Music is a universal phenomenon spanning all cultures, and is the most social of the arts. There is no one definition to describe this term. Its term changes with each individual’s perspective. Some find it as the rhythmic vibrations of sound, some describe it purely as an art form, some feel it creates emotions and interacts with the emotions we already feel, or, some associate it with the process of healing.

Music therapy, a biofeedback or a coping technique instituted in the allied health profession, uses music to promote healing and enhance the quality of life in patients. It has been used for decades as a way to treat neurological conditions such as Parkinson’s, Alzheimer’s, Anxiety and even Depression [1]. There have also been attempts to translate EEG data into music [2]. Also, studies show that rhythm of music tends stimulates brain waves based on the tempo, with a slow tempo promoting a calm and meditative state. HISTORY OF MUSIC IN HEALTHCARE The therapeutic value of music has been recognized since ancient times.

Archaeological evidence showing flutes carved from bones, suggests music preceded language as a tool for communication [3], [2]. Greek physicians used flute, lyres and zitters to heal their patients and used vibrations produced by these instruments to aid in digestion, induce sleep and ward off mental disturbances [4]. Even the Greek philosopher Pythagoras, who is considered the founder of music therapy and geometry prescribed music to restore harmony of the body and soul [3]. Early Egyptians also, used musical incantations for the healing process.

Native Americans and Africans used singing and chanting as a part of their healing ritual [5]. Robert Brown (1773-1858), a Botanist, described the Brownian movement – Protoplasmic movements within cells are random, rhythmic and produce music [4]. With the advent of western medicine, art of medicine was replaced by science of medicine, thereby separating music from healing. However, end of 19th century, studies on the healing power of medicine was again looked into. Florence Nightingale (1820-1910), a nurse, recognized the power of music in hospital wards to promote healing for soldiers injured in the Crimean war [3].

With the advent of phonograph, recorded music was introduced in hospital settings. Music interventions were slowly being appreciated in the healthcare setting. Furthermore, a group of surgeons conducted studied to show that music produced a calming effect on patients who were generally tense and nervous, thereby reducing patient anxiety and pain. Studies reported effects of music on physiological responses, such as, cardiac output, pulse rate, respiratory rate and Blood Pressure. Diogel, a physician from Paris in late 1700’s measured blood pressure and pulse rate of his patients while live musicians were brought in to play.

His studies showed that music lowers Blood Pressure, increases Cardiac Output, decreases pulse rate and overall assists the parasympathetic system [4]. MUSIC AND BRAIN Virtually every human loves to hear music, or at least responds with some kind of emotion when music is heard. Music can bring back a memory so clear that you can virtually touch it. Music can make us cry at the movies or bring us to our feet at sports events. Music can make us experience happiness as well as bring tears to our eyes. Research in neuroscience is trying to find answers to these connections between music and human brain.

Knowledge of the specialized functions of the brain was deduced from understanding the failure of the normal functions following a stroke or an accident. It is also believed that babies respond to music while still in the womb. An interesting fact is that at the age of 4 months, dissonant notes at the end of a melody will cause them to squirm and turn away [15]. Such responses provide evidence that music is wired into the brain. Also, advances in neuroscience and brain imaging are revealing what’s actually happening in the brain as patients listen to music or play instruments and why the therapy works.

Electrical activity emanating from the brain has been studied extensively, through electroencephalograms (EEGs), magnetic resonance imaging (MRI) and more recently, even functional magnetic resonance imaging (fMRI) [2]. This latest scanning technique (fMRI) is a brain scan that gives a clear image of which parts of the brain are working during any given activity. It measures blood flow to various parts of the brain over time as opposed to showing a static image of the brain. MRI can show the location in the brain that’s more active while listening to music, and scientists are using this technique to gradually map those areas in greater detail. New research using the fMRI has shown that the brain’s activity changes with the music being played. It has been found that the area of the brain that is active while processing music is also active during memory retrieval, reasoning and while processing emotions [14]. A human brain is divided into two hemispheres, and the right hemisphere is identified as the seat of music appreciation and the left hemisphere is the arena of speech.

