tony wigram - music vibration and health.pdf

8/17/2019 Tony Wigram - Music vibration and health.pdf

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Tony T9igram

&

CherYl

Dileo

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00023804N

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M985m

Burke.

Martha;

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Jos;

Music vibration

and

health

TEFFREY

BOOI$

538

Cwered

Bridge

Rd'

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Cherry

Hill,

Nl

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r:_'j,

'ffiCflON

L FOTNDATIONS

OF

UIBROACOASuC

ónapter

1: Dweloprnent

olVibrmcoustic

Thempy

BY

TonY

WWn

11

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JEFFREÍ

BOOKS

53E

Ca¡etd

Briilge

Rd.

Cherry

HA

M

0E034

This

book is

prctel by

upyriglt

, No

prt

of

it

may

be rcprdwd

h any

manrcr

withant

wrifr¿n

permbsbn

of

tlu

pblblur.

(c) 1997 bl

feÍtey

Boolcs

Prinbd

in

th¿ Anibd

St&s

of

Aneriu

For

ptrposes

of

wlfidentiality,

tln

rumes

of

dicnts

apryring

thruglnut

this

book

uefrditious.

Ttt¿

Publislur

of

this

book

is not rcsponsible

for

tlu

iqformatiott, ophiotts,

uttútsions

or

vi¿ws

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"

,n

By

ClwrYl

DíIe'o

,

Chapter

4:

Potential

Applicafions

of

Vibroacoustic

Therapy

Ota,,

Skille

49

ffiCIToNII:RESEAR9E,aI'IMa|LAI{DANE@|0TALnEFoRIs

ónupt""

5: The

Effecr

of

VA Therapy

on

lvfulfipty

Handicapped

l¿uits

with

High

Muscle

Tone

and

Spasticity

.4

By

TonY

Wigan

Chapter

6:

The

Effect of

Vlb¡oacoustlc Therapy Compared

wlth

Music

and

Movement

Based

Physiotherapy

on

Multiply

i-""¿iopp"A

Pafients

with

High

Muscle

Tone

and

Spasticity

---

-

lirw

wiwm

6e

Chapter

7:

The

Measrrement

of

Mood

and

Physiological

ñ".porrr",

to

Vibroacoustic

Therapy

in

Non'Clinical

Subjects

By

TonY

WiErzn

E7,/

coustic

Therapy

to

Reduce

Pain

During

I

Kne¿

Replacemcnls

Patients

Over

Age

55

KathY

Tlmmas

99

Chapter

9:

Effects

of

Physloacoustlc

Intenentlon

on Paln

tvtanagerent

ol

Postoperative

Gynecological

Patients

-

-By

Maftlu

htrltc

1o7

Chapúer

10: The

U

c Parkinson's

Disease

Bl

paLri

dd

nilez

de

12s

,/

IlIarclnl¿

&

Chapfer

11: The

Effect

of Ampliiude

Modulation

of

the

Pulsed

Sinusoida|I.owF.rcquencyToneasaStimu|usinVibroacousticTherapy/

-:

ry

fonY

Wig;n

133

V

7'

;4

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il

iii

Qhpúcr

llh

Vlbnmousúlc

Thcmpy wiJh

H¡ndicappcd

md

Ar¡tisdc

Adolcsccnls

L'

'

ri

d'

4

Jan

Pcnoons

l*,Ios

Dc

fufur

....,ii,.

"

*"w e

ww

'

'].

.i.i

'd-i-

Chapúer

13: Vibroacoustlc

Therap

In 3hG

l|oatment of Retf

Syndrome

By Tonl

Wig,am 149

Chapúer

14: Vibroacoustic

Themp

wifh

Adula

PaJients

wifh

Prclound

Lcarning

Disabilities

By

Tony Wtgan,

tenny

Mr/,laryfttr

luttc

&itt & Lyn

Wek¿s

lS7

Chapter

15: The Use of lhe

Somatmn

in úhe Trcatment of Anxiety

To

all

the

súaff

and

patlents

who have

been

involved

in the

pioneering

dcvelopment

ol vibrmcoustic

therapy.

To

the mem)Iy

ol

n¡y loving

cousin

and

lifelong

fhiend,

Robcrt

Anthory

Md)onnel

who has nol

gone

awa¡

but

gone

ahead.

i

:if

Prublems

wlth Cllents

q&o

II¡ve

l¡arnlng Dls¡blltles

ry

JetHoopu

& Bü Lindmy

.169;

r/

Chapfer

16:

A

Comparison of

Auditory

and

Vibmfory

Súimulation on

St¡uss-Relaúed Responses

of Prcmalure Infants

úúh

Bronchopulmonary

Dyrylasia

By

Matlu &ttb,Ienny Walsh

leni

Oehlcr &

feaninc

Gingras

Chapter

17: Vibroacoustics

with

Hospiúalized Children

Bl

Laaalones

Chapter

lt: Physimcoustic

Therapy

with Cardiac Sulgery

Patienls

By Clniles

Butlcr &

Penelope

tohnnn

Buflcr

Chapfer

19: Two

Case

Studies

in

Vibroacoustic Therapy

By

OIav SkiII¿

Chapter

20: The

PhysioacousJic

Meúhod

By

Petri

l¿hiloinen

Chapter 21:

Vibroacoustic Therapy

in

General

Medicine

By

Riitw Randsik

SECIION

III:

OIIMCAL

AND PR0FESSIOIüL

¡.s,S¿lEs

Choptcr 222 Cllnlcr,l

¡nd

Efhlc¡l

Conslderstlons

By

Tony

WiWm

& Cheryl

DíI@

Chapter

23:

Maklng

Music for

Vibroagoustic

lherapy

By

Olat

Skillc

Chapter 23: Equlpment

for

Vlbroacoustlc

Therapy

By Tony Wigmm'

Cont¡ibutors

tw

177

rils

t/

197

?n5

''

20s

J

217,/

cd

43

2{l



s,

]iTil'

Itfii,

ffitu

have

rvork

r

ACKNOffi

The editors rvould

like to acknowledge

the conhibutions

mny

people

mde

both towalds

fhe

rtsearch

fleld

of

vibrcacoustic

therapy and

to the

underfaken

for this

book.

Reklor

Olav

Skille

has

inryirrd

many with

the

possibilities

ol

vlbro¡coustlc

therapy

slncc 1985 wtúh

hls

ploneerlng

work. Dr.

Robert \ilest

has been

vcry

helpfirl

and supportive

and

has

taken a

great

deal

of

inte¡est

in

the

entirc

ffeld.

Horimn

IIIHS TrusJ

has

made

financial

conJributions

towards

the

developrnenl

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

therapy

Senlce at Herperbury

Hospltel.

Financial

support which

has enabled vibmacou$ic

research

and

clinical

services has

been

generously proüded

by the

Spastics

Sociefy,

the

Oak Tree

Trust, úhe

Platinum Trust and

fhrough a

personal

fund-raising

efforJ

in memory of

Humphrey

Mors

by

Mrs.

fuina

Clemence-Mervs

The editors would

also

like

to acknowledge

the

srpport

of colleagues

internationally:

Dr. Kenneth

Bruscia, Dr. Bruce

Sapersúon, Ms.

Denise

Erdonmez-Grccke,

Mrs.

Penny

Rogerg

Dr.

David

Aldridge,

Dr.

Kris

Cheslry,

Dr.

Don

Mlchel,

Mr. Petrl

Lehlkolnen

and

Mr. R¡ul

Vatsar.

The

ediSors are

very

graúeftrl

úo the contribulors

to this

present

volume

for

their coopemtion and

insighfs:

M¡rth¡

Burtg

Jos

De Baclrcr,

Ctarles

Buüer,

Penclopc

Joh¡sn

Butlc4

Junc

Cein,

Petxi

del Campo

San Vinentc,

M¡gud Fe¡n¡ndcz

Jcannirc

Gingreg

Jclf

Eoopcr, L¡¡¡¡a

Jmcq

Bill

ündsay,

Iñ¡ki

Fernándcz

Mencüob,

Peúri

Lchikoincn,

Jcn¡y

McNaughq

Jclri

Oehlcr,

Jm

Persmnq

Riiu Reudd\

Olav

SHllg Kathy Thomg

Eryeranza

To¡rcs

Setu,

Jcnny

Tlhkh

and

Lyn Weckcs.

Speclal thanks

to l&thleen

Avlns for

pruofleadlng

the manuscrlpú

and

to

Navine Malherrs

lor

the cover

design.

And

finally, fhe

editors uould

like to

acknowledge

the

confinued

support

of

their

families

withouJ

wtrich

this

or

any projert

would

be

impossible:

Jenn¡

Roberf,

Michael and

llavid Wgrarq

Jeffhey

Dile¡

Maranto

and

José

Ignacio

Castaño.

Tony Wigram and

Cheryl Dileo

January

1997

tr'

I.ne

úurpose

of

fhis book

is

úo

proúde

info'ri¡rition

on ióniC

cuñini

Tr".

or"¡t"ücoustic

therapy.

Res¡chand

clinical

info¡maJion

flrom

arcund

lne

wort¿

is included

to

givá

the

rcader

an

idea

ol

Jhe

potential applications

of

music

vibmtion

in

the

facilitation

JE

,i

stimu

rcd

fo

ú

dtlaii

rtíf

r''

ing

and

uses

and

applications

ol

music

vibmt

of

products

3y¡Jlable,.to

.aclrlerg

súm

¿iftercnccs

in

itre

nature

and

delivery

of

the

trcatrent

stimulus

The

intenfion

of

this

book

is

to focus

on

clinical,

ethical

and

resgarrch

aspects

of

vibroacousfic

therapy

rafher

úhan

fo

provide

a wide'ranging

overview

of

the

field.

The

information

prcvided

herein

is

neither

crmprehensive

nor

exhaustive.

This

is

the

first

book

concentrating

on

the

therapeutic

pofential

of

musicvibrati

s

been

made

to próvide

Jcontext for

music

vibrat

examples

of

tts

potenflalr

some

results

of

controlte

ivenesg

and

some

guidelines

for

its

use.

Theinformationdocumenfedherebyaninternationa|groupof

"

both

Professionals

and non'

p

both

in

clinical

and

research

d

Provlded'

Not

all chaPters

w{ll

tions

which

cover

resPectivelY

sis

of

vibroacoustic

fhemPY'

cal

and

Professional

aspecfs



I

)

I

t

I

¡

I

)

)

)

)

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)

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)

)

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)

potentlal

u ¡es

of

this

nrclbod

lo enhance

h€al3h.

The

second

sectioq

'R'eseanclr,

Ctinical

and Anecdotal

Reportq"

cnnfains

¡resea¡rch

studies

and

descriptions

of clinical

methods

and

maúerials

its

úhempeutic

applicalion.

Tie

thtrd

scction,

'€linical

and

Pmfessional

Issreg"

confains

infor¡nation

and

guidelines for

using

this therapeutic

rnedium

with clientg

including

srggesfions

fo

calions

that are

currenfly believed

to

be

music tapes

are

c¡eated

for

trcafment

art

of some

types

of

equipment

is

included.

The

edlfors

lnltlally

felt

the

need

to

underlake

thls

proJect

ouf

of

úoncern

for

the

rapidly

expanding

usc o

modatify

and

the

incrcasing availability

devices

Thert

is

a

lack

of clinical and

guide

this

work.

In

addition,

therc

is an

apparenl

need

to

address

ethical

and

úaining

issues

to

provide a foundation

lor fufure

dialogue

and the

establishmenf

of standards

of

pmclice.

It

is

felt

fhaf

fhis

volume

is

only a

starting

point

for

Úhis

effort to

develop

and

lmprove

cllnlcal

and

profesdonal

aspects

of vlbroacoustlc

therapy

interventions..

Undoubtedty,

this

field

will

grow

as

new

applications

and

methods

are

carefullY

fested.

Cheryl

Dileo

Tony

Wigam

SECTION

I

FIOT]NDATIONS

OF

VIBROACOUSTIC

IUBNU\PT



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r;l

tl./il'¡Í.,vl

ttdi,r;i1

i:fr.fr

efl{

'j

{S+S'S1{,'i4¡as

W

nnuwnrww

oF

ulBRoaoousrrc

TuERAPr

relaxing

lhe

child¡enP -

___r

_¡

rsal

-

ifll

Tory

Wignm

HISTORICAL

BACKGROI'NI)

ft"

on

what

he

deflned

as.{hltP;

rsal

principtéi'

rys 9:

ii

low

frequencióC

ci

ciec'

üf

¿i."

t"¡sion;2)

rtryitrmic

music

can invigorate;

rgqf,Fylhmtc

mus¡c

can-.

p'áéily;

and

3)

loud

music

can

creaÚe

aggression;

soft music

can

act

as

a'"

mudiuhe

lnú¡oduced

úhe

element

of

low fitquency

sound

es

e

pulsed tone

wtrich

he

rccorded

on

tapes

together

with

relaxing

mudc'

skille

defined

tbe

principles and

method

of

vibroacoustic

therapy

and

desqribed fhem

at

the flr$

symposium

of

fhe

International

Society

for

Music

an¿

tVtedicine

(Skitle

19E2):'IIe

summarized

lhe

process

of

vibroacoustics

a9

follows:

'The.¡rpg

of sinusoidal,

low

flequency

sound

pnes$¡ne rr¡ves

betrveell

S0-lZthz,

tlen¿e¿

w¡tn music

for

use

with lhcrapeutic

poryttC

.

Iícorporating

both fhe

elements

of

vibration

and

music,

Skille

initially

11



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)

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deflned

hls

fechnlque

as

ubsequentl¡

he

^

J

'"-.¿

it

Vibruooustic

pnooess

of

tbis

Ür

ln*rument¡flon

and,

pre-com¡osed

melodles

on

úhe

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

tY

ZVo

ol

the

energr.

underfaken

on

ai 't

vfüratlonal

ellect

r

sudace

of

the

equiPment'

o'

Skille's

investigtions

e4anded

o

include

other

conditions

which

he

varied.

I¡r

1987,

the

rcsearcb

underlaken

in

Nonray

and

Finland

n¡as

still

L2

"n"ü"r

r¡ere

foúnd

in

subirctd

respiration,

pulse or

behaviomlly

f;il*ñ;ññ-":

1'-lh-:,PI:1,:,:I^g'

ror elther

the

vlbroracrlle

or

Jhe

non-vib¡oÉactile

stimulafion

administered'

H

13



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)

reproducible effects

aú

a

llequency

of 1f)

heriz.

Again, this

rcscarch

focused+

ffnsory

vibration

on the

han$,

using an elecfro-mechanical

:i

'deliverod

Slriumidal pulses

of

va¡iable

lhequency

and

P

W"d"ll

and

Cummings

(193$

studied fhe

concenrs

of

fatigue

of

the

vibmúoiij'$énse

in

an

experirnent

looking

af

the

effecf of

mechaniczt

"tbo,ton,r,

n

the

palm

of

úhc

hand.

In thls

paper,

lhey

ctmmented

that therrc

r¡as

¡

lack

ol

scientillc

interesú

in

úhe

percepfion

of rnechanical

vibration, probably

due

lo

úhe

fact that although

a fecling

ol

vibration

is an

every

day

occurrcncg

it;,

does not

seem

to

play

a

very

important

part

in

the

adjüstmelit

ol

lhe

human.r

bcing

to his environmenÉTheir

nork

explored

fhe

generation

of ftequencies

befween

64 and

1024

cycles

per

second, generated

by

a

Wesfern Elecfric

hee

fleld

audiomefer

into

a

rnefal

rud

connecúed

fo the

palm

of a srbjecl's

hand.

They

took

readings over a

three

minuÍe

period

between

the

frequencies

mentloned

al

Inlensltles of 10-40 declbels

above

threshold.

Flrst,

they lound

.,;

thaú

the

amounú

of faligue depended

upon the

flequency

of

stimulatiof,, and

in

a

sununary

of fheir

trialg

lhey

concludéd that

a

sensitivify fo vibraloryy.,

stimulation applied fo

the palm

of

the hand

w¿s

ndu'cpd

5.15

decibets

aftep

3

minufeb of

conúinuous slimutatid.

Secondl¡ they found that the

loss

of

i

oÉ

?t.

'

^''

tf

.s

measured at a lower

frcquencXl

FuÉher

sfudies indicated the

signiflcance of

,ú

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

per

seoond

sinusoidal Jone

delivercd fo a llngertip

by means of

a circular

plastic

butfon.

They also found

that

the

decrcase

in

perceived

intensity is greaterSt

r

tlme uas

regulred

for complete adaptatlon

,n

''16*'i¡ffisii,'iüt'recuiery

is fas,

actually

Berglund

and

Berglund (1970)

also

found úhat lhe

perception

of

vibrotactile

sfimulation is complicaled

and

diflicult

úo evaluafe. The

interaction

thaf

goes

on

befween amplitude,

fbequency and duration on lhe

perreptual

counterparls

of

these

parameters

provide

inferesting

problems

for

p

sychophysiological research.

Studles

on

vasodllaflon were

canled

out by

Skoglund

(l9E9)f,ooklng

ir

L4

gffect of

hlgher flcqucncy

(150-250

H¿)

on

skln

n

hrcas of

the

toq

rof"o

thal

re¡¡ tested inclúdó¿in"

tiCnUs,

parfs

of

legg

anns and trunk

in a

Joúal

ol

l3() vibmtlon

'experlmenús

performed

on E0

healfhy

nren

¡nd tvomen

between

20-70

years

old.

He

again

used the technique

of

infi-a-red

thermography

to

indicate

lemperafure

changes

and

vasodilation.

His rtsults

gupported

the viery

fhat

dl

/

performed

in

a

few comparative

e:rperirrentg

caused

vaso-consúricfion.

{n

"Oaition,

he

found

that úhe

inc¡ease

in

temperature

fq

fhe

given

stimulqs'sas

.'

gtatei

the

lower

fhe

prevaleut

úin Éempenature

at lncepllon

of the

stlmulus.

TVherc

vibmtory

applicators have

bec'ome

a oommon Jool of

thempy

in

s

physiotherapy

defrartnrnf$

some researrh

is cenúered

around

muscular

Y

1f+:

It

f¡

/

hurnan

skeletal muscle

nas

made,

noting fhe

effecú

of the involuntaryg

asynchronous

motor

unlf contractlon

In

the muscle subJected

fo

a

mechanlcal

r''

vlbrátiory

with

a reciprocal

rela:ation dl

fhe

prime

antagonists.

:t

"

In

experiments

underúaken by

Hagbarth

and Eklund

(1966),'this

'r

Reflex

G\|tr).

Stiltrnan

(lYl0)

il

tory mofor

súimulation

.?9--lhe¡

active

rüüscie'contraclion and

/.

inhibition

of muscle

contraction.

Sf illman

proposed

3hat,

when

superimposing

#

vib¡orinotoi'

siimulafion

on

a

voluntary

muscle

contraction,

the

result

¿t

pibduces

a

greater

muscle

úenslon

or

a grcafer range of

movementi depending

on whefher

"the

inifial

cont¡action

is against

a

yielding

or

unyielding

resistance."

fn some

sfudies

involving

spasfic

hemiplegia,

spinal

quadraplegia

and

acute incomplete spinal

quadraplegia,

he

found improvements

in

hand

grip,

scapular stability,

funcfional

use of

f he

limb

and

range of movement.

In

this research, the Tonic

Vibrafory

Reflex induced

by

vibmtory

measu¡ed

sfimulafion

caused

improvemenf in

muscle

acfivity

to fhe

point

where

studenf

physiotherapists could gain

some

insight

into

úhe

simulation

ol

spasticity

in

i

fhelr

own

muscles.

Vibrafory motor

stlmulatlon

actlvated

muscles,

and

as

a

i

rezult,

Sfillman

also listed a number

of

adverse reacfions

he

found

in

some

clients,

including

increascd

spasticity

and clonus of spa$ic

muscles,

increased

ilgidity

and

wide spread tremor from

application

to

pafients

with

ParHnsonisnr, spread

nesponse

to spastic muscles

during

the

vibratory

motor

stimulation

of

non-spastic

paretic

muscles, and

a

general

sprtad

response

to

other

muscles,

paficularly

a

feeling

of

discomfoÍ

fbom

vibralory

moúor

sfimulation

over

bony

pruminence.

If

ls importanl

to

note

these

stimulatory

effects

of

speclfic

vibrafory

15



{

f(

){

;f

ú

I

Í

il

fl

i

i

i

I

I

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

motor

stlmul¡tlon

rpplled

fhrough

the

rpptlcetor

th¡ú

Sflllmen

rvas

usln&

iihi"n

was

an clecúr{cally

powerod and

commrcially

¡rn¡ilable

vibrating

Tlfco

Vib¡¡úory Massager.n

This

vibnÚor

opcratcs on a

4

trrnmtttlng

vlbretlon

through

r sllghÚly

curvcd

plestlc

dlsc,

some

35 cpntimet¡ps

ln

diameter.

several

further

ludies

have

been

undertaken

on

the

effect of

mechanical

vibr¡tion in

srrpden

by Hagbarlh

and

Eklund

(1968).

Their

rescarch

follmcd

the

path

of

the studies

on

Tonic

Vibration Reflex

(Eklund

and

úhe

rclanfion

periods and also

during

periods

of

the

volunÚary

afÚempts

of

the clienús

to

move

thcir

affecfed

limbs.

The

vibrator

fhey

used

oonsisted

of

a

snall

elertrically

loaded

mofor

in

a

cylinüical

shape.

They

used

rubber

bands

to attach

the

vibraJor

over muscle

tendong

and the

motor

was

rctated

ib

¡pduces

,o

ther the

in

reflexes

srcte

oflen

of normal

slrength,

but they found

that

the

vibration

incrtased

fhe

tremor

and

rmy

have

also

impaired

the

patient's

abili$

Úo

perlorm

alf

ernating

movernents

INFRASOUND

A¡lD

LOW

FREQUENCY

SOt

ND',

Between

19E3

and

19Ell,

the

Forsvarcfs

Materielverk

(FI\[\') ol

Úhe

Swcdish

l)efense

Material

l¿niriÍ3tiátio4r

assenrbled

a

substantial

Étéri ¡il

üürh$itflót

hüiltüle

sou$dn'

O.

5).

*

They

go

on to

say:

'Sre

adopt

wifhout

any

resenation,

3he opinion

that

pelow

lQQ*{"

irw$.+94

.

lnfbecound

shóuld

not

be

¡

16

(Detow r9 l

,-i.,--tLgg+Pr¡¡'

¡nd thelr



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

))

)

)

)

)

)

)

)

I

;f

{,

such

as: a)

tungs

-

s¡nounded by the chest, b) nasal cavities

-

sunounded

by..,

bone,

c)

gasoous

intestineg

d) air-ftlled middle

ear in rclation

lo

lhe

car-'="

'mcnürane;

and c)

air-fillcd middte ear

with

the ear membrane

in

relation to

"

the

liquid-fllled

inner

ear+'

TIIE MFECT

OF

I¡IFRAÍIOI'ND

Ohf

HTJMITI\IS

Tf

A study

emmlnlng

úhe

effect

of

inhasound

(below

2O

IIz) on

human

physiolog

naq4onducted

by Alford

et

al.

(1966fwith

21men

betu¡een

21'33

years

old.

A

sffmulus

of

pure

tones between2-12 Hz

in the

mnge

of

ll9-l4/

decibels

was

intrcduced

into a simulated chamber.

ResulJs

showed

úhat

rNo'

electric

cardiographic

alJerations

wene

obsened

during fhe

period

of

stimulation

or afte¡rvards.

The heart rale

sas

noted

to

increase-in

6

subjects

by 6

beats

or rnone

per

minufe during maximum sfimulation,

bul in

5

other

subjecfs

the hearl

rafe

was slowed

down by

6 beats

per

minute

wilh

similar

stlmulallon.

Resplratory

funcllon

as

obsened

wlth

lmpedance

pneumography

rras

normal

for

all

subjects

during exposure to the low

frcquency

stimulus.

In

7

subjects,

however,

Íhe respiralory rate

was

increased

by 4

or

more

rcspirations

per minute

when

a

stimulus greater

fhan

140

decibels SPL

u¡as

delivered. These

are

probably

insignificanú alúerafions"

(Alford

eJ

al.,1966,

p.

14).In these

experimentg no'*mbjects

reported

discomfort

wifh

regard lo

body

vibmllons,

disorientáúióñ,

mental confusion, sensory

decremenf

or

posl:

cfiiosure fatigrp.

In

a

ano'ther

sfudy

(Englund

et

al"

1978h

ü

pllots

were

dlvlded

Inlo,

3

grorfl's.

One

group rras er<posed to infrasound

(14

Hz), a second

group

$rls

e:rposed

to inftasound

(16

Hz) and a

third

group

uas

exposed

lo

noise

oI

16 Htn

found

no signiflcant change

in ECG

activiúy

and

pulse

rate

(Landsúrcm

et aln

19tl). However,

in rnost caqes,

in

,fhiq

,gp-e¡ment

(20

'.-.s

infrasound

did cagp an

inbrease..in

dias3oli_c-

blood

pressure

and

i{ffiiffi'&i'fU¿Uutort'in

systolÍó

pressurffthi

effect on

diastolic

pncssur€

wirs,:

statistlcally

rúgnificaqh

whercas

the effect on systolic

pnessune

r¡as not

when

fif

in systolic

statistically

rúgnificaqh

whercas the effect on systolic

pnessune

r¡as

not

when

calculated on úhe

who=le

group

ol subjects

In the mme orperiment,

mcasrr-ements

wer¡ taken

of

respiratiotdby

placlng

a

tendon

probe

on

the

chest of the subJect,

ln order

to rcglster

the

18

of

brtathlng.

In mosl

cases

agalr¡

lt

un¡

p9 $

lh¡t

there

r¡ns

a rcductlon

Ját"

of

tütning

qpnng

inlfasonic

eqiodtidü''howver,lhc.

affect

rras

Fiiira,

iütñJ¡i##al""úiü

*rin r..$t

to

tbe

nhol 'írntg1sf

F-

-J"-"

-u?¿""ition

ol

the

n¡u$ous

effcct

of

low

fLequeqcy

sound

uast

'atso

given

cunside¡ation-

in

a

studl

underfaken

in.Jana-Tg11d:.:1.5

:

I

:

I

,l

J

chamber.

'll

¡

la

I'

(

t

l:

.t

,'I

t

t':

t-

;E

,il

:;

;j

iI,

ij;

rl

ll'

iii

i:

ti

[j:

iüi

t¡i

H

r(¡

U

t

l{.

l:,

['.

Ii

9



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

Érd

$trc.ttp.aled

¡

D||der

iad¡'ion

ú'hi

r¡bj.ct¡

rú ¡

*rd-hJ4eElily

ia.s

r.fr

gmü¡'cd

'

iri.tb.r

Into

rth

.i*¡t

-

kgt'

d h.¡4

¡tr¡s

.Dd

lú¡it¡

¡nd

r

¡. mr¡l

dt

ct

'

¡

conslsLN¡(t

ol ¡rspon$

b.g¡n

to ctnc|gc

(rÍ3t¡m

1996).

I¡l¡ai

c¡D bc concludcd

ftom |r¡r¡y

ot

hcs.

lud¡.r

i¡

abal

lh.

locut

tt¡llaht¡on

or|

boah vibnaio¡r ¡¡d lott lltquanct

soutd h¡r

conceDlEbd

on

a¡á

if.cf;

oi

diicootolq

plv¡iotogi.¡l

ch¡qg.

üd a¡noy¡Dor

a3

lhr

Élñal.rs

fa¡

av¡¡u¡alng

r¡y sign¡fcant or

slimulaúory

eff.ct

In

lhcar

the

,,1

dfutlncl¡o¡rs

bclrE

n

tho

ctrcutÍst¡nc.s

¡n

wrucn

o¡rc

t3

qP@qurÉ

¡F

i

¡qfffliáielñl

colhd.d

Dt lha

Sxcdii D.f.nia M.úG¡i¡l

Adminilr¡tioD

üi|¡-tl*'""

ü

*"rt"t

lt

gancr¡3o¡

¡

fonr¡

of

dtlcornforl,

Fo¡.t(¡r|plc.lh

I

l¡

lookcd.¡t

|lfr¡mu¡d

lD

.für.e .nd

lls

p¡op¡8¡doq

fhc .dstGhcc

of

g;trI-Jri"Tgfi'"T,fi":'#:*?s#;H:^tii$:fi#fr"J

iiffi:iüiü#Hü91fiil-S:f:;HiTfri Ttli$,i:#;",1',1.i.fi

;il;";;;;-#-ñ-;;.-ü-o*¡rnry

l'r¡g¡'t"¡og

"t."

;

:: -¡ttt.,ft:'¡fcc&

D.fiDr

or

th.

.unri¡ÍrDts b.vc

b.cn

und¿lr.¡keD

using

üillirillli-1""""

"r

¡ctivirv

drsturbo¡cq

h.^-:y1*iJ

lffi?J::J*¡¡5,g"IL*t*:5"fl:-a

srihtrrus

of inft"ound

uq¡ru¡"6'

-:

;; ;;";o. irrrt.

lbn

loudspe-kers

within

a

small

enclosed chamber.

"rrporuñ

to

vibmfion

can

sometimes

induce

a

se.ns:

I 11"";-;- ,,,¿1,..,

"vs¡

ruú

ü

H

tt

0

I

n

ft

$ililil;-'il;;;

vibrarion

and

rarigue-"n¿

¡"n"."n

larigu.

.il1*

p€rfomance

u""

"t.n

.o.]---t.*

,^,t

hale

not

vef

been

cuanúilfed¿

:lt r

MUsIc

As

VIBRATION

r.atlof

il

-{

".

bndrl:i

In t.ñnc

ol he¡ltb

tdu

crus.

ph¡siol

halrn

úett'Llli¡

om

ol

th.

a¡rllrl

sludh¡

unddf¡kcn on

thc

ahd¡p.ufic

alf.cts

of

i

t],lfó]fi'¡-

iiü

TEI*

H:,:ll

l_ol. :¡'ol

el¡yryo:g4

Triviry

w'

br

rcrrich

(ft5e).

H.

was

}iffiEitrx*'**ffi*ffi'*H,,1"Í.",'"Hi:sfr" ü#l

ffiil{11i;:üiff:ü5#j{ipii*¡'i{ü,iüi*Hü

20

2t

)



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

l"{

Ír- end

he became

e

rcgular

c:oncerl

goer.

He

r¡as eble

to

recplvc

thc

sound

--

/¿LúrrñL lL^

,,rl

but

lot

in

the

same

rray

Helcn

Keller'

(thtorrgh

1¡g

i'ut

her

fingers),

but

ralhcr

wh'

anr.'lnnerr

scns

oF'

l"r{

lfer

descrlbcd

tt

thls

w¡y:

¡rnln

rccclvlng

stetlon

ls

fer

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¡¡ü

wrrure

fr

q¡¡ñ

u¡

r¡ry

I

utv

which

feels

tike

"

tlbllói

vessel

struck

rhythmically,

resounding

norr

I

iñ";;;;

;ft"r,

dependcnt

on

the

intensity

or

the

mr¡sic.

BuJ

there

is not

I

lhe stightest

."nsai¡on

in rqy

head and

hands

-

the

head

is

fhe

least

sensitive"

i.

i

In

concluslon,

thc

dei'elopmenf

of

VA

theraif'has

úrken

plqta

bver

th9

/

ffieen

years

and

hdi

lnvolúed

e

Varlety

of

profesdonalg

lncludlng

mudd

ti"-ri¡g*

music

educaúorg

music

therapy

educatorg

psychologifgr

biologists,

physicians,

nutses

and tgachert'Jh:

JheroreJical,P::-f"-"

-t11

.'

CONCLUSIONSfl

showed

lively

colours.

Al

other

times,

I

se€

no

images"

(p'10)'

Anotñer

musical

subject

conrmented,'If

r¡as

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

':i

f involving

the

use of

music

and

low fhquency

i

22

REÍERENCES

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

hearing

impai

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.

É

¡;

23

)



)

)'

),

)¡

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

úlL

K.

En

& Eklunq

G.

(1963).

Thc

efnecas

of

muscle

vlbr¡tlon

In

spod¡cigj

rigd¡ty

and

ccrcbell¡r

diotders.

.Iounral

of

Neurolo.r.

Neuros¡rqeryr

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

úhe

effect

of

vlbroacoustlcal

fhenapy

on

strcss.

slbellus

Acadenyt

Helsinki'

UnPublishcd

PaPer.

I*hikoinen,

P.

(1989). Vibracoustic

trtafmenf

to

reduce

stress'

Sibelius

Acadenry,

Helsinki,

Unpublished

paper.

Madsen,

C.

K,

Súandley,

J.

M,

& Grtgory,

D.

(1991)' The

effect

of a

vibrotactile

device,

Somatron,

on

physiologiczl and

psychological

responses:

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

cllents

per

presented

at the

Second

ticg Slein\ier,

NoruaY'

19E9.

Published

ISVA.

skilte,

o.

(1969a).

Vibroacoustic

rrsearch.

In:

R.

spinúge

& R.

Droh

(Eds)

Skille,

SHlle,

ion

and

fherapy.

In:

T.

Wigram,

B.

SaperSon

& R.

\ilest

(Eds.)

The

Arú

and

Science

of

Music

ihempy:

Á

Handbook.

[-ondon:

Hanvood

Academic

Publications.

Skoglu

Skoglu

Scand-

125'

335.336.

24

It¡r. JM.

(f991).

The

effcci

ol

vlbrot¡cllle

¡nd

eudltory

Slmull

on

i;¿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).

Vtbr¡tory

motor

stlmul¡tlon:

A

prcllmlnary

¡€porl'

-tl¡D

Tcir

ons'

In:

H'

A¡s

\I¡va

Verlag.

Verillo,

ñ.

L

tffZl.

Invesig¡at

rne

parameters

of

.the

cufaneous

'-'

inrcsnold

lor

vibrafion.

nat of

the Acousical

Society

of

Americ4,

34

(11)' tl6B

L773.

:on

cññEp,

& r.¡r*oq

c.

w.

(re76,;TfTll1lllilii,.lFil,ill1,ll

riirl

¡ess

.'{,'

I

Wedel

figue

of the

vibratory

sense'

4294E.

wigram,

T.

(leeO. The

effects

ol

vibroaco

l '"t"pLoa11iY1"li^lli;

i

I

":;h;üi

pop,rt"tioor.

Doctoral

disserratioq

st.

Gcorge's

Medical

School,

London

UniversitY.

Wtgraq

T.

(1993) 'The

Feellng

of

fhequencY

sound

in

rcducing

clients

with

learning

dilfcul

197).

London,

Philadelphia:

Jessica

Kingsley'

Wigran,

ú

e

WoX.s,

L.

(19-tl).

Report

on

Lcvanger

Symposium'

Norway'

In:

O.

Skille

@d.)

Kompleft

ra

Levange4

Norway:

ISVA

Publlc¡tlons'

Yamada,

S,

I-kugi,

wt'

tr'q¡it<ata,

S,

Watanabe,

T,

&

Kosaka,

T'

(19E3)'

Body

sensation

of

low

fiiqu.n.y

nois

of ordinary

persons and

profoundly

deaf

persons.

.Iournál

of

l¡rv

Frequency

Noise

and

vibration,

z

(3),

32-36.

25

)



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)

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)

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)

)

)

)

)

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)

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)

)

)

)

)

)

)

)

)

)

)

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..

:,

::.1;lit $i:.

É¿i.tr.

'l:i

,r;

i ¡.

i¡¡

(¡

/:t):

,,:

t+

t,S.¡IfiFi:{{STli,:

j,

jt',r-.r:

r

r':-,.

i.r

:

i¡r,

;i:if-¿it&¡,.t,,,

.,,

'i'

:

r

tri

i,o._li*iif¡é1,,

i

ANIT

INVENq|L

UOVEilENT

percePtion.

Thesesensesarespecia|izedinrcceivinginformationhomthesmall

TvcrYthing

Is

Moviry

¡nd

VYc

Fcd

A

P.rl

of

this

Movi4i

Thi.*;hñéht

i.

m"

key

to

understanding

many

of

the

questions

w'ich

are

evidenl

¡n

tfre

fieU

of atouSics.

Real

movóment

and

our

perception

of

thls

moyemenr

.*

"iüi"Jsúlc

ldees

of

a unlque

phenomenon

-

that

of

our

áii".i*¡,.

the

world

tñat

srrrounds

us

thr¡ugh

the

prcoess

of sensorl

I

.lIlE*

Jsr¡*r

_¡v

vrvv'_-_---

---

and

rapid

movements

that

are

produced

around

ug

l"tt"""

"n¿

our

hearing

senses.

Thougb

these

are

Jwo

hc¡f|Dg,Ilp$l9,psl9F.in¡

4eF9"

.pt4llPre'

*l'::

-'-

t"--------

---'

.-t¡rof¡ ho¡arrco rtrev come inio

the

field

of

srbircfive

perreption'

,t

on

human

physiologr.

This

evaluation

b'e

diftcrcnce

ü"it""n

ibscillation"

and

'qvibration"'

'

Osillafion

r

*

c

f

lhe

bodY

is elastic'

and

the

force

the

cohestve

lorccs

that

malnt¡ln

aunityofthemolecu|esandcanaccomplishoscil|atorymovementgthenfhe

body

becomes

disforted.

It

can

then

be

stated

that

fhe

body

has

entered

into

a

state

ol

vibmÍion.

Whenthebodyisnotüsortedthroughosci||ation,asjnJheftrstcase'

the

movemenfs

are

isocronos

where

he movements

are

alnays

the

sa¡ne'

Thercforc,

the

num¡er

of

moverrrents

that arc

accomplished

in

the

space

of

a

unit of

time

.an

te

;*tfi"¡

as

a I

oscillation

frequency

-

and

can

be

Mfugcl

Ferundez

27

)



)

)l

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

derúgnated

¡s

elther s

purc

fone

or

dnusoldal

lone. This namc ls

deflncd

bcc¡usc

thc dlqlacement lollows

the slnusoldal

ft¡nction of the anglc

fo¡md

ln

a triangle.

In

the

second

cese,

rthen tbc

force

ls iufñclents

lerge

to

dti¡torl

the

body,

each moleculc

or

grcup

of molecules

will oscillate

wilh a

numbcr

of

lsocronos

movemenls

whiclq anpng other

fhingg

might be

caused

by

the

ela$ic

properties

of úhe

body and

will

cause

multiple

oscillation

fhequencies

or

pure

úones.

A clcar hierarthy

has

been

cstablished

between

them

s¡ch

that

the

slor¡rcí

movemenl

produces

the lorvest

oscillation

fluquency,

which can

be

designated as

'the

fundarnenfal fone," and

olher

movements

generated

will

Jhen

create additional

frequencies above

the

fundamental

oscillation ahat

arr

catled

"partlal

tonegt' or'byertones."

Here it

can

be found

lhal

the

partial

fones may

or not be divisible

by

the fundamental

üone.In

thc

flrst case,

fhe

partial

tones can

be

designated

"paÉial

harmonicq"

or

simply

"harnmnics."

These

continue in

the

proportions

which

rperc

defined

by the

ancient

Greeks

according

úo

fhe harmonic series

In

this serieg

the obtained

number ol

the

division

of

a

partial

harmonic

with

respect

to

the fundarrental

means

thal

the

number

or order of said

parlial

harrnonic

(ie,

úhe fourth harmonig

the

twelfth

harmonic,

fhe

fZ3rd

harmonlg

efc.) resrlts In

the

comblnaúlon

of

all

of

these In an overall

spectrum.

This

creaúes

what

we

lgrow to

be

a

"Complex

Toner"

where ifs

primary

ftiequency

value

is

known as the fundamental

tone.

In

fhe

evenú

lhaf

it

is

not divisible,

it

can be

designaúed

as

rlartial

inhar¡nonics,"

because it

is

evident úhat if

does

nof

continue

in the

hannonic

serieg

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 rmjor

inharmonics,

eg, four

parfial

inharrnonicg flfteen

parlial

inharmonics

elc,

one

can obtaln

a result

where the comblnatlon of

all can

glve

an

effect of

what

we know

as

"noise,"

and

it

will nof be

possible

to

quanti$

their

fbequency.

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

purcly

physical

context,

and although

it would

be

current

praciice

to

define in the

same

way

cause

and

efnect,

we

should not

forget

that

we ourselves ¡nove in two

dlfferent

ftelds

-

the

obJectlvc

and

the subJectlve. These

c¡nnol

be

mlxed.

Thercforg

a

great

number

of mistakes

can be

rmde

when these

terms

are

conftrsed, and

if

is

not

clear whaú 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 the

initiator of fhe

movemenfg

the

medium

by which

the movelrent is

fransnitted

(for

enmple,

air)

and the reccptor,

which lorms the

last link ol

the chain. In a Ulopian

rr,orld wherc onc c.ould

frnd an ideal

chair¡

the

Inltlator would

generale

a

perfect

oscllleflon, the

transmltter

or medlum

(for

28

Do¡nL

-'--

Th"

effect

accomptished

reoutd

in

fhe form

of

a feld

of

increasing

and

ooo-J*f

size

which

coutd

be

described

as

a

"ryheri@l

$ave,"

growing

as

makes crontacf

with

a

surface.

crashes

against

úhe

limits

of Úhe

object

and

is

difllacted

around.

abs"t¡too ls a

mechenlcal

energl

converslon

In

calo¡les

by

the

rubbing

ol

tht

molccules

togelher

where the

energ fo¡ce

is

absorbed

within

,l

r

fl

29

)



É

¡;

$

H

0

r

fl;

QI

)

)

)

)

)

)

)

)

)

)

)

t

)

)

)

)

,

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

¡ne

osc¡ilat¡on

info

a

vibmtion.

This

energl,

in

fhe

form

of

an

electrical

I

currentr

pas$s

fhrougt

a sylem

invotving

a

t¡ansducer

which

is

capable

of

i

converflng

lt

lnto

mechanlc¡l movementg

Normall¡

the

úransducers

are

the

loudryeakens

located

wiJhin

the

chairs

or the

beds.

Here

is

one

of

úhe

most

critical

poinfs

of

úhe

"chainr'

-

fhe

loudspeakers

Loudrycakcrs

These devices

have

conical

and

rigid

rrcmbraneq

capabte

of

being

moved

by

controlled

movernents

which

are

obfained

thmugñ generating

á

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-l¡l,r

jtli

:,"

/-I

HARD

BoDY

I

DIFFRACTEO Ef{ERGY

30

FREOUENCY

IHZ.I

31

)



I

I

I

I

I

)

)

)

)

)

)

)

)

.)

)

)

t,

t

)

)

)

)

)

)

)

)

,)

)

)

)

',

)

)

.)

)

)

)

)

I

onc

of

then thc mmbr¡ne.

Thc

posltlon ol

Jhc

membr¡ns

lb¡t

úo

ncslvo

lhe

stlmulus

ls In

the

vc¡lex

of úhe

ong

and

the

force

will

iáiá over

lbc nholc membr¡nc

ll

ordcr

úo

movc

iJ.

fnls

ts

e

rysiem

rvüerc the

prtnary

Inltletlng

'

transmlttlng

'rccelvlng

intliating

-

transmitting

-

I úhis

process

is rcpeatcd

aan

Huygens

in

úhe

latter

lOtECUtE

ACTIVITY

Dlagnam

3

MOtEcutE

ACTtvtTY

cave

f¡onú

can

be

those

which

ane

movemenf

by

the

¡c{lon

ol¡ttractlon

or

repulslon

wlSbln nregnetlc fleldg

behave ln a

uay

that

ity

hus

:il

:l:

nembrane,

and

other

parfs

of

Jhe

residual

ene¡Ey

arc

reflecfed

back

again

lomrds

the

cone

of sPeaken

The

refected

waves

go

in

opposite

dircctions

wiÚh

respect

fo

the

ouÍgoing

raves,

and

thertforc

generafe

a

se¡ies

of

staÚionary

$aves thaf

cause

lhc

rembr¡ne

lo

be

delormed

and

begln

vlbratlng.

