11

th
Congress of the EAPC/Meet the Expert
Gnther Bernatzky, Michaela Presch
University of Salzburg, Faculty of Natural Sciences, Departm. of Organism Biology
The Contribution of Music Therapy
to Quality of Life in Older People
Music as a Pharmacon?
Vienna, May 2009
Enhance the
Quality of Life !
Content
Introduction
Physiological Effects of Music
Research Studies
Summary
Enhance the
Quality of Life !
Content
Introduction
Physiological Effects of Music
Research Studies
Summary
Enhance the
Quality of Life !
physiological,
psychological,
social,
spiritual,
Improving comfort
QUALITY OF LIFE
.... alleviate ... stress
INTEGRATED
INTERDISCIPLINARY
APPROACH!
QUALITY OF LIFE
Most Common Symptoms
in Patients with Cancer
Pain 70 - 84%
Shortness of breath (Dyspnea) 25 - 50%
Nausea and Vomiting 25 - 30%
Depression/Anxiety ~ 30%
Weakness/Cachexy 45 - 100%
Fatigue ~ 75%
(Lymphatic) Oedema ~ 30%
Agitation/Confusion 20 - 80%
Walsh, Donnelly, Mercadante 2000; David Cella: Jahrestagung der Gesellschaft fr Hmatoonkologie 10/2003
?
?
yes
Multimodal Therapy
for Treatment of Fatigue
Elements of the therapy:
Relaxation techniques
cognitive stress management group therapies
medical training therapy
Onkologie 2003;26:607-608 und Cancer 2001; 92 (Suppl.6)
Desires/Wishes of Palliative Patients
NO PAIN
TIME, LONG LIFE
RELAXATION, WELL-BEING
HOPE
EMPATHY, COMFORT, SOLACE
SINCERITY
RELIABILITY, SAFENESS
DIRECTNESS, FORTHRIGHTNESS
INFORMATION, EXPLANATIONS
Complementary Therapies
300 randomly selected hospices
Most popular methods:
Massage and Music Therapy
Demmer C. (2004): A survey of complementary therapy services provided by hospices,
J Palliat Med: 7:510-516
History of Music Therapy
Roger Bacon (c. 1214-1294 ) called attention to the
"delay of aging's symptoms" through music, and
demanded that all doctors have a thorough knowledge
of music.
Music as a fountain of youth.
Paracelsus (1493-1541) practiced musical medicine -
he introduced a vibration method into medical
practice, a method that used art, music in particular,
as a remedy.
Abbildung: Verffentlichungen zur Musiktherapie in Fachzeitschriften pro Jahr berblick
(Quellen: Psyndex, PsychInfo, MedLine 1950 -2005)
Scientific Publications on Music Therapy
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Enhance the
Quality of Life !
Content
Introduction
Physiological Effects of Music
Research Studies
Summary
further literatur for figures:
www.biologie.de, www.auric.de
signal
Acoustic signals are
translated into neuronal
activity in the
cochlea and progressively
transformed in the
auditory brainstem
How Music Affects the Brain
thalamus
primary
auditory cortex
amygdala medial orbitofrontal
cortex
emotions
control of emotional behaviour
pitch height
timbre
roughness
intensity
How Music Affects the Brain
a-c: pos. corr. with incr.
chills intensity
a l. dorsom. midbr.; r. Thal., bilat. Cereb.
b l. ventr. striatum, bilat. Insula
c r. orbitofr. cortex
Amygdala is switched of less fear
You dont have
to be a musical
genius to have
music running
through your
head!
MUSIC promotes/regulates
physical relaxation
power of concentration
social behaviour
capacity of memory
MUSIC promotes
MUSIC regulates
affective,
cognitive and
sensorimotoric components via:
emotion
cognition
attention
behaviour
communication
Luisa Lopez: Music Therapy: The Long Way to Evidence-Based Methods - Pending Issues and
Perspectives. Ann. N.Y. Acad. Sci. 1060:269-270 (2005); doi: 10.1196/annals.1360.064
* Hillecke T, Nickel A, Bolay HV: Scientific Perspectives on Music Therapy. Ann. N. Y. Acad. Sci. 1060:
271-282 (2005); doi:10.1196/annals.1360.020
VITALISATION
autonomic nervous
system
cognitive integration
of musical- and non-
musical information
electrodermal activity
heart rate
MUSIC
emotional reactions
bodily reactions
(tensioned or relaxed)
How the body reacts to music
immune system
variations of (salivary)
IgA concentrations
motor activity
overlap between neural
activities of the late
stages of perception &
those related to the early
stages of action
heard pieces of music
activate
music perception
movement induction social functions
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How the body reacts to music
premotor activity
perception
action
cognition
social cognition
emotion
learning
memory
cognitive processes
MAKING MUSIC
Enhance the
Quality of Life !
