Alfredo Raglio

Efficacy of music therapy treatment based on cycles of sessions: A randomised controlled trial

We undertook a randomised controlled trial to assess whether a music therapy (MT) scheme of administration, including three working cycles of one month spaced out by one month of no treatment, is effective to reduce behavioural disturbances in severely demented patients. Sixty persons with severe dementia (30 in the experimental and 30 in the control group) were enrolled. Baseline multidimensional assessment included demographics, Mini Mental State Examination (MMSE), Barthel Index and Neuropsychiatry Inventory (NPI) for all patients. All the patients of the experimental and control groups received standard care (educational and entertainment activities). In addition, the experimental group received three cycles of 12 active MT sessions each, three times a week. Each 30-min session included a group of three patients. Every cycle of treatment was followed by one month of wash-out. At the end of this study, MT treatment resulted to be more effective than standard care to reduce behavioural disorders. We observed a significant reduction over time in the NPI global scores in both groups (F 7,357 = 9.06, p < 0.001) and a significant difference between groups (F 1,51 = 4.84, p < 0.05) due to a higher reduction of behavioural disturbances in the experimental group at the end of the treatment (Cohens d = 0.63). The analysis of single NPI items shows that delusions, agitation and apathy significantly improved in the experimental, but not in the control group. This study suggests the effectiveness of MT approach with working cycles in reducing behavioural disorders of severely demented patients.

Music, music therapy and dementia: A review of literature and the recommendations of the Italian Psychogeriatric Association

This study reviews the most recent (from 2000 to 2011) Clinical Controlled Trials (CCT) and Randomized Controlled Trials (RCT) concerning the use of music and music-therapy (MT) in the context of dementia and related issues. Studies which explored the efficacy of music and MT on behavioral and psychological symptoms of dementia (BPSD) are prevalent, while those aiming at assessing a potential effect of these approaches on cognitive and physiological aspects are scant. Although with some limitations, the results of these studies are consistent with the efficacy of MT approach on BPSD. In this context, the ability of the music therapist to directly interact with the patients appears to be crucial for the success of the intervention. This review was endorsed by the Italian Psychogeriatric Association (AIP) and represents its view about the criteria to select appropriate music and MT approaches in the field of dementia. Accordingly, we have developed a list of recommendations to facilitate the current use of these techniques in the context of non-pharmacological treatments for patients with dementia.

Effect of Active Music Therapy and Individualized Listening to Music on Dementia: A Multicenter Randomized Controlled Trial

To assess the effects of active music therapy (MT) and individualized listening to music (LtM) on behavioral and psychological symptoms of dementia (BPSDs) in persons with dementia (PWDs).

Effects of music and music therapy on mood in neurological patients

Mood disorder and depressive syndromes represent a common comorbid condition in neurological disorders with a prevalence rate that ranges between 20% and 50% of patients with stroke, epilepsy, multiple sclerosis, and Parkinsons disease. Notwithstanding, these conditions are often under-diagnosed and under-treated in the clinical practice and negatively affect the functional recovery, the adherence to treatment, the quality of life, and even the mortality risk. In addition, a bidirectional association between depression and neurological disorders may be possible being that depressive syndromes may be considered as a risk factor for certain neurological diseases. Despite the large amount of evidence regarding the effects of music therapy (MT) and other musical interventions on different aspects of neurological disorders, no updated article reviewing outcomes such as mood, emotions, depression, activity of daily living and so on is actually available; for this reason, little is known about the effectiveness of music and MT on these important outcomes in neurological patients. The aim of this article is to provide a narrative review of the current literature on musical interventions and their effects on mood and depression in patients with neurological disorders. Searching on PubMed and PsycInfo databases, 25 studies corresponding to the inclusion criteria have been selected; 11 of them assess the effects of music or MT in Dementia, 9 explore the efficacy on patients with Stroke, and 5 regard other neurological diseases like Multiple Sclerosis, Amyotrophic Lateral Sclerosis/motor neuron disease, Chronic quadriplegia, Parkinsons Disease, and Acquired Brain dysfunctions. Selected studies are based on relational and rehabilitative music therapy approaches or concern music listening interventions. Most of the studies support the efficacy of MT and other musical interventions on mood, depressive syndromes, and quality of life on neurological patients.

