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Tony T9igram & CherYl Dileo

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Burke. Martha; Ile Backer. Jos;Music vibration and health

TEFFREY BOOI$538 Cwered Bridge Rd'

. Cherry Hill, Nl 08034

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r:_'j,'ffiCflON L FOTNDATIONS OF UIBROACOASuCnapter 1: Dweloprnent olVibrmcoustic Thempy

BY TonY WWn 11

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JEFFRE BOOKS53E Caetd Briilge Rd.Cherry HA M 0E034

This book is prctel by upyriglt , No prt of itmay be rcprdwd h any manrcr withant wrifrn

permbsbn of tlu pblblur.

(c) 1997 bl fetey Boolcs

Prinbd in th Anibd St&s of Aneriu

For ptrposes of wlfidentiality, tln rumes ofdicnts apryring thruglnut this book

uefrditious.

Ttt Publislur of this book is not rcsponsible for tluiqformatiott, ophiotts, utttsions or viws esErcsseil

by its contributhg antlors.

rABtE OF CONIENTS

TgENAPT

Chapter 2: Acoustics and Universal Movemenf--- B! Migucl Fernatdez 27

Chapter 3: The Context of Music and Medicin" ,nBy ClwrYl DIe'o ,

Chapter 4: Potential Applicafions of Vibroacoustic TherapyOta,, Skille 49

ffiCIToNII:RESEAR9E,aI'IMa|LAI{DANE@|0TALnEFoRIsnupt"" 5: The Effecr of VA Therapy on lvfulfipty Handicappedluits with High Muscle Tone and Spasticity

.4By TonY Wigan

Chapter 6: The Effect of Vlboacoustlc Therapy Compared wlthMusic and Movement Based Physiotherapy on Multiplyi-""iopp"A Pafients with High Muscle Tone and Spasticity--- - lirw wiwm 6eChapter 7: The Measrrement of Mood and Physiological".porrr", to Vibroacoustic Therapy in Non'Clinical Subjects

By TonY WiErzn E7,/

coustic Therapy to Reduce Pain DuringI Kne Replacemcnls Patients Over Age 55KathY Tlmmas 99

Chapter 9: Effects of Physloacoustlc Intenentlon on Palntvtanagerent ol Postoperative Gynecological Patients

- -By Maftlu htrltc 1o7

Chaper 10: The U c Parkinson's DiseaseBl paLri dd nilez de 12s ,/IlIarclnl &

Chapfer 11: The Effect of Ampliiude Modulation of the PulsedSinusoida|I.owF.rcquencyToneasaStimu|usinVibroacousticTherapy/--:

ry fonY Wig;n 133 V

7';4 r''1

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il iiiQhpcr llh Vlbnmouslc Thcmpy wiJh Hndicappcd md ArtisdcAdolcsccnls L' ' ! ri d'

4 Jan Pcnoons l*,Ios Dc fufur....,ii,. "

*"w e ww ' '].

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Chaper 13: Vibroacoustlc Therap In 3hG l|oatment of Retf SyndromeBy Tonl Wig,am 149

Chaper 14: Vibroacoustic Themp wifh Adula PaJients wifh PrcloundLcarning Disabilities

By Tony Wtgan, tenny Mr/,laryfttr luttc &itt & Lyn Weks lS7Chapter 15: The Use of lhe Somatmn in he Trcatment of Anxiety

To all the saff and patlents who have been involved

in the pioneering dcvelopment ol vibrmcoustic therapy.

To the mem)Iy ol ny loving cousin and lifelong fhiend,

Robcrt Anthory Md)onnel!who has nol gone awa but gone ahead.

i :if

Prublems wlth Cllents q&o IIve larnlng Dlsblltlesry JetHoopu & B Lindmy .169; r/

Chapfer 16: A Comparison of Auditory and Vibmfory Simulation onStuss-Relaed Responses of Prcmalure Infants h BronchopulmonaryDyrylasia

By Matlu &ttb,Ienny Walsh leni Oehlcr &feaninc Gingras

Chapter 17: Vibroacoustics with Hospialized ChildrenBl Laaalones

Chapter lt: Physimcoustic Therapy with Cardiac Sulgery PatienlsBy Clniles Butlcr & Penelope tohnnn Buflcr

Chapfer 19: Two Case Studies in Vibroacoustic TherapyBy OIav SkiII

Chapter 20: The PhysioacousJic MehodBy Petri lhiloinen

Chapter 21: Vibroacoustic Therapy in General MedicineBy Riitw Randsik

SECIION III: OIIMCAL AND PR0FESSIOIL .s,SlEsChoptcr 222 Cllnlcr,l nd Efhlcl Conslderstlons

By Tony WiWm & Cheryl DI@

Chapter 23: Maklng Music for Vibroagoustic lherapyBy Olat Skillc

Chapter 23: Equlpment for Vlbroacoustlc TherapyBy Tony Wigmm'

Contibutors

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197

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ACKNOffiThe editors rvould like to acknowledge the conhibutions mny people

mde both towalds fhe rtsearch fleld of vibrcacoustic therapy and to theunderfaken for this book.Reklor Olav Skille has inryirrd many with the possibilities ol

vlbrocoustlc therapy slncc 1985 wth hls ploneerlng work. Dr. Robert \ilesthas been vcry helpfirl and supportive and has taken a great deal of inteestin the entirc ffeld.

Horimn IIIHS TrusJ has made financial conJributions towards thedeveloprnenl olVA therapy and has supported the project and esoarch qork:in parficular, Mr. Tom F'reeman, its Chief Executive, Dr. Barbara Kugler,Dircctor of the Harper House C:hildrents Servicg Mrs. Lyn Vtteekeg Mrs.Jenny McNaughl and Mrs June Cain, who have developed fhe VA therapySenlce at Herperbury Hospltel.

Financial support which has enabled vibmacou$ic research andclinical services has been generously proded by the Spastics Sociefy, theOak Tree Trust, he Platinum Trust and fhrough a personal fund-raisingefforJ in memory of Humphrey Mors by Mrs. fuina Clemence-Mervs

The editors would also like to acknowledge the srpport of colleaguesinternationally: Dr. Kenneth Bruscia, Dr. Bruce Saperson, Ms. DeniseErdonmez-Grccke, Mrs. Penny Rogerg Dr. David Aldridge, Dr. Kris Cheslry,Dr. Don Mlchel, Mr. Petrl Lehlkolnen and Mr. Rul Vatsar.

The ediSors are very graeftrl o the contribulors to this present volumefor their coopemtion and insighfs: Mrth Burtg Jos De Baclrcr, CtarlesBuer, Penclopc Johsn Butlc4 Junc Cein, Petxi del Campo San Vinentc,Mgud Fenndcz Jcannirc Gingreg Jclf Eoopcr, La Jmcq Bill ndsay,Iki Fernndcz Mencob, Peri Lchikoincn, Jcny McNaughq Jclri Oehlcr,Jm Persmnq Riiu Reudd\ Olav SHllg Kathy Thomg Eryeranza TorcsSetu, Jcnny Tlhkh and Lyn Weckcs.

Speclal thanks to l&thleen Avlns for pruofleadlng the manuscrlp andto Navine Malherrs lor the cover design.

And finally, fhe editors uould like to acknowledge the confinuedsupport of their families withouJ wtrich this or any projert would beimpossible: Jenn Roberf, Michael and llavid Wgrarq Jeffhey DileMaranto and Jos Ignacio Castao.

Tony Wigram and Cheryl DileoJanuary 1997

tr' I.ne urpose of fhis book is o prode info'rirition on iniC cuiniTr". or"t"coustic therapy. Reschand clinical infomaJion flrom arcundlne wort is included to giv the rcader an idea ol Jhe potential applicationsof music vibmtion in the facilitation

JE

,i stimu rcd fo dtlaii

rtf r''! ing anduses and applications ol music vibmtof products 3yJlable,.to .aclrlerg smiftercnccs in itre nature and delivery of the trcatrent stimulus

The intenfion of this book is to focus on clinical, ethical and resgarrchaspects of vibroacousfic therapy rafher han fo provide a wide'rangingoverview of the field. The information prcvided herein is neithercrmprehensive nor exhaustive. This is the first book concentrating on thetherapeutic pofential of musicvibrati s been madeto prvide Jcontext for music vibrat examples oftts potenflalr some results of controlte ivenesg andsome guidelines for its use.

Theinformationdocumenfedherebyaninternationa|groupof

" both Professionals and non'p both in clinical and researchd Provlded' Not all chaPters w{ll

tions which cover resPectivelYsis of vibroacoustic fhemPY'cal and Professional aspecfs

I)ItI

I

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potentlal u!es of this nrclbod lo enhance hal3h.The second sectioq 'R'eseanclr, Ctinical and Anecdotal Reportq"

cnnfains research studies and descriptions of clinical methods and maerials

its hempeutic applicalion.Tie thtrd scction, 'linical and Pmfessional Issreg" confains

infornation and guidelines for using this therapeutic rnedium with clientgincluding srggesfions fo calions that arecurrenfly believed to be music tapes areceated for trcafment art of some types ofequipment is included.

The edlfors lnltlally felt the need to underlake thls proJect ouf ofoncern for the rapidly expanding usc omodatify and the incrcasing availabilitydevices Thert is a lack of clinical andguide this work. In addition, therc is an apparenl need to address ethical andaining issues to provide a foundation lor fufure dialogue and theestablishmenf of standards of pmclice.

It is felt fhaf fhis volume is only a starting point for his effort todevelop and lmprove cllnlcal and profesdonal aspects of vlbroacoustlctherapy interventions.. Undoubtedty, this field will grow as new applicationsand methods are carefullY fested.

Cheryl DileoTony Wigam

SECTION I

FIOT]NDATIONS OF VIBROACOUSTICIUBNU\PT

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Tory Wignm

HISTORICAL BACKGROI'NI)

ft" on what he deflned as.{hltP; rsalprincipti' rys!9: ii low frequenciC ci ciec'f i." t"sion;2) rtryitrmic music can invigorate; rgqf,Fylhmtc musc can-.p'ily; and 3) loud music can creae aggression; soft music can act as a'"

mudiuhe lnoduced he element of low fitquency sound es e pulsed tonewtrich he rccorded on tapes together with relaxing mudc'

skille defined tbe principles and method of vibroacoustic therapy anddesqribed fhem at the flr$ symposium of fhe International Society for Musican tVtedicine (Skitle 19E2):'IIe summarized lhe process of vibroacoustics a9follows: 'The.rpg of sinusoidal, low flequency sound pnes$ne rrves betrveellS0-lZthz, tlene wtn music for use with lhcrapeutic poryttC

.

Icorporating both fhe elements of vibration and music, Skille initially

11

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deflned hls fechnlque as ubsequentl he ^ J'"-. it Vibruooustic pnooess of tbis

r ln*rumentflon and, pre-comosed melodles on he plryslologlcal and

il"ii"t-r rcsponses b[ nro-tgunalv. *9d{ :Fdryl, T1.1o.l1t:i:

used.''f,'ihere has been limifed research on the absorption of sound into fhe

human bodY, but tYZVo ol the energr.underfaken on ai 'tvfratlonal ellect rsudace of the equiPment' o'

Skille's investigtions e4anded !o include other conditions which he

varied.Ir 1987, the rcsearcb underlaken in Nonray and Finland nas still

L2

"n""r rere fond in subirctd respiration, pulse or behaviomlly

f;il*;-": 1'-lh-:,PI:1,:,:I^g' ror elther the vlbroracrlle orJhe non-viboactile stimulafion administered'

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reproducible effects a a llequency of 1f) heriz. Again, this rcscarch focused+ffnsory vibration on the han$, using an elecfro-mechanical :i'deliverod Slriumidal pulses of vaiable lhequency and P

W"d"ll and Cummings (193$ studied fhe concenrs of fatigue of thevibmoiij'$nse in an experirnent looking af the effecf of mechaniczt

"tbo,ton,r,on the palm of hc hand. In thls paper, lhey ctmmented that therrc ras lackol scientillc interes in he percepfion of rnechanical vibration, probably duelo he fact that although a fecling ol vibration is an every day occurrcncg it;,does not seem to play a very important part in the adjstmelit ol lhe human.rbcing to his environmenTheir nork explored fhe generation of ftequenciesbefween 64 and 1024 cycles per second, generated by a Wesfern Elecfric heefleld audiomefer into a rnefal rud conneced fo the palm of a srbjecl's hand.They took readings over a three minue period between the frequenciesmentloned al Inlensltles of 10-40 declbels above threshold. Flrst, they lound .,;tha the amoun of faligue depended upon the flequency of stimulatiof,, andin a sununary of fheir trialg lhey concludd that a sensitivify fo vibraloryy.,stimulation applied fo the palm of the hand ws ndu'cpd 5.15 decibets aftep3 minufeb of coninuous slimutatid. Secondl they found that the loss of i

o?t.

