11th Congress of the EAPC/Meet the Expert Vienna, May 2009

The Contribution of Music Therapy

to Quality of Life in Older People
Music as a Pharmacon?
Gnther Bernatzky, Michaela Presch
University of Salzburg, Faculty of Natural Sciences, Departm. of Organism Biology

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 !

QUALITY OF LIFE
.... alleviate ... stress
physiological,
psychological,
social,
spiritual,
Improving comfort

Enhance the
Quality of Life !

QUALITY OF LIFE

INTEGRATED
INTERDISCIPLINARY
APPROACH!

yes

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

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.

Number of papers

Scientific Publications on Music Therapy

Year

Abbildung: Verffentlichungen zur Musiktherapie in Fachzeitschriften pro Jahr berblick

(Quellen: Psyndex, PsychInfo, MedLine 1950 -2005)

Content
Introduction
Physiological Effects of Music
Research Studies
Summary
Enhance the
Quality of Life !

How Music Affects the Brain

further literatur for figures:

www.biologie.de, www.auric.de

Acoustic signals are

signal

translated into neuronal

activity in the
cochlea and progressively
transformed in the
auditory brainstem

How Music Affects the Brain

thalamus

primary
auditory cortex

pitch height
timbre
roughness
intensity

medial orbitofrontal
cortex

amygdala

emotions
control of emotional behaviour

a-c: pos. corr. with incr.

chills intensity

Amygdala is switched of less fear

a l. dorsom. midbr.; r. Thal., bilat. Cereb.

b l. ventr. striatum, bilat. Insula
c r. orbitofr. cortex

You dont have

to be a musical
genius to have
music running
through your
head!

MUSIC promotes/regulates

MUSIC promotes

physical relaxation
power of concentration
social behaviour
capacity of memory

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

How the body reacts to music

MUSIC

VITALISATION

cognitive integration
of musical- and nonmusical information
emotional reactions
bodily reactions
(tensioned or relaxed)

autonomic nervous
system

heart rate
electrodermal activity

How the body reacts to music

immune system

premotor
motor activity
activity

overlap between neural

activities of the late
stages of perception &
those related to the early
stages of action

positive effects

variations of (salivary)
IgA concentrations

heard pieces of music

activate

music perception
movement induction

social functions

MAKING MUSIC

perception

memory

emotion

cognitive processes

social cognition

action

learning
cognition

Content
Introduction
Physiological Effects of Music
Research Studies
Summary
Enhance the
Quality of Life !

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
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
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

R McCaffrey, E Freeman: Effect of music on chronic osteoarthritis pain in older people.
Journal of Advanced Nursing 2003, 44(5), 517-524.

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 !

Pain and Quality of Life

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.

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

Dependent variables

Curtis

1986

Journal

Altering treatment

Yes

Pain relief and relaxation

Whittall

1989

Conference
proceedings

Pilot study;
pre/post test

No

Heart and respiratory rate,

extremity temperature

Calovini

1993

Masters thesis

Pre/post test

No

11 State anxiety

Longfield

1995

Masters thesis

Quasiexperimental
pre/post test

No

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

Mood and pain

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

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, counterbalance

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

ABAB, session A consisted of cognitive-behavioural music therapy (30 min) and session B consisted of a nomusic visit (30 min)
MT, music therapy

Hilliard EH. Music Therapy in Hospice and Palliative Care: a Review of the Empirical Data. Advanced Access
Publication 2005, 2(2): 173-178.

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.
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.

More rigorous studies are needed to establ.

whether music therapy may play a role in the
treatment of older people with dementia.

Wirkung von individualisierter vs. klassischer

Musik auf Unruhe bei Alzheimer
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.

Cochrane Database of Systematic Reviews

Maratos AS, Gold C, Wang X, Crawford Mj (2008)
Music therapy for depression.
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

High quality trials evaluating the effects of

Music therapy on depression are required.

Klinische Evidenz von Musiktherapie

fr verschiedene Krankheitsbilder
Gewichtung der
Evidenz

Richtung der
Evidenz

Schwerwiegende
Sicherheitsbedenken

Alzheimersche
Krankheit

Ja

Angstzustnde

Nein

Depression

Nein

belkeit und
Erbrechen

Nein

0
00
000

gering
mittel
hoch

eindeutig positiv

unklar

tendenziell positiv

Eindeutig negativ

Ernst E.: Praxis Naturheilverfahren Evidenzbasierte Komplementrmedizin. Spinger Medizin Verlag, 2001

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
http://www.bethabe.org/MT_and_Motor_Rehabil220.html

MLS - RESULTS
AIMING - Fehlerdauer - rechte Hand
Interaktion zwischen Gruppen- und Messwiederholungsfaktor

AIMING - Fehlerdauer
0,6

0,6

rechte Hand: F(1,19)=7.253; p=0.015

linke Hand: F(1,19)=0.399; p=0.535

F(1,19)=5.254; p=0.033

0,5

0,4

Fehlerdauer (sec)

Fehlerdauer (sec)

0,5

0,3

0,2

0,1

0,4

0,3

0,2

0,1

0,0

0,0

rechte Hand

linke Hand

Parkinson-Gruppe (n=11)
VOR Musik
NACH Musik

rechte Hand

linke Hand

Kontroll-Gruppe (n=10)

Parkinson-Gruppe (n=11)

Kontroll-Gruppe (n=10)

VOR Musik
NACH Musik

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.

