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#REDIRECT [[Music therapy]] |
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'''Neurologic music therapy''' ('''NMT''') is the therapeutic application of music to cognitive, sensory, and motor dysfunctions that come from human [[neurologic diseases]].<ref name=Thaut /> NMT treatment is based on stimulating music perception and production parts in the human [[brain]], and the effects thereof on nonmusical and behavior functions.<ref>{{cite book | last = Thaut | first = Michael | name-list-format = vanc | title = Training manual for neurologic music therapy | year = 1999 | publisher = Center for Biomedical Research in Music | location = Colorado State University }}</ref> The targeted neurological dysfunctions include [[stroke]], [[traumatic brain injury]], [[Parkinson's disease]], [[Huntington's disease]], [[cerebral palsy]], [[Alzheimer's disease]], [[autism]], and other neurological disease affecting cognition, movement, and communication (e.g., MS, [[muscular dystrophy]], etc.).<ref name="Thaut">{{cite web | last = Thaut | first = Michael | name-list-format = vanc | title=Robert F. Unkefer Academy of Neurologic Music Therapy | url = http://www.colostate.edu/dept/cbrm/academymissionstatement.html | publisher = The Center for Biomedical Research in Music at Colorado State U. | accessdate = 2 August 2011 }}</ref> |
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== Common neurologic dysfunctions and Brodmann's areas == |
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Here are seven common neurologic dysfunctions categorized into one of four domains that are motor, sensory, cognitive, and communicational dysfunctions. For each dysfunction, specific parts of the brain are impaired, and the corresponding locations of the brain are denoted with Brodmann area numbers. In neuroscience, a [[Brodmann area]] is a conventional way to express different regions of [[cerebral cortex]] based on diverse cortical functions. |
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[[File:Gray726-Brodman.svg|thumb|upright=1.8|right|alt=A large clock tower and other buildings line a great river.|Brodmann Area]] |
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{| class="wikitable" |
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! Name of dysfunction !! Dysfunction Category !! Part of Brain !! Brodmann area # |
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| Parkinson's disease<ref name="Hackney 2009">{{cite journal | vauthors = Hackney ME, Earhart GM | title = Effects of dance on movement control in Parkinson's disease: a comparison of Argentine tango and American ballroom | journal = Journal of Rehabilitation Medicine | volume = 41 | issue = 6 | pages = 475–81 | year = 2009 | pmid = 19479161 | pmc = 2688709 | doi = 10.2340/16501977-0362 | department = primary }}</ref> || Motor || [[Basal ganglia]] ([[substantia nigra]]) || not specified |
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| Stroke (motor function)<ref name="Rodriguez 2012"/> || Motor || [[Motor cortex]] || 4 and 6 |
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| Hearing loss<ref name="Norena 2005"/> || Sensory || [[Auditory cortex]] || 41 and 42 |
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| Stroke (sensory function)<ref name="Huang 2010"/> || Sensory || [[Somatosensory cortex]] || 3,1,2, and 5 |
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| Alzheimer's disease<ref name="Cuddy 2005"/> || Cognitive || [[Hippocampus]] || 35 and 36 |
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| Multiple sclerosis (memory function)<ref name="Thaut 2010"/> || Cognitive || Bilateral [[frontal lobe]] || not specified |
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| Expressive aphasia<ref name="Schlaug 2008"/> || Communicational || [[Broca's area]] || 44 and 45 |
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|}{{Clear}} |
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== Area of Application == |
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=== Motor === |
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Motor dysfunction involves malfunctioning of the nervous system controlling muscles and movement of body. There are different kinds of motor dysfunctions to which neurologic music therapy can be applied with beneficial results, and the dysfunctions include [[stroke]], [[Parkinson's disease]], Post-encephalitic, [[Huntington's disease]], and [[aphasia]]. |
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==== Instrument learning and stroke ==== |