' ^''tf .smeasured at a lower frcquencXl Fuher sfudies indicated the signiflcance of

,the level of intensity of fhe tones used.

In a study on adaptalion and neoovery in vibrotacfile perception,Berglund and Berglund (1970) ilound that perteived intensity decreases."'e4onenfially with incrcased time of $imulationfThey used a 250 cycles perseoond sinusoidal Jone delivercd fo a llngertip by means of a circular plasticbutfon. They also found that the decrcase in perceived intensity is greaterSt

r tlme uas regulred for complete adaptatlon ,n

''16*'iffisii,'it'recuiery is fas, actuallyBerglund and Berglund (1970) also found hat lhe perception of

vibrotactile sfimulation is complicaled and diflicult o evaluafe. Theinteraction thaf goes on befween amplitude, fbequency and duration on lheperreptual counterparls of these parameters provide inferesting problems forp sychophysiological research.

Studles on vasodllaflon were canled out by Skoglund (l9E9)f,ooklng ir

L4

gffect of hlgher flcqucncy (150-250 H) on skln nhrcas of the toq rof"o thal re tested incldin"

tiCnUs, parfs of legg anns and trunk in a Joal ol l3() vibmtlon'experlmens performed on E0 healfhy nren nd tvomen between 20-70 yearsold. He again used the technique of infi-a-red thermography to indicatelemperafure changes and vasodilation. His rtsults gupported the viery fhat dl/

performed in a few comparative e:rperirrentg caused vaso-consricfion. {n"Oaition,

he found that he incease in temperature fq fhe given stimulqs'sas .'gtatei the lower fhe prevaleut in empenature at lncepllon of the stlmulus.

TVherc vibmtory applicators have bec'ome a oommon Jool of thempy in sphysiotherapy defrartnrnf$ some researrh is cenered around muscular

Y1f+:Itf

/hurnan skeletal muscle nas made, noting fhe effec of the involuntarygasynchronous motor unlf contractlon In the muscle subJected fo a mechanlcal r''vlbrtiory with a reciprocal rela:ation dl fhe prime antagonists. :t

"In experiments underaken by Hagbarth and Eklund (1966),'this 'rReflex G\|tr). Stiltrnan (lYl0) iltory mofor simulation

.?9--lheactive rscie'contraclion and /.

inhibition of muscle contraction. Sf illman proposed 3hat, when superimposing #viborinotoi' siimulafion on a voluntary muscle contraction, the result tpibduces a greater muscle enslon or a grcafer range of movementi dependingon whefher "the inifial contaction is against a yielding or unyieldingresistance." fn some sfudies involving spasfic hemiplegia, spinal quadraplegiaand acute incomplete spinal quadraplegia, he found improvements in handgrip, scapular stability, funcfional use of f he limb and range of movement. Inthis research, the Tonic Vibrafory Reflex induced by vibmtory measuedsfimulafion caused improvemenf in muscle acfivity to fhe point where studenfphysiotherapists could gain some insight into he simulation ol spasticity in ifhelr own muscles. Vibrafory motor stlmulatlon actlvated muscles, and as a irezult, Sfillman also listed a number of adverse reacfions he found in someclients, including increascd spasticity and clonus of spa$ic muscles, increasedilgidity and wide spread tremor from application to pafients withParHnsonisnr, spread nesponse to spastic muscles during the vibratory motorstimulation of non-spastic paretic muscles, and a general sprtad response toother muscles, paficularly a feeling of discomfo fbom vibralory moorsfimulation over bony pruminence.

If ls importanl to note these stimulatory effects of speclfic vibrafory

15

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motor stlmultlon rpplled fhrough the rpptlcetor th Sflllmen rvas usln&iihi"n was an clecr{cally powerod and commrcially rnilable vibrating

Tlfco Vibory Massager.n This vibnor opcratcs on a4 trrnmtttlng vlbretlon through r sllghly curvcd plestlc

dlsc, some 35 cpntimetps ln diameter.several further ludies have been undertaken on the effect of

mechanical vibrtion in srrpden by Hagbarlh and Eklund (1968). Theirrescarch follmcd the path of the studies on Tonic Vibration Reflex (Eklund

and he rclanfion periods and also during periods of the volunary afemptsof the cliens to move thcir affecfed limbs. The vibrator fhey used oonsistedof a snall elertrically loaded mofor in a cylinical shape. They used rubberbands to attach the vibraJor over muscle tendong and the motor was rctated

ib pduces,o ther the

in reflexessrcte oflen of normal slrength, but they found that the vibration incrtased fhetremor and rmy have also impaired the patient's abili$ o perlormalf ernating movernents

INFRASOUND AlD LOW FREQUENCY SOt ND',

Between 19E3 and 19Ell, the Forsvarcfs Materielverk (FI\[\') ol heSwcdish l)efense Material lniri3titio4r assenrbled a substantial

tri!il rh$itflt hiltle sou$dn' O. 5). *They go on to say: 'Sre adopt wifhout any resenation, 3he opinion thatpelow lQQ*{"

irw$.+94 .lnfbecound shuld not be

16

(Detow r9!l,-i.,--tLgg+Pr'nd thelr

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such as: a) tungs - snounded by the chest, b) nasal cavities - sunounded by..,bone, c) gasoous intestineg d) air-ftlled middle ear in rclation lo lhe car-'="'mcnrane; and c) air-fillcd middte ear with the ear membrane in relation to "the liquid-fllled inner ear+'

TIIE MFECT OF IIFRAIOI'ND Ohf HTJMITI\IS Tf

A study emmlnlng he effect of inhasound (below 2O IIz) on humanphysiolog naq4onducted by Alford et al. (1966fwith 21men betueen 21'33years old. A sffmulus of pure tones between2-12 Hz in the mnge of ll9-l4/decibels was intrcduced into a simulated chamber. ResulJs showed hat rNo'electric cardiographic alJerations wene obsened during fhe period ofstimulation or aftervards. The heart rale sas noted to increase-in 6 subjectsby 6 beats or rnone per minufe during maximum sfimulation, bul in 5 othersubjecfs the hearl rafe was slowed down by 6 beats per minute wilh similarstlmulallon. Resplratory funcllon as obsened wlth lmpedance pneumographyrras normal for all subjects during exposure to the low frcquency stimulus. In7 subjects, however, he respiralory rate was increased by 4 or morercspirations per minute when a stimulus greater fhan 140 decibels SPL uasdelivered. These are probably insignifican alerafions" (Alford eJ al.,1966,p. 14).In these experimentg no'*mbjects reported discomfort wifh regard lobody vibmllons, disorienti, mental confusion, sensory decremenf or posl:cfiiosure fatigrp.

In a ano'ther sfudy (Englund et al" 1978h pllots were dlvlded Inlo,3 grorfl's. One group rras er

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rd $trc.ttp.aled D||der iad'ion 'hi!rbj.ct r! !*rd-hJ4eElily ia.s r.fr gm'cd 'iri.tb.r Into rth .i*t - kgt' d h.4 trs .Ddlit nd r .!mrl dt ct ' conslsLN(t ol rspon$ b.gn to ctnc|gc(r3tm 1996).

Ilai cD bc concludcd ftom |rry ot !hcs. lud.r i abal lh. locutttllahton or| boah vibnaior d lott lltquanct soutd hr conceDlEbd ona if.cf; oi diicootolq plviotogi.l chqg. d anoyDor a3 lhrlal.rs fa avualng ry signfcant or slimulaory eff.ct In lhcar the

,,1

dfutlnclors bclrE n tho ctrcutstnc.s n wrucn orc t3 qP@qur F i qfffliiell colhd.d Dt lha Sxcdii D.f.nia M.Gil AdminilrtioDi|-tl*'"" *"rt"t lt gancr3o fonr of dtlcornforl, Fo.t(r|plc.lh I l! lookcd.t |lfrmud lD !.fr.e .nd lls pop8doq fhc .dstGhcc ofg;trI-Jri"Tgfi'"T,fi":'#:*?s#;H:^tii$:fi#fr"J iiffi:ii#H91fiil-S:f:;HiTfri!Ttli$,i:#;",1',1.i.fi;il;";;;;-#--;;.--o*rnry l'rg't"og

"t." ; ::!!-ttt.,ft:'fcc& D.fiDr or th. .unrirDts b.vc b.cn undlr.keD usingillirillli-1"""" "r

ctivirv drsturbocq h.^-:y1*iJ lffi?J::J*5,g"IL*t*:5"fl:-a srihtrrus of inft"ounduqru"6' -: ;; ;;";o. irrrt. lbn loudspe-kers within a small enclosed chamber."rrporu

to vibmfion can sometimes induce a se.ns: I 11"";-;- ,,,1,.., "vs ru

Htt0Inft

$ililil;-'il;;; vibrarion and rarigue-"n "n"."n larigu. .il1*prfomance u""

"t.n .o.]---t.* ,^,t hale not vef been cuanilfed :lt r MUsIc As VIBRATION

r.atlof il -{.". bndrl:iIn t.nc ol heltbtdu crus. phsiol halrn ett'Llli om ol th. arllrl sludh unddfkcn on thc ahdp.ufic alf.cts ofi t],lf]fi'- ii TEI* H:,:ll l_ol.!:'ol elyryo:g4 Triviry w' br rcrrich (ft5e). H. was}iffiEitrx*'**ffi*ffi'*H,,1".",'"Hi:sfr"!#l ffiil{11i;:iff:5#j{ipii*'i{,ii*H!

20 2t

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l"{ r- end he became e rcgular c:oncerl goer. He ras eble to recplvc thc sound--

/LrrL lL^,,rl but lot in the same rray Helcn Keller' (thtorrgh 1gi'ut her fingers), but ralhcr wh' anr.'lnnerr scns oF'l"r{ lfer descrlbcd tt thls wy: rnln rccclvlng stetlon lslfer descrlbcd 13 thls wey: mln rccclvlng stetlon ls

my back. The sound penetptes herc and llows thro-ugh the whole trulfllmV{ mv back. The lrtund penellalgt-nerc ano llows IrnuuBlr f wrrure fr q u rryI utv which feels tike "

tlblli vessel struck rhythmically, resounding norrI i";;;; ;ft"r, dependcnt on the intensity or the mrsic. BuJ there is notI lhe stightest ."nsaion in rqy head and hands - the head is fhe least sensitive"

i.i In concluslon, thc dei'elopmenf of VA theraif'has rken plqta bver th9 /ffieen years and hdi lnvoled e Varlety of profesdonalg lncludlng mudd

ti"-rig* music educaorg music therapy educatorg psychologifgrbiologists, physicians, nutses and tgachert'Jh: JheroreJical,P::-f"-"

-t11 .'