Ihls

generefes

overtones

th¡l

are

disúorfed

by

this

pnocess.

These

overfoneq

generated

by Úhe

distoltion,

have ffcquencies

much higher

than the

fundarrcntal

and can

be

morccadly audible fhan

the

fi¡ndamcntal, crcating conftrsion

in

the

operation

of thls

system.

It must be rernembercd

fhaf lhe frequency

ol a

sound

for

ehich

úhe air

is

rmf

sensiúive

is in

the arca of

4'0fi1

Ha and

below

Jhis

fltquency

the

auditory

sensitivity

decrcases

continually

and

irregularly. The

ncoessarT

energy to

perceive

a

tone

of

30

Hz

with úhe

sarne

inJensity

as

thaÚ

of

d000Hz

ls

almosf

a

mllllon

times

latger.

This indicates

that

our hearing

abiüty

does

not

respond

in

a

linear

way

to

cause

and

effect,

but

follors

random

curves

in

relation to energt

levclg

fhequencies

and

the

production of

sound

sensation.

The low flequencies

(below 30Hz) are

pracfically

inaudible

as

an

airbonr

sound

within

fhe

environmenf.

Horrever,

they

are

perfecfly

perrceived

by

úhc

sensation

ol

fouch,

an

enmple

being thc

facility

of hearing

through

the

l¡ansnission

of

sound energr

via

bones

TVhen

we

raise the

flGquency

of

fhe

tong

the

capectty

to hear through

the

llmpanlc

menrbrane

vla

¡lr

¡lso

gluws

quickl¡

wlrile

the

possibility

to

perceive

the

sound

in

a

tacfile nay

dccnases.

Either

when

the

speaker

is of

poor qualify,

or

if it is

a

good

ryeaker

but

driven

by high

power

cnusing

high

levels

of

energr,

the

sarne

rcsult will

oocur

-

the

overtones

that

arc

generated

in the membrane

ol

the

speakers

rtach

very

high enelgr

levels.

This ¡tsults

in

a

clearly

audible

tone

through

tbe

air¡

combined

úlh

a fundarental tone

which

is

perceiyed

by

means

of

touc\

when

In

reallty

what edsts ls a complex

tone

condsúlng

of

a

'l1rf

FREQUET{GY

(Hz.t

DIAGRAT|

OF

O

FACTOR

{

i

ii

32

33

)



)

)

)

)¡

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

ll¡nd¡msnt¡l

úone

and ¡

scrles

of

partlel

hlgher

úones

$ ''r

Thls

fblc

imprcssion

produced

¡n

ítrc

perrcepJion

of

tone

may

..,

cause

grcat

probl

otner

conlpli

il:l"T.,i:"r*l

be

srgnrncanny

ffben.bn

el0clronlc

sygtem

ls

used

fo

rcproducu

¡

muslc¡l

prcg¡¡n¡

also

be

t¡ken into accuunl

in

tenns

of

the

low

lbequencies

ffrf,,,ñ"

hrt"u*itr thar

may te

generatlng

irt"

i"itltt-;;¡

:;i.t

base

wlfhln

the

muslc,

and they should not

conlllct

or

lnterfere

wlth

,t

too"r

of

fhe

sinusoidal

oscillatorg

because

fhey could

also

produce

ilr¡romrf

alterations.in

the

rhythm of-the

beats

To

avoid

fhig

if

should be

possible

fo flller

the musical

program

to

diminate

all

the

tones

that are coincidentally

identical

with the

sinusoidal

oscillator.

Aú

a

musical

perceplual

level,

this

will

noú

be

scen

to alter

fhe

nalure

of

fhe musig

because

the

ear

will

restore

the

losl

infonnafion

on an o¡gan,

nous

process

sc is fo avoid

r

oonlicf

beJrreen

fundarnentals and overfones fhom fhe

stimulus. Therefore

lbe

music

can

have these

frequencies

filfered

oul.

Condusions

The

relevance

of this acoustical

p¡ooess

needs

úo

be taken

into

conslderatlon

In underslandlng fhe

physlcal

efÍects expedenced

frcm

vibmacrusfic

stimuli. A cumplex Íone stimulates

whole and

parlial

vibraJion

ola

body,

causing an efiect

in

the

human

being

of a

percepúion

of

vibmtion

in

spccillc

locationg

and also a

geneml

vibration

in

the body,

experienced as

a

whole body

vibration.

Mechano-receplors

sensitive

úo

vibration

are

rcryonsive in

speciflc fhequency

bands,

and therefore

the sensafion of

vibrafion

will

vary

depending

on

Jhe frequency and

upon

the ovefones

above

the

fundamental

fone.

i

bl

f,;

fi

H

0

E

É

m

34

35

)



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)

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)

)

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)

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)

)

)

)

)

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, ,.,i |

:,

.,..1,

-,

.:'i,

.r,..J

fl?Jl

r;.r'tHri'ltvi

r"n:

.]jntlrriilg-¡4lili Fú'f

i'iiÍii

lrr¡fjlt'lF''¡

,.i:r'itlr'':

r'ATW

e

etQloring

the

usic

and/or

low

disorders'

Úhe

ülD¡lo

Inhoduclim

h6c'

tones

app[efi

f*Fgcrry

ru

r'E

wsJr

t.¡'--

------

disorderst

Úhe

tq-x.rr---

__

.--'irr

rti¡Hnv is nor

without

a

scientillc

context.

^'aññr

o

níghlight

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

and

of

music

in

medical

(lrrtlctl

1996;

Ilodges'

1980;

Maranto'

liú),

thc

prcsent

chaPter

will

sene

Iúprtllng

these

re$ltsr

rether

then

as

-d

bc notcd

that

the

sections

lD¡).

spcc¡ncau

f¡tüological and

It

rthrionship,

trrrrtt.

)



)

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)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

Phyiolo3ic¡l

R:qoncr

úo

Muic

Rcscarch rcgading

physiological rcsponses

úo

mudc

typically

vorlous't5ps

of muslc

(Slmulettve vs.

scdatlve)

orv¡rlous elements

o?

in

ah

,a-ttempt

to dete¡mlne

if and

how

thec flmuli

infuence

a

physiol

sintel

Phydotogical

sates

most

often

sudied

irylu{g:

heart

ratg

temperature,

g¡-ivanic

skin

residancflcsn¡,

btood

prcbiure,

blood

respiráüibn,

digestion/gastric

nmfility,

muscle

and motor

nesponses,

SálCsr

and

biochemical

rcryonses.

E

In

studies

cmñining

the

el?ects

of music

and

heart

rate,

mixed

1996; Hodgeg

1980; Maranto,

1993b).

conclusivé

Íbnner,

i's

judged

by

the liferature.

However,

Úrends

of

music

decÉaé

bttiod

prcssurr o" to

have

no elfeci

have

been nofed

@arfletl,

l9l

Maranto,

1993b).

The

influence

of music

on blood

volume

is

inconclusivg

with

showing

eifhtir

an influence

or

no influence

of

music

on

blood

Mudc

¡nd shln

temperature

researqls

for

the rnosÚ

parl,

I

supported

musicls

ability

to incrtase

slcin

tómperature'(an

indicatio¡

reHlhfi

óilfl@artlett,'1996;

Hod

geq

19E0

;

Ma

ra nto,

1993b).

Resulfs

of rcsearch

enmining

the effects of

music

on

skin

(galvanic

skin

resistance)levels

have

suggesÚed

that.nusic

can effect

with

trends

fonards

a

positive-relalionship between music

and

"n

GSB.

An

anatysis

of subjectd

experience

wifh

the

music

in

some

of

studies

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

prcdicted

4_

Maranto,

1993b).

38

have

bccn

found

and

it is dimcult

fo

generalize

úhese

Íindings

or

pr{l

heari

rate

nesponses

lo muslc

In

a

glven

dlrtctlon'

(acceleratloo

-



:rri

clcarl¡

¡ddldonal

rcscarch

uülch

add¡esses

somo ol

lhesc lssues

is

nbcdod ln

the fl¡tur¡.

.t;.,:

rit:t

t'¡

f,li.,

",

:.

'

Prycüotoglcrl/Aftcflvo

Rc4oncc

o

Mudc

i:

,

'T[gry-

.

i_s

oonsiderable

difttculty

in

deflning

and assessing

psychologid¡VáfiCti*e

rcspohss

tó

music.

Tlresc

are

indeed

"complex

and

may

have different

independenú

determinants

....

The rcsca¡cher

is often

concerned

with

affempting

to sú¡ip

a$ay

or

neufralize

efraneous

envi¡onrnental.

factors

in

order

to

gain

indghf on

fhe

affeclive

set.

The

relatively

unstable

cha¡acteristics

ol

mmüe¡notion

nesponses

make

this

task

dlffcult" (Abeles

&

Chung

19Ed

p.

291),In

splte

ol thlg

In thls

sectlon,

there

will

be

an

aúlempt

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

with

caution.,similarly,

therc

a¡e

mixcd ftndings

rcgarding the

sex of úhe

lisúener

,:w**it

relates to

affective

nesponses

to

musiqt' but therc

appears to

be

a

relationship

bctrreen the fermle

sex

and

heightened emofional

responsesF

(Abeles

& Chung

1996).

affecf

the

emotlonal

with the

music

playeü,

srggesled

tl¡at

mood

Chung, 1996).

Olhe¡ Sudies

have tentafively

showr¡

Jhat

music can afÍect

'hnxiety,

symbolic

sexr¡al arousal,

inferpersonal

interacfiong

self-concepf

and

lest

performance"

(Abeles

&

Chung

1996,

p.310).

Elements

of

music associated

wiÍh

emofional

response

have

also

been

Investlgaled. Allhough

lhere

are

no cuncludve

flndlngs to thls

reseerch

wllh

regard

úo

ryecific

musical

elements,

fherc

do

appear to be r¡lationshipg

and

these

rclationships

are

also

influenced

by

characferistics

of

the

subjects

themselves

(Abeles

&

Chung, 1996).

It is

zurprising

to note

how

liftle we

still

know about

affective

nesponses

úo music fbom a

research

perspectivg

particutarly

when the

clinical

r

uses 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

more

solld

basls

for

cllnlcal

pracflce.

Efnocts of

Mudc

in

Mcdicel

TmJmcnJ

The liúeralurc

docunrenting

the

effects

of music

in

medical

t¡raúmenú

is burgeoning.

Music

has becn

used

s¡ccessfully in the

following

medicat

specialúies:

nconatal intensive

care,

pediatricg

physical

rchabilitation,

pulmonologl,

surgery

pain

mana

gemenl,

intensive cary

obstetrics-gmecologr,

end

oncologr/úermlnal

lllncss

(Mrrento,

1996i

1993e).

40

Iaborarory

and

clinical

¡escorch sludies

pyl{ing.gvidencc'of

thcsc

nena

have

-bcen

wll docr¡mented ¡nd ñúü*iti

Ott¡¡*ñie''D9di'1e93h)'i

arcas

arc s¡mm¡rized

very

brief[y In

3his'ütlon

In outüie

form

eccordlng

3o

phydologlcal,

psyclolo$ce[

behovlor¡l

end

psychoplrydologlcel

ne*onses

(fFom

Maran.o

1991f,

19)J)3a). Psychophysiological

ltsponses a¡s

those

(e€, st¡¡ss and

pain

responscs)

which

a¡¡ ¡clated

to

both domains.

Nanalog

Pryiologicd

norc rePiil

wcig[t

3ein

inñ.sd

food

eoocPúrre

tdrcd

vonltlng

end

g¡gglng

'

inotasd

oltgcn

selr¡r:rtion

lcYcls

shoúr

ho*ital súaY

Bcbvio¡et

rcdued

crting

iryrcvcd

bch¡vi,orel

fetcs

Pdiúi6

Prycüological

incrtescd

vcrüdizetims

reg¡rding

illncss

hclp lhmities

edjus

to

cüilds

illncss

i4rovcd

mood

dcca*s

in fcar

Bch¡vlorel

dcsta*d

bcbavi,onl

diú¡tss

Prytuphysiological

dcmscd

enxicty

rtducfion

in

sücss

syrytoms

doctasd

pein

Prrtsirnl RMllitobn

Phydologicat

strucfr¡¡cd

ftylhnds

movcmcnt

iryroved

mofon

ftmcfioning

rcinfored

dedr¡d

movcmnts

dcqtasod

musde

tension

H

lt;

t

0

ñ

É

m

I

>t

t

4t

)



E

ü

l¡

ü

H

0

T

a

n

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

PutmM

PFdoleical

rcduc{ion

in

rcqintion

ralc

lcss

hcart

r¡lc

incncasc

tugery

Phydological

,

-ó-

-..-ri¡t

htñrrl

Drcssurc

dcm*sinsydolicrdiastoücandmnartcrialbl'oodprcssll

dccreas

ln

hcert

r¡te

¿ocn

s¿

strcss

bomonc

lcvcls

do¡¡cascd

rcrPiretion

retcs

dcc¡tlscd

nusdc

lcndm

PrycholoClcd

ñffiúwiih

rudc

c:Pcricnc

fi

G-Om

-

":t.ririr .Éüirif

*lYd,*t

"l'

enritfY

io."ta.a

Pain

tolennce

l#f"nt*Fcuircd

ffiffitoryproadurts

cnUnoa

nlenuon

43

)



'Ux

)

)

)

)

)

)

)

))

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

mpc¡s.d

dm duüt

l¡bor

ah¡nood

L¡nlc

ptooodurcr

llcn.sd

GtrDbdir

oÍbffi

riilTirlF,Jt

PrycüoFydohCic¡t

dmsd

pin

Uiá

ry-Jn

st

f,.rl.t¿

fi.3-¡:.'.:r...

x

'

'

tÉl*.q

f*¡tri¡vi:¡l

1,,

Otdqilfetmitd lÍh¿ss

Prydohgicel

dootlsd

cücmoabc$rpy

ddc

clfocts

dccrc¡sd

vomlt@

dcsrasd

D¡uscr

Prycüologiel

i4rovcd vigor

iqlrovcd

mood

incrllsd

sdfdis&surs

Prycüophysblodc¡l

lcss

tcndon¡hn&ty

lcss

phydcel

disomfol

end

pein

Thorlaic¡I conefls

To sum¡narizg

there ane some theorctical concepfq

some of

which

are

b¡scd

on neseench,

whlch

provlde

e

bads

¡nd ratlonale

for

fhe

uses of mudc

in

medicine

and in strcss management

(Maranto,

1993b).

1).

Music

elicits

physiological

responseq however,

the direction

of

these ¡esponses

is

difficult

fo

predicf

in

a

consifent nnnner.

2). Music

elicifs

psychological

(mood/affecúive

rcsponses).

3).

Music rnay

evoke imagery and

associaúions

4). Music

elicits

cognitive nesponses.

O.

Music

has the

potential

for

physiological

and/or

psychological

entrainmenÍ.

6).

Phydologlcel,

psychologlcal

and

cognltlve

¡esponses

fo

mudc

ane unique

for

cach individual.

7).

Music

can elicit

psychological,

cognitive and

physiological

responses

simultaneously; these

nesponses ¡nay be

interrelated.

8).

An

indiüdual's

history with,

undcrstranding

of,

and liking

for the

music

ane dgnifcant factors in

psychological

and/or

physiological rcsponscs

elicited;furthermore

a

number

of

other

individual

variables may influenae

responses

to music.

9).

Elements

ol mudc, as well as the

muslc

gesúaltr

affecú

44

psyclologicat

and

plrydologica

rcagtlons

10)'

M"t-*

TTy 8""

I- ..r'""¿oo or dimídshins

effcca

(wücn

comblned

wlth

ofher

U,

i

''---

^--t¿t-.-

-o*rG.o

la

14.

Phyrúologicatr

psycholoEcat

and/or

oognitive

rcsponses

to

music

may

rn¡ry

according

ó music

haining

(Maranto'

1 t93b'

and

PsYchological

elfects

ment'

there are

a

numbe

,."1,,

be addressed

in

rcselnch

and

t¡¡atment'

2.

Whercas

some

physiological

and

psychologicat

effects

ol

music

arc

known,

f

hese

havs

yet

to

'ue

aet..ñtin

I

for

vA

therapy.

This

type

of

research

should

be

underJaken.

3.

Just

as

wiSh lrcatment

withouJ

low

frcquency

úoneg

m-usic

uscd

in

VAtherapyshouldtake|ntoctnslderatlonthe|ndtvidualneedghlsforles'

ñf";;;ñ

efc.

of the

patient.

Furrher,

the

choice

of

tow

firquencies

fo

be

use¿

mug

also

be

an

individualized

process

4.

need

fo be

considerc

of music

as

rvell

as

th

nces

as theY

rtlate

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,aswellasthe

contmindícadons

(see

chapter

n¡

otve,

trsatment

for rnedical

patients

should

be

careful$

sÚudied.

):

.

g.

Ferr

studies

have

compared

the

effecliveness

of

music

therapy

vs. vA

treatmenf.

This

in

another

important

area

for

investigation'

-

l

It

ts

ho@

that

thls

brief

chapfer

has

provlded

the

reader

with some

inforrmtion

about

the

brnader

context with

which

vA

therapy

may

be

viewed

in

terms

of

resear¡h

and

clinical

practice.

There

are

certainly

numenous

possibilities

inherent

in

the

fufure

of

tn¡s

trcatment

modality'

Rcfcnenes

Abeleg

H.

F,

&

Chung,

J.W.

(1990.

Responses

to

music'

In:

D'

Hodge:

(ry)

'i

'

------nli¿boon ol

"muslc

psyctrology

(2nd

Edtrton)

(pp.

285-342).

San

,iil

;i

45

H

u

t

I

m

q

)

)



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

T

I

I

)

'ti.,

Anionlor

IX:

IMR hrcss

Borúle

l.

In:

,.PÉr

(pp.

i

'iíki.:

Dafnow, E.

$nn.P[yslcal

effects

and

moúor

nesponses

fo

music..Iournal

of

Rcsrch in

Music Erlucation

á,211-221.

Harrur,

Go

& HarrtrrH. (lÍ17.

Musig

emotion

and auúonomic

fl¡nction.

In:

M. Crifchley

& RÁ-

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:

Kendall

Hunt

Pubüshlng Co.

Lacey,

J.I.

(l 156).

Thc €valuation

ol

autonomic

responses: Tonard a

general

solution. 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:

A

creafive

arts

child

life approach

(pp.

39ó6).

Cherry

Hill,

NJ:

Jeffhey

Books.

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

P¡ess.

Maranúo,

C.D.

(1992).

A

comprehensive dellnifion

of

music

úherapy with

an

integrative

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.

MaranÍo

(Ed.)

Anplicafions

of

music

in

medicine

(pp.

l-d).

Washingúor¡

D.C.:

NAIVÍ

T.

Maranto, C.D. &

Scartelli,

J.

(1992r.

Music

therapy

and

psychoneuroimmunolog5r.

In:

&

Spintge

& R.

Droh

(Eds)

MusicMedicine

(pp.142-É9.

St.

Louis:

MMB Music.

Schacte¡

S.

(1957).

Pain,

fear and

anger

in hypertensives

and

nonhy¡lerf ensives Psychosomaf

ic Medlcine

P,

17 -29.

Schacter,

S.

(f964).

The

lnúeraclon

ofcognltlve

and

physlologtc deterr¡rlnenfs

of

emofional

states. Advances

in

Experimental Social Ps.vcholog¡,

t

49{0.

Sfandley,

J.M.

(1995). Music

as

a therapeutic inlervention

in

medical and

dental

lreatmenú:

Research and clinical

applicafions In: T. Wigrar4

R.

TVest

&

B.

Sapersfon

(Erls.)

The

arú

and

science of

music

fhe¡apy:

A

handbook.

(pp.3-22).

Swiúzerland:

Harrvood Academic

Publistrrers

Standle¡

Ji\{.

(1992).

Metaanalysis

of ¡esearch

in music and

medical

tr¡atment: Eflecf

slze as a

basls for comparlson acmss

multlpte

añatyds

¡nd'cllnlc¡l

lppllcaflons.

1r:"

l2Z

rnuut,

n¿

n.

(leseb)'

rhe

influence

ot m,.1s1j1t:1"I*ll3^:t:::*

"n"og".'in

reíaxatioq

affect

and

tho'tghl

in

psychlatric

prisoner

patients

.Iournal

of

Music

Therapy.

Ú'

t.55'166'

,:i

.,.

:;i

',l

:I

lii

ti

:¡i

47

i,j

6



,

I

I

FOT'R

ür

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

use

v¡rioul

fpcs

olvibroacuusúic

equipment

to explore

its

effects

on a

variety

of

cfinicat

populations

(skitle,

1982a,1982b,19E6).

During

fhe

mid

1980'9

there

ms

no

comrnercial

produclion

of

vibroacousúic

equipmenÚ

in Europe,

and

much

of

it

r¡¡as

conlrucled

for

rtsearch

purposes.

I

recommended

in

my

vlbm¡cousúlc

therapy

menual

(19E6,

1991)

lhat,

for

eÚhlcal

nealnnq

lt uas

important

and

necessary

for

the therapist

and

the

staff

who

were

experimenting

wifh fhis equipment

to fest it

on

themselves

first

beforc

they

used iJ

with

clienfs. The

reports that

were then submitted

showed

me

that the

trcafinent

had effects

on

several

different

conditions

fhal

were often

found

prinarily

in

staff. In

this

way, the

variety of

pofential

applications

of

vib¡oacrustic

therapy

began

fo emerge.

The anecdotat

res¡lts

fhat accrued

over

many

years

of experimenfation

can

be looked

at

as helpfut

and

guldlng ralher than

sJatlstlcally

slgnlflcant

(Skille,

been

a cerlain

amount of

objectiv

although

very ferv

studies

underta

rc has

been

a

wide

clinical

a

lication

of

fhis method

wifh

many

reported

positive

effects

collated

rcports

fall

into

flve rmin

clinicafpathological

areas: 1)

pain

disorderg

2) muscular

condifions,

3)

pulmonary

disorders,

4)

general

phydcal

ailrnenfg

and

5)

psychological

disorders

P¡in

Disordcns

,:',

There

have

been

rcports

of

the

effecfive

use

or

vibrcacoustic

fherapy

with

colic

paing

borel

problemg

fibromyalgia,

migraine

and headache'

low

H

f,;

0

H

1.1

H

m

I

I

f

t

49

)

)



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

¡

)

i

J

I

t

I

I

I

I

I

I

fbequencies

beúween

50-S5IIz.

The

fhequencieg

as

opposed

fo

ofher

fheq

noJ

based

on

any

¡esearch

¡esr¡lts.Iti

over

flfly

per

cunt

of patien

helped

úhrough

a

rtducúion

A

deJailed

analysis

of

rnechanoreceptors

r¡as

undertaken

(1992)

In

súudtes

on

paln.

Thetr

s

(MVTfm)

have

found

significant

e

¡rduction

when

cumpared

fo

music

speciflc

frcqucncy

mnge

(60{(X)hz).

Mi

equipmenf

which

r¡as

a

juS$

to-generate

g*ater

acfivity

in

lhe

frequencl

ranges

known

fo

pruduce

pain

re[óf

(appnoimat",y

t'ó:iió-h;;:

back

pain,

menshual

paiq

d

fensio4

bechtercw,

ncck

and

st¡oulder

¡rxorto_

,.-,-_

Some

of

úhc

lnaúments

und

^

.

,{

il'óüircessfiit.

The

use

"r

mq¡;lJ"¡-

I

S'

all

other

ÚreatmenJ

'¿ln"and

Gcncrat

Phydcal

Ailments

clinical

problems

in

Úhis

category

mighÍ

include

fhe

following:

decubiditus

ulcers,

rtduced

btood

circulation,

and

post'operalive

lhaú

iú

has

had a

successflrl effecf.

Psyclolo

gical

Di

srders

VA

treafment

can

have

an

efnect

on

psychologlc¡l

sfates

whlch may

or

may

not

contribute

to a

physiological

condiÍion.

In

fhis

group of

problemg

vibroacoustic

therapy

tras

tecn

ur"¿

in

the

treafment

of:

insomnia,

anxiety

disorderg

self-iaiurióus

behavior,

challenging

behavior,

autism,

depression,

and

stress.

'l

Autisn is

though

to be an

organic

condition,

and

Jherefore

should

not

Musr¡lar

Conditbns

Vibroacoustic

therapy

has

parficularly

when

those

prpblems

has

received

a loú

of

atfenfion

fho

of

vibroacuusfic

therapy

in

reducing

muscle

úone.

p

reacú

wilh

spasns

to

over

excifement,

high

stimulafion.

Therefore,

relaxing

music

using

iow

rarrge

has

been

importanf.

some

or

fhe

freafmenJs

thal

have

taken

prace

wifh

vlbroacousfic

úherapy

have

arso

Invotved

dorng

acúrve physiofherapy

durrng

or

immediately

after

the

session.

other

muscurar

crnditions

thaf

have

been

herped

incrude

murtipre

sclero_sis,

Relf

syndromg

spa

súicity,

and

muscula"

o""r-ur"

rjna"o,,,".

Research

in

úhe

crinic

nor

cñila.,

and

adurts

,,rfh

R"il,y"drome

af

Harper

House

rffordshire,

England

has

already

indicaúed

a

posit

to

VA.

sp"á¡n"uilv,

iicrease¿

levets

of

relantion,

uced

hand pru"fñi

ai¿

re¿ue¿

hyperventllaflon

n

noJed

(Cass

er

^l"ieX;'Wtgram

&

Casg

1995).

pai

pai

ane

50

lft

ñ

tr

It

¡\

t:

t

Fi

0

t

H

m

51

'

)

)



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

SUMMARY

applica

úions

of

vibroacuusJic

e:rperience

does

not

claim

fo

material

docu¡nented

in

this

the

oufcome

of

vibroacroustic

summarize

reporrs

rhom

crinica,'.i;lj;';#t'*:H$"Tli"TTffi:I

:?

pathological

conditions,

and

indicafe

tñe

extensiie

pofential

oflvibroacousric

lherapy.

REEERE¡{CES

Casg

H,

Slonimg

V.,

Wee

services

for

Relú

Sy

needs?

paper

presented

úo

Jhe

Ro

M'.orm

on

rhe

retier

or rheuma-fil[H3:tfir:'*%:f

University

of

Norúh

Tens.

skiffe,

o.

(DE2a).Musikkbadet

-

Anvendú

for

de

svakesfe.

Nordisk

ridsskúft

__

--

for

Sspeciale pedagogil<k,

4

275-54.

skille,

0

(19E2b).

Musikkbadat

-

enn

musikk

tempeutisk

metode.

Musikk

Te¡api,

l2+27.

Sú. Louis:

Magna

Music

T"

L€vanger,

Nonray:

ISVA

publications.

SHlle,

O.

(1991).

Vibrcacoustic

Therapy:

Manual

and

RepoÉs

l-evanger'

Nonray:

IS|VA

PubllcaÚlons

gfg|"anL

T,

&

Casg

H.

(1995)

The

role

of

music

therapy

in

a clinic

for

-

chilücn

and adults

with Rett syndrome.

Paper

presented

to

the

BSMT

Confercncer

l¡ndon.

I

I

I

t

(

t

(

t,

t,

F

fl

Skllle,

O

(1986).

Manuat

of

Vlbroacuusflcs

Publications

Levanger,

Nornay:

ISVA

skille,

o

(IgEga)

vibroac¡usfic

research.

I"

.R.

Spintge,

&

R. Droh

(Eds).

_

-_

Music

Medicine.

SJ.

Louis:

Magna

Music

Baton.

tllle

O

(r9E9b).

Vibroacousfic

therápy.

Music

Therapy.

&

6t-77,

skilfe,

o

(1992).

vibroacousri"."**-h

l9E0-199t

lrñ:si¡nrg.'e

R.

Droh

52

53

)

)



'.-

I

'l;{.r'r..-

,'

¡

I

)

t

)

)

)

)

)

I

I

I

I

I

I

I

I

I

I

I

I

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

SECTION

tr

Rr^sEaRcu,

CT.,INICAL

AND

AIt{ECIX)rat

REPORIS



,

I

l¡.:.i.;.,{¡¡¡.r{¡

.

i

.'

-..r

EEECT

OF

VA

TEERAPT

ON

MTTLITPLY

EANI'ICAPPEI'

lWtn

WTIfl

úIGE MarcIE

TONBAND

SPASITüIT

foryWtFm

Inhoduclion

The

study

documenfed

in

fhis

chapfer

focused

on

fhe

effecl of VA

thcrapy

in

rcducing

muscle tone in

patients

with

spasficity.

Cercbml

palsy

is

riúsc¿

as

¡ ¡cstlt

of

an lnJury

to a

part

of

the braln before

lt

ls fully

dtivelopea.

I-b9

thrce

rmin

types of

c'erebral

palsy

art

ryaslicil¡

athetosis

and

."¡¡.The

pafients

in tniJituUy

srlfer ft.om

spaslic

disorUers.

peopiJrüin

spaficity

have

different

levels of

muscle spasn, causing

a rigidity

of

the

nuscles

A

spagn is

an

invofuntary

and

sor¡etimes

painfU

conf.raction-of-Jhe

musclg

mrtscle

gn¡up

or

of lhe

muscle

r¡all

of a

hollor

ofgan. Spasms of lhe

rúlile

body

are

referred

úo as

convulsions;

painful

spasms

of muscles or limbs

¡s

cramp;

and

úhose

in

Jhe stomach

and

abdomen as coüc.

In cereb¡al

pal.

slg¡

petlcntg the most

comnt)n

form of

spesm ls ¡ tonlc spi3m

Involvlng a flrm

sfro4g

contfaction

causing

ng¡dity

in

the

muscles.

The spasn

effect in

sriñCicity

¡esulib-f¡orfi a release

of fhe

gamma

system

from higher

inhibitory

pntml

and

is chamcúerised

by a

synchronized cxciúatory

phase

followed

by

a synchronized

phase

of

post+xcitatory

inhibition.

Afler

úhe

passing

of

this

phasc

of

post-excifatory

inhibition, one

of inhibitory excitation

returns. These

crents

can

be

clinically obse¡ved

in the

phenomena

of a spasúic muscle and

art

demonstraúed

in

an

exaggerated

stretch rcfle4

"clasp

knife,'r and the

léngfhenlng

¡nd

shorfenlng

ol

rvacflons

(Bobath,1972;

Bobeth

and

Bobath¡

rna.

..

Patienús

wilh

spasficity

are usually

found to

have:

1)

A loss

of

confrol

and

differenfialion

of flne volunlary

movements;

2)

suppression

of normal

¡ssociated

movernenls;

3)

presencc

of ccrfain

normal associated movernenls;

4)

hypertonus

ol

úhe

"clasp

knife"

gpg

with

a

following buitd-up of rpsistance

to

passive

¡novement (súretch

reflex);

5)

emggeraled

tendon

¡eflexes

and

possible

clones of

úhe

other

joints;

and

6) deprtssion of srperllcial reflexes.

I

More

typlcalty In

ryaltlc

paflents

onc

wlll

flnd an

lnc¡eese

ln

flexor

long

and

this is often

grtater

than extensor fone.

Imbal¡inces

in

fhe strengfh

of

muscles

will lead to contraciure

of spastic muscles and

weakness

resulfing

fhom

disuse

of

their opponenfs

(Jones,

lgTS).

rll

u

fl

¡{

H

0

fr

m

m

57

)

)



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

,

)

)

)

)

)

)

)

)

)

)

)

)

')

)

)

I

I

I

I

I

)

I

I

I

I

wücre¡s¡

lrcaÍment

ú""1-"1ry. og"therq¡¡

.

,

scd¡tlvc

baelgroun

diñáÁ-.or es^

,J

¡

lt.I"

n

üsue+

fttt¡

Ftr

s

ls

mr{ed

ii{

i.t

ruler/ms¡re

to rccord the renge

of

moverent

beforc

end

¡fler

iüil.f¡:,

..

i,

: ¡'

i.

,

I 'i

:

r:,¡'R'il:.¡';ii :i]+¡r¡

,J' ¡'i¡i¡¡r

l--ffi-t' ThC

qQerimeni

was

designed

as

a within'srbirfs

study wiúh

single

i

iñiu

ev"lu"tlon'

rhe

e:perlment eveluated-

l:i:, Iii"-11l^lí^-Y.'-^**:t;

1*"1"^'.*ñ;-d;'

iiffil;"%H;

can

De

used

in

cu4iunction

stúment

and

a

pulsed,

sinusoidal

lor

frequency

lone,

com

played

through

the

vibroacousfic

unit

sithout

¡

cncy

tone.

EXPERIMENTAL

EYPOIEESES

_

The

operimenf

described

in

this

chapfer

rmked

at

fhe

effect

of

vA

Sherapy

In

reduclng

qy"p

acüvrty

and

hrgñ

muscre

tone

In

pailenfs

n{rh

crrcbral palsy.

Ihe

lollowing

hypoúheses

we¡c

made:

'/

a)

sedaúive

music

in

cumbinaúion

with

a

pursed

row

ftre4uency

sinusoidar

toneol

4/lrrz_rpourd

have

a

greater

effect

in

reducing

muscrc

fone

in

ccrebml palsied

subjecfs

than

sedative

music

alone.

7'

b)

scdative

muslc

and

a

pulsed

lor fhequency

sinusoidal

tone

oI

44Hz

w_ould

have

a

greafer

effect

on

brood

pressure

fhan

sedative

music

alone.

Subids

Thrre

male

and

seven

female subjects

resident

in

a

large

mental

bospltal

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.

The

subjects

were

selecied fbom

a

wider

group

of

patients in 3he hospital

with

motor

disabilifies

because

they all had spastic

cercb¡al

palsy.

AII

Jhe

subjects

had

measumbly

high

muscle

tone

which

affected

each

of

them

in

differing

rmyg although

there

rvere some

aflected

muscle

groups

thaf

wert

strared

in

cornmon

by

all of

the

subjecfs.

Ihe

most

common

pmblems

shared

by

the majorify

of

the subjects

were flexor-spasm

in Jheir

¡rms

and

legs,

and

adductor-spasm

causlng

dlfllcultles

in

separaflon

of

the

tcgs,

which

in turn

can lead

fo

"scissoringtt

of

the

legsr

with

a

potential

consequense

of

subluxed

or

dislocated

hips

M¡tcrials

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 mounled

In

boxes underneafh

the sprlngs

with

the

cones

dlrecÚed

upuards.

The

speaker

boxes

contained

t'by

8"

porfs

for acousfic

balancg

and fhe

cone of

each

speaker

nas

approximately

two

inches

below

fhe

springs

of the

bed

so

that

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 lay

on

the

bed, one

speaker

nas

placed

under

the thoracic and

upper

abdominal

arca

of

fheir

body,

and

the

other speaker

nas

placrcd

under

the lower fhighg

knees

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

plle

sheepskin

rug.

The speakers

were

powe¡ed

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

pulsed

sinusoida

low

frequency

sound

nave, and

the music

in condition

2 rras

played

through

a Technics

RS-Tll

stereo

cassefte

deck.

ti:"

The intensi$

and

tone

controls

on

the

amplifler

were

gmded

nutrcrlcally.

In

Jhe

pmcedure

of thls experlment,

the

controls

ol rnaster

METHOD

(

b

t,

F

A

)

)



'+tci

I

)

I

t

I

)

I

I

I

I

I

I

I

I

I

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

,

)

)

)

)

)

)

)

.)

)

)

)

.)

)

)

)

D

:ilil

trcble tone contr¡ls

uer¿ seú at

zcrc, ensuring fhat

an

equal

balance

of

tonc

and

equivalent volurne

nas

mainfained

in

fhe

music only

condifion.

The

subjecús rvert

frcated

horimntall¡

and

úhe

spcakers were

set into

tbe

bed

ryith

the

cones

facing

up. The

equipmenl s¡as

isolated elecfrically,

and recordings

rve¡e

used so

the

style

of

music, intensify

of

the lor

hequency tone

anl

geneml

intensity of

lhe music

we¡¡

cronstant

for

each

trial.

A mal*er

pen

$as

used

fo

rnark

poinfs

on the

subjecf,s bodies

for

measunementr

and ¡

crnvenflonal

cloth

fape-measurc

wlth

centlmet¡e

markings

rvas

u*d

to ¡ecord the

range of movernent

beforc and

afte¡

each

trial.

.

AJohn,

Bell

and

Croydon

Model

DS-175

Auúo

Inflation Digital

blood

iprcssurc

monilor rvas

used

úo

record

pressunes

and

hearJ

mte.

The music used

in both

condilions

rvas

'Crystal

Caverns" by

Ilaniel

Kobialka.

This

music is

described

as'Nery Age,"

and

is

tonal,

melodic

and

harmonic non-pulsed,

arhythmic

music

prcduced

on a synthesizer.

The

piecr

lasfed

3()

mlnutes,

and e 44

Hz

slnusoldel

tone,

pulslng

aú

a

speed

of

approximately

8

seconds

peak

to

peak

nas recorded

from a

ftlncúion

genemtor

wilh the

music on the úape.

Mcasurcs

Blood

pressure,

hearf

rate and

range

of

movemenl

were measurcd

before

and after

the trials.

Nine

measurements

were

identified

on the

subJects'

bodles

(Table

1).

Baseline

measurcmenfs

were

taken of the

minimum

range of movernent

in

measurcments

that had

been

decided

as

pafhologically

important

and

appropriate

for

each of

the subjects.

These

baseline meias¡¡nements were

Jaken

by

measuring

the

minimum range

of movernent.

For emmple,

if

the righf

arm

was

flexed

to

the

poinú

wherc

the

right radial

artery

came as

close

as

possible

to

the

right

shoulder,

this uas ¡ecorded

as

the

minimum range

of

movemenl.

Measurements

werc

faken of the

degree

of

efension for

each

of

thesc

movements

beforc

¡nd

after each

hlal.

Each

subJect

hed a dlfferent

set

ol

measunementg although

there were

lnme

measurcments

lhat

we¡e common

to nnny of

the

subjects

(Table

2).

Data

were

rccorded in

cenfimefres

ol

the

measunements

Jhat

werc

faken beforc

and

after

each

hial.

The

differencp befween these ¡msurernents

indicated

an

incrcase,

or

conversely a decrease,

of

the

subjecf,s range

of

movement.

The besú

impmvement

in mnge

of movenrenl

thaf a

subjecl

achieved

in

any

of

3he

conditions r¡as considered

úo

be

the

subject's nraÉmum

range

of

movemenf

In

that

measunement.

The

mlnlmum

range

of

move¡nent

l:

nibi¡¡U

De¡r¡rd

drer¡A

ü¡L

n

-rt,¿tr

.

á;¡S,.¡ir.,1,'

i1

l.ñl

iliirá¡f-¡¡r -

,:ttJt

,

Tb..*lttc

Dol¡a

of lb.

bn

¡üor¡l&t

ao

lü.

.lüm

Pol¡l

of

tb3

riaht úould.r

To u¡¡u¡r

¡u¡ndcd

rbor¡ld.rt

t

Tb.

cl¡tolc

Pobt

ol

lbc

¡Lbl

3h@ldc

lo

thr rl3h¡

Edhl

.¡l.tt

To

ÉtuE

.lÁtlo¡

of

ah.

rltba

¡tm

J

ThG

GlrcD

Po¡Dt

of ah.

hn

thouldcr

lo

lhc lclt

Édl¡L 4 q-

To

rp¡u¡:

afan¡lon

ol

lhc lcll

¡m

4

Th.

rkhr.lbfl

lotüt

rEbt

sc¡th

¡ib

To

¡sru¡r

l¡irint

ab.

rhhl

clbow

ftoD

lb.

bodY

(

Thc

lcll

clbow

lo

lhc lcll

svcnab

db

To

[pg¡re

]rl3lng

lhc lcn

clbr hom

lbc

bodY

ó

ThG

llP of

lhc

no$

lo

lhc

n¡vcl

To

rsrun

d6re

of

krDbot¡3

7

ThG

¡Lhf

tidc

art

l.¡ lmch¡nlcr

lo

lh. ¡Lhr

¡¡dc

Llq¡l mrl¡colús

To

nÉtur

clcn¡ion

of

lbc

riSDt

l€

E

ThG

l.n

s¡d.

grt

lc¡

lllcb¡o¡cr

ao

¡h.

lclt

sld.

l¡lcl¡l

m¡llcolu¡

To

¡s¡un

.Lns¡o

ol

lhc

hn

¡€

9

Thc

antn

b¡sr

ol

lbc dthr

Ftcll¡

lo

lhc

anlrc

b¡r

of

lhc lcn

Pal.lh

To

¡g¡¡rt

¡bductlo¡

ol

ahc

hip3

:,'i

:Ifl¡.li.t$;('f{tf

.';

i 'I.t

:¡t-'zii¡¡ti

'

wasthen

subtracted

define

the srbjectts

naximum

potential

fhis'

the

difference

scores

achieved

in

percentage

ol

this

¡n¡¡ximum

potential

range

of mvement.

A

calculalion

could

then

be

made

ol

thc

srbjectts

p""".rrroglimpro"em"t't

in

range

of

movement

in

each

of

lhe

conditions.

i

In

each

trial'

an

[osdble

extended

range

independent

evaluator

measured

the

maximum

ntt"".n

each

of

the

two

marked

polnfs ln

each

)

)



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

t;;

bourse

of thc

trlal.

Vthen

úhc

Hal

evaluator

cene

b¡ck In

order

úo

i¡ke

the

post-

they

w,e¡e

blind

as to whether

the

srbject

had

condifiou

B.

Conirol of

dcr

Ellcrfs

In

a

repeated

measr¡res

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

beúween

the

two

cnndifions

was

nol

eslablished,

because

fhey were

all

functioning

af

a

pre'verbal

level. The

order

of the

trials

uas the¡eforc

randomized

to reduce

the

potenflal

effecf

of

any

crndltlontng

to

the stlmull.

Bl'ood

Prcssu¡c

¡d

Hcarf R¡lc

seven

of

the

subjects

had

blood

pnessu¡e

and heart

rate

measu¡rcd

benore

and

after

the frials

There sas

a five

minute

resting

period

at fhe

beginning

beforc

fhe

inifial

blood

pressune

measurement

nas

taken.

wifh

fhree

subjecls

in this

grcupr

it nas very

difticult

fo

measurc

blood

pressure.

one

subJect

had such llghú

flexor-spasm

that

lt

nas

physicalty

lmposslble úo

put

the

BP

monitor cufÍ

on

his arm.

Another

subjecú

consistenfly

rec¡rded

emors

due fo lhe fact

thaf she had very

short

arms and

flexor spasm,

making

it difflcult

to

recrrd

rcliable

data.

Another

srbject

had such

thin

arms

blood

p¡esstre

measunes

were

unreliable.

Wilcoxon

Signed

Rank

Je$s

werc

undertaken

on

the

data.

Proedure

Subjects

wert

laken

out

of

their

wheelchairs

and

ptaced

on

fhe

vibrcacousúic

uniú.

They had

foam

rubber

pillows

(sound

dampening

maúerial)

under their heads,

and

where

necesery

fheir

bodies were

supported

by

pillows

containing

polystyrcne

beads.

After

a resfing

period

of

five minuteg

their blood

pressunes

and

heart

rates

werc taken,

and

úhen

measuremenls

n'erc iaken

as

prwiously

specifled

for

each

srbject.

