Lively nontechnical discussion of how the gift of music can have positive effects on health and disease. Music as a part of the health care culture is discussed from the prehistoric era to present day

1. MUSIC AS
MEDICINE
OR
“LISTEN TO TWO
JAZZ RIFFS AND
CALL ME IN THE
MORNING”
Randy M Rosenberg MD FAAN FACP
Associate Professor of Neurology
Lewis Katz School of Medicine at
Temple University
Principle Flutist of the Warminster
Symphony

2. IS MUSIC AS MEDICINE A NEW IDEA?

3. MUSIC MEDICINE
The Chinese character for
medicine comes from the
character for music

4. OLDEST MUSICAL INSTRUMENTS IN
THE WORLD
Age: 7,000 – 9,000 years old
Country of Origin: Jiahu, Yellow River
Valley, China
Material(s) Used: Red-Crown Crane wing
bones
Age: 42,000 – 43,000 years old
Country of Origin: Geisenklösterle Cave,
Blaubeuren, Germany
Material(s) Used: Mute Swan bone and
Mammoth Ivory
Geisenklösterle
Flute
Jiahu Flutes

5. THE ANCIENTS AND MUSICAL RELIEF
• Egyptian papyri, over 2,600 years old, refer to incantations as cures for
infertility and rheumatic pain.
• In the Bible, David played the harp to lift Saul’s depression (1000-600 BC)
• 1 Samuel 16:16 (NKJV) Let our master now command your servants, who are
before you, to seek out a man who is a skillful player on the harp (probably
lyre). And it shall be that he will play it with his hand when the distressing spirit
from God is upon you, and you shall be well.
• The ancient Greeks (800-600 BC) believed music had the power to heal the
body and soul. They used the flute and the lyre for gout and sciatica.
• Paeans were a classification of ancient Greek songs that cured specific illnesses.
For example, when the plague hit ancient Greece, they played a specific song
with the frequencies and rhythmic patterns thought to halt the illness.

6. ANCIENT GREEK MUSIC

7. JUST HOW POWERFUL IS RHYTHM?

8. “THE BEAT”: A CRITICAL PART OF MUSICAL
RHYTHM
What allows to do snap your
fingers, tap your foot and
DANCE!
Every culture has music with a
beat
Ancient-throughout history
Very early part of the human
machinery
Perception of the beat ties to
motor systems

9. BEAT BASED PROCESSING TIES IN
WITH LANGUAGE
Accurate perception of temporal patterns is crucial to
hearing, speech, motor control, and music.
Beat perceptions requires:
Predictability
Flexibility
Man is the only primate that can process the beat…with
exceptions
Beat processing is tied into a specialized network that
includes motor activity including the movement in speech
Therefore beat processing and the neural connections
allow us to be vocal learners with which we acquire
language

10. THE BEAT AND OTHER VOCAL LEARNERS

11. RHYTHM: AS A POTENT TRIGGER
FOR MUSICAL MEMORY
Queen: We Will Rock You
Michael Jackson: Billie Jean
Benny Goodman: Sing Sing Sing
The Knack: My Sharonna
Pink Floyd: Money

12. DOES MUSIC IMPROVE SCHOLARSHIP
AND LEARNING?

13. THE ”MOZART EFFECT”
Rauscher et al. reported that listening
to ten minutes of Mozart’s music
briefly increased the abstract
reasoning ability of college students
The effect is limited to spatial–
temporal tasks involving mental
imagery and temporal ordering.
(predicting paper shapes)
In 2010 a larger meta-analysis of a
greater number of studies again
found a positive effect, but that other
kinds of music worked just as well but
only if you enjoy it.
In 1998 Zell Miller, the Governor of
the state of Georgia, asked for
money to be set aside in the state
budget so that every newborn
baby could be sent a CD of
classical music.
ThanksZell!!

14. DOES LISTENING TO PREFERRED MUSIC IMPROVE
READING COMPREHENSION PERFORMANCE?
Students who revised study material in quiet environments performed
more than 60% better in an exam than their peers who studied while
listening to music that had lyrics.
 Students who revised classwork while listening to music without lyrics did
better on later testing than those who had revised to music with lyrics.
It made no difference if students review or revised classwork and notes
while listening to songs they liked or disliked. Both led to a reduction in
their test performance.
Students who revised or did homework in silence rated their environment
as less distracting and accurately predicted that this would lead to better
performances in subsequent tests.
Applied Cognitive Psychology 28: 279-284 2014