Content
Introduction
Physiological Effects of Music
Research Studies
Summary
20 Minutes of Mozart mutes OA Pain
RCT examining the influence of music as a nursing intervention
on osteoarthritis pain in elders (n = 66)
Measurement of differences in pain perceptions over 14 days
R McCaffrey, E Freeman: Effect of music on chronic osteoarthritis pain in older people.
Journal of Advanced Nursing 2003, 44(5), 517-524.
Andantino fr Flte, Harfe und Orchester, KV 299;
Ouvertre von Le nozze di Figaro KV 492;
Beginning of Sonate Symphonie No. 40
significant decrease in pain
Results Those who listened to music for 20 minutes daily
(experimental group) had less pain, when compared with those who sat
quietly and did not listen to music (control group).
Listening to music was an effective nursing intervention for the reduction
of chronic osteoarthritis pain
Listening to music can reduce chronic pain by up
to 21 % and depression by up to 25 %. It can
also make people feel more in control of their
pain and less disabled by their condition:
n=60; 2 groups (mu,con); painful conditions (osteoarthritis, disc
problems, rheumatoid arthritis....6,5 yrs)
1 h music/day/week reported improved physic., psychol.
symptoms compared to Contr.
Sandra L. Siedlecki, Cleveland Clinic Foundation, Ohio, Journal of Advanced Nursing. Vol. 54,5, pg.553-562
TAKE HOME MESSAGE
Music and Music guided imagery
have shown to be an ideal adjuvant
combination with other standard
therapeutical methods.
www.schmerzinstitut.org
Music therapy not only reduces pain
BUT
also addresses associated
psychological
distress in a positive way.
Nickel AK, Hillecke T, Argstatter H, Bolay HV: A Step on the Long Road to an Evidence-Based Treatment.
Ann.N.Y.Acead.Sci.1060:283-293 (2005)
How does it work Music?
MUSIC MAY ALTER COMPONENTS
OF THE TOTAL PAIN EXPERIENCE
IT DECREASES THE PERCEPTION OF PAIN !
Pipam W, Likar R, Klocker J, Bernatzky G, Platz T, Sittl R, Janig H. Results of a poll of cancer patients
with respect to pain and quality of life; Schmerz. 2002 Dec; 16(6): 481-9.
Pain and Quality of Life
Russell E. Hilliard (2005)
Music Therapy in Hospice and Palliative Care: a Review of the
Empirical Data. eCAM 2005; 2(2)173-178
PURPOSE: Review of empirical studies found in the literature and to
document the emergence of an evidenced-based approach to the
use of music therapy in hospice and palliative care.
METHOD: Total of 11 studies are reviewed: 6 show sign. differences
support the use of music therapy.
RESULT: The methodological quality of these small, short-term studies
was generally poor, as was the presentation of results. No useful
conclusions can be drawn.
The need to create an evidence-based approach to
hospice and palliative care music therapy is articulated,
and future researchers are empowered to continue to
conduct investigations among this population.
Empirical studies in hospice/palliative care music therapy
Author Year Publication type Research design Randomization n Dependent variables
Curtis 1986 Journal Altering treatment Yes 9 Pain relief and relaxation
Whittall 1989 Conference
proceedings
Pilot study;
pre/post test
No 8 Heart and respiratory rate,
extremity temperature
Calovini 1993 Masters thesis Pre/post test No 11 State anxiety
Longfield 1995 Masters thesis Quasi-
experimental
pre/post test
No 8 Mood and pain
Abbott 1995 Masters thesis Pre/post test No 28 Quality of life
Gallagher 2001 Journal Pilot study ex
post facto
pre/post test
No 90 Pain, mood, anxiety,
shortness of breath
Hilliard EH. Music Therapy in Hospice and Palliative Care: a Review of the Empirical Data. Advanced Access
Publication 2005, 2(2): 173-178.
Empirical studies in hospice/palliative care music therapy
Author Year Publication type Research design Randomization n Dependent variables
Krout 2001 Journal Pre/post test No 80 Comfort, pain, relaxation
Hillard 2003 Journal Clinical trial Yes 80 Quality and length of life,
time of death
Wlodarcyk 2003 Masters thesis ABAB, counter-
balance
No 10 Spirituality
Batzer 2003 Masters thesis Experimental Yes 15 Discomfort behaviours
Hilliard 2004 Journal Ex post facto No 80 Time and duration of MT
provided, needs treated
by MT
Hilliard EH. Music Therapy in Hospice and Palliative Care: a Review of the Empirical Data. Advanced Access
Publication 2005, 2(2): 173-178.
