Name: Music therapy, Rhythmic Auditory Stimulation, Neurological Music Therapy
Number of scientific references: 33
Level of Evidence: Level III What is this?
Note:Music therapy provides beats that help regulate body’s internal timing and rhythm and stabilizes gait. It can also improve other symptoms of the disease such as bradykinesia, difficulty in swallowing and breathing etc. As per the research, music therapy is an effective add-on therapy in management of Parkinson’s symptoms.
Music is that one medium of communication that needs no common language for comprehension. How often have you grooved to beats of a song that is sung in a different language that you are not well versed in?
Animal movement has been appropriately described as ‘the silent music of the body’ by English physician William Harvey. Our gait has a certain level of rhythm and flow, and this flow of movement is disturbed in Parkinson’s disease patients.
Neurological music therapy benefits in Parkinson’s disease by restoring motor function, improving gait and reducing other symptoms the disease. Perceiving music is a complex brain activity and requires various parts of the brain such as those dealing with auditory perception, attention and memory, rhythmic and motor function, etc.
Owing to the intricacy, the mechanism behind music therapy for Parkinson’s is not clearly understood. However, in the next section, we will go over a few aspects about how music may help in neurological disorders like Parkinson’s.
How does Music therapy help in Parkinson’s disease?
Parkinson’s disease involves progressive dysfunction of dopaminergic neurons resulting in impairment of movement. (Dopamine is a neurotransmitter that is involved in various brain functions but in this disorder it’s dysfunction affects movement. To know more read Understanding Parkinson’s)
Table of Contents
- 1 How does Music therapy help in Parkinson’s disease?
- 2 4 Clinically Proven Benefits Of Music Therapy In Parkinson’s
- 3 However, some scientific evidence suggest that music therapy does not benefit in Parkinson’s
- 4 How is neurological music therapy practiced for Parkinson’s?
- 5 Conclusion
Also, there are psychological symptoms such as anxiety and depression that occur in this disorder. Music can have significant effects on gait, emotions, communication, etc. which makes it therapeutic for such conditions.
The prime focus of music therapy is rehabilitation or to improve motor function and gait. Internal timing is the mechanism that coordinates and times the movement of our body with our thoughts.
This internal timing is disturbed in Parkinson’s disease patients. The irregular timing affects gait, coordination and causes freezing in patients.
Music provides an external audible stimulus that serves as a rhythm that coordinates body movements with beats. This rhythm compensates for the internal timing disturbance.
The therapy involving the use of rhythms as a stimulus to coordinate movement is known as Rhythmic Auditory Stimulation.
Thaut et al. were the first to prove that rhythm can help improve gait in Parkinson’s and this study dates back to 1996.
Beats in music can be perceived as pulses for a response to patterns. Beats that form rhythm help establish a pattern and once this pattern is established, the individual remembers the rhythm even if the music is not played.
This phenomenon of learning the rhythm and coordinating movement with it is referred to as ’entrainment.’
Now in case you are wondering why music is used and not something visual then here are two reasons as listed by researchers:
• Reaction time for auditory cues are 20-50 ms shorter than visual cue
• Auditory system has a stronger bias for time-based patterns than other systems making it easier to develop a pattern of movement based on timing of beats
Various parts of the brain are activated in response to music therapy. These parts are adversely affected due to Parkinson’s disease, and this may make one wonder that how do these parts respond to music then.
Researchers feel that there may be a compensatory mechanism developed by other parts of the brain such as cerebellum.
Not only gait, but neurological music therapy can also even help resolve symptoms such as anxiety, depression, difficulty in swallowing and breathing in Parkinson’s.
A certified music therapist and neuroscientist, Elizabeth Stegemöller describes how she has used music therapy to improve respiratory control in patients with Parkinson’s.
In much simpler terms, here is how neurological music therapy helps in Parkinson’s
• Regular beats in rhythm provide external cues for regulating timing and pace of walking.
• Beats can help regulate internal clock that is deficient in Parkinson’s.
• Learning the beats can help the patient coordinate movement even in the absence of music.
• Listening to music that one likes can activate the reward system. Dopamine is the neurotransmitter that regulates this rewarding system and is impaired in Parkinson’s.
• It can help improve mental health symptoms like depression and anxiety.
• Experienced therapists help coordinate activities such as swallowing and breathing with rhythmic music which otherwise is impaired in disorder.
• It supports neuroplasticity. It triggers neurons associated with auditory perception, and simultaneous practice of regulated movement with this trigger helps establish a strong and permanent connection with motor neurons.
4 Clinically Proven Benefits Of Music Therapy In Parkinson’s
Let’s go over the various studies that have examined and proved the benefits of music therapy for Parkinson’s.