15. LANGUAGE AND LITERACY THROUGH MUSIC
A 2014 study published in The Journal of Neuroscience found that children who
took music lessons for two years didn’t just become better at playing an
instrument—they became better at processing language.
Harmony project in low income neighborhoods with drop out rates of 50%
3 years of participation=97% high school completion with many going on to college
Language and music share the elements of pitch, timing, and timbre.
As children become more familiar with pitch, timing, and timbre through musical
instruction, their language-processing skills also improve—enabling them to
distinguish nuances in speech more easily
Music enhances vocabulary and verbal understanding (short sentence
interpretation)
Repetition, rhyme and melody
Leads to enhanced memory, learning,
Reinforces language patterns

16. DIANA DEUTSCH “SPEECH TO SONG ILLUSION”
The neural circuitries underlying speech and
song are at some point distinct and separate
They can accept the same input, but
process the information in different ways
so as to produce different outputs
This illusion is in line with what philosophers
and musicians have been arguing for
centuries…
strong linkages must
exist between speech and
music.
SHORT TERM PLASTICITY
LONG TERM CHANGES
The perception of speech as
song requires isolation and
repetition

17. CAN MUSIC BE AN ANALGESIC?

18. PAIN IS A
CONSEQUENCE
OF ILLNESS AND
PRACTICALLY
INESCAPABLE

19. MUSIC THERAPY FOR THE
TREATMENT OF PAIN
For acute pain patients, especially
post-operative:
The hypotheses that patients in the
music group will need less analgesic,
have a shorter length of hospital
stay, and experience less adverse
effects than those in the control
group were not supported by the
data
A number of studies suggest that
there is a benefit but these are
poorly controlled and variable in
outcome measures
For chronic pain patients:
Music may be beneficial as an
adjuvant as it reduces self-reported
pain and depression.
Importantly, the analgesic effect of
music appears higher with self-
chosen over researcher-chosen
music.
But…as my grandmother wouldsay…”It couldn’t
hurt.”

20. IS MUSIC A ”HEALTH SUPPLEMENT” FOR
AN AGING BRAIN?

21. • “Anatomists today would be hard put to identify the brain of
a visual artist, a writer or a mathematician, but they would
recognize the brain of a professional musician without a
moment’s hesitation.”
-Oliver Sachs MD
• “Ah, music. A magic far beyond all we do here!”
• Albus Dumbledore
• Headmaster Hogwarts School

22. ANATOMICAL CHANGES IN A
MUSICIAN’S BRAIN
• Studies using prospective
longitudinal designs have found that
children who receive musical training
show changes in structural brain
development compared to those
who do not ( Habibi et al., 2017;Hyde
et al., 2009),
• Suggests that musical training may
contribute to, rather than simply
correlate with, neural plasticity ie
changing the structure of the brain
• ?Bigger brain=?Better brain

23. MANY NEUROSCIENTIST ACCEPT THESE CONCEPTS…
Musicians have stronger auditory cognitive skills across
the life span.
Playing an instrument improves
working memory
hearing speech in noise
neural speech-sound processing across the life span.
A lifetime of playing an instrument protects musicians
from age-related neural declines.
Adults who played an instrument as a child still reap
neural benefits even 40 years after stopping lessons.
Even older musicians with hearing loss have superior
hearing in noise and auditory cognitive skills.

24. SO WHAT IS THIS I HEAR ABOUT
NEUROLOGICAL MUSIC THERAPY?

25. FIVE BASIC DEFINITIONS ARTICULATE THE
MOST IMPORTANT PRINCIPLES OF
NEUROLOGIC MUSIC THERAPY
It is defined as the therapeutic application of music to cognitive,
sensory, and motor dysfunctions due to disease of the human nervous
system.
It is based on neuroscience models of music perception and the
influence of music on changes in non-musical brain functions and
behavior.
Treatment techniques are based on data from scientific and clinical
research and are directed toward non-musical therapeutic goals.
Flexible treatment techniques are adaptable to a patient’s needs.
Practitioners are educated in the areas of neuroanatomy and
physiology, brain pathologies, medical terminology, and rehabilitation
of cognitive, motor, speech, and language functions.

26. RHYTHMIC AUDITORY
STIMULATION

27. MELODIC INTONATION THERAPY
MIT in Stroke
MIT: Present Controversies
and Future Opportunities
Overall, 14 studies between 1973 and
2011 found positive effects for the use
of Melodic Intonation Therapy to
improve verbal production in
individuals with aphasia.
The majority of participants were in
the chronic phase of recovery. Further
research is warranted as many studies
were exploratory case studies or case
series pre- and post-test designs.