Also, brain mainly processes music and speech separately, although there is some overlap [12]. For example, a patient with dystimbria, a distinct form of musical disorder, with defective pitch discrimination, described music to sound as pots and pans thrown on the floor had no problem with speech [12]. Therefore, effect of music is seen on the right hemisphere of the brain; however, the analytical aspects of cerebral interpretation of music occurs in the left hemisphere of the brain [3].

Studies conducted on musical understanding in people, who have damage to either hemisphere, as well as brain scans of people taken while listening to tunes; reveal that music perception emerges from the interplay of activity in both sides of the brain [11]. Furthermore, singing more than humming showed additional right-lateralized activation of the superior temporal gyrus, inferior central operculum, and inferior frontal gyrus which may offer an explanation for the clinical observation that patients with non-fluent aphasia due to left hemisphere lesions are able to sing the text of a song while they are unable to speak the same words [9].

According to Levitin, music is said to have certain attributes and the brain has a specialized capacity to extract each of these attributes namely; pitch, rhythm, timbre, melody, and reverberation [16]. Nerve impulses from the cochlea arrive at the auditory cortex of the brain and are first processed to extract specific categories of information. The right side of the cortex is crucial for perceiving pitch as well as certain aspects of melody, harmony, timbre, and rhythm. The left side of the brain in most people excels at processing rapid changes in frequency and intensity, both in music and words.

Such rapid changes occur when someone plucks a violin string versus running a bow across it [16]. Music is said to engage many brain functions; emotion, memory, motor control, learning and plasticity, attention, pattern perception, imagery and more [17]. Studies on stroke patients revealed that recovery of verbal memory and focused attention improved significantly in the group of patients who listened to their favorite music on a daily basis compared to patients who received no listening material [11].

To a large extent music activates the pleasure inducing part of the brain which is basically, the limbic system, and is considered the seat of human emotions. This area is responsible for autonomic or vegetative functions such as breathing, appetite, body temperature, moods (e. g. , anger, sorrow, love, hatred, sadness, compassion, and violence). Serotonin and Dopamine are the primary neurotransmitters involved that affect mood [17].

Listening to music not only increases blood flow to certain areas of the brain involved generating and controlling emotions, but it is also accompanied by a general increase and change of brain activation within a distributed network comprising many areas of the brain and the peripheral nervous system [11]. Music is an evolutionary adaptation as described by Levitin, and he suggests mating and several other possible purposes including social bonding and improved cognitive development [16].

The March 2009 issue of Smithsonian magazine reports that when two mosquitoes of the opposite sex approach each other, they harmonize their wing beats to produce a love duet. If the male can’t keep up with the female’s rhythm, he is rejected by the female and becomes history. HEALTHY AND UNHEALTHY MUSIC Many scientific experiments, studies, and research projects have been performed to try and discover the extent of the power of music. One key component of music that makes it beneficial is the order of rhythm [18]. Music can produce as well as reduce stressful conditions.

We all have an inherent musical rhythm called as Dominant Rhythm Style, DRS, suggested by Dr. Manfred Clynes, a neurophysiologist. These are considered as rhythmic cycles that exist within us as well as around us. The human body is like a musical instrument, expressing numerous frequencies and rhythms in a constantly changing spectrum of life. It responds and resonates in consonance with music, sounds, speech and thought from the environment, and undergoes changes of heart beat, breathing, blood chemistry and circulation of energy in various energy centers (Chakras) of the body [13].

For example, the day and night circadian rhythm, seasonal changes, breathing-inhalation and exhalation, and the most prominent human heart rate. Imbalance in these cycles effects health. Although, heart rate varies from person to person, the average human heart rate is 60-80 beats per minute. Studies conducted by music therapist’s states that music paced at this tempo produces physiological homeostasis [13]. Hence, slow musical rhythm representing classical music is associated with relaxation. An Australian physician and psychiatrist, Dr. John Diamond, found a direct link between muscle strength/weakness and music.