The measurtmenls

were

faken

by

marking

wifh

a

nm¡ker pen

a

c¡oss af the

specified

points

on the

body

and

fhen

aftemptlng

fo

exfend

fhe llmb.

A measurement

r¡as

laken

of

62

betncen

the

tno

polnts.

Thls

proccdunc

w¡3

noJ used

lor

one and

dr lbe s{¡air¡ttor

lefiafler

ÚaHng thc

meas¡rements,

sitting

quietly

in

the

roonr,

avoiding

eye-contacÍ

or

any olher

form

of

physical

or communicafive

contacf

.

At

the

end

of

the 30 minute

tape,

fhe

therapist

Jurned

all

the

controls

lo1a¿ro,

and

the

Independent

evalualor

nas asked

to return. Blood

pressure

ás

micetr

immediately.

The independent

evalualor

then

took

again

lhe

measunements

relevant

to

each

individual.

Finally,

fhe

measuremenls

were

entered

on

a

fotm

which also

recorded

the

day

and

thc fime.

Other

observed

behavior

was

recorded

for

the

purpose

of clinical

rccords.

essed

onlY

to

The

subjecfs

l.i,??lillli:

eryecially

blood

preszure

measurements.

RESIJLTS

Table

3

gives

the mean soo¡es

in

perttnfages of incrcases

or

decreases

in range of movement

within

a minimum

and

maximum

mnge.

In

fhe

box on

the 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 the

bottom

right hand

oorner

of

fhe

table,

and

show

a

l37o

improvement

in their

range

of

movemenf

in

the

trealment

condition,

and

lVo

improvemenf

in

the

placcbo

condition.

The

mean

scones

of

all

the

nrca$lnements

in

fhe treatment

condition

are

shown

in

the same box

at

the bottom

right

hand

corner

of

the

tabfe

and

revgal

a

167o improvement

in

the

treatment

condition,

anll a

3Vo

imprnvement

in

the

placebo

condifion

in

range

of movemenl.

The table

shows

lhaf,

in

atl

subjects,

fhe

rncan

scones

revealed

an

lmproved

range

of movement

ln

Condltlon

A

over

Condltlon

B.In

some

cases

this

result is

quite

dramatic,

and

in other

cases

it

is

less marked.

'

,

A

Wilcoxon

MaSched-Pairs

signed-ranks

test

calculated

on the mean

pelt:enúage

improvernent

in

mnge

of movement

within

fhe

srbjects

(comparing

fhe

Íreatment

and

placcbo

conditions)

found

a

signiflcant

diffcrence

between

conditions

(P

=

0.0051).

This

resulÚ

indicated

that the

Úrcatment

achieved

signiflcantly

greater

range

of

nrovement

in

fhe

zubjects

than

fhe

placebo.

a TVllcoxon

Matched-patrs

Slgned-ranks

Test

on

lhe

measurements

me. ¡urcmcnf.

The method

of

meesr¡remenú

ls

descrtbed

In

more deú¡ll

ln

fhc;

proedurc

soctlon.

rhe

independent

craluaúors

w€rc

irot

prescnú

durlDg

tb;

t

ll

l¡

t-

h

r

¡:

1*

(:

tl-.

F-

É

ú.

63

)

)

T'T

DISCUSSION



)

)

)i

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

tn"

oot"om

or

this.'q1*1:-"

#:i:*ttl'gff"t5i:

*H

ion

in

muscle

lone

ion

in

muscle

lone

when

music

alone

pFessure

was

not

li

'f."f..r.

.i

I

I

I

TrD ¡

$

M¡¡

FÉ.f lEld

c dÉltrd

É a"t

Dml

rltf,l¡

¡blru

ud

-{ffi

nn rf,ñ ú maE PÉ

lor

bclh

o¡d||loú

bnú

pÉ

Mc¡¡¡¡c¡:

I

2

J

{

5

6

7

t

9

M

E

.{

N

s

St

Ccr¿l

Ctú2

+t

.¡

+J

.t

+5

-6

+¡

.l

+la

.{

+7

J

Sll

Co¡d.l

C;¡ú2

+¡5

-3

+41

-2

+ 1

+

:.J

S.1

Col"l

cod¿

+ll

+5

+15

.t

+t2

+5

+5

0

+u

+l

S*

Cod.f

C.rod2

+Ió

.lJ

+ l

.3

+27

.J

+U

+J

+l

9.{

S*

Co¡d.l

C.tú2

+{

-E

+ló

+1

+ 5

+10

+15

+J

Só: Co¡d.l

c,,d'2

+l

+-l

+l

+J

+

+l

+%

+5

+7

+2

S7:

Co¡d.l

Ctú2

+U

+{

+l

+l

+l

+2

+5

+

S&

Cold.l

c,'d,2

+:0

+

+10

+5

+15

+{

S

Co¡¿l

c',ú2

+tz

0

+22

.J

+9

+J

+9

+6

+12

+3

+-rl

.t

+19

+l

Slocod.r

Ctd2

+3

+2

+ 7

+tó

+5

.5

+31

+l

+17

+J

+ll

+{

CoD¿l

Me¡¡c

Cord,

Mcru:

+lE

.¡

+l,|l

+9

+5

+

+J

+ 5

+10

+U

+ló

+t

+l

+9

+J

+19

0

+l¡

+l

+16

+J

.¡aniflcant'

't""ih"*

results

indi

and

in

sPecific

aneas

r

exemple'

where

they

nfage

terms

in

their

Ptcal

asyrület¡T

commo

cercbml

Palsy'

quite

ol he

dislocation.

Regular

imoortant

to

Prwent limbs.

fixe¿ nexion

deformit

scones

ln

the

placebo

SubJects

one'

il

I

I

t

I

I

i,'

h

li.

soones

showed

the

tr¡atment

condltlon

obt¡lned

slgntflcantly

better

scores

fhan

the

placebo

condition

(P

=

'fi151)'-

Analysis

or

rnc

aineüoe

sooncs

fbom

the

blood

prcssures

and

hearf

t?t€

measunements

takei

¡"lot

and

after

the

trials

fbom

the

seven

stbjecfs

úose

blood

prrssrrc

qas

rnonitorcd

rcvealed

no

slgniflcant

difference

;;;;t

condiiions.

Therc

w¿s

an

indication

that

sysolic

pnessrnc

qas

reduced,butfhere*'.'.*¡¿"variationsinthedatatakenfbomdiasto|ic

pnessune

and

Pulse

mfe.

65

)

)

ondltlon.

Thls

lndlc¡tcd

úhet

thcy

octudS

became

tlgbter

end morc

[s¡4-'

tests

¡re

rcqutred

to

cvalu¡te

the



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

t;l

I

as ¡

¡¡s¡lt olMng on a

bed

and

llstening to

rela:dng

music.

Subjecú

fourr¡i:

au.anxious

laf who

found 3hc

pnoocss

of

bclng measured

difllcula.

ihls docs

pmr,lde

cvldencc fhat

for thls

subJccú

the

tre¡tment

condlt|on

qi

sig¡iflcanJly mone suoge ¡srfut

in

helping her to rela4 desplúe

raised

an:det

become

fighten

In

the trcafment

cudilion

where they were receiving

both

muslc

and

e

slnusoldal

lor

frcquency

tone lhey

became slgnlflcantly

mo¡

relaxed, highlighting

the difference

befween

the treatment

and the

placebo

condiüons

Therc we¡e

a

number of

problems

which

emerged during

the cnurse

ol

the frialq

which

should

be

considered

as

limitations

in

this

experiment.

Thc

equipmenú

used

needs to

be

carefully

assessed

in terms

of resonance.

Fbequencies

can

cause

an incrcase

in vibration

in fhe

bed. This appeared

to

happen

at

ce¡fain

points

in the

music

that r¡as

used, and

it

r¡as

noticed

uhen

a bass tone

sounded In the

muslc.

Horrever, thls was

conrmon In

bofh

conditions.

The

skill and

cunfidence

of

the

staff underlaking

the independent

evaluation

varied.

Sorre

rre¡e

orperienced

in handting the

subjects

and

maintained

consisúency,

whercas

othens began

in

a

mone

tentative

manner

and

grew

in

conlldence during

the c¡urse

of the

trials

which

could

nrean that

early results

reflected

a

less signiflcant

result than

later

resulfs. This

nny

have

averaged

ouf

and

the

dala

recorded

rcflecl

averaged

sc'ones.

However,

In future trlalg

a

famillarlzatlon

perlod

would

be

lmporfanf In

order lo

obtain

rcliable baselines.

Some

evalualors

gave

supporfive

verbal

encoutagement úo úhe

subjecfq

and may

have affected lhe

ubjecld

re+onse

during úhe

measuremenfs

Evaluato¡s

varied

in

the

length ol time

they applied

pnes$re

to

¡neasr¡¡t

range of

moyem€nt, as lherc rtas

no

defined

limit

in

úhe

experimenfal

procedurg

and

lhis

rmy have

caused individual differences

in

ranges

of

extension.

Evaluators

may also not have

applied enough

pnessure

at

fimes

Most

of

these

Influenclng varlablcs

would

be counteracted

by lhe 'bllnd"naturrc of the trials.

Vfhen

J¡eating

srbjects who

had

high

muscle

tone, il uas frequenfly

nocessary úo

support

various

parts

ol

their

bodies

due to to the

increasing

spa$ns and

fixed

deformities fhat

were

developing. Tlris

nas

achieved

by

using

pillows

f¡lld

wilh

polysgrene

beadq and typicalty,

one

would need

to

place

them

under the

knecs

or

legs where

flexor-spasm

had

caused

conúracfure.

This

variable

r¡as noÚ

taken info

consideration

in

the

trialg

and

It

was not clcar

how

much energ¡

was

absorted

by

the

polysúyrene

beads.

66

oy

n"

bodY.

In

looking

1 ih"

t-t

I

IIY

uv

vwJ

---

---

ñá"m"t

thc

differcncesrvould

bccome

less

usrwr¡;¡r

tu- rwe

ffiJ*"

ro¡chcd

"

por"r

*rr"rc

they

h¡d

echleved

thel¡

rn¡Émum

give many

indications

of

effecl

and

ft¡tur¡

rcsearch'

Genemlly'

attention

fitquencY

sound

on

muscle

tone'

In

use

a

spring

loaded

sÚrain

gauget

so

rcased

range

of

extension

could

be

across

all subjects,

and

individual

evaluetors

take measrrements would

f

is

achieved

by

the

absorption

by

the

ced

under

the

bodY.

l¡ials

were

run

reduced

or

ctunterüalanced

lhe

potential

effect

ng

variables

such

as have

been

described

above,

and

that

pulsed

sinusoidal

low

fitquency

sound

combined

significantly

more

efTective

in

rtducing

muscle

tone

an

ovemenl

in

spastic

subjects

lhan

music

alone.

rti

h

h

t'l

,.(

il

ll

f

(,

t*

t-

rÉ

nc

REFERENCES

M.

(1eeo)

rlritich

Association

Boakes,

M.

(1990)

OccuPational

Bobath,

K.

(19728).

I¡ndon:

Heinemann'

Bobath, K,

&

Bobath'

B.

(

Williamg

C.

E.

@ds')'

.

disabilities,

(pp. Sf'flq'

Springtleld,

IL:

Charles

C Thornas'

Carr"lngton,

M. E.

tfqE0l.

Vlúration

as

a

fralnlng

tool

for

the

profoundly

-i.rli¡ply

handicapped

child

wifhin

the family'

Paper

presented

at

Castle

PriorY

College'

Joneg

M.

H.

(197q:

Dífferential

diagnosis

and

natural

history

of

fhe

cercbral

paksiJ

"r,ir¿.

l"t

Robert

L.

Samilson

@d.)

orfhooaedic

a+ects

oi cerebral

palsy

(pp' 5'26)'

I¡ndon:

Heinemann'

Ichikoinen,

p.

(1990)m-yio""ou.ti"

methoü.

Kalamazoo,

Michigan:

Ne:rfwave,

Inc.

scertetn,

J.

P.

(19E2).

The

effecf

of

sedatlve

muslc

on

electromyographic

blo'

67

)

)

)



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

T

I

I

I

lit{Hrr}

},

r.,

In\ier,

SVe

i{li,,i

fcodback

¡sdÍed

¡¡l¡nJlon únlnlng of

ry¡stlc

cereb¡¡l

palsled

¡dults:i

Publlc¡tlons

Skille

O.

(19t9).

Vib¡oacoustic

r¡search. In R.

Spintge

& R.

Droh

(Erls)

MusicMedicine.

St l¡uis, 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

vryw

tornltw

sPASncnÍ

Tory

Sligram

INIR,ODUCTION

'to:

The

t*atment

of

chlldrcn

and

adultswlih

cercbral

palsy has

lndlcated

eniion.

This

therapeutic

treafment

in,

develoP

and

extend

a range

of

of

flxed

nlxion

deformities'

Speciflc

leveloPme

,tic

disabil

h¡s

also

becn

some

critique

ol

the

value

and

¡nfuntt

and

young

children

@almer

et

al,

19EE)'

Vlbroacoustt"

CUÁ

ü"opy

has

developed

as

a-

form

-of

treatmenl

which employs

a

relaxing

sedativó

simutu-s

through

music

and

low

frequency

sound.

The

conccp¡

álinvolv¡ng the

elementJ

of

music

in a

specified

pmgramme

of

movements

to freat

more

formalized

over

the

last

15

Y

&Weekes,

19E3'

19E5).In

a

structu

movement'

music

is

not

used

in fh

meant

to

be

relaxing,

but

Provide

a

ln the

session

and

for

the

patient'

The

used

is

imPortant

for

the

effec

lcmpo,

structurc,

rhythm

and

have

to

be

carefully

considered

for

each

movement'

pafient

is

fbequently

rhYthm

and

lemPo

in

it

(Wigram and

Weekeg

19E3).

Clinical

e:rPerience

has

al

Positivety

to music

and

movement

and

it

has

benefits

for

the

health

.

undertaking

such

treatrrents

is

vetX

'

daily

or

twice

daily

session

in

orde

ldt

r,.

pi

il

ii¡

[-4

0

fi

19

OQ

)

)

) defo¡nrlúlcs

of

l¡ck

of



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

movement

and

Increrslng

oontmcture

d

joint

mvemenls.Currcntl¡

rcsot¡¡Geg

avallable

to

m-lely rean

thal

one

ls

abli

to

providc

morrc th¡n

¡

onoc

or twloe

ueekly

sesdon.

condltlon,

úhese

follotu

up

trlals

rnay

shed

some

llghf

on

whefher

fanrlllarlty

wiúh

the

Jrealmenú

changed

úhe

results

in

any uay.

E4crimcntal

l{ypolhcses

The

hypotheses

for

this

e:rperimenl

rpere

:

effecJ

in

improving

a

placebo.

y

greafer

effecf

In

werc

trc¡ted lylng

dowtr elúher

on

e

bcd,

or

on ¡

m¡a

on the floor.

ifl,

and

C,

therc nas no actlvc

intuvention,

and

lhe subjects

rrerc

taid

suplnc on

the

vibroaooullc

unit.

In

condition

d

the

dme.

Measuremenús

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

wheÚher

the subjects

werc

receiving

VA

therapy

(condition

B)

or a

placebo

freatment

(condifion C).

However'

they

werp

not

blind

during

fhe MMBP

trials

(condition A)

and

were

aware fhe

subjecfs

werc receiving

lhis form

of freatment.

Therefore,

an element

of bias

w¿s

inevitably

present for the

evalualors

in

making

fheir measurerncnls

before

and

after

fhe

MMBP

frials.

The

trials

werrc randomly ordered

to confrol

for

order

effects. Baseline

meesunements

were taken

to establlsh

a

mlnlmum

range

of movemenÚ in

o¡der

to

be

able

to

calculate

what changes

in

range

of

movement

could be

lound

after

each

trial.

Addirional

ltials

Ten

subjects

wene randomly

selecfed

from

the

group

of

27,

and each

subject

was

given

an

additional three

frials

ofVA

Úherapy

(condition B) and

úhrte trlals

of

the

placebo

trcatmenf

(cudltlon C).

Measurtments

were

car¡ied out

in

the same

uay as

in the other

trials.

Subjects

Fourleen

male

and

lÍl

fermle

subjects rcsident

in a

larSe

hospital for

the

mentalty

handicapped

were

chosen

to take

part

in

the

trials. The

stbjects'

ages

mnged f¡om24

to

6E

years,

and

their

level

of

ftrnctioning

ranged

from

severcly

fo

profoundly

handlcapped.

All

the

subJects

had htgh

muscle

tone

nüich

alfected each

of

fhem

in

differenJ

nays,

although

thert

wene

some

aflected

muscle

groups

that

wert

shared

by

all of

the

srbjects.

The mean

age

of

fhe male

zubjects

ras 4ó,

and

the mean

age

of

the

female

subjecfs

w¿s 39.

The

mean

age

of the

28

subjects

was

41.04

(S.D.

1s.01).

t¡

l¡

h

F

l¡

I

I'i

v

L,

l-,1

¡.É

$,

Af

METEOD

7T

)

)

)

M¡úqlds

ln

llmbs

and

hlp

range

of

the subJects

before

and

afier

each

fÉal



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)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

x

I

=l

T

¡

I

t

I

)

I

I

¡

)

I

I

i

I

I

I

I

I

:'.,,

The

equlpmenl

used

in

jhis

ernerirlrcnl

qo

hr¡h^-^

L-- r¿

ñr

n?a on-.-- L^l

-^

---

.

l

¡

sPrung

bed

w¡s

uscd,

and

Jwo

Fnr¡

undernealñ

fte

ryrings

with

fhe

co

boxcs

contained

2rt bv 8rt nnr{c ?a¡ oñrr-r

I

I

I

únntained

2"

by

8u

poñs

for

acoust

uas

appmximaúely

luo

inches

below

f

would

be

Mng

within

Jrvo

inches

of

reo

casseffe

deck.

on

fhe

amplifler

wene

graded

erimenú,

the

confrols

of

masfe¡

seú

aú

the

same

point.

When

the

sic,

úhe bass

and

rrca

masfer

:*ü:*r::.j;

rcb

and

at

?*;¡10,

uring_

úhat

an

equal

balance

of

fone

<¡rrrr

mainta¡

in

fhe

music

ónly

condition.

The

VA

fhcrapy

lrcafmcnl

nusic

The

music

used

in

condition

B

and

condifion

c

in

these

triars

uas

Danlel

Koblalka's,''Crysf

al

Caverns."

Mcasurcs

In

a'

fhree

condrtronq

measunernenfs

were

faken

measuring

range

of

72

subJ-'.o

we¡E

lr'Eareq

nonzonrat¡

ena

the

speakers

were

set

Info

,nil"#;ff

i

h"

""J$

tt

T

jt

ll.^f :,,r. ::"1_T :

¡;oi

a

1eg.

er egica

l),,

;

n

d';;"*i

ü

iere

used

so

fhe

súyte

of

Turi'

inrensify

of

the

l"*

hú;;;;;HT

eneral

intensity

of

Jhe

music

wene

oo¡

stant

for

each

trial.

rj'b-'

_t:'

These

six measunes

werc

nof

used

on

all

subjects.

one

subjecl

had

all

six

measrrements

taker¡

eighf

srbjecf

s had

five

measunements,

five

subjecls

hed

lou4

four

subJects

had thrtc, four

srbJecls

had

two,

and

flve

subJects

onty

had

one

measunement

taken. Decisions

about

which of

fhe

measuremenf

s

lo

use

on

each

stbjecú

were

made

with consideration

of

Úhe

ryecific

nature of

their spasticity and muscle

tone.

Baseline

measunementswere

taken of úhe minimumrange

of movement

in

each measunement

used

wiJh each stbjecÚ.

For

enmple,

if the

right

arm

was

flexed

to the

point

where the right

radial

arlely

came

as

close

as

possible

fo

the right

shoulder,

this

was

recorded

as the

minimum

range

of

movemen .

Measurpments

were

taken

of the

degree

of

exfension

for

each

of these

movements

before

and

after each

trial. Data

were ¡ecorded

in centimetr¡s

of

lhe

measurcmenús

that

were

taken

before

and

aller

each

trial.

The

difference

befween

lhese measuremenls

indicated

an increase,

or

conversely

a

decreaset

of

the

srbjectd

range

of movement.

The

best

improvement

in range

of

movemenl

úhaf

a

subject

achieved

in

any

of

fhe

cudifions

was considered

to

be

the

subjectts maximum

range

of

movement

in

thaf

measurement.

The

minimum

mnge

of

rmvement

uas then

subtracted

from

fhis

maximum

scoret

In order

to

define

fhe

subJect's

rnadmum potentlal

range

of

movement.

Having

done

thig fhe differcnce

sc'ores

achieved in

fhe

trials

wert

converted

inúo

a

perrcentage

of this

rnaximum

poúential

range

of movement.

A

calculation

could

then

be

made of the

subjectts

percentage

imprcvemenf

in

range

of nrovement in

each

of

the conditions.

The

independent

evaluafor

r¡as

not

present during

the course

of the

f¡iat.

In

cnnditions

B and C,

he or

she

was not

aw¿re

of

the condition

in

which

the

zubjecú had

been treated.

nscn¡

i¡fa

bcfo¡r

¡d

¡flr

¡ci

l¡lrl'

Th.

cxtrc[r

Polna

on

lh. l.fl

shouldcr

¡o

lb. Glrcmc

Polnt

on

To

m*tn

dc¡nc

of

Thc.lrrmc

Polna

on lh. rlthl

To

mm

d.8rÉ

ol

clcnsion

of

ahc lGñ

¡m

h.

cfnm

poina

on

th. lcn

shouldcr

lo lhe l.n radl¡l

To

rc¿$rc

dcgn

of

Thc

rlghl

sid.

tE¡lcr

3rech¡ntcr

lo

Tbc

lcñ Cdc

aml.r

lmch¡nlCr

to

th. l.fl

lstrÉl

m¡llmlus

C.nan

b.e ol

lhc

righl

P¡lclla

ao

thG ccnlr bas.

of lhc lcn

Flclla

73

)

)

)

Mc¡cm'Gorlfl¡&rltc

for

eocl¡

mvemcnt

c¡nst¡nt

¡nd

the

performnoc

ol

úhe mudc

for



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

.,í

:;

.,

A

pGn

ms

ucd

to

m¡rk

the

po¡nts

on fhe

subjcctC

bodies

?or

messuncmeng

rnd

e convenúlon¡l

cloth

úepe-measure

wllh

centlrnetro

marHngs

ms

usod

3o

roco¡d

the

range

of movement.

we¡e

Each

a

gro

and experienced

in

MMBP

trtaúment

fechniques.

The iniúial evaluaúion

of

range

of movement

fook

prace,

and

the

chosen

meiasunements

for

each

srbject

were

faken.

The

procedurc

for

taking

the

measunements

wias

the sme

as

in

úhe

eraerimenf

described

in

chapter

five,

marldng polnts

on úhe

body

wlth

a rnar*er

pen

and

rneasurlng

a"g"e"

oi

movernenl

before

and

after

úhe

trial.

The session

proceeded

wifh

a

MMBP

treatmenf prúgmm

described

in

Table 2.

T¡bl¡

a

Muic

¡¡d

M@l B.$d Pbtrú.taüapy

Prtgnre

Mcccl

Tin ol

Mut¡c

Crtcd

wml

Spln¡l

ml.lion

(R¡3hr)

J

H¡p

Ex|cnCon

(Rlghl)

2

Shouldcr

g¡dlc

(suplnc)

¡

(fesl

lh.D slow,

Am¡

-

R¡lhl

¡nn

J

I:n

¡¡m

J

Sbür b€¡

(3

d üa6)

Splml rot¡llon

(fr¡)

3

Hip clcnslon

ltrfl)

2

Bouncy

lcAs

(Supln.)

2

flcdon ¡¡d

Gf.nCon

{

ol

lct3($plnc)

AMucllon

( uplnc)

{

Fisb

go¡nt

to

Ssim

lrem Shmücl

ilf¡ln

lhcm

fmm

'Thc

Godf¡lhar"

Humrcsquc Dvomk

llf¡ry

qull.

onanry

l\f¡ry

qu¡1.

conlmry

Fldr

to¡rt

to

sr{m

(Showbcl,

Mr¡n lhcÍÉ fiom

"Thc

Godl¡lhc¡'

Thc'€¡n4AN"

lmm

Orphcu¡ l¡

lhc

[hdcl?o¡ld

Tdclrwi¡f llom

Tbc Sound of Mudc

Orcr

lhc

n lo Sky

Folk

lndlllonrl

?4

The

researcher

played

the

muslc

for

atl

of

fhe

frlals

and

kepÍ

fhe

üme

75

as

condsently

úhe

sams

a3

nas

possible. Tl/hlle

a rccording

of

lhe

ffi"

ol"V"¿

would

have achio,cd

greater

consilency

in

presenúation ol

the

ilr"rút'

thls

erqerlrnenf

was

-d"ÍeoS.

to

find

qy"*i::t-

T-yTii:,:

r{

r;

r

rl

f...t

L.t

o

H

H

m

)

)

)

3o

¡ppb

pftssunc

¡nd move

the

paflent's

lqt

hken

afler

the



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f;;

I

I

a

I

I

thcrrpl$

usos

hlq/her

elbows

ai

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

tbc

vibroacousic

unit.

They had

a

foam

rubber

pillow

(sound dampening

material)

under

their

head

and

wlrere

necessary

fheir

body utal

spporfed

by

piuows

óntaining

polysúyrcne

beads

After

a

rcsting

period of

flve minuteg

in"¡"

tloo¿

pnessu¡e

and

hearl

rate

were

taken,

and

fhen meas¡rements

were

tsken

as

deñned lndlvldually

for

each

subJect.

The

measurements

were Íaken

by

marking

with

a

pen

a cmss

al

the

ryecified

points on

the

bod_y

and then

aitempting-to

extend

the

limb.

A

meas¡rement

nas

taken

of

the

distance

between

tñe

two

points. In rrcasrrtrnent

one,

no

extension

$as

attempted,

and

the degree

of relántion

in

ihe

shoutder

and

back

muscles

influencld

changes

in

fhis

measunemenf.

The

evaluator

teft

after

he

or

she

had

taken

the

measunemenls,

and the

researcher

began

Úhe tape.

on

the

Amba

amplifier,

the

nraste¡

volurne

control

rr¿s

incrcascd

to

seven.

In

the treafment

condition

(condltlon

A)

wherr

the

tow

fnequency

tone

nas

belng

used, the

bass

confrol

rras

then

also

increased

to

seven.

I{hen

the

sinusoidal

low

fiequency

tone rpas

not

being

used, the

bass control

n¡¡s left

at

zc¡o'

As

the

treafment continued, lhe

therapist

rernained

with

fhe

subjecl'

sitting

quiefly in

the

roonr,

avoiding

eye-contact

or

any ofher

form

ofphysical

or

communicaf

ive

conlact.

At

the end

of the

30 minute

tape,

fhe

therapist

turned

all the

controls

to

zero,

and

fhe independent

evaluafor

vas

asked

lo

reSurn.

Blood

pressrrc

rns

laken

lmmcdlately.

The

lndependent

evatuator

fhen

took

agaln

the

measunements

relevanf

fo

each

individual.

Finallyr

the

measurements

were

enrered

on

a

form

which

also

rccorded

the

day and

the

time.

other

observed

we¡t

undertaken.

RESI]LTS

The

data

converted

info

percentage

scones

for

each

subject

3

shows

changes

in the

range

of

movement

In all

es

found

after

the

MMBP

fdals

76

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77

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M¡¡¡I

M¡¡5

il¡¡¡

0t

+01,0a

+039ó

02

+50.00

+lJ.6J

{DóJ.I

+0t.t5

+075¡

4.ú

03

00.00

+04J0

+02J0

+29.{l

u

+

t3J3

+0t:.r

00.00

atE.{ó

41.92

05

00.m

(xl.00

+02.65

00.rx)

+09.72

06

+

t{Jl

01 +

toóJ

06

+(¡7..¡0

+otJJ

43.32

09

+15J5

¡5JE

. :a¡t

+02-El

+.('.75

t0

{t5.1¿

+09J0

+Vt-O7

42.U

+12.96

It

00.00

t2

00.q)

+0J.+l

+0J.5t

f 0.1.90

00.00

l3

+0J.6t

I¡JE

l.t

00.00

+o{.+¡

+0s.¡{t

+ólJ3

t5

+0:.15

+J7J?

t6

41.15

0o.oo

|

+oa.ts

+0-r.?5

4J.+{

t7

00.m

[email protected]

.¡6.6|t

IE

00.00

+04,{ó

+(n.06

l9

+

lTJE

m

+

tJ.95

+.lJ2

|n.tx

+01,05

2l

4J:9

+0J.92

+0096

+-rl:l

f

+0t.t{

+0J-92

{rJ..fl

09.37

+:l|,00

ts

+0.1,óE

+Of.{9

+G¡,Es

+ 01.90

+ 0Jt

A

.ol.{9

+2t.12

t'

+t¿Jo

76.92

+

¡J.63

+t:¡lt

26

+21.15

+- J.7ó

+01.1¡

+04.¡ró

+01.92

n

+0J.+l

Table 5

shorrs

changes

in the

range

of

movenrenJs

in

Jhe

subjects

in

pencenfages

after

the

music

alone

frials

(condifion

c).

where

zero

scones

ane

Indlcated,

Jhe

¡neasurements

fhef

wene

faken

after

úhe

frlal

rccorded

no

change

in lhe

subjecúd

ranle

of

movement

for

thal

measuremenf.

The

overell

mern

pencentage

scores

of changes

In

range

of

movemenf

?8

¡i..llll

&

er¡¡¡¡¡ ¡¡¡ b n¡rolrd:

O¡d,lc ,

.

j

:,:

.r

,

rl

SIDE

M-al

tú¡¡,2

M..1t

M.ar,

M.lrj

M.rr.ó

0l

42.00

+0t.9t

44.00

02 +3¡t.00

46

tl

00.00

{J.70 +00.9{

+05.00

03 m.q)

+02.15

.r{.95

.05¡6

0.ú

{tE.00

+01:J

+0{.1? +00,(x¡

4t.v2

05

+0t.lt

+01

l{

+0.lJJ

+oóJl +

IJJt

0ó

+09.ót

v,

+27 55

(E

00.(n +55J5

+

l .90

09 +oE-Et

+00.00

-u.7r

+01..O

+DJO

l0 + J.07 +m.00

+V|.07 +0 .04 +t|.10

It {¡J.ll

t2 + 10,12 +

oJ.¡.t +02.65

00.tx) +16,11

t3 +06.02

+ It.75

l.t 00.(X,

.20.00

+

lt.tl

.t3Jl

+5J-E.¡

l5

00.00

+ lt.ll

t6

00.(Xt

00.00 ¡rJ5

.t J0

.r0J4

t1 +03J7

+01.9{

00.00

tt

+01¡ó

4-¡J7

-r¡51

l9

(xl.fi,

4

+.12J5 +02.70 00.00

+01.05

2l

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 +05Jó

A

{2 9E +fi.1,1

ra

rSJE

rJ.óJ

I

+10.q)

x 00,00

00.ü,

{rss5

|

+00¡9

[email protected]

.Jr.{E

(S.D.

13.E67o),

wifh

a

ge

of

movemenl

in

one

sco¡e

of -10.93Vq

where

n rangc

of

movement

In fhis

condition,

fhe

the mean

scores of an

rded

deterioration

in

range

of

movement

in an

individual

srbjecl

tms

-S2lVu

ib-

,

In

condition

C,

the

overall

mean

penoentage

score of changes

in

range

of

movernent

was

i336vo

(s.D.11.4szo).

The

madmum

lmprovemenl

found

12..-

r,;

¡,ll

-T

f'rl

F/{

f-4

o

.l

¡.l

4

-l

)Q,

':

I

ih

f

'|.

,l

l:

i

)

)

)

ll

TrDb G

Me b¡rrrarr

L t .3 üqr

lr ROll

r

t

crltlo



)

)

)

)

)

_)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

t,

I

J.sut¡c

ifipüd-,A

.

fMMNDI

:

¿-

Cc¡dJ'

IV rlFDet

fi:i

Coo¿¡"sr¡

tPbc.üo)

I

+01.02 +OlJ0

{lJ7 B

,

+toJt +0l.ll

+03.¡0 A

J

+lxtf{ +(¡9.00

&ló7 B

4

+Gt19

{xt.ró

{xtJ0

.l

5

.{H.üt

+02.t1

+05:1

c

6 + lJ..ló

+

laJl

+O.61 B

7

+óJ-E2 +

10.6J

+27.65 A

E +U.07

+0{.t7

+ ;82

c

I

+t .10 +

t09

{t0-9

A

t0

+vt25

+o{..tJ

+Vt92

c

ll

-t0,93

(xr.00

43,U

B

l:2

+lNrt +02J?

+06Jt

c

lt +96

+|l9.09

+

I2JE

A

t4

+

lt50

+

ltr¡

+lü7t6

.{

l5 +

ta.to

+Y).16

+0555

B

l6

+04.60 +0t.{ó 4{J?

I

t7

+ütJ9 {¡5:t

+01.84 A

It

{t9J3

+0l.lt

¡5.{l A

t9 +0 ¿9

+

l?sE

qt.00

B

+(l9.0t +09tJ

+09.0t

B

2l

+U.42

+1tr.95

.{L}J2

B

u

+0¡l:4 +06.{)

42.0ó B

73

40.l¡t +ú9.29

+05.93 B

A

+(ni, +0996 +02.0E

B

ta

+n.49 +Jl.a7

+ 3.00 B

%

+U¿a

+ Lz.{t

+00r9

A

n

+06¡9

+0J.¡|. +4..¡B

A

in

range

of moyement

in

the mean

soones of

any one subiect

was +27,65Vq

and the

fargest

rccordd

deterloratlon

ln

any one

subJect

was

-34.48Vo.

A

Friedman 2-Way Anova

lound

no

ovemll differcnce

bctween

conditions

(P

=

0.105e). In

order úo look

at comparisons

betlf,een

the

conditiong

orthogonal

planned

conrparisons

were undertaken

by

partiSioning

the X'riedman

Clri squarcd

compaúng

ctndition

A

with condition B,

and

condition

A

and B

with condition C. No signiflcanú

difference

was found

betrpeen

MMBP

trtatment

(Condition

A)

and VA

therapy

(Condition

B)

(Chi

squarc

=

0.1 ns).

For some srbJcctg the

mnge of

movement

incr¡ased

mo¡s

wlfh

VA

fherap¡

whlle In an equal number

of

subJects

fhe

range of movement

80

ment'

r{'

DrscussroN

n

u

a

and

also

of

collaborative

Pnogmms

trtafment

would

be

hetPful

for

the

both

MMBP

fr¡atment

and

VA

inpnovements

in

range

ol

mo

VA

therapy

comPartd

with

a

81

r4t

tu

[.j

ilt

[-r

()

fl

5

)cl

F

of- movemenfs

fh¡n



r

I

range

of

moyermenf

were

thercfore

found

in

condifion

A when

fhese

sublrts

were

treated

wifh

MMBP.

conversef,

less

improvernent

in

range of

nrovement

n¡rs

found

in

thc

glven

VA

úherapy.

As

the

communicate

why

they

pvc

apprmch

as

opposed

to

VA

difference.

Attenlion

strould

be

paid

to

fhe

facf

that,

when

lying

on

a

bed

o<posed

to

music

and

tory

hequency

sound,

fhe

subjects

in this

group,

for

wlrom

the

results

indicated

movement.

nd general

physical

over-sensiúivify

to

being

handled

during

can

rtsult in

increased

fension

in the

subjects

and

greafer

ssive

movemenús

designed

to

promofe

extension

in

theii

mnge

Thercforc,

when

these

subJects

were

lylng

on

a vrbrracousúlc

unlJ

wlth

82

Ii

t:

,

I

I

I

i

I

I

I

a

t

6

li

fr

il

I

if

ii

I

¡

I

it

soones

Indlcetlng

greeler

lmprovements

ln renge

It

"y

ot"

being

treated

in

the MMBP

frlal,

the

following

arCurylrs

ffi¡? l"-Lottol"r"¿

ior

this effect:

1)

these

subJecJs

rcacted

apinst

being

'ñ"'¿1"¿

fór

a

vartetvof

rcasonq

Includlng

enf:q

1-u1ll llll}|111"":T:t.:

and tcnsion.

Another

variable

that

was

not fully

faken

into

consideraÚion

during

t

to

the

staff

regutarly

using either

MMBP

as

a

t

hat

both

of

these

treatment

apprcacheswere

found

t reducing

muscle

tone

and

improving

range

of

mov

mined

in

more

detail'

In

a

als

in each

condifiont

and

e

nas found

between

these

conditions.

In

the

additional

trialg

subjects

were

given

an

extra

three

trials

of

both

VA therapy

and

fhe

placebo

treaúrnent.

In

the

first

trialg

18

of

the

83

)

)

);

subJects reryonded

mre

posltlvely

to VA therap¡ nülle

nlne

responded

r¡e¡

-

'l

|i

I

fisfnemrnn

,,3-l--rrorn\

rn¡óidye

-.i:_,11":jyrlyJ*"

rveek

rcsldential

'ri

.;

parkinsons

disease.

,,_,i,i

,r,,i

:'lii[ll*¡ÍÍi



ppsiÍivery

lo úhe

plaebo

wüen

compartng

dlflenenccs

ln

msuremcna

scotq,.

Dótween

theee

two

oonditions.In úheso

addiJlonal

frlalg

mean scDne ¡

rwealcd

Jh¡t

¡ll 10 subJccts

respondcd

morc

podtlvely

fo

VA

therrpy then

to

thc

placebo.

Iú

could be

infered

fhat,

in

the

additional úrials of

this

experimenl,

the

resrlts indicate that

with

rupetition, subjecls

becrme

mone nesponsive

to

this

form

of frcatmenf

and

a

grtater

number of

Jhem demonstrate improve¿

range

of movemenú.

It

is

likely

that

úhe

srbjecús

became familiar

and

accusfomed

úo

the

VA

fherapy

sess¡ons.

Wral uas

not

evaluafed

is

whefhe¡

furfher

Jrials

of MMBP

Srcalrrent

would also

have achieved

the

same

eflect.

Because

the VA fherapy

treatrnent

does

not

Involve

handllng

and

ls

r

predictable

form ol treatrnenf

carried out

consi$ently

the

same evety

time

it

is underfaken,

the

rcsults thaf

one

might

expect fo

improve

through

rcpetiúion

ane mone

likely

úo

occur. Pafients wiúh

these

particular

problemq

coupled

with severe

limitafions in

e:rprrssive

and

rccepúive

communicalion,

may

lecl

more safe and comforfable.

Neiúher

fhis e:periment, nor anofher by

úhe

same

author involved

evaluation

of cumulative effects

broughÍ

on by

a

gradual

improvement

over

a number

of

trcalmenús. However,

they have

indicafed VA

therapy

as a

slgnlflcantly effectlve

ú¡tatrnent when comparcd

wlth

a

plactbo.

One other variable

that

needs to

be

considered

is

the differencr

between

gmup

and

individual trials.

This

may have

influenced

úhc

resultg

as

fhe group

environnrent

may have

provcn

intimidating for

some,

and conducivc

for

others in the

trials The sarne arguments

can

be

applied 1o

úhe

effect

of

individual attention

and

isolation in

lhe

VA

fhempy and

placebo

trials. For

future studieg underiaking

t¡ials

individually

in all

conditions would be

a

more consi$enl mefhod and may

produce

differenf

results.

Although

some

concluslons

can

be

drawn

fbom

thls sf

udy

regardlng

fhe

differences

found

befwecn

Jhese

úhrce intervenliong

(and

there

is some

evidence

from

this study and

the

study

in

chapter flve supporfing lhe

eflicacy

ofVA

fherapy), further

studies

ane neoessary

before

lirm

conclusions can

be

dmwn about

the

rcliablevalue

of

eitherVA

therapy or MMBP

treatmenf wilh

pafients

hom this clinical

group.

REFERENCES

Bean,

J.

(1995).

Music Therapy and the

child with certb¡al

palqy:

Direcfive

and nondirective

intervenlion.In:

T. VUigran¡

B. Saper$on

& R

West

(Eds.)

The

art

and science of

music

therapy:

A handbook.

(pp.19+

20E).

London:

Hanrood

Academic Publishers.

Bobathn

K. & Bobath,B,

(1972),

Cercbral

Palqy.

In:

P.H.

Pearson

& C.E.

Williamg

(Etls),

Physical

therapy

services in

the

developmenúal

disabiliúies.

(pp.31-185).

Springlleld,

IL:

Char{es

C Thonns.

Bobafh, K.

(1972).

The

motor deflclts In

patlenf

s

wlth

cerebr¡l

palsy.

London:

84

t

(4)

Deernber'

2:

tt

--

..

F.

B,

Shapiro,

B.

K,

whghÚ9lt

-n

'r^{lten¡

r'ro

v1

'::-'L::-'

h;ffi ü*'J,ira9rr'"",r.s,¡'ícine¡t-_".":_t_9itli*;li$*

il;'#;ññ;ñ;i

h;-pi

o"

""I:'b4.

palsv:

rhe

-contror

child

and

lnf¡nts

wfür

spaJt

dtplegta'

The

New

Engl¡nd

'Iournal

of

Wigta

speciflc

approach

to

overrcoming

moúor

adolescents

with

severe

physical

and

sic

and

movement'

British

'Iournal

of

uw

.il3i

'd¡t

at lhe

World

Conference

of

Music

T

)

)

)

)

)

)

)

)

)

.)

)

)

)

)

,

)

)

)

,)

)

)

)

)

)

.)

)

)

)

,

)

)

:l

t,

2i

r{g

tr;

t

o

;il

5

)Q

85

)

)

)

I

SWEN

I"

.lllii



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

.)

)

)

)

)

)

tl

I

SUBTECTS

i7*'""-

INTRODUCTION

rhe

hypothese

s

fo

r the

exaerimen

:'f- I T: 3:::T ::Ln

*tffi';

-lHJlTil-i"io';la*r"?5il;""an":'tf

Tl-l1::l':J""lii::

LffJfil1l";"*;;;ü

"""p"-*u

with

a rreatment

or

relaxing

music

and

a

cont¡'ol

condition'

llT¿Tü'##i#;niii-oo'tvo'e.rat*rl::in.f

t:*Ttli"l

-

:dlrfflü

ffiI;ñ:;-*iyf::".':

::,,¡,:Inv

rhan

to

a

;i:[ilffi;,

;l"dú;"sic

oi

in

a

con*ol

condition'

ridi

E*;

".rl

1-f

'i"1

l)

::l

:9

)cl

I

e

F

E

É

METIIOD

ü,""i.-

)

)

)

)

rha

bGdr

one

spe¡ker

qas

pl

l'"*lr

their

bo(Yt

*d,li

IIFF

J;l tt



)l

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

i

sound

uavg

and

the

music

in

condition

2

ms

RS'T1l

ster¡o

cassette

deck'

^---

^^-r¡at"

""-ii"

o-plifler

were

graded

the

controls

ol

rnasúer

a

triat

which

lasted

30

minuies.

SubJccls

M¡tcrlds

EE

the

controls

ol

rnasúer

Point'

Wren

the

íC

the

bass

and

s

maintained

in

the

m

Daniel

Kobiatka'

This m

rs

tonal,

melodic

and

ha

synthesizer.

New

age

poPulations,

because

t

o?

the

muslc

reduces

inlluencing

resPonse'

T

tong

pulsing

^t

on

the

tape.

rccorded

from

a

run

Mrams

1.1

Measurementsof

In

thls

exaeriment.

Blo

¡fter each

trial.