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
http://www.bethabe.org/MT_and_Speech_Rehab221.html

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 < 0,05

p < 0,1

p < 0,05

p < 0,1

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 life1 or reduces odd
disturbance in cancer patients2.
RCT (n = 60) suggested that procedural pain and
anxiety are not influenced by music therapy when
compared with simple distraction3.
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 selfesteem, 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.

How do the elderly benefit

from music therapy ?

ENHANCEMENT OF
QUALITY OF LIFE

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.

Standardisierte Musiktherapien
Welche Musik hat bei
welchen Menschen
unter

REZEPTIVE
AKTIVE

welchen Bedingungen
welche Wirkung?

ZIEL:
Enhancement of
quality of life

How do the elderly benefit

from music therapy ?
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 ?

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

Indications for music therapy

in palliative medicine (2)
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

Content
Introduction
Physiological Effects of Music
Research Studies
Summary
Enhance the
Quality of Life !

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 spirituallybased rituals)
COGNITIVE (neurolog. impairments, disorient., confusion)
Enhance the Well-Being Reduce Stress and Suffering

Promote the quality of life !

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

Standardisierte Musiktherapien
Welche Musik hat bei
welchen Menschen
unter
welchen Bedingungen
welche Wirkung?

MUSIC AT HOME

Musiktherapie Definition
Musiktherapie ist die
wissenschaftlich fundierte,
diagnosespezifische Nutzung
von Musik oder von musikalischen
Elementen zu Heilzwecken.
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.
formuliert von H.P.Hesse, 1980

Universitt Salzburg, Naturwissenschaftliche Fakultt

Fachbereich fr Organismische Biologie
Arbeitsgruppe fr Neurodynamics & Neurosignaling

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
Anregung

2. BERUHIGEND
Entspannung

Mglicher therapeutisch nutzbarer Einfluss

von Musik
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

(Claudio Abbado, geb. 1933)

Musik ist die beste Medizin. Mehr als jede Behandlung
hat mir die Musik geholfen, diese schwierigen Monate
zu berstehen.

Musikalische Hausapotheke = Musikament

AKTIVIERUNG
+
Mozart: Eine kleine
Nachtmusik

Universitt Salzburg, Naturwissenschaftliche Fakultt

Fachbereich fr Organismische Biologie
Arbeitsgruppe fr Neurodynamics & Neurosignaling

Starke Opioide +/Nicht-Opioide

+/- Adjuvant.
Schwache Opioide und
Nicht-Opioide
+/- Adjuvant.
Nicht-Opioide
+/- Adjuvant.

Radetzky-Marsch
Walzer
L.v. Beethoven
Rondo a capriccio

Koanalgetika

Bobby McFerrin
Don`t worry...
Music from
the Coffee lands

SCHMERZ: BIO-PSYCHO-SOZIALE EINHEIT

Universitt Salzburg, Naturwissenschaftliche Fakultt

Fachbereich fr Organismische Biologie
Arbeitsgruppe fr Neurodynamics & Neurosignaling

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.

Musikalische Hausapotheke = Musikament

ENTSPANNUNG

MOZARTMUSIKAMENT

Mozart: Hornkonzert Kv447

Universitt Salzburg, Naturwissenschaftliche Fakultt

Fachbereich fr Organismische Biologie
Arbeitsgruppe fr Neurodynamics & Neurosignaling

Starke Opioide +/Nicht-Opioide

+/- Adjuvant.
Schwache Opioide und
Nicht-Opioide
+/- Adjuvant.
Nicht-Opioide
+/- Adjuvant.
Bruder Jakob: Happy Baby Guten Morgen
Ade zur guten Nacht. Abendlieder HappyBaby
Baby Dreams: Close your eyes

Entspannung
bei Schmerzen.
Mentalis Verlag
Traumreise
Mentalis Verlag
Echoes of Silence
Schumann:
Trumerei

Koanalgetika

Franz Liszt:

Liebestr. Nr. 3
Enya

SCHMERZ: BIO-PSYCHO-SOZIALE EINHEIT

EMOTIONALE REAKTIONEN AUF MUSIK

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

Juslin PN (2001) Cue Utilization in Communication of Emotion in Music Performance:

Relating Performance to Perception: J. Exp. Psych. 26:1797-1813

EMOTIONALE REAKTIONEN AUF MUSIK

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

Juslin PN (2001) Cue Utilization in Communication of Emotion in Music Performance:

Relating Performance to Perception: J. Exp. Psych. 26:1797-1813

MUSIK UND EMOTION

MUSIKALISCHE CHARAKTERISTIK UND
DEREN KRPERLICHE WIRKUNG BEI SPRACHE/MUSIK

FREUDE

TRAUER

(PRESTOTYP)

