Music, Science & Medicine

Agenda

* Presentation times are subject to change

Abstracts

Session I: When Science Research Meets Clinical Music: A New Translational Medicine

The Science In Clinical Music: Questions Needing Answers

Dorita S. Berger, PhD, MT-BC, LCAT, The Music Therapy Clinic

Throughout the past decade there has been extensive research in the contribution of music to brain science, informing the work of neuroscience and physiologists. Music Therapy, the clinical use of music as a treatment resource has been growing in research areas paralleling science and medicine in dealing with diagnoses such as Alzheimer’s, Autism, Stroke, Pain, Stress and Anxiety, Language, Coma, and more. But in many ways, scientists still consider "music" basically as entertainment rather than serious clinical intervention, even as music clinicians are trying to learn and to translate the science into treatment interventions.

Today we gather to bridge the divide between science and clinical music treatment, bringing together scientists to inform music clinicians what scientists are discovering in various diagnoses, music clinicians to advise scientists what interventions with music elements have been effective as treatment, and what questions music clinicians need answered in order to influence and to translate scientific data into clinical music applications. What we need is to understand each other's quests and language, so that we can unite in bringing well being to patients through music interventions. This gathering aims to pose and perhaps answer some questions both science and clinical music will be investigating.

Neural syntax: what does music offer to neuroscience (and vice versa)

György Buzsáki, MD,PhD, Rutgers University

Brain activity is in perpetual change. Such changes are present at the level single neurons, neuronal assemblies and neural networks. The time-dependent variations of such changes can be quantified (by reocording from populations of neurons or, non-invasively, from the scalp) and characterized. The spectral qualities of such patterns reveal a 1/f relationship – in the language of engineering brain patterns belong to a special category of noise: ’pink’ noise. Pink noise is special because of its fractal nature and because it is halfway between absolute predictability (e.g., perfect rhythm) and white (or random) noise or between certainty and absolute uncertainty. All music, quantified this way, is pink noise, perhaps because it is both generated and perceived by brains. Music is characterized by the temporal overlap of many instruments, much like cell assembly patterns in the brain. The temporal overlap is special because of its correlational structure: short-term correlations are related to longer correlations in both music and brain activity, thereby providing first order and higher order relationships. I hypothesize that the esthetic features of music arise from its pink-noise nature because brain dynamics are tuned to this mid-level certainty vs uncertainty. Esthetic pleasure generated by music arises when from the short-term correlations the brain can guess/predict what can possibly come next. This definition may also explain why appreciation of more and more complex music structures require extensive training, since such learning process expands the brain’s ability to predict higher order relationships from simpler correlations. (Obviously, all these speculations are subject to serious objections – I will get prepared).

Music For NICU Infants: Effects and Mechanisms

Aniruddh D. Patel, PhD, The Neurosciences Institute

The Neonatal Intensive Care Unit (NICU) provides necessary medical care for infants born prematurely or with problems requiring surgery soon after birth (such as heart defects). Infants the NICU are exposed to many painful and stressful procedures. This is a time of rapid brain development. Animal and human research has shown that prolonged stress adversely affects the structure and function of a number of brain regions, including the frontal cortex, hippocampus, and amygdala. These effects are mediated in part by chronically high levels of stress hormones such as cortisol (for one review, see Radley & Morrison, 2005, Repeated stress and structural plasticity in the brain. Ageing Research Reviews, 4, 271-287.) Thus anything that can be done to lower stress in NICU neonates may have a lasting beneficial impact on their brains.

Music therapists have developed techniques for using music to soothe NICU infants, and have reported a number of beneficial effects. These include faster weight gain, improved oxygen saturation, and earlier discharge from the NICU unit (for a review, see J. Standley, 2010, Music Therapy With Premature Infants, 2nd ed., Sliver Spring, MD: American Music Therapy Association). The current presentation will review findings from this research and propose a neurobiological framework which accounts for the findings and which leads to specific ideas for further research. Methodological suggestions will be provided for future studies, in order to bridge basic research in music neuroscience with clinical studies of music’s effects on NICU infants.

Healing Mozart? The Science of Music In Medicine

Claudius Conrad, MD, PhD, Harvard Medical School, Massachusetts General Hospital

Music has been an essential part of healing since the beginning of cultural history. However, the precise physiological mechanisms by which music might achieve this therapeutic benefit have not been elucidated. We studied these mechanisms in critically ill, intubated ICU patients to investigate whether a well-defined selection of Mozart music can alleviate stress in critically ill patients, and how this effect might be mediated physiologically. Based on these findings, we developed a model of how music might act on neurologic, hormonal, and humoral levels to effect this relaxation.