A Johnt

blood

pressrre

monitor

In

addition,

heart

rate

¡ve¡age

readingsnrcrc

The

first measuremen

the

final nrcasurement

ffi:LlTtffi'lllfii

t'rc

nnger

rileasure

uás

E9

rti

It

$u

i"f

b.{

tr'

ti

L"

f

ü

(

I

É

E

F

I

I

I

I

)

)

)

)y

used.

D¡t¡

werp

collected

fhrough

¡

BBC

mser

oomputer,

uslng

a

p _og¡am

o

rucord

pulc

"



)

i'r

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

rr;,,.¡,,

The

UMST-MACL

was

used

both

¡s

r

generel

Indlccto¡

of

mood

Fornrs

r¿ere

uscd

to

collecú

subjecfs

were

ast<ed

fo

mfe

fhe

encouraged

lo

use

a

ruler

on

úhe

At úhe

end

of

the

friatg

scones

we

procedurc

of

Jhe

LIMST-MACL.

mca

u¡emnús

aJ

5

minule ¡i¡."""¡"

ofvariance.

Expectd

olhogonal

planned

VA

fherapy

comblned

Proedu¡e

Subjects

were

then

askcd

fo

lie

on

úhe bed

and

rnake

themselves

After

a

5

minufe

resting

period,

blood

pressure

and

heart raúe

*b

t"Lrn

udng

the ¡utomstlc

Infeúlon

dlgltal

blood

prtssrre

monltor.

The

iíilror"t""

nas

fhen

aJtached

to their

flngers

to begin

continuous

nmniloring

í¡¡a¡

rate.

The srbjercfs

were given

no

infor¡mJion

about

the

Jrial

other

f¡¡n

the

following

stafements:

(for

Groups I

anil2)'We

would

like

you

to

üe

o¡

the

bed

for

30

minutes

Please

dontt

gef

up.

You

will

hear music

playing.

fou

can

think

abouf

anyúhing

you

like, and

just

allow

yourself

to

rclax. We

¡¡r

nof

going to

advise

you

now as to

what you

ane

receiving but

we

will

tell

tou

mone

about

what

we ane

trying

úo

llnd out

after the

úrial

is

over.

At the

"Ed

of

30

mlnuteq I wlll

come In

and

take

your

blood

pressurc.

please

keep

frut

."tn.

resting

on fhe

bed

until

after

I have

faken

the

blood

pnessure

Dcasurcment.

Afler

fhat

the t¡ial will

be

over."

For

Group 3,

the

following

insfructions

wene

given:

'\üe

woutd

like

you

lo

lie

on

the

bed for 30

minufes.

Please

don't

get

up.

You can

think

of

.nyfhing

you

like,

and allow

yourself

to

relax. We wilt

tell

you

more about

wüaf

re are trying

to flnd

ouf

when

the

úrial

is

over.

At the end of 30

minutes

I

will

come

in

and take

your

blood

pressurc.

Please keep

your

arrns

resfing

on

lhe bed unfll

after I have

flnlshed faklng

fhe

blood

pnessure

measurcment.

Aller

fhat, the frial

will be

over."

Immediafely

after

fhe

frial

was over,

a blood

pressur€

measuremenJ

was

hken.

The

subjecús

were

invited

to

complete

the UwIST-l\{AcL

for the

sectnd

lime,

recording fheir

rnood

after

the

trial. care sas

laken fo

ensure

lhey

coutd

nof

reference fhe

scores

they

wrote

before

the úrials.

REST]LTS

Table 1 slrows

úhe differences

in

mood,

blood

pressure

and

hearÍ

rate

lor

the

three groups.

rhe

plus

score

documented

in rtre

conJrol

group

for

eneryetic

arpusal

indicated

an

increase

in

energetic

arousal,

and

fhe

plus

scorc

in

the

übrcacoustic grcup

for

hedonic

fone

indicated an

incrcase

in

hedonic

fone.

AII

the renuining

s"o..r

in fhis

table

indicafed

a

decrcase

in

3to¡sal

levelg

blood

pressurc

and hearf

rafe,

or

no

change

or decrcase

in

hedonic

tone.

Table

2

shows lhe

results

of

an

analysls

of

varlence

of

energetic

tension

arousal

which

reveals

signiflcanf

the

measurements

of hedonic

fone, although

xpected direction,

no significanf

difference

Table

3 shows

the

analyses

of

variance

of

Systolic

Blood

pressure

fllpl,

Diasfotic

Btood

pressuró

pnf¡

and

Heaf náte

6n¡.

Alrhough

rhe

ttlflerences

were in

fhe

expecfed

direcfion,

no

significanf

difference

between

8¡oups

r¡as

found.

l;"ii¡

tik*

rFk

r$

itl

,,:"{

.:)

t:l

;9

rQ

I

I

i

I

(

t

fiil

in

rhe

IJWIST-MACL.

The

subjecrs

ions,

according

fo

the

instrucfions

for

L (Matthews

et

al.,

1990):

,you

will be

ro

comprele

úhe

,TffJ:"Tiff,i:ii;:'*lr*f"1llr1:

how

you

feel

AT

musl

choose

one

and

'deflnitely

n

('deflnifely

not)

fhe

reply

fhaf

be

spend

too

much

oirs

usrary,ie

T"ffi:Jl',fi.j"TilLT,illJlf

ase

do

not try

a rcply

answers

will

be kepú

,lively',

and you

felt

DEFINITELY

SLIGHTLY

SLIGHTLYNOT

DEFINITELYNOT

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|

2

I

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90

)

)

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rd

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t liflT

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r'¡iil

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a

31

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r,57

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Table

5

shows

the

rcsults

of

P

;

tt

T¡blc

5:

Pl¡o¡cd

6FdDÚ

ol

sDP'

DBP

' d

HR

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:

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ol

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of

EA

GA

TA

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D.F.

EclwÉn

(:ñuot

D.F.

1¡lahln

CreuD3

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F

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EA

t?

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a

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ll- l{?

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51

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31

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3.

ADFG

of

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of

SBP'

DBP

¡¡d

HR

Gr.l

rs GtJ

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B¡ood

PrcsuE

Gr.l

tnd

Gr2

vr GrJ

Gr.l

end

Gr

vs GrJ

93

)

)

)

measunement

of

hcart

¡¡a

thrcegroupsJteaft

rahü

h

grouP

three

i't"g_tqq|*g



and

therc

uas

evidencc

ol¡

ime.

. r

-

^-.rl

^-^^

^?

alr-

¡

)

lr

)

)

)

)

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)

)

)

)

)

)

)

)

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)

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)

)

)

)

)

)

)

)

)

)

)

)

general

declfne

ln hc¡rt

r¡fe

over

t

'

]h

*

nt

i

signif¡canf

differcncre

in úhe

múe

fhe

groupq

F(IZ,

gZ)

=

2.A4,

P

=

.02

for

the

I

T¡DbG Mor¡d

$Ir."olHRffi7

EsÉ

Group

I

lT16lmnl)

[l6nrSldl).r'l

Gruup

(Iluslc ¡lon.)

tlahtSld-D.vl

Group

J

(Conlrcl

l,

ItaDlStd.DcYl

H6rt

R¡ac

MÉ¡.

I

12.7

t1Á31

7 J

(

rJ.r7)

75J

(r0.r0)

Ha¡l

R¡ac

Ma .:

70.7

(7.{r)

70¡

tt .ot)

7J,9

r

roJ{)

Hart

R¡ac

ilta¡.

ó9.7

t7.0ó)

70.ó

(rr.r2)

7{.0

(r0aE)

H?¡l

R¡lc

M.¡s.

{

óE.9

(?.0{) 70.2

{t::E)

?2.{

{r0.ó7)

Harl

R¡te

Yc¡s.

5

6óJ

t6.00)

69.1

112.76,

70.7

(rJ.t-t)

Hart

R¡1.

Mar.6

65J

(ó.{E)

69J

(12:3)

7J.7

(rr.ro)

Hé¡a

R¡lc

ñfc¡r.

7

ó{5

(5.ó7)

ó9"t

I

r2.¡2)

7-r.ó

(u.¿ól

from

Prcvious

Tamnr'

19E9)'

or

a

treafment

the

results

of

reductions

in

blood

design

u

ovel$

of

ind

influence

on

the

subjects

Further

a

number of

frials

might

yield

differe

that

the differences

werc

in

the

e4e

thc

difference

between

VA

therapy

a

.o*i"

-"t"

signiflcant

effect

on

blood

pressrre

and

heart

rale'

.f

i

The

results

concernlng

hedonlc

tone

ar¡

more

dlffcult

to

explaln'

i$

'r.ü

.J

:,il

.)

ril

,'

:

I

I

I

I

É

t

(

F

F

e

,-

A

f

DISCUSSION

Whlle

thc

subJects

obvlous$

e:perlencld-e

¡cductlon

ln

thelr

¡rcusol

le

and

satlsfaction

with

Lces

found

th¡t

tbe

¡ddltlon

of

a

pulsed'

slnusold¡l

low

fhequencl

tone

mudq

bv



¡rr- ..o ants n

"r*ll

¡rr"t"u*

in

eqioyrrent

r

-

--

^

¡-^^.-^-l an¿l tha

-^.

effecl

on

retaEll¡ult

urvr¡rurrj

the

treatment

aPPears

to

be

on

sfale

of

mind.

Subjercts

scores

and

awareness

of

thc

'g*g¡ffif;ax'

e¡ther

to

yglqg"$#.'hffi

stete

nuY

Prevent

th^'

$ate

rmY

Prevet

in

a

$ate

ol

anxictY'

thesc

states'

It

nould

er

VA

theraPY

in

PhYsical

"tt"f

'#"ffi";n,thigryf.y1{}fl

.*H

ffi.#iTii;ffiffi,ilfi'i""r*nó

iodic"tor

or

rhe

errec'

u'

yó

usic

alone

trcatment

and

lhe

cont¡ü

"cf

e¡r

lndlc¡tlon

lf

$F.Djects.c¡¡

ent

and

morc

rcceptive

to

t[¡

deÉaken

over

a

Period

of time.'

T[¡

hin

a

large

hosPital

for

PeoPle

wift

üt

working

conditions

and

fhe

responsibilit¡

of

caring

for

patients

wrro

demonsúmte

diifurbed

and

challenging

behavior,

thesaffrrasliketyverysrcssed.Theyrreryalsoatfendingthesetria|sduring

their

working

hours.

{ft"*f"t",

they

rmy

have

experient"d

Try

incrcasc

i¡

hedon|cionestmp|ydueúothesat|sfactlonofbelngabletolledowrrforh¡ll

anhourduringer,therewe¡emanysrbjectswhosr

res¡lts

fnom

th

ed

a

reduction

in

hedonic

fone'

In

discussion

with

er

the

trialg

they

confded

anecdotally

that

it

n¿s

diffcutt

to

e:rperience

pleasure

and

content¡nenl

lying

dow¡r in the

9,,p"1

*111

^'Tg:""-t:*

n?;.'Tl

9ll

{

it"

h[¿

::(

tl

.i.

::::

c,

E

1

¡

ü

f;

t

E

(:

D.,

ts,

E

C¡

ii

l:t.

i,1

I,

l,

l't'

i.l

t,

l'

il

;I

.I:

ii

i

;'

i

¡r'

i'ii'

l.ilr

;iil

ii

'

ili

I

iri

Published

ISVA

Skille,

O.

(1991)

'

Manuat

of

Vibroacoustic

Therapy'

kvanger'

Nornvay:

ISVA

Publlcations'

wigram.

r.

(1ee3).'rhe

reelins

gr,":*:-:

T"if,i:il'#;:fJt:lJ1;.

T.

(1993).

'The

feeling

9t

""^1':^-;

i-'"rr"li"n"ing

behaviour

in

Handbook

of

andbook

of

'(pP.177'197)'

psychological

change

theY

had

exa

It

could

be

a

matter

for

continuous

tr¡atments

of

VA

therapy

and

the

muslc

alone

condltlon'

Furthe

lhe

differtnces

befween

a

VA

therap

relax

The

t

eprc

Londoq

Phtlaoerpua;

Jsw¡w

¡D'-e--

v

97

)

)

)u

)

.j

r.rt

\,:l

'-ri

a

-

ji:¡1



)i:

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

PAlflBNIS

OVEN'AGE

59

PNWIOAOOASTIC

TflBAPT

TO

NET'ACB

PAIN

PEJ/fJIAL

niBAH

ro\

TUTAL

NEE

,{ü

l.d,{

i'5

':

'{

'""{

.)

,.I

rq

iQ

'r

¡

I

D

t

É

E

q

h

t

el

'

(Siegele,

1974).

t

-

viu-tibn

and/or

sensory

sti

I

catdiac

output

following

heart

su

aluate

the

Po.tential

benefits

cal

theraPY,

following

a total

search

questions

were

Posed:

-:i'

gg

rytÉb

Bulrc

l¡?.thY

ThoDrs

fl

FI

belore,

durlng

end

¡fia

end

ol

their

$sdom

rU¡

s

rms

used

In"

which

ms

uscd

¡



f'r

Do

patienfs

".oirhl'

¡ihydoocoustlC

therepy

In

conJunctlon

wltb

pnyscal therapy

¡chleve

Src¡t;

p"rS"" mnge

of

motion

than

those

in the

contrcl

grcup?

MEISOD

folloss:

PloiFD

004

(legs

and

thighs)

Volm

002

for

whatever

is

bmfortable

for

Pt')

Strcnglh

006

Nct[

004

Thss

007

Tire

006

(30

minutes)

F¡Goucnct

iniü*ln-tt"u

bY

comPuter)

Mudc

(Irblc)

003

Bec[

006

Lcgs

007

Subicds

patienús

over

lhe

age

of 55

who

urcrc

hospitalized

for

a fotal

knct

rcplacement

and

who

wert

receiving

physical therapy

úo

assist

them

in

ruialntng

m:dmum

functlonlng

nrrt

ellglble

for

Inclusion

in

the

study.

Eictusion

criteria

included

age

less

than

55,

pnesenoe

of

a

paccmaker,

e:pected

hospital

stay

of

less

than

6

dayg

and

pafienfs

who

werc

unable

to

gei

to

th"

gtm

for

physical therapy.

Paiients

ed

to

stay

anay

from

magnetic

flelds

and

werc

fh

dy

because

of magnets

in

the

ryeakers

housed

i

Mcúbodologl

This

su

y

r¡as

a

collaborative

effort

between

the

music

therapist

and

scveral

physicai

therapits

in

lhe

Physical

and

Occupaúional

Therapy

n"p""t"*"i

aJ

Duke

Univcrdty

Medical

Cenúer.

A mndomized

control

and

ffirimental

group design

r¡asused

(Neale,

&

Lieberl,

r9E6).

Once

patients

nad

becn

i¿enline¿

as

being

scheduled

for

knee

replacement

surgerl'

they

wene

appnoached

by

a

ptrysical thempisú

who

explained

the

purpose ol

fhc

rtuJy

"na

obtained

infoHed

consenl.

Pafients

were

randomized,

by

drawing

"

ord,

lnfo

elther

the controt

or experlmental

group.

Following

surSery,

ell

patients

received

a

normal

course

of

therapy

table. All

subjects

were asked

physical

fherapY

using

lhe

Visual

Thermometer

(Ahles, Ruckdeschelr

&

& Buckingham,

1983).

Subjects

in th

phyrúcal thempy

routine

which

consisted

of

lor

"xórcis".,

acfü

and

passive range

of

mofion

to the knee,

and

ambulation'

subJects

ln

lhe

e:rperlmental

group

recrclved

lhe

physloacoustlc

fherapy

inte.irenúion

during

the

firsl

physical

therapy

scssion

in

which

range

of

n

each

thereafter'

a speci

qüich

contained

srbjet

of

Pain

uóing

the

VAS

and

Pain Thermomeler.

Piior

to

beginning

physical

fherapy,

srbjeds

in

the

experimenfal

group

receivcd

10

minules

of

music

and

lolr

frcquencJ

vibmtions

emitted

via

fueakers

along

the

length

of

the

PhysioacousticR

Jablc

and

thrcugh

headpfrones.

A

htgñ

qua[t]

portable

fape

player

wllh

100

srbject

unless

the-

sublect

fn

wf¡f"ft

case

the

strcngth

was

vibmtiong

PhYsical

nlal

grouP

continued

ses$on

'period

bY

the

measuring

fool

for

range

for

the

PhYsical

theraPY

scssions.

RESI'JLTS

.lü

:f.

J'4

,I

"k

,\

.1r

l

'-"(

,.t

tn

rll

,t

lij

iJt

I i.i

il

.'

,1

¡l

)

)

)

)



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

E.9C.9

Aar

(l'ü)

&22 6.t e, ¿a .g

E¡l.od..

lllt

) l|l.t¡

{A l3.l¡ 1¡0

.:9

ll.Fl.¿

(ttd)

4a ¡ ll.li

Wl¡l6d

(t

t

r) ¡Y5

34$

Dlrorad

(it..)

ll{¡

ll3

Yrlc

5 .1$

t

¡

Dl¡tro.l.

O.gn¡¡lrlr ¡00& . .i

Rdllo. ll.lt

Rü.uD.b¡d Añtrld. 33,¡9

Passivc

Range of Motion

Measured

in Degrees

,o

.o

t

@

30

¿lO

30

m

10

0

O.yl

O.y2

D.y¡

¡).ya

D.ys

,

O.tt

I

oc-ñi--rE

p.,t",."t

il

Figw

I

motion.

In

addiúion,

AVo

ol

the

control srbjecls

were able to

obtain

a

90

degree

bend

at

the knee,

comparcd

to 66Vo of

fhe

experimenfal

group.

Figure

2 represenús

a comparison

of

mean

post-physical

therapy

pain

scones usfng the

Vlsual Analogue

Scale.

I{lth

Úhe exceptlon

oI

dey

2,ihe

LO2

Mcan

Post-Physical

Therapy

VAS

Pain

Scores

@

50

¡O

3tt

20

t0

0

Figurc

2

Pre

to

Post

Physical Thcrapy

Pain Change

Scores

{o

5

t0

25

20

t5

't0

5

0

aEs

+;ti

i

"hi¡

¡

"14

"ra

:l

r'l

.r{

",{

.)

:l

3

a

't

¡

B

(

E

H

$

h

F

F

;

',j

,l

i:l

DISCUSSION

The

Purpose

of

this

study

$as

to

Phy

soal'ousii

"f

ttt..py

i n

re-ducing-pa

in-.

á

iotal

knee

replacement'

Using

a

oay-

*

signiflcant

differenccs

(p

<

'05)betweel-tl:

'*o

*

.ñ;;;ti;n

".*tiitthed

on

post-op

dav

4

(p

103

TA¡LE I

R¡¡t ol

Volloq

Al¡. . d Prb Ca¡¡t. S@r.

.il.6ó

lt Í Jtlt

n.2t .91

ó1.11

l¡,to 1t.22 ¡3.10 .tó

69.tt

t2.t¿

761t

12.¡E

.26

6&S0

I

ó.J'

ll.,t e2¡

.04r

rs.ó(

20.30 15.00

a?a

.,o

4.6

29.12 .rla 22.U

.¡A

¡{óó rc90

a2¡ ta6 .a

¡aro 19ú rat2 l¡.ót

.y

¡r00

t9.Jt tt.oo t¿ot

,17

f9.to t6.tl

I.3 ¡aü

J9

la$ tl, :¿tl tl¡ .ot.

NS

ROMI

ROM2

ROlt

ROM{

ROMI

FOSVASI

ROSI'AS¡

POSVAS

FOSV^S.l

tostirsl

FOsr

A6

ÍIwAS

r{

)

)

)

)

post

phydcal

Íherepy

porn

rcpoñed

on

posa{p

day

ó (p

<

.01).

Drffercnocr

i.:*f*""

rance

of notlon

approochea

igntfican"i

tp

i

.üi"íp""op

d¡yj

durlng

potentlal$

palnful

phydc¡l

therepy

ererclscs.

Ir



.ft¡

f¿

',14

:{

)

:'l

,'{

'"{

)

:f

f;

il

I

I

t

{

D

;:

H

ü

:t

)r

)

I

t

)

)

)

)

)

)

)

I

)

)

)

)

)

)

)

)

.I

)

)

)

)

)

)

)

)

)

)

)

REFERENCES

Ailes,

T.

H,

Ruckdeschel,

J.

C,

&

Blanchard,

E.D.

(lg%).

Cancpr-related

I

pain

-

II.

Assessrnenú

with

visual

analogue

scales

Journal

ol

-,-

PsychosormticResearch,

QE(Z),lZl-t}4.

lnderson,

s.

A.

(1979).

Pain

conlrol

by

sensory

sfimulation.

Advances

in

pain

:'

Resea¡ch

and

Therapy,

3,569-585.

BúleyrL,

M.

(1986).

Music úherapy

in

pain

management..Iournal

of

pain

and

,

Symptom Management,

L(l)r

25-28,

,s3_urkc,

MA.

(1994).

Use

of

physloacoustlc

tnterventlon

In

paln

managemenl

t+t

ol

postoperative gynecological

patienús.

unpublished

Maste¡rs

Thesiq

,-{

University of

North

Ca¡otina-Chapel

Hill.

Burkq

M.A, Walsh,

J,

Oehler,

J,

&

Gingrag

J.

(1995).

Music

therapy

following

suctioning:

Four case

studies.

Neonatal

Networ&

A

e),

4t-

49.

Cheslry,

K.

S, & Michel,

D. E.

(1991).

The

music

vibrafion

rabte

(MVT):

Developing

a technologr

and

concrcplual

model for

pain

relief.

Music

Therapy

Perspectives.

91

32-38.

Gardner, W.

J,

&

Licklider,

J.

C.

R.

(1959).

Audifory

analgesia in

denfat

operafions. The.Iournal

ol

the

American

Dental

Association.

gg"

lt4+

1149.

Gardner,

W.

J,

Licklider,

J.

C.

R,

&Weisz,

A.Z.

(1960).

Suppression

of

pain

'

by sound.

Science.

132.32-33.

Guieq

R,

Pouget

J.

(1990).

Pain

reliefachieved

by transcuianeous

eleclrical

ne¡ve

stimulaÍion

anflor

vibratory

stimulation

in a case of

painfut

legs

and

movlng toes.

Paln. 42r

434fi.

l*hikoinen,

Petri. (1991).

The

Physioacoustic

Mefhod.

IGlamazoo,

MI:

Nextuave,

fnc.

,,,

paln

threshold

and paln

tolerance.

.Iournal

ol

Denfal

Research

,i;i;

Supplemenf

to

No.

6,

160E.1617.

l.lieale' J.

Mo &

Lieberú,

R. M.

(Eds).

(19EO.

Science

and Behavion

An

:

,r,

Introduction

to

Mefhods

of

Research.

(Jrd

ed.).

Englewood

Cliftg

NJ:

'''.

Prpntice-Hall.

Res¡lfs

sugget

that

phydm

nonpharmacological

lntervenúion

to

of

motion

during

physical

f

subjecús

in fhe

operimental

eryerienoe

uslng

the nrusic

sesslonc

Subjecls

used

nords

such

as

úo

describe

how

they

fclt

aftcr

cuntrol

group

although

úhe

conúrol group

47 vs,S.Eg;

range

4-9).

Reommendafions

Therc

arp severar

rimitations

to

rhis

sfudy.

Firsú,

the

number

of

subjects

nas

snrall.

Origi

each

group;

however,

t

incrcasing sfalf

to pafien

the

sfudy.

A

larger

study

sample

decreasing

fhe

influence

of

individu

ROM

r¡as

begun,

lenglh

of

stay

or

early

dlscharge

to

a

less

expe

Data

on

pain

medicalion

u

Differences

in method

of

administmti

analyses

diflicult.

F'uture

studies

sho

pain

medicalions

used,

buf

should

ti

comparable

analgesic

agenfs.

Ofher

enrolling

subjecfs

included

the

loss

dcpartnrenú

and

a reducfion

in

lhe

PhysloacoustlcR

table.

Condusions

,*^--,YJ_{,: 1l".pi:1:

and physicat

therapisfs

can

work

coilaborafivety

ro

tmploye

both

úhe quality

and

effectivet

to

patienfs

r.equiring

physi_cal

therapy

úo

reach

functioning.

.PJrysim_cousticR

úherapy

is

a

benellc

herapy

and

should

be

sfrongly

consrdercd

as

a

nonpharmacorogrcar

mcthod

oi

parn

104

)

),

)

)



)

I

)

)

)

.,

)

)

I

,t

,)

)

)

)

)

)

I

,)

)

)

)

)

)

.)

)

)

')

)

)

t

l

NINE

Ag

cr

Burte

t¡

¡artofic

analgesics

(such

as

Morphine,

Demerol,

and Fenfanyl)

are af

hcftased

risk

for

side-effects

such

as

nausea'

vomifing,

decreased

bowel

finc{lon,

sedatlon,

and

rcsplratory

deprrsslon

(cancer Pain,

19E4).

In

¡ddilion

to narcotic

analgesicg

a variety

of

behavioral

techniques

including

nbxation,

irmagery

biofeedback,

and

cogniÚive

rcdirec3ion

strafegies

have

Ücn

used

in

the frcafment

of

acute

pain

(Cancer

Pain,

19E4;

Clum'

Luscomb,

tscott,

l9Ea;Melzacft,

Weisz,

&

Spmgue,

1963;

Riderr

19E5;

Siegele,1974;

,,1.19¡e,

1991; wells,

1982).

'.f+t

$tmcnt

of

thc h,obtcm

.ril

vi

r;

,'A

:¿o

;l

,'.{

)

:l

n

::

$

&

(

¡'

E

E

(

l.

F.

E

Cil

;,

i¡

il

'l

I

I

I

',

t

I

I

I

The

authors

wish

fo

acknowledge

and

rhank

Dr.

Tho¡rns

parker

vail

for

hi¡

supporf

úhroughout

úhis

súudy.

¡ {¡nE¡

tThe

data

rcporúed

here

rverc

collected

under

don

or

Aging

GranJ

No.

9O-ANL-0676.

n.;;;i

s

0t

fhe

authors

and

do

not

represenf

any

ottlcia

lbe

agency.

106

ary

to distention.

In

uPon

movemenJ

rmY

contrlbute

to

to an

incrcase

in

the

frequencY

of

'irt',

";¡;

increased

anxiety

self-administered

1^?



F

ft

¡

METHOD

p

dr|:

E

rhis

piror

ouor

"::1.1

Tl.":fiTi:y::*:Yi#."::1,:::,iii'il

iñ-1"

&

Liebert,

úEd).

All subjects

were

approached

and

enrolled in

iy

by

the

investigaSor

or

by the

rcsearch assistant.

tflG.rs

tho

nursing

admission fornr,

were excluded

from

the

study.

I¡lnmcnls

:r

The McGill

Melzack

Presenf

Pain Intensity

(PPD

scale

and

the

Linear

Anatogue

Scale

Assessnrent

(also

known

as

a

Visual

Analogue

Scale"

VAS)

flom

the

Memorial

Pain

AssessmenÍ

Card

were

used

to

document

overÚ

'Éryonses

fo

paln (Ahtes, Ruckdeschel,

&

Blanchard,

1984;

Flshman,

.Prstcrna\

Wallenstein,

Houde,

Holland,

& Foley,

19E7;

Graham,

Bond'

Gerkovich

&

Cook,

19E0;

McGuirt,

19E4;

Melzacl

1975;

Price'

McGratlq

Ratli

e

Buckingham,

Dü).

The Mulfiple Affect

A{ective

Checklist

(MAACI,)

nas

used

to document

current levels

ol

anxiety

(Zuckerman

&

I¡bin,

1965).

The Rhodes

Index of Nausea

and

Vomiting

0IW)

qas

used

fo

doQment

bolh

perceived

nausea

and

actual

hequency,

durafior4

and severity

olvomiting

(Rhodeg

Wafson,

&

Johnson,

19E4).

F4uipment

':'j:

The

Physioacousfic

ReclinerR,

a specially

designed,

commercially

posú-surgery

protúr

requires

úh¡

;;;¡.,i,i'

ü#i::h"il#*m,

;tT#

bv

no

nausea

or

vomitini

"n¿

u uo*r"*.ñ"oi

prior

¡

PurTosc

of

lhe

Study

ii;¿

\

:d

;{

)

;tl

'-{

)

jl

I

lt

t

F

&

fl'

É'

ts

,{

&-

F

FJf

fo

have

evidence

of

bowel

function

iúal.

This

nas

lo

assune

thaf

úhe

rist

ons

such

as

bowel

obsfructioq

r

wound

dehlscence

secondary

lo

108

109

)

)

)

)



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

avalle

vib¡af

music

components:

the

a(fustable

chalr,

audio

system

and

fhe

transformer.

wifh

one

cord

for

fhe

úransforme

transforrner

reductd

the

current

fo

Thus

úhe¡e

$as

no

¡isk

of

eleclric

and

sound

flcquencies

rms

used

a

strong,

rhythmic

pulse,

were

infen

patterns

and conf¡ibute

fo

the

pea

Procdurc

PaflenJs

ldenúlfied

as

belng

ellgible

for

úhe

eifher

fhe

music

therapisú

or

the

resea-rch

assistan

to

lhe pafienúq

and

if

fhey

agreed

to participa

oblained

prior

fo

surgery.

pafiónls

assigned

to

a

gmup

which

would

sutgery

or

fo a

gnoup

which

would

assigned,

by

f

on

the

day

prior

úo

sulgery.

Aú

fhat

time, subjects

subjects

""n¿or¡H¡TrT

rne

e:rp".ir*nfar

group

were

shorvn

how

ro

use

the physioacoustic

¡ecriner

"r¿

horr

ao

fiil

our

fhe

rcquird

-surgery

teaching

and

inúenentions

rrcn

al

and

control

groups.

The

confrol

group

to llll

out

lhe

required

questionnaircs

and

on post-surgery

ambulation.

-

All

srbjects

were provided

wifh packeús

which

incruded

fesfing

lnsfn¡menús

and

forms

for

dafa

coilecúron

wtrrcn

they

fiiled

out

each

day.

Tbl

head

nurse

on fhe

unit

collected

al

reco¡d

and

rpcorded

it

onfo

a

med

day

before

sutgery,

all

subjects

i

Thfs

scale

wes admlnlsfercd

agaln

on

po$op

dry

2 at

bedtlmg

and

q*.:t-,1ÍllTi"r-..

rrav r.

and conrinuing

rhroughourheir

hospital

ln

noln rrslne ihe

McGtll

r

)

i

.l

¿

:'

;,

x

x

I'b

rF

r

.&

IP

|

Éll

f.fl

)fr

fg

)o'

I

I

,

I

I

I

15

minutes.

The

flrst

and

last

sessions

l¡tewention

continued

in

this

manner

lhc

experlmental

subJect

nas

dischs

.,pntinued

When

the

nndomly

werc

colle

therc

nas

only

one

physioac-oustic

rc

d

to

rafe

thelr

Paln

udng

the

McGtll

nd

the

ng

lafe

a

mte

any

cryerimental

patient

at

a

time.

The control

grouP followed

th

Included

gettlng out

of

bed

and

slt

Anbulation

$as

encouraged

as soon

a

and

amounts of

Pain

medication,

adninister€d,

werc

rtcorded

starting

t

110

111

)

)

)

)

)

I

I

TAALE

¿



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

\

I

ond

vlt¡l

dgns

rnere

rpcorded es docurnented

ln fhe

patlentts

medlcal

recort

Day

ol

flatug firsú

bowel movemen$

and tofal

number

of

days

in

the

hoqit¿

lollowing

s¡rgery

rpere

noted.

To

protect

oonfdenúl¡llty,

ell

ubJecls

rverc

glven

a

code

llsle{

6¡.

rescarrher

coding

sheet which remained

in a

locked

flling cabinet.

RESI'LTS

Ol

the 32

subjects

rvüo were enrolled

in

the study'

Zl

(625n

completed

the

protocol.

Ol

thosg

eight

werrc in the

e:perimental

g¡oup

ad

tuelve were in

the

crntrul

group.

Reasons

for

wifhdraual

ftom the

study

Included

medlcal compllcatlons

followlng

sutgely

(N=6),

enrollment

ln

¡

conflicting

study

(N=1), prcvious

chronic

pain

rc4uiring melhadone

(N=1),

headaches

(N=1),

and

noncompliancc

(N=3).

See

Table

I

lor

demographic

and

clinical

cha¡acúeristics

of

the entire

smple.

Analyses

of

Variancrc

nere

used

to assess

potential group differcnces

on continuous

variables such

as age,

education,

and number

of

children.

Cti

squane

analyses

r¿ere

used

to assess differences

on

dichotomous

variablcs

such as

whether

or not

subjects

had

been

hospitalized

previouslyr

whether

they hed

undergone

$rgery

prevlously, end

whether they hed

exaerlencd

serious medical

problems (i.e,

heart

disease,

kidney

failure'

diabetes)

in

thc

past.

No

signiflcant

group (experimental

vs.

control)

differcnces

wert

found

on any

of the demoglaphic

variables

(See

Table

2

for

demogsPhic

characieristics

by

group).

t¡.otFD¡¡c

Cl¡Eüftllcr

81

GmP

E

(X.l)

C

iN-tl)

N

¡t.óó

I

tóóó

2

25.m

lcúó

¿

0.00

0

NS

TVilcoxon

rank

sum

lesÚs

were

in

the

control

grcuP'

the

course

of

a

daY,

comParisons

of

VAS

sctres

on

Post'oP

daY

1

are

of

the

daY,

the

e:rPerimental

grouP

(26Vo)'

and

evening

VAS

t

grouP

rePorted

a

the

cuntrol

grouP

dex

of Nausea

and

Vomiting

scorcs

for

ghout

the llve-

the

use

of W

of

E27o)

when

,iompared

with

the

control

group

(meandecrease

of

727o)'

:,

,

F,igure

O *pt"r"ntt

ti"nr""n

andety,

hostility,

and

depresslon

scores

all

subjects

F'igures

7r 74and

78

represent

a comparison

of

levels

of

anxiety'

tility,

and

aepreJion

betweenthe

control

and

experimental

groups

113

ti¡

¡{

d

.A

ra

)

ii

-{

)

"l

l

I

:t

TAELE I

Ilrqnprb rrd dhbl OEdda d

fi{ú

N. 20

^r¡

orrt

O.8

lüodo

(F¡0

lLTt

C¡[¡üq

(¡o¡r

I

Ltl

f¡rLd(ftt

?o.O

Hd.E

?,

(trrd

9l.O

H-rlq..'

(¡t-)

&,O

Oüc

lAl-

¡t

a

ll.r

(¡t

i

31O

nDl ILúF.L

O¡t¡¡O¡c

(¡ttd

,lto

¡- ¡lbc

(¡F)

2cO

Edrraíd

CrE

(¡tr{

2OO

O¡rrlol C¡c

(*

r{

10,@

U¡rb.OE

(rt¡)

LO

tclt ne

L3 ¡rt

ttt G,

N

,

a

a

¿

I

LL2

)

)

)

)



)

)

)

)

)

)

)

)

)

)

)

)

)

))

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

Ftgurrs

E,

E{

and EB rcprcsent

rnean change

saones

lor

ande¡,

hostility,

and deplession

fbom

prc-op

to

post'op

day 2

(I1'T2)' fborn

postop

i

¿"y

2

úo

discharge

(T2-T3),

and

fbom

preop

to day

of discharge

(T1'T3)

?0¡

I

both

groups.

Figure

9 rcprcsents

a

comparison

of return

of

flatug

reÚurn of

bonrl

functioning,

and

day

of

discharge

(or

day

patients

would

have

[sc¡

discharged

had

they

not

begun chemtherapy)

between the

two

groups.

,irdr

MEAI.¡

Iv

PAIN

MEDS

t0

|0

n

a0

T

i,|0

i0

0

HOSTILNY

SCORES

POO¡

E@ffiffiEffiLl

Figurc

7A

POOa

fo-.ffiiffiI

Figurc

78

12

l0

a

a

a

2

0

MEAN

VAS SCORES

Gyn-Onc

Surg.

Pts.

AM.AF-PM

VAS

DAY 3

MEAN INV

SCORES

t5

l0

23

n

t5

t0

I

o

ti¡

¡r

f,;

5

iJ

"{

)

:l

l

;t

20

ll

t0

t

0

ts

l¡"

t'.

I

/L

POOJ

l¡c"^tr"t-¡

etp¡iiffi¡

Figurc

I

AM.AF-PM

VAS

DAY

I

AI¡

E PI¡

lEco.¡rRot

r ErtERfffi

raLl

Figurc

2

t¡

la

ta

l2

l0

¡

a

a

I

0

s

2.¡

2

1.3

I

0,t

0

t2

l0

¡

a

a

2

0

Figurc J

114

115



¡

:

¡

T

¡

I

)

I

I

MEAN

CHANGE

SCORES

A¡.T)(IEry

loffiarl

figurc t

tvfEANCHANGE

SCORES

HOSTILITY

RETTIRN

OF

FI.ATUS

BOWELRJNCNON

DAYOFDISCHARGE

Figurc

8A

H¡I¡¡

Bo|vE-rñ,Mt

DAYSE

'offiffiA¡-'

Figt.ue9

DISCTJSSION

Paiu/Pain

Mcdicaiion

Use

Both

the

PPI and VAS pain

rating

scales

yielded

resr¡lts

whicb

indicated

lhat,

although

the

experimental group

initially rcported

mott

infense

pain,

lhe

overall decrease

in

pain

nas greater

for

the erperimentd

group

than

úhe

control

group.

Thls may

have been

due

úo a

htgher

Inlflal

level

of

IV

pain

medication

use

in

fhe

e:rperimentat

group.

However, it

is

possible

thaf

the use

of fhe

Physioacoustic

rtcliner

cont¡ibuted

to

periods

of relanúon

and

comlorf

which

my

have, in

turn,

provided

sonre

pain

retief,

possiblt

116

-

rhe

neod

for

¡ddltlonal

paln medlcallons

f

"U'j";;-iyi-uyÑ:l3'.:'::ff3:lliil?1"';1ffi

'."JS

I

rePorT'"

L'-;;:

decrease

of

3137o

(not

Dedications'

wmte

confinued

use

of

the

¡

in

graph)'

This

.^

nrñr,".rfe rela:ation.

T.ffi

[":ñ1il;-^ir'rnr."""nron,

wnrcn

I

s

rrru

uÉ,r,]

to

promof

e

rtla:cation'

Sñliftrlin

rtducing

the

need

for

narcotics'

u

E

[f,

x-

É;

E-

É

F-

g

HT

rr¡

\

nr

4

)

rJ

{

-{

)

:{

-i

:l

;t

I

7

a

¡

a

I

2

t

0.

it"t-

end

Vomiting/Antiemetic

Usc

¡neshesla

tlrne.

t

Although

the

exPerimenta

vomiting

on POD

1,

overall

fheY

lor

lhisiould

be

that

of

8

subiec

¡tductd

the

pofential

for

vomiting'

(N=4)

had

an

NG

tube.

It

is

also

f¡cilitated rela:¡ation

which

maY

¡ntienretics required.

Patients

with

an

NG

usage

(i.e.

GI

bleed).

No

patient

'

ómplications following

surgety'

:,¡J,i

An interesting

flnding

is

that

"o?l7Voless

ZantacR

fhan

the

control

'is

that

theteturn

of

flatus

and

borrel

cqerlmental

grouP

fhan

ln

the

co

combination

of

vibration,

decreased

a

liaY

have

contributed

to

incrcased

-

¡nd

bowel

function

in

the

exPe

tt'

I

0,1

0

{J

-t

-1t

t

{t

.¡

r .5

.

1.

2

t.3

I

o.5

0

4,5

-t

.r.t

.

¿.

)

)

)

)

)

vlbratlon

my

have

contrlbuted

3o

a morc

plcasant



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

documented,

the

NG

tube

ls rermved

and

Jhe

patlent

ls

sfarted

on

a

llqu¡¡

diet.

The

use of

ZanfacR

is

usually

discontinued

following

the removal

of

tht

NG

tube.

Anxictyfi

Iof

ilitY/DcPrc*don

118

erience,

thereby

teaáilt

to

an

overall

decrsase

in

fl,om

PrcoP

to

Post'oP

rePorting

a

slightlY

lower

ssíon

nray

have

been

due'

It

maY

also

have

rnean

dePression

scores

úhe

studYt

lt

was

changes

in

rmod'

I

emotional

exPerien

depression

for

the

experimental

group'

Frdors

Conhibuting

to

DisclargP

,

F""ro"s

s¡ch

as

extent

of

srrgery'

return

of fl

nrnctoiiig,

"ll

affect

the

length

of

stay'

Fro.m

;;

náde

about

the

length

of

hoqita

il'coñ"'*g"ty'

n

was

noted

that

$Wo

ol

il;.i

-ln-p*iton

was

made

on

lengfh

of

stay

wirhour

NG

rubes.

,,

ilff;

irr"r

ñr¡.nrr

wño

ai¿

not

need

NG

tubes

rccovered

more

quickly

and

werc

able

to

tt

¿i*f'""g"d

sooner

than

those

who

had

NG

tubes.

all

length

of

hospital

stay

,".,n,Jlliii"t"I#'':,

t*,U"1'T:ll'H:;

I

g¡oup e:rperienced

returl

,-in..'"tliJgrouP,

ttreY

r'

Smmery¡tondudon

Although

results

f¡om

this

¡tr1 V

werc

púrnarily

descriptive

in

naturc'

,

j

rhe

rrends

which

;;;;;.¿

¡nai-t.áiüar

ttre

physioacoustic

therapy

:i¡ji;ij

119

iü

\

'(,¡

I

{

\

)

"t

-t

'¡

¡

I

ri



Iimitefims

for

Fr¡fur Rssce¡cü

res¡Its

of this

study

indicaúe

that

music

and low

flequency

rmy

be

beneflcial

ln

promotlng

relantlon

and reduclng

the

ilrception

of

pain

following

surgery.

\ilith the

potential

development

of a

ñsp¡'t"l

mattresswhich

incurporates

the Physioacoustic

technologt,

there

will

,

Second,

in

order to

determine

which

of

fhe two

media

(music

or

low

ided

Jhe

mo¡e

effectiv

using sepamte

groups

.

In

addif ion,

addit

be

used

so

fhat resul

larycr

population.

Data

from

this

study

suggested

that

emotional

stales

of

the

eryerlmental

group

wene

more positlvely affected

than

those

of

the control

ffh

e

inf

s

lwi

s

in

order

to

obtain

an

experimental

group

and

a confrol

group who

do not

differ

in their baseline

psychometric

measures

in order

to

fnrly

determine

fcaomplishing

these goals.

REFERENCES

'l

,T

'i

'l

*ÁNes,

T. H,

Ruckdeschel,

J.

C,

& Blanchard,

E.D.

(19E4).

Cancer-related

il

pain

-

II.

Assessment

wilh

visual

analogue

scales.

.Iournal

of

'i]{

PsvchosornaticResearch,

8.Q),l2l'124.

Cancer

pain:

A

monograph

on the management

of

cancer

pain. (19E4).

A

lr

121

)

)

)

)

)

.tT

tenslon



u

q

Bi¡

r;

ü

E.

S

ts-

r

-

tr

llil

iljl

rl.ll

ilrll

:il

)

)

)

)

)

)

)

)

)

)

)

.¡

)

)

)

)

)

.)

I

)

)

)

report

ol

the e:rpert

advlsotl

commlftee

on the

managenrent of

seven

ch¡onic

pain

in

cancer

patients

Úo

the

Honourable

Monique

Beg\

Miniser

of National

Health

and

Wellare.

Cfunq

G.

A,

Luscomb,

R.

L,

& Scoft,

L.

