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Neuro-cognitive Rehabilitation after Surgery through Music Therapy

Zarghi A*, Zali A, Ashrafi F, Moazzezi S

Neuroscience Departments, Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences

Abstract: Introduction: Rehabilitation of brain function through music therapy has grown significantly in the past half century. Surgery often makes cognitive changes such as memory, attention, executive function, speech, motor function and these impairments need to rehabilitation. Music therapy is used to stimulate brain functions including movement, cognition, language, emotion and sensory perception. Musical interventions should be based on the principles and they needs to settings for rehabilitation. Therapists are engaged to work in different settings from hospitals to educational and also private rehabilitation after surgery. Diagnostic evaluation of this technique and applied research models are accounted as new low-cost priorities in treatment of surgical complications. Empirical successes of music therapy in neuro-cognitive rehabilitation open the way for new research.

Keywords: Neuro-cgnitive Rehabilitation, after surgery, music therapy

Received January 15, 2014; Revised January 25, 2014; Accepted August 12, 2014

Citation: Zarghi A, Zali A, Ashrafi F, Moazzezi S, Neuro-cognitive Rehabilitation after Surgery through Music Therapy. Global Journal of Surgery, 2 (2). 30-33. January 2014. doi:10.12691/js-2-2-3

1. Introduction

Research on rehabilitation of brain function by music therapy has grown significantly in the past half century. Today, modern cognitive rehabilitation methods like music therapy can help to improve neural impairments. After surgery, Rehabilitation by music therapy is a general approach which allows the patients to enhance their self-knowledge, social skills, verbal and non-verbal communications, emotional and body awareness, self-confidence and integration [1,2,3]. Music plays a very important role in neuro-cognitive rehabilitation (NCR), especially, in after neurosurgery disorders. Cognitive rehabilitation should be done step by step. It starts with basic skills and leads to more complex skills. This method is another complementary form of treatment that is used for many diseases including psychosomatic disorders, peptic ulcers, chronic Pancreatitis, Asthma, Diabetes, obesity, cancer, dementia, chronic dialysis, rehabilitation activities due to the cerebral vascular accident (CVA), blood pressure stability, sleep facilitation and pain reduction [3]. Acquired brain injury (ABI) may cause impaired motor functions, language, cognition, sensory processing and emotional disorders. This may seriously affect a person’s quality of life. As a result, one of the primary concerns in rehabilitation of acquired brain injury is restoration of motor function. Other communication deficiencies such as lack of understanding, speaking, spoken and written language creates serious problems [4]. Surgery often results in memory, learning and consciousness impairments. Finally, sensory disorders, neuropathic pain, disinhibition, apathy and unresponsiveness may also occur [4]. Rehabilitation of these disorders seems attractive with music therapy. Despite the empirical evidences on the benefits of music therapy, the scientific proof is not easy. Before the development of non-invasive research tools on the human brain, there were many restrictions for researches on neuro-cognitive studies from cognitive neuroscience standpoint. Advanced brain imaging techniques which upgraded in the mid-to-late 1980s were not fast enough to be used for music research on brain [5]. Brain imaging studies have shown that neural activities associated with listening to music go beyond the auditory cortex and involve a wide range of bilateral frontal, temporal, parietal and subarachnoid networks [6]. These include attention, semantic processing, memory functions as well as limbic and paralimbic brain regions related to emotional processing. The mechanisms such as attention and memory which lead to musical cognitive processing exist in similar non-musical cognitive processing. Music therapy is used to stimulate brain functions including movement, cognition, language, emotion and sensory perception. Music interventions are different that consists of using auditory stimulation to assist movements and normalization of parameters, listening to music and singing in order to reduce pain and song composition for solving emotional needs and promoting a sense of well-being [6,7]. Physicians have used music listening in other rehabilitation environments to enhance relaxation, mind diversion and pain reduction [8].

2. Principles of Music Therapy Interventions

Music therapy techniques are varying. In all the methods, conditions of therapist and clients should be considered.

