Music can benefit not just your mind, but also your lungs. Music therapy combined with standard pulmonary rehabilitation (PR) improved respiratory symptoms, psychological well-being, and quality of life in patients with chronic obstructive pulmonary disease (COPD) and other chronic respiratory disorders, compared with patients receiving PR alone, the AIR* study showed.
Lead author Mr. Bernardo Canga, a music therapist and researcher from the Louis Armstrong Center for Music and Medicine at Mount Sinai Beth Israel (MSBI) hospital, New York, New York, US, believes music therapy has a huge impact on the quality of care provided.
“Music therapy is cost-effective, has no adverse side effects, and improves communication between patients, families, and medical staff,” Canga said. “Therefore, music therapy has an impressive profile of treatment adherence, which is vital in the recovery process.”
Study participants given music therapy in addition to PR (treatment group) demonstrated fewer depressive symptoms (Least-Square [LS] mean -0.2), compared to control group receiving PR alone (LS mean 1.3, p=0.007).
Health-related Quality of Life (HRQL), as measured by Chronic Respiratory Questionnaire Self-Reported (CRQ-SR), improved in the treatment group in the four criteria evaluated: dyspnoea (LS mean 0.5, p=0.01), fatigue (LS mean 0.3, p=0.01), emotional function (LS mean 0.3, p=0.005), and mastery (LS mean 0.5, p=0.06), compared with controls. Additionally, music therapy significantly improved perceived dyspnoea in patients, measured by a Dyspnoea Visual Analogue Scale (VAS), especially in week 5 and 6 of the study (p<0.001), compared with controls.
“We hope that our results reinforce a comprehensive foundation for the establishment of music therapy as part of PR care… and [it will become] more commonly used in clinical settings,” said Canga.
A total of 68 participants (mean age 70.1 years), with moderate to severe GOLD stage II-IV lung diseases and other conditions causing chronic airflow limitations, completed the study. Participants were randomly assigned to control group, receiving PR alone, or the treatment group, who received PR plus psycho-music therapy administered by certified music therapists for 6 weeks. The music therapy included live music, visualizations, singing, and wind instrument playing, which incorporated the patients’ preferred music styles.
Canga said allowing patients to choose familiar music encourages self-expression, increases engagement in therapeutic activities, and provides an opportunity to cope with the challenges of a chronic condition.
“Our study is the first to our knowledge that incorporates a multimodal intervention adjunct to standard PR using certified music therapists.”
Expanding on the current study, the Louis Armstrong Center for Music and Medicine is currently using music therapy to enhance the breathing capacity and quality of life of children and teens with asthma under the Asthma Initiative Program. Canga said his team would like to focus on the effect of music therapy intervention specifically on pulmonary function in future study.
Music is powerful — it moves us physically and emotionally, often transporting us back to a previous place and time. A foot will start to tap along to a beat or tears begin to well up in response to a touching melody. Far from just stimulating memories surrounding a song, though, many believe music can actually help to preserve and even enhance cognitive function.
Rhythm of Music and Mind
File this away for small talk or to use as a retort when someone declines your invitation to dance because they “have no rhythm.” Every person — or at least every brain — does have rhythm. This pattern changes depending on the state of activity: increasing when you’re alert and focused and slowing when you’re sleepy.
In certain diseases, like Parkinson’s, the brain rhythm in the circuit controlling movement gets off track. Specific treatments work to restore normal rhythm: deep brain stimulation delivers electrical stimulations and a new device breaks a freezing episode by playing a rhythmic clicking in the ear.
Knowing we all have this inherent rhythm and that we all respond to music somehow, researchers have investigated the brain changes that occur when listening to and playing music. The emotional experience of hearing music can increase the release of dopamine — the brain chemical lacking in Parkinson’s disease. People with musical training have better memory, executive function (planning, problem solving, organizing, etc) and visuospatial perception (ability to determine the relationship of objects in space). While playing music, multiple different areas of the brain are activated and in the long run, this leads to an increase in the volume and activity of the corpus callosum — the bridge that allows communication between the two sides of the brain.
Can Music Mend the Mind?
What if you have no musical background or ability to carry a tune? What if dementia or Parkinson’s disease has already caused cognitive changes or movement difficulties? Can music help?
According to members of the 5th Dementia — an unconventional group of musicians whose only requirements for participation include an interest in music and a diagnosis of Parkinson’s or dementia — that answer is a resounding yes. Their twice-weekly jam sessions have brought about a remarkable transformation in each individual involved. Through the universal language of music, those who have trouble recalling a daily schedule or holding a conversation are able to communicate in a different manner, express their emotions and connect with others on a deeper level.
