of four rappers’ brains, similarily to the previous experiments, language areas were shown to be active. However, when free-styling occurred, there was an increase in brain activity in the visual areas as well as cerebellar activity (i.e.motor coordination).

The connections between the brain and creativity are insightful, but because these results are preliminary, it is Limb’s hope that in the next few decades, we will be able to see more comprehensive studies that demonstrate this connection.

Response:

It really is amazing to think just how a jazz musician such as Keith Jarrett, can improvise on a piano for an entire concert. It is also interesting to see the results that one might expect when the participants are expected to improvise laying down in an fMRI scanner. Seeing the results of this preliminary study, the brain areas that are affected when performing a creative task, I am led to some questions for future studies.

1. What brain activity would occur if participants did not have a memorized piece, but were given a new piece to improvise?

2. What is the definition of creativity? For example, some people are able to think creatively almost immediately while others are able to be very creative with more time and thought. It would be interesting for researchers to consider this concern in their future studies.

As researchers try to find the root of creativity in the brain, I think about how this and future studies relate to children and creativity. Though the results are preliminary, the connections that are involved between the brain and creative tasks provide some insight into the pedagogical implications for music education. I look forward to hearing about these future studies.

A Larynx Area in the Motor Cortex: study dispels previous conclusions that laryngeal function generalized across lip, jaw and tongue areas of brain

Source: Brown, S., Ngan, E., & Liotti, M. (2008). A larynx area in the human motor cortex. Cerebral Cortex, 18, 837-845.

Have you ever wondered how your voice actually works? If you have, and looked into it, you will have discovered volumes of information on laryngeal function, aerodynamics, physics, and neurology to name a few. Vocal function is a field that has only recently come under the microscope, quite literally. Though Hipocrates speculated on the workings of the human voice as early as the fifth century BC, it wasn’t until Manuel García thought to shine a mirror down someone’s throat in 1854 that the living voice was seen in action. García presented his findings to the Royal Society of Medicine a year later. Voice medicine has been a slow and late bloomer compared to other specialties, but with increasing interest and new technologies there is unprecedented growth in a number of voice specialties. It’s no wonder than that neuroscientists have “answered the call” (vocally speaking) and begun exploring voice function where it really begins: in the brain.

Article Summary:

Until this study was concluded in 2008, it was widely believed that laryngeal control was spread across several areas of the motor cortex that corresponded to motor control of the articulators – the lips, tongue and jaw. This was based on the motor homunculus (pictured below), which was established by Wilder Penfield and others through neuro-stimulation in the 1930’s and 40’s.

The absence of a specific laryngeal centre in the brain is a pretty substantial thing when you get to thinking of the significance of phonatory communication to the human race. It is, after all, one of the most obvious evolutionary triumphs setting us apart from other species on this planet. Thus, Steven Brown of the McMaster Institute for Music and the Mind conducted a study of 16 individuals using fMRI imaging with a primary goal to define a somatotopic location for the larynx area.

This article described 4 of 6 oral tasks that the participants were asked to do while scanned. The tasks ranged from singing on a “schwa” vowel to performing glottal stops (ie. forced adduction of the vocal folds), lip protrusion and tongue movements. Each activity was done in a repeated pattern with breaks in between, this specificity requiring the subjects to attend a training session before their scan.

There were two principle findings in Browns analysis of the data gathered. First was that the peak activations in the motor cortex for glottal stops and those for phonation were nearly identical in all 16 subjects. This yields a strong argument that there is a common motor region underlying adduction (closing) and abduction (opening) and tensing/relaxing of the vocal folds – the major functions of the intrinsic musculature of the larynx. Brown refers to this general region as the larynx/phonation area (LPA) of the motor cortex. There was also activation in a superior temporal region known as “cortex of the dorsal Sylvian fissure at the parietal-temporal junction” (Spt). The Spt has been previously connected to audiomotor integration for vocal production, but Brown’s data revealed for the first time that this area could be activated in the absence of vocalization (during glottal stops), vocal imagery, or strong auditory stimulation – though Spt activity was significantly stronger during vocalization. It is unclear if the activity was due to auditory stimulation, increased laryngeal activity, or perhaps a combination of the two.