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For [[stroke]] patients, the motor circuit has a difficult time being activated by itself. Using music-supported therapy, their motor circuit can be co-activated along with [[auditory cortex]].<ref name="Rodriguez 2012"/> This therapy is based on [[neuroplasticity]], the capacity of brain to induce plastic changes and repair damaged brains of adults. After brain damage, new neuronal connections and pathways can be built, reshaped, and rewired. Music-supported therapy has been developed recently to improve the [[upper limb|upper extremity]] function of stroke patients. Patients learn to play electronic pianos and electronic drums, each instruments serving as a training method for fine and gross movements.<ref name="Rodriguez 2012"/> An intensive one-month program is conducted on stroke patients which teaches them to move their upper extremities in sync along with the song. |
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After finishing this program, chronic stroke patients showed significant motor improvements in Action Research Arm Test, which is one of the most widely used measures of upper extremity function. There was partial re-establishment of the default dynamics of the motor circuit, and this is induced by auditory-motor network co-activation. |
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Also, after finishing this program, the trained song was played to these patients, and researchers studied [[fMRI]] activation of the brains. From this fMRI study, researchers discovered bilateral activation of both auditory and motor circuits.<ref name="Rojo">{{cite journal | vauthors = Rojo N, Amengual J, Juncadella M, Rubio F, Camara E, Marco-Pallares J, Schneider S, Veciana M, Montero J, Mohammadi B, Altenmüller E, Grau C, Münte TF, Rodriguez-Fornells A | title = Music-supported therapy induces plasticity in the sensorimotor cortex in chronic stroke: a single-case study using multimodal imaging (fMRI-TMS) | journal = Brain Injury | volume = 25 | issue = 7-8 | pages = 787–93 | year = 2011 | pmid = 21561296 | doi = 10.3109/02699052.2011.576305 | department = primary }}</ref> Mean functional connectivities were calculated within the audio-motor network for pre- and post-experiment, and there is a clear increase in connectivities between the auditory network and the motor network.<ref name="Rodriguez 2012">{{cite journal | vauthors = Rodriguez-Fornells A, Rojo N, Amengual JL, Ripollés P, Altenmüller E, Münte TF | title = The involvement of audio-motor coupling in the music-supported therapy applied to stroke patients | journal = Annals of the New York Academy of Sciences | volume = 1252 | issue = | pages = 282–93 | year = 2012 | pmid = 22524370 | doi = 10.1111/j.1749-6632.2011.06425.x | department = primary }}</ref> Stroke patients can improve on initiating movements by music-supported therapy which utilizes auditory cortex for co-activation of motor circuit system. |
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==== Enriched acoustic environment and hearing loss ==== |
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Enriched acoustic stimulus within the frequency region of the hearing loss may prevent tonotopic reorganization in [[auditory cortex]] by compensating for the decrease in firing rate caused by the hearing impairment.<ref name="Norena 2005"/> An experiment was done on cats to prove rescue effect of enriched acoustic environment from hearing loss. Fourteen short-hair, wild-type cats were exposed to a traumatizing noise of high frequency around 40 dB for two hours as an experimental group. As a result of the exposure, significant damage is observed in the high frequency region of [[cochlea]].<ref name="Norena 2005"/> There are auditory nerve fibers connecting this high frequency region to corresponding auditory cortex in the brain, and the firing rates of these auditory nerve fibers in the high frequency region significantly decrease due to cochlear damage. This decrease in firing rates shifts the cortical tonotopic map toward a lower frequency range. This reorganization of cortical tonotopic map can result in [[tinnitus]] or phantom sound. |
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After this impairment, half of the cats were placed in a quiet room, and the others were placed in a room with enriched acoustic environment. In enriched acoustic environment, the cats were stimulated with high-frequency multitone complex stimulus. They were exposed to this environment 24 hours/day for 35 days, and results were compared.<ref name="Norena 2005"/> |