He discovered that all of the muscles in the entire body go weak when subjected to the stop anapestic beat from hard rock music. As described by Dr. John Diamond this beat causes switching of neural messages between right and left hemispheres of brain causing alarm in the body along with lessened work performance, learning and behavior problems in children, and a general malaise in adults [13]. It even decreases many cognitive functions such as judgment, perception. Also, this beat has an addictive quality, and repeated exposure alters the homeostatic baseline resulting in higher resting heart rate and blood pressure values [13].

MUSIC IN THERAPY Musical sounds have a natural harmony between them. When combined in a specific manner, they have a relaxing, healing and harmonizing effect in balancing the energies of the body and invoking different feelings that influence even our DNA [4]. Moreover, studies by Susumu Ohno, a Japanese Geneticist and Musician suggests that when notes are assigned to the four nucleotide bases of DNA – cystine for do, adenine for re and mi, guanine for fa and sol, thymine for la and ti, the genes made music [4]. Thus, throwing light to the fact that music is inherent in us and is carried on from time immemorial as a healing tool.

There are a wide variety of music based methods employed for various therapeutic purposes which are modified from patient to patient. Music therapy itself has emerged as an allied health profession, wherein music in its various forms is used to improve and maintain health. It aims to improve a person’s quality of life by helping relieve symptoms, addressing psychological needs, offering support, facilitating communication, and meeting spiritual needs[4]. In addition, music therapists assist family and caregivers with coping, communication, and grief/bereavement [20].

Music in the field of neurorehabilitation is very broad ranging from treating motor deficits to speech disorders, from cognitive deterioration to dysfunction in emotional control, from coma conditions to hyperactivity [10]. Music activates simultaneously and synergistically, 3 cognitive components of the brain: Motor, Iconic/Symbolic and Verbal component [19]. The Motor component is the body gestures such as blowing, beating or tapping the feet that initiates music [10]. For example infants show preference for rhythm by synchronized rocking of cradle.

Due to its association with the motor activities, music along with computer technology has been used to treat patients with spinal cord injuries, stroke that has resulted in physical disabilities [19]. Such electronic music programs are designed to activate auditory-motor representations in the patient’s mind thereby, contributing to restore motor functions. Iconic/Symbolic component involves translating music to visual images [10]. For example, Sound of music can be visualized as dark, shining, inspiring a sense of closure or opening; it may take shape or form colors [10].

In therapy, a method called Guided Imagery and Music (GIM) has been increasingly applied in the recovery of cognitive and emotional functions [5]. In this method, visual imagery is intentionally elicited in the mind of the patient originating from sound stimuli and is also effective in cardiac rehabilitation. Even in patients with Alzheimer’s, music is used to facilitate recalling visual scenes form the past, hence enhancing the production of autobiographical memories [12]. Lastly, the verbal component is the inflections of spoken language through musical sounds [10].

Both language and music involves putting discrete elements in sequence, notes in case of music and words in case of language [11]. Aphasia is an acquired language disorder involving difficulty in producing or comprehending spoken or written language [12]. Aphasic individuals having difficulty in grasping the linguistic aspects of language also, have difficulty in grasping the linguistic aspect of music in terms of harmonic relations [10]. However, trainings such as Music Intonation Therapy, focused on the sequential aspects of music helps in recovering the linguistic abilities.

Also, studies indicate that when patients with mild-moderate Parkinson’s disease are made to walk while singing mentally, it helps to overcome gait disturbances [10]. Furthermore, the major effect of music in reducing pain, anxiety and stress is that it acts as distracter, focusing the patient’s attention away from the negative stimuli [3]. For example, when a child is upset, the introduction of a novel stimulus (turning on some music) will at least temporarily divert their attention away from what is upsetting them. Some hospitals play soft background music in intensive care units for premature babies.

Researchers have found that such music, as well as a nurse’s or mother’s humming, helps babies to gain weight faster and to leave the unit earlier than those who don’t hear these sounds [12]. Music seems to activate the relaxation response, which helps promote deep breathing, lower heart rate, and lower blood pressure, ease muscle tension and create less stress. As difficulty in sleeping is a common problem for cancer patients, music can help them sleep better [19]. Relaxing the body can also help to relieve physical pain, and thereby patients may need less pain medication.