ABAB, session A consisted of cognitive-behavioural music therapy (30 min) and session B consisted of a no-
music visit (30 min)
MT, music therapy
Dependent variables positively affected
by music therapy (Review)
Pain
Physical comfort
Fatigue and energy
Anxiety and relaxation
Time and duration of treatment
Mood
Spirituality and quality of life
Cochrane Database of Systematic Reviews
Vink AC, Birks JS, Bruinsma MS & Scholten RJ (2003)
Music therapy for people with dementia.
More rigorous studies are needed to establ.
whether music therapy may play a role in the
treatment of older people with dementia.
Objectives: To assess the efficacy of music therapy in the treatment of
behavioural, social, cognitive and emotional problems of older people
with dementia.
Results: 5 studies included (354 studies-254). Randomised controlled
trials that reported clinically relevant outcomes associated with music
therapy in treatment of behavioural, social, cognitive and emotional
problems of older people with dementia.
Conclusion: The methodological quality and the reporting of the
included studies were too poor to draw any useful conclusions.
Frequenz der Unruhe
whrend der Baseline,
klassischer und
individualisierter Musik
Individualisierte Musik
war assoziiert mit einer
signifikant greren
Abnahme des erregten
Verhaltens verglichen mit
klassischer Musik
L.A. Gerdner (2000): Effects of individualized versus classical "relaxation" music on the frequency of
agitation in elderly persons with Alzheimer's disease and related disorders. Int Psychogeriatr. 12(1): 49-65.
Wirkung von individualisierter vs. klassischer
Musik auf Unruhe bei Alzheimer
Objektives: examine the efficacy of music therapy with standard care
compared to standard care alone among people with depression and
compare the effects of music therapy for people with depression
against other psychological or pharmacological therapies.
Results: Analysis of 5 studies (RCTs): 4 studies: reduction in symptoms
of depression; 1 study: no significant change in mental state; dropout
rates from music therapy conditions low in all studies.
Conclusion: small number and low methodological quality
of studies mean that it is not possible to be confident
about its effectiveness
Maratos AS, Gold C, Wang X, Crawford Mj (2008)
Music therapy for depression.
High quality trials evaluating the effects of
Music therapy on depression are required.
Cochrane Database of Systematic Reviews
Gewichtung der
Evidenz
Richtung der
Evidenz
Schwerwiegende
Sicherheitsbedenken
Alzheimersche
Krankheit
0 Ja
Angstzustnde 0 Nein
Depression 0 Nein
belkeit und
Erbrechen
0 Nein
Klinische Evidenz von Musiktherapie
fr verschiedene Krankheitsbilder
0 gering
00 mittel
000 hoch
unklar
Eindeutig negativ
eindeutig positiv
tendenziell positiv
Ernst E.: Praxis Naturheilverfahren Evidenzbasierte Komplementrmedizin. Spinger Medizin Verlag, 2001
http://www.bethabe.org/MT_and_Motor_Rehabil220.html
MUSIC STIMULATION
IN PEOPLE WITH PARCINSON
Music, Rhythm and Motor Rehabilitation
What would you think if you saw a person unable to take a step on his own
walk independently while listening to a rhytmic beat?
They cannot plan movements on their own - however they may still have the ability
to move, and this ability is unlocked by music.
Outcomes:
Motion initiated in parts of the body that have limited movement
Movement maintained in affacted extremeties
Increased range of motion
Repertoire of exercises built up resident can perform indipendently with
confidence
Motivation to participate in daily activities
Increased neuromuscular control
AIMING - Fehlerdauer
Parkinson-Gruppe (n=11) Kontroll-Gruppe (n=10)
rechte Hand linke Hand rechte Hand linke Hand
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)
0,0
0,1
0,2
0,3
0,4
0,5
0,6
VOR Musik
NACH Musik
rechte Hand: F(1,19)=7.253; p=0.015
linke Hand: F(1,19)=0.399; p=0.535
AIMING - Fehlerdauer - rechte Hand
Interaktion zwischen Gruppen- und Messwiederholungsfaktor
Parkinson-Gruppe (n=11) Kontroll-Gruppe (n=10)
F
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(
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)
0,0
0,1
0,2
0,3
0,4
0,5
0,6
VOR Musik
NACH Musik
F(1,19)=5.254; p=0.033
MLS - RESULTS
G. Bernatzky, P. Bernatzky, H.P. Hesse, W. Staffen, G. Ladurner (2004): Stimulating music increases
motor coordination in patients afflicted with Morbus Parkinson. Neuroscience letters 361: 4-8.
http://www.bethabe.org/MT_and_Speech_Rehab221.html
MUSIC STIMULATION
IN PEOPLE WITH STROKE
Music and Speech Rehabilitation
What would you think if you met a person who had lost her ability to speak
after having a stroke, but who could sing with perfect clarity?