Irwin Rosenstein, who plays keyboard for the group, describes the music as giving him a purpose so that Parkinson’s and dementia don’t define him. He and his wife Carol founded the 5th Dementia and its parent organization, Music Mends Minds in 2014. Regarding the changes she’s seen in Irwin since then, Carol says “I think he’s much more alert. He’s much more interesting. His cognition has improved… We really were losing a connection, and he was really slipping away. And I can really say that he’s — he’s back again.”
Playing Music Is “a Full Body Workout for the Brain”
Playing music is a complicated undertaking that engages multiple areas of the brain simultaneously. In essence, it’s the definition of multitasking. Translating black and white symbols into pleasing sounds requires:
– fine motor movements and an intact sensory system to manipulate an instrument,
– immediate processing of visual and auditory elements of a melody,
– mathematical precision and internal rhythm to keep tempo,
– emotional interpretation of the sound, and
– coordination with other performers.
Playing music exercises the mind and body. It provides a route for social interaction. In drawing someone into its rhythm, it can calm a resting tremor, break a freezing spell and bring gait into a more normal pattern. Music can boost memory, lessen depression, and improve the volume and tone of speech. It’s no wonder some say music is magical.
Make Your Own Music
You don’t have to have any musical training or talent to participate in music therapy. The leader of 5thDementia says there are “no wrong notes” and their website states that the only possible side effect is “happy memories.” Although the 5th Dementia is based in Los Angeles, music therapy is widely available. You can find a music therapist in your area through an online search or talk with your doctor or support group for other recommendations. If no opportunities for formal participation in a band are available, consider singing in the church choir, reaching out to a local music school or picking up your own instrument at home.
When I was a child, on most Fridays, my dad, mom, brother and I would travel to Cape Cod to visit my grandparents. For my father, this drive would come after a long day of work, during which he had already commuted from our home, an hour outside of the city, to Boston, where he worked as an accountant, and back home again. He was an intense man, and during these drives to the Cape we were often silent, on edge – unsure how to interpret his sullen and grave demeanor.
After we arrived, my grandmother would typically begin playing a mix of classical music, folk songs and pop songs on her spinet piano – and I would watch my dad’s face transform: his jaw would slacken, while the lines between his eyebrows softened, lifting the intensity of thought that always seemed to burden him.
This was my first experience of the power of music.
Nearly two decades later, I learned of music therapy as a profession. I was a rising junior in college and, without hesitation, I switched my major to learn how to clinically wield music’s ability to transform and heal – a power I had observed years earlier.
Music therapy has grown from relative obscurity to a practice that is becoming fairly mainstream, largely due to the advocacy of colleagues in the field, along with media coverage of the burgeoning profession. Jodi Picoult came to Berklee College to study music therapy to develop the main character – a music therapist – of her novel Sing You Home. Meanwhile, following the gunshot injury she sustained, Representative Gabby Giffords underwent rehabilitation efforts that included music-based interventions. Although she initially couldn’t speak, she could sing, an ability that was used to further her speech recovery. And films about music’s capacity for healing and improving quality of life include the recent releases Alive Inside, The Lady in Apartment 6, Landfill Harmonic and The Music Never Stopped.
In my practice as a speech language pathologist and music therapist, I’m able to use music to serve a variety of patients with an array of needs. Children with autism tend to be more attentive to musical sounds than speech sounds (especially when they’re very young), so I’ll use music to foster their linguistic and cognitive development. In my work with hospice patients, I’ll use quiet music that has a lulling rhythm to help even out their ragged breathing (which is sometimes very difficult for families to watch).
For cancer patients, I’ll use songs of hope and resilience. And by pairing music with imagery, such as relaxing nature images, I’ve helped patients preparing for surgery achieve a state of tranquility that can decrease their need for anesthesia and pain medication. I’ve used the same protocol to decrease the use of anti-anxiety medications among hospice patients I’ve served. Ultimately, carryover is the endgame: we help patients take the tools they’ve learned in music therapy and apply them to their everyday lives.
As a professor of music therapy at the Berklee College of Music, I’m preparing the next generation of music therapists to work in a variety of settings: early intervention programs, public schools, hospice and palliative care, cancer clinics, nursing homes and private practice. For many students, it’s an attractive opportunity – a chance to use their artistry to make the world a better place.
