Introduction

'Music has charms to soothe a savage breast, To soften rocks, or bend a knotted oak'.
(William Congreve, 1697)

Mothers have always known that a soft song can calm a distressed infant. Indeed, music has been used for many years to help in the rehabilitation of handicapped children, and in older people with slow mental function and signs of depression. However, its use as a form of treatment has been based more on trial and error, rather than actual proof of clear-cut benefits. Now an Italian study has examined the possible benefits of active music therapy (MT), compared with routine physical therapy (PT), in the rehabilitation of Parkinson 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 doesn't involve any activity by the patient other than just listening to music.

How the study was done

Thirty-two patients with mild to moderately severe Parkinson's disease were randomly placed in one of two groups. There were 23 men and 9 women, with an average age of 63. All of them were taking levodopa, with the addition of pergolide or bromocriptine, if necessary.

Each group received weekly sessions of either MT or PT, for 3 months. Various tests were conducted by a neurologist one hour before, and repeated one hour after a given session,. They included an assessment of Parkinson symptoms (the Unified Parkinson's Disease Rating Scale - UPDRS), a well-tested Happiness Measure, and a Quality of Life Questionnaire (the PDQL). The UPDRS was broken down to give information on movement (slowness, rigidity, and tremor) and Activities of Daily Living (ADL).

Some of the tests were done at two-weekly intervals during the study, and others half-way through and at the end. All tests were repeated when the patients came back two months after they had stopped the MT or PT sessions.

The 90-minute PT sessions consisted of stretching exercises, specific movements to improve activity, weight shifting and balance training, and exercises to prevent falls and improve posture and gait.

The 2-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). People played in groups of 2 to 6.

What was found

In the patients receiving MT there were significant improvements in slowness of movement (bradykinesia) after the sessions, right though the 3-month study period. Examinations 2 months after the end of the study showed no persisting benefit from MT.

No improvement in bradykinesia was seen with PT, but in this group of patients the sessions did produce an improvement in rigidity. Again, there was no persisting benefit from the PT sessions, when assessed 2 months later. Neither MT nor PT affected tremor.

The Happiness Measure gave similar beneficial results with MT as those seen for bradykinesia - significantly increased post-session scores, with, in addition, a marked improvement during the course of the study. However, the improvement was no longer evident 2 months after the end of therapy. PT had no effect on the Happiness Measure.

The Quality-of-Life and the Activities of Daily Living tests mirrored those of the Happiness Measure, and again, these benefits were no longer evident 2 months after the end of therapy.

Conclusions

This is the first controlled study demonstrating the benefits of MT in Parkinson's disease patients. It should be noted that active, not passive, MT was used. It seems likely that MT worked, while PT didn't, because the MT program had a greater effect on mood and personal interaction - the music making required some teamwork.

Both listening and playing music provides rhythmic cues and can be emotionally arousing. It can also help with relaxation and reducing anxiety. Maybe these factors played a part in the good results with active MT in this study.

Whatever the mechanism, the results of this study should serve as a stimulus to those trying to help Parkinson patients overcome some of their difficulties. Active music therapy is not commonly used, at present, but it is obviously an approach that deserves more attention. Music may indeed help to "soften rocks, or bend a knotted oak".