However, music has not only positive effects on patients, but also on physicians and relatives of patients. We have investigated the positive role of music in surgical performance and learning and contrasted the findings to the harmful effects of auditory or mental stress in the operating room. The findings of these studies show that music can have a positive effect on surgical motor skills as well as surgical learning. Further, in relatives of patients waiting to be treated in an Emergency Department our results suggest that music can have a significant positive effect on stress levels.

It becomes more and more clear that music is a potentially powerful tool for improving clinical outcomes with little known risk when applied appropriately and judiciously. Whether music in medicine will grow to be widely accepted as an adjunctive therapy will depend on a better understanding of its role through clinical and scientific experimentation.

Session II: Children in Treatment: Autism, Language, Stress

Auditory Processes

Music to Shape Brain Networks for Auditory Skills

Nina Kraus, PhD, Northwestern University

Hearing depends on cognitive and sensory processes that function by means of an interactive circuitry extending from the cochlea to the cortex and back again. Given this functional neuroanatomical overlap, it is not surprising that the auditory expertise gained over years of consistent musical practice fine-tunes the human auditory system in a comprehensive fashion, strengthening neurobiological and cognitive underpinnings of both music and speech processing. Of specific interest is the potential for musical training to promote neural mechanisms that undergird language-related skills, such as reading and hearing speech in background noise, that, when deficient, significantly impair academic progress, vocational success and emotional wellbeing.

Formation of sound-to-meaning relationships involves attention to sensory details, neural sensitivity to statistical regularities in sound, the extraction of key signals from a complex soundscape, and efficient cognitive skills related to working memory and attention. Music is a demanding activity that requires active engagement with sound and the mapping of its individual components to meaning. Reading and hearing speech in background noise hinges on similar sound-to-meaning relationships. Work from our laboratory demonstrates that core auditory-based neural and cognitive processes that are deficient in poor readers (e.g., developmental dyslexics) are enhanced in musicians. Difficulty hearing in background noise can be debilitating for children with learning disorders and older adults. Musical experience strengthens neural, perceptual and cognitive skills that undergird hearing speech in noise throughout the lifespan.

The Role of Auditory Processing in Language Development and Disorders

Paula Tallal, PhD, Rutgers University

Previous research has demonstrated a strong relationship between individual differences in language and reading skills, and the ability to process both rapidly sequential sounds and dynamic spectrotemporal changes within sounds. This finding has been corroborated by fMRI studies that show that discrimination of speech and non-speech stimuli (characterized by rapid spectrotemporal acoustic cues) activate brain regions traditionally identified as language areas.  More recently, our focus has been on understanding the effects that explicit training (focused on improving auditory attention, processing speed, sequencing and memory capacities) has on individual differences in language and reading skills.  Data will be presented that demonstrate that direct auditory training using both speech and nonspeech signals, as well as musical training, alters the functional anatomy of the brain that is traditionally associated with speech and language processing.  Furthermore, behavioral data show that musical training, as well as neuroplasticity-based acoustic training, significantly improves language and reading skills. Thus, one route by which music therapy may most significantly impact clinical populations is by improving dynamic auditory attention, sequencing and memory processes.

Autism

The Impact of Stress and Anxiety on Individuals with Autism and Developmental Disabilities

June Groden, PhD, The Groden Center

Although numerous books and articles have addressed stress and anxiety in the general population, very little has been written to address the implications of stress and anxiety for individuals with autism. This presentation will discuss the constructs of stress and anxiety which have pragmatic value in understanding the behavior of persons with autism and developmental disabilities. Many of the behaviors that are typically labeled as autistic or stereotypic are functionally related to the experience of stress and anxiety by individuals who lack a repertoire of appropriate coping mechanisms. Research in the areas of stress and anxiety will greatly aid in the development of successful treatment and coping strategies for this population.