CONCLUSIONSfl

showed lively colours. Al other times, I se no images" (p'10)'Anoter musical subject conrmented,'If ras quitc remarkable.I could

hear only wirh the solar plexug atso the softest notes but nothing at all with-y

"""r. My hands

"od f""t rtmalned cold thls tlme, In spite of the

"utog"rro.r, training which preceded the experience' It is a primieval

e:perience. A pity i3 is so shori" (p. 10).This study can be seen as inspirational to the early pioneers of VA

described here, and flrom the principles and "nd music apptied in the fleld of medicinet VA ':if involving the use of music and low fhquency i

22

REERENCES

AIford'

Brtne ency noise on people 'a rcview'(4), PP.483'500.Bryan, M, & Tempest, I4/. (1972).Does infrasound nnke drivers drunk?. New

Scientist. 9, 5E4'5E6.D""ro*, I A, & Goll, H. (1989). The effect of vibrotactile stimuli via the

somatron on the identification of rhythmic concepts by hearingimpai

Eldund, G,, stimu

Administration.Grimn, M. J. (1983). Effects of vibrafion on humans. In: R. Lawrence (Ed.)

'proceedings of Internoise. t Op. 1-14). Edinburgh: Insfitute of

Acoustlcs.

;

23

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lL K. En & Eklunq G. (1963). Thc efnecas of muscle vlbrtlon Inspodcigj rigdty and ccrcbellr diotders. .Iounral of Neurolo.r.Neurosrqeryr and Prychiatryr 3L 2n Al3.

ffita O, e n nesz, C. (1954). Muslkgenuss bel Gehorlosen. Zschr Psychol,BD.99Jr5/6.

IandS

Adminishalion.Lehikoinen, P. (19ES). The l(anms project. Report |}om a control study on

he effect of vlbroacoustlcal fhenapy on strcss. slbellus AcadenytHelsinki' UnPublishcd PaPer.

I*hikoinen, P. (1989). Vibracoustic trtafmenf to reduce stress' SibeliusAcadenry, Helsinki, Unpublished paper.

Madsen, C. K, Sandley, J. M, & Grtgory, D. (1991)' The effect of avibrotactile device, Somatron, on physiologiczl and psychologicalresponses: Musicians versus non-musicians..Iournal of Music Thempy'

31 (3), 1E6-205.Rolana, f. f, & N"il."n, K. V. (1!lE0). Vibratory thresholds in the hands.

Saluv fherapy n'lth neuroJlc cllentsper presented at the Secondticg Slein\ier, NoruaY' 19E9.

Published ISVA.skilte, o. (1969a). Vibroacoustic rrsearch. In: R. spinge & R. Droh (Eds)

Skille,SHlle, ion andfherapy.

In: T. Wigram, B. SaperSon & R. \ilest (Eds.) The Ar and Science ofMusic ihempy: Handbook. [-ondon: Hanvood AcademicPublications.

Skoglu

Skoglu

Scand- 125' 335.336.

24

Itr. JM. (f991). The effcci ol vlbrotcllle nd eudltory Slmull oni;t"9p,t.i o! co.mt14 ncar!^ra,f lnlqfnneral flngcr t"mPtmlw' ,,,

-ioifial o?Muslc ltempy.2E (3)' 12/0.ry';B. CJ1970). Vtbrtory motor stlmultlon: A prcllmlnary porl'-tlD

Tcir ons' In: H'As \IvaVerlag.

Verillo, . L tffZl. Invesigat rne parameters of .the cufaneous'-' inrcsnold lor vibrafion. nat of the Acousical Society ofAmeric4, 34 (11)' tl6B L773.

:on cEp, & r.r*oq c. w. (re76,;TfTll1lllilii,.lFil,ill1,ll

riirless .'{,' IWedel figue of the vibratory sense'4294E.wigram, T. (leeO. The effects ol vibroaco l!'"t"pLoa11iY1"li^lli;

i

I

":;h;i pop,rt"tioor. Doctoral disserratioq st. Gcorge's MedicalSchool, London UniversitY.

Wtgraq T. (1993) 'The Feellng offhequencY sound in rcducingclients with learning dilfcul

197). London, Philadelphia: Jessica Kingsley'Wigran, e WoX.s, L. (19-tl). Report on Lcvanger Symposium' Norway'

In: O. Skille @d.) Kompleft ra

Levange4 Norway: ISVA Publlctlons'Yamada, S, I-kugi, wt' tr'qit

)))))t)))))))))))))))))))))))))))))I

.. :,::.1;lit !$i:. i.tr. 'l:i ,r; i . i ( /:t):,,: t+ t,S.IfiFi:{{STli,: j, jt',r-.r: r

r':-,. i.r : ir, ;i:if-it&,.t,,, .,,'i' : r tri i,o._li*iif1,, i ANIT INVENq|L UOVEilENT

percePtion.Thesesensesarespecia|izedinrcceivinginformationhomthesmall

TvcrYthing Is Moviry nd VYc FcdA P.rl of this Movi4i

Thi.*;hht i. m" key to understanding many of the questionsw'ich are evidenl n tfre fieU of atouSics. Real movment

and our perception

of thls moyemenr .* "ii"Jslc ldees

of a unlque phenomenon - that of our

ii".i*,. the world tat srrrounds us thrugh the prcoess of sensorl I

.lIlE* Jsr*r _v vrvv'_-_--- ---

and rapid movements that are produced around ugl"tt"""

"n our hearing senses. Thougb these are Jwo

hcf|Dg,Ilp$l9,psl9F.in 4eF9" .pt4llPre' *l':: -'- t"-------- ---'.-trof hoarrco rtrev come inio the field of srbircfive perreption' ,t

on human physiologr. This evaluation b'ediftcrcnce "it""n ibscillation" and 'qvibration"' '

Osillafion r*

c

flhe bodY is elastic' and the forcethe cohestve lorccs that malntln

aunityofthemolecu|esandcanaccomplishoscil|atorymovementgthenfhebody becomes disforted. It can then be stated that fhe body has entered intoa state ol vibmion.

Whenthebodyisnotsortedthroughosci||ation,asjnJheftrstcase'the movemenfs are isocronos where he movements are alnays the sane'Thercforc, the numer of moverrrents that arc accomplished in the space ofa unit of time .an te ;*tfi" as a I oscillation frequency - and can be

Mfugcl Ferundez

27

)))l)))))))))))))))))))))))))))))))t

dergnated s elther s purc fone or dnusoldal lone. This namc ls deflncdbccusc thc dlqlacement lollows the slnusoldal ftnction of the anglc fomdln a triangle.

In the second cese, rthen tbc force ls iufclents lerge to dtitorl thebody, each moleculc or grcup of molecules will oscillate wilh a numbcr oflsocronos movemenls whiclq anpng other fhingg might be caused by theela$ic properties of he body and will cause multiple oscillation fhequenciesor pure ones. A clcar hierarthy has been cstablished between them sch thatthe slorrc movemenl produces the lorvest oscillation fluquency, which can bedesignated as 'the fundarnenfal fone," and olher movements generated willJhen create additional frequencies above the fundamental oscillation ahat arrcatled "partlal tonegt' or'byertones."

Here it can be found lhal the partial fones may or not be divisible bythe fundamental one.In thc flrst case, fhe partial tones can be designated"paial harmonicq" or simply "harnmnics." These continue in the proportionswhich rperc defined by the ancient Greeks according o fhe harmonic seriesIn this serieg the obtained number ol the division of a partial harmonic withrespect to the fundarrental means thal the number or order of said parlialharrnonic (ie, he fourth harmonig the twelfth harmonic, fhe fZ3rdharmonlg efc.) resrlts In the comblnalon of all of these In an overallspectrum. This creaes what we lgrow to be a "Complex Toner" where ifsprimary ftiequency value is known as the fundamental tone.

In fhe even lhaf it is not divisible, it can be designaed as rlartialinharnonics," because it is evident hat if does nof continue in the hannonicserieg and iJ will only be possible to obtain it if a spectrum analysis is rmde.In fhis analysis, by putting into order fhe numbers of minor to rmjorinharmonics, eg, four parfial inharrnonicg flfteen parlial inharmonics elc,one can obtaln a result where the comblnatlon of all can glve an effect ofwhat we know as "noise," and it will nof be possible to quanti$ theirfbequency.

In either case, the fundamental tone will be the first partial harmonic,because il it is divided by iSself the result will be one.

The terms prcviously known as tone and noise herc have a purclyphysical context, and although it would be current praciice to define in thesame way cause and efnect, we should not forget that we ourselves nove in twodlfferent ftelds - the obJectlvc and the subJectlve. These cnnol be mlxed.Thercforg a great number of mistakes can be rmde when these terms areconftrsed, and if is not clear wha confext is being used in each separate case,either ob!rctive or subjective.

A logical prooess can be found by nreans of a chain fonned by theinitiator of fhe movemenfg the medium by which the movelrent isfransnitted (for enmple, air) and the reccptor, which lorms the last link olthe chain. In a Ulopian rr,orld wherc onc c.ould frnd an ideal chair theInltlator would generale a perfect oscllleflon, the transmltter or medlum (for

28

DonLt-'-- Th" effect accomptished reoutd in fhe form of a feld of increasing andooo-J*f size which coutd be described as a "ryheri@l $ave," growing as

makes crontacf with a surface.

crashes against he limits of he object and is difllacted around.abs"ttoo ls a mechenlcal energl converslon In caloles by the

rubbing ol tht molccules togelher where the energ foce is absorbed within

,lr fl

29

;

$H0rfl;QI

))))))))))))t)))),

))))))))))))))))I

ne oscilaton info a vibmtion. This energl, in fhe form of an electrical Icurrentr pas$s fhrougt a sylem invotving a tansducer which is capable of iconverflng lt lnto mechanlcl movementg Normall the ransducers are theloudryeakens located wiJhin the chairs or the beds. Here is one of he mostcritical poinfs of he "chainr' - fhe loudspeakers

Loudrycakcrs

These devices have conical and rigid rrcmbraneq capabte of beingmoved by controlled movernents which are obfained thmug generating sysem of nragneflc llelds whlch cause the comlng togefher o" golng apart of

Dlagram 2

MOIECUtE ACTIVITY

DIAGRAil OF ACUTE RESOI{AIICE

:, r, ,i i-ll,r jtli :,"

/-IA HARD BoDY

IDIFFRACTEO Ef{ERGY

30

FREOUENCY IHZ.I

31

II

I

I

I

!

))))))))).)))t,t)))))))),))))',

)).)))))I\

onc of then thc mmbrne. Thc posltlon ol Jhc membrns lbto ncslvo lhe stlmulus ls In the vclex of he ong and the force willii over lbc nholc membrnc ll ordcr o movc iJ.

fnls ts e rysiem rverc the prtnary Inltletlng ' transmlttlng 'rccelvlngintliating - transmitting -I his process is rcpeatcdaan Huygens in he latterilOtECUtE ACTIVITY

Dlagnam 3

MOtEcutE ACTtvtTY

cave fon can bethose which ane

movemenf by thec{lon olttractlon or repulslon wlSbln nregnetlc fleldg behave ln a uay thatity hus

:il :l:nembrane, and other parfs of Jhe residual eneEy arc reflecfed back againlomrds the cone of sPeaken

The refected waves go in opposite dircctions wih respect fo theougoing raves, and thertforc generafe a seies of staionary $aves thaf causelhc rembrne lo be delormed and begln vlbratlng. Ihls generefes overtonesthl are disorfed by this pnocess. These overfoneq generated by hedistoltion, have ffcquencies much higher than the fundarrcntal and can bemorccadly audible fhan the findamcntal, crcating conftrsion in the operationof thls system. It must be rernembercd fhaf lhe frequency ol a sound forehich he air is rmf sensiive is in the arca of 4'0fi1 Ha and below Jhisfltquency the auditory sensitivity decrcases continually and irregularly. ThencoessarT energy to perceive a tone of 30 Hz with he sarne inJensity as thaof d000Hz ls almosf a mllllon times latger.

This indicates that our hearing abity does not respond in a linearway to cause and effect, but follors random curves in relation to energtlevclg fhequencies and the production of sound sensation.