Effects of music therapy on psychological symptoms and heart rate variability in patients with dementia. A pilot study

We assessed the effects of music therapy (MT) on behavioral and psychological symptoms (BPSD) in dementia associated with changes in physiological parameters, as heart rate (HR) and heart rate variability (HRV). Twenty subjects were randomly assigned to MT treatment or standard care; all patients underwent neuropsychological assessment and ECG Holter recordings before and after the 15-week treatment. The treatment included 30 MT sessions. Depression significantly decreased (p=0.021) in the MT group. PNN50 improved in 50% patients of the MT group, but in none of the control group (p=0.013). MT may improve symptoms of depression and increase HRV in demented patients.

Music Therapy Interventions in Parkinson’s Disease: The State-of-the-Art

Parkinson’s disease (PD) is a neurological disorder involving the progressive degeneration of the dopaminergic system, which gives rise to movement-related dysfunctions (such as bradykinesia, tremor, and rigidity) as well as other symptoms, mainly of cognitive and psychological nature. In the latter case, mood disorders prevails frequently causing anxiety and depression in all phases of the disease, sometimes even before the motor symptoms occur. Aarsland and colleagues (1) report that 35% of the patients affected by PD present depression, whereas Richard (2) states that anxiety is to be found in 40% of the cases. The literature shows that playing and listening to music may modulate emotions, behaviors, movements, communication, and cognitive factors,modifying the activity of the brain areas involved in the perception and regulation of these aspects (3, 4). Music can produce substantial effects on movement-related symptoms as well as psychological ones in PD treatment. Concerning the first aspect, rhythm has a crucial role in rehabilitation, enhancing connections between the motor and auditory systems (5). Literature showed how a rhythmic auditory cues-based training can produce a compensation of the cerebello-thalamo-cortical network leading to beneficial effects, for example, improving not only speed and step length but also perceptual and motor timing abilities (6, 7). Areas involving rhythm perception are closely related to those that regulate movement (such as the premotor cortex, supplementarymotor area, cerebellum, and basal ganglia – especially putamen) (8–18). A study conducted with fMRI (19) shows that whereas a regular pulse (in contrast to an irregular one) generally activates basal ganglia in a significant way, this is not the case in PD. Other studies (7, 20) support the idea that external cues (in particular rhythmical cues) can modulate the activity within the impaired timing system. This may mean that a regular rhythmic pulse stimulates the putamen activity, facilitating movement and providing an input for sequential movements and impaired automatized processes. Moreover, this could compensate for the lack of dopaminergic stimulation. Rhythm can be also perceived visually and through the tactile sense, but the reaction time of the human auditory system is shorter by 20–50ms, when compared to visual and tactile stimuli; moreover, it has a stronger capacity of perceiving rhythm periodicity and structure (6). Therefore, rhythm influences the kinetic system (through synchronization and adjustment of muscles to auditory stimuli), facilitates movement synchronization, coordination, and regularization, and may even produce an internal rhythm that persists in the absence of stimuli (21–23). Many studies report that musical rhythm in PD treatment can improve gait (speed, frequency, and step length), limbs coordination, postural control, and balance (7, 18, 24–36). In view of the above, Neurologic Music Therapy (NMT) – especially Rhythmic Auditory Stimulation, one of its techniques – characterizes this approach to the disease: NMT aims at enhancing sensory, cognitive, andmotor functions (as in PD treatment, in which specific rhythmic techniques can strengthen and improve the rehabilitative process).