Speech and singing use different areas of the brain to complete their tasks MT
allows people to reconnect with their voices & exercise vocal.
People who have not been able to talk for many years are slowly learning to sing, to
communicate, and finally to talk to others. Everyone can use singing to promote
vocal support, organize conversational speech & improve communication skills the
focus is language & speech improvement, not professional musical achievements.
Outcomes:
Conversational phrases are embedded into familiar song phrases to support
speech
Improved Communication Skills: improved clarity and fluency, increased
expressive speech and vocal range and volume.
Increased confidence in communication attempts
Enhanced expression
MUSIC STIMULATION
IN PEOPLE WITH STROKE
How Can Music Therapy Help Stroke Survivors?
Particular areas of benefit include:
Movement and Muscle Control
Speech and Communication
Cognition
Mood and Motivation
Playing a drum to increase range of motion in the arm
Exercising to up-beat music
Timing music to match your natural walking rhythm
Exercising muscles of the mouth
Setting a phrase to music, first singing the words, then
transferring these words to speech
Rhyming, chanting, or rapping
Creating a song with lyrics containing important information
Conducting or performing in a band
Rhythm repetition games
http://www.bethabe.org/MT_and_Stroke170.html
P < 0,01
P < 0,05
Srkm T, Tervaniemi M, Laitinen S, Forsblom A, Soinila S, Mikkonen M, Autti T, Silvennoinen HM,
Erkkil J, Laine M, Peretz I, Hietanen M: Music listening enhances cogntive recovery and mood after
middle cerebral artery stroke. Brain (2008), p 1 - 11
p < 0,1 p < 0,05
p < 0,1 p < 0,05
Srkm T, Tervaniemi M, Laitinen S, Forsblom A, Soinila S, Mikkonen M, Autti T, Silvennoinen HM,
Erkkil J, Laine M, Peretz I, Hietanen M: Music listening enhances cogntive recovery and mood after
middle cerebral artery stroke. Brain (2008), p 1 - 11
Cancer
RCTs show that music therapy, compared with usual
care, improves quality of life
1
or reduces odd
disturbance in cancer patients
2
.
RCT (n = 60) suggested that procedural pain and
anxiety are not influenced by music therapy when
compared with simple distraction
3
.
RCT (n = 8) showed that music therapy plus guided
imagery improved mood and quality of life of
cancer patients, compared with no additional
treatment
1 Hilliard RE. The effects of music therapy on the quality and length of life of people diagnosed with terminal
cancer. J Music Therap 2003, 40: 113-137.
2 Cassileth BR, Vickers AJ & Magill LA. Music therapy for mood disturbance during hospitalization for
autologous stem cell transplantation. Cancer 2003, 98: 2723-2729.
3 Kwekkeboom KL. Music versus distraction for procedural pain and anxiety in patients with cancer. Oncol
Nurs Forum 2003, 30: 433-440.
Multiple Sclerosis
2 small RCTs of active music therapy showed positive
trends for respiratory muscle strength
1
or self-
esteem, depression and anxiety in MS patients
2
The effects failed to reach statistical significance
possibly because of too small sample size
1 Wiens ME, Reimer MA & Guyn HL. Music therapy as treatment method for improving respiratory muscle
strength in patients with advanced multiple sclerosis: a pilot study. Rehabil Nurs 1999, 24: 74-80.
2 Schmid W & Aldridge D. Active musc therapy in the treatment f multiple sclerosis patients: a matched
control study, J Music Ther 2004, 41: 225-240.
ENHANCEMENT OF
QUALITY OF LIFE
How do the elderly benefit
from music therapy ?
How do the elderly benefit
from music therapy ?
Better awareness and concentration
Enhances interest levels and social
interaction
Improves memory and recall
Happier outlook on life and higher
self-esteem
How do the elderly benefit
from music therapy ?
MT increases mobility and coordination
MT diminishes pain and improves
recovery time
MT reduces tension and promotes
relaxation
Was ist zu beachten?
PRIMR
Bildung, Hrerfahrung und Herkunft
prgen den Musikgeschmack
Selbstwertgefhl muss erhalten
bleiben; persnlicher Geschmack,
Prferenzen miteinbeziehen!