The low flequencies (below 30Hz) are pracfically inaudible as anairbonr sound within fhe environmenf. Horrever, they are perfecfly perrceivedby hc sensation ol fouch, an enmple being thc facility of hearing throughthe lansnission of sound energr via bones TVhen we raise the flGquency offhe tong the capectty to hear through the llmpanlc menrbrane vla lr lsogluws quickl wlrile the possibility to perceive the sound in a tacfile naydccnases.

Either when the speaker is of poor qualify, or if it is a good ryeakerbut driven by high power cnusing high levels of energr, the sarne rcsult willoocur

- the overtones that arc generated in the membrane ol the speakersrtach very high enelgr levels. This tsults in a clearly audible tone throughtbe air combined lh a fundarental tone which is perceiyed by means oftouc\ when In reallty what edsts ls a complex tone condslng of a

'l1rf

FREQUET{GY (Hz.t

DIAGRAT| OF O FACTOR

{

iii

3233

))))))))))))))))))))))))))))))))))I

llndmsntl one and scrles of partlel hlgher ones$!''r Thls fblc imprcssion produced n trc perrcepJion of tone may.., cause grcat probl otner conlpliil:l"T.,i:"r*l be srgnrncanny

ffben.bn el0clronlc sygtem ls used fo rcproducu muslcl prcgnalso be tken into accuunl in tenns of the low lbequencies

ffrf,,," hrt"u*itr thar may te generatlng irt" i"itltt-;; :;i.tbase wlfhln the muslc, and they should not conlllct or lnterfere wlth

,t too"r of fhe sinusoidal oscillatorg because fhey could also produceilrromrf alterations.in the rhythm of-the beats

To avoid fhig if should be possible fo flller the musical program todiminate all the tones that are coincidentally identical with the sinusoidaloscillator. A a musical perceplual level, this will no be scen to alter fhenalure of fhe musig because the ear will restore the losl infonnafion

on an ogan,nous processsc is fo avoid

r oonlicf beJrreen fundarnentals and overfones fhom fhe stimulus. Thereforelbe music can have these frequencies filfered oul.

Condusions

The relevance of this acoustical pooess needs o be taken intoconslderatlon In underslandlng fhe physlcal efects expedenced frcmvibmacrusfic stimuli. A cumplex one stimulates whole and parlial vibraJionola body, causing an efiect in the human being of a percepion of vibmtionin spccillc locationg and also a geneml vibration in the body, experienced asa whole body vibration. Mechano-receplors sensitive o vibration arercryonsive in speciflc fhequency bands, and therefore the sensafion ofvibrafion will vary depending on Jhe frequency and upon the ovefones abovethe fundamental fone.

i

bl

f,;

fiH0Em

34 35

)))'))')')))')))))))))))))))))))))))))I

,!!,.,i | :, .,..1, -, .:'i, .r,..J

!fl?Jl r;.r'tHri'ltvi r"n: .]jntlrriilg-4lili!F'f i'iiii lrrfjlt'lF'' ,.i:r'itlr'': r'ATW

e etQloring theusic and/or lowdisorders' he

lDloInhoduclim

h6c' tones app[efi f*Fgcrry ru r'E wsJr t.'-- ------ disorderst he

tq-x.rr--- __

.--'irr rtiHnv is nor without a scientillc context. ^'ar

o nghlight this rcsearch in anattempt '9u

"s a stimutui: It ls hoPed thaf thls

---r--:-- rL ffmls nf mUSiC ,l'n for studying the effects of music ;

de PhYsiological andof music in medical

(lrrtlctl 1996; Ilodges' 1980; Maranto'li), thc prcsent chaPter will seneIprtllng these re$ltsr rether then as

-d bc notcd that the sections

lD). spccncauftological andIt rthrionship,trrrrtt.

))))))))))))))))))))))))))))))))))I

Phyiolo3icl R:qoncr o Muic

Rcscarch rcgading physiological rcsponses o mudc typicallyvorlous't5ps of muslc (Slmulettve vs. scdatlve) orvrlous elements o?in ah ,a-ttempt to detemlne if and how thec flmuli infuence a physiolsintel Phydotogical sates most often sudied irylu{g: heart ratgtemperature, g-ivanic skin residancflcsn, btood prcbiure, bloodrespiribn, digestion/gastric nmfility, muscle and motor nesponses,SlCsr and biochemical rcryonses. E

In studies cmining the el?ects of music and heart rate, mixed

1996; Hodgeg 1980; Maranto, 1993b).

conclusiv bnner, i's judged by the liferature. However, rends of musicdeca bttiod prcssurr o" to have no elfeci have been nofed @arfletl, l9lMaranto, 1993b).

The influence of music on blood volume is inconclusivg withshowing eifhtir an influence or no influence of music on blood

Mudc nd shln temperature researqls for the rnos parl, Isupported musicls ability to incrtase slcin tmperature'(an indicatioreHlhfi ilfl@artlett,'1996; Hod geq 19E0 ; Ma ra nto, 1993b).

Resulfs of rcsearch enmining the effects of music on skin(galvanic skin resistance)levels have suggesed that.nusic can effectwith trends fonards a positive-relalionship between music and "nGSB. An anatysis of subjectd experience wifh the music in some ofstudies has indicated a relationship between positive affect and GSR res(Bafletf 1996; Hodges, 1980; Maranto, 1993b).

The effects of music on btood pressune may not be prcdicted4_

Maranto, 1993b).

38

have bccn found and it is dimcult fo generalize hese indings or pr{lheari rate nesponses lo muslc In a glven dlrtctlon' (acceleratloo -

:rri clcarl ddldonal rcscarch ulch addesses somo ol lhesc lssues isnbcdod ln the fltur.

.t;.,:rit:t t' f,li., ", :. '

Prycotoglcrl/Aftcflvo Rc4oncc !o Mudc i:

, 'T[gry- . i_s oonsiderable difttculty in deflning and assessingpsychologidVfiCti*e rcspohss t music. Tlresc are indeed "complex and

may have different independen determinants .... The rcscacher is oftenconcerned with affempting to sip a$ay or neufralize efraneousenvionrnental. factors in order to gain indghf on fhe affeclive set. Therelatively unstable chaacteristics ol mmenotion nesponses make this taskdlffcult" (Abeles & Chung 19Ed p. 291),In splte ol thlg In thls sectlon,there will be an alempt to surrunarize somc of the rsearch flndings to dafe.

Trained mudcians tend to have more intense affective reacJions to -'

music than nonmusician{, however, this trend should be interpreted withcaution.,similarly, therc ae mixcd ftndings rcgarding the sex of he lisener

,:w**it relates to affective nesponses to musiqt' but therc appears to be arelationship bctrreen the fermle sex and heightened emofional responsesF(Abeles & Chung 1996).

affecf the emotlonalwith the music playe,srggesled tlat moodChung, 1996).

Olhe Sudies have tentafively showr Jhat music can afect 'hnxiety,symbolic sexral arousal, inferpersonal interacfiong self-concepf and lestperformance" (Abeles & Chung 1996, p.310).

Elements of music associated wih emofional response have also beenInvestlgaled. Allhough lhere are no cuncludve flndlngs to thls reseerch wllhregard o ryecific musical elements, fherc do appear to be rlationshipg andthese rclationships are also influenced by characferistics of the subjectsthemselves (Abeles & Chung, 1996).

It is zurprising to note how liftle we still know about affectivenesponses o music fbom a research perspectivg particutarly when the clinical ruses ol music lherapy appear to suraass fhis knorledge. Again, a grut deal

:

of effort needs fo be dcvoted lo fhis area, however complex, to provide a moresolld basls for cllnlcal pracflce.

Efnocts of Mudc in Mcdicel TmJmcnJ

The lieralurc docunrenting the effects of music in medical tramenis burgeoning. Music has becn used sccessfully in the following medicatspecialies: nconatal intensive care, pediatricg physical rchabilitation,pulmonologl, surgery pain mana gemenl, intensive cary obstetrics-gmecologr,end oncologr/ermlnal lllncss (Mrrento, 1996i 1993e).

40

Iaborarory and clinical escorch sludies pyl{ing.gvidencc'of thcscnena have

-bcen wll docrmented nd *iti Ott*ie''D9di'1e93h)'i

arcas arc smmrized very brief[y In 3his'tlon In outie formeccordlng 3o phydologlcal, psyclolo$ce[ behovlorl end psychoplrydologlcelne*onses (fFom Maran.o 1991f, 19)J)3a). Psychophysiological ltsponses asthose (e, stss and pain responscs) which a clated to both domains.

NanalogPryiologicdnorc rePiil wcig[t 3einin.sd food eoocPrretdrcd vonltlng end ggglng

' inotasd oltgcn selrr:rtion lcYclsshor ho*ital saY

Bcbvioetrcdued crtingiryrcvcd bchvi,orel fetcs

Pdii6Prycologicalincrtescd vcrdizetims regrding illncsshclp lhmities edjus to cilds illncssi4rovcd mooddcca*s in fcarBchvloreldcsta*d bcbavi,onl ditss

Prytuphysiologicaldcmscd enxictyrtducfion in scss syrytomsdoctasd pein

Prrtsirnl RMllitobnPhydologicatstrucfrcd ftylhnds movcmcntiryroved mofon ftmcfioningrcinfored dedrd movcmntsdcqtasod musde tension

Hlt;

t0m

I

>t

t

4t

El

H0Tan

))))))))))))))))))))))))))))))))))I

PutmM

PFdoleical

rcduc{ion in rcqintion ralclcss hcart rlc incncasc

tugery

Phydological , -- -..-rit htrrl Drcssurcdcm*sinsydolicrdiastocandmnartcrialbl'oodprcssll

dccreas ln hcert rteocn s strcss bomonc lcvclsdocascd rcrPiretion retcsdcctlscd nusdc lcndm

PrycholoClcdffiwiih rudc c:Pcricnc

fi

G-Om - ":t.ririr!.irif *lYd,*t "l'

enritfY

io."ta.a Pain tolennce

l#f"nt*Fcuircd

ffiffitoryproadurtscnUnoa nlenuon

43

'Ux

))))))))))))))))))))))))))))))))))I

mpcs.d dm dut lborahnood Lnlc ptooodurcrllcn.sd GtrDbdir obffiriilTirlF,Jt

PrycoFydohCictdmsd pin

Ui ry-Jn st f,.rl.t fi.3-:.'.:r... x' ' tl*.q f*trivi:l 1,,

Otdqilfetmitd lhssPrydohgiceldootlsd ccmoabc$rpy ddc clfoctsdccrcsd vomlt@dcsrasd Duscr

Prycologieli4rovcd vigoriqlrovcd moodincrllsd sdfdis&sursPrycophysblodcllcss tcndonhn&tylcss phydcel disomfol end pein

ThorlaicI conefls

To sumnarizg there ane some theorctical concepfq some of which arebscd on neseench, whlch provlde e bads nd ratlonale for fhe uses of mudcin medicine and in strcss management (Maranto, 1993b).