(ADAGIOTYP)

GRUNDFREQUENZ,
TONHHE

hoch

tief

VARIABILITT
(MELODIE)

stark

gering

SPRECHTEMPO

schnell

langsam

LAUTSTRKE

gross

gering

TONHHENVERLAUF

auf/ab

abwrts

KLANGFARBE

hell, strahlend

weich,dunkel
SCHERER (1982); EIBL-EIBELSFELD (1984)

MUSIK UND EMOTION

MUSIKALISCHE CHARAKTERISTIK UND
DEREN KRPERLICHE WIRKUNG BEI MUSIK

FREUDE

TRAUER

(PRESTOTYP)

(ADAGIOTYP)

TEMPO

schnell, mit Accelerandi

langsam, mit Ritardandi

RHYTHMUS

punktiert, synkopiert,
abwechslungsreich

konturlos, mit Tendenz zum

Stehenbleiben

LAUTSTRKE/KLANGF. laut, hell, strahlend

leise, dunkel, verschmelzend

MELODIK

groer Ambitus, sprunghafte Intervalle, aufwrtsstrebende Motive

geringer Ambitus, kreisend

schrittweise fallende
Motive

HARMONIK

einfache Harmonien,
Betonung der Diskanttne

komplexe Harmonik mit

komplizierten Akkordfortschreitungen
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

Schmerztherapie: multimodales Konzept

adjuvante

&

pharmakologische Basistherapie
Starke Opioide
+/- Nicht-Opioide
+/- Adjuvant.

Physikalische,
psychologische,
physiotherapeutische

Verfahren:
- Musik

Koanalgetika

Schwache Opioide
Nicht-Opioide
+/- Adjuvant.

- TENS
- Biofeedback
- Akupunktur

Nicht-Opioide
+/- Adjuvant.

SCHMERZ = BIO-PSYCHO-SOZIALE EINHEIT

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

GLCK

TRAUER
p<0.01

p<0.01

p<0.05

n.s.

ZORN
FURCHT

ZORN

p<0.01
p<0.01

J. Panksepp, G. Bernatzky: Emotional sounds and the brain: the neuro-affective

Foundations of musical appreciation, Behavioural Processes 60 (2002) 133-155

QUALITY
OF LIFE

MUSIC

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

Allgemein

Gesang
Aktive
Musiktherapie
Aktive &
Rezeptive
Musiktherapie

Erhobene Parameter & Ergebnisse

Verbales, unruhestiftendes Verhalten sank zu 31%
Verbessertes Selbstwertgefhl und bessere
Lebensqualitt
Verbesserung der physischen und kognitiven
Funktionen
Durchgefhrte Tests wurden besser ausgefhrt
Selbstausdruck, Sozialisation und Rckblick
gefrdert
Scheinbar vergessene Assoziationen & Gefhle
knnen durch Musik als Gedchtnishilfe wieder
gefunden werden
Mentale und physische Anregung
Verbesserung der Fhigkeit zur Namensgebung
Verbesserung der Unruhe
Vor allem rastloses Umherwandern wird reduziert

Autoren
Cohen-Mansfield, 1997
Ellis, 2004
Hagen et al., 2003
Hanser, 1994
Johnson et al., 1992

Sacks & Tomaino, 1991

Sorell, 2008
Carruth, 1997
Choi et al., 2009
Fitzgerald-Cloutier, 1993

Vermehrtes Selbstvertrauen; verbesserte

Kommunikation

Fukamizu et al., 2009

Verbessertes Umfeld; verbesserte Lebensqualitt

McCaffrey, 2008

Literature Survey
Art der Musik

Rezeptive
Musiktherapie

Erhobene Parameter & Ergebnisse

Autoren

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

Scientific Publications on Music Therapy

European Pain in Cancer Survey

68% of cancer patients receiving treatment for their pain use
alternative methods the most popular are massage and vitamins
Base: all who receive
treatment (n=506)

I don't use any other methods

Other
Imagery
Hypnosis
Nerve stimulation or TENS
Alcohol rubs
Cold (ice packs)
Alcoholic drinks
Therapy/counselling
Ointments/creams
Meditation
Relaxation therapy
Change in diet
Support groups
Herbal supplements
Physical therapy
Acupuncture
European Pain in Cancer Survey,
Exercise
European Association of Palliative Care.
Heat (heating pad)
Half of European cancer patients have
Vitamins
moderate to severe pain: one in five patients
Massage

32%
19%
1%
1%
1%
1%
2%
2%
3%
4%
4%

Q52: What, if any, other

methods, remedies or
treatments, apart from
medications have you
ever tried to relieve
your pain we have
been discussing?

does not receive treatment. J pain Palliat

Care Pharmacother. 2007; 21(4):51-3

7%
8%
8%
9%
9%
11%
11%
12%
13%
14%
0%

5%

10%

15%

20%

25%

30%

35%

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.

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
http://www.bethabe.org/MT_and_Motor_Rehabil220.html