Musikerfahrungen, die in Jugend
gemacht werden, sind in lebhafter
Erinnerung
SEKUNDR
Optimale Tonwidergabe
Altersgebrechen
(Schwerhrigkeit)
Technikumgang
Durch aktives Musizieren, Musikhren & Singen erfolgt eine
Strkung der Kommunikations- und Kontaktfhigkeit und
des Selbstvertrauens.
Einer Isolation und Vereinsamung wird so entgegengewirkt.
Welche Musik hat bei
welchen Menschen
unter
welchen Bedingungen
welche Wirkung?
Standardisierte Musiktherapien
ZIEL:
Enhancement of
quality of life
REZEPTIVE
AKTIVE
AKTIVE MUSIKTHERAPIE
nicht fr jeden alten
Menschen geeignet, da
Energie aufgewendet
werden muss.
setzt Lebens- und
Spielfreude und Mut zum
Improvisieren voraus
es muss mglich sein nur
ruhig zuzuhren, die
Gruppe zu verlassen
REZEPTIVE MUSIKTHERAPIE
fr alle alten Menschen
geeignet
Gesprche, die dem Hren
folgen, sind sinnvoll.
setzt leicht handhabbare
Technik voraus!
AKTIVIERENDE oder
BERUHIGENDE Musik ?
How do the elderly benefit
from music therapy ?
Indications for music therapy
in palliative medicine (1)
communication disorders
stress / other psychological
problems
pain
neurological disability
Ernst E. et al. (2006): The Desktop to Complementary and Alternative Medicine
An Evidence-based approach. Mosby,Elsevier
Pain/Anxiety
Extreme muscle contractions of body
Insomnia
Breathing problems
Introversion, depression
Deficits with acceptance of life situation
Delhey M. (1997): Musiktherapie. In: Aulbert E, Zech D. (Hrsg.):
Lehrbuch der Palliativmedizin. Schattauer, Stuttgart, 916-922
Indications for music therapy
in palliative medicine (2)
Enhance the
Quality of Life !
Content
Introduction
Physiological Effects of Music
Research Studies
Summary
Effects of Music Therapy for
Older People
PYSIOLOGICAL (pain, shortness of breath)
PSYCHOLOGICAL (depression, anxiety, anger, fear,
frustration)
SOCIAL (isolation, loneliness, boredom)
SPIRITUAL (lack of spiritual connection, need for spiritually-
based rituals)
COGNITIVE (neurolog. impairments, disorient., confusion)
Promote the quality of life !
Enhance the Well-Being Reduce Stress and Suffering
RESEARCH
Lack of controlled studies with large
sizes that would allow for generalization.
Need for studies with higher levels of
control and randomization of subjects.
Guidelines for future studies should be
established.
LIMITATIONS
MUSIC SHOULD NOT
EXCEED 90 dB AS THIS MAY LEAD TO
HEARING IMPAIRMENT
Welche Musik hat bei
welchen Menschen
unter
welchen Bedingungen
welche Wirkung?
Standardisierte Musiktherapien
MUSIC AT HOME MUSIC AT HOME MUSIC AT HOME MUSIC AT HOME
Musiktherapie Definition
Musiktherapie ist die
wissenschaftlich fundierte,
diagnosespezifische Nutzung
von Musik oder von musikalischen
Elementen zu Heilzwecken.
formuliert von H.P.Hesse, 1980
Sie bedient sich entweder der
Musikrezeption (REZEPTIVE MUSIKTHERAPIE)
oder der musikalischen Aktivitt des Patienten
(AKTIVE MUSIKTHERAPIE),
wobei jeweils sowohl Einzel- als auch
Gruppenverfahren mglich sind.
Universitt Salzburg, Naturwissenschaftliche Fakultt
Fachbereich fr Organismische Biologie
Arbeitsgruppe fr Neurodynamics & Neurosignaling
ALLTAGSERFAHRUNGEN ALLTAGSERFAHRUNGEN ALLTAGSERFAHRUNGEN ALLTAGSERFAHRUNGEN
1. Musik aktiviert Krper und Psyche,
versetzt in Stimmung,
regt zum Mitsingen/zur Bewegung an.
Beispiel Klarinette: ...........
Beispiel Klavier: W.A. Mozart, Sonate A-Dur, KV 331,
Alla turca
Der therapeutische Einfluss erstreckt sich
in Abhngigkeit vom Charakter der
verwendeten Musik in folgende Richtungen:
AKTIVIERUNG Krper & Psyche
krperliche Aktivierung,
emotionale Neuorientierung (Stimmungsvernderung)
Ouvertren & Mrsche regen an und zerstreuen negative
Gedanken.