1. Rhythmic auditory stimulation improves gait
The major symptom of Parkinson’s is a disturbance in gait. This can involve difficulty or hesitation to start walking or moving, freezing of the body, reduced the pace of walking, etc.
These symptoms occur due to the disturbance in internal timing and may even affect the patient’s perception of time and sensing beats or perform interval based activities such as clapping hands in a sequence to form a rhythm.
Wittwer et al. demonstrated that music improves the speed of walking and length of stride in healthy older adults better than metronome sounds. A recent study published in Frontiers in Neuroscience, 2014 demonstrated that high groove music was better than low groove music in gait rehabilitation.
Freedland et al., in 2002, recommended rhythmic auditory stimulation as an add-on therapy to conventional dopamine therapy for Parkinson’s.
In 2006, researchers from Belgium demonstrated that rhythmic auditory stimulation improves speed of walking.
However, the frequency of playing the rhythm may have different effects on gait in freezers and non-freezers.
Their study suggested that low-frequency setting may benefit freezers while non-freezers may find 10% higher than normal frequency beneficial.
Further, a study published in PLoS One, 2010 confirmed these findings and proved that neurological music therapy could avoid freezing episodes in Parkinson’s patients.
Natalie de Bruin and her colleagues were the first to examine the effect of listening to music on walking in Parkinson’s patients under home settings.
Playlists were prepared based on patient’s music preferences, and the tempo was adjusted to patient’s preference and rhythm of walking. The 13 week home based music and walking training program improved the speed of walking, time to take a step, number of steps per unit time and severity of other motor symptoms.
Researchers have shown that music therapy can have benefits beyond improving gait. Benoit et al. investigated the benefits of rhythmic auditory stimulation in idiopathic Parkinson’s disease patients.
Four week training was found to improve the patient’s perception of timing and coordinated movement. Patients showed improvement in tasks that involved interval based timing; their ability to adapt to duration based changes in hand tapping activities increased.
A review study published in Neurological Sciences, 2017 confirms that music therapy is clinically beneficial in improving movement and gait in Parkinson’s disease and to a certain extent may benefit thinking and other brain functions as well.
Quick Gist: Music therapy provides cues for patients to coordinate movement. Clinical studies show that it may improve the speed of walking, increase the number of steps per unit time as well as step length. The therapy may have benefits beyond gait; it can improve the perception of time-based activities in patients.
2. It improves cognition and quality of life
Schiavio and Altenmüller highlight that music therapy not only affects movement related symptoms but also improve cognition, psychological symptoms and interactive behaviors in Parkinson’s.
The Ronnie Gardener Rhythm and Music (RGRM™) is a novel music based movement therapy that was developed in 1993. This therapy aims to improve cognition and mobility in patients with neurological disorders.
This therapy aims to make the training enjoyable and engaging to increase the motivation of Parkinson’s disease patients. A study published in Disability and Rehabilitation, 2013 reported that this intervention improved cognition and quality of life in patients apart from improving mobility.
A recent study published in Science Reports 2017 suggests that rhythmic auditory stimulation may have beneficial effects beyond gait improvement; it can increase patient’s motivation to walk and thus improve their quality of life.
Parkinson’s disease may lead to speech impairment such as slow speech, less accurate speech, reduced verbal fluency, etc. Research suggests that music therapy may help in improving such deficits.
Reaching for a particular object and grasping it may seem an easy task for us but in Parkinson’s disease impairment of systems involved in movement and perception, this activity is an arduous task.
The reach-to-eat task is a skilled movement where an individual reaches for a food item, grasps it and transports it to the mouth. Patients with Parkinson’s are slow to complete the movement, find it difficult to grasp the item and rotate it towards the mouth.
Research suggests that training with familiar music along with medication helps stabilize actions such as grasping, moving the hand back and forth as well as rotation of the hand and normalizes such skilled movements.
These effects may be pronounced in advanced Parkinson’s as well.
Quick Gist: Regular training with neurological music therapy may help improve motivation of patients to walk and strengthen their cognition.
3. It supports neuroplasticity
Neuroplasticity is that term used to describe the fact that your brain can rewire itself irrespective of damage or environmental changes. This neuroplasticity helps our brain adapt and develop compensatory mechanisms for our survival.
Earlier I mentioned that detection of beats or tempo by the brain is a complex mechanism and these parts are damaged in Parkinson’s. Patients can sense music and coordinate their movement with the beats.
This is indicative of the brain’s ability to plasticize and develop neural connections that support such movement.
Rhythmic auditory stimulation may also help relieve psychological symptoms by neuroplasticity.