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This is where enriched acoustic environment comes into play. Enriched acoustic stimulus within the frequency region of the hearing loss may prevent tonotopic reorganization in the auditory cortex by compensating for the decrease in firing rate caused by the hearing impairment.<ref name="Norena 2005">{{cite journal | vauthors = Noreña AJ, Eggermont JJ | title = Enriched acoustic environment after noise trauma reduces hearing loss and prevents cortical map reorganization | journal = The Journal of Neuroscience | volume = 25 | issue = 3 | pages = 699–705 | year = 2005 | pmid = 15659607 | doi = 10.1523/JNEUROSCI.2226-04.2005 | department = primary }}</ref> This compensation did not happen for the control group placed in the quiet room, and hearing loss is inevitable. Human hearing loss at a certain frequency can be treated by gentle stimulation of acoustic sound at that pitch. |
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==== Mobile music touch and partial tetraplegia ==== |
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Mobile music touch, developed by Dr. Starner and his Contextual Computing Lab at Georgia Tech, is an innovative wireless glove paired with a computer or mp3 player to help regenerate dissipated nerves.<ref name="Markow">{{cite journal | vauthors = Markow T, Ramakrishnan N, Huang K, Starner T, Eicholtz M, Garrett S, Profita H, Scarlet A, Schooler C, Tarun A, Backus D | title = Mobile Music Touch: Vibration stimulus in hand rehabilitation | journal = Pervasive Computing Technologies for Healthcare | publisher = PervasiveHealth| date = 2010 | pages = 1–8 }}</ref> As this mobile music touch system plays a song, five vibrators on glove are tapping the fingers using vibration motors to indicate each key on the piano keyboard. Usually, learning requires active attention, but professor Starner came up with a concept called Passive Haptic Learning.<ref name="Huang 2010">{{cite journal | vauthors = Huang K, Starner T, Do E, Weinberg G, Kohlsdorf D, Ahlrichs C, Leibrandt R | date = 2010 | title = Mobile Music Touch: Mobile Tactile Stimulation For Passive Learning | journal = Chi2010: Proceedings of the 28th Annual Chi Conference on Human Factors in Computing Systems | volume = 1–4 | pages = 791–800 }}</ref> Haptic includes both [[tactile]] sense and [[proprioception]], and this passive learning is, potentially, applicable for all other somatosensory senses. What distinguishes Dr. Starner's mobile music touch from all other therapeutic interventions is the passive nature of this therapy without the following general requirements of learning which are attention, hard practice, and motivation. |
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The mobile music touch has a potential clinical application. Dr. Starner works with Shepherd Spinal Cord Center for patients with partial [[tetraplegia]]. They are patients with all four limbs partially paralyzed, mostly from [[spinal cord injury]]. In one study, patients were wearing this glove two hours a day, five days a week, for eight weeks. After eight weeks of therapy sessions, a significant improvement was observed on somatosensory sensation of their hands especially on 'grasp and release' test which supports the improvement on motor system.<ref name="Markow"/> This experiment supports that passive learning is possible and can be effective. This therapy is still in the process of research, and [[PET scan]] or imaging studies have not been done yet. However, Dr. Starner has preliminary hypothesis for neural mechanism. As the glove sends the vibrations repeatedly to the paralyzed hand, the brain may be recruiting more neurons to explain these random somatosensory signals.<ref name="Markow"/> Stimulations result in more activations. At the same time, there may be a [[mirror neuron]] effect. While vibrations move the fingers and stimulate our somatosensory neurons, there is firing of motor neurons mimicking the movement of the hand caused by vibration.<ref name="Markow"/> Repetitive stimulation of vibration rejuvenate degenerated tactile sensory system. |
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====Rhythmic Auditory Stimulation (RAS)==== |