1). Music elicits physiological responseq however, the directionof these esponses is difficult fo predicf in a consifent nnnner.2). Music elicifs psychological (mood/affecive rcsponses). 3).Music rnay evoke imagery and associaions 4). Music elicitscognitive nesponses. O. Music has the potential forphysiological and/or psychological entrainmen. 6).Phydologlcel, psychologlcal and cognltlve esponses fo mudcane unique for cach individual. 7). Music can elicitpsychological, cognitive and physiological responsessimultaneously; these nesponses nay be interrelated. 8). Anindidual's history with, undcrstranding of, and liking for themusic ane dgnifcant factors in psychological and/orphysiological rcsponscs elicited;furthermore a number of otherindividual variables may influenae responses to music. 9).Elements ol mudc, as well as the muslc gesaltr affec

44

psyclologicat and plrydologica! rcagtlons 10)' M"t-* TTy 8""I- ..r'""oo or dimdshins effcca (wcn comblned wlth ofherU,ji

''--- ^--tt-.-

-o*rG.o la

14. Phyrologicatr psycholoEcat and/or oognitive rcsponses tomusic may rnry according music haining (Maranto' 1!t93b'

and PsYchologicalelfects ment' there are anumbe,."1,, be addressed inrcselnch and tatment'

2. Whercas some physiological and psychologicat effects ol music arc

known, f hese havs yet to 'ue aet..tin I for vA therapy. This type of research

should be underJaken.3. Just as wiSh lrcatment withouJ low frcquency oneg m-usic uscd in

VAtherapyshouldtake|ntoctnslderatlonthe|ndtvidualneedghlsforles'f";;; efc. of the patient. Furrher, the choice of tow firquencies fo beuse mug also be an individualized process

4. need fo beconsiderc of music asrvell as th nces as theYrtlate fo VA theraPY is needed'

5. Cognitivi rcsponses of patients to vA therapy should be identified.6.Btochem|calresponsesfoVAtherapyarc|oglcalartasforfuture

invesfigafions.T,Theareasofmedicalintenentiondescribedinfhischapter(andin

thisbook)areripeforinvestigtion.Theeffectiveness,aswellasthecontmindcadons (see chapter n otve, trsatment for rnedical patientsshould be careful$ sudied.): . g. Ferr studies have compared the effecliveness of music therapy vs. vAtreatmenf. This in another important area for investigation'

-l It ts ho@ that thls brief chapfer has provlded the reader with someinforrmtion about the brnader context with which vA therapy may be viewedin terms of researh and clinical practice. There are certainly numenouspossibilities inherent in the fufure of tns trcatment modality'

Rcfcnenes

Abeleg H. F, & Chung, J.W. (1990. Responses to music' In: D' Hodge: (ry) 'i '------nliboon ol "muslc psyctrology (2nd Edtrton) (pp. 285-342). San ,iil

;i

45

Hu

tImq

))))))))))))))))))))))))))))))))))T

!

II)

'ti., Anionlor IX: IMR hrcssBorle l. In:,.Pr (pp. i

'iki.:Dafnow, E. $nn.P[yslcal effects and moor nesponses fo music..Iournal of

Rcsrch in Music Erlucation ,211-221.Harrur, Go & HarrtrrH. (l17. Musig emotion and auonomic flnction. In:

M. Crifchley & R- Henso4(Eds) Music and ihe bmin. London:Heinemann Medical Books.

Hodgeg D. (19E0). Physiologlcal rcsponses lo music. In: D. Hodges @d)Handbook of music psycholo$r (pp. 392400). Dubuque, IA: KendallHunt Pubshlng Co.

Lacey, J.I. (l!156). Thc valuation ol autonomic responses: Tonard a generalsolution. Annals ol fhe New York Acadenlv of Sciencres 6L l?3-164. i

Marantq C.D. (1990. Research in music and nedicine: Thc sfate of the art.In: M.A. Floehlich (Ed.). Music thempy wiih hospitalized children: Acreafive arts child life approach (pp. 396). Cherry Hill, NJ: JeffheyBooks.

Marantq C.D. (1993a). Applications of music in medicine. In: M. Heal & T.Wgram (Eds) Mudc lherapy In health and educatlon (pp.153-t7a).London and Philadelphia: Jessica Kingsley Pubtishers.

Maranlo, C.D. (1993b). Music therapy and strcss management.In: P. Lehrtr& R. Wmlfolk (Eds.) Principles and practice of strcss rnanagement(2nd Editlon) (pp. aO7-43). Noz York Guillord Pess.

Marano, C.D. (1992). A comprehensive dellnifion of music herapy with anintegrative rmdel for music nedicine. In: R. Spintge & R. Droh (Eds.)MusicMedicine (pp.19-29). St. Louis: MMB Music.

Maranfo, C.D. (1991). A classlflcalion model for mudc and medlclne.In: C.D.Marano (Ed.) Anplicafions of music in medicine (pp. l-d).Washingor D.C.: NAIV T.

Maranto, C.D. & Scartelli, J. (1992r. Music therapy andpsychoneuroimmunolog5r. In: & Spintge & R. Droh (Eds)MusicMedicine (pp.142-9. St. Louis: MMB Music.

Schacte S. (1957). Pain, fear and anger in hypertensives andnonhylerf ensives Psychosomaf ic Medlcine P, 17 -29.

Schacter, S. (f964). The lneraclon ofcognltlve and physlologtc deterrrlnenfsof emofional states. Advances in Experimental Social Ps.vcholog, t49{0.

Sfandley, J.M. (1995). Music as a therapeutic inlervention in medical anddental lreatmen: Research and clinical applicafions In: T. Wigrar4R. TVest & B. Sapersfon (Erls.) The ar and science of music fheapy:A handbook. (pp.3-22). Swizerland: Harrvood Academic Publistrrers

Standle Ji\{. (1992). Metaanalysis of esearch in music and medicaltratment: Eflecf slze as a basls for comparlson acmss multlpte

aatyds nd'cllnlcl lppllcaflons.1r:" l2Zrnuut, n n. (leseb)' rhe influence ot m,.1s1j1t:1"I*ll3^:t:::*

"n"og".'in reaxatioq affect and tho'tghl in psychlatric prisoner

patients .Iournal of Music Therapy. ' t.55'166'

,:i

.,.

:;i',l:Iliiti:i

47 i,j46

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I

FOT'R

r r"o"CTJRRENT APPLICATIG{S

In the beginning the initiative for developing vibroacousf ic (vA) fherapy

applicability of vibroacouslic thempy.The author rms significanfly influential in developing vibroacoustic

lbetapy in Nornay, and rmny colleagues in different professions began to usevrioul fpcs olvibroacuusic equipment to explore its effects on a variety ofcfinicat populations (skitle, 1982a,1982b,19E6). During fhe mid 1980'9 therems no comrnercial produclion of vibroacousic equipmen in Europe, andmuch of it ras conlrucled for rtsearch purposes. I recommended in myvlbmcouslc therapy menual (19E6, 1991) lhat, for ehlcal nealnnq lt uasimportant and necessary for the therapist and the staff who wereexperimenting wifh fhis equipment to fest it on themselves first beforc theyused iJ with clienfs. The reports that were then submitted showed me that thetrcafinent had effects on several different conditions fhal were often foundprinarily in staff. In this way, the variety of pofential applications ofviboacrustic therapy began fo emerge.

The anecdotat reslts fhat accrued over many years of experimenfationcan be looked at as helpfut and guldlng ralher than sJatlstlcally slgnlflcant(Skille, been a cerlain amount ofobjectiv although very ferv studiesunderta rc has been a wide clinicala lication of fhis method wifh many reported positive effects

collated rcports fall into flve rmin clinicafpathological areas: 1) paindisorderg 2) muscular condifions, 3) pulmonary disorders, 4) generalphydcal ailrnenfg and 5) psychological disordersPin Disordcns

,:', There have been rcports of the effecfive use or vibrcacoustic fherapywith colic paing borel problemg fibromyalgia, migraine and headache' low

Hf,;

0H1.1

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)iJItIIII

I

I

fbequencies beween 50-S5IIz. Thefhequencieg as opposed fo ofher fheqnoJ based on any esearch esrlts.Itiover flfly per cunt of patienhelped hrough a rtducion

A deJailed analysis ofrnechanoreceptors ras undertaken(1992) In sudtes on paln. Thetr s(MVTfm) have found significant erduction when cumpared fo musicspeciflc frcqucncy mnge (60{(X)hz). Miequipmenf which ras a juS$ to-generate g*ater acfivity in lhe frequenclranges known fo pruduce pain re[f (appnoimat",y t':ii-h;;:

back pain, menshual paiq d fensio4bechtercw, ncck and stoulder rxorto_,.-,-_ Some of hc lnaments und ^ . ,{il'ircessfiit. The use

"r mq;lJ"- I S'

all otherreatmenJ'ln"and

Gcncrat Phydcal Ailments

clinical problems in his category migh include fhe following:decubiditus ulcers, rtduced btood circulation, and post'operalive

lha i has had a successflrl effecf.

Psyclolo gical Di srders

VA treafment can have an efnect on psychologlcl sfates whlch may ormay not contribute to a physiological condiion. In fhis group of problemgvibroacoustic therapy tras tecn ur" in the treafment of: insomnia, anxietydisorderg self-iaiurius behavior, challenging behavior, autism, depression,and stress.'l Autisn is though to be an organic condition, and Jherefore should not

Musrlar Conditbns

Vibroacoustic therapy hasparficularly when those prpblemshas received a lo of atfenfion fhoof vibroacuusfic therapy in reducing muscle one. preac wilh spasns to over excifement, highstimulafion. Therefore, relaxing music using iowrarrge has been importanf. some or fhe freafmenJs thal have taken prace wifhvlbroacousfic herapy have arso Invotved dorng acrve physiofherapy durrngor immediately after the session.

other muscurar crnditions thaf have been herped incrude murtipresclero_sis, Relf syndromg spa sicity, and muscula" o""r-ur" rjna"o,,,".Research in he crinic nor cila., and adurts ,,rfh R"il,y"drome afHarper House rffordshire, England has alreadyindicaed a posit to VA. sp"n"uilv, iicrease levetsof relantion, uced hand pru"fi ai reuehyperventllaflon n noJed (Cass er ^l"ieX;'Wtgram &Casg 1995).

paipaiane

50

lfttrIt\t:tFi0tHm

51'

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SUMMARY

applica ions of vibroacuusJice:rperience does not claim fomaterial docunented in thisthe oufcome of vibroacroustic

summarize reporrs rhom crinica,'.i;lj;';#t'*:H$"Tli"TTffi:I :?pathological conditions, and indicafe te extensiie pofential oflvibroacousriclherapy.REEERE{CES

Casg H, Slonimg V., Weeservices for Rel Syneeds? paper presented o Jhe Ro

M'.orm on rhe retier or rheuma-fil[H3:tfir:'*%:fUniversity of Norh Tens.

skiffe, o. (DE2a).Musikkbadet - Anvend for de svakesfe. Nordisk ridsskft

__ --

for Sspeciale pedagogil

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SECTION tr

Rr^sEaRcu, CT.,INICAL AND AIt{ECIX)ratREPORIS

,Il.:.i.;.,{.r{ . i .' -..rEEECT OF VA TEERAPT ON MTTLITPLY EANI'ICAPPEI'

lWtn WTIfl IGE MarcIE TONBAND SPASITITforyWtFm

Inhoduclion

The study documenfed in fhis chapfer focused on fhe effecl of VAthcrapy in rcducing muscle tone in patients with spasficity. Cercbml palsy isrisc as cstlt of an lnJury to a part of the braln before lt ls fullydtivelopea. I-b9 thrce rmin types of c'erebral palsy art ryaslicil athetosis and.".The pafients in tniJituUy srlfer ft.om spaslic disorUers. peopiJrinspaficity have different levels of muscle spasn, causing a rigidity of thenuscles A spagn is an invofuntary and soretimes painfU conf.raction-of-Jhemusclg mrtscle gnup or of lhe muscle rall of a hollor ofgan. Spasms of lherlile body are referred o as convulsions; painful spasms of muscles or limbss cramp; and hose in Jhe stomach and abdomen as coc. In cerebal pal. slgpetlcntg the most comnt)n form of spesm ls tonlc spi3m Involvlng a flrmsfro4g contfaction causing ngdity in the muscles. The spasn effect insriCicity esulib-forfi a release of fhe gamma system from higher inhibitorypntml and is chamcerised by a synchronized cxciatory phase followed bya synchronized phase of post+xcitatory inhibition. Afler he passing of thisphasc of post-excifatory inhibition, one of inhibitory excitation returns. Thesecrents can be clinically obseved in the phenomena of a spasic muscle andart demonstraed in an exaggerated stretch rcfle4 "clasp knife,'r and thelngfhenlng nd shorfenlng ol rvacflons (Bobath,1972; Bobeth and Bobathrna... Patiens wilh spasficity are usually found to have: 1) A loss of confrol

and differenfialion of flne volunlary movements; 2) suppression of normalssociated movernenls; 3) presencc of ccrfain normal associated movernenls;4) hypertonus ol he "clasp knife" gpg with a following buitd-up of rpsistanceto passive novement (sretch reflex); 5) emggeraled tendon eflexes andpossible clones of he other joints; and 6) deprtssion of srperllcial reflexes.I More typlcalty In ryaltlc paflents onc wlll flnd an lnceese ln flexor

long and this is often grtater than extensor fone. Imbalinces in fhe strengfhof muscles will lead to contraciure of spastic muscles and weakness resulfingfhom disuse of their opponenfs (Jones, lgTS).

rllufl{

H0frmm

57

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IIII)III

I

wcres lrcament ""1-"1ry.!og"therq.