The second finding was that the human LPA is not ventral (in front of) the tongue area as was previously suggested in multiple sources. The LPA is actually located in a dorsal position (or behind) the tongue area and directly across from the lip area in all 16 subjects. Brown concludes that the human larynx area appears to have a novel localization next to the articulators and is much further away from the pharynx area than might be expected.

Reflection:

This was quite an ambitious read for me as I am in my first months of study of music and the brain. I was lead by my interest and investment in vocal function especially as it relates to vocal disorders. In the world of vocal disorders, nodes and polyps (physical abnormalities of the larynx) are what a singer often associates with voice disorders, however there are many vocal disorders that are neurological. Spasmodic dysphonia is one such disorder involving hyper function of the laryngeal muscles. Patients with spasmodic dysphonia deal with what seems to be a mis-firing of the larynx resulting in over adduction (too much closure) of the glottis. Sadly, this disorder has a fairly high incidence in professional voice users.

Though recent research into this disorder has shed some light on the cause (a problem in the feedback loop between the brain and organ with the dystonia), in many cases treatments only marginally restore function, and all treatments centre on the larynx instead of the brain. The most standard treatment is botulinum toxin injections (BOTOX) into the muscles that are spasming. These injections last about 4 months and often immobilize the muscles so much that singing isn’t possible. Other treatments include cutting the nerve to the voice box and attaching another nerve, changing the shape of the voice box, and speech therapy. Non of these treatments are particularly reliable from patient to patient.

Spasmodic dysphonia is just one example of several neurological disorders effecting the larynx. My hope is that Brown’s research will eventually lead to easier identification and diagnosis of neurologically based vocal dysfunction, and perhaps steer specialists toward treatments that include the brain.

Reading this article has helped me understand why the brain is left out of the treatment of these disorders and given me hope that the vocal specializations community is on the threshold of understanding the brain as it relates to vocal function in a whole new way.

Treadmill Training with Music Cueing: a New Approach for Parkinson's gait facilitation

Reference: Treadmill Training with Music Cueing: a New Approach for Parkinson's gait facilitation

Author: Dootchai Chaiwanichsiri, Wuttinganok Wangno, Wasuwat Kitisomprayoonkul, Roongroj Bhidayasiri

Source: Asian Biomedicine Volume 5, No. 5 October 2011; 649-654

DOI: 10.5372/1905-0505.086

Summary:

This article describes the effects of musical cueing on treadmill training within a randomized single-blind controlled trial of thirty male Parkinson's disease (PD) patients. Participants eligible for the study were males between the ages of 60-80 years of age, diagnosed as idiopathic PD, Hoehn and Yahr stage 2-3, and possessing good cognitive function on Thai Mental State Examination, stable symptoms with unmodified anti-parkinsonian medication throughout the study, and independent walking skills without any aids. As well, there could not be any other existing medical conditions among the patients, nor could they have participated in any previous training during the previous two months, and good hearing and vision were imperative.

Participants were divided into three randomized groupings, each containing ten members: Group A, B, and C. Group A completed treadmill training with music cueing for three days/week and a home walking program for three days/week; treadmill training for three days/week combined with a home walking program three days/week was prescribed to group B, and group C participated in six days of home walking/week. Each treadmill session consisted of ten minutes of stretching exercise followed by twenty minutes of treadmill walking with long steps at each participants' preferred speed. Once the appropriate gait was selected, the pace was adjusted 5-10% faster, to the degree that the patients could still maintain an appropriate gait without difficulties or missteps. The music cue involved the use of five relaxing green music pieces which were chosen and modified by stretching or retracting the tempo using a computer music program manager. In group A, the treadmill speed was measured by an electric metronome, which was then matched with prepared music of a corresponding tempo. Participants were trained to walk in step with the rhythm of music on the treadmill, and were given MP3 recordings to take home and use during their home practice. Subjects’ home practice included a ten minute stretching exercise followed by twenty minutes of walking, which was monitored by a stretching handbook and walking diary.