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Rhythmic Auditory Stimulation or RAS is a Neurologic music therapy tool in which audible, rhythmic cues are provided to clients in order to strengthen and improve intrinsic rhythmic functions, such as [[gait]]. Through [[entrainment]], the process in which a person's internal rhythm syncs with an external source, RAS can provide a safe, effective treatment in rehabilitation of rhythmic biological movements. The rhythmic cues can be provided by a [[guitar]], a [[metronome]], or any other medium that can deliver accented beats in a manner that follows a prescribed [[tempo]]. These cues are most often in meters of 2/4 and 4/4.<ref>Thaut, M.H. 2005. Medical Coding and Records Manual: Neurologic Music Therapy. Robert F. Unkefer Academy of Neurologic Music Therapy</ref> |
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From 1991-1993, the very first studies focusing on entrainment for physical rehabilitation took place. These studies, done by [[Michael H. Thaut]], PhD and his colleagues, showed that subjects who were healthy as well as those with stroke could entrain to rhythmical and music input <ref>Thaut, M., Schleiffers, S., & Davis, W. (1991). Analysis of EMG Activity in Biceps and Triceps Muscle in an Upper Extremity Gross Motor Task under the Influence of Auditory Rhythm. Journal of Music Therapy, 28(2), 64-88. doi:10.1093/jmt/28.2.64</ref><ref>Thaut, M. H., Mcintosh, G. C., Prassas, S. G., & Rice, R. R. (1992). Effect of Rhythmic Auditory Cuing on Temporal Stride Parameters and EMG Patterns in Normal Gait. Neurorehabilitation and Neural Repair, 6(4), 185-190. doi:10.1177/136140969200600403</ref><ref>Thaut, M. H., Mcintosh, G. C., Prassas, S. G., & Rice, R. R. (1993). Effect of Rhythmic Auditory Cuing on Temporal Stride Parameters and EMG. Patterns in Hemiparetic Gait of Stroke Patients. Neurorehabilitation and Neural Repair, 7(1), 9-16. doi:10.1177/136140969300700103</ref> These studies showed great success in areas such as velocity, cadence, stride symmetry, and stride length. It was thought that these result came due to priming the [[motor system]] with cues, allowing the brain to better plan and deliver motor actions.<ref>Thaut, M. H. (2013). Entrainment and the Motor System. Music Therapy Perspectives, 31(1), 31-34. doi:10.1093/mtp/31.1.31</ref> These observations led to future studies using auditory stimulation to assist those with strokes as well as [[Parkinson's disease]] (PD). |
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=====RAS and Parkinson's disease===== |
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More and more studies took place showing the power of auditory stimulation to positively affect change in gait. Statistically significant improvements were observed regarding mean gait velocity,<ref name=Mcintosh>McIntosh GC, Brown SH, Rice RR, Thaut MH (1997) Rhythmic auditorymotor facilitation of gait patterns in patients with Parkinson’s disease. J NeurolNeurosurg Psychiatry 62: 22–26.</ref><ref name="Howe TE 2003">Howe TE, Lovgreen B, Cody FW, Ashton VJ, Oldham JA (2003) Auditory cues can modify the gait of persons with early-stage Parkinon’s disease: a method for enhacing parkinsonian walking performance?. Clin Rehabil 17: 363–367.</ref> cadence,<ref name="Howe TE 2003"/> and stride length.<ref name="Mcintosh"/><ref>Rochester L, Hetherington V, Jones D, Nieuwboer A, Willems AM, et al. (2005) The effect of external rhythmic cues (auditory and visual) on walking during a functional task in homes of people with Parkinson’s disease. Arch Phys Med Rehabil 86: 999–1006.</ref> Positive results have also been seen in improving motor timing abilities as well as perceptual abilities.<ref>Benoit, C., Bella, S. D., Farrugia, N., Obrig, H., Mainka, S., & Kotz, S. A. (2014). Musically Cued Gait-Training Improves Both Perceptual and Motor Timing in Parkinson's Disease. Frontiers in Human Neuroscience, 8. doi:10.3389/fnhum.2014.00494</ref> Affecting a smaller percentage of patient's with PD and [[parkinsonism]] is another mobility issue known as FOG, or freeze of gait, and it's one of the most inhibiting. In this condition, all movement ceases, as though the person is stuck in place. RAS has been applied in this area as well and resulted in a large reduction of FOG episodes, increased velocity, and gait speed.<ref>Arias, P., & Cudeiro, J. (2010). Effect of Rhythmic Auditory Stimulation on Gait in Parkinsonian Patients with and without Freezing of Gait. PLoS ONE, 5(3). doi:10.1371/journal.pone.0009675</ref><ref>Plotnik, M., Shema, S., Dorfman, M., Gazit, E., Brozgol, M., Giladi, N., & Hausdorff, J. M. (2014). A motor learning-based intervention to ameliorate freezing of gait in subjects with Parkinson’s disease. Journal of Neurology, 261(7), 1329-1339. doi:10.1007/s00415-014-7347-2</ref> As with any treatment option, results are not always positive, as some patients do not have the synchronization abilities to entrain to the given cues.<ref>Bella, S. D., Benoit, C., Farrugia, N., Schwartze, M., & Kotz, S. A. (2015). "Effects of musically cued gait training in Parkinson's disease: Beyond a motor benefit" Annals of the New York Academy of Sciences, 1337(1), 77-85. doi:10.1111/nyas.12651</ref> |