28. DOES MUSIC HELP HEAL INDIVIDUALS WITH
BRAIN INJURIES?

29. PHINEAS GAGE: LIFE
WITHOUT A
PREFRONTAL CORTEX
• On September 13, 1848, 25 year old
Phineas Gage was working with a
blasting crew
• An accidental explosion drove an
tamping iron through the left
cheekbone, past his eye and out the
top of his head, severely damaging
he orbitofrontal cortex
• Survive but with significant
behavioral changes
• Crude language and behavior
• Marked personality changes

30. TRAUMA TARGETS
Brain damage can affect movement and
language abilities, having a significant
impact on quality of life.
An estimated 1.5 million people in the
U.S. sustain a traumatic brain injury each
year, of whom 80,000 to 90,000 will be
left with long-term disability.
Damage to the orbitofrontal cortex (OFC)
and prefrontal cotex often occurs following
traumatic brain injury (TBI) and can lead to
complex behavioural changes with a
negative impact on the individual’s social
outcome.

31. NEUROPLASTICITY
• “Neuroplasticity” refers to the brain’s ability to change
throughout the lifetime in response to new activity, learning and
damage.
• Changes might occur in the actual anatomy or to the way that
the same anatomy functions.
• Motor skill learning: neuroplasticity applied to a specific task e.g.
juggling, playing the piano

32. ARE MUSICIANS BRAINS
ALWAYS DIFFERENT?
 A large body of
literature now exists to
substantiate the long-
held idea that
musicians' brains differ
structurally and
functionally from non-
musicians' brains.
 There are however
many variations in the
conclusions drawn
 A review of the
literature highlights a
number of variables
that appear to
moderate the
relationship between
music training and
brain structure and
function Dawn Merrett: Moderating variables of music training-induced neuroplasticity: a review and
discussion. Frontiers of Psychology 2013

33. • In 2018 Dykesteen et al Brain Injury, 32:5, 634-643 demonstrated behavioral
improvements and functional brain changes after 8 weeks of playing piano on
patients with mTBI having attention, memory and social interaction problems.
• Present evidence for a causal relationship between musical training and reorganization
of neural networks promoting enhanced cognitive performance.
• SMALL patient size

34. CAN MUSIC BENEFIT SOMEONE WITH ALZEIMER’S
DISEASE OR OTHER DEMENTIA?

35. MUSIC THERAPY (MT) IN
ALZHEIMER’S DISEASE
• Many articles which have found that MT can reduce the mood
symptoms and behavior disorders in dementias, especially
depression, anxiety and agitation
• Although there are some researches which demonstrate that
MT is beneficial for preserving cognition of dementia
especially of AD, these are not convincing enough
• Combining MT with other adjuvant interventions such as
dance, art, video game, physical exercise, and so on, is
another area for research and clinical use

36. APPLAUSE SIGN: WHEN ACTIONS
WON’T STOP ON THEIR OWN
• The ability of the frontal lobes
to put a “brake” on motor
activity can fail in patients with
dementia
• Music Therapy with Rhythmic
Auditory Stimulation may be
useful in reestablishing
effective “on-off” function
• Disinhibition
• Motor perseveration

37. ACTIVATING THE MIND
OF SOMEONE WITH
ADVANCED DEMENTIA
The absolutely miracle
of bringing someone
back to who they were
and resurrecting their
spirits

38. HOW DOES MUSIC CHANGE THE
CHEMISTRY OF THE BRAIN?

39. MECHANISMS OF REWARDS AND
PLEASURE IN MUSIC
• Music can reliably induce feelings of pleasure
• Preliminary studies have shown that music listening and performing
modulate levels of serotonin, epinepherine, endorphins, dopamine,
oxytocin, and prolactin
• Dopamine liberations:
• Released when we make plans and predictions to satisfy wants=appetitive
component
• Released with goals are met=consummatory component
• Blocking μ-opioid receptors with naltrexone appears to cause decrease
physiological reactions to music for both positive and negative
emotions.
• Therefore brain opioid activity appears to moderate the
pleasure of music

40. FUTURE DIRECTIONS OF MUSIC AND MEDICINE

41. Autism
The Cochrane Collaboration provided evidence that music therapy may
help children gain improved function in the core domains of autism:
Social interaction, verbal communication, initiating behaviour and social-
emotional reciprocity.
Improve rhythm sense may help with speech discrimination and
interpretation
Addiction recovery
Schizophrenia
Depression
Eating disorders

42. AUDITORY HALLUCINATIONS IN
SCHIZOPHRENIA: A VERYSCARY WORLD

43. MUSIC THERAPY IN PATIENTS WITH
SCHIZOPHRENIA
 Music Therapy vs Standard Care
Effects inconsistent across studies
Dependent on number of music therapy sessions
and quality of music therapy provided.
 Therapy added to standard care superior to
standard care for global state
 Good effects on negative symptoms (apathy, lack of
emotion, poor or nonexistant social functioning)
 Some aspects of cognitive functioning and
behaviour improved.

44. THANK YOU SO
MUCH FOR
LISTENING
QUESTIONS ARE
ALWAYS WELCOME
AND APPLAUSE IS
NICE TOO