Global music approach to persons with dementia: evidence and practice

Music is an important resource for achieving psychological, cognitive, and social goals in the field of dementia. This paper describes the different types of evidence-based music interventions that can be found in literature and proposes a structured intervention model (global music approach to persons with dementia, GMA-D). The literature concerning music and dementia was considered and analyzed. The reported studies included more recent studies and/or studies with relevant scientific characteristics. From this background, a global music approach was proposed using music and sound–music elements according to the needs, clinical characteristics, and therapeutic–rehabilitation goals that emerge in the care of persons with dementia. From the literature analysis the following evidence-based interventions emerged: active music therapy (psychological and rehabilitative approaches), active music therapy with family caregivers and persons with dementia, music-based interventions, caregivers singing, individualized listening to music, and background music. Characteristics of each type of intervention are described and discussed. Standardizing the operational methods and evaluation of the single activities and a joint practice can contribute to achieve the validation of the application model. The proposed model can be considered a low-cost nonpharmacological intervention and a therapeutic–rehabilitation method for the reduction of behavioral disturbances, for stimulation of cognitive functions, and for increasing the overall quality of life of persons with dementia.

Autism and music therapy. Intersubjective approach and music therapy assessment

Autism is a pathology in which the communicative and relational deficit is quite clear. After giving an up-to-date general view to the nosographic aspects and to the interpretative models of the Autistic Disorder, the authors focus on an improvisational music therapy approach in an intersubjective theoretical perspective. Coherently, with the theoretical frame and the clinical evidence, important process indicators were extrapolated into the analysed session. By using an appropriate coding scheme made to evaluate the music therapeutic process, the authors present an example analysis about the coding of some music therapys sessions of a clinical case of infantile autism. Such analysis highlighted the occurred changes within the sessions and it can be considered a useful tool for a longitudinal evaluation of the music therapeutic treatments.

Improvement of spontaneous language in stroke patients with chronic aphasia treated with music therapy: a randomized controlled trial

Aim of the study: The aim of this research is to evaluate the effects of active music therapy (MT) based on free-improvisation (relational approach) in addition to speech language therapy (SLT) compared with SLT alone (communicative-pragmatic approach: Promoting Aphasics Communicative Effectiveness) in stroke patients with chronic aphasia. Materials and methods: The experimental group (n = 10) was randomized to 30 MT individual sessions over 15 weeks in addition to 30 SLT individual sessions while the control group (n = 10) was randomized to only 30 SLT sessions during the same period. Psychological and speech language assessment were made before (T0) and after (T1) the treatments. Results: The study shows a significant improvement in spontaneous speech in the experimental group (Aachener Aphasie subtest: p = 0.020; Cohens d = 0.35); the 50% of the experimental group showed also an improvement in vitality scores of Short Form Health Survey (chi-square test = 4.114; p = 0.043). Conclusions: The current trial highlights the possibility that the combined use of MT and SLT can lead to a better result in the rehabilitation of patients with aphasia than SLT alone.

Addendum to ‘Efficacy of music therapy treatment based on cycles of sessions: A randomised controlled trial’ (Raglio et al., 2010)

Objectives: The aim of this paper is to provide further detail about the results of a randomised controlled study published in this journal (Raglio et al., 2010, 14, 900–904), in which we assessed the efficacy of music therapy (MT) on the behavioural disturbances in people with moderate-severe dementia. Methods: Sixty patients were randomly assigned to the experimental (MT and standard care) and control group (standard care only). The experimental group received three cycles of 12 MT sessions each, three times a week. Each cycle of treatment was followed by one month of washout period, while the standard care activities continued over time. Results: The impact of the treatment (12 MT sessions) was reliable on NPI global scores, as the interaction Time by Group was significant (F1,49 = 4.09, p = 0.049). After the end of the treatment the NPI global scores of the experimental and control groups tended to become similar, as both groups worsened (Time effect: F1,48 = 4.67, p = 0.014) and the difference between them disappeared (F < 1). Interaction Time by Group was not significant. Conclusions: The study confirms that active MT determines a positive response and can amplify and strengthen the efficacy of therapeutic interventions towards people with dementia.