, scdtlvc baelgroun di-.or es^ ,J lt.I"n sue+ ftttFtr s ls mr{edii{i.t

ruler/msre to rccord the renge of moverent beforc end fleriil.f:, .. i, : ' i. , I 'i : r:,'R'il:.';ii :i]+r ,J' 'iir

l--ffi-t' ThC qQerimeni was designed as a within'srbirfs study wih singlei iiu ev"lu"tlon' rhe e:perlment eveluated- l:i:, Iii"-11l^l^-Y.'-^**:t;1*"1"^'.*;-d;' iiffil;"%H;can De used in cu4iunction stment and a pulsed, sinusoidal lor frequencylone, com played through the vibroacousfic unit

sithout cncy tone.EXPERIMENTAL EYPOIEESES

_

The operimenf described in this chapfer rmked at fhe effect of vASherapy In reduclng qy"p acvrty and hrg muscre tone In pailenfs n{rhcrrcbral palsy. Ihe lollowing hypoheses wec made:

'/ a) sedaive music in cumbinaion with a pursed row ftre4uencysinusoidar toneol 4/lrrz_rpourd have a greater effect in reducing muscrcfone in ccrebml palsied subjecfs than sedative music alone.7' b) scdative muslc and a pulsed lor fhequency sinusoidal tone oI 44Hzw_ould have a greafer effect on brood pressure fhan sedative musicalone.

Subids

Thrre male and seven female subjects resident in a large mentalbospltal took part in fhe trlals. Ages ranged lrom 28 to 77 years (Mean 4.2,SO. USe, and they were all diagnosed as prnfoundly handicapped. Thesubjects were selecied fbom a wider group of patients in 3he hospital withmotor disabilifies because they all had spastic cercbal palsy.

AII Jhe subjects had measumbly high muscle tone which affected eachof them in differing rmyg although there rvere some aflected muscle groupsthaf wert strared in cornmon by all of the subjecfs. Ihe most commonpmblems shared by the majorify of the subjects were flexor-spasm in Jheirrms and legs, and adductor-spasm causlng dlfllcultles in separaflon of thetcgs, which in turn can lead fo "scissoringtt of the legsr with a potentialconsequense of subluxed or dislocated hips

Mtcrials

The equipment thaf uas used in fhis experiment was pur?ose builf.The flame of a sprung bed was used, and two 18-inch speakers were mounledIn boxes underneafh the sprlngs with the cones dlreced upuards. Thespeaker boxes contained t'by 8" porfs for acousfic balancg and fhe cone ofeach speaker nas approximately two inches below fhe springs of the bed sothat the subject could lie within two inches of the surface of ihe speakers,i , The speakers wene posifioned in fhe bed so fhat when the subject layon the bed, one speaker nas placed under the thoracic and upper abdominalarca of fheir body, and the other speaker nas placrcd under the lower fhighgknees and upper calves Or top ol the springs lras a single polythene sheef(as a precaujlon agalnsf Incontlnence), and on top of thls rms a half Inch pllesheepskin rug.

The speakers were poweed by an Amba-414 pur?ose built amplifier.The nnximum potential output from fhe amplifier rms 80 rvatts per channel(RMS). The vibroacoustic stimulus of relaxing music combined with a pulsedsinusoida! low frequency sound nave, and the music in condition 2 rrasplayed through a Technics RS-Tll stereo cassefte deck.ti:" The intensi$ and tone controls on the amplifler were gmdednutrcrlcally. In Jhe pmcedure of thls experlment, the controls ol rnaster

METHOD

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trcble tone contrls uer se at zcrc, ensuring fhat an equal balance of toncand equivalent volurne nas mainfained in fhe music only condifion. Thesubjecs rvert frcated horimntall and he spcakers were set into tbe bed ryiththe cones facing up. The equipmenl sas isolated elecfrically, and recordingsrvee used so the style of music, intensify of the lor hequency tone anlgeneml intensity of lhe music we cronstant for each trial.

A mal*er pen $as used fo rnark poinfs on the subjecf,s bodies formeasunementr and crnvenflonal cloth fape-measurc wlth centlmetemarkings rvas u*d to ecord the range of movernent beforc and afte eachtrial..

AJohn, Bell and Croydon Model DS-175 Auo Inflation Digital bloodiprcssurc monilor rvas used o record pressunes and hearJ mte.

The music used in both condilions rvas 'Crystal Caverns" by IlanielKobialka. This music is described as'Nery Age," and is tonal, melodic andharmonic non-pulsed, arhythmic music prcduced on a synthesizer. The piecrlasfed 3() mlnutes, and e 44 Hz slnusoldel tone, pulslng a a speed ofapproximately 8 seconds peak to peak nas recorded from a ftlncion genemtorwilh the music on the ape.

Mcasurcs

Blood pressure, hearf rate and range of movemenl were measurcdbefore and after the trials. Nine measurements were identified on thesubJects' bodles (Table 1).

Baseline measurcmenfs were taken of the minimum range of movernentin measurcments that had been decided as pafhologically important andappropriate for each of the subjects. These baseline meiasnements were Jakenby measuring the minimum range of movernent. For emmple, if the righf armwas flexed to the poin wherc the right radial artery came as close as possibleto the right shoulder, this uas ecorded as the minimum range of movemenl.

Measurements werc faken of the degree of efension for each of thescmovements beforc nd after each hlal. Each subJect hed a dlfferent set olmeasunementg although there were lnme measurcments lhat wee commonto nnny of the subjects (Table 2).

Data were rccorded in cenfimefres ol the measunements Jhat wercfaken beforc and after each hial. The differencp befween these msurernentsindicated an incrcase, or conversely a decrease, of the subjecf,s range ofmovement. The bes impmvement in mnge of movenrenl thaf a subjeclachieved in any of 3he conditions ras considered o be the subject's nramumrange of movemenf In that measunement. The mlnlmum range of movenent

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To srur lirint ab.rhhl clbow ftoD lb. bodY

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ThG llP of lhc no$ lo lhc nvcl To rsrun d6re ofkrDbot37 ThG Lhf tidc art l. lmchnlcr lo

lh. Lhr dc Llql mrlcolsTo ntur clcnion oflbc riSDt l

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To grt bductlo olahc hip3

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wasthen subtracted define the srbjecttsnaximum potential fhis' the differencescores achieved in percentage ol thisnximum potential range of mvement. A calculalion could then be made olthc srbjectts p""".rrroglimpro"em"t't in range of movement in each of lheconditions.i In each trial' an[osdble extended range

independent evaluator measured the maximumntt"".n each of the two marked polnfs ln each

))))))))))))))))))))))))))))))))))\

t;; bourse of thc trlal. Vthen hc Hal evaluatorcene bck In order o ike the post- they w,eeblind as to whether the srbject had condifiouB.

Conirol of dcr EllcrfsIn a repeated measrres design, bias arises due Jo the fact that

eryeriences change individualg and the srbircts may have learned what rms

or nof fhese parlicular zubjects would be able to tell the difference beweenthe two cnndifions was nol eslablished, because fhey were all functioning afa pre'verbal level. The order of the trials uas theeforc randomized to reducethe potenflal effecf of any crndltlontng to the stlmull.

Bl'ood Prcssuc d Hcarf Rlcseven of the subjects had blood pnessue and heart rate measurcd

benore and after the frials There sas a five minute resting period at fhebeginning beforc fhe inifial blood pressune measurement nas taken. wifhfhree subjecls in this grcupr it nas very difticult fo measurc blood pressure.one subJect had such llgh flexor-spasm that lt nas physicalty lmposslble oput the BP monitor cuf on his arm. Another subjec consistenfly recrdedemors due fo lhe fact thaf she had very short arms and flexor spasm, makingit difflcult to recrrd rcliable data. Another srbject had such thin arms bloodpesstre measunes were unreliable.

Wilcoxon Signed Rank Je$s werc undertaken on the data.

Proedure

Subjects wert laken out of their wheelchairs and ptaced on fhevibrcacousic uni. They had foam rubber pillows (sound dampeningmaerial) under their heads, and where necesery fheir bodies were supportedby pillows containing polystyrcne beads. After a resfing period of five minutegtheir blood pressunes and heart rates werc taken, and hen measuremenlsn'erc iaken as prwiously specifled for each srbject. The measurtmenls werefaken by marking wifh a nmker pen a coss af the specified points on thebody and fhen aftemptlng fo exfend fhe llmb. A measurement ras laken of

62

betncen the tno polnts. Thls proccdunc w3 noJ used lorone and dr lbe s{airttor lefiafler aHng thc measrements,

sitting quietly in the roonr, avoiding eye-contac or any olher form of physicalor communicafive contacf .

At the end of the 30 minute tape, fhe therapist Jurned all the controlslo1aro, and the Independent evalualor nas asked to return. Blood pressures micetr immediately. The independent evalualor then took again lhemeasunements relevant to each individual. Finally, fhe measuremenls wereentered on a fotm which also recorded the day and thc fime. Other observedbehavior was recorded for the purpose of clinical rccords.

essed onlY toThe subjecfs

l.i,??lillli:eryecially blood preszure measurements.

RESIJLTS

Table 3 gives the mean sooes in perttnfages of incrcases or decreasesin range of movement within a minimum and maximum mnge. In fhe box onthe efreme right are lhe means of all the measunements for each subjecf.The means of all the soones of lhe subJecfs are shown In the box ln thebottom right hand oorner of fhe table, and show a l37o improvement in theirrange of movemenf in the trealment condition, and lVo improvemenf in theplaccbo condition. The mean scones of all the nrca$lnements in fhe treatmentcondition are shown in the same box at the bottom right hand corner of thetabfe and revgal a 167o improvement in the treatment condition, anll a 3Voimprnvement in the placebo condifion in range of movemenl.

The table shows lhaf, in atl subjects, fhe rncan scones revealed anlmproved range of movement ln Condltlon A over Condltlon B.In some casesthis result is quite dramatic, and in other cases it is less marked.' , A Wilcoxon MaSched-Pairs signed-ranks test calculated on the mean

pelt:enage improvernent in mnge of movement within fhe srbjects(comparing fhe reatment and placcbo conditions) found a signiflcantdiffcrence between conditions (P = 0.0051). This resul indicated that thercatment achieved signiflcantly greater range of nrovement in fhe zubjectsthan fhe placebo.

a TVllcoxon Matched-patrs Slgned-ranks Test on lhe measurements

me.!urcmcnf. The method of meesrremen ls descrtbed In more dell ln fhc;proedurc soctlon. rhe independent craluaors wrc irot prescn durlDg tb; t

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T'T!

DISCUSSION

tn" oot"om or this.'q1*1:-" #:i:*ttl'gff"t5i: *Hion in muscle loneion in muscle lonewhen music alonepFessure was not

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St CcrlCt2

+t. +J.t

+5-6

+.l +la.{ +7J

Sll Cod.lC;2

+5-3

+41-2

+!1 +!:.J

S.1 Col"lcod

+ll+5

+15.t

+t2+5

+50

+u+l

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+I.lJ

+!l.3

+27.J

+U+J

+l9.{

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+{-E

+l+1

+!5+10

+15+J

S: Cod.lc,,d'2

+l+-l

+l+J

+!+l

+%+5

+7+2

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+U+{ +l+l

+l+2

+5+!