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===Communicational and cognitive=== |
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The cognitive dysfunction involves impairments of nervous systems managing intellectual functions such as thinking, reasoning, planning, and remembering. Communicational dysfunction involves impairments of nervous systems handling communication abilities such as speech, language, and auditory processing. |
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In the realm of neurologic music therapy, [[cognitive rehabilitation]] is, compared to the other domains, the newest domain that has recently been getting major attention by research and clinics. Music therapies below are applied to the speech processing system and the memory and recall system of the brain. |
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====Melodic intonation therapy and aphasia==== |
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One of the most-studied communicational dysfunctions is [[aphasia]]. Aphasia is dysfunction characterized by loss of ability to communicate verbally. Largely, there are two main category of aphasia, and they are [[expressive aphasia]] and [[receptive aphasia]]. Expressive aphasia, loss of spoken language, results from damage or dysfunction in left [[frontal lobe]], especially [[Broca's area]]. Receptive aphasia patients have difficulty understanding speech, and it is caused by damage or dysfunction in [[Wernicke's area]], a different speech area in the left [[temporal lobe]].<ref name="Belin 1996">{{cite journal | vauthors = Belin P, Van Eeckhout P, Zilbovicius M, Remy P, François C, Guillaume S, Chain F, Rancurel G, Samson Y | title = Recovery from nonfluent aphasia after melodic intonation therapy: a PET study | journal = Neurology | volume = 47 | issue = 6 | pages = 1504–11 | year = 1996 | pmid = 8960735 | doi = 10.1212/wnl.47.6.1504| department = primary }}</ref> |
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An interesting characteristic about [[Broca's aphasia]] patients is that the patients are not able to make meaningful propositional phrases, but, often, they are able to sing along to their familiar tunes. Based on this intriguing tendency, [[Melodic intonation therapy]] was developed. Melodic intonation therapy contains two essential components of melodic singing and rhythmic tapping of each syllable.<ref name="Belin 1996"/> Patients start with singing short intoned phrases, and intonations are gradually removed to normal speaking level. |
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There are many studies that examined the neural mechanism of this therapy, but it has not been firmly agreed upon yet. However, the possible neural mechanism boils down to two routes to recovery. First, for patients with small [[lesions]] in the left hemisphere, there tends to be more activation in the left hemisphere around the lesions and small amount of right hemisphere activation.<ref name="Schlaug 2008"/> Second, for patients with large lesions in the left hemisphere, there tends to be more activation of right Broca's area, the Broca's area in the right hemisphere.<ref name="Schlaug 2008">{{cite journal | vauthors = Schlaug G, Marchina S, Norton A | title = From Singing to Speaking: Why Singing May Lead to Recovery of Expressive Language Function in Patients with Broca's Aphasia | journal = Music Perception | volume = 25 | issue = 4 | pages = 315–323 | year = 2008 | pmid = 21197418 | pmc = 3010734 | doi = 10.1525/MP.2008.25.4.315 | department = primary }}</ref> Songs are promising to treat expressive and receptive aphasia patients by activating speech part of the brain through melodic and rhythmic notes. |
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==== Cognitive music therapy and memory ==== |
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[[Dementia]] is one of the most prevalent cognitive dysfunction. Interestingly, even when dementia is very advanced, the patients succeed to respond to music.<ref name="Cuddy 2005"/> The patients can often respond to familiar melodies and are able to sing along. They can also recognize when the original melodies are distorted. Dementia can result from different causes, but Alzheimer's disease is the most common cause. |
