Introduction

Music therapy as been used for many years in helping the rehabilitation of handicapped children, and in geriatric patients with impaired cognitive and intellectual performance, or senior depression. It has also been shown to benefit the well-being of patients with presumptive myocardial infarction in coronary care units. Now an Italian study has used a prospective, randomized, single-blind controlled study to show the benefits of music therapy (MT) in Parkinson's patients.

There are two types of MT -- active and passive. In the active form, patients and their therapist, using instruments and voice, improvise music. Passive MT is done with the patient at rest, by exposure to music. The present study used active MT, comparing it with physical therapy (PT).

Method

The study sample consisted of 32 patients with mild to moderately severe idiopathic Parkinson's disease (Hoen and Yahr scale 2 or 3), randomly allocated to one of two groups (16 subjects in each). There were 23 men and 9 women, with a mean age of 63 years. They were all stabilized on levodopa, with additional dopaminergic medication (pergolide or bromocriptine) if required.

The sixteen patients in each group received weekly sessions of either MT or PT, for 3 months. Examinations by a blinded neurologist were done one hour before and one hour after a MT or PT session; the Unified Parkinson's Disease Rating Scale (UPDRS) was used to assess severity of parkinsonian symptoms, the Happiness Measure for emotional functions, and the Parkinson's Disease Quality of Life Questionnaire (PDQL) for quality of life assessment. The UPDRS was broken down to give information on motor systems (bradykinesia, rigidity, and tremor) and Activities of Daily Living (ADL).

The UPDRS motor exam and the Happiness Measure were administered at the end of weeks 1, 3, 5, 7, 9, and 11 of the study, and again at a follow-up exam 2 months after completion of the study. The PDQL was given at baseline, half way through and at the end of the study, and two months after completion of the study.

The 90-minute PT sessions consisted of passive muscle stretching exercises, specific motor tasks for hypokinesia, weight shifting and balance training, and exercises to prevent falls and improve posture and gait.

Two-hour active MT sessions (done in two groups of 8 patients each) consisted of choral singing, voice exercises, rhythmic and free body movements, and musical improvisation using any or all the instruments available (piano, organ, xylophone, drums, cymbals). Participants played in groups of 2 to 6.

Results

The motor subscale of the UPDRS showed a significant improvement between the pre-session and post-session scores for MT, especially with regard to the bradykinesia component (p<0.034). This was evident at each examination made during the 3-month study period. There were no such significant differences for PT, and the effects of MT were significantly greater than the effects of PT (p<0.0001). Examinations 2 months after the end of the study showed no residual benefits of MT.

Rigidity was significantly improved in post-session scores with PT, whereas MT had no such effect (p<0.001). Resting and postural tremor showed no significant effects of MT or PT.

The emotional test (Happiness Measure) gave similar results with MT to those seen for bradykinesia -- significant post-session scores above pre-session scores, with, in addition, marked improvement during the course of the study, yielding a significant overall improvement with MT (p<0.0001). However, improvement was no longer evident 2 months after the end of therapy. PT had no effect on these measurements.

Similar significant benefits of MT were shown in both the ADL part of the UPDRS and the PDQL -- again, these benefits were no longer evident 2 months after the end of therapy.

Conclusions

This is the first evidentiary study of the effects of MT in Parkinson's disease. The improvements in motor and emotional factors were related to active, not passive, MT. The authors speculate as to why PT was not associated with measurable improvement in any of the measures, except rigidity; they postulate that traditional PT has little influence on mood, and that it is not so readily incorporated into the patient's lifestyle. MT has clearly a higher level of sensory stimulation and personal interaction.

Further beneficial actions of music include those of rhythmic cues and affective arousal. The improvements in emotional response suggest these may be important factors. Relaxation and reduced anxiety induced by music are benefits anyone can appreciate, and they may well have played a part in these patients.

This study should serve as a stimulus to those charged with helping Parkinson patients overcome some of their difficulties. Active music therapy is not a common component of rehabilitation programs, but it is obviously one that deserves more attention.