For example, following heart bypass surgery, patients often experience erratic changes in blood pressure. Such changes are treated with drugs. However, studies show that those in intensive care units where background music is played require lower doses of these drugs compared with patients in units where no music is played [5]. An interesting application of music is with working activities. For instance, in Ghana gardeners work more swiftly when accompanied with music; some songs of sailors change according to the required maneuvers, thereby, linking music with workers health.

Even during World War II, music was piped into the workplace to keep up morale and enhance production [7]. Hence, the concept of Music therapy is dependent on correct intonation and right use of the basic elements of music. It helps to subdue, the emotional imbalance and subsequently aids in healing the physical, psychological and mental health. Finally music recommended therapeutically should have the following characteristics [3]: * Slow and flowing music, approximately 60 to 80 beats per minute. * Non-lyrical Maximum volume level at 60dB * Patient’s own choice, with guidance. * Suitable equipment chosen for the specific situation. * A minimum duration of 30 minutes in length * Measurement, follow up, and documentation of the effects. MUSIC AS A RELAXATION TOOL FOR STRESS MANAGEMENT Modern life is full of hassles, deadlines, frustrations, and demands. For many people, stress is so commonplace that it has become a way of life. Stress isn’t always bad. In small doses, it can help you perform under pressure and motivate you to do your best [13].

But when you’re constantly running in emergency mode, your mind and body pays the price. The power of music is evident from the lullabies we would have listened to during our childhood; such maneuver was basically to relieve stress with music. It is understood that music calms our system and put us as ease as well as, aids in healing. When we are stressed for a long time and are relentlessly thinking about a problem, it takes on huge dimension and it seems highly impossible to come out of it.

Music can elicit the body’s natural counterbalance to stress: The Relaxation Response [12]. When we listen to music of our liking, it changes our state of mind: we tend to forget our surroundings and get immersed in the sea of sounds. It is like you have entered another world, free of tensions, anxieties and many other petty things of life. It is like getting into a meditative state associated physiologically with decrease in the levels of adrenalin (involved in flight and fright response) and increase in serotonin levels (involved in altering mood and behavior) [2].

Thereby, bringing down the stress levels and leaving you with more space to deal with problems by creating a positive state of mind. Music also aids along with other stress relieving activities. Such as it can help to get into a zone or a frame of mind when practicing yoga, self hypnosis or guided imagery; it can help to feel energized while exercising or even help to dissolve the stress when soaking in the tub [6]. Listening to our favorite songs or music, transports us to happy memories, and happy days, and more happy days that are yet to come.

Thereby, surrounding you with positive energy and more often helps you look on the bright side, letting stressful events roll off your back more easily. Finally for music to be an effective relaxation tool it is beneficial to consider the following [13]: * Select a music that you enjoy, an instrumental or an acoustic piece with a slow tempo. * The listening environment should be peaceful and comfortable. * Posture should be a meditative one, where you can sit or recline in a comfortable position with eyes closed or an active posture while involved in office work or housework with music in the background. Making your own music is an active style, where you sing, hum or play a musical instrument, or even compiling your own playlist into a CD so that you can play when you need or want to relax. Hence, music can be utilized as a very effective stress management tool. CONCLUSION Music has a great healing potential. The entire human energetic system is extremely influenced by sounds [7]. Music in therapy, as well as a part of our life, alters the brain functions and subsequently, helps as a tool for recovery and relaxation.

Multimodal nature of music offers scaffolding over which one can learn to perform movements, carry out cognitive functions or articulate verbal expressions [10]. We need to actively de-stress, relax and consciously devote a little time to find a state where the body can re-activate its wonderful self healing abilities. Music put in as a coping technique along with other therapies in Alternative medicine. Such as along with Yoga Therapy, Massage therapy, Autogenic Training, Tai chi, it enhances the therapeutic effect.

It provides us a platform to train the brain to work for us rather than against us [8], and alleviates the stress caused by our lifestyles, diseases, disabilities, and various other factors. Music intervention can help maximize efforts to promote patient comfort and relaxation as well as reduce or reduce perioperative distress. Further research is required to better understand the rehabilitative power of music although; in one sense it belongs to medicine as an adjunct resource in healing [6].

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