Clinical Music Therapy Treatment Addressing Autism Characteristics

Maria Leticia Alberti, MT-BMT, FLENI Neuro–rehabilitation Hospital

Music Therapy treatment for clients on the Autism Spectrum provides an auditory stimulus with targeted interventions seeking to assist the body in developing organization of sensory information processing leading toward more adaptive responses to internal and external environment. Treatment protocol targeting such physiologic and sensory functions through specific music-based interventions that involve specific music elements such as rhythm and movement activities has been shown to be effective in improving patient’s language and communication, cognitive functions, social skills, and emotional outlet (Berger 2002 , Patel 2003, Thaut 2005, and others). Treatment that first identifies and addresses possibly deficient sensory processing and coordination issues can bring about new, adaptive options which can then result in communication and social skills, controlled and purposeful behaviors, and general adaptation to their environment on a day-to-day basis.. Presentation covers cases of children diagnosed with autism and PDD along with a description of their clinical issues, where Music Therapy has served as a physiologic adaptation treatment. Music interventions will show how aspects and elements of music parallel and interact with those of the human physiologic function, which can result in systemic changes (Berger, 2002) on patient’s high levels of anxiety. Lectures will discuss why when music interventions are carefully designed to address physiologic goals they reach beyond “symptoms”, treating also some causes.

Session III: Adults in Treatment: Pain, Coma, Parkinson's, and Dementia

Pain Management

Molecular Orchestration of Pain

Alban Latrémolière, PhD, Harvard Medical School

Pain is the unpleasant sensation caused by noxious mechanical, thermal or chemical stimuli detected by specialized sensory nerve fibers called nociceptors. These fibers express a wide variety of high-threshold transducers ion channels that when activated generate nerve impulses into the central nervous system (CNS). The first relay of this transmission occurs in the dorsal horns of the spinal cord where the information is processed, before being sent to higher order brain structures where pain sensation is ultimately formed. Although long thought to be only dependent on a rigid wired architecture, the last decades have established the nociceptive system as one of great plasticity. Upon intense stimulation, nociceptive neurons of the CNS exhibit a form a plasticity called central sensitization. This state of heterosynaptic facilitation is caused by numerous transcriptional and post-transcriptional events that lead to an increased excitability of the neurons as well as an enlargement of their receptive fields and is responsible for symptoms like allodynia, the sensation of pain caused by non-painful stimuli and secondary hyperalgesia, an increased pain sensation upon painful stimulation outside of the injured territory. Central sensitization acts as the nociceptive system’s amplifier, turning whispers into screams to alarm the organism that there is an imminent risk of damage. In physiological conditions, this sensitized state disappears when tissue damage dissipates. In pathological states however, like chronic inflammatory diseases or when the nociceptive system itself is damaged (neuropathic pain), central sensitization persists for years. Understanding what triggers or maintains central sensitization should help discovering new therapies to alleviate chronic pain.

Music in the Treatment of Acute, Chronic and Procedural Pain

Joanne V. Loewy, DA, MT-BC, LCAT, The Louis Armstrong Center for Music & Medicine at Beth Israel Medical Center

Music and music therapy can be integral to the management of pain in its variety of applications. Since pain is defined by the International Association for the Study of Pain as not only a sensory perception related to tissue damage, but also one’s emotional response to the perception, the inter-relationship between music and therapy provides promising potential in our ability to diagnose and treat pain. This lecture will include research as it relates to clinical practice, providing rationale as well as video and live case examples inclusive of cultural aspects of treatment-form sedation to vibration; release to music mediation; from neonates through end of life-the use of music psychotherapy will illustrate how acute, chronic and procedural pain can be effectively treated.

Session IV: Adults in Treatment: Pain, Coma, Parkinson's, and Dementia (Continued)

Motor Function and Parkinson's

Pattern of Alterations in Motor Circuit Resting State fcMRI in Parkinson's Disease Patients Due to Medication and Forced Exercise

Jay L. Alberts, PhD, Lerner Research Institute

Introduction:
Parkinson's Disease (PD) is a progressive neurologic disorder primarily characterized by altered motor function. As the disease progresses, medication has a diminishing effectiveness in controlling symptoms in most patients, leading to increased dose or in some patients, invasive surgical procedures such as deep brain stimulation. An assisted bicycle pedaling exercise paradigm (rate is controlled to be above the voluntary pedaling level) has been found to have similar effect as medication on motor symptoms [1] and on functional activation [2]. Functional connectivity MRI (fcMRI) has been used to examine resting connectivity between brain regions in PD patients as a result of medication therapy[3,4]. This technique affords the ability to look at how strongly nodes of the motor circuit communicate with each other, and can provide insight into the complementary effects of various therapies. Here we present results from a group study comparing the effect of controlled-rate aerobic exercise and medication therapy on fcMRI of the motor circuit in PD patients (compared to the off-medication state), with bilateral motor fMRI, resting fcMRI and continuous motor fcMRI. We find that in many important nodes of the motor circuit, the observed changes in functional connectivity effected by forced exercise and medication are positively correlated. Although this positive correlation was observed both at rest and while continuously tapping, the correlation was stronger while measuring connectivity in the tapping state.