1) Targeted use of music interventions by a trained therapist. Some of the major interventions include but not limited to these items: improvising music (using musical instruments), recreating (singing a song that already exists), solemnization (creating and recording a new song by patient with the help of therapist) and receptor (listening to recorded songs).

2) Using music experiences based on the patients’ needs in rehabilitation settings: These interventions include listening to live or pre-recorded music, stimulating auditory rhythm, playing musical instruments, performing improvising music using voice or instruments or both, singing or vocal music activities and music composition [9]. Music therapy interventions are determined on the basis of patients’ needs and are used in the following cases: a way for communication, interaction and self-expression, exploring connections, promoting creativity and immediacy, sensationalism, improving cognitive-perceptual and sensory-motor skills, growth of sequential skills, promoting short term and long term memory, expression and development of emotional integration, improving organizational and behavioral skills, promotion of coping and self-reliance skills, enhancing problem solving skills, promotion, integration and transmission of inner experiences, transforming part to the whole, body awareness and promoting listening skills [1,2,3,4,5,10].

3. Based Rehabilitation

In cognitive approach of music therapy, optional parts between anterior and posterior brain structures were integrated, and functional networks that could involve in one lobe of the brain might be avoided and replaced through the subcortical and outer connection ways. Ideal ranges for exploring the brain's ability to perform cognitive tasks were complicated [10]. Extensive list of researches on art therapy and rehabilitation is presented which cover brain injuries and cerebral vascular disorders and events. Automatic nervous system is associated with relaxation and furthermore refers to the impact of activation on the selected treatment. Music therapy can affect automated system and heart rate, blood pressure and stress hormone production through psychoneuroimmunology with music techniques.

Since music is instantaneous and has intimacy, it causes consensus and attraction of a dynamic system to another system and higher imagery in patients. Studies have shown the relationship between imagery mediated music therapy, emotional drain, and the disease [2,3,4,5].

4. Neurocognitive Rehabilitation Model in Music Therapy

This model in music therapy based on cognitive interaction theory is presented and has been suggested with emphasis on environmental factors and is required to develop combination of approaches that exist in understanding of psychological, cognitive, and neural processes In this model is discussed in relation to the body and mind and patients are evaluated in acquiring control on automatic system functions. This method is often used in high blood pressure, mild pain, reducing stress through images, suggestion, music, quiet environment and the like. Researchers consciously or unconsciously enact certain principles and rules to stimulate the brain visual regions. In fact, there are three bases [6,7]. In the first instance, whatever might be termed as the phenomenon internal logic. Second, the evolutionary logic answers the question that why these rules have evolved and why they have such certain form (e.g. grouping facilitates understanding of the object) and third, neurophysiology, that present the involved neural pathway. These three foundations are interrelated with each other. Although at first these rules were designed for a normal mind, its advantage was sufficient to provide licensing issuance and adequately was served the purpose.