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Memory is enhanced when it is accompanied by emotional context, and music is a powerful stimulus for various emotions. The [[hippocampus]] network is the part of the brain that manages memory forming, organizing, and storing. However, when Alzheimer's disease patients are using short term memory, the amygdala network gets activated rather than hippocampus network.<ref name="Rosenbaum">Rosenbaum, R. S., Furey, M. L., Horwitz, B., & Grady, C. L. (2010). Altered connectivity among emotion-related brain regions during short-term memory in Alzheimer's disease. Neurobiology of aging, 31(5), 780-786.</ref> The activation of amygdala network, the network that processes emotional memory, signifies that emotion is a critical factor for short term memory of Alzheimer's disease patients.<ref name="Thaut 2010">{{cite journal | vauthors = Thaut MH | date = 2010 | title = Neurologic Music Therapy in Cognitive Rehabilitation = | journal = Music Perception | volume = 27 | issue = 4 | pages = 281–285 | doi = 10.1525/Mp.2010.27.4.281 }}</ref> |
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Memorization performance and EEG record support the idea that song rehearsal for [[multiple sclerosis]] is an effective therapeutic intervention for improving memory, by activating the bilateral frontal lobe.<ref name="Cuddy 2005">{{cite journal | vauthors = Cuddy LL, Duffin J | title = Music, memory, and Alzheimer's disease: is music recognition spared in dementia, and how can it be assessed? | journal = Medical Hypotheses | volume = 64 | issue = 2 | pages = 229–35 | year = 2005 | pmid = 15607545 | doi = 10.1016/j.mehy.2004.09.005 | department = primary }}</ref> Music is organized with a highly developed temporal structure, and it functions as a powerful metric template organizing and chunking information. This well-organized information is easier to process for patients with memory disorders. For multiple sclerosis patients, memory dysfunction is one of the main cognitive symptoms. To help this memory problem, a strategy similar to melodic intonation therapy is applied, and patients rehearse the list of words embedded in the song.<ref name="Thaut 2005">{{cite journal | vauthors = Thaut MH, Peterson DA, McIntosh GC | title = Temporal entrainment of cognitive functions: musical mnemonics induce brain plasticity and oscillatory synchrony in neural networks underlying memory | journal = Annals of the New York Academy of Sciences | volume = 1060 | issue = | pages = 243–54 | year = 2005 | pmid = 16597771 | doi = 10.1196/annals.1360.017 | department = secondary }}</ref> As a result, the patients showed much better memory performance compared to spoken rehearsal patients.<ref name="Thaut 2005"/>[[Electroencephalography]] (EEG) records support the hypothesis that song rehearsal is more effective than spoken rehearsal.<ref name="Thaut 2005"/> When EEG was recorded to examine neural activity of both a music rehearsal group and a spoken rehearsal group, the music rehearsal group showed significantly higher activation in the bilateral [[frontal lobe]], where memory is processed. The temporal sturucture of music and emotion invoked my music are essential mechanisms for patients with memory disorders. |
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== Profession == |
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A [[board-certified]] music therapist who is professionally trained according to the standards of their country must complete a foundational training in neurologic music therapy and may use the professional designation of NMT to become a member of the Academy for three years. Completion of the NMT training allows the board-certified music therapist to practice and use the credential of NMT.<ref name="Thaut"/> |
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==References== |
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{{reflist|33em}} |
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{{Music psychology}} |
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[[Category:Music therapy]] |
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[[Category:Neurology]] |
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[[Category:Parkinson's disease]] |
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Latest revision as of 10:07, 5 October 2017
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