Two physicians and one research assistant performed regular evaluations of participants that included interviews about medical history, gait and balance assessments, tests on step length and stride length, walking speed over 6-meter walking sections, and calculation of step cadence.

An assessment of the data collected throughout the study confirmed significant improvement to step and stride length only in group A, which was maintained to the end of the eight week study. Group A also showed the greatest increases in speed and balance, as compared between all three groups. Although one participant in this group fell during one of the at-home training sessions, he was still able to continue with the study, and did not sustain any injuries from the fall.

The enhancement to PD patients’ gait that members of participant group A displayed confirm the effectiveness of auditory cues, such as music, to module the gait pattern of an individual. External motor cues provided through the use of a 6-week intensive treadmill training sessions also increased the stride length and walking speed of those with mild to moderate cases of PD. During these sessions, the speed of the treadmill was increased in increments related to the patient’s ability to maintain gait. Evidence, however, shows that dual tasks, such as auditory and attentional cues, when used in synchronicity, can be detrimental to gait pattern in PD sufferers. Those patients who were given music cues, though, were able to follow the music-treadmill training without any difficulties, and compared to the use of a metronome, had a more therapeutic effect. Therefore, participants who walked with music cues were able to maintain a faster cadence than those who walked to the sound of metronomic cueing. The relaxation and positive emotions that result from music can also be linked to the overall improvements of music to PD patients, as typically, these are deficient areas, as well.

Conclusively, the use of auditory rhythmic musical cues can be used to improve gait and balance, through treadmill-training, for mild to moderate PD sufferers. Additionally, improvements to gait training, as well as to mood and adherence are other applications where musical cueing combined by treadmill walking can be effective.

Reflection: 


This trial study, which measured the effectivity of musical cueing combined with treadmill training among Parkinson's Disease sufferers, affected me in an overwhelming way. I have always been a staunch advocate of practicing "music for music's sake" and not as an enabler or a tool to facilitate other learning or to accomplish other extrinsic goals. I do not promote or support the claims that music makes you smarter or that music should be used to build mathematical skills, and have always lumped music therapy in this same category--one that relies upon music to do something beyond simply existing. However, through my encounters with research that shows the transformative effects that music can have on one's overall health, I am evaluating my own value system and beginning to question why should music not be used to its full potential. In accordance, I am looking at the ways through which musical practices can improve the quality of one's health and thus, one's life, and realizing that it is a more indispensable component to our lives than just music on its own.


Several thoughts arise as I reflect on these results. For starters, the benefits that the participating PD patients encountered after an 8-week trial of treadmill training using musical cues hopeful to individuals suffering with PD, as well as other diseases which attack cognitive function, such as dementia and Alzheimer's disease, and possibly even victims of stroke. If music proves an effective tool for remoulding one's brain, forcing in-tact cerebral areas to assume the functions that the primary control-centres no longer support, there is future potential for rehabilitation in a myriad of situations. Patients who are experiencing depression, anxiety or even Post Traumatic Stress Disorder (PTSD) stand to benefit from the therapeutic benefit of music. I am fascinated to conduct my own trials with individuals suffering from the early onset of both dementia and Parkinson's disease, and also, to test the effectivity of music in more pronounced cases of Alzheimer's. It is ironic, that, in an age of medical advancements technological developments, which are occurring at an alarming rate, the Western societal acceptance of music as a means of healing is only in its developing stages. Music education, therefore, needs to be an all-encompassing goal of not only developing musicians for aesthetic purposes, but also developing music for the health of body, mind and spirit.