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+:0+!

+10+5

+15+{

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+tz0

+22.J

+9+J

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+12+3

+-rl.t +19+l

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+!7+t

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+ll+{

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+J

.aniflcant't't""ih"* results indi

and in sPecific aneas

r exemple' where theynfage terms in their

Ptcal asyrletT commo

cercbml Palsy'

quiteol hedislocation. Regularimoortant to Prwent limbs.fixe nexion deformit scones ln the placebo

SubJects one'

il

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soones showed the tratment condltlon obtlned slgntflcantly better scores

fhan the placebo condition (P = 'fi151)'-Analysis or rnc aineoe sooncs fbom the blood prcssures and hearf

t?t measunements takei "lot and after the trials fbom the seven stbjecfsose blood prrssrrc qas rnonitorcd rcvealed no slgniflcant difference;;;;t condiiions. Therc ws an indication that sysolic pnessrnc qasreduced,butfhere*'.'.*"variationsinthedatatakenfbomdiasto|icpnessune and Pulse mfe.

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t;l

Iondltlon. Thls lndlctcd het thcy octudS became tlgbter end morc [s4-'as slt olMng on a bed and llstening to rela:dng music. Subjec fourri:au.anxious laf who found 3hc pnoocss of bclng measured difllcula.ihls docs pmr,lde cvldencc fhat for thls subJcc the tretment condlt|on qisigiflcanJly mone suoge!srfut in helping her to rela4 desple raised an:det

become fighten In the trcafment cudilion where they were receiving bothmuslc and e slnusoldal lor frcquency tone lhey became slgnlflcantly morelaxed, highlighting the difference befween the treatment and the placebocondions

Therc wee a number of problems which emerged during the cnurse olthe frialq which should be considered as limitations in this experiment. Thcequipmen used needs to be carefully assessed in terms of resonance.Fbequencies can cause an incrcase in vibration in fhe bed. This appeared tohappen at cefain points in the music that ras used, and it ras noticed uhena bass tone sounded In the muslc. Horrever, thls was conrmon In bofhconditions.

The skill and cunfidence of the staff underlaking the independentevaluation varied. Sorre rree orperienced in handting the subjects andmaintained consisency, whercas othens began in a mone tentative mannerand grew in conlldence during the curse of the trials which could nrean thatearly results reflected a less signiflcant result than later resulfs. This nnyhave averaged ouf and the dala recorded rcflecl averaged sc'ones. However,In future trlalg a famillarlzatlon perlod would be lmporfanf In order loobtain rcliable baselines.

Some evalualors gave supporfive verbal encoutagement o he subjecfqand may have affected lhe ubjecld re+onse during he measuremenfsEvaluatos varied in the length ol time they applied pnes$re to neasrtrange of moyemnt, as lherc rtas no defined limit in he experimenfalprocedurg and lhis rmy have caused individual differences in ranges ofextension. Evaluators may also not have applied enough pnessure at fimesMost of these Influenclng varlablcs would be counteracted by lhe 'bllnd"naturrc of the trials.

Vfhen Jeating srbjects who had high muscle tone, il uas frequenflynocessary o support various parts ol their bodies due to to the increasingspa$ns and fixed deformities fhat were developing. Tlris nas achieved byusing pillows flld wilh polysgrene beadq and typicalty, one would need toplace them under the knecs or legs where flexor-spasm had causedconracfure. This variable ras no taken info consideration in the trialg andIt was not clcar how much energ was absorted by the polysyrene beads.

66

tests re rcqutred to cvalute theoy n" bodY. In looking 1!ih" t-t!I IIY uv vwJ! --- ---

"m"t thc differcncesrvould bccome less usrwr;r tu- rweffiJ*" rochcd "

por"r *rr"rc they hd echleved thel rnmum

give many indications of effecl andfttur rcsearch' Genemlly' attention

fitquencY sound on muscle tone' Inuse a spring loaded srain gauget sorcased range of extension could beacross all subjects, and individual

evaluetors take measrrements wouldf is achieved by the absorption by the

ced under the bodY.lials were run reduced or

ctunteralanced lhe potential effect ng variables such as havebeen described above, and that pulsed sinusoidal lowfitquency sound combined significantly more efTectivein rtducing muscle tone an ovemenl in spastic subjectslhan music alone.

rtihht'l,.(illlf

(,t*t-rnc

REFERENCES

M. (1eeo) rlritich AssociationBoakes, M. (1990)OccuPational

Bobath, K. (19728).Indon: Heinemann'

Bobath, K, & Bobath' B. (Williamg C. E. @ds')'

. disabilities, (pp. Sf'flq' Springtleld, IL: Charles C Thornas'Carr"lngton, M. E. tfqE0l. Vlration as a fralnlng tool for the profoundly

-i.rliply handicapped child wifhin the family' Paper presented at

Castle PriorY College'Joneg M. H. (197q: Dfferential diagnosis and natural history of fhe

cercbral paksiJ "r,ir.

l"t Robert L. Samilson @d.) orfhooaedica+ects oi cerebral palsy (pp' 5'26)' Indon: Heinemann'

Ichikoinen, p. (1990)m-yio""ou.ti" metho. Kalamazoo, Michigan:Ne:rfwave, Inc.

scertetn, J. P. (19E2). The effecf of sedatlve muslc on electromyographic blo'

67

))))))))))))))))))))))))))))))))))T

I

I

Ilit{Hrr} }, r.,In\ier, SVe

i{li,,i fcodback sded lnJlon nlnlng of rystlc cerebl palsled dults:i

PubllctlonsSkille O. (19t9). Viboacoustic rsearch. In R. Spintge & R. Droh (Erls)

MusicMedicine. St luis, MO MMB.SHlle, O. (19E9). Vibmac-oulic Therapy. Music Therapy, $ pp. 6l-77.

ica 69

sx

fiILwLY E/INDICAy?E t rA[rENrD rvttr', tttr"' E vrywtornltw sPASncnTory Sligram

INIR,ODUCTION'to:

The t*atment of chlldrcn and adultswlih cercbral palsy has lndlcatedeniion. This therapeutic treafmentin, develoP and extend a range ofof flxed nlxion deformities' Speciflc

leveloPme,tic disabil

hs also becn some critique ol the value andnfuntt and young children @almer et al, 19EE)'

Vlbroacoustt" CU "opy has developed as a- form -of treatmenlwhich employs a relaxing sedativ simutu-s through music and low frequencysound. The conccp linvolvng the elementJ of music in a specifiedpmgramme of movements to freatmore formalized over the last 15 Y&Weekes, 19E3' 19E5).In a structumovement' music is not used in fhmeant to be relaxing, but Provide aln the session and for the patient' Theused is imPortant for the effeclcmpo, structurc, rhythm and have to be carefullyconsidered for each movement' pafient is fbequently

rhYthm and lemPo in

it (Wigram and Weekeg 19E3).Clinical e:rPerience has al

Positivety to music and movementand it has benefits for the health

. undertaking such treatrrents is vetX

' daily or twice daily session in orde

ldtr,.piilii[-40fi19OQ

)))))))))))))))))))))))))))))))))))

defonrllcs of lck of movement and Increrslngoontmcture d joint mvemenls.Currcntl rcsotGegavallable to m-lely rean thal one ls abli to providcmorrc thn onoc or twloe ueekly sesdon.

condltlon, hese follotu up trlals rnay shed some llghf on whefher fanrlllarltywih the Jrealmen changed he results in any uay.

E4crimcntal l{ypolhcses

The hypotheses for this e:rperimenl rpere :effecJ in improvinga placebo.y greafer effecf In

werc trcted lylng dowtr elher on e bcd, or on ma on the floor.ifl,B and C, therc nas no actlvc intuvention, and lhe subjects rrerc

taid suplnc on the vibroaooullc unit. In condition d the

dme.Measuremens were taken before and after each trial of lhe srbjecld

mnge of mvemenf, and the evaluators that werc used fo make fhese'mcasurements were blind as to wheher the subjects werc receiving VAtherapy (condition B) or a placebo freatment (condifion C). However' theywerp not blind during fhe MMBP trials (condition A) and were aware fhesubjecfs werc receiving lhis form of freatment. Therefore, an element of biasws inevitably present for the evalualors in making fheir measurerncnlsbefore and after fhe MMBP frials.

The trials werrc randomly ordered to confrol for order effects. Baselinemeesunements were taken to establlsh a mlnlmum range of movemen inoder to be able to calculate what changes in range of movement could belound after each trial.

Addirional ltials

Ten subjects wene randomly selecfed from the group of 27, and eachsubject was given an additional three frials ofVA herapy (condition B) andhrte trlals of the placebo trcatmenf (cudltlon C). Measurtments werecaried out in the same uay as in the other trials.

Subjects

Fourleen male and ll fermle subjects rcsident in a larSe hospital forthe mentalty handicapped were chosen to take part in the trials. The stbjects'ages mnged fom24 to 6E years, and their level of ftrnctioning ranged fromsevercly fo profoundly handlcapped. All the subJects had htgh muscle tonenich alfected each of fhem in differenJ nays, although thert wene someaflected muscle groups that wert shared by all of the srbjects.

The mean age of fhe male zubjects ras 4, and the mean age of thefemale subjecfs ws 39. The mean age of the 28 subjects was 41.04 (S.D.1s.01).

tlhFl

II'iv

L,l-,1.$,Af

METEOD

7T

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xI1

=l

TItI)II)IIiIIIII

Mqlds

:'.,, The equlpmenl used in jhis ernerirlrcnl qo hrh^-^ L--!r rn?a on-.-- L^l

-^ ---

.ol sPrung bed ws uscd, and Jwo Fnrunderneal fte ryrings with fhe co boxcscontained 2rt bv 8rt nnr{c ?a orr-r

I

II

nntained 2" by 8u pos for acoustuas appmximaely luo inches below fwould be Mng within Jrvo inches of

reo casseffe deck.on fhe amplifler wene gradederimen, the confrols of masfese a the same point. When the

sic, he bass andrrca masfer :*:*r::.j;frcband at ?*;10, uring_ hat an equal balance of fone

))))))))))))))))))))))))))))))))))I

Mccm'Gorlfl&rltc ., :; .,

A pGn ms ucd to mrk the ponts on fhe subjcctC bodies ?ormessuncmeng rnd e convenlonl cloth epe-measure wllh centlrnetromarHngs ms usod 3o rocod the range of movement.

weeEacha gro

and experienced in MMBP trtament fechniques.The iniial evaluaion of range of movement fook prace, and the chosen

meiasunements for each srbject were faken. The procedurc for taking themeasunements wias the sme as in he eraerimenf described in chapter five,marldng polnts on he body wlth a rnar*er pen and rneasurlng a"g"e" oimovernenl before and after he trial. The session proceeded wifh a MMBPtreatmenf prgmm described in Table 2.