Methods:
10 mild to moderate PD patients (6 male) between the ages of 44 and 79 were recruited for a series of 3 identical scanning sessions: off medication (OFF), on medication (ON, and off medication with forced exercise (FE), with the order of conditions randomized across subjects. In each session, subjects were scanned in an IRB-approved protocol at 3T using a bitebar to reduce head motion, in a 12-ch receive head coil. Scans included T1-MPRAGE, a bilateral complex finger tapping fMRI EPI scan, a resting connectivity fcMRI scan and a unilateral (with most affected hand) continuous motor performance fingertip force tracking (visual display feedback) task during task connectivity fcMRI. EPI scans were identical (apart from duration) at 2x2x4mm voxels, 1954 Hz/pix BW, 31 axial slices, TR/TE/FA=2800/29/80. fMRI and fcMRI data were corrected as described in [5] and the fMRI student’s t-map was coregistered to the connectivity scans. ROIs were drawn on the MPRAGE for bilateral putamen (Put), globus pallidus (Gp), thalamus (Thal), supplementary motor area (SMA), and primary motor cortex (Mot) and were coregistered to connectivity scans. Seed-based correlation connectivity maps and values were determined using fMRI activation and ROIs as described in [5]. Inter-hemispheric fcMRI determined between left and right sides of same brain region, intra-hemispheric fcMRI determined between pairs of ROIs on same side of brain. Correlation of low-pass filtered reference timeseries were converted to t-scores, which represent our fcMRI connectivity metric between two ROIs. Difference in connectivity as function of FE or ON state was referenced to OFF state by subtracting the OFF state connectivity. Connectivity difference for FE was correlated with that for ON for each ROI pair.

Results and Discussion:
The connectivity between most nodes of the motor circuit is altered in a similar way by both exercise and medication, and this similarity is strengthened during continuous performance of a motor task. This suggests that forced exercise and medication may have the same underlying mechanisms on most of the motor circuit.

Music Therapy and Parkinson's Disease: Research and Therapeutics

Concetta M. Tomaino, DA, MT-BC, LCAT, Institute of Music and Neurologic Function

Music Therapy has proven to be particularly effective for persons with Parkinson's Disease (PD) however the application of music based techniques to facilitate balance, gait and speech is not widely used to benefit these individuals. Research in both music therapy and neuroscience have shown that music can affect function in very profound ways.

Many individuals with Parkinson's have problems with initiation and consecutive movement. They also have problems with slowness of movement or bradykinesia. Music, particularly rhythm, can become a template for organizing a series of movements.

Some people with PD may have problems with articulation where their speech becomes slurred and unclear. Sometimes this is due to poor breath support and sometimes as a result of difficulties with the motor aspects of speech, ie moving the mouth and tongue to articulate a specific sound. Other aspects of Parkinson's Disease can affect a patient’s mood causing depression, anxiety and or even social isolation.

Drawing from current neuroscience research and evidence based clinical practice, this presentation will illustrate how and why music based techniques can be an effective tool for PD.

Dementia

Research in Dementia: Early Treatment and Prevention of Alzheimer's Disease

Steven H. Ferris, PhD, NYU Langone Medical Center

Alzheimer's Disease (AD) is the major cause of dementia in late life. There are more than 5 million people diagnosed with AD in the U.S., a number projected to triple by 2050 as the elderly population continues to grow. AD is a devastating and costly neurodegenerative disorder involving synaptic loss and neuronal dysfunction leading to neuron death. It is associated with complex, widespread neuropathology (including amyloid plaques and neurofibrillary tangles) of unknown etiology. A 10-20 year "pre-symptomatic" disease phase apparently precedes the 5-15 year clinical phase that involves gradual loss of memory and most other cognitive functions and culminates in severe mental and functional deterioration and death.

Much has been learned in recent years about genetic, medical and "life-style" risk factors for this disease, as well as about the biological mechanisms associated with AD pathology. This growing knowledge initially led to drug treatments with modest symptomatic benefits that have been available for two decades, and more recently has spawned many promising compounds in the clinical trial pipeline that target specific aspects of disease pathology. Unfortunately, there are still no "disease modifying" treatments proven to slow clinical progression or prevent the disease.