$: m4,

RelaxaÚlon

tralnlng

and

cogniÍive

rcdircction

sfrategies

in

fhe

freatrnent

of

acute

pain.

Pai¡,

LZ

175-lE3.

Fishnmn,

B,

Pasterna

Holland

J. Q,

& Fotey,

K.

M.

J

Card:

A

valid

instrument

for

60,

1151-1ü,E.

Graham,

C,

Bond,

S.

S, Gedrovict¡

M.

M.,

& Coolg

M'

R'

(19E0)'

Use

oltht

McGill

Paln

Questlonnalrc

tn

the

assessment

of

cancer

peln:

Melzaclg

R.

(1919. The McGill

Pain

Queslionnaire:

Major

properties and

scoring

methods.

Pain.

t

277'299.

Melzack,

R,

Wets4

a.z,

&sprague, L. T.

(19ó3). Stratagems

for

controlllng

paini

Confributions

of

auditory

stimulation

and zuggestion.

Neale,

86).

Science

qnd

Behavion

An

(3rd

ed.).

Englervood

Cliffg

NJ:

Prentice-Hall.

Price,

D.

D, McGrafh'

P.

A'

Rati

A,

&

Buckingham,

B'

(1983)'

The

validation

olvisual

analogue

scales

as

ratio

scale

measunes

for

chronic

and

eryerlmental

paln.

Paln,

1,

45'56,

Rhodeg

V.

An

Watson,

i.

M' &

Johnson,

M.

H.

(19E4)' I)evelopmenf

of

reliable

and

valid

measunes

of

nausea

and

vomiting.

Cancer

Nursin&

X'eb.,

pP.3341.

Rider,

nf.

s.

iigASl.

Entrainment

mechanisms

are

involved

in

pain

reduction'

muscle

rtlanúion,

and

music-mediated imagery.

.Iournal

of

Music

Therapy,

Li¿'

@)'

lE3'192-

Si"g"t",

D.

S.

(197a).Tle

gate

conlrol

theo¡yÁmerican

Journal

of Nursin&

stein

t¿.tf:

ngtont

t22

n

on

posl'operaflve

muscle

i

'"

serrice'

:ü

¡a

ta

4

)

1

{

,¿

)

l

:l

:l

rt

t+.:.

.;ii

lSl:.

';5¿

-ti'

rTlrts

proJect

qas

funded

by a

grant

no¡n

tlre

Glaxo

Research

Institute

and

was

camied

out

as

pJúiiurnilments

l"t

ñ

Master

of

science

Degree

in

Rehabilitation

Counseling

ftom

the

Univerjty

of

North

Carolina

at

Chapel

.Tiil,

NC.

t

The

author

wishes

to

acknowledge

Susan

Avent'

MSN'

RN

for

her

assisfance

and

srpport

throughout

the

project'

)

I

)

)

)

)

)

betr¡ecn

the

zubdancia

niga

and

ofher

basal

nuclei,

ol the

i'"p;rtanc.

in

the

conlrot.ina

si1$fli

1-:*-*::::"*.Í:ii

il#Jsffi

il";;;:ñ"rions.

rhe

main

maniretarrons

"f

rl;,drdg

itiíni"-ii¿

l¡ck

of

movemnt

crnfro[

trcmorg

slownesq

rlg



)

)

)

)

)

)

)

)

)

)

)

)

t

t

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

alterations

in

posture, equilibrium

and

gait'

'l

l'

I

Subfirts

Si-{ryaJi-9¡ -s

(ages

40'75

years-of

age)

wifh-

Idiopa-ft¡ic

P,arkinson's

discase

in

Stases

U

aní

Iu

of thó

Hoehn

y.Ürueft:

(19";

1

Yálir'

te6l¡

*"r*

..rráo-ly

selected

¡¡om

fhe

tofel

number

of

Parklnsonts

paflenls

rl

an

indePendenl

.

Subjects

wen

oPa

medication

ParttclPatlon

ll

they

were

beyond

the

designated

age

ml-g",

if

the{

were

d.iagnosed

wilb

"-"áná"I.

parkinson's

disea"se

or

with

multisysfemic

degenerative

disease'

or

il

there

was

an

associated

cardiologic

pathologt

or

a

recenl

moderale

lo

severe

trauma.

Subjectswercmndom|ydividedinlotwogroupsofthirtysubjectseacb.

The

e:perinrental

group

rcceived

music

vibráacoustic

fherapy

tr¡atmenl

f-ori"

uo¿

a

pulsed, slnusoidal

low

fhequengr

vibration)'

The

control

grouP

recelved

muslc

only

wlfh

no

low

hcqueniy

tones

whlle

lytng

on

the

bed.

METHOI'

Mcasu¡emen3

Insfurents

ol

treatmenf,

the

Scale

of

Daity

Activifies

Aspectg

toi'tr

a"cot¿ing

to'

the

Unifid

(UiDRS)

(Fahn

&

Elton,

19E7),

as

well

as

the

Subjective

Assessment

Gtobal

Scale

were

used

in

this

study'

t26

ütatment,

and

th¡ee

treatment

procedurc'

;'

The

followinc

;;r"r,"¿itr"¿

durlng

n'hlch

the

I An

tnliial

iris

*""

also

provided

an

lrcatment

proce

"..

lft"

"

Its

interests

and

i

oPPortunitY

for

ri¡

,:

rq

li

't

.t

'¿l

il

fl

ltt

tliminate

or

serye as a

'..i.1i

leam

a

Interests

were

rooted

i

L27

-

-..---**--A'q-e#

)

)

)

)

)f

rhythms

and

melodies that

had

been

part

of

their

adolescence.

f,-

Thisflndlng

presnted

somc

challenges

in

selecting

appropriatc

g¡f$."

wüich.

_ms-

rcla¡ing,

_bca,uti

r¡ifeetlng

for ¡ll

subJects

¡nd ¡t

the

materiü

the

e:Perimenters

flnallY



)

)

)

)

)

)

)

',

)

)

)

)

t

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

\

rh

n:

,4

Sig-

of

lf

F)

.t

.000

"5

)

d

lt

.wt

:ii

tl

,ll

rpould

alternate

throughoul

fhe

sess

compositions

in

an

adagio

temPo f

offer

a

positive and rclaxing

harmo

mone

ener¿etic

hand

accordi.on

indrument

is fypical

to Basque

musi

music

close

to úheir

own cultu're.

rl

d

tr

DTJ

F,,

Fr

h

É

ts-

F

FC

I'

if

li

ili

:,li

t

i

I

I

¡1

li

ti

wers noted

and

recorded

wifhout conversation.

Throughout

the study,

lhe experimenterswere

cognizant

of

the

posdtlr

Influencc

of

thetr retatlonshlp

wlth

the

subJect

on the

resulls

ol the

ludr,

consi-dering

that

the subjects

wene seen

for

25 minutes

a

week

for

six

month¡

Bticause

of

fhis

possiblity, the

music

therapy

feam

systemalized lhür

o"bserrations

and limited

verüal

inferacf

ion

with

the

patient to

a ferr

cuurleo¡¡

phmses.

A

contrcl

llle

was

maintained

for

each

subject.

It

included

noles

tala

at

fhe

beginning

of lhe

session,

such as

the

degree of aulonomy,

lhe

prcscng

of

uncontrolled

movementg

difficulties

in movement

and/or

in

ve¡üd

exchanges.

These assessnrents

were

compared

wlth those

Jhaf

wer,e

made

¡t

the

end ofeach

scssion. Also,

during

the

session

possible

other

observafio¡¡

werc

made,

for enmplg

variations

i

and

volunlary

movemenúg

steep,

etc. These

observat

systematicálh

were not

been included

for

analysis

been

used

for

clinical

insight

into

the treatment

p¡ocess employed.

Evah¡ation

Two medical

doclors

seruing as

blind

and

independent

raters

evalualcd

the

subjecfs

in

5

periodic

check.-ups.

Their ratings

were included

in

e¡cb

subject's

control ftle.

RESTJLTS

A comparison

of the

subjectst

UPDRS

sooncs rcvealed

no

signifiail

dlfferences

beiween experimental

and control

groups

(See

Table

1)'

Howeven

L2A

ffi[5"tr

=;áfiorv¡ri¡nccs

F

-482'E;p

= 'o32

t{cst for

EqrnlitY

of Mcans

Vr¡iances

t-vduc

Equel '194

ü

s2

&29

ncqual

-''94

)

)

)

I

)

¡.rtr.¡¿.

-

"'

:''

Bas€d

on

thcs€

ñndlngs

it-'cqn

be

ally

vlb¡¡ac¡oustlc

treetmeñÍ-dppeercd

for

n

D.B'

Calne'

&

M'

Goldstein

(Eds)'

B+Ú

s.

Fahü

c.P.,yl1*i.'--,o

.r

¡c4ose rv"l.

a-i;;.

;$-;¡t:'fu""'"-

'..-rj:

Wt

t,

and



t¿

Y

.4

{

f

.[

{

T.

{

I

t

I

I

)

)

)

)

)

)

)

.,

)

)

)

)

)

)

)

ir

)

)

)

)

)

)

)

)

)

)

)

)

)

t

antlclpated,

p¡tt¡".ontt

patients.

These

effects

rpert

rno$

and

;;;ii".

of

haity

l¡v¡ng.

Thus,

rhese

flndings

are

consi$ent

wifh

prcvious

;ésEarch.

It

is

imPorlant

to

sPeculate

the

music

theraPY

grouP

and

the

v

vibroacoustics

¡eceived

¿t0Hz'

low'fr

measured

uay.

Houever,

the music th

bul

ln

a

randon¡

uncontrolledr

unmea

ofthemusicitself.Thus,theon|ydifferencesintrtatmenteffectscanbe

attributable

to

the

&

H;.

srimulus

rhat

r¡as

provided

to

the

exaerimental

subjects.

Itcouldbethalvib¡oacousticlrealmenlmaybeatechnique 'haf-rvitl

help

alieviare

or

relieve

Parkinsonian

symptomg

but

much

more

research

is

needed

to

find

out

if

lhis

is

lhe

case'

There

are

some

conE¿erations

to

be

taken

inlo

account

in future

research.

In

Úhis

studY'

through

the

bed

withou

variable

nas

intnoduced

;ü;;d.

in

the

nrturr,

¡ris

should

be

confrotted

so

that

the

control

group

receives

none

other

dl"

"rair""y

stimuration. To accomprish

this,

the

audio

"rr"in"l

feeding

ilre

ue¿

speakers

should

hlve

a filler

which

cuts

frequencl

at

no

less

lhan

¿ouúL-

oi

the

highest

ftequency

generated

by

the

low

frequencY

oscillator.

Addlt|onalresearchshou|dbeconductedconcerningtheoptime|

frequencies

needed

rá

ii"ur

the

variety

of

parkinsonian

symptoms,

such

as

tremorg

rigiditY

etc.

In

a

similar

mannert

fhert

should

be

research

underiaken

to

defermine

the number

of

sessions

a

optimize

trcatmenl

effects

in

these

iiw¿s

decided

that

one

session

Per

However,

during

the

multtple

sesslons

Per

The

authors

ar

areanxioustoconfinuewor|rinfhisareainthehopesofrefiningthisnerv

method

or

rca¡meni-*rri"ii

rr"r¿s

promi."

for

rerieving

the

sufrering

ol

individuals

aftlicted

with this

diso¡der'

D

Rcfcr¡cncs

Fahn,S.,&E|ton,R.I.(1987).UntftedParlr|nsons'd|sgaseratlngscale.In:

r

?n

-nrtelitv-

Neurolo¡ry,

tL+n+l^

---.:^

.L^Éñú.

The

llet

131

F

F

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üigf¡m

INIRODUCTION

both

the

music

and

low

ffiily-lTHüffl

surr

or

rhese

rrequency

danges

w¿s

varied'

an

after

the

frtquency

was

chenged

was

often

difft

e

$as

assumed

fo

add

a

There

have

becn

no

de

modulation

for

the

ol

fhe

Pulse

rras

th

PhYsical

behaviour

i¡

:

4

{

f

t

{

I

I

I

I

I

in

early

e:rperiments

undertaken

at

"."Ju'Jint'ri"

t"o"r

of

comfoñ

and

133

)

)

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tt|{

rF{

irú

ln

arousal

lcvel

¡nd

l"9Tl"

Tbcrt

woul

&s

of

amplitude

modulanon

ne

betWCe¡

mndant

tgne.

,-

'-

l'

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'

.

iIffi

3#S"i:'g*T"""iff

3iJ#::[si'#*'iilH,ilsE

ffi

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¡ril

ril

,11

h¡e

ltror

Pe¡

¡w

-

-tWC¡¡

be

foo

fast

bY

some

of

the

PeoPle

*¡

wifh

rclantion

and

with the

mus¡c

mments,

and

it

became

aPParcnt

tht

f

the

stimulus

rms

necessarY

to

tcE

low'ftequencY

tone

has

not

bce¡

was

designed

fo

measure

dilferencts

o

determine

whether

there

was

anJ

ulsed

lorv'frequenúY

tones

or

a

conslanl

tot*afn"

experiment

was

intended

to

measure

the

effect

of

the

lorr'

i

hequency

fone

at

difr;;;

p"ü

speeds.by

varying

the

amplitude

modulafion

and to

measure

nesponse

to

a

conSant

fone'.Itwas

decided

Jo

concentmle

0n

evaluating

the

effect

'oi

áirtt*nt

speeds

of

the

pulsed

low'frequency

tonc

alone,

in

order

to

avoid"a

iiiir""i

"""f"unding

variables

of

tempi

and

rhylhn

t"

'n"rilffi:Íual

rtporl¡of

effects

peopte-have

felt

when

rrying

Úhe

trtatmen[

togethir

wtth

the

o*;t'i;.

"-p"ti"'.,".-"¡

cllnlclans

expeiimenttng

with

lhc

freatmenf,rhu""

¡n¿¡-iJin"i"

longer

pulse

speed

*oul¿

u"

more

relaxing

and

therefore

have

a

greafer

effect

in

reducing

iJltt¡.

tone,

increasilg

relaxati-on

.a1f

redu

or*r.u"".

Subiective

t*pottt

have

also

indicated

t

iliüfñ

tá signifcantly

less

cffective

than

a

putse

sneedg'r

METIIOD

,rii

I

tension

and

hedon

tb¡t

can

last

for

a

were

H:;

,

verc

taken

five

minutes

."thti;l-'

-r^Lr¡¡

in rhis e:oeriment

were

the

different

speeds

t;,

" "'Ti"

independent

variables

in

T:Y":1H"d;#;;I"'".

of pulse

(ó

seconds,

ñ:;;;¡t'

14

scconds¡'

and

the

constanl

tc

behavior.

Eryerimental

HYaolhcscs

I

Basedonanecdotalevidence'andevidencefhomctinicalex¡lerience'fhe

following

experimental

hypotheses

were

posed

for

these

trials:

\

\

,)

134

rü

l1

r:

t¡{

7l

pj

t,.

1.

-

.¡-{

i¡

tii

jll

ri

ri

'tl

[¡

i

¿t

al

rl

)'

4r

(,

lr

a

t

I

I

I

looi**

-'|-

en romale)

volunteered

to

take

part

in

t'ials'

i

Sixty

subiects

(30

nble'

30

female)

vot

135

{

)

)

)

)

)

)

The

srbJects

c¡mo

lhom

wldely

dllfertng

backgrounds They

conslsted

ol

¡

SeIf

w¡lu¡Jlon

of

tteh

steÚe

of

rcleptlon

w¡s scorcd

by

the

ubJecls

and

afier

the

trials

on

a 9

digit

scale

rcquiring-

1- :i i:-EJ:j

ol

Jheir

late

fbom

very

rchxk

3o

very

iensc'

tVhetber

thcy

liked

ñ;

",e;".Gc

s¡s

elb

scored

by

rhó

srbJccf

on

e 9

dlglt

scale'

the

trial.



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

.)

)

1E

to

6Q

wiJh a mean

age ol32.4

(S.D.

10.0E).

MeJcrids

Vlbroacroustlc

beds urcrc

used

for

úhese

trlals.

The

beds conslsted

of

a

sotid

woodcn

fhame unif

wifh a

two

and a half

inch foam

rubber

mattrcss

cover¡d

in PVC.

Secu¡td

into

the unil

werc ó x

E ohm bass speakers'

with

the

cones facing

up.

The speakers

in the unils

were

powered

by Mamntz Inlegmted Stereo

Ampliflers

PM

52,

and

the

pre-recorded

tapes

were

played

lhrough

Maranfz

Stereo

Double

Cassetfe Decks SD

45. Numerically

gladed

volume

and

tone

controls

were

used to

ensure

that a consistent intensity

and tonal balancc

were rnalntalned

for

¡ll

the

trlals

Four

tapes

wiúh low frequency

sinusoidal

úones

of 44Hz

wene

produced

for

fhe trials:

1) Tape 1.

(Condition

l)

llHz sinusoidal

u¡iave with

an

amplitude

rmdulalion

o1 .17;

2) Tape 2.

(Condiiion

2)

44Hz

sinusoidal rvave

with an

amplitude modulation

of

.10; 3) Tape

3.

(Condifion

3)

44Hz

sinusoidal

nave

wiúh

an

amplitude modulation oI

.07;

and

Tape 4.

(Condition

4)

constant

44Hz sinusoidal

tone.

Mcasurcs

Systotic

and

diaslolic blood

pressune

and hearf'rate

were

measurcd

using an

Ormon Automaúic

Oscitlometric

Digital Blood

Pressure

Monitor

HEM

-

704C.

The

LMIST-MACL

rvas used

for

srbjective

evaluation

in

this study

to

evaluate

changes

in energetic

aruusal,

general

arousal,

Jension arousal

and

hedonic

tone.

The

uwlsT-ll{Acl,

is

a

2fuitem

a{iective

checklisÚ

which

rrcqulres

the

sub$cts

lo score on a 1-4

scalg ranglng

through Definltely

'

Süghfly - Slightty not

-

Deflnitely

not. The adjectives

ane

selected

to

indicate

po"itivó

(+)

ór negative

(-) aspects

of

energefic

artusal

@A),

general

arousal

(GA),

tension

arousal

(TA)

and hedonic

tone

(IIT).

Forms

were used

fo

cotlecf

data

before

and

after

each

trial

and

the

subjects

were

ashed

the four

poinf

scale.

They

were

encouraged

fo

use

a

Yent inaccuracies

or

omissions

tne

UWIST-MACL

of

úhe same

piece

of

paper,

and

the r¡searcher

took

care to ensunc

úhaf

spbJects

did

not check

úhe scores

they

136

PRESENT

MOOD.

':

Work

quicklY,

and

don't

sP

anslf,ers.

The

ñrsÚ

ansrer

you think

,word,

even

if

you

flnd

iÍ

difflcult'

true

of

YOU.

Please

do

not

try

a

;

lhing

to

say.t

Your

ansr,Yers

will

be

ke

the ñrst

word

r¡as'lively',

and

you

felt

¡s

shown:

í:_

:¡;:

DEFINITELY

SLIGHTLY

SLIGHTLY

NOT

DEFINITELY

NOT

'Livelv--

t

2

g 4

rr

t"l

¡i

4l

{l

0l

)

?

{

fl

{rrial

tes.

The

srbject

rms

checked

to

rnake

-T*

thu1,

ht

T

:T

-Y:

"iJ*á¿V

to

begin

the

trial'

The

subject

w¿s

then

covered

with

¡

;

The

subjects

were

asked

to

choose

a

piece

of

paper

hom¿

container

inh would

randomly

urrigtt

ttr"-

to

one

of

ihe

four

conditions.

The

stbjects

ST.MACL.

tlorrtng

ln$nrctlong

acc'ordlng

to

Jhe

on

of

the

IJWIST-MACL

(Matthews

et

f words

qüich

describc

the moods

or

efe

the

checklis,

you

should

indicate

m drn rt^r,lErlt'n /an¡l naf irrCf

el

AT

THE

MOMENT

(and

not

just

""

;";li

;l

fl:l

fi

:]"''"iff¿T:";

itely

noi')

respectively'

Simply

circle

"hc

number

whlch

corresponds

to

the

reply

that

be$

descrlbes

your

¡o record

fheir

date

of

birth

and

sex'

state

of

relantion

at

thaÚ

momenl

on

laxed

and

9

representing

very

relaxed'

o

lle dorvn

on

the

bed,

make

him

or

period was

allowed

before

the

initial

time the

themPist talked

with

fhe

he

five

minuÚe

reS

period,

the

subject's

aken.

The

cuff

of

the

sphygnono¡refer

ann

so

that

it

rras ready

for

the

post

I

bhntet.

L37

)

)

)

)

)

)

¡ bl¡nkeü

, The

rublrts

ne¡e

told

thaú they r¡ould hear

a mund c,omhC

ihe

bed.

Ibcy

were a*ed

to

rcl¡¡x and

think

olrvüatcver

they

wanted.

rü

wGir

asked not to

geú

up.

They

rrerc

fold

th¡t

the e4erlence

rvould

ooo,il

tor

15 minutes

and

lhaú the

rcscarcher

would

not

rcmain

in the

mo¡n

$ii

them

so

that they

nould be on

úheir

onn,

and

not

be

distracted

by

ji

.

,-l

,

',

r.i¡

&

M-¡r

¡d-íffi

d:vltfou

d od'

hf| l|lq

'

i¡¡¿ ¡lt¡o,t'

ltt¡ltlo¡

rd

llla/dilf¡

'i,

:,

:

:;.

-

1'

1:9ftr-{]5'

,

'',,''

'.t

"

l

'i¡ir"

'

,,;i,ft

.

t;

.,t

Aoq

I

66

M.a¡

rs-D-l

Gúq2

l0

r¡

M¡¡

tsD.)

eoupt

11s

Mr¡¡

rsJ).)

eoqa

C.ill¡ú

M¡r

lsll-)



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

pncsenoe of the

rcscarcher.

Th

fhe

volume to

+S

oD

tb

ampliller

ctnstant

point

for

a6

trial.

At

t

get

up.

The

researcbc

came

back

in the rcom

three minutes

before the

end

ol the

trial

and

n[¡¡

the

15 mlnute

tlme

perlod

r¡as flnlshed,

he reduced

the

volume

of

th

amplifler

to

zero,

and

switched

olf

lhe

equiprenf.

At

lhis

point

in

the trial the

rcsearcher

took

a

blood

pressurc

aü

heart rafe rcading

agpin,

and fhen

lhe

zubjets were asked

lo

complete

th¡

LTWIST-I\4ACL

again, and score

on Jhe

rela:¡aúion

scale. Finally'

úhe

srbjeor

were

asked to

score

on

lhe

like/dislike

scale.

RES['LTS

Table

1

gives

úhe Ineans

and

standard

deviaúions

of

changes in úhe

lour

conditions

ol

arousal levelq

hedonic

lone, blood

pressure, hearl ralg

relamtion and like/dislike.

The

analyses

of

variance

in

Table

2

of

energefic arousal,

general

arousal, tension

arousal and hedonic

úone

of

lhe

(MIST-MACL

revealed

no

signiflcant

differences

between

gnoups. Analyses

of

Variance

of

blood

pnessr¡re,

pulse,

and

degree

of

rtported

relaption

measured

before

end

¡fter

the

trials

also

indicated

no

significant

differences

between

gnoups.

Therc

rtas

no

significanf

difference

befween

gFoups

on

the

scones

úhey

recnrded

for

liking

or

distiking

lhe

sfimuli.

The¡t

uas

no

suggesfion

of

any

difference

betwecn

age

groups,

or

befi¡een

male

and

fernale

stbjects.

DISCUSSION

tnat

nughl

a

consÚanl

úrlats

and

138

T¡bb

2:

ADlttÉ

ol

vÚbE

ol

dlGé

ir

ood'

pb':iologial

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rrLBlb¡

¡od

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ri

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f

rq

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ril

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i

tl

,l

rll

I

*

t

t¡

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{l

ú

¡

l

t

..;

I

']

Eu¡cdc

ADrl(EA)

.lJ

r¡.98)

¡¿

(6.t9)

.1.9

r3.251

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1.7

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(4.E1

Ta¡lo¡

AnElfiA)

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r6.0t

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({.13)

.3J

r-1.2l)

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(5.76)

Hcdo¡ic

Ton

¿HTI

+

l.l

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r{.73)

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139

)

)

)

)

)

)

I - -''

fltquencYtone

'o"opfc

have lndlcatd

intónded

in

the

ÍvAtneraPy

eraPY

Some

c

thevl

henctng

thevl-.

'lnotion

efnect'

sl

ddr nn vestibula

Ir-

.¡l



)

)

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)

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)

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)

)

)

iÍ,*"tfi:'*tl""e*l.j13ffi:Tilff

;l'$;"ru#ili*,ñndrhe

t:J

of

this

st

subiect

in

e

effects

or

order

effects'

süpport

anY

of

the-huBp

puiJe

useO

in

VA

theraPY

s

a

PFOUlltul

f¡r¡t

yrvw"-

FEREhICES

':

Saperston,

B.

(1995)

'

:. interactive

temP

t

rapport

fra

symposiu-m'

.Vibroakustish

innen

II"pu

Og'

'folitttittitL'

Flsikalslt

by

the

lnteJiafJn'al

society

of Vibroacoustic

Through

Music

and

Vibrations'

From:

Sd"[ilt

Ls

Viva

Verlag

Mainz'

141

,¿

i

I

at

a

E

¡

I

i

)

)

)

)

)

)

IWELVE

IflENáPfi,

WÍTfl

EANDIA'PPEI'

ANI)

lmncvt¡ts



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)

)

)

)

)

)

)

)

)

)

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)

)

)

Hfi""",üTffi"riJ

rd

'a

-t

I

{

F,tt

*rf

{

r)

tl

J

-

t

I

F

;I

I

'il'

I

i

, i

'l)

.i¡

r¡

$i

{

rl

FdSs

Dc

B¡cIcr

heatment Plan

is

and

weaknesses

U4ftetlong

p[y$o-soclal

dlffcultles

¡nd ¡lso

prcpl".G.f¡-rsw[h skllls

of

et

arise

-due-to--Eu g q

weakness

o¡

sensoriJ$

such

es

mlnlrn¡l

braln

damege.

Moúor

probd

can

occur

at all

{fner9nl'l9¡r-g s

of severify,

tlqg--gilq

= q.--D'Lt

to

PllY-end--U J

ñil

emerien@

and

raoist

cvaluates

the

aoist

cvaluates

the

.

of

"¡isyóhotherapy

tscnnqu:"t

":'

u¡:'-.:-:-

:

',,1

'-'*"-'-;l'

thie

iotlowlng

¡nces:

:

the

quality

-of

gÚ-+ta:t'

interaction

and

e¡QreS-ive



:f

I

t

H

rü

rri

it

t

#t

U

T

-t

{

,l

I

,,f;

tf

't'

,ti

ll

:j

',ii

'll|

,rl

diffculties

(that

can

caüse

r¡¡r¡ting

problems),

lgyery

severe

body

spasücih

riilti-ortho@ic

deformities

All

different

types anl|*m-ánilF$ef¡-ons of

ce¡rbhi

i:

Cese

StüdY

1.

JGnEn

.i,

Introduction

i/

j

jl¡.

)/--

ii

Jeroen

rs

a

moderar.i6-r"'v

rerarded

fourteen

year

old

boy

with

nccntration,

attention'

ability

to

follorr

dircctions

";;;;

;tsc

Ñi"

"i*

o"

dislikes

of

ccrtain

n musical

forms

I

as

in

sPeaHng

and

e

chlldren

duri-ng

this

oustic thelaPY are taken

muslc

theraPY

essessme

it

and

rccommendations

f

after

the

evaluation

b

n meetings'

, ttcraPeutic

APProach

iT

is

based

on

carl-Bgggl9

siven

to

the

genuineness

""nir*-

ttt"

-

unconditional

strategies

to

address

these

needs.

Uss of

Vibmouúic

thenPY

Research

in Great

Britain

and

Scandinavia

.has

supported

the

use

0f

specifically

the

use

music,

as

clinicallY

ure,

and

paln,

and

I

of

the

client.

AsscssmnJ

hrocducs

as

an

observer.

-

The

assess¡nenl

genenally

takes

about

forty-flve

nrlnuÍes.

Durlng

thls

L4

rl

'l

I

r¡

:¡

,l

I

E

)

145

)

)

)

)

)

)

itrl

ir(

i|¡l

trl

l

music

themp

on

a

rveekly

basis

for

forty

minutes

a week;

he

has

r

thes

sessions

a

grcat

dcal.

The

gml

of

lhis

work

has

becn

to

develop

motor

ond

vlsually

handlceps

He

has

aÚtendd

flve

yeans

of

i

scsdonrercenJstctrvclPL:11':::til.li:"*:";if":fi

:t"ltl#

sral

imPulsive,

short

hlm

to

suSaln,

I4lnlY

muscle

one'

interestins

that

he

began

to

use

?-

.r.ooo music

fherapy

sEss|ur¡rt

*

'--

interestins

that

he

begSn

to

use

ru]rrv*-

-

.

,--.^r

--ior

anrt enioved

ptavi]ng it.

To

do

thig

he

¿;um

with

rrnner bodv

was

qdtn

body

was

sllmulste

l¡tenf

and

sesslong Jeroen

edri

inCfeaSe

With

eVefy

infenUonAt

$tmutus

or

€rxtrru¡rór

r GIPUIñ.

r

rus

A'.,td

¡¡



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

I

I

üum

uppor

eood

leg'm

ing

to

note

from

.Lnt

but

i3

..nfrnnted

with

ir"iot'

tot

it

-,,--

confitnted

with

rhation

that

J

ed

intense

pleasure

at

lcn

sounds

or

"

'lli*ill"Tn-1"?J*'Yikillt

hu""

rernained

at fhe

be conúrolled.

Thcraw

Scssions

During

the first

session

of vibrcacousfic

Úherapy,

Jeroen

showed

lha¡

he

qas

very

anxious

and

concerned.

He

nas

ashed

to

siú

in

the

vibroacouslic

chelr

and llsten

to

muslc

nlthouÚ

the

added

low

ftequency

vlbratlon.

Th

same music

woutd

lafer

be

used

with

the vibroacoustic

treatmenf.

The

music

selecfed

for

Jeroen

uas

Vaughan

Williams

'The

[¿¡t

Ascending"

and

Wim Merten's

"Minimal

Music

for Piano

and

Voice" whici

HSand

the

vibroacoustic

sessions

ctive

ortho-agogic

music

themPt

RcsIJs

of

tbc

ThcraPY

Scssions

ffter*the

flrst

si:¡

sessions

of

vibroacoustic

therapy,

lhere

were

n0

¡mmearáie

o"

,".".Lr¡le

changes

In

Jeroen's

behavlor.

However,

during

tbe

t6

Os.

SndY

2z

&ft

r&

',,

Gert

is

a

twenty-f-ou"

y3i

tl'd-3.-iiillf

t^t'While

he

was

attending

¡úool¡

it

was

noted-il'aii"'iiolateri

h'i-ni&lT

mort

and

more

and

became

onfi¡scd.

His

behavio;1;;;;""e

rigid

uná

s"t*otvped'

Being

a

good

'fudcnt,herras"tr"rJi'nisr'secondary""loolsuccóisfully.Afterrrards

bo*eve¡

Ge¡t

became

apathetic

"td

tiltilll:

:+

He rr¿s

admitti

to a

day care centre

for

autilic

clientg

and

his

'

il

with

how

he

could

m

fottft"t

helped'

how he could

farcnts

""T"

":l:::llmr"lr

and

fulfill

r,¡,

pát"ntitl,

and

also

how

he

could

Itnd

e

waY

to

e)rPress

n

'be

abte

to

relax

un¿

improo"

his

communicalion

skills'

ii-.

During

the

first

Ission,

Gert.nnas

"oYi-tq

be

very

tense

and

rigid'

it.

p"*iniiiíy

of

using

vibroacoustic

therapy

was

neans of

helping

hi"'"";;';;-ñeaiarety

wittr

lS

nal

d

to

him.

and

vocal

muslc

bY

Wim

o

the

new

age

stYle'

The

.r$uenW

chosen

v¡as

52

Hz'

Gertts

stereotyped

behaviorg

moving

his

fingers

mpidly

over

lris

thumb

and

making

tacial

grima*t'-

"o'ntt'

''ü

'tiili

r"r

his

tension'

had

''¡liirost

dtsappeá-red

r"ii""iiü

trtt

'r*rr'

'"ttio"

o

vlbroacoustlc

therapy'

At

'ti:

l{l

a

I

t

(

.t

J

)

a

i

)

)

)

)

)

)

iT,'l,iillll'T,lfl;"Tl#H",,j#'mi*rffi

thls

tlmg

Geñ

could

placc

hls

h¡nds

gently

on

hls

aHomen

¡,,rr r-

he was

abte

ro consciousry

derecr

andioilow

rtre

moveÁiñ].:l*

r

,t

,

.-

-'"

i.,

,

'::

-i

:

:

'

i'

TNERAPr

IN

INE

TNFINENT

OF

NETT



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

,

)

)

Tbe

frst

descrlptlons

of

the

condlSior¡

lafer

to

be

knorvn

as

ReSt

-l

t"t.

made

by Professor

Andreas

Rett

(1966)'

Yory

detailed

fid;;;iá

iá"i,iry

the

sirls

who-

werc

srfrering

lrom

rhis

ffió;"

¡cach

the

rtóraturc-in

the

earlv

t:.Ti|ltt

Ito,t"l|SllT

iii¡in"ii

&

srephenson'

:'9t5;

K"""

-&

Stephenson'

11166)'

Rett

í"

¡:

;

nrofoundlv

nandicapPis

l"fTfggt-l

disorder

which

onlv

W"i:.:

ttai¿ir"uiliti""

lfccls

gtr¡s

üctoss

of

P

1"i:-:3::Tl*

lgDD

u¡

l'

ñ.it"rn.lor

and

a

generaltzeq

moror

dlsorder'

The

--*'

o|apparcntarounotheageof14tolSmonthsandaffecfslin10'000

frg¡e,m

associated

wifh

Rett

hand

clasPing/hand

imbs;

4)

scoliosis;

5)

bs

and

sometimes

in

Jhe

arms;

6)

l¡prventilation;

7)

air

snallowing

and

distended

abdomen;

and

E)

elevated

lmdon

and

anÍetY

levels.

,t=

From

previous

research

in

vib

oacoustic

therapy'

it

was

lhoughf

that

¡ome

of

fhese

symptoms

should

rtspond

successfully

to

this

fonn

of

lmlment,

particulariy

as music

has

u en

indicated

as

an effecf

ive

therapeutic

¡cdium

of

treatment

for

girls

with

Rett

Syndrome

(Hadse|l

&

Coleman,

198E;

Monlague,

1988;

Wigram'

1991).

Rcfcr¿l

¡nd AssessmnJ

Pr¡oedures

j*t

^L rr-^-r¡

I

Retf

¡H,

The

Hamer

House

Chilüen's

t,ñhnr.tiii-añi¿al.ñ¡r¿*n

t¡om

clinic

'lsd..ñn"d;peciltcatly

to

addrcss

so

.

, --

ant

to

and

the

mulfidisciPlinarY

feaqr

";il:'JT3'J':'*m1"ff

nñ';

nonrc'

I

Chi

sYndrome

are

rtferred

lo

the

dinic,

and

ensive

assessment

of

specific

Jfi

f*

inciude

a

music

therapY

¡

t

I

I

I

t49

)

)

)

)

)

)

a

compreherffi

moflvaüon

{i

lizcsin

asses\

the

h¡nds¡nd

encroureges

the

¡s

go

se.oil

rbls

cl

hand

lo

retch

ed

esscssmcnt

t'o

er'¡lu¡tc

ln

a

gencral

rqy

cllentC

firnctlonlng

"lwel-s'

-

.:

-__- -¿ian

iñt¡:n¡.fson¡l and

motor

sHlls

and

their

rtspg--nryl

¡

rnmnmlr^

fr"|.a

period

ot

approxirmrelysix::-y*

minutes'

the

therapist

u"¿

*ou-gJJrii"

to

lie

srill

and

.i



)

)

)

.)

)

)

)

)

)

)

)

)

)

)

¡

)

)

)

)

)

)

)

)

)

)

t

.)

)

t-

--

o,e

client

to

tne

pron'e

position

"r¡""i

t

often

talks

to

the

crient

in

a

reassrrils

urav.about

what

is

an

assess¡nent

*1t"t"'it

it

q"i 'tyti":t

for

the

tives

to

r¡atch

what

tt

n"pp]tt"i"J

fF

¡m

the

corner

of

the

d

unobtrusive

uay'

ults

rdings

were

made

of-all

the

assessments'1?t

*-:""

done

on

.J;#f

'""ffJffi

*k';#m*"*:uh;'$::i:*sessionwere

C"*

Sto¿Y

Metcrial:

Introduc'tion

confidentialitY'

JAND

quite

still'

although-'she

w¿s

still

PJ';"";i;ñ

lana

ao'vn

on

the

bed

"#"is*iH'Jfl'T':,ffi:il:1

:

band

back

into

her

mouth,

and

at

on"

ooint,i'tt'int

stt*

lefl

her

arm

there

.

lor

as

long

as

15

seconds'

jr,

I

turned

rr",

o'r"ito

tnur.

:

lrtn*

PnDne'

I

eorvn

and

made

on"-oit*o

t*t

--,t;

tn"*

*"*

i

bodv

was

in

"

ttnJá'tiá'"'

sltt-**tu.i:ty::.t:v

t;HJ;

.h"

*r.

iiJ""its

ilteltlv

lo,

the

musc'

iffiH;,T;ü'""l"'Hilil;il;:

"'d'

*

l#i5ix.

body

rensron.

\*hen

Vibro¡couúic

EquiPmcnt

A2xlmete

mtfress

Ttre

te¿

contains

ó

whlch

ar

V"^"fr"

amPlifier

te

deck'

isolated.

The

foam

over

the

thick,

oPen

Pore

foam

sÚn¡cture'

Mudc

and l-ow

Frcquency

Sound

Stimulus

Two

tapes

art

consisfently

used

for

the

assessmenl

sessions

with

the

's

"shepherds

Moons"

under

which

has

40

hz

Pulsed

low

frequencY

tone'

I

Asscssmnt

hoccdr¡r¡s

--

)

)'

Initiatly,

each

clien

the

supine

posiiion'

The

therapist

begins

the

fape

ft"

"oüt"

of

fhe

music'

Afler

a ferr

seconds,

the

th

controls

to

introduce

thc

p

ursed

i5,ff

illffi

tooii,o",i

on

s

a

y

nra

f

e

"

1 l1:.r

:::::*

::

on."

wi

t

ho

ut

any

Intenenrlon.

iL-ir,"

event

that

th"-"ri""t

contlnues

rvlth

hano

150

l(

tsv ¡r¡v¡lt

151

iL

.,i,

F-

&t

-*'-éo.-É''+a'*Pr

I

I

¡

I

.,

)

)

)

)

)

she

w¡s lylng

pronc she

only

lnflcqucntly

puÚ

her hsnds

ln

hc¡

houlh

and

restcd

her

hcad

on

the

surface

ofthe

bed'

:

*

o"oo".nry

tiffit"H;

,dl¿nót¡nnl

¡

fFom

the

e

to

comfo¡f

to

become

o

comfo¡t

to

become

:lÍ

;IiI

i.

#."'",,Sil;"#,ll¡'";ilt

h";1"

a

prone

position'

iE[:$,

:

;

tf'ti'l

STILVIA



)

)

)

.)

)

)

)

)

)

.)

)

)

)

,

I

)

,}

)

)

.)

)

)

)

t

r'

.)

)

)

.)

T

down

and

made fer¡¡er

vocal

noises

and

fenar

hand

rnovements

to

he¡

facr.

A number of llmes,

Sylvla

puf

her

hands

over

her

ears

I looked

at

b¡

ifriffi*f'x

ears and

found

thaú

there

nas

some

yellow

tluid

discharge inside

therq

r{

so the

cons¡ltant

and

I

undertook

some

hearing

te$s

and

an

examinatioo

f

'

her ears

to

see

whether

there

wene any

problems

there'

SHARON

sharon

laid

on

her

back

lo

starl

with,

rniggling

quite

a lot and feeli4

the

vlbratlons

through

the

bed.

After

¡ few mlnutes

ln the

sesslon' she

begt

to realize

the

unusual

sensations

undernealh

her body

and

furned herscll

again

sometimes

resfing bcr

There

were,

again,

nmmcnlr

zed,

her

finger

moverncnls

and

physical

exPerience.

ELIZI\BETH

registertd

it and

rr¿nfed

mort.

Sr-¿otoc

and

she

was

ffi J.

began

to

brtath

cal

sounds'

rcultuEu

to

look

trYing

to

turn

her

over

the

olher

w

'ü

g"i

"p

into

the

sitting

position'

xís

.

\ilhen

she

was

on

her

a lot.

She

seemed

very

shorf

Period

of

times

¡he

viLrations

of

the

hands

there

for

a

ferP

em

uP

again'

-

th

also

continued

tqing

ücn

eventually

put

her

head

down

and

srcked

the

t

[crvocalizations

decreased

on

the

bed'

and

I

;ffiffiil-tt*

tot¡"

shewas

hearing

and

uiliiúá¿

down,

her

respiration

slowed

a

-ic

CSARLOTTE

At

flrst,

Chartotte

was

quite

apprehensive

about

being

on

the

acousic

b"d.

ch;i;;;'*il;

'¡d

o'iJ

le

had

a

tvpe

or

vlbratlng

'tir

at home

which

was

"outine

for

going

to

bed

at

lor

periods

of

time

her

ttgutar.

She

moved

her

.lhe

pillow

in

placc

and

t

h*

, :l

-ri.

3,j

aa

52

)

)

)

)

)

)

Affcr

tbe

flrsl

few

mlnuteg

slles

end

happy

expresslons

wc¡

ftrqueng

and

shc

rclaxed

and

eq¡oyq

qe.lmcri-e ;t:--$to

we

tu¡u

;ñ.

i"eJ"üh,-siac

sn"

tps

ato

comfoÍ3b.b

uld

rclaxed'

--

,'

,Jr,

Cr¡rníe

communlcates

¡

lot

wtt

ty

f":

iry

l119tn

:*m'll$:ny.ffi

iP"H'ffi:1";'1ff

#;n'il'apprebenrúvcfi

T#ft",il""J11$ili*T"11'JHl1'#lractton+thereqonscs

'¡;¡Tn"i'i'

;

:

REITERENCES

I

:l

ti

'

rr

a

&

Coleman,

KA'

(1ry0'R:ll-.Ttt*:

A

challenge

for

musc

^

ñdrcssive



)

)

)

)

.)

)

)

)

)

)

)

,

)

)

t

)

)

)

)

.l

I

)

)

)

)

,|

)

)

ITAREN

I(arsn

rmlly

eqioyed

fhe

vibroacoustic

therapy

unit.

she

reclind

¡

her

back

and

atso

on-

tt."

fFonf

. She

rclaxcd

completely

on

the

unit

r¡

eqJoyd

thc

feellng

of

the

Lying

on

her

baclq

left

hand

in

her

6t

When

wó

turned

her

over,

her

arms fo

start

rif

and

then

rclaxed

cnmpletlly,

placing

s side

and

bringing

ü

"ürtr

""-

up

near

her

face.-Her

left

of

the

tirnq

[¡

ii".r

I

-or.d

it

up.

When

I

moved

i

arms

and

rltl

;;;;

uussic

"po."."