5. Options and Discussion

Music therapy is used in many surgery departments and clinics for neuro-cognitive rehabilitation of patients with surgery [6-11]. After surgery, in patients with hypertension, the blood pressure comes down and became constant. Orthostatic hypotension is also stabilized with the use of music therapy. Music therapy has been used in long-term treatments and rehabilitation of cardiac complications after surgery [4]. Such studies of musical interventions are available about patients who are in coma [12]. We live in an era, the era of advanced technology, in which medical science cannot cure the diseases alone. So, we need to non invasive method such as music therapy in medicine, health care, education and social welfare. [13,14,15]. Today, many music therapists are engaged to work in different settings from hospitals to educational and also private psychotherapy environments after surgery [15]. Also, music therapy is mostly used in internal medicine for the treatment of peptic ulcers, non-ulcer dyspepsia (NUD), chronic pancreatitis, bronchial asthma [15], diabetes, obesity, cancer [14], dementia associated with aging [16] but we must thing to these complication after surgery. Chronic dialysis, blood donation, cerebral vascular accident (CVA), endoscopies, pain reduction [17,18]. This type of rehabilitation has complementary effects besides to its beneficial impacts on the treatment of diseases [18]. Music therapy covers all aspects of patients care. Previous studies have shown that music therapy can help to reduce pain of surgery and increase comfort as a supportive treatment in patients with paraplegia and tetraplegia [19]. Long-term effects of daily music on speech and sensory-auditory memory after cerebral injury have been approved. The results indicate that listening to music improve neural damage in sensory processing [20]. Traditional speech therapy also was used to facilitate speech, voice and breathing functions and was effective in swallowing practice and these complications induce after surgery [21]. Temporal motor and auditory processing are parallel with neural processes. As a result, motor system is responsible for auditory system. Music therapy also affects on motor functions including walking. [21]. The Shared Affective Motion Experience (SAME) which has been formed on the basis of brain imaging research suggests that music not only is understood through auditory signals, but also intentional and classified motor functions make it perceptible. In a neural network including the temporal cortex, fronto-parietal Mirror Neuron System (MNS) and the limbic system, auditory characteristics of music signals are primarily processed in superior temporal gyrus and are combined with structural characteristics of motor data in MNS [22]. It assumes that motor control is caused following the rhythm. Auditory rhythms which occur semi-consciously can be synchronized with the movements and facilitate them regardless of cognitive processes. The patient’s breathing pattern can be matched with the melody which makes keyboard keys moves up and down [23]. A key aspect of SAME model is the proposed role of anterior insula as a conduit between limbic system and the MNS [22]. Musical experiences are multimodal which include at least hearing, vision, cognition, memory and motor systems. A number of studies have shown that music processing involves independent practical models. Music activates the right side of the brain which is parallel with the left side of the brain that becomes activated during speech reading. Modern imaging suggests that centers of language and music expression in the brain are not isolated and have some important and common neural processing aspects. Language and music analyses have shown that magnetoencephalography in Broca’s area of the brain associated with language production is not enabled just in time for syntactic analysis of auditory language but also is involved in analysis of received harmonic arrangements. Based on animal studies, cortical plasticity is increased by related behavioral motivation [23]. Diagnostic evaluation of this technique and applied research models are accounted as new low-cost priorities in treatment of surgical complications. Researchers have found that several musical elements including rhythm, harmony and disharmony, voice tone and loudness can affect pulse, respiration and blood pressure which are measurable. Although current medical claims are too little compared to past centuries, music therapy has gained an accepted place in the treatment of mental disorders and music programs have been established in many hospitals. Even many of those patients whom seem to have no awareness of their surroundings react to rhythmic elements of music [24,25,26]. Also, patients who cannot communicate with each other may get out of isolation through group musical activities. Music has been used to relief and stimulates the patients in electro-shock therapy. The music occasionally is applied for feeling excitation and helping the patients to recall contents of the subconscious mind. Music therapy reduces anxiety of patients [13]. Physiotherapists have diagnosed muscle strength and performance improvement as the effects of playing a musical instrument. Music helps reduce anxiety and distress caused by pain and relieves restlessness. Listening to music makes patients calmer when undergo surgery, so that they experience less pain and unfamiliar surrounding sounds may not bother those [6]. The increasing use of music therapy in bran rehabilitation is the direct result of advances made in brain imaging technology which leads to improved understanding of brain functions. Since great steps have been taken in this field, huge leaps in technology are expected to be created. Researchers from different disciplines have sought to the human brain. Empirical successes of music therapy in neuro-cognitive rehabilitation open the way for new research. Following the repeated results, understanding of neuroscience and creation of standardized protocols will occur. Also, the music is an ideal scope for exploring the brain’s ability to perform complex cognitive tasks [7,25,26,27,28,29]. Ultimately, music is effective in improving neuro- cognitive impairment after surgery but we need to the more researches in this area.

References

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