Recent treatment failures in clinically diagnosed AD, coupled with methods for early detection of disease using spinal fluid and brain imaging biomarkers, have led to increased interest in very early diagnosis and in studying treatments in mildly impaired, pre-dementia cases or even in pre-symptomatic cases at high risk for progressing to clinical dementia. The assumption is that treatment is more likely to succeed when there is less brain pathology. There is also increased interest in non-pharmacologic methods to improve clinical management and reduce impact on families, as well as on enhancing life-style factors (diet, exercise, and mental activity) that might reduce AD risk by enhancing "cognitive reserve" and possibly slowing cognitive decline. Music therapy is potentially relevant both for clinical management and for enhancing cognitive reserve.

Music Therapy and Dementia

David Aldridge, PhD, FRSM, Nordoff-Robbins Zentrum, Witten, Germany

Dementia is often referred to as a neurodegenerative disease. My argument is that it is often a dialogic-degenerative disease where dialogue fails between caregivers and the person with dementia. This dialogue is exacerbated by the loss of speech.

Using a series of videotape examples I will demonstrate how music therapy, based on features of utterance, gesture and timing, can be used to promote meaningful communication for those who have apparently lost language skills. This is a performance perspective on human behavior based not on the concept of "I think therefore I am" but "I perform therefore I am".

While the principal examples will be from a residential home, there will also be video examples from individuals with aphasia following stroke. Music therapy improved speech fluency by focusing on prosody using repetition and articulacy.

There will also be references made through musical examples to the use of music therapy in a palliative care and working with the dying.

Music therapy is an appropriate intervention in neurological rehabilitation. The process of neurological rehabilitation is concerned with returning us to those performances of ourselves within which we can dwell and recognize ourselves; where we feel at home within others and ourselves. Rehabilitation is an ecological process refitting us to a set of habits that make living sense. Sense, in a neurological way of feeling, and sense as cognitive understanding. Fitting into an ecology is a continuing performance that we have with others; it is dynamic not fixed—and, like making music, not necessarily dependent upon verbal language.

Coma

Nicholas Schiff, MD, Weill Cornell Medical College 

How Consciousness Recovers after Severe Brain Injuries

In this talk the evolving neuroscience of measuring recovery of consciousness will be explored. Several challenges are raised by new understanding of the brain's capacity to on the one hand harbor cognitive function without a person showing definite behavioral signs of awareness or on the other hand maintain a potential to recover significant cognitive function over indefinite time intervals.  Neuroimaging and electrophysiologiçal studies will be discussed that reveal evidence for common mechanisms underlying recovery from stroke, traumatic brain injury and oxygen deprivation. Understanding the fundamental circuit mechanisms underlying functional recovery may leaf to new diagnostic and therapeutic approaches as well as insights into mechanisms of general anesthesia and sleep.

Music Therapy Applied to Patients in Low Awareness States

Camilla Pfeiffer, MT-BMT, FLENI Neuro-rehabilitation Hospital, Buenos Aires, Argentina

Music Therapy (MT) offers an unique clinical tool in the recovery of patients in low awareness states. Music applied as a treatment intervention is a non-invasive, high motivational auditory and sensory stimulus which involves the vegetative systems, the brain emotional systems and behavioral responses. Music helps the agitated patient to regulate and adapt his system to the stimulus, whereas it also activates patients with a low arousal level. Music Therapy elicits responses at physiological, emotional and behavioral levels and represents a useful tool to assess the subtle responses of patients in low awareness states.(Magee, Boyle, Berger, Juslin and others)

At the Neurological Rehabilitation Institute FLENI, in Escobar, Argentina, Music Therapy is part of the multidisciplinary rehabilitation program of hospitalized patients in vegetative and minimally conscious states. Clinical interventions we will see in this lecture will show which elements of music have an impact on the arousal and expressive responses of these patients. Case vignettes will be presented of clients whose diagnoses where contradicted by the responses within Music Therapy and methods for interdisciplinary work will be suggested.

Keynote Address

The Emotional Power of Music: Aesthetic and Clinical Implications

Klaus R. Scherer, PhD, University of Geneva, Switzerland

Music has often been considered a language of emotion and it does demonstrably mirror some of the dynamic aspects of the emotion process. More importantly, from antiquity it has been recognized that music has a powerful emotional impact on performers and listeners, for both instrumental and vocal forms of music. Starting with some considerations of the evolutionary functions of music and emotion, and considering the special nature of emotion as a process involving all of the subsystems of the organism in a synchronized fashion, theoretical arguments and empirical research findings concerning the nature of the emotions evoked by music will be presented. In particular, the role of aesthetic or "subtle" emotions will be highlighted and exemplified with the help of recent research findings. Grounded on these theoretical analyses and empirical results, the implications of using music in clinical settings and the mediational role of emotion will be discussed.

* Additional abstracts coming soon.

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