ENTSPANNUNG ... Krper & Psyche
Lsen von krperlicher Verspannung, Beseitigung
von psychischen Spannungen (z.B. Angst)
Entspannungsmusik entspannt Krper und Geist und hat
konzentrationsfrdernde Wirkung.
1. AKTIVIEREND 2. BERUHIGEND
Anregung Entspannung
Einwirkung primr ber den Krper
Aktivierung des Krpers (z.B. Tanz)
Beruhigung des Krpers (z.B. Wiegenlied)
Lsung von krperlicher Anspannung
Einwirkung primr ber die Psyche
Emotionale Aktivierung (Stimmung)
Befreiung von ngsten und Lsung von angstbedingten
Spannungszustnden
Mglicher therapeutisch nutzbarer Einfluss
von Musik
?
?
(Claudio Abbado, geb. 1933)
Musik ist die beste Medizin. Mehr als jede Behandlung
hat mir die Musik geholfen, diese schwierigen Monate
zu berstehen.
SCHMERZ: BIO-PSYCHO-SOZIALE EINHEIT
Ko-
analgetika
Mozart: Eine kleine
Nachtmusik
Radetzky-Marsch
Walzer
L.v. Beethoven
Rondo a capriccio
Bobby McFerrin
Don`t worry...
Music from
the Coffee lands
Musikalische Hausapotheke = Musikament
AKTIVIERUNG AKTIVIERUNG AKTIVIERUNG AKTIVIERUNG
Nicht-Opioide
+/- Adjuvant.
+ ++ +
Schwache Opioide und
Nicht-Opioide
+/- Adjuvant.
Starke Opioide +/-
Nicht-Opioide
+/- Adjuvant.
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Universitt Salzburg, Naturwissenschaftliche Fakultt

Fachbereich fr Organismische Biologie
Arbeitsgruppe fr Neurodynamics & Neurosignaling
ALLTAGSERFAHRUNGEN ALLTAGSERFAHRUNGEN ALLTAGSERFAHRUNGEN ALLTAGSERFAHRUNGEN
Beispiel Klarinette: ........
Beispiel Klavier: W.A. Mozart, Sonate A-Dur,
KV 331, Var. V
2. Musik entspannt (beruhigt) Krper und
Psyche,
lst Erinnerungen und Assoziationen aus,
regt zum Trumen an.
SCHMERZ: BIO-PSYCHO-SOZIALE EINHEIT
Ko-
analgetika
Entspannung
bei Schmerzen.
Mentalis Verlag
Traumreise
Mentalis Verlag
Echoes of Silence
Schumann:
Trumerei
Franz Liszt:
Liebestr. Nr. 3
Enya
Musikalische Hausapotheke = Musikament
ENTSPANNUNG ENTSPANNUNG ENTSPANNUNG ENTSPANNUNG
Nicht-Opioide
+/- Adjuvant.
Bruder Jakob: Happy Baby Guten Morgen
Ade zur guten Nacht. Abendlieder HappyBaby
Baby Dreams: Close your eyes
Mozart: Hornkonzert Kv447
MOZART-
MUSIKAMENT
+ ++ +
Schwache Opioide und
Nicht-Opioide
+/- Adjuvant.
Starke Opioide +/-
Nicht-Opioide
+/- Adjuvant.
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EMOTIONALE REAKTIONEN AUF MUSIK
Juslin PN (2001) Cue Utilization in Communication of Emotion in Music Performance:
Relating Performance to Perception: J. Exp. Psych. 26:1797-1813
Schneller Rhythmus und Stakkato (meistens Dur)
Frhlichkeit ... strkeres Atmen ...
Freude wird durch hohe Frequenz, groe Intervalle,
hohe Lautstrke und hohe Stimmlage ausgedrckt.
Bsp.: Joseph Haydn: Symphony No. 70 D major, Classical
Johann Strauss II: Tausendeine Nacht,Romantik
Georges Bizet: Carmen Suite No. 1. 2nd movement:
Musette de Choisy, Classical
(G. Kreutz et al., 2008)
G.B. 2001
EMOTIONALE REAKTIONEN AUF MUSIK
Juslin PN (2001) Cue Utilization in Communication of Emotion in Music Performance:
Relating Performance to Perception: J. Exp. Psych. 26:1797-1813
Langsamer Rhythmus und Legato (berwiegend
Moll) Traurigkeit ... Puls, Hautwiderst., Htemp.