Her

legs

actua

nd relaxed'

-----

-

Á.o,

f"r"t

did

not

hypervent

lying

donn

I

her

hont.

s'he sopped

wtttrholatng

her

breath

and

brsalhed

in

a

quite

rehltl

and

moderatelY

Paced

rhYthm'

When

she

was

on

ier front,

Ikrcn

did

not

try

lo

put

her

hand in ba

mouth

af

all,

although

she

nas

lyíng

with

her

head

facing

to the

right,

so

it

*""1¿

have

úeen

difticult

to

bring

her

left hand

up'

Rcs¡tts

and

Rocommendations

;'lñ?;"i'frT#ñ::

ln¡ils¡tlsrsls'

g

. ¡ c^^¿land

Therapy. Phoenixvule¡

rAi

Dors-'

ers'

;.('offJ;

j.'1i1",J"""'11'i"i;t;i'é;"'t''2a77'

ic

therapy

and

the

treatment

-"f

R:tt^

syndrome'

by

United

Ki"gd;;

ü;-sy"ato-"

Association'

ent

of

Rett

sYndrcme'

Rctl'

tt

s'ndrcme:

Balancing

s'E¡a

-¿&

stu¿¡""

t"

lvt"sc

|

"tt'

.rt:l"

-t

)

ñ

t3

IH

It

ls

aPParent

from

these

vlgne

are

being

achieved

in

almosl

all

our

while

on

the

bed,

and

therc

was

a r

levóls.

Someti¡nes

with

encourageme

étienfls

handnringing

or

handpluckin

to

show

signs

of

sleePiness'

As

a

reduced,

including

a

slowing

of

b

reldlátion

of

muscle

tone.

'

These

were

not

confrolled

sfu

fhe¡c

were

ofher

people

present in

th

thc

cnurse

of

the

session

nas

influe

pnesenoe

of

a vldeo

fechnlclan

and

v

154

)

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rl

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a',

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l

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'

l' ¡

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dt

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)

)

Paakrt

Populeliolt

fltFm

Md{eugbt

C¡¡n

floclcs

I

,q

.¿

\

rJ

\

i

t

tj

'+

r

ll

5¡-

F

Vibroacousic

(vA)

Therapy

was

esablished

aú

ttml

inA139

the

llrsf

infroduction

of

vib,r"i:".tÍ1:

s

effective

in

relaxing

patients

wiúh

scle

tone

(Skilte,

19E7;

Wigram

and

in

HarPerburY

HosPiSal

to

rs. The

hosPltal

ls

a

center

for

nd includeJpatients

with

challenging

self

iqiurious

behaviors

and

a yariety

in

a mixed

population

of

people

with

ts7

Rdcrr¡l

hoc¡durcs

i.

Patients

can

bc

rcferred

m

or

ffi

püilofher¡py

depaÉment

for

urhh

E

übrooodc

fnárpy Equlpm'

rnd

Tr¡¡hcnt

Tepcq

|i,

uiPnrcnt

is

uscd

in

the

treatment

of

b

iiroo

cholr;

Multlvtb

su2oo

lt-

ln

*oror

hed-

containing

two

lE

t

bass

ln

-----r¡¡

r

I

rrlet€r

bed'

containing

tw-o^-1^E''bass

purlose

bltl.-1Tll::

:-;;;;

¡ra¡k: SheFWoo¿

u-soro

tt

:o

i

'^-

n

Gold

ü

n

cold

rreter

ill'

i

I

i

.t



vibroacoustic

therapy.

i

C,rrtt'.,

¡;

i:

i)

¿'J

'

t

Asssscnú

hoocdurcs

p

10'

stereo

^--lilla¡

:r.,

ftami

Proocdunc

P-eri

chCl

may

fahiliarization

period befort baseline

rrcasuremenfs

may be

úaken.

Inctuded

in

fhe

assessment

period

is

a

consideralion

of

the music

tapes

may

be

chosen

from classical,

nw

age

ot

possible

musical likes and dislikes

of

the

patieol

choosing

music

for

the assessment.

The

choict

of

ftequencies

used

(within

a range

of

l0

Hz

-

80

Hz)

is made

depending

on

fñe

conditlon

for

whlch

he

or

she

ls belng

referred and

ls based

on

evidenct

that

fhequency

variafion

induces

a

lo

t

in

fhe

bod,r'

Eifher a single

frequency

tape will

be u

iepll¿¡e..pgasc

tó

'treatmenl

or

a

mulúi-frequency

three

to

fnc

flequencies).

Tapes

pruduced by Vibroso-p

(Lcvanger,

Norway)-

or

lapes

proiucea

Uy

tna

vn

in"-py

Department

ln

rrarpertury

Hospiia áie

usd

referrpd

pathofogl,

during

-assessñent

may include:

l}

b p4

ryiration

and

4) range

of movemenf.

Ii'r;

un¿

a

Yamaha

AX470

natural

sounds

amplifier'

¡i.',

:

rbe* I:?t

Pe"t

-ol

"u

-tl".I:,,:

"::*""1'""tX1'#ltffi

tt:

ff"lI

;I

;il:

**]li#lffi

:il|?'"'li'ffi

ffi

;il*:":-f:,1':i1;'tlll#'l;

ff

il'illi?";'::T:ffiil;rlil,::**rj:'::::T'"';ffi','ffi

ff

lllHl:

P*?"T,i",lTg::'f

ffii.T"""i*"ii,"'*¡":"1,::.':"uinrormationrs

É*

;;;.p*t

r"

;;*"'

*ry-l"-

lL

::::,T"tll;;Í;vcn

on

the

spccific

¡rearmenr

sryrs

'ur

"'-*

;th"i"parfment

follows

in

the

ili-

orn"-ily,

there

are-some.PrinctPt-"-t1111.",,."s

are

arnays

forrorped:

¿ii

Genemry'

thereare

sorr€

¡''rsr¡r'-

-:;;*s

are

alnays

foltorped:

ürt.nt

or

ati

patients'

Some

important

pro

Patientd

general

health

on

the

day

of

frcatment

is

alnays

checked

to

ensune

that

they

1r"""-J

developed

an

acute

problem

that

might

.':

lt,

':i-l

#:'

t;,

t..;

..

fl{'

:l

contraindicate

vibroacoustic

therapy'

i"ilJ

fli-Tffi

ffiil;

ffi

¡*:i

tf

u"i

t]1,'

l^'1"" 1",'*':

I[J",lllfti:ilnH'""'i"J*"r]'"*""¿

to

a¿á

ttre

pursed

row

itr'ffigfJt."r*.",

fhe

patienf

befo::ll:

t*ttent

and

is

ihere

t"'ú.

*iilrfte

patient

at

the

end

of

treatment'

The

therapist

is

wittr¡i

tilt;;;;*1

as.jhe

patients

when

thev

are

trtated,

although

J';;";;rily

in

the

üme

room'

Frequent

observational

checks

are

¡mde

to

ensure

that

the

patient

is

comfortable

and

nof

ln

any

dlstress'

15f

)

)

)

)

)

)

)

6.

A

qulct

end

peoceful

rtmosphere

ls

provlded.

7.

The

patients

arc

ahvrys

leñ for a short

rrhile

aftcr

the

1q:¡.,

ffnlshd, ¡nd

as

thcy

are likely to be vcry relaied,

wiúh

low

i tone4

ano

nc

naru

to

the

i"

p"t-"o"otly

dlslocarcot

lnr¡

|

w¡uuewlrt

tone

¡nd

somellmes

In

¡n dúeied lefe ol consclousness.

Thil

brought

carcfully

off the bed or chair and

given

tirrc

befo¡¡

theyi;

fhe

uniú.

However'

rvurr¡D

¡o

neror

rp"á.}

t"

¡

limited

lange-mln

s.

His

úon€4

and

he

haso

to

the

His

*eech

is

uncoordinated

and

incomprchensible

to

fhosewho

do

not

However,

*T

r



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

Evalualion hocdurcs

Evaluaúi

ing

on whether the

patients

¡t

involved in a

program.

However,

the

folb{

mefhods

of

coll

heve

been used:

-

ttyCcet

Hrndicep¡Rengc

of Movcmcnl.

Measurement

of

i¡¡ptsU

range oi movenrents For

eÉmple, mi*ing

points

on the

grcater

tnocha¡tc

and

lateral rmlleolug and rmsrring

before

and after in order

to

evafi¡úr

changes

in

the range of extension

in úhe

leg.

Cenfimeter

measuremenlg

befon

and

after,

(in

rcsearch trials

nrade

by

independent evalualors) indicatc

tbr

impmvement or non.improvemenf

in mnge

of

movernent. Gonionxt¡¡

measunes angles in

joinls

(i.e,

elborr

joinfs)

fo

calculafe

changes

in

th

ranges

of

movement,

and

lncrease

or

decrease

In cont¡actures.

Phyrnohgical Mcasunments.

Blood

pnessure

and

hearf

mte.

Obscw¡lion¡l

Measurcmcnl.

In the rrsearch úrialg

an Epsom

HPl0

compuacr

n¡¡s used

as a

mulúi-channel

evenJ

recorder lo

measure changesil

behavior.

These

dafa

give

frequencies

and durafions of behavior

in

secundr

Cas

Stuües

The department underlakes

treatmenl with

persons

displaylng

I

variety of clinical

problems wifhin

fhe

general

field

of s€vene

learninS

disabilily.

Two

very different

pathological condiúions

are

documented

in

lbc

case

studies

below.

Cesc Study

1

Grtgory

is a

52

year

old

man ¡tsiding

af

Harpertury.

Af

3

years

of

age, he was

documented

as

belng

'beyond

hls mothefs

control."

AJ

4

yesrC

he w¿s

confirmed

as

epileptic wifh

profound

mcnfal handicap

and

r¡as

unablc

to

rralk

independently.

When

he

nas 5

years

old, he

rms admitted lo

a

mental

institution,

and

his

epilepsy rvas

controtted

fhrough medication.

Some degree of

spasticityurls

evident.

Hls timbs

wer¡

unable

to

passively

extend, uttá

his

hinds

werc

in

ulnar

deviation.

He

nos,

presents

as a

profoundly handicapped, wheelchair

bound,

fhll-

f

dependent nran-. He

ls

rccelvlng

antl-epileptl"

d-g". Bofh

his upper

[mbs

m.

""i,t

t¡ii;ril"Lingó"

the

role

of

two

different

fo

have

conversalionsr

Means score(7d

+22.0

'3.0

i

These

rcsults

ind

¡vement

oI

22Vo

in

this

'

patient's

range

of

mover

r

and

hip

abduction

nas

,

achieved

over

a

course

;ffi.Ili:$,condition

orated

on

average

during

Parficular

Patient

rvas

a

responslve

to

muslc'

As

a result'

he

starls

to

move

i

161

bim.

"'q

-tf¡i1

n *T#":l"t"h#ffi.Iff:

'i

f

'4

+

tr4

Ét

H

O

H

Él

FE

i,l

::l

lil

.lii

iii

iii

iril

Trtatmenf

condiJlon

(mlnVo)

Cont¡ul

conditlon

(winVo)

I

,

3

.¡i

¡ll

';¡

Right

shoulder

to

right

wrist

+15'1

'5'0

Left shoulder

to

lelt

*titi

-

+23'5

'2'0

Base

of

right

Patella

to

base

of

left

Patella

+27

'o

'2'0

160

)

)

)

)

)

)

rdhe

i, :: -

----^-ttal

nohr¡ct ln

bls left

eV'g

a1

n(

:

H"

:Pl:

He

sleePs

is

unsteadY

-

rl

in

cause

of

concern'

lng

lnto

flexor

sPom'

Therclort'

6¡

"i¡r**u.Ai

A100

chatr

Each

session

la$s

for

approximtely

roacoustic

therapy

trtatment'

Thc



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

(Julian

LloYd'Iilebber)

PlaYing

a

Hz);

UónC'

(3E Hz);

and

3) Engli$

s

(Elgar),

'l

Waf

1"

tI"

Paradist

rst

C-uckoo

(Delius)'

Fantasia

on

sion'

out

on

GregorY

bY

a

PhYsiotheraPY

s,

and

At

one

-

^*,1

iii

,ii:i'

iiri

.ii.

andsomemoreactivenesponsesanord¡lÉgv¡¡r¡v'v¡..-..----

At

one

;;

h"¡

cyclic

periods

of

this'

De-navror'

and

it

with

uny

po't¡"-oüi

"r'"ng"t

in

his

environment'

imes

of

il'"

v"""]üi*Jt""'

"n"

sn""irt--"'paltern

has

.r,.awiars

'trñ;-'l;1'::::::::-.:,::,:;

tl

croup

of

Patients

who

"o?

*i'rt

vibroacoustic

tment

ln

4

'Ews¡r¡¡

t'-;--;

wittr

viuroacoustic

163

his

bodv'

"

to

the

nature

of

Gregorv's

patholog,r

"31t:::Y'::"lY'ill

aluavs

be

necessary,

as

no

p:;;,,*;

d""

o"

to"gi'

t'i

t'*ting

T" P':

expected'

Treatment on

"

'"gut""

üJs

wil

conti"u"

lo

áinl"in

his

health'

mobility

and

general

awNnenesrl

Cesc

StudY

2

Adam

is

a

36

year

old

rnan

who

was

admitt

ase

of

¿-tt.

t*t

diagnosed-as-

having

tihavior

and

self-injurious

behavlor'

;;ü;;;ñes

tnf&ttons

Although

he

occaslon

)

a4,

)

)

)

)

)

)

)

|¡t

pr

ltl

¡

-,,.¡i

i

Adem

w¡s

lrc¡ted

on

¡ MultlVtb

VA100

chelr,

drlven

tV

¡

MulUúi

SU200

ste¡co

sy$em.

The

same

muslc

and low

fbequency

tone

rverc

ur.tUl

''í¡Nl¡tt:

tflcq

úúrd

dGtl¡¡¡ort

¡d

¡ch¡¡

d

rh

t'bv|út

':

.¡-lC

b

A¡l¡ ';r ''':l

htm

during

fhc

¡escoltü

fri¡ls

and

the

trtatrent.If

consists

of

¡

a0¡É

d¡sslc¡l

muslc

irpc

oloello

muslc

(Jull¡n

Lloyd'Webber)

pl¡ylng

a

scfij



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

t

Ma¡

Score¡

ln

Co¡d2

(Pl.o.to)

(sD.)

TABLE

l:

R.ordd

lic

i¡

rco¡d¡

of

b'hvia3

@¡l"td

l¡

Ad¡B

lhe

quality

of the

rich

sound

ol the

ccllo

ag:ainst

fhe

srpporfive

backgroul

of

an

orchestrzt

accompaniment

lends

itself

very

appropriately

for

use

i¡

\A

did

not

cause

conflicts

wiJh

the

mode

or

harmonic

structurc

of the

variou¡

pieces

that

were

PlaYed.

The

results

of

these trials

were

as follows

Table

1

shows

the

length

ol

tlme

In

seconds

Adam

exltlblúed

th

treatlng

hlm

fhree

tlmes

a week.

\

Mcdb¡

SaoaÉ

BEIL/I

No

RG.ariDr

a

I

:

{

a

,

,

t

I

)

I

21

óa

(¡l¡it?)

{5¡

BEE¿

SbpPaC

fclüilc

¡¡ócr

Éstzi¡t

BEHJ

Cr¡0c

Il¡¡d

Snlo¡dE

Tlt¡l

Nrúb.r

Cúd-

ldou

BEll.t

Sl¡PPloC

F¡c

0

ll04

ItJl

01

I

6

0

5r

l5

JEó

50

0

{2ó

03

13

IJ

536

04

I

{E2

05

I

tE

0

r609

lE00

(b

a

534

t1

l&¡

lllt

a

tüt

0

L21t

lE00

a

0

l{9-r

lE00

06

JI

62

1416

09

I

&¡2

t0

t

6E2

I

0

1070

ll

I

91r

0

I

róri

l1

I

0

0

l?50

It00

0

0

rEüI

tE(n

l{

0

0

1793

$m

0

1{57

lEm

l5

1

0

t6

I

l¡

0

1739

tEm

ffi''

subscqucnt

Trcatmf.

Adam

is_quite

variabre

in

his

behavior

before

,treatment.

He

walks

ñ;ñree

hundred

yards

fbom

his

n'¿rd

to

the

unit'

.¡nrl

dependins

on

rh;;'th"tl;

:'. f .:".1:*

::,u:'::il:lHTH;

:illff

|;lf'il¡,

;l;ñX#ffi

'ffi

;

o¡

o

i'"o

tn.en

t,

ra

ngin

g

rrom

a car

m

,tlh;ilil,

io

"

¡¡tt""ssed

state

causlng

sIB'

tu

16:

l

tl

ll

fi

Tone

¡nd

Clrcr¡l¡tlon'

Europc¡n

'Iourn¡l

of

Hun¡nlstlc

Psychology'

&

'ln

tEr D¡h¡vimrr moditlcation

*'ith

clúldren:

fi-LJ

Y-

"-

&

suÉecs

P.

(1e7s)

PPÍ*

A:

-ürooód.-r,'

Murruq*l

;Iio6

i'

nmnaetent.'t

Ther¡py'''fe1 [t

cea..

BrcngclnailU

J'C'



5

,

I

I

t

)

I

)

I

taken

back

to

his

nard.

The

notes

that have

been

taken

do

not

take

into

account

timd

SI'MMARY

REFTREhICES

Murphy,G.,&Wilson,B.(Eds.)Selfinjuriousbehaviour'I¡ndon:BIMH

Pollin

o

compaDe

car¡y'over

effecf

when

fi

.-Hff

:H",';",'li?'oJrnifi

England.

SHtle,

O.

(19S7).

Komplett

rapporl

fra

symposium'

.

Vibroakusti$

BehandlingsnetodikL

innen

-

Hvpu

Og"

Poliklinisk-

$sif{f

stimuteúng.

Pubtished

by

Internaiional

society

of

vibroacous¡rc

Therapy

flSVA).

Levanger.

Nontay'

Wigram,

T,

&

Wecies,

L.

ilg90).

Treatment

and

Research

into

the

physlologlcal

Effccl

of

I¡w

Frequency

sound

and

Muslc

on

Muscle

t6

I

L67

-'+'

.l

I

i

.;il:

:j;il

t

*

)

)

)

)

)

)

)



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)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

t

EooFr

¡jdgy

Inhod¡rcfion

Tbere

ls

evldence

to-suggesl

thet

adults-wtth

a

learnlng

dlsabltity

,nceanxietv.tnt'"'o"üXiL-tJ""t'"lo'-'lt*¡,[#"ii:'il.:;

ffi¡;1;1",f1Í"Jjih"l'3],"¡*

1,¡i;1rs

ro

'r¿rch

and

imihre.

rhe

i¿so¿

thts

places

J:;";;il;lon

"na-

áti"itro"

mav

prove

too.

greaÍ

for

itosc

wittr

a

learning

irJii'it'

"td

thereby

"*"i"¿"t

them

from

this

form

of

'iratnent.

jubjects

regarding

''itoudenmire

(1975)

training

and

in

reducing

wider

range

of

treatment

'dlcnts

who

have

learnln

ij,,

In

a

Pilot

studY'

'

iiusic

orttre-anxietY

icated

that

thcrt

were

fcw

ii'ifferences

in

the

trea

music

condifions'

Both

ng

music

had

a

long

term

,;cflect

on anxiety

(IIoo

nrrted music

in

treating

)

)

)

)

)

)

)

$oqld

r€spond

lo

¡

vlb¡uecoustlc

ñudc

fhom

standard

casscttcs

or

dcvices.

According

to

its

dwclopcr

dllfcrent

vlbratlng

flequcncles

or

ry

They

convert

music

into

highdensity

p""iri""¿

by

the

ears

and

atso felt

with thc

enti¡t

body.'

It

is an

experiencr

á"Jgn.¿

to

be

pleasurable,

lo

ptmote

rctaxatior¡

to

aid

stress and

to

c¿l¡

f

ge:

F

rne

orf

set

on

15

'set

on

15

E'ryd

"lit

ltr::

HiT#I".'"T

ñ;';J_;n L

or

5

degnes

hom

..- rit?apnf nosiiions

w¿s

ur

different

Positiong

uas

sectiong

3'rvaY

sPeakers



,l

I

I

I

'I

i

I

I

I

t.l

I

I

I

:

i

i{l

-l

,

tl

rll

,i

(

,ll

t

ll

I

I

I

i.

I

i

I

I

I

-¡

I

)

)

)

)

)

)

)

)

)

)

)

)

)

¡

)

)

)

\

)

)

I

)

)

I

)

)

D

]

)

)

t

hyperactivitY.

-r

r

The

áse

sludie-s

repoled

in

this

PaPef

gnt¡rine

the

nesponse

olclients

with

a

ürning

aisaUility

io

Somatro

t

trtatment.

Trvo

speciflc

questions

art

iddressed:

*

How

elfectlve

ls

the

Sormtron

ln

deallng

wlth

andety

among

thor

with

learning

disabilities?

*

How

does

the

Somatron

compane

with

the

musical

intenenlions

already

e:¡amined?

Clicnt

poPuleiion

The

clients

chosen

were

drawn

ftom

lhe

community

and

a

local

lllty.

Thls

group

has

wide

efrenres

ol

l)

it

rely

on

rnakaton

or

conrmunication

some ane

learning

and

develoPing

ski[s

rhat

will

allow

them

3o

live

independently,

ofhers

rcq-uire

total

nursing

care.

While

,oln"

"r"

"*átionally

batanced

"ttd

huppy,

others

express

their

frustratlon

and

anfety

in

vtoteni

or

dtsturbed

behavlor

agalnst

themsclves

or

others.

The

clients

were

not

sPecifica

They

weE

alreadY

attending

an

ind

Sómatron

w¿s

inúroduced

within

th

author

has

aluays

altorped

a

time

fo

generallY

Providing

the

music

The

Somatrcn

nas

olfered

to

Cllents

wetrc not

speclficnlly

assess

rtiónr,

nor

was

fhe author

anare

of

nas

governed

by

the

fact

that

they

e

tor¡ards

otherq

hyperactivity

and

evidence,

suggests

under{ying

anxie

intercsted

in

assessing

whether

the

and

inactive

nesPonse

from

lhem'

back

and

calf

areas

Head

F"ffiT,i5f#,fi

J:X,iHifr

l::i.:lll"iliHJ;"*".apanasonic

,i-

The

musc

tYas

PraJEu

truvEÉ¡'

to¿"t

VZO

with

a

4X25

va'tr

caPacltY'

'i'rlinures

of

"Antarctica"

by

Vangeli

Hfr*.

set

miduaY

on'

-'-

"^rrrnb

ffsas

set

mioway

on

i¡ss

(O

trcble

(ó) anc

Ratings

to'Veryo'Very

i"iü

"i"*ter'

The

overall

head

sPeakers,

aid

feeling

,:

it

ln

ttre

vlbratlon

secllon'

.;-1

Tn¡mcnt

and

evatr¡ation

preccdures

i,,

.,',

A

treatment

pnog¡am

rms

-desislel

forihose

using

fhe

Somatron'

The

rtrst

eiglt

sessions

w9{

oganizej

T

l:ry:;

;.S*"'*$:fr"Ti1"rffi"":iffi:'i1i::,i;*-:::;l'orthesomarronristening

'l'ro

rh"

n

erapisr's

singing

19comryni¡'i,ol.ill':::

heraprsl's

srnErrrÉ,

f

lhe

Somatron

llstening

6;J;.

3&a:

ihe

cltent

sal

at

tl¡e

foot

:nl-:,^^^,

i*

ñranr nr rhem-

i.

"

u*f

ilti*Í"ü

;;s;."

i:l-"

":::Id^::1t:fi:

in

rronr

or

them'

iii,

session

5&6,

{il;i'i".;?;Jirr"

rog,

end

of

the

so¡natron

listening

+

\:.

ii'ro

vu"g.lis

being

pl"vg

thnouglr

iT TT':"1;

s"*l"i

l"cb:

The

client

lay

on

the

Somatron

and

exPerienced

a

vibroacoustic

sensation'

;ili:ffJüf

;ffi

"rhe-crient'iry.'.:-"-"T::::*"I':"X"il¿*:

.'#ll"ffi

f*:'i**#o;*.;$u'¡q-9.1":i:?::""'"::['ftfi

:

omatnon.

tloweYcrr

wrrrt

u'v

,pónSe

to

fhe

separate

elements

rt

ñáiti¡-lt

pbsslble

to

assess

fhe

cllent's

:::-^-,

rLá óñ¡Ficn¡e of

tvinq

on

L'',l"l,l'J',^llj1ffi

;"ff;;;;;;h'"ringand:11T::T:":i::*H:l

;iitffi

ltrt'"ilT':il":'ñ:"il;ll1',41l::s,::.,l:y""l#o,ilTl

$iily.'ffi*''"""11'lL,fu"Jltll,i'r'ñ"ii,r""'"--inainrheearlierstudv

on.

ent

hip

the

:wtth

ttre

clienf.

c-..o¡sequsnlrv¡

u'rrn

rnÜ

G^lsPf¡v

170

L7t

)

)

)

,)

)

)

)

r,

thenplÍ,

d

'

,,¡¡,

4,9

tü-;n;

cllcnlts

re tbc

degitc

of

¡relax¡tlon

¡nd

fhe levels

of

¡

lhe

trtahnent.

Each

rating scorcd

on

a flve-point

scalg

was completed

after

obsening

a video of

fhe session. Ratings

lor

Relamtion

ranged

from

'Tense"

(0)

30

'Very

Rclaxed"

(4);

for Actiüty

l¡vel

from

'Very

Active" (0)

to

Subjcct

B's rcsponse

fo thc

Srcatment

pnogram

ms calculaled

as

a

*"?

tm

total

scorc

of

ll.

Results

üowd

a

negafive

rrcaction

úo

fhe

ifi.

rrr"r*

was a

drop

In

response

ftrom

sesdon

th¡se

oncardg

and

lt

l¡

m"t

lherc

werc

¿iginct

differences

betwcen

the'live"

and

recorded

sessions.

ñ;*

rvas

a slight

improvetrent

in

response-whe¡

thc

n:*di:

T:



)

)

)

)

)

)

)

I

)

)

)

)

)

)

)

)

)

)

.)

)

)

)

)

,)

l

)

I

'Inaclivet'

(4);

and

for Eqioymenú

fhom'Distrcss"

(0)

to

"Obvious

Pleasu¡t"

(4).

For

each case,

higher

ratings curresponded

to

incrcased

rclantion

in

the

"f"of.

In o¡der

lo

assess

improvement,¡hd

thrce

scores

(Relaxation,

Aciivity

üve[

Eqioyment)

rverc combined

fo

provide

a total

score

(Range

0'O).

Deryl3e

the

lacú

that untr¡lned

raters

rvere

usc4

Shere

rvas

an

lnter-rater

reüability

of E97o

wiShin one

scaled

point

which reflected

their

sensitivity

and

clinical amneness.

Subir-rs end Rcsults

Subjccf

A

subJect

A

(female,

40

yearg

moderate

learnlng

dlsabllify)

n¿as

one

of

four

subjecfs

involved

in

the

pilot

study

which had

invesfigated

the

effects of

listening

lo

rclaxing

music

on

anxiety.

She

had spent

ten sessions

listening

to a

tape

of relaxing

musig

and her level

ol

anÉety

r¡¡as

reduced

(Hooper

&

Lindsay

f990).

subject

A

rarety

looked relaxed.

she

nas

easily, frustraÚed

by

circumslances

beyond

her

confrol. She

w¿s

prone

fo

periods of

extreme

agitaúion,

and

her anÉety

manifested

itself

in

a number

of

inappropriaÚe

bóhavlors

-

screamlng

abuse,

pultlng

ofher resldents'

halr,

tearlng

clotheq

unexplained

crytn&

and

hyperacfivity.

The

client,s

r"rponses

to lreafmenf

were catculated

as a

pereentage

of

the

tofal score

of 12. Resulfs

shoued

úhe

client

responded

very

positively

to

fhe

vibrcacoustic

eryerience

offered

by

the

Somat¡u.

Although

there

rms

a

drop

in

nesponse

al

session

7,

it

srggested

Úhaf the

client

naas unsettled,

nol

by fhe

vibroacou$ic

equipment,

but

by

having

fo

lay

dorvn

fo

¡elax'

The

rcsulfs

wifh fhe

somat¡on

(session

5-8)

were significantly

befter

fhan

those

wlth a non-vlbloacoustlc

appraach

(sesdon

14).

The

average

sco¡e

for

the Somatron

sessions

wasE3%orin

comparison

lo

an

average

o,l

49.57ofor

the live

and

recorded

music

conditions.

Subjcc{

B

subject

B

(male,

30

yearq

moderafe

learning

disability)

was

described

as hyperaciive.

He

"o,rl¿

t.

aggrcssive

tow¿rds

others

when

frusJrated.

Hc

eryiii'ence¿

eplsodes

of andet -when

he

became

moody,

uncúoperaflve

and

t72

lrru

ril¡gü

ln"

s"fi"t-o.'Ho*"r,"",

rhe ctiónr

reft¡sed

to

lie

dorn

on

the

Oü..U

thi-s

accounted

for the

zeno scones

in

sessions

seven

and

eight'

Dissssi,on

of

Re.srlts

.,music.Thiswoutd'uppo"ttheauthordbeliefthatthereareadvantagesin

ooper'

1991b)'

to the

atfention

of

an

individual

úhan

person's

nesponset

and

it

ls

somethlng

evaluating

a

clientts

response

to

the

6

"n"

res¡lts

highligbt

a rmrked

disparity

in

the

treatment

success

of

fo.

*#i-i;;bñr-;-

responded

posilively,

while

SubjecJ

B

failed

to

complete

the

treafment

schedule'

[.

The

studY

design

allowed

the

aut

frcqonding

to

the

live

music.

This

would

ar"

uA"untages

in

providing

the relaxing

¡

¡¡e

¡út-----E--

E

tnestuay

design

did

not

randomize

fhe order

of

the

lour

srages

or

rrtartucur'

iil.

""ti".t

ür,

only

.peculate

that

SubJect

-B.-*1t-.*tp"tdtli-.1"-.'l-"^]tl:

Somatron,

or

indeed

any

form

of

treatmenf'

,;.

It

is significanr

iiat

other

clients

involved

in the

study

have

rtsponded

'io

"r,

io"otsiient

toy

iá

the

Somatron'

In

some

sessi-ons

Lh"i"

t"t:tl:

li:

f

''üffiffi;

ió

rJ""

round

rhe

somtron

rclaxing'lT.ltT:::1":"''il"I

;ff*.;

;;;"'üi'ii.rr"ted

bv

the

-

e4erience'

1 .il-t1",:

T:*.:

;fift;

úv

tii'-*'p"i'".

rt

is

sometlring

*'.

-":::.'lJ:11.:1,"n:l'"""'i:

,

iirfii.ñ.

""J,,*lii

ffi;ft;uog6g.

It

sigge$s

that

the

client

ls activelv

-

a---

--- --

rLa Qanafnnn

¡u;iü;"-¿"g.""

of

pleasurc

he

o¡

she

derives

ryT:'1lf*thl

t-Ly,tllT:

;#.';il"Tiffi;.iil;

irtool¿

not

always

be

epected

to

elicit a

phvsicallv

¡

[tlaxed

nesponse

fbom

a..-cl 991t

*'-:*

^"i

; ;;T#;iri"

"

7" ;6rha

r b

orh

ct ienr

s

e¡co

unlered

di

ff_cul

tv

whel

1

it

came to

the

SdrñáÍron'

Subject

B's

response

qas

not

uñétimmón.

have

refused

to

lie

dorvn

on

it'

One

clienÍ

oommented

O

to

n"a

in lhe

afternoon"'

Since

then

she

has

¡eft¡sed

fo

be taken

near

the

Éomatronn

and

lt

has

been

lmpossible

fo

reason

173

)

)

)

.)

)

)

)

wlJh

her.

Sbe

h¡s

bccom

dlstreught

wen

¡t the

mentlon

ol

uslng

ll

toi.bcd

ls

olten

usod ¡s,o

nlireoul"

or form

of

secludon in

a

drodlfcatlon

progmm.

Conscquently,

in

fhe clientts

mind,

having

úo

go

to

{

ln

lhe afle¡noon

may

be

assoclafed

rlth

publshmenl and not

pleasu¡r.

lying

:l



)

.)

)

)

)

.l

)

)

)

)

,

)

)

,)

)

I

)

)

'

)

)

)

I

.')

)

)

)

tbss

h

grcund,

the Somatrcn

is

very low,

and

the

author

has

found

that

some

clien¡

tbok uneasy

about

using

if.

They

ane un ilne

aboul

how to

get

down

onto

th

Somatron,

and

they have

difficulty

positioning

themselves

into this

shapt

The

Sornatron

also

resembles

a

fr¡eat¡¡rent

lable. Clients

whose

perccpt¡o¡r

and understandlng

¡rc llmlted

rnay

rmke

sr¡ch

an assocl¡tlon.

A trcstmc¡t

table

rmy

carry

unpleasant

¡nemories

lor

them.

This

ludy

rcgarding

lhe

use

ol

lhe

Sornatron

with

people

who

have

r

learning

disabili$

is

slill

al a

vety

early

sfage. Neverlhelesg

some problems

have

been

identified.

Clearly,

with certain

clientg

the

Somatron

Sound

Lounge

is

effective

in dealing

with anxiety,

however

several

polenfially

serious

dilflculties have

been discussed

above.

More

rcsearch

is

needed

which

evaluaÚes

individual

rcsponses, befon

It may be

posslble

1o

fully

¡s ¡ess the

Sornatronts

value and

offer

guldellnes

for its use

with

clients

with a

learning

disability.

REFERE¡¡CES

Baf

linger, B.R,

&

Reid,

A.H.

(1977).Psychiatric

disorder

in

an

adult

fraining

-center

and

a

hospital

for

the mentally

handicapped.

Psychologiol

Medicine.

L

525-52E.

Corbetf,

Já.

(1979).

Psychlatric

F.E,

Snaith,

R.P.

(Eds.)

I¡ndon:

Gaskell

Prcss.

Guralniclg MJ.

(1973).

B

reta¡ded

young

adult

Psychiaú¡y'

L

263-?Á5.

ttoop""j

Linaiuy,

B.

(1990).

Music

and

the

mentally

handicapped:

thc

eflecf

of

music

on

anxiety.

.Iournal

of Brifish

Music

Therapy.

4Q),19'

26.

Hooper,

J,

Lindsa¡

B.

(1991a).

Improving

the

quatity

of life

lhrough

mustc'

4041.

:

ifs

use

ar23'

12/t.

Lindsay,

W.R, Baty,

f.

(úE6b).

Behavioural

¡elamtion

fraining:

explorations

wlth adults

who

arc menfally

handlcapped.

Mentel

Handlcap'

b

tou'

11^

L75

)

)

)

)

)

)

)

OF

AUI'NORY

ANI' VIBRATOXT

SÍRES$.REIATEI'

NESNA/VSES

OF

$WIULATTON

ON

PBfuTAruRE

INFINIS WNfl

BRONCflOPUI}TOIüN



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

,DWPIASIA

1'

i,:

\

f¡

u""t

Burte

,41

t

,fi

I

.i

I

¡¡

iii

#ri

,:.:: The

fetus,

as repofed by Walker,

Grimwade,

and

Wood

(1971)' has

a

,t'"

built-in

"lullaby"

consisfing of blood

pulsafing

through

the

placenta causing

..

a

'khooshing"

sound

with a

mean noise level

of 85

decibels.

Rosner

and

:'

Doherty

(1979)

repoÉed

that these

intrauúerine

soundg

when

prerecordedt

elicited

soothing

responses

from

fussy

newborns

but

had

minimal influence

',

on

bables

who werc ar¡ake

and

calrn. In addition, Glass

(1994)

sfated

that

r:

rrstimulafion

of the

senses

should begin

wifh lhe

most

mafure;

and optimal

',

sfimulation

for

initial

post-natal

developmenf rcsembles

the sources natumlly

;_

available to

the

fetus and infant

-

those

that

come

fronr

the mother"

(p.78).

f'

Ghss'

stafemenl supporfs the use

of

maternal sounds

as

an appropriale

auditory

sfimulafion

for fhe

premature

infant.

Wifh lhis in mind,

it

uas

:

believed

fhal

the

audiotape'Transitions"

(used

in

this

sfudy)

would

mosf

I'

closely

resemble lhe

audilory

environrnent

of

lhe

fetus

in

uJero

since iú

is

li

comprised

of

prerecorded placental

pulslng

sounds

comblned

n'ith

s¡'nfheslzed

]t,

music.

According

fo

Collins

and

Kuck

(1991), intubated,

prtmafure

infants

in

a

NICU

who heard faped

music

blended wilh

intrauferine

sounds

had a

,significanf

increase

in

orygen saturation

levels

and a

decrease in

agitafed

,behavions

(thmshing

extremitieg incrcased

movenrents

or facial

grimacing)

when

compared

to

baseline

observations

without

audifory

input.

F

In

a

ludy

by

Chaprnan

(1975),

premafure

infants

who

received

music

fn

thelr

tsoletfes

6 tlmes dall¡

reached

fhelr farget

welght

oI

4lbs.

1 oz.

:,s@ner

than the infants who did not receive

music.

Caine

(1991)

-systematically

played recorded

lullabies fo

52

preterm

and low

birth

weight

infants

in

their

isolettes.

Results

showed fhat

the

experimenfal

group had

significanfly

shorfer NICU

hospifal

days

and

overall

hospital

days as

well as

a

significant

decrease in initial

weight

loss.

Nonstress

behavioral

indices

(i.e.

little

or no

body

movement,

lack of rigidify in

limbq

nof crying

and lack of

lacial

grimaces)

were

also higher

for the music

group,

suggesting

thaf

fhe

f

.tt

5

í1.

i

It

¡i

I

I

L

I

L77

Fl

Fl

h

t

t:

controlled

use

ol muslc rney

esdl

In rcduclng'dgns of overt

stress

¡

prcmature

and low birfh

rvelghú lnf¡nts.

babies

li$ened more

intenfly

(eye

behavior

was

tnone flnted)

during

thc

Four

prematurcly

born infants

rcquiring

persistent

venf ilalory support

enroileá

in

this study

which

was

ca¡ried

out

in the

Neonatal

Infensive



l

music

stimuli lhan

other

audiÍory stimuli and had less

gloss

motor

movement

during music

than

during

all other

$imulus

condiúions. This

.tlndi¡g

¡¡,

important

implicafions for

preterm

inf¡nts

who need úo use their

calories

lor

growth

rafher

than

pulposeless

movement.

In

addition lo

music, other

sounds

have been

used

to

elicif

a

varietv

of

rcsponses. Oehler, Eckerman, &

I{ilson (19EE)

reported

that falking

tá

very

lor

birlh

u,eight

infants led to

a

quiet,

visrally

attentive

stafe,

while

touching

produced a

more active

state.

Clinicat

Goal

Infanús born

prcmalurcly

are often

placed

In e neonalal Infenslve

czre

unit during

the

firsl weeks

of their

liveg where

they may receive ventilatory

support in addifion

Jo ofher

invasive

but

life-saving

procedures.

Infants

requiring venúilaJor

supporf

rcquirc frequent

naso-gastric

or endotrachcal

tube

suctioning

to nemove

secretions

in lhe lungs and upper respiralorl

sysúem.

This

procedurs

has

been

known

to

cause

stress

rcacúions including

decrtased

orygen

saturalion levelg

increased

aufonomic instabilify,

and

increased agilation.

The

purpose

of

this

descrlptlve study

nas

to evaluate and compare

lhe

elfec3iveness

of

music

presenled

boúh

aurally

and vib¡utactiley

in rcducing

agitation

and

physiological

instability following stress-producing

interventions

in infanfs

wifh bronchopulmonarl

dysplasia

(BPD).

Using

the

neonate

as

his/her

own control,

this

study was

designed fo answer

the

lollowing

questions:

1) Do music intenenfions

decrcase

'hegalive"

behaviors

(crying

facial

grinncing,

limb movemenl,

rigid or starfle responses) when compared

to

the control

condifion?

2) Do hearf

rale

and

o:rygen

saluration

levels

remaln

withln

the

normal range

(HR

120

-160

bpn¡

orygen

saturation

957e

100Vo)

for longer

periods

of

time

during

Jhe

music interventions

than

in

lhe

confrol condition? 3)

Is

fhe

vibrolactile applicafion

of

music

mort

effecfive

in

reducing

agiúafion, as

shown by decreased limb

movemenf

and

decrcased

il-Jnáus¡ott

In

fhe

sÍudy.

Addltional

crlferla

for

lnclusion

conslsted

of: a

rveight

of

2ü10

grams

so

that

the

infant would

be

able

to

maintain

rcgu-laúion

in

an open

crib

(neccssary

lor

the use

of

the

Somat¡tnR

úhe

need

for

flequent

s¡ctioning

(q3q4

hours)r

and

medical

iAUfity

as

determined

by

the

affending

physician. In

additionr

each

inlant's

,Si"¿i"ü

capacity

mus have

been

determined

fo

be

within

normal

limits

,t r

-

r-

-- ---l:¿^-

^-,^1.^A

^^r^-riol

a¡¡a¡cmnf

iiaccording

fo

an

auditory

evoked

potenlial

assessrnenf'

''I

r-a-.-

--,:.L

l'-^.'-

^^----irot

anamqlioc

qom

oa

lnfantswith

known

congenital

anornalieswere

excluded

from the

sfudy.

i''

Post-conceptual

ages

at

fhe Úlme

of

f

he study

were

35

weeks,

and

57

weeks.

One

subject

uas nrale

and

one

nas

female.

Prior

to

being

included

in the

,,

study,

the

mother

of each

infant

read

and signed

a consent

form

which

i'¿.*iiU"¿

the

purpose

of

fhe sfudy.

The

sfudy

was approved

by

fhe

,,

Inlitutional

Review

Board

of

the

hospifal.

''.

¿i

-':

,*¡Pmcedurc

:l

,

,1, To

controt

for

exlraneous

noise,

the

sfudy

nas

conducted

ln

an

;.

isolation

noom

separated

fiom fhe main

intensive

cane

nursery

room

by

a half

,r'wall

and

windov.

Entmnce

info

this

noom

$as through

a separate

door.

ll:On".

informed

consent

was

obtained

from

a

parenlr fhe

infant

nas brought

fij,

¡nto

th" room and

remained

in

the isolation

roonr,

in an

open

crib

on a

maltress

for

lhe

duration

of

the study.

Data

collection

nas

nof

until

Jhe

following

day. An

audiotape

using

specilic

tones

was

used

cue

fhe beginning

and

end of

the observation

and

rec,ording

periods.

Each

trlal

conslsted

of:

1)

one rnlnute

of basellne

daÚa

collectlon

prior

lo

suctioning,

2) suctioning

(oral/endotracheal);

and,

3)

15

minufes

of

post'

interventionássessrnent.

Each

infanf

received

lE frials

(2E8

minules)

with

rst

subjecf

who

data

signs

and

chest

wing

ioñ

period,

nasa

fube

suctioning

nas

performed.

This

was

part

of

the

routine

cane

for

lhe

infant'

and

not an additional

interuention.

Immedlafely

followlng

this

procedure Úhe

Infant

was

exposed

to

one

of

L79

)

)

)

)

)

)

)

)

o

)

bf

t)

.n/

ry

rqD

,ld)

,¡{

ra

ü(

irl

t

t

the followlng lhrcc cundltlons A) mudc

played

for 15

mlnules

th¡ou¡r.i

Som¡tmnR

malSress; B) mudc

played

through a

Panasonic"

Rns4úro

player

placrd

¡t the

foot of

thc lnl¡ntts

crib for 15 mlnutes;

and

C)

o"S

NIcu lsol¡tlon

rcom envlronrnenf. Eech

Infant

rccelved

each

condlüo¡-l

times in

a counferbatanced

orde¡

(ABC-BCA{aB-ABC-BCA{AB)

ro.¡¡rlri

for

a

possible

conditioning

elfect.

tape

player

rves

ected

because

of

its

as

simil¡r

úo

thc

,

declbel

levels

for

both

the

úape

player ¡nd

the

SomatlonR

werc

to

be

65

decibels

by

an audiologist.