Even in a healthy population, music supports brain plasticity. A study published in The European Journal Of Neuroscience, 2006 compared the brain structure of violinists, pianists with non-musicians.
The brain structure of musicians showed better signs of better hand control than non-musicians. Pianists showed similar changes in both hemispheres of the brain since they require both their hands to play while violinists showed significant changes on the right side which are indicative of their asymmetrical use of their hands.
Music therapy in Parkinson’s causes firing of the neurons that are linked with listening as well as those that are linked with movement.
Regular training helps to establish a permanent connection between these two types of neurons; thus an individual remembers the rhythm, and this helps him overcome freezing, bradykinesia, and rigidity.
Quick Gist: Music therapy helps rewire the brain in Parkinson’s. The auditory cues serve as a stimulus to move, and with practice, this response strengthens, and the patient learns to move even in the absence of music.
4. It improves mood and emotional status
Listening to music can have a rewarding effect. When you listen to a song that you like or a song sung by an artist whose voice seems mesmerizing to you, you do tend to experience a sense of elation.
A study published in World Journal of Psychiatry, 2015 reveals that music therapy can alleviate depressive symptoms and improve mood in various neurological disorders.
Pacchetti et al. conducted a study where Parkinson’s patients were treated with active music therapy. The therapy involved choral singing, voice exercises and rhythmic as well as free body movements.
Improvement in bradykinesia was observed. Also, music therapy brought about improvement in emotional well being, daily activities and quality of life.
Researchers state that group singing may benefit in Parkinson’s by increasing connectedness and flow of social and biological rhythms.
A recent study published in Disability and Rehabilitation, 2016 demonstrated that group singing helped patients manage consequences of their disorder such as low mood, social isolation and communication problems.
Quick Gist: Music therapy can help elevate mood and reduce depressive symptoms in Parkinson’s disease patients. Group therapy can help alleviate consequences of the disease such as social isolation.
However, some scientific evidence suggest that music therapy does not benefit in Parkinson’s
Certain studies highlight that the ability to perceive emotions and beats in musical sounds is impaired in Parkinson’s patients. In such cases, patients might find certain musical rhythms unpleasant or may find it difficult to adapt to its beats.
Researchers from Cambridge University, University of Western Ontario and MRC-Cognition and Brain Sciences Unit conducted an exploratory study to assess whether patients perceive the benefits of music therapy in their health and life.
Interestingly 100% of the patients stated that there was no change in Parkinson’s symptoms with music therapy; however, 64% reported pleasant, calm feelings on listening to music.
But the researchers behind this study state that such negative responses could be a result of lack of sensitivity in the questionnaire or due to poor memory or lack of awareness of perceived benefits.
Certain studies have found that the following conditions may have negative effects on gait :
• lowering the frequency of beats by 20% than the preferred pace
• using plain metronome sounds that are not in sync with patient’s pace
• using music which does not have suitable beats to coordinate movement with
• combining music with other types of cues (visual or tactile cues)
The reason for such negative effects of rhythmic auditory stimulation could be due to increased cognitive load.
For example combining music based and visual cues can cause divided attention and hence not prove to be beneficial. (yes, some studies have found the combination effective)
Most of the factors that may render music therapy ineffective can be mitigated by an experienced music therapist who can coordinate and identify music and beats that suit the patient.
How is neurological music therapy practiced for Parkinson’s?
Certified music therapists develop sessions that suit a patient’s needs. This may be a group or individualized session. Music is provided with the help of stereo or portable music players. Experienced musicians even create music with reduced levels of noise.
Utilising rhythms or music that the patient is familiar with makes the therapy more effective and easier for the patient to adapt to. Music with pronounced beats is used. This resource lists popular songs that are used for music therapy in Parkinson’s.
Initially, the rhythm is provided at a normal pace. With gradual progression, the pace is increased by 5-10% each week. With each pace, patients are taught to coordinate their movements.
Mobile apps are devised to provide these auditory cues outside of the therapy settings. Continuous training, even at home, helps to improve the therapeutic outcomes of Neurological music therapy.
The benefits of music therapy for Parkinson’s were proven in 1997. We have come a long way since then, and the use music therapy is extended beyond gait rehabilitation.
Rhythmic auditory stimulation can help normalize gait, reduce bradykinesia and freezing. It is more effective when employed as an add-on therapy to medications.
Expert therapists can help overcome language deficits, swallowing difficulties, respiration issues, etc. with rhythmic auditory stimulation.
Though the mechanism is not clearly understood, neurological music therapy is clinically proven to benefit in Parkinson’s, and practitioners should recommend this therapy frequently especially at early stages.