erniedrigt
typisch mittlere Aktivierung, Kleinschrittigkeit der
Melodie und fallende, sequenzierende Abschnitte
Bsp.: Tomaso Albinoni, Adagio, G minor, Baroque
John Dowland, Dances from Lachrimae: Semper
Dowland Semper, Dolens, Goe Nightly Cares
W. A. Mozart: Piano concerto no. 21, KV 467, C minor,
2nd movement: Andante Classical
(G. Kreutz et al., 2008)
G.B. 2001
MUSIK UND EMOTION
MUSIKALISCHE CHARAKTERISTIK UND
DEREN KRPERLICHE WIRKUNG BEI SPRACHE/MUSIK
hoch
stark
schnell
gross
auf/ab
hell, strahlend
tief
gering
langsam
gering
abwrts
weich,dunkel
GRUNDFREQUENZ,
TONHHE
VARIABILITT
(MELODIE)
SPRECHTEMPO
LAUTSTRKE
TONHHENVERLAUF
KLANGFARBE
FREUDE TRAUER
(PRESTOTYP) (ADAGIOTYP)
SCHERER (1982); EIBL-EIBELSFELD (1984)
MUSIK UND EMOTION
MUSIKALISCHE CHARAKTERISTIK UND
DEREN KRPERLICHE WIRKUNG BEI MUSIK
TEMPO schnell, mit Accelerandi langsam, mit Ritardandi
RHYTHMUS punktiert, synkopiert, konturlos, mit Tendenz zum
abwechslungsreich Stehenbleiben
LAUTSTRKE/KLANGF. laut, hell, strahlend leise, dunkel, verschmelzend
MELODIK groer Ambitus, sprung- geringer Ambitus, kreisend
hafte Intervalle, aufwrts- schrittweise fallende
strebende Motive Motive
HARMONIK einfache Harmonien, komplexe Harmonik mit
Betonung der Diskant- komplizierten Akkordfort-
tne schreitungen
FREUDE TRAUER
(PRESTOTYP) (ADAGIOTYP)
SCHERER (1982); EIBL-EIBELSFELD (1984)
Music examples
Wolfgang A. Mozart
Klarinettenkonzert A-dur, KV 622, 2. Satz: Adagio
Edvard Grieg
Peer Gynt, Suite Nr. 1 op. 46, 1. Satz: Morgenstimmung
Peter Tschaikowsky
Konzert Nr. 1 fr Klavier u. Orchester b-moll op. 23,
2.Satz, mehrstzig
Antonio Vivaldi
Die vier Jahreszeiten; Konzerte fr Violine, Streicher und
Basso continuo op. 8, Nr. 1-4
ALLTAGSERFAHRUNGEN ALLTAGSERFAHRUNGEN ALLTAGSERFAHRUNGEN ALLTAGSERFAHRUNGEN
SCHMERZ = BIO-PSYCHO-SOZIALE EINHEIT
Nicht-Opioide
+/- Adjuvant.
Schwache Opioide
Nicht-Opioide
+/- Adjuvant.
Starke Opioide
+/- Nicht-Opioide
+/- Adjuvant.
Ko-
analgetika
Physikalische,
psychologische,
physiothera-
peutische
Verfahren:
- Musik
- TENS
- Biofeedback
- Akupunktur
Schmerztherapie: multimodales Konzept
adjuvante pharmakologische Basistherapie
&
MUSIK HAS ENOUGH
POWER TO INCREASE
QUALITY OF LIFE AND SHOULD
BE SEEN/USED LIKE A
PHARMACON !
MUSIC AS A PHARMACON ?
PHARMACOKINETIC/DYNAMIC
DOSIS/MAX/MIN
INDICATION/CONTRAINDICATION
SIDE EFFECTS
APPLICATION (ACTIVE/RECEPTIVE)
Enhance the
Quality of Life !
Musik und Gehirn
ZORN
J. Panksepp, G. Bernatzky: Emotional sounds and the brain: the neuro-affective
Foundations of musical appreciation, Behavioural Processes 60 (2002) 133-155
p<0.01 p<0.05
n.s.
p<0.01
p<0.01
p<0.01
ZORN
FURCHT
GLCK
TRAUER
MUSIC
QUALITY
OF LIFE
Fotos: O. Anrather (Salzburg) Musik: Mozart
Klarinettenkonzert, KV 447 (Mozarteffekt)
Thank you !