The

appropriate

volume

level

Hiü;;

each

votume

conrrol

knob

using

surgicat

rape,

The.

úape

.?-*,

,rr"n

placed approximately

65

cm

from

each

subject's

head

and

ffiü;Jl;

plroauce

ttr"

.ttt"

¿eciuel

level

as the

music

when

presenfed



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

.a,

m9

rrV

)

.¡,

er,

r

Q9

n1

43

tt)

h)

te)

r¡t

n\

)

Di9

)

gr)

.t\

2J

'sd

')

ir,

ut)

)

z)

II

t:

li

l{

lr

I

I

t,

¡'

t,

{r

{r

ai

I

)r

I

t¡

,

I

afternoon

or

late

afternoon

but

not

during late

evening

hours

to

control

tor

the

possible

influence of cilqdian rhythms.

Ihta were collected

by

eilha

r

Regisfered Music

Therapisú

or

a

Registered

Nurse.

Inúerobsewer

reliabilitr

was

assessed at

90Vo

by

performing

obsenations

simultaneously

and

comparing dafa. Total

lime

for

the

complefion of lE trials

ranged

fhom

8

to

21

days.

Inlrument

A coding sheef,

developed

by fhe invesfigators,

rras

used

fo deúe¡minc

úhe

presence

or

absence

ol

selected

behaviors

and

to

record boJh

hearl

ratc

and

orygen saturafion levels.

Behavioral

codes

were:

sfate, body

movemenlq

facial

expressiong

and

autonomic indicators" Behavioral

state

uas coded as

1)

quiet

sleep; 2) acfive

sleep;

3)

drowsy

or

transifional

sfate;

4)

awake and

alert;

5)

acfive/anake;

and 6) crying (Brazellon,

1973).

Facial

expressions

included

grimaclng, yauming,

ooh face, neutral, and

smillng. Llmbs

movlng

ranged

from

1-5

wilh

5

including

all limbs

and

the head. Autonomic

indicators

included

none, arthing,

sfarfle, tremor, and clonic

movemenl.

Equipmcnt

The SomatronR maútress used

in this sfudy

uas

made

speciflcally

for

a

newborn crib. The dimension of the SornaJronR

matúress

is

approxinntely

50" by 2e' by

5'

and ls

made

up of 1"

of dacrun

shfÍng, 1"

of

lrigh

denslly

foanr, a 1/4" mahogany sound board,

U2"

air

space,

one

patenfed speaker

uatt

stereo

fhequency equallzer.

180

lbc

Somatron^'

r ,h----^ r:---rr

/nr^Á^hró

ii"

-uE"

used

was

the

audiocaset3e

entitled'nTransilions"

(Placenfa

ii".,

etfu"ta,

Georgia)

consisting

of

sounds

of

fhe

intraufeúne

plf",

a"igoed

tó

emulaúe

netural

wonrb

soundg

blended

with

¿

f"rr.l"

"o]i"",

singing

in

harmony

on

Ahhh.

The

general feeling

tV tfrit

combination

oivocalizing

and

steady

pulse

uas

one

of

ion

and

even

nronotony.

anarr,cr. norfahle o.."tt"

nlaver

r¡as

used

to

play timed

beeps

which

nationperiod.

A Novametricsr

sturafion

levels.

A

Horizonr

to

determine

heart

rate

during

the

ibse¡v¡tlons.

.l'

rl

-rI

)t

ll,

JI

l

í.s'l

ItnlYds

'#

í;li

obsenafional

recordings

of

idually

and

ümpodtely

to

deterrnine

the

number

o

90 minuteg

i[at'each

infant

spent:

1)

with

heart

(120

'

160

bpm)

(HR);2) witñ

aÍerial

orygen

sat

igher

(oX);

3)ln a hlghly

aroused

state

(agltated

or

c

iQl);

an¿ 5)

in

a

low

arousal

state

liuorenrcnt

was

analyzed

and

averaged

ove

. r ._ _ -l

iil

six

trials for

eaih

cóndition.

The

number

of

stressful

facial

expressions

umber

of

autonomic

indicators

nofed

fle, tremo¡

clonic)

were

tecorded

but

)

)

)

)

)

)

)

SrbJc.f

A

'

..,

¡nt

of

a 25

wcck

gesation p-*;#n

rle

vl¡

c¡es¡ns¡n

sectlon lo¡

scut

udy,

she

nas

261

days

old

and

weigbcl

he

studY

she

nas

2E1

daYs

old

ad

ical

problem

was Reryiratory Disr6¡

nical

ventilation.

Two

efubation

tri¡l¡

hnEn'li;,H*,1l:,t':;l;Í"'1.lÍJgJff

,T"'JJiSffi

;i

Hí:é'ii;:4:...3'i1:

bn

(seo

graph

in an

increase

peo mus¡.,

wtru¡uvrt'

in

an

increase

ig

*ft¡.f,

the

heart

rate

nas

within

normal

p-u"r*¿

to

the

no

music

condition'

O:rygen

i.^- ¿,,,i.o

rh¿ music

conditions

r,*"rrt#?;

ess

time

in



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

the

infant

had

cYstic

BPD based

3¡

chel

x-ray

and

her

clinical

qourse.

'r'nis

infant

was

extremely

sensitive

to

stimuration

and

had

,.q;i;.d

Fentanyr,

Ativan,

and

Morphin"

ro."

sedatio¡"

During the

study,

¿"f"

i"t"

not

coltected

lf

narcotlcs

had

becn

admlnlstend

ute

¡úals

for

each

condition'

The

fiml

due

to

medical

complications'

lterc

rt

rate

during

the

three

conditionq rs

ent

within

normal

limits;

howevcr'

with

her

heari

rate

within

norm¡l

s

¡han

during

the

control

condilion

lon

levels

were

higher

durlng

both

lbc

condition

(AOVo)

than

during

the

no

autonomic

indicafors

such

as

lremo

Subjcct

C

than

during

SomatronR

stale

I

an

lncrcase

ln

fhe

numoer

ot

stale

. an

optirnal

state

for-devepnml

t:t:l;

2Vd

'an

opurnat

-$arc

rut.ue:-v:"-r:::---------

sleep

íoi.

-"dlion,

the

taped

music

conuruu'

P¡vuulvg

I

t

¡ :

-t:

tl

.l¡t

.rl

-1l,r

)l

Jl'

JI

:ü

|

.1.

i,i1tr

.o

:.il¡

r¡

t

SUBJECT

A

Minutes

SPent

in

Each

State

8o

70

m

60

a0

T

t0

0

HR

1201c0

bPn

Subject

A

Limb

Movement

a.6

3

L3

Mm Numht

cf

umb.

2

MoYlng

1.5

I

0.5

0

lllnut..

Figurc

lB

]-82

183

)

)f

)f

)¡

)l

),

)

l¿

' l

-._.,

:;

i,;

':

llt

"i9.F"J

-ir;:t

':'i1l¡'¡',.

':'"

SUBJECT

C

Minutcs

Spcnt

in

Each

Statc

l0

J

of

d¡te

to

te

collected

on cach

lnlent'

Thesc

d¡ta

werc then aver¡ged

trials

for

each

infan$

Jln?*

rir"r

acring

as

hiq/her

own

contr¡l

the

bo

mudc"

conditlon"

':i'

l

Data

fbom

¿L^¿

k

'I-

ot'rlies suscesú

':::l}:i:rt:flttT$*'l

the

bo

mudc"

conditlon"

''1

ln

5fi

ds

of

asitation

lolloring

a

interven

.

'*

Yl^T:'*....::l*i

#ffi;

to

rhese

\rhooshing,,

soundg

parricularty

during

rhe

..r

-r_¡^-.^-.ran

ao

"lr.rr-,

fro otslAl

attentlVenesS

and

qUlet

alertnesS'

our



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

70

to

5|,

ao

30

m

l0

0

HRl2sllo

ol>e6*

Hlghlt

OsLl^Ltl

sL'P

bPn

A¡q ''l

ffi;Wffi

Figurc 2A

lfuitati,ons

of

StudY

It

is

clear

that

the

sample

size

of

the

study

was

small.

A

larger

sample

185

can

Uncno

r, both

through

the

;'

¿e¡reeslnq levels

of

player

yer

lants,

when

comPared

fo

fhe

- -"t¡¡

'

e'

This

quiet

alert

nrgher

er

f

"#fi"r;

n

the

critically

rrr

¡rt

otot

tr¡

r¡¡¡E¡"t

ion

and

tne

coñservaiion

ofcalories

required

-

-4 ¿L^

--ua¡l

nrrial

alerl

stafe r¡as

srowth

and

healing'

fn"

als"o"ery

of

the

incrgased

quiet

alert

stafe r¡as

ñnexpected

and

Posltlve

flndlng'

Subject

C

Limb

Movement

.¡

t

r¡u

a5

Nunbrol

2

Umb.

1.5

lloYl¡g I

0.3

0

o

z

a a

a

10121'

lllnqlaa

Figw

28

ation

ofvibrotactile

and

auditory

would

be

the

most

effective

in

i- rlroc¡

infenfs

the ¡aeaÚcsl

,'pnoducing

a

rclamtion

in

fhese

infantg

the

greaÚcst

-

rclanúion

response

(sle

ring

the

periods

o-f

auditory

;r stimulation

alone'

Thesr

thoó

of

Lcona¡d

(1993)'

who

t rr,r"e

aciüted

neonates

exhlbtfed"an

"tililil:t"j],ütü.-;;;

ount of time

sPent

in

the low

fo

auditorY

stimulation

onlY'

t

Thcse

flndings

are

supported

ty

the

th:rv

that

there

is

a

'hierarchical

iorganization

and

¡nrü"{ti-

of

sensory

function"

with

tactile

and

auditory

:;

fi¡nctio

.-

-

-'-:-:-;;

r^

visual.

iunclt:t:ff

(Gla

ss

199

4)'

music

condition.

Disr¡ssion

184

)

)

)

)

)

)

)

slzg.

úlch

ls

morc

homogencous

ln

naturg

á¡íu,*""

lfndings.In

additior¡

thc

incrtased

u

rt

t¿v

-ott¡butcd

to

a

decreased

number

ol

inpnrs

wno

qcvc¡opefl

ñ¡5"t¿

thc

nccd

for

efendcd

nech¡nlc¡l

ven3ll¡lon'

cnvlro

1Ed$)

ncott

Qompany.

;o$l

ncott

company.

On17

riff"

g¡"uñA

irir:appltcatlon

of

sÚimulation

and

term

age'

Infant

att

Behavtor

?nd

:DeYetgl#fll,;r;']

::"'::l of neonares

ro

inrrauterine

Rcmmndrtions

for

Fufhcr

S'oÑ

It is

important

to

note

the

individual

differencts

in

responses

to

bot¡



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

arl

\rl

?'r

Iri

I

rrl

fi

,til

il

ll

l

Il

Il

rl

rl

ü t

¡'¡v'----

t

5+91.

?

rlo7l)-

Intmuterine

noise:

A

'.

D.

Grimuader

Jr s w'u'

C'

(fgZf)'

Intmuterine

noise:

A

-,',ionent

of

the

ftt"l;J;;;;eni'

American

'Iournal

of

obstetrics

the

auditorY

and

vib

fhom

Yecco

(1993)

individual

infanf's

beneflcial

when

comblnd

wlth

a

prev

prograrn" (P.63).

For

somc

infants,

the sensorl

experience

of

the

somaÚrcnr

may

be

¡63

stimulating

and

therefo¡e

not

as

effective

in

promoting

sleep

although

it

nny

J;;;

agiiation

wtren

his

study

using

a

larger

lI

attune¿

to

ihe

intraut

trt

pre

and

post

infervention

is

needed

'

-,

--

.-^-

^r¿L^-

a

ant

["iti"rr"i

types

of

infanfs

which

may

beneftt

more

from

elther

audltory

or

vibrotactile

stimulation.

Music

w¡tt¡

anJw¡rhout

vibrotactile

stimulation

appear

benefcial

for

ologicat

súability

and

reducing

strcss

ons.

Future

research

might

focus

on

length

of

staY

bY

Promotlng

longer

the

healing

P¡ocess.

Referencs

Brazelton,

T.B.

(1973). Neonatal

Behavioral

Assessment

scale'

Philadelphiq

PA:

LiPPincolt.

Caine, J.

(Ú91).

The

effects

of

music

on

Úhe

se|ected

stress

behaviorg

weighl

calorlc

and

formu|e

lntake,

and

length

of

hosplta|

sfay

of

premafurc

and

low

uirth

weigttt

neonaúes

in

a

newborn

intensive

cart

unil'

Chap ii'*

silulalign

of

short

iimu

activitY.

UnPublishd

rk

Universi$'

CollingS.K.&Kuclr,K.(1 )91).Music-fhe-rapy¡nttreneonajalintensivecarg

unif.

Neonafal

Nefwork,

L(q'n'26'

Glasq

p.

(1gg4).

Th;

"oln"oble-neonate

an-d

the

neonatal

intenslve

caFc

186

:

iThi.

r".earch

was

suPPorted

bY

Research

Instltute.

,lhis

chaPter

is

a

nortio-1^gf

an

a

nursing

research

grant

from

Glaxo

article

that

was

originally

prcsented

in

il

lt

li

Ñeonatal

Ñemorh

SePt'

1995'

187

)

)

)

)

)

)

)

)

i;-:'l;"

r,

I

:ji

rl ,

,.

ir ;;'.

,-.

r,,:

ri:)

I

'.

¡i

..

,

j,

,,.r,

l,gt,.

j;r¡¡,

wIIfl

n(ñPfrAI.rnD

cflILDnEN



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I

Cli¿ra

Populetim

d

'1

ri

rl

l

tl

i

'lr

,l'

t,

) ,

lir

t

),i

Tampa

Chi|drcn's

Hospitat

at

St.-JosePh's

is

a

f¿O.bed

hospital,

t.iithe.pu,

Florida.

T'his-hospiter

ryry-es

all

childrel

PqrlTil

ió

yoÉ9ggg",

t"g.tdt"tt

of

óne's

eblllty

to

Pay'There

is

a-l:,'bed

,f;C¡¡i"-"

i:"r"

Un¡t

(¡¡vel

I),

an

8-bed

Pediatric

Cardiac

Surgery

,i#:;t:il-ñeonatar

rnrensivc

care

unir

Qo:l {D,

c9-nredicaus¡rgical

ffi

;

p.¿¡"ti"

Emersencv

center

1a

reaillic

:fa1iv-1'fi:',fi":

arr

occasions

when

patients

over

the

age

of 1t

years

"ry-

-Td

for

in

the

a)^

ne

s[ur

r------

--

lnesses.

rosis

or sPina

biflda

ri

mlfo

nmPles

of illnesses

)Íi . ¡r- ¿-r^r---

^-

-^rrar¡r¡

..ontattef e wnrrld nrenase

Úhe

c?rc

of

patlents

,.ir¿.*

pedlatrlclans

or

pedlatrlc

speclallsf

s

would

manage

Úhe

care

of

patlents

r

1E

Years

of

age.

'

Cfinicel

DcscriPtion

ThemajorityofchildrencaredforatTampaChi|dren'sHospitalatSt.

scph's

ha

ve

-illdl*.

¡y-,ti9}

?

r",-?"u

t

:

i

1.,nar

urc'

T:y3" T:

:1T"1:.t^":1

ifone.ilñ-;f

thó

cüii'dññ

ñáve

cñronic

illnesses

which

require

frtquent

Yil;htt*iioit.

r"r.¿ul

anÜor

surglcal

cane

ane

provlded

for

chlldrcn

qv.i"i"ti"" and/or

disease

ol

the

foitowing

body

syslems:

N^eurologl'

r-loo,

Cardiologl,

Endocrinologl,

Gastroentcrologr'

Oncologrt

¡¡,--Ñ"ptñíog¡,

Utologt'

Hematologr,

ophthalmologfr

ñna

Otinop"A¡"t.

I

s¡gn¡ncant

number

of

children

having

;.d;át$;g

degrtes

of

traum

rcceive

emergencT

care

at

lne

Eryryencr

ó"it"i"uoi

oir

inpatient

unitg

if

necessary.

Ihere

is

a Pediatric

. irtg""y

p"ogratn

*lri.h

repairs

simple

to-cnmplex

cardiac

ano-rnalies'

¡¡

6¡-rrro

"rr¡lár.n

cen

oofentlalty

benefl

fhom

Vlbrmc'ou$lc

therapy;

';iñ;

igrtv

copnfex

disorders

can

benellJ

primarilv

Vibroa

É¡-..

or

thpir

mglicallv

complex

¿iryil-t¡.-1

in

providiñg

co;ffií

via

medicinái

means

are

someliÍñes

.Tor

énmplg

gtme

children

rcceive

medication

ühi"h

int"t'¿t

:

¡l

p."i¿"

sedation.

gb*.n"t,

these

childr:1.

9 9.n

ryt'it"

": i ,lnd/q'

ustic

measures

to

comfori

ü-ñlil

tñé-m-edicatlon

reaches

its

full

)

jf

)

)

)

)

)

)

rhe

chitd

to_

the

5*lt","i_::S,",::

;'ri;ilóh"

u.-

u¡4/or. ee

'r'".ünv



.I

)

)

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)

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)

)

)

)

l

)

)

)

)

)

)

)

)

)

)

)

)

I

hospital

beds.

Af

this

insÚitufion,

we

do

not

have

a

specific

refenal

profocol

for

oatients

who

maY

have

invasive

while

utilizing

the

Vibroacoustic

utlllzed

when

the

chlldrcn

dlsP

uring

and

after

the

Pnocedures

Assgsent

hoocdurcs

190

rt.

Infants

througn

-r."i¡illv

still

as

possible

hurt.Infants

lhrolgx

sfill

as

possible

¡cstraints

so

that

¡ne

oi

itt"

procedureq

such

as

D

1

catheteratheter

bodY'

'?ff;;"

bcf.orc,

,ioiro*"ar"rr"n

ónscious

sedation-

o

hetlcs

arc

used'

itóí."¡oor

Sedation_

o

hetlcs

arc

used.

$roce¿urts

arc

performeo

ln

wr¡rsr^l*¡¡¡v

---

'iÚ"'

sound

and

vibration

stim¡rlus

pnescn(rurnrDo

meanS

Of

ift"-1"--i"atloñ

table

is

used'

'lne

vrurarru'

w¡

rvY

--

t

sion

duriñ -

ihe

Prucedures

F"

Beau$

"Td

iI:

Beast

are

-^r

and nrr¡rr€

PlaYed

for

mal

and

naturt

Pr'¡JGu

¡v¡

dolesccnt

Patien

songs

are

Puti*t':nli

,tffJ#;i

Pl€schoolers

means

ol

T¡catmnt

P¡oocürre

At

this

institurion,

we

do

not

hi,":".^t:i:1t-:":*lfJ:"TJitt'"t#

At

this

institqJignt

we

do

nor

¡raYG

q

'"'"'11i"-minafion

table

has

rffitmüú¡¡*usic

enrninatt"::::*

1r"o"

with

or

without

the

l,i5ffi*'ffi'?#ü

;;.

;1;i,T¡::l"i5

db-ilffji-to

play

the

muslcat/sou¡l¡

qr*"Y

--r

n'ybeadjustedfrom

,L*í¡""

"itátion.

Both

Íhevolut""

ulL"t|

.^-^:fr,

^?

rhe vibralio'

ar€

mpanying.vil-,1:lfillj:"Jl|ü#'ir,"iii.-"",voithevibra-tionare

to

high.

The

loudness

¡r^-

^r^rocm.r.r

ni¿.

tn

tt

"

case

of

lnfants

to

high.

Th:

to:d_Tr

or

¡no

sounu

"""

"'-ri'"iu,-tn

ttr"

case

of

lnfants

mit.""of

patlent

prtferencc

(for

adolescent'

191

)

¡

l

,¡

)

.T

)

)

F

¡

F

It

li

s

dlscretlon'

Howevert

the

volunc

a

should

be

adJusted

so as

to

h1¡or;,

tióm

an

lrrltatlng

envi¡o¡r¡m¡hi

'

and

vibration

should

have

a

di¡tq

titioner

r|ants

to

achiet

rovide

a

calrq relax\

I

procedurt.

The

sound and/¡¡

coustlc

One

Pa

lmateti

dmate$

dth

an

InferruPted

[ypertension

. As

a

r€su¡lr

¡¡tl

rql

-

^

^--^l

tñóaf

ñcnls

":,v-r"n

theraPY'

#;i*.

Tfuforcl

a



lili

rll

lll

ili

tll

,li

rli

lli

il

l.¡

,

I

I

I

I

)

)

)

)

)

)

)

)

)

T

)

)

)

.,

_)

)

)

)

)

)

I

)

)

)

)

,

t;,

l

lii

)

lit

{

)l

ll

il

1i

It

hild

auay

fr¡m

the

unPleaunt

r

S

to

feed

to

feed

b

niPPle

nt

of

hls

ls.

itris

ctrin

rr¿s

YerT

fragile'

Íhe

--r-^r

--

rhaf

l¡ig

¡

quite

a

tcntPEr

rlr-

rsvn

-

.:ipñor"til.

PeriPherallY

and

become

olz

*-¡-ro¡--ini¡avenous

access

during

his

a

dose

of

morPhine

dose

of

morPhine

'to

two'hour

Period

of

back

to

his

original

environment.

He

nas

often

held

i.

i"

f"lfi"g

asleeP,

a

musical

-r*as

PtaYea

wnile

he

was

gentlY

his

p

eri

pheral

int

raveno

u'-1'::1":Y::n

;;i

;iñ;üi

;

;lcc

ss.

r

herefore,

^r.ottanoc

r¿¡

the

staff

so

that

a

Evah¡ation

Proocdurc

\ile

do

not

have

an

establish

Case

StudY

#1

ter

challenge

to

the

staff

so

that

a

*"áiJnot-*nt

to

medicate

him

ünless

absolutely

necessarX'

lab

P'

Wt

"tt

the

little

Pu'l-",l'

lay

tess

ble'

ess

ble'

$m

l;';::#;"i"'iJ'"ice

and

then

chitd

to

fall

hitd

to fall

mponent.'l'ne

esrablishing

. Our

favorite

th

this

Patient

intention

to

would

be

so

t"tLT;Uñill"'"

o"'*"

would

be

so

LEJ

DlssCo

¡nd

Rocomrenüdms

Crc

SúuQ

#2

l::

-

,

ljj

,jr¡i\*6

The

sccond

pallcnt rras

a

baby

boy

who

vas born

prcmaúu¡ely

and

'frfint

severel

months

ln thc

Neon¡t¡l

Inúendve

Csrc

Unlt

(MCt¡:

suffercd

Grade

Itr

intracranial

bleeds

when

he

uas in

the

NICU.

A

he

subsequcntly

dwelopcd

hydrocephalus

and

cerebral

palsy.

s

a

rc¡üq

to ade

head.

rsv.

-rJ

r

--

so

the

child

maY

rre¡

're

*'¡cln

¡l¡ssical

music

and

other

sounds

^J

e

to

the

child's

:i

-

L-

tn



,,l

rl

tl

ti

.l '

?l

\rl

{ll

irt

cause

grcat

pnessune

to be exerfed

on his

braiq inevifably

datmging

the

bnü

itself

and

potenfially

causing

death

as

a

¡esult

of

compressing

the

braiu'r

vltal

components.

This

little

pafient

had spastic

cerebral

palsy.

His

leg

and arm

musclq

werc

aluays

tighf lexed

and c¡ossed.

However,

when

he

rvas asleep,

his

a¡u¡

and

legs

urcre

rtlaxed.

AIso,

he

could

arch

his

back,

causing

his head

to

touü

his

toes

when he

was agitafed.

Feeding

this baby

presented a big challenge

to his

parents

and

th

nunses.

He

rtas

given

a sedative

every

four

to

six

hours

fo help relax

his

arm¡

legg

and

the

resú

of

his body.

as anficipated,

minimal

stimulation

rrculd

exclte

thls

llttle

boY.

He

nas

hospifatized

for several

months

and

would

oflen rtfurn

for

subscquent

hospitatizations

after

the

prior

discharges.

His

subsequent

hospitalizafions

rvere

often

for

pneumonia.

When

this tif

tle boy

vas agitated,

he

nould

cry, arch

his

back,

twist

his

to fhis

liftle boy,

an

Therc

uas on

music.

\ilhen he

was

head

softly sfroked.

efremity

that

rpas

being

used

for drawing

blood

or

establishing

int¡avenous

acoess.

IVilh fhis

particular

baby,

we

found

that the

vibration

componenl

ol

the

enmination

Sable

was nof

effective.

194

rus

chlld.on

taPe'

théY

á-rónot

PhY

I

se

of

security

emmination

utilizing

the.

vibmt¡on

comllgnerr

ur

rr¡v

emmination

gl¡.¡¡.--Ei.'-"1:..'".'.

ousfi

:

enmination

¡^Lr^ ñ^F¡

nncifive

--.^r

lo

usfi

:

enm¡narlon

chtld

w¿s

ellowed

lo

iñnncnf : thercforc.

nt

,lnnovative.

For

some

of

our

o|der

chronicchi|drtn,

the

''special''

enminatiorr

,lable

is

a

treat

ro"

ür"ln.1i.-iui*r

ano

pnysicianó

attempt

to

focus

fhe

child

flin

the

"speciat"

"rt-in"ti;;;"bt;

'u''"'

''""ift"

p""¿ini

procedure

needing

of

the

Vibroacoustic

ercam

iable

to

be

'-.:

'

--^

¿u^

tra¡¡ialrt

or-nminatiotl

t

rl

trt

\"

)

til

I

ltl

r

I

r :

II

lrl

lr¡

tl

lll

iI

l

ti

lr

l¡

tr

lü

ineeicat

conditions.

19:

)

)

)

)

)

)

)

)

Butlcn

Johnson

BuJlcr

HGHTEU{

,.:

'i

.,,'i

.t

r

-

i:r.'

,.

,.'

:

-,

''r

,

"

i

i

iti:r.'l-':r'ii"+:il

IWATT

Wnfl

CARDNC

SITRGERY



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)

)

)

rl

I

)i

i,

{

1l

),

I

I

I

rTvhen

I

nas

first

introduced

to

fhe

idea

of

using

sound

to.prod-uce

bsi;i

an¿

psyctrotogicai

tenefits

aft

er

.t"F".tT'.I-T::t1lLIll

ilñ'"rll,,ni"J.

ü;;;";J;

tr'"

psycholó_giál

beneflts

are

jusf

as

rt.

The

feeling of

sertnity

'I

.Soi

fbom

the

'*

9l-:1"..}f,,:3:

HiTlll.,,,".;-;rd

hJ;;LniZs

auour

my

ne.oye¡r

and

used

little

tdffi;;

;

chemical

ñ

+f

¡:r

I

"T

3

*tl:"::,rr"*'

rhe

bed

has

derinite

s

flr

a

faster

recnvety."

@atient

Xr

2'L9'95'.'

ñ^nrmdtnrn'.,

"orr"""t.it

costs

ind

quallty

engulf

the

dellvery

of

-a --^l

L..l-¡l¡

'

cc

tighter

and

tighter

national

budgeús'

'l"f

i

crñ¡c¡an

wi"]*:::,1f-o:::i.:

llto"O

o*

technologl

1o

,p."¿

hcal¡n-g

and.decrtase

the

cost

of

getting

sick'

:

This

chapte"

o""i

specittcal¡-ly

with

the

adult

population

of

our

;r-;i,t

;;';;;

open

heari

T"c:ry'

It represents

our

atlempts

to

decrease

their

rish,

il,"it'il¿

ror

the-iniensive

care

:1"-T:1i"1iiii-i

shorten

hospitalizati""-,l"rougi

the

introd-uc¡ion

of

lorp

fiequencl'

pure tonal

mund

to

the

perlopeori*.ñ"ronment.

More

speclfically,

our

goals

arc:

1)

g wullu lv fr¡v l,v¡ ¡ vrv

i'fo shorten

time

.oent

on

the

ventilator

postoperativelyr

J)

$

I--;-;-,:;-: .,-l 1\

rñ rtecrease

nain.

anÉety

and

de

Patienl.

t

arrY

rEr¡rvtcr

of

staY

in

the

intensive

fnom

the

hosPital'

The

populaÍion

to

be $udied

comprises

"d"llt

":f:T1,::"^:S;:::

H*""'ll'"üJñIffi

;;]r"**i""'"uu"-"n -::-f¡ll":1f

f::T"'

F.i"'-l"rn"

ñrii';;i;;;h'rn

óo*.

"orr,"

to

$rgery

with

vi-gorous

hearfs

-

--l

r:t^ *inlainino

ililJ;H

üfffi:

needing

the

supporr

of

drugi

and

lile'rnaintHlll

ffi ;;;;

coi¿¡iion.'rlhar

lie

somsrvhere

between.

These

ft-l^-^'^^

ü;¡#il?"..Jr

;;;ü

lo

B

ro

nso

n

-

M

etho

di

sú

.Y :'tlj"

1

-ti

Y:T:'T:

ili."::ü;".'

; r,"

rt

-"""

-"

r

two-

a0 0'b

ed

T.ry {"tl,tg'*i

^"

.11ll"Tt:T

ü;'tffi

to";

i

"t'i

i

so,o

oo

p-p

r''

rhe

ho

sp

ttal

s

.r"

T i-:"^"1T-Tff

ffi#i :;ff

,;

;;;,;;[i,iigrrhv

under

one

mmion

.neoile.

g:i.t-?:

ü"xffiffiüffiP;;;;";ff-;""h

y*"

berween

rhe

rwo

hospitars.

I

i

I

i

)

L97

It

obstructive

lung disease.

However,

our

unif

is

not

optitml

for

quanti$ing

it3

candlil¡tes

for

open

berrt

srgery

ttüo

h""."

consentcd

to

use

the

-

-

-

^-r^-.il*#l¡í

the cools

listod

eadier'

trrunt.

The

meni.

The

n,

séúse

of

'w¡nfilalor.

I

well'being

anxiety,

and

t¡me

¡equlr€u

urr

t¡¡v'ventilator'

ar

-

. ,,- -.^--:k

,-

-'"Lrr

"'rrdomized

-"trjY:"tJjj.l

lj

archers

at

rapid

decrease

in

sioacoustic

urr¿

utt

inclcá.á

usc

o

ation.

A

study

at

o

lv¡¡¡¡e¡

t-t--ation'

A

sfudY

at

u¡¡¡¡



rii

lii

benellt

for

severe obstructive

lung

disease

palienfs as only

a for

patients*itb

scvene

emphysenn

are

candidates

for

heart

$rgery.

Tbo

Phydooustlc

Syfcm

The Physioacnustic

system

consists

of the

administrafion

olpurt

tonal

sounds

(withoul

music)

using

fhequencies

which

stimulate

resonanf

vibmtion

in

human

muscle

flbers

and neryous

systel1.

If consists

of

a sef

of

speakers

embedded

within

a fleúble

foam

malfress.

A

circuit

board

is

used to

create

low-f|equency

sinusoidal

sound

naves fitm

27

toll'3

Hz.

Through

a

propriety

sysem

of

scanning,

putsation

and

relamtion,

a

rest

period

is

secured aflcr

each

sflmulaflon

to

avold

dlscomfort,

far3et

exhau$lon

or tetany.

The sounds

and

progmrns

can be modifled

úo

isolaúed

muscle

groups

for

geneml

re

sensitive

flequencies),

or

pulmonary

cost

by

elimi

bY

a

nurse

or

lechnician).

T

ic

beds

available

commercially

o, Michigan'

Eah¡crl

Conslderrüons

and the

Review

Board.

Contraindications

to fhe

use

of lhe

Physioacoustic

sysÚem

include:

swollen

or

inftamed

areas,

skin

eruptions,

únexplained

calf

pain,

and

hypotensive

hea¡t

disease

(shock

wilh low

blood

presure).

Subj'ods

patlenfs

Included

In the

t¡eatment

populaúlon ere

both

electlve

and

of

Dn

v

searcd

to

measuring

heart

on

Pt

pall€nrJ wrfu c uw'f¡rrtse ----

t*"f"d

in

an

attempt

to

reverse

that

ii

ilfr

tl

ti

lr

rll

?

'|l

and

Ppccdurc

pnysiotogical

changes

as

they

occur'

Clinical

Considerajions

Each

patlent

to

be studled

ts

indtvtdually

assessed

by

the

investlgatlve

L99

{¡¡

{l '

t

)'¡

t'u

rll

I

tlli

I

llr

t

h . t- ---^

se

fi

rhe

Preferred¡1 ::lj:::*"tt"':":T

a

ncesunes

^.2

of

Sticr¡r

ro

s^l'v'vs

of

pnogram

using

the

Physioacorrstic

-t

.Ló ñrrKo toaln

Ht'S:l

when

the

compurer.

turns

-:hi'.¡ilt"""

on'

the

nurse

again

'incasurcs

cardiac

"tp;;;;i';;ining

another

thrce

io

six

measurements

in

the

f

"*"

f#:htl'i,

no

r

con

sid

ened

va

ri

d ir

t

he

p

ili:ll: i::: :::""':i':,Hffi

:

i,

"*"lfiril"ililitT."iiiün"iil

ffi;:";q

iloving¡'

or

if

anv

anhvthmias

ñ;;;;;";;ú-oo,-"n;"l'il*":*f-;"l*-":l;,:zu*"'n*,f,llli;1*l:T

clinical

suilnatY

-'---

linical

summary

i,enous

orygen

fe

pinned

to

a

coPY

d

to

a

coPY

H"$il:'ffi

il'T,ilil'#J"T',T.#ü'",';;lü';sedationwithin

hou¡s

of

the

measrre¡nent

Period

All

cardiac

output

d#;;

Jü""J"ry

datedlvrheJ::t#:-"r1l:

k. u"flr1ffi"*Iffi:ffi;i;;l¿

ro

'"¿*.

op"oto"

bias.

Patients

who

continue

to

use

th"

Pñ;;;;oo'ti"

'vs"t

tl

tLt:,:Yt

T"T

f1:i;1

ontinue

to

use

Ine

rnYstuauuqr¡¡v

".ls'v"-

--""otu"t¡on

if

they so

desit¡.

sei;

of

we['being

may

write

a

subjeciive

B¡onson

Hospital

,rfl"J';;;--oiUi""ti""

corn¡nents

or

nole

other

t¡í

titf

llr

lii

iii

tI

iI

l ,

ll

il

)

)

)

)

)

)

)

)

i:'

lmprcsslons

of

system

benellts

or

problems'

Mr.

X

is

a

4E'ycar

olll,227

pound

male

with-a

good

heart

ftrnction

(left

re).

He

complefed

"n

*á-plicared

tri*,1iT:::"j::I

ffIJ;tI

;t;l;r'il"TTffiü';;l;;ü"

;pport"Ij

is

veIl

earrv

in

the

post'

ive

period.

He

is

'J;;;"';";;,X*:l^iL1

f

"r'*ti""l,rl1;

.Hl[";Ji.'it'"ir.'*"i,

ii

it

¿"t¡t"ble.ro

use

a

stnong

signal



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

basis.

Eveluation

200

.

Because

he

is

still

t"i"tf

i."uh"lil

lt:,::*'$i"#l};tl:

l,:tX

i

-ff;ll"T

ii';

;;

o r

"i

nd

uci

ng

motío

n

sickne

ss.

Accordi

n

grv'

Physrmcousu"'v"t"'i'

;j

1;'

TT.T.:,i,9:1"*,Tlffiitl?-1;l

Hff;:il;

üffi

;;;;;

J¡'i"r"'

to

tñe

back

(e)

and

neck

(e)'

Baseline

cardiac

*tp"i

"""-e"

u-'l-o

--"P:

*:'f":i

J'il""':

x1ñ'H;"fil'iio"

ii"-pr'v'ioi"ou'ti"

pT.so-

rms

then

run

ror

a

rd

durati

-

-'in

*,-"r..-ii,er cessation

of

trcatment"n"

n*tl"f*ttll

i{¡ndant

durall

his

tirnc

aú

ippeared

fo

.be

magnitude

9 six

cardiac

ix

cardiac

'¡¡

s¡

s¡r]

o

e

and

lowest'

The

change

between

the

o--

:rrátrrtnt

four

rneasr¡rements

was small'

i

Patient

X

r¡nas

ii"'iii'¿

*

a

series

lf

t:i-p*i^"^l'

tm"*:::tJill

i;on-"lf

";;',ilT;;"TJi.üjii,r'l+¡1.:":X"mi;,il increasein

.car¿iacoutputt-"""i'ñ;ish"h":Y.'-":-Ti1

j1:.:11"":lil"'li:til

fifiil#tXllü*T.;;reisturne¿

orrto

rerun

rhe

s¿rdiac

output

tests

witlr

ttre

patient

.tin

"11'Ip"ii"ty{i'.1",.*:.T$i

performance w¿s

still

¡rLit

i"ut"

il

i¡*¡"'

wiitr

a

mixed

venous

ot

73vo'

l'

rhe

3llter

ptt

t¡ntit

int""tt

in

T'di":

oyl::t^1lt:

Tf:'::11,1

il.

toollit""ti:',Tffiüilii'

iiur

is

usuallv

seen

in

responders'

rhe

results

arc otherwise

rypicar.

ii"r':;-;--,"".,"i"ted

wirh

shuntir,r.g_.

Yil*,i"J"",:;

ffiJ*l:XilJf'ffi:;ül

in

cardiác

output

isarso

hssociated

with

increased

:"--:::":t-T,:::ffi

i:Í,

#

tfl

ff

l-óTJ"o

and

venous

ex¡racuon

of

o:ry

gen simutraneouslv

tses.

This

case

was

chosen

for

illusfmtion

purpose$

in

spite

of

its

atypically

lncrea

se

ln

card

ia

c

"

t

tp'"t,'-¡"*

"¡

f

t

if

";-

1Ht:

t-'::*1":::ll

| :

iIHHT

I,T

"iiffi

il;"r"n

i

¡.

nof

."

Iil'

:1

-':::""

Í1

I'on"

n""

motion

or activitv

".

;ü;;

Jifi"-p"ii""t

inaucealv

T:*":1nt'5:f:

ilg':ilffil"'g"S#.:ffiiffifi;;;;:;

"rr.

rhe

increase

in

cardiac

butnut and

tisse

ut¡rüi¡on

áio)rysen

u"as.slJ

p*f1-1T:::

?::TT"fi::

IilLHH"HT;#'

ffi"li'.

fi

:;'''"i

{;r;1

1 11'13?:

^'

ime'

At

thi

s

boint.

we

made

the

Jliil'iiíi-'th"

;"

t""ryT

j"-.-11f.",,:J'll'¿T

il:*#

tT:ff

;fiáiilllffiil;;

''i

"*'o"¡"ted

with

the

use

or heart

'(lnotroptc)

drugs

or

"l**Ñ"

in"creasea

work

on

the

part

of

the

patlent'

20L

)

)

)

)

)

)

)

)

rrere

good

lhlngs

ln the

postoperetlve

pedod.

for

qulte

som ürne

after

the tre¡fmenf

sÚopg

so úhe

s¡me

paflent

bc usd agpin for

prog¡am

comparion).

To kcep

fhings

sirnple, rve

initially

used

only

standard

pmEam

#1.In

currenÍ

worlq

u,e

are

obfalnlng better

Increments

by

varylng

Intenslty,

back and

neck

súimulus

according

úo the

patienl's

body

and

cardiac

'irass

I{e

have

on

occasion

obtained

good

resulús

by

cusúom-progamming

generally

felt

in the mid-back

region.

i

Our

study is,

of

course,

ongoing. We are

completing

a

series

of

fen

tl



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

ll'

iiri

rL

L,U

fi

)ri

t

¡t.

<¡r

i,"

l¡¡

I

iÍ,

iir

ki

i.ll

r¡,

lii'

'ii,

l,

F

h

Cesc

SMy #2

Aftcr

a

discussion

with

the

pafient's

wife,

it

r¡as

decided

fo activafe

the

g

an

addifional

inotrope

medication

tes,

the patientts

ca¡diac

output

uas

uration 6lVo.No

addiúion

of inotrope

During

eI

inotropes

and

ent

uas

quife

sick

tbe

use

ol

the

Physioacousúic

mattress.

No srbjective

rcport

r¡as

obtained.

This

case rms

selected

because

it rr¿s

d¡amtic

and

prescnts

a

striking

acc¡unt

of

lhe

effects

of

Physioacoustic

t¡eaúnrcnt.

The

incrrcase

of

about

Socc/f{in.

in

cardiac

output

nofed

is

also

much

more

typical

of fhat

obtained

in very

sick

people.

Discosdon

our

speciflc

project -

the

eflect

of Physioac,oustic

treafmenJ

on

caldiac

output -

is

in

its infancy.

sfill,

certain

questions

need

to

be

addressed:

wrat

a¡s

lhe optirml

frcquencieq

intensitieg

cycle

rates,

pnrgram

lengfhs

to

maximize

an

inc¡nease

in

hearf

performance?

once

a

patient

is

tesed

and

demnst¡aJes

an

incrrase

in thig would

a different program

dermnsfmfe

a

larger

or

smller

Increment?

(once

en

Increasc

ts

demonsfrated,

l tends

to

202

iratienfs

and have

requested cleamnce fo

sfudy twenty

more.

Of fhe eight

pafienfs

treaJed

al

the fime of

publication

of

this

chapter,

six had

increases

in

cardiac

ouúput

(five

in

the

f)0ccffin úo

ll-ffin. range,

one

an

increase

of

,

one

rpes unchanged,

and one had

a

sllghú

decrease

(300cc/Mtn.).

the number

of

paúients

ireated

is still

snall

and has

not been

subject

ió

peer

review,

no

absolufe conclusions

sl¡ould

be drawn.

I1 is

the

belief of

úhe

irufhors

fhaf the evidence

so far

supporfs the

notion

úhat

purt

tonal

fiequency

sound

can be used

to enhance

heart

perfonnance

(cardiac

outpu

and tissue

órygen

ufitizalion) af least

in some

patients.

Inifialty,

pafients

of enormous

body

mass

proporfional

to

height or

huge

ca¡diac

mass

(aolic

stenosis)

should

be excluded ftrom

cardiac

enhancemenú

studieg as

they

úend

nol fo

rcryond.

Howeve4

fhese

patlenús

do

receive the

benefits

of decreased

pain

and

anxiety. The authors

believe

úhat

better resulfs

and

a

higher

percenfage

of

responders

will be

obfained as

knowledge

increases regarding

how Jo

maxrnuze

pnogmrnmmg.

Roommndations

*i,

The use of sound

as a therapeutic

modality should be of

enormous

interest

úo those

in mediclne nif

h a

physlcs

background,

Just

as

drugs

a¡e of

inferesf

fo

úhose with

a bent for chemistry.

Physioacouslic

science

is in

its

infancy,

buú the authors

believe that fhis

system

has

ifs

place

in

every

care

uniú fo

decrease usage

of narcotics

and sedative

drugs, to

pulmonary physical

thempy

at fhe

fouch of a

button, and

probably

enhancc

cardiac

output.

CosJ Confi¡ol

Aid.

For fhose of a mo¡e

mundane bent, this

rnay

be the

most

imporúanf

paragraph

of

the

chapfer.l{'e

have,

since the

introducfion

of

physloacoustlc

mattresseg

been able

to svlfch

to shorJer

acting

anesthefics.