Tbl a Muic d M@l B.$d Pbtr.taapy PrtgnreMcccl Tin ol Mutc Crtcd

wmlSplnl ml.lion (R3hr) JHp Ex|cnCon (Rlghl) 2Shouldcr gdlc (suplnc) (fesl lh.D slow,Am - Rlhl nn JI:n m JSbr b (3 d!a6)Splml rotllon (fr) 3Hip clcnslon ltrfl) 2Bouncy lcAs (Supln.) 2

flcdon d Gf.nCon {ol lct3($plnc)AMucllon (!uplnc) {

Fisb gont to Ssimlrem Shmclilfln lhcm fmm'Thc Godflhar"Humrcsquc Dvomk

llfry qull. onanryl\fry qu1. conlmry

Fldr tort to sr{m(Showbcl,Mrn lhc fiom"Thc Godllhc'Thc'n4AN" lmmOrphcu l lhc[hdcl?oldTdclrwif llomTbc Sound of MudcOrcr lhc n lo SkyFolk lndlllonrl

?4

The researcher played the muslc for atl of fhe frlals and kep fhe me

75

for eocl mvemcnt cnstnt nd the performnoc ol he mudc foras condsently he sams a3 nas possible. Tl/hlle a rccording of lhe

ffi" ol"V" would have achio,cd greater consilency in presenation ol theilr"rt' thls erqerlrnenf was

-d"eoS. to find qy"*i::t- T-yTii:,:

r{r;rrl

f...tL.t

oHHm

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f;;

I

Ia

II

thcrrpl$ usos hlq/her elbows 3o ppb pftssunc nd move the paflent's lqtai far apart as possiblc ln older to achlcvc maximum possible abduction i'tbb hips

proocdun cmditi,ons B (va Thc.repy) rnd c (Pleebo llrcafmenl)

subjects rerc laken out of thei wheelchair and placed on tbcvibroacousic unit. They had a foam rubber pillow (sound dampeningmaterial) under their head and wlrere necessary fheir body utal spporfed bypiuows ntaining polysyrcne beads After a rcsting period of flve minutegin"" tloo pnessue and hearl rate were taken, and fhen measrements weretsken as dened lndlvldually for each subJect. The measurements were akenby marking with a pen a cmss al the ryecified points on the bod_y and thenaitempting-to extend the limb. A measrement nas taken of the distancebetween te two points. In rrcasrrtrnent one, no extension $as attempted, andthe degree of relntion in ihe shoutder and back muscles influencld changesin fhis measunemenf. The evaluator teft after he or she had taken themeasunemenls, and the researcher began he tape. on the Amba amplifier,the nraste volurne control rrs incrcascd to seven. In the treafment condition(condltlon A) wherr the tow fnequency tone nas belng used, the bass confrolrras then also increased to seven. I{hen the sinusoidal low fiequency tone rpasnot being used, the bass control ns left at zco'

As the treafment continued, lhe therapist rernained with fhe subjecl'sitting quiefly in the roonr, avoiding eye-contact or any ofher form ofphysicalor communicaf ive conlact.

At the end of the 30 minute tape, fhe therapist turned all the controlsto zero, and fhe independent evaluafor vas asked lo reSurn. Blood pressrrcrns laken lmmcdlately. The lndependent evatuator fhen took agaln themeasunements relevanf fo each individual. Finallyr the measurements wereenrered on a form which also rccorded the day and the time. other observed

wet undertaken.

RESI]LTS

The data converted info percentage sconesfor each subject 3 shows changes in the range ofmovement In all es found after the MMBP fdals

76

hken afler thetat' mcasurtmjnj. : ji:,

i:ttii.

:.':

of rvcoa Coodtrb A

M..d Ma12 MaJ Maaa Mer5Mrr

91 42.000l

+{0.0002 -75.) +,:t.lt + -10.15 + l.El

+02J5 +0.{5 +05.?5 00.0003+01.91

04 +06. {r9t6 m.00+-0.77

+01.!t 4229 76 +0J.60-25.00

+ ft.{06 +Glt2o7

+15006 -l{Jl +22-2

4'422 +4.12D9 +8,22 + llJ3

+{!.06 +222210 +07.69

+0232 +07.07

ll -10.93+05E +06.t2

t2 1JJ +$.90t3 +06.0!

+JE.06la +.6 +0tE +U2tt5 +05J7

+01J5 4l:5 +D.79l6

+!:.91t1

+0J.8E

+01.17 {)t 7t .J5 {EIE

+03J9t9

+01.05n +09J0 +21.62

00.00 +01.92 + 15.7tzl 00.00ta +03J? 43.92 {3.+r 00.00 +5.00

3 +0a12 +06.11 J9 + 10.7+ 15.78

7A.10.+l + ll.{2

2:t + lE.?5 +J0.7+ lE.lt + l4:t

x +n.69 +20.17 .u.ll 427+!5!

ll+06.E9

I'l"L

h

t,b.

t'

t;('\'ly,",

.t:.riii

:

,i,ti: rabre4srrowschange'-iltl'"119lil,l;"ifril::tfi"d;:*'::l:, :ffi1?*','"t*,#1; :1ll*'1"#ll1 ;;il i"'" tur"n after

the triar

lr;;;;-;o-change In ttre range of movement'77

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I,)

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:': 'I Tt.4.-P|--

| sGI t--Srd Mcr.l M..r2 MCJ MI M5 il0t+01,0a +039

02 +50.00 +lJ.6J {DJ.I +0t.t5 +075 4.03 00.00 +04J0 +02J0 +29.{lu + t3J3 +0t:.r 00.00 atE.{ 41.9205 00.m (xl.00 +02.65 00.rx) +09.7206

+ t{Jl01

+ toJ06 +(7..0 +otJJ 43.3209 +15J5 5JE .!:at +02-El +.('.75t0 {t5.1 +09J0 +Vt-O7 42.U +12.96It 00.00t2 00.q) +0J.+l +0J.5t f 0.1.90 00.00l3 +0J.6t IJEl.t 00.00 +o{.+ +0s.{t +lJ3t5 +0:.15 +J7J?t6 41.15 0o.oo | +oa.ts +0-r.?5 4J.+{t7 00.m +@.91

.6.6|tIE 00.00 +04,{ +(n.06l9

+ lTJEm + tJ.95 +.lJ2 |n.tx! +01,052l 4J:9 +0J.92 +0096 +-rl:lf +0t.t{ +0J-92 {rJ..fl 09.37 +:l|,00ts +0.1,E +Of.{9 +G,Es + 01.90 +!0JtA

.ol.{9 +2t.12t' +tJo 76.92 + J.63 +t:lt26 +21.15 +-!J.7 +01.1 +04.r +01.92n

+0J.+l

Table 5 shorrs changes in the range of movenrenJs in Jhe subjects inpencenfages after the music alone frials (condifion c). where zero scones aneIndlcated, Jhe neasurements fhef wene faken after he frlal rccorded nochange in lhe subjecd ranle of movement for thal measuremenf.

The overell mern pencentage scores of changes In range of movemenf

?8

i..llll & er b nrolrd: Od,lc !, !. j :,: .r , rlSIDE M-al t,2 M..1t M.ar, M.lrj M.rr.0l 42.00 +0t.9t 44.0002 +3t.00 46 tl 00.00 {J.70 +00.9{ +05.0003 m.q) +02.15 .r{.95 .0560. {tE.00 +01:J +0{.1? +00,(x 4t.v205 +0t.lt +01 l{ +0.lJJ +oJl + IJJt0 +09.tv, +27 55(E 00.(n +55J5 + l!.9009 +oE-Et +00.00 -u.7r +01..O +DJOl0 +!J.07 +m.00 +V|.07 +0!.04 +t|.10It {J.llt2 + 10,12 + oJ..t +02.65 00.tx) +16,11t3 +06.02 + It.75l.t 00.(X, .20.00 + lt.tl .t3Jl +5J-E.l5 00.00 + lt.llt6 00.(Xt 00.00 rJ5 .t!J0 .r0J4t1 +03J7 +01.9{ 00.00tt +01 4-J7 -r51l9 (xl.fi,4 +.12J5 +02.70 00.00 +01.052l 00.m +00.9E 4lJ2 l-t.15

4.7E .rt.96 4J..t4 00.00 .0.1.t!

fJ + llJ0 +0JJ7 {'J.EE l2Jt +05JA {2 9E +fi.1,1ra rSJE rJ.J I +10.q)x 00,00 00., {rss5 | +009 +@.61

.Jr.{E

(S.D. 13.E67o), wifh age of movemenl in onescoe of -10.93Vq where

n rangc of movementIn fhis condition, fhethe mean scores of anrded deterioration in

range of movement in an individual srbjecl tms -S2lVuib- , In condition C, the overall mean penoentage score of changes in rangeof movernent was i336vo (s.D.11.4szo). The madmum lmprovemenl found

12..-

r,;,ll-Tf'rlF/{f-4oF.l.l4-l)Q,

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Iihf

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l:i

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llt,

I

TrDb G Me brrrarr L t .3 qr lr ROll r t crltlo

J.sutc ifipd-,A .fMMNDI

: - CcdJ'IV rlFDet

fi:i Coo"srtPbc.o)

I +01.02 +OlJ0 {lJ7 B, +toJt +0l.ll +03.0 AJ +lxtf{ +(9.00 &l7 B4 +Gt19 {xt.r {xtJ0 .l5 .{H.t +02.t1 +05:1 c6 + lJ..l + laJl +O.61 B7 +J-E2 + 10.6J +27.65 A

E +U.07 +0{.t7 +!;82 cI +t!.10 + t09! {t0-9 At0 +vt25 +o{..tJ +Vt92 cll -t0,93 (xr.00 43,U Bl:2 +lNrt +02J? +06Jt clt +96 +|l9.09 + I2JE At4 + lt50 + ltr +l7t6 .{l5 + ta.to +Y).16 +0555 Bl6 +04.60 +0t.{ 4{J? It7 +tJ9 {5:t +01.84 AIt {t9J3 +0l.lt 5.{l At9 +0!9 + l?sE qt.00 B! +(l9.0t +09tJ +09.0t B2l +U.42 +1tr.95 .{L}J2 Bu +0l:4 +06.{) 42.0 B73 40.lt +9.29 +05.93 B

A +(ni, +0996 +02.0E Bta +n.49 +Jl.a7 +!3.00 B% +Ua + Lz.{t +00r9 An +069 +0J.|. +4..B A

in range of moyement in the mean soones of any one subiect was +27,65Vqand the fargest rccordd deterloratlon ln any one subJect was -34.48Vo.

A Friedman 2-Way Anova lound no ovemll differcnce bctweenconditions (P = 0.105e). In order o look at comparisons betlf,een theconditiong orthogonal planned conrparisons were undertaken by partiSioningthe X'riedman Clri squarcd compang ctndition A with condition B, andcondition A and B with condition C. No signiflcan difference was foundbetrpeen MMBP trtatment (Condition A) and VA therapy (Condition B) (Chisquarc = 0.1 ns). For some srbJcctg the mnge of movement incrased moswlfh VA fherap whlle In an equal number of subJects fhe range of movement

80

ment'r{'

DrscussroN

nua

and also of collaborative Pnogmmstrtafment would be hetPful for theboth MMBP fratment and VAinpnovements in range ol moVA therapy comPartd with a

81

r4ttu

[.jilt[-r()fl5)cl

FrI

range of moyermenf were thercfore found in condifion A when fhese sublrtswere treated wifh MMBP.

conversef, less improvernent in range of nrovement nrs found in thcglven VA herapy. As thecommunicate why they pvcapprmch as opposed to VAdifference. Attenlion strould

be paid to fhe facf that, when lying on a bed o

))); subJects reryonded mre posltlvely to VA therap nlle nlne responded re

ppsiivery lo he plaebo wen compartng dlflenenccs ln msuremcna scotq,.Dtween theee two oonditions.In heso addiJlonal frlalg mean scDne! rwealcdJht ll 10 subJccts respondcd morc podtlvely fo VA therrpy then to thcplacebo.

I could be infered fhat, in the additional rials of this experimenl, theresrlts indicate that with rupetition, subjecls becrme mone nesponsive to thisform of frcatmenf and a grtater number of Jhem demonstrate improverange of movemen. It is likely that he srbjecs became familiar andaccusfomed o the VA fherapy sessons. Wral uas not evaluafed is whefhefurfher Jrials of MMBP Srcalrrent would also have achieved the same eflect.Because the VA fherapy treatrnent does not Involve handllng and ls rpredictable form ol treatrnenf carried out consi$ently the same evety time itis underfaken, the rcsults thaf one might expect fo improve through rcpetiionane mone likely o occur. Pafients wih these particular problemq coupledwith severe limitafions in e:rprrssive and rccepive communicalion, may leclmore safe and comforfable. Neiher fhis e:periment, nor an