FURTHER INFORMATION: www.schmerzinstitut.org
guenther.bernatzky@sbg.ac.at
Literature Survey
Art der Musik Erhobene Parameter & Ergebnisse Autoren
Allgemein
Verbales, unruhestiftendes Verhalten sank zu 31% Cohen-Mansfield, 1997
Verbessertes Selbstwertgefhl und bessere
Lebensqualitt
Ellis, 2004
Verbesserung der physischen und kognitiven
Funktionen
Hagen et al., 2003
Durchgefhrte Tests wurden besser ausgefhrt Hanser, 1994
Selbstausdruck, Sozialisation und Rckblick
gefrdert
Johnson et al., 1992
Scheinbar vergessene Assoziationen & Gefhle
knnen durch Musik als Gedchtnishilfe wieder
gefunden werden
Sacks & Tomaino, 1991
Mentale und physische Anregung Sorell, 2008
Gesang Verbesserung der Fhigkeit zur Namensgebung Carruth, 1997
Aktive
Musiktherapie
Verbesserung der Unruhe Choi et al., 2009
Vor allem rastloses Umherwandern wird reduziert Fitzgerald-Cloutier, 1993
Aktive &
Rezeptive
Musiktherapie
Vermehrtes Selbstvertrauen; verbesserte
Kommunikation
Fukamizu et al., 2009
Verbessertes Umfeld; verbesserte Lebensqualitt McCaffrey, 2008
Art der Musik Erhobene Parameter & Ergebnisse Autoren
Rezeptive
Musiktherapie
Entspannende Musik verbessert Unruhezustnde Denney, 1997
Klassische Musik erhht die Gedchtnisleistung Mammarella et al., 2007
Entspannungsmusik verbessert die Schlafqualitt
und Angstreduktion
Ziv et al., 2008
Verbesserung der Unruhezustnde; musikalische
Vorlieben sollten beachtet werden
Gerdner & Swanson,
1993
Verbesserung von Unruhezustnden whrend der
Mahlzeiten
Goddear & Abraham,
1994
Verbesserung des Sprachgedchtnises von 60% Srkmo et al., 2008
Teilnehmer prferieren Physiotherapie mit
Musikbegleitung
Johnson et al., 2001
Weniger Arthroseschmerzen McCaffrey et al., 2003
Vermehrte Bewegung und Aktivitt Olson, 1984
Verbesserung beim individuellen Erkennen und
Reduktion der Angstwerte
Irish et al., 2006
Beruhigende Musik und Handmassage verndern
Umwelt positiv
Remington, 1999
Literature Survey
Scientific Publications on Music Therapy
68% of cancer patients receiving treatment for their pain use
alternative methods the most popular are massage and vitamins
14%
13%
12%
11%
11%
9%
9%
8%
8%
7%
4%
4%
3%
2%
2%
1%
1%
1%
1%
19%
32%
0% 5% 10% 15% 20% 25% 30% 35%
Massage
Vitamins
Heat (heating pad)
Exercise
Acupuncture
Physical therapy
Herbal supplements
Support groups
Change in diet
Relaxation therapy
Meditation
Ointments/creams
Therapy/counselling
Alcoholic drinks
Cold (ice packs)
Alcohol rubs
Nerve stimulation or TENS
Hypnosis
Imagery
Other
I don't use any other methods
Base: all who receive
treatment (n=506)
Q52: What, if any, other
methods, remedies or
treatments, apart from
medications have you
ever tried to relieve
your pain we have
been discussing?
European Pain in Cancer Survey
European Pain in Cancer Survey,
European Association of Palliative Care.
Half of European cancer patients have
moderate to severe pain: one in five patients
does not receive treatment. J pain Palliat
Care Pharmacother. 2007; 21(4):51-3
Depression
RCT of depressed elderly patients (n = 30)
Superior results with music-based therapy (various
therapeutic modalities) than no treatment
1
PCTs with depressed adolescent females who listened
to rock music control groups received massage
2
or simply relaxed
3
Changes to physiological & biochemical parameters
but not mood or behaviour.
1 Hanser SB & Thompson LW. Effects of music therapy strategy on depressed older adults. J Gerontol
1994, 49: 265-269.
2 Jones NA & Field T. Massage and music therapies attenuate frontal EEG asymmetry in depressed
adolescents. Adolescence 1999, 34: 529-534.
3 Field T, Martinez A, Nawrocki T, Pickens J, Fox NA & Schanberg S. Music shifts frontal EEG in depressed
adolescents. Adolescence 1998, 33: 109-116.
http://www.bethabe.org/MT_and_Motor_Rehabil220.html
MUSIC STIMULATION
IN PEOPLE WITH PARCINSON
Music, Rhythm and Motor Rehabilitation
What would you think if you saw a person unable to take a step on his own
walk independently while listening to a rhytmic beat?
They cannot plan movements on their own - however they may still have the ability
to move, and this ability is unlocked by music.
Outcomes:
Motion initiated in parts of the body that have limited movement
Movement maintained in affacted extremeties
Increased range of motion
Repertoire of exercises built up resident can perform indipendently with
confidence
Motivation to participate in daily activities
Increased neuromuscular control