Every week, our Berklee students Skype with a group of child soldiers in Uganda. These young adults have suffered a great deal: forced to kill as children, they often started with their own family members and neighbors. They’ve emerged from the bush traumatized and without purpose. We’re teaching them to use meditative practices in music to calm their minds and to infuse meaning into their lives. As our students share therapeutic practices with the child soldiers, they, in turn, perform and share their music and dance for our students.
It’s this fusion of what many consider two distinct, incompatible entities – art and science – that ultimately elevates both; and the two, as one, can more readily accomplish their shared purpose: the healing and betterment of humanity.
Importance Alternatives to sedative medications, such as music, may alleviate the anxiety associated with ventilatory support.
Objective To test whether listening to self-initiated patient-directed music (PDM) can reduce anxiety and sedative exposure during ventilatory support in critically ill patients.
Design, Setting, and Patients Randomized clinical trial that enrolled 373 patients from 12 intensive care units (ICUs) at 5 hospitals in the Minneapolis–St Paul, Minnesota, area receiving acute mechanical ventilatory support for respiratory failure between September 2006 and March 2011. Of the patients included in the study, 86% were white, 52% were female, and the mean (SD) age was 59 (14) years. The patients had a mean (SD) Acute Physiology, Age and Chronic Health Evaluation III score of 63 (21.6) and a mean (SD) of 5.7 (6.4) study days.
Interventions Self-initiated PDM (n = 126) with preferred selections tailored by a music therapist whenever desired while receiving ventilatory support, self-initiated use of noise-canceling headphones (NCH; n = 122), or usual care (n = 125).
Main Outcomes and Measures Daily assessments of anxiety (on 100-mm visual analog scale) and 2 aggregate measures of sedative exposure (intensity and frequency).
Results Patients in the PDM group listened to music for a mean (SD) of 79.8 (126) (median [range], 12 [0-796]) minutes/day. Patients in the NCH group wore the noise-abating headphones for a mean (SD) of 34.0 (89.6) (median [range], 0 [0-916]) minutes/day. The mixed-models analysis showed that at any time point, patients in the PDM group had an anxiety score that was 19.5 points lower (95% CI, −32.2 to −6.8) than patients in the usual care group (P = .003). By the fifth study day, anxiety was reduced by 36.5% in PDM patients. The treatment × time interaction showed that PDM significantly reduced both measures of sedative exposure. Compared with usual care, the PDM group had reduced sedation intensity by −0.18 (95% CI, −0.36 to −0.004) points/day (P = .05) and had reduced frequency by −0.21 (95% CI, −0.37 to −0.05) points/day (P = .01). The PDM group had reduced sedation frequency by −0.18 (95% CI, −0.36 to −0.004) points/day vs the NCH group (P = .04). By the fifth study day, the PDM patients received 2 fewer sedative doses (reduction of 38%) and had a reduction of 36% in sedation intensity.
Conclusions and Relevance Among ICU patients receiving acute ventilatory support for respiratory failure, PDM resulted in greater reduction in anxiety compared with usual care, but not compared with NCH. Concurrently, PDM resulted in greater reduction in sedation frequency compared with usual care or NCH, and greater reduction in sedation intensity compared with usual care, but not compared with NCH.
Music therapy improves well-being in hospice patients, distracts patients during endoscopy, and helps treat depression in elders. Could it also decrease anxiety in critically ill patients?
Investigators randomized 373 awake and interactive intensive care unit (ICU) patients to one of three groups: patient-directed music through noise-cancelling headphones (with a visit by a music therapist to find preferred music and twice-daily prompts to listen to music), patient-initiated noise-cancelling headphone use only, or usual care. Anxiety was assessed daily with a 100-point visual-analog scale (VAS; range, 0 = “not anxious at all” to 100 = “most anxious ever”), and sedation doses and frequency were analyzed post hoc.
During a mean follow-up of 6 days, daily VAS scores of patients who received patient-directed music were significantly lower (by a mean of 19 points) than those of patients who received usual care; the headphones-alone group scored nonsignificantly lower (by a mean of 8 points) than the usual-care group. Sedation use was somewhat lower in the music-treated group.
Comment: As an editorialist notes, this trial has several limitations, including lack of a standardized sedation protocol and use of an unvalidated anxiety-assessment tool. Despite this, the results suggest that an inexpensive intervention like patient-directed music in the ICU could help limit use of sedating medications and all the complications associated with them.