The

use

of

pain and

sedative medication

has

decrcased,

and

pafients

are

mobilized

earlier. The

avemge

fime

on

Jhe

venJilator

has

been reduced

from

7

hours

úo

7 hours.

Time

in

the cardiac

surgical unit

has been

reduced

fnom

ln

average of 36 hours

to lE hours. Hospifal sfays

have

been

reduced fnom

p-n

average of

9

days

lo an average

of 5

days All of this

has helped

our

hospital

cut

cpsts

trcmendously

for

ifs cardiac

surgery

pafienfs.

These systems

should

have a

place

in

the

routine hospifal

bed where

may

markedly

decrease the

use

of

paln

and

sleep

medlcatlong

Is

there

)

)

,

)

)

)

)

)

)

¡

placc

for

fhcm-

&ndon

or

sleeP

tl

tüüi'btt

thc,Y

usó

át

:,

'

Bibliog¡ePE

Anderson,

S-e

(Ú79)'

Pain

cont¡tl

by

sensory

stimulation'

Advances

in

Pain

sic

in

the

control

ol

Brown

NNEIWN

CASE

SruDIW

N

VIBNOA@USNC

ffiAET

s|ril|d

Cas

StudY

#1

The

first

case

study

describes

th:'o:'{ibroacoustic

(VA)

therapy



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

.)

)

)

)

Gardner,

WJ,

Licklider'

Sirppression

of

pain

bi

sound.

9132--32'31 .---.:-

Lrhikoinen,

PJ' ln"

pf'VS*coustic

Method'

Next Wave: IGlamazoo'

Lunde

nasaPain'

of

music

on

Mosg

.Iournal,

s

(1)'

6ryg'

Naukkarine,,,

tt,

t*nitffiñ'}'

Pallrkli'

T''

&

S

"--"

PÑJácoustt"

method

In

the

srcatment

presented

at

the

5th

International

Cong

BudaPest,

Hungary'

a12yarold,braindaffi;;ñ*itt'inr"rmittent'alúernatingesotropy

a

stnong¡

upwarú

,u'""p1"üi3'iiltt

v¡'

t'*-"tt""ntt

were

implemented

1994.

Eriza,

the

client,

was

a

retugec

ry-."-TTil.:T1t#J;l#tl

Hl

$#l,ini:ttl'?"#,;$ir "i¡¡ülilir*lr;-*:'rr":,'

fi

il;"i"-N.:yl:.T;"11t"i,"":ñil"#;;"*rnningromakeherserf

tías

receiving

her

educr

'i;.i...tood.

,,r¡r ahd

visual

conditions

were

A

[ninutes

the

visral

firotion

er

to

stretch

her

i----i.lo"

to

VA

thempy'

ne

body,

and

this

s

wene

obsewed'

'

After

about

45

f

iri

i"

lui

I

lu'

lsi

she

disPlaYed

better

ining

a-freouencY

of

rall

the

eve. head

and

muscle

her

'¿u¡ation

of

which

was

liiri

liit

)

)

)

)

)

)

rt-.

&",

o'

en

obJect

long

enough

to

lnterarct

lts

meenlng'

These

res¡lts

¡lso

#á"

it

possttte

ro

U[tn.*--aiog

and

nriting

taskg

which

stre

not

fead'c

bttorc.

,iFi-'-'tr

ruis

rcconinóhdcd

th;t

b'ecl¡l'eqiilptii""t/ft

4iiirc'contelntng

v4

equipment

bc

designJior

her

*it

"t

she

could

beneflt

mo¡.e

continuouslr

hom

these

effects

*tttl;

ttt"

;s

involved

in

other

types

of

education

and

theraPeutic

interventions

C¡s

Stuü

#

tbe clfects

¡t

¡?ct¡st¡nt

lelvel'

|\+4t)4#É

4

/.,

skole'

)i.

)¡



The

second

case

e:omple

describes

a

pilot

sudy

o-f

a

$ormn

with

he

woman

was

born

in

1945

and

had

fheraPY'

in

her

arms

and

legs

and

$iffness

the

mornings'

The

client

was

taking

Í

baths

and

rccrcived

massages

in

the

n

so¡ne

dayg

she

uas

unable

to

function

before

noon.

Res¡lts

of

hcr

x'mys

and

bloodrvork

were

negative'

She

bepn

rcceiving

vA

therapy

il-r"ii,

r'ggg

ana

continued

to receive

maintenance

sesslons

for

6

Years.

At

the

beginning

of

trcatme

flequencies

consecutive

'like

a

nerP

extremely

positive

results

wene

seen

Following

rnis

inrenJve

ireatment period'

she

was scheduled

for

freatment

onoe

eve¡Y

2'3

weeks.

For

fhls

*o,n"n,

and

for

other

cllents

wiÍh simllar

prcblems'

an

the

cllent

d

by

using

client

has

Regular

malntenance

sesslons

ane

nocessary

to

avoid

rclapse

and

to

206

)

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)

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)

)

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)

)

\

rJ

ü{l

20'l

)

)

)

)

)

)

)

)

)

Pcrri

t¡hikoim

Hidory



209

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

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)

J

)

)

\

,The

Physioacoustic

Method

is

based

on knowledge

obtained

f¡om

efensive

clinical

work in music

therapy.

The

ffrst

clinical

trials

in Finland

werc

conducted

with

mentally

and

physicalty handicapped

children.

As

Jullette

Alvtn,

Peul Nordoff, Cllve Robblns and

many

other ploneers

of

muslc

in.rpy

have

agreed,

music has

a

very

strong

effect

on the

human

body

and

mind,

-whether

these

function

in

a norural

or

resÚricted

nay.

Because

i

ian¿icappea

people

usrally

need increased

scnsory

Simuli,

sound

is one kind

:

of

sensation

-which

can easily

be

used

for

therapeutic

and

rccreational

(Kuulonhuolúolllfto)

In

b¡ss' The

music

r¡as

converJed

in

sit

on

foP

of

loudspeakers,

by lean

tting

their

hands

on

fhe

shin

of

a

Perceiving

vibrations instead

of thmugh

nornral

hearing.

In facf,

all sound

is

flrst

just

in

all

di¡ections.In

lhe

sensorY

structurcs

in the

acousfic

area

tes

large

areas

of lhe nervous

system ¡nd

stlmulafes

psychophyslologlcal

functlons.

These

baslc

flndlngs

werc the

foundation

for

the physioacoustic method and

equipmen ,

Pbys¡oeoustic

EquiPmat

que

fherapeutic

technique.

A

tems

the

adustable

chair,

th

stem

and

the

fiansfo¡mer'

pul?oses.

..

one

of

fbe

important

findings

in the

early

trials

w¿s

that music

pmvides

nof

only acoustic

infonnation

to

be

heard,

but also

vibrational

"

The

tlrst eryerirnents

with the

physioacousÍic

method

were

conducted

at

úhe

Rehabilitatlon

Cenler

for

Deaf

and Hard

ol Hearing

in

Hclsinki

)

¿

)

)

)

)

)

)

.)

thc

system

utlllzes

norm¡l

electrlccl

cul¡ent'

wlth one

cord for

the

tr¡nsfórmer

and

anolher

lor the

music

unit.

The

transforrner

reduces

ihe

c¡ürent

to

trpo circr¡lts

ol15

volts

each

in

úhe

dcvice.

Thug

there

ls

no

risk

for electrlc

shock.rlow

tbcquency

slnusoldel

sound

comes

fhom the

computer

cüich

is

specitically

designed

lor

the

physioac,oustic

system.

If

controls

the

baslc

sound

paramelers

as

well as

fhe

progmn$. The music

is

specially

selected,

or even

oomposed,

for

this

lrcthod.

Thug

it

is

possible Úo choose

music

which

is

ideal for

this method

and

which

also

meets

the musical

epectations

of

the

client. The

physioacoustic

device

gives the

lherapist

an

Fs

to

be beneflclal

In the

treatrrent

of

cprlaln

sÚ¡essreleted

symPtomq

as

psychosomatic

painb

¡nd muscle

tensions.VThe

movernenl

of

thc

'causcs

a traveling

sound

prcssurc

inside

tbe

body.

This

pressure has

¡n

efnect

on

the

vascular

system

and lymphatlc

clrtulatlon.It

also

stlmulafes

the neurctransmi

tters

(chemical

s which

transmi t inlormation

through

neural

pathnays

to

the

brain).

There

is

evidence

úhat

physioacouslic

treatrnenÚ has

an

effect

on

endorphines

which

c¡ntrol emotional

e4leriences.

This

is

eryeciatly

useful

in

the freatmenf

of

deprcssion.-1

-

Pulsationg

scanning

and

direction

together

provide

enorlnous

It



il.'

ll.

:

ti'-"

rl.

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)

)

)

)

)

)

)

)

)

)

)

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J

)

)

,l

)

)

)

I

)

I

.,

)

\

eiraordinary

ability

to mix

fhe

lo,v fhequency

sound

sigral

and

music

togefher

s()

as

to

prcduce

the

ideal

physiological

and

psychological

therapullc

effect-

IThe

physióacru$ic

devict

uses

lon,

flequency

sinusoidal

sound

crmbined

wiih-specially

selected

mus¡c.

The

flequency

range

varies

from

27

flz

to 113

ttz.

tnis low

fnequency

sound

oomes

fbom

a

specially

designed

.jomputer.

Any sound

sounoe

(a

cD

or

tape

player,

lor e:cample)

can

be used

.o

produce

fhl musical

effecJ. Thrce

sound

paramefers

are

important

in

lhe

physioacoustic

method:

pulsation,

scann¡ng'

and

direction'

ft

Pulsation.

The

low

fiequenc]

sound

varies

in

a certain,

confrolled

time

.cquenc-e.

The

purpose of

power

putsallon ls

fo

prevent muscle

contractlon'

Continuous

stimulation

conrmonly

causes numbness

and

contraction'

Wifh

.he

sound

pulsating

slowly,

this

effect

can

be avoided,

and

relanfion

is

'btained

instead.

.k

Ssanninq.

The

computer

cztuses

lhe

frtquency

fo

vary

within

a

certain

.rptitua"

"na

ryeed.

This

is

necessary

to

guarantee

that

each muscle is

dt"¿

"t

its

optinral

frequencl,

i.e,

the

pitch

at

which

a

particular muscle

rcryonds

naturally.

The

approdmate

Lesonllce

hqquencles

ene knoüm'

thanks

to

basic

esear^ch

conducted

in

the field

of

physiothempy.

The

nesearch

work

in

the

Karolinska

Instifulet

in

sfockholm

has

srpported

fhese

ideas.

Professor

r.homas

Lundeberg

and

others

(19EE) have

lound

that

vibmtions

are

useful

¡

the

tr¡atment

of

muscle

pain.

To

obtain

relief,

the

ftequency

musl

be

-¡ecise,

however.

'In

the

physioacoustic

method,

fhe

ftequencies

are

p-go.-.a

in

3he computer

tnemorTr

and

the

pmgram

üBk:s

the

sound

'-,riaround

these

fhquencies.

This

et

s,ttes

that

at a

certain

point,

fhe

ideal

-*Jn"n""

ftequency

ts

ln¿ee¿

reached.

At

that

mornent

the

muscle

responds

ro

the

stimulation.

During

a

fherapy

session

(usually

20 minutes),

the

. .,+onse

(vibration

effect)

áf

tnu

muscle

is

triggered

dozens

of

times.

Each

.'me

úhe

muscle

respondq

the exfent

of

rcla:otion

gnows.

This

allows

a

program

to be designed

so that

every

muscle

and

each

part

of the

body

can

¿

trcated

in

the

besl

possible

rvay.

Treatment

for

the

whole

body

and

for

reciflc

areas

can

be

combined

in

one

program'

'

,[

Direction.

Sound

can

be made

to

move

hom

the lower

parts

of

fhe

-ray

upnaUs

or

In

e neverse

dlrccJlon.

The

abtllty

to changc

dlrcctlons

-10

possibilities

in

designing

pnograms

to meet

individual

therapeutic

needs.

is

possible

fo make

a change

in

the

program when it

seems

fo

be

fherapeutlcally

approprlate

even

ln

the

mlddle

ol a

sesslon.

il[ai¡r

Appücations

of

fhe Physioaou$ic

Metbod

The results

have

becn

n-injurPd

children,

in

e

symPioms

of autlsm'

studieq

it

has

been

2tL

and

cducaaioq

the

physioacouSic

method

is used

f

executives

or innovations

teamg

wi3h

the chairs

connecúed.

with

chronic

psychotic

patients

at

the

(Nikkila

HosPital)

revealed

thal

ts

with

psychoseg

such

as catafonic

ncreased

muscle

úension

of

calatonic

c

fherap¡_¡

Hospitái,

trials

with

neurotic

r_

I

In

everyday

environmenfs,

people

receive

-u -r^¡

oná

ncavn rnachines

However'

in

the

#t

¿r;i,

Goüsrrs

r¡Pr¡¡w

s*e

i.ii.

;lt:

T

paúients

who

have

r¡ceived

ly

on

thc

4

Htfhequency'

Speclat

Progr¡ms of

course

employ

other

cies

aó

well.

il,¡

I

il



ukkarinen,

M'D'

(1990)

in

the

Clinic

ts

(ages

32'67')

partlclpaled

in

fhe

e:rperiment. The

purpose

of

rhe

¡esearch

was

to determine

if

low

frequency

vibmtions

c-ombined

wilh

music

would

alleviaie

physical

anxiely,

tension

and

pu¡rr.

fft"

loltowing

dependenl

measune-s

were

laken

four

iimes

during

iüt

."tr

1)

srbjtr-tive

ieelings

of

pain;

2)

srb|rctive

feelings

of

tension;

3)

subjective

-

túU¡*ti"e

feelings

of

depression;

5)

sleep

problems;

re;

7¡

aiastolic

blood

pnessure;

E)

pulse;

9)

state

anxi

fb¡

rait

anxiety

scones

(Spielbetger);11)

lotal

an:dety

score

(Splelberger);

and 12)

andefy

score

(Zung scale)-'

sfatisicat

"n" y.",

ieve¡led

lhat

úherc

were'reductions

in

all

dependenfmeasunesasares¡|tofthephysioacoustictherapy,andtherewere

.ióiñL"t

reductionsin

pair¡ tensior¡-.,.n¡*ti""

feelings

of

anxiety

and

to3al

anxiety

scong$

-¡

Itrrasconcludedfromthispilotstudythatthephysioacoustic

treafment

appears

to

be

a

promisin

,

method

of

thempy

for

this

group of

patienf

s. It

rms

rtcommended

thaf

future

researth

involve

larger

numbers

of

subJects

In

control

and

placebo

groups'

hrúu¡c

APPlicadons

There

a

s that

impact

on

physioacoustic

therapy

in

cu

P¡ofessor

Naa

$gg})

have

found

that

the

40'Hz

rr.qu.o"yfromthethalamusarcahasanimportantro|eintheregulationof

audltory-evoked

Potenf

lals.

'*'-'É;;;;J

l;¡ou.

and

Ribari

(and others)

(1993)

have

found,

fhat

in

some

exceptional

cases,

such

as

beginning

Alzhei

les

and

some

brain

iqiuiiág

the

40 H-z

brain

nave

ed'

Llinas

has

zuggeste¿-Otui

*itft auditory

stimulaf

it

is

possible

to reinforcc

this

fhalamus

hequency'

3

Theprtsentaulhorhasa|sofoundthatthat40Hzstimulationthrouglt

the

ears

and

body

tras

potential

in

tl

e rehabilitaÚion

of

brain

injured

and

.t

"t"

gatlents.

iVfo.i

ir"goms

In

the

physlcacoustlc

method

arc

based

2L2

ss

power-

,r.

Crs

StudY

#1

6*

#2

Case

#2

involved

a

Zit'vear

old

free'stvle

itier

t¡ai-]i9,"t:Ij:

Atb"É;1il'r4íi.l'b"ti"int*'nJl"¿asev.:rei"g"^?11l1":Xl':i:T;

fl'ff

Í":':f

#Tl;'i"l'#i üd;'-li.'[:-::"Í.*:H;ff'1'X".7

iagnoseo

as

a

prnrur¡¡uD

DJuurv¡"-

--

-;;g;;

during

his

training

and

oi""tronissulaitos

ln

Helsinki'

The

problem

b:cll^"-:i::.1':r"rl',,,r..*o,

"*'ffi:?f,ilHi

il

ffi;ñil;;üdt"oiil'.

parienr

had

to

interrupt

the

iour

bec¡use

of

hts

dlsorder'

2L3

)

)

)

)

)

)

)

)

)

,ilDZ

(wlo¡tunatelY

at

a

for

PhYsiotheraPY

s

wenc

velY

S0ret

So

the

¡uscle

lnfemrn¡tlon'

For

zero

level)

werc

used.

At

in

the

30

degrec

angle.

anea

wene

targeted

for

ed.

The

Pulsaúion

used

at

slorred

at

the

end ofthe

Rdtñncs

Gou

lil,r"i" '.

aTl;'"

fr*"t"[i".n*



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

les),

Program

4

w¿s

uscd

to

lncrease

thtgh end

le

tlonel

tractlon

angle

was

incrcased

slowly

to

90

d

six

t¡eatments in all

and

cas

able

to

ctmpete

il

'

the

athlete

fell

during

competition,

nas

unabl

and

evenÚually

required

tutga.V

because

of

muscle

darnage'

Cas

#3

Case

#3

lnvolved

an

accident

and

had

sustained

ior

three

and

a

half

mnths

her

and

monitor

her

Pr

After

three

rnonths

the

following

prog

spasticity

an¿

toiic

reflexes

ha

decreased;

2)

;ffi;;t

ableio

control

her

head-¡osition

a

electrtnic

communicator'

Some

rmbility

was

see

digestion

and

metabo

reiminingin

hermusc

'

slceP

had

becorne

dec

anilshe

was

hoPeful

actlvltY

were

rePorted

i

to Produce

words T

,

""i"*

and

deal

with

Because

of

t

'i

recommpnded

PttYsi

iii

ir

Phydologlcal

condltl

Congress

of

ient

rePori'

2L5

)

)

)

)

)

)

)

)

)

CHAPITR.

TWENTY-ONE

.s

t.i,,,,1:

I

.,

,,',.":

..,"r¡

YIBROAOOASNC

TflENAPT

IN

GENENAL

AMICINE

R¡in¡

R¡udtdk

Inttd¡¡clion



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

t

The

developmenl

of

vibrcacoufic

fherapy i"

útooñ

began

in 1987

wüen

it

was

initialty

introduced

at

lhe

Talli¡n

Pedegogical

Institute.

During

úhts

tlmg

lt

rr¡s used

to

lnvestlgrte

en:dety

dlso¡ders

ln

cduc¡tlon

fudenÚs

Subsequentty,

Esonian

flrms

have

built

vibrcacoustic

equipment

which is

being

used

in rcsearch

in various

unifs

in

England,

America,

Spain and

E$onia.

Vib¡oacou$ic

therapy

r¡as

int¡oduced

at the

Jur Egalth

Q¡ter

Clinic

in December,

t99l.In

this

clinic,

vibroacoustic

tlierapy

is one

method

of

Jrcatment

which nny

be

combined

with othcr

prescribed

treatments.

The

apfmach

fhat

has been developed

here is

practical,

not scientilfc.

Thóreforc,

the

rcsults

so

fer

are

recorded

f¡om

cllnlcal lrc¡tments,

na3her than

research

trials.

A

srmmary

of the

work

undertaken

at

the clinic

between

19 12 ¡nd

1993 r¡as ¡mde

and

presented as a

Paper

at

the

Seventh

World Congress of

Music Thempy

in

Spain.

Ohnl

G¡oüp

Durlng

the

per{od

1992-1993,

156

people

wene frcated

$'lÚh

vibroacoustic

úherapy

in

this

clinic.

A

Íotal

of

t560

vibroacpustic

sessions

were

undertaken,

with

El

somen,

55

men

and 20

cNldren. During

the flrst

year

of

utilizing

this

method,

patients

we¡e

selecfed for

furlher

trcatrnent

when the

initial

rcsrlls

appearcd

to be

prumising.

Diagnoses of

these

patients

werc mainly

within 3he arca

of

functional

disorders

of

fhc

nervous

systeq

specifically:

1)

tic

syndronrc

(twisi in facial muscles),

2)

st¡tss'relaÚed

disorderg-3)

neurosi;

or neurctic

condifiong

and

4) sammering.

(+o,l-

,.--, .'

,

-\

Stnce

199d

lmpruved cqulpment

h¡s

been

lntroduced

Info

lhe cllnlg

including

a

Pioneer

tape recorder

lhaú

reproduces

the

vibroacoustic

stimuli

with

a

higher

quality.

The

clinic

treatments

arc

undefaken by

a

qualifled

nurse

who has

been trained

to

use vibroacousfic

therapy

with the

pafienús

Tñufftrients

are

given

throughoul

the

uorHng day which runs

ll'om 8

am

to

5

pm.

Tbp

p¡t i9nt9

yho

arc scheduled

lo

receive

vib¡¡acoustic

thempy

are

those wtro have

prwiously

heard

of lhe

treatment,

those

who have

had the

I

.t11

)

)

)

)

)

)

)

)

)

thc

éllnlcal

so

post-trcatment

convenso

-ilavf5ee¡

terúúrratd'

p¡ovides

a

sell+valuañon

ol

the

trtatment

-oounse

received

to

tbe

doctor'

The

paticnts

arc

then

"r*J'i"'""it""i

their

doctors

again

after

Úwo

weeks

for

follow

uP.

Rcsults



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

tü.

11*

¡'qi

i$r

'r|ti

Vib¡oeoulic

Stind¡

UsGd

Therrorkbegun|n1994andr+ülchtsbelngreportedlnthlschapter

"¡

"rr"

tpáñc

tape

in

trtatment'

which

*lttÍt

of

tbrcc

"f

ffi;;-il.quóncies:

t)

36Hz

(7

minutes),

2)

46Hz

(6

nHz"(

minutcs)'

This

compri*J

i

tw"nty'-i"1t1

freafment

tape'

and

these

fhree

fnequencies

w.."

"noá

in-ttre

uasis

of

the_rcsults

of

the

earlier

worlr

in

1992

and

1993.

During

,ñ;;;i;-ctie 9

se_lf+valuations

revealed

that

lower

ftequencies

""t

¡""i"-t"ir*-

t"'¡¡l;'

Higher

frcquencies

often

causcd

excltement

"n¿

*-il*,

e"en

nea¿actres.

ilnese

trcátment

lapes

were

made

by

using

the

function

generator'

TlcaJmnts

c¡rricd

out

bctwccn

l '9+1995

Afotalof3k4patientshavebeentreatedinthisperiod,inc|uding152

women,7E

men

"rd;ilffiil;:ooi

olrtt"re

31

of

the

rvomen,

12

of

the

men

and14olthe"r,ir¿.enre""¡vedrepeatedtreatrnents.Inaddition'sevenwomen

wtJh

a

dtagnosts

"f

;;il;i;at'tgnant

rtvp".i"".¡o"

were

also

trcafed'

AII

the

patients

r"".¡""¡

"

'"ies

of

Zó'minureireatments

for

10

days'

of

the

É0

;;;-

r""t"a,

145

had

the

follorring

complaints:

nervousnessr

insomnia,

hyperagitation'

tenjon

h

adacheg

and

a

decrcase

in

concentration

and

working

ability'

-

Of

the

94

children

trcafed'

manY

had

functional

disorders

of

the

nervous.

systen¡

ti

ii*Ñ",

and

a

dccrease

in

conccntration

and

wor

;;;;

i.*t

chlldren

hequently

at

the-

end

of

the

t."o."

more

tired

and

their worh skills

and

conc

Of

the

7E

men

who

we¡e

trcated'

35

had sl

tendon

at

worrkr2lreported

headacheg

and

21

h

McJhods

of

Evahntion

Physiologicalmethodsofevaluationwereused,includingarterialblood

p¡es$ne

"n¿

pt'l*''iiu,i""ttt*¿

b"f;;-;"¡

aner

each

vibroacoustlc

21R

uced

on

the

average'

fbom

92

beats

per

who

had

p

taklng

of

fhem

iiopped

having

headaches'

Results

of

tf"

qu"it¡onnaires

with

7E

men

ane

presenÚed

in

Table

2'

VAT.

Se

rtceive

vi

a¡e

not

al

Ces

SÚufr

#1

Subject

A

qas

a

34

Year

old-

children.

ior

three

years

her

arÚerial

hypertension

^L^

r.a¡r rrccd n B-blocker.

Atenololi.

This

F'or

one

ano

a half

yearq

she

had

used

a

B'blocker'

Aten

medication

kept

her

arteríal

tiooo

pressrie

within

the

limits

of

1¿10'160

mmHg

sy$ollc

pnessuFe

and

100'120

mmHg

diaslollc

pressu¡e'

2L9

)

)

)

)

)

)

)

)

)

ri'$ürü]

''li,riat

){i

'j.

.

1,:':

.,

"

i.:lri;'g,t:l:r

¡:?.i,rtí,Jii..,l,i¿eti¡i

.,:i,,iill,hui

rri

lt.:,it.r

'¡;

,l

¡r

:'

:

1.

:,i'r¡

ril

"-i,ii,

,',

.,

'

i.'

Thc m¡ln concluslon

fhom

lhls cese stu(y

rrrs lhal

vlbroocousdc

iherapy,l¡*rive$.bauscd

a d¡sosóe ln

alterlal blorid

pressure.'

It'iscemed

in¡r

thc vibrocoustic

theñpy

had:

1)

a spasrolytic effecf on blood

vessels

(inflenúswlfh

chronlc hypeÉendon

heve

vasoryasm),

2) e balenclng

effect

on

úhe

vegetative nervous

system, and 3)

a

dehydrafing

éffect. It

sas ¡lse

highly

'possible

that

an

inc¡eased blood

srpply

nas

furnished to

the

kidneyg

and less

rein.angióten5iñ

w¿s sec¡eted info the

blood.

Ces Stufr #

2

TrD .

I

WOIUEN

(nsrtc

{.

Jt)

Rcpoñ.d

conplrlalr bcfon

VAT

R.portcd

mphhlr rllcr

VAT

S

ol

Kvcrt

f¡oE EDo|t.d

ohDl¡l¡l¡

Dadd¡m3t

l.|5

t2 9r.7

hadrtc¡

JO

3 923

onvul¡lon¡ o¡ tcndon



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tm

i¡$

:fr

ftr

lt^

'$t

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rb¡

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)lu

lis

)l*

,

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fi

lF

h-

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ll

tf,

,,|

I

I

¡

T¡DL

Z

MEN

J2l

R.polcd

ompl.lnls

bclon

IAT

Rcporl¿d ñmpl¡lnlt

¡fif

lAT

% of revgt

?¡oD

nm]lcd mnDl.lDi

trarvousnC3¡

l15

I

9JJ

haad¡chct

tt

J

tóJ

convulsions

or a.nCü

in

musclc¡

r o

100

sléD dlrrdcrr

.15

0

r00

fellng of tb:d.ncss

J5

J

9t.4

¡¡dcty

t2 7

¡tl'ó

dca,ac of mr*-in¡

rblllty

r5

1

t0

She

was

offered vibroacoustic

therapy because she had

stomach

complalnts

efter taklng the

prescrlbed

medlc¡tlon.

Durlng

the coursc

of

the

Sneaúment,

the terrible

headaches

wer¡

eliminafed.

Furthermone' afler

úhe

third

day

of

frtatmcnt

and

fhom

fhen on,

her

arterial

blood

pressune was

reduccd

and

ranged

between 150 and

170

mmHg

and

between

90

and

flO

mmllg

(diastolic).

X'rom thaf time until

the

end of trcatment,

she

nas

able to discontinue

her medication.

Following

freafment, her

stomach

pains

subsided.

At úhe

end

ol each

vibroacoustic

therapy

session, she also

started

to urinate morc

flequentl¡

220

Subject

B

nas a.trvelve

year

old

grrl

whq had staq¡4e¡gÉ-pl.4S.e.*,r¡¡

fras

slx

years

old. Her

stammerlng

v¡rled ln frequency

and

Intenslty, but

lt nas

*ever-pnesent

in

her

specch.

After

úhe úhird and fourfh

session of

vibruacoustic therapy, the

stammering

became

more

fiequent. The aulhor had srspecfed that lhis might

happen

and

advised

the subject's

parents

accordingly. By the end of

fhe

trcatment

period,

her

starnmering

had

become less

hequenf, and

after an

additional

two

nrek

period,

she

sfopped slammering

completely. Since

fhe

first

ten sessions

of vibroacoustic

therapy

were

compleaed, sheTf$'not

'

stammered

for

oygr len

rnonths.

Now,

as a r¡sul3

of

lncreaslng fensfon

af fhe

-end

of

the

school

year,

her

parenls

have noticed

fhat

she is

sfarting

úo

stammer

again

fFom

time

to

fime. Reccntly,

a secund vibroactusfic

therapy

course

ol

treatment

uas

completed,

but the resulfs

have

not

yet

been

evaluated.

Additional

Resulls

Thrce

women

who

suffercd

convulslons due fo

epilepsy were treafed

wifh

vibroacousfic therapy

for more

than

three

years.

Following

treatmenf,

their

electroenccphalograms

appeared

to be nonnal. They

continue

fo

fake

their

anti-convulsive medication,

but

none

of

lhem have

had seizurts for

four

monf hs

following

trealmenl,

Also,

a

number

of childrtn

with

Enuresis

Noctu¡na

(bed wetting)

have

been treated. F'ifty

percent

of

the

children betr¡¡een 3he

ages

ol5

and 7

who

were

freafed

showed a

decrcase

in symptoms. However,

for

f[rggg

childrcn

wlJh

chronlc kldney

lnflammatlon,

thelr

condltlon seemed

to worsen.

Because

óf fllis,

cniidrcn with

úhis

probtem

are no longer candidates

for

vibroacousfic

Jltprapv.

Conclusions

Fqllowing

fhe studies

undertaken

beúween

1992

anil 1993,

it was

decided

to

imple'ment vlbroacousic

therapy

primarily

wifh

patients

who had

functlonal

dlsorders

of lhe nelvous

system,

as they seemed

fo derlve the most

ln Durcl.r

l0 0

r00

¡lep

dlrcda¡

5

92

fcll¡t of

lhtdrcr¡

l.t5

20

E62

¡Dd.ay

{t

l5

6t.4

dmr

oluortlng

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90

1l

2t.l

,tal

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PeoPle

believe

in

of

that'

The

Positive

the

t¡¡atment

has

SECTION

III



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appcar

a

weck

or

two

after

ftnished.

Even

up

,

"

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clients

have

reporled

some

effects

s

been

enthusiastically

rcceived

by

many o

eatth

centei

Ño*

iltii

method

is

being

used

ir

everYdaY

work

CLINICALAITIDPRoIT^ssIoNALIssIIF^s

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CHAEIERM

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\:¡'r

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UNrcÁL

ADiD

ErnIeaL

oouwlltgnanor{s

Tory

Wtgnm

CberYl

Dilco

Inhoduc{ion

Vibroacoustic

theraPY

has

been



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urY

HosPital

in

England'

wlrerc

the

tras

reac'tre¿

a

point

where

fhere

is

a

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h{

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{,:

canbcFesoud'¡ndth|stextw|||p]ov|defurthermateda|forthosew|shlng

Jo

¿."A"p

thelr

hnorledge.

In

a

fieid

as

young

as

vibrroacoustic

thcrapy

there

i;;;

;ó""d

acvelopme-nt

or

dirccrion

amóng

¡tsc¡nche*

and

cliniclans

i"*",oJ"

requtred

úvel

ormo,wledge

and

cllnlc¡l

sldll

for

the

eppllcetlon

ol

lf".

li.-p'.'Oepenaing

on

the

dieñt

group

for

whom

the

treatrrent

is

being

;.]"l,-[ffi,

pór"rsoiats

may

already

have

fraining

and

clinical

knou{edge

that

will

enable

ttrem

to

apily

vibroacousfic

therapy.

Horrever,

as

fhe

trcatment

spocifically

employs

an

arl

a

vibrational

Simulus

in

the

lorm

of

therapisús

alrtadY

have

contef

fheraPY

in

Prascsdon

PlrPrntlon

As

part

of

the

prtparation

lor

aqy

¡

stic

or

vlbrot¡ctlle

equlpmeii,

the

bed

or

chal

lor

the

patient

nüo

is

going

to

be

detrimentallY

affecfed

if there

treatment,

so

preparafion

is importa

the

correcf

consideration

should

be

needs

with

piuors

o"

*"0g".,

as

Úhe

client

may

becomc

uncomforlable

if

he

or

she

is

not

appropriately

supported'

The

equipmentlt¡outa'úe

prcpared

lor

use with

the

controls

turned

tape

ls

starfed



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ü

+

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+

*

.í

,5

h

¡

¡

ri

]

I

I

use

ofvibroacoustic

[no,*r"¿g.

wlll

¡lso

""ü"

*l¿"lv

dependtng

on

the

tratnlng

mllleu

and

tradition

hom

which

a

misic

therapist

conrcs.

A

lack of

understanding

of

the

naturc

of

this

Simulus

án

possibly

lead

to

a lack

of

clarify

in

administering

and

'

training

aimed

af

equi

;,-;f;;jirifl*:"7

fhis

knowledge,

and

also

to develop

an informed

approach

in

both

theoretical

and

practical

arcas

to the

appticaiion

of

the

treatment.

Alongside

fhe

acquisition

ol

úheoretrcat

tinowljie

ls

rhe

lmporlance

of

developlng

a

cllnlcally

"pp-p.iutu

and

sensitive

mefhod

of

adminisfering

the

trtatment'

Iiaaretra

P¡oocdt¡¡cs

Cumenttreatmentproceduresinvibroacouslictherapyarevaried,and

thereareatpresentferv,ifany,forrnalizedguidelinesgoverningthe

applicationofthistormoffrcalment.Asconunercialorganizationshave

developed

vlUroacoustic

equtpment

end

sold

lt'

fhere

has

been

little

or

no

inSn¡ction

to

purchasens

on

aPpropr'

The

develoPment

of

vibroacousf

run

health

sYst

which

peoPle

develoPment

at

nas

rvrifúen

(W

formulated

describing

good

pmcfice

re

assessment

and

treat-rient,

and

guldellnes

for

contralndicatlons'

Guidelines

on

the

Procedures

thempy treatment

have

been

docum

treatmlnt

can

be

deflned

in

six

Introduction,

3)

SÚarting

fhe

freat

Ending

the

freatment

aná

O¡

Posf'treatment

work

donm

to zero.

Thls

last

potnt

ls

important.

If

a

vlbroacoustlc

wifh

the

volure

turned

up,

patients

will

be

subjected

to

a_

srdden

intensity

of

sound

and

vibration.

1'fte

óun¿

stimulus

should

be

introduced

gadually'

The

p"ii"

t-¿.

regarding

prcparation

may

seem

obvious'

but

fhere

needs

to

be

i

consistent

gan¿ar¿-oi

tütment,

aná

norly

qualifled

staff

engaged

in

any

trpatment

need

a

procedutt

fhat

deflnes

this

process'

Introduc{ion

If

úhis

is

lhe

first

time

a

pafient

is receiving

vibroacoustic

fherapyt

he

to

what

is

going

to haPPen'

The

at

theY have

control

over

what

is

lus unconrfortabte

or

irritating'

Úhey

unit.

With

patients

who

are

severcly

l,

this

reassurance

period sfill

needs

to

occur,

and

the

lone

ofvoice

and

fhe

words

used

can

set

the

scene

and

create

the

envlronment

for

an

effective

sesslon'

Thls

ls

Just

as

much

a

part of

buitdingtheasinanyotherformoftherapy.

The

patients

n¡

and

they

need

to

be

reassured

by

fhe

way

r

hat

whaf

is

going

to happen

for

them

is

safe.

nment

for

the

beginning

of

fhe

session

is

an

imPofant

Part

of

the

Process

StaÉing

the

Tftatment

With

some

vibraacoustic

equiP

sound

is used,

it

is

important

to

aliow

a short

period

of

response

only

to

music,

then

to

g*¿"ui-fi

i""*."

bass

fiequencies

to

introduce

this

part

of

the

stlmulus.

226

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)

)

)i

I

)l

)'

)

)

.)

'ñ¡v

need

to

h¡vc

e

good

lrctch

¡nd

m

¡ck

lnto

r --

r.

ñ:^r^-á

-n¿t

meqrrh

in

beart

thetaw.

uurrrÉ,

¡u.

wrY-----

lhenPYt

-m¿''ñ"t

ór

¡

¿ePry'rel¡xcd

^-^r

añ¡¡ o

eesdon

nefhaps

at"t".

,"

.r-..o."1

after

a"seidon,

perhaps

necdr

"il^'lf-Y,yils'#;ffi"F#

uf;"t"o

deep

sate

they

nave

rcacneo'.Thc

ilrt"rapis

mul

be

-rytu

fo'be

there"

for

the

patient,

íulnot

necessrily

to

talk

ioo

much

or

to

demand

too

much

of

the

Patient'



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t

Mmiúoriq

thc

Tstunt

Ending

the

Tr¡atmcnl

Scsdon

little

tinrc

before

patients

ca¡.b"

1:tive

after

a

session.

E:rperiencJ

fu'

ttt*-

that-some

p"opry

1:"d

utes

after

a

s"sson,

iiá

*ft""

they

leave

the

unit

fhey

:

l

t

¡

t

T

¡

I

:l

E

,I

lil

Iir

lr

lrl

rr

f,r

tr

228

)

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)

rvherethcpertodoft|memeybcdetcrm|nedbyfhepatlent'slo|eranceofthe

tütmcnt

and

of

the

dtuaiion.

Cheslg

(1992) used

30

minute

lrcatment

(Thls

does

not

apply

to

choflct

pre'

isychotlc

or

borderline

p

oonditions'

bj

qh"n

suffering

lhom

mYocardial

lnlarctlon.

If

there

is any

doubt

that any

of

fhese

conditions

my

be

presenf,

a

doctor

musf

be

consú["d

befo¡l

the

trcatment

is commenced"

(Skille'

1991e

pp

6l'

64).

The

list

of

contmindications

fhaf

have

been

atÚendcd

fo in

the

trials

undertaken

by

the

author

at

Harperbury

Hospital,

and

also

in

currenf

work

ane as

follows

(Wlg¡anl

1990:

l. AcuTE

nwuuulToRY

coNDInONS

- will include

condifions



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)

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)

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)

)

Contraindbti'ons

Vibroacousticandvibrotacfiletherapyfrpatmentsarestil|infheir

experimenüal

stageg

and

although

various

rcsearch

studies

have

been

undertaken

to

evaluafe

in

a objectiie

way

the

efflcacy

of

these

trcatmenls,

fhe

iniánrnt¡on

rcg¡arding

any

coritraindicaiions

or

unpleasanl

side

effects

¡¡om

i-f,"

t.."t-"nrJts

tariely

anecdofal.

Tlere

has

been

no

experlmentation

to

speciflcally

identi$

when

this

frcatm

Some

elfects

have,

howevert

concern.

Some

patients

have

experien

effect

which

seems

to

be

unrelated

to a

prcducf

of

treatment

lhat

subjecls

exp

I;j"".

io" *rrom

f

his

experience can

cause

nausea,

it

needs

to

be

clear

wlmt

is

the

besf

naY

of

treating

them'

Itlsatsounclear-astotheeffectofVAonpeoplewhoaresuffering

fhomanacufecondition,srchasacardiacdisorder.Assumptionshavebeen

made

that

VA

fherapy

,.du".,

blood

prtssure

(due

to

its

effect

on muscle

activity),

causing

arteial

dilafion,

andiherefore

would

be

contraindicated

as

a

frcatment

for

certain

condilions'

Thercfort,

the

Process

of

i

treatment

is

PartlY

ba

option

currcntlY

is

to

encourege

Paflents

to

in

the

event

that

theY

are

unsunc'

Ski|ledeflnedalisfofcontnindicaSionsthatheencounteredwhen

using

the

equiPment

regularlY

acutó

condition,

egr

Thrombosi

active

or

acute

inllammation.

C)

inverfebml

disc.

D)

After

and

acciden

iqjuries,

eg'

whiplash

iq¡uries'

E) D

wñen

acllve

bleedlng

rmy

be

started

230

where

inflammation

is encerüafed,

such

as

in

the

acufe

phase

of

rüeumatoid

arthritig

or

in

s¡ch

cases

as

earache,

foothache,

or

back

pain due to

a

prolapsed

intmvertebrat disc

(slipped disc).

2.

PSYCHOTIC

PATIENTS

-

psychotic

patienús

may

be

unable

to

understand

what

sfimulus

lhey

art

receiving.

They

can

be

trtated,

buf

only

when

someone

is

present who

knows

them well

and

can

explain

to

them

what

is

happenlng

.

-

-

3.

PREGNANT

WOMEN

-

no

frials

have taken

place

involving

pregnant

women,

and

the

effecf

on

an

unborn

fetus

is

unknown.

Therefore

iÚ is

safer

to confraindicate

pregnan¡

women.

4.

ACATE

CONDITIONS

-

when

pafients are

suffering

from

an

acute

condition

for

which

theY

arc

al

wlfh

the

general

Practltioner

or

The

thempy

should

be sfrictlY

this

treatment.

OR

ACTIW

BLEEDING

'

because

of

the

effecf

ri

rafe,

if

is

important

to

contraindicate

lhis

experiencing

interna I

hemo

rrhagi

ng or

b leeding

of

any

sort

(excluding menstruation).

6.T'HRnMB^,IS.pat|entssuffedngfromthmmbos|sorany

"

VA

theraPY'

This

maY

have

an

e

srally low

blood

Pressure.

S.PA1EMAKER9.patientswhohavepacemakersfiftedare

contraindlcated

as

tt ls

recommended

fhat

they

should

nof be

exposed

for

periods

of

time

to magnetic

fields

Further

contraindicafions

are

speculative,

and some

suggestion

has

)

,I

)

)

)

¡

l

,

)

.)

)

v¡rl¡b|e.Asnotong|tud|nalsudlesorlud|eslook|ng¡tthccumu|¡t|ve

it

is

diftlcult to

be

categorical.

patients

rcceiúng

lfvc

to

scven

pcrlod

ol

She

lllnesg

In

o¡der to

sults

In

the

VA Treatnrcnt

Centre af

Harperbuhphysicalhandicapsandlhosewithsc|f.

iqjurious

trcatmnt

tlrcquency

increald

fhom once

a

week

to

mproved

resulfs'

But

as

yet' the

hequency'

;";ii;

and

intensity

of

trcatment,

as

well

as

tbe

optimum

musical

and

vib¡ationar

tequency"reiains

a

quesfion

fo¡

ftrrther

rescarch,

in

order

to

""ti¿"t"

the

limited

anecdotal

anilresearch

reports

available

at

prescnt'

fu

ts

Qo¡tl|ld

úo Pr¡cdc

VA TñGtr¡PY?



)

)

.)

)

)

)

.)

)

)

.l

)

)

)

)

)

)

)

)'

)

,

)

't

)

,

trcatment

PoPulations

served.

The

situation

now

is

that

anyone

can

purchase

music

vibration

practice

and

ethicg

be

considered

prematurc'

REFERENCtsS

chesky,

K.

s.

(1992).

The

effecfs

of

music

and

music

vibrafion

using

the

-ilrnt-

on the

relief

of rheumatoid

arthriiis

pain,

PhD.

Dissertation'

h¡thcr

EShic¡l

Issues

Can

VA

therapy

be

considered

music

thempy?

lTho

is

qualifled to

practice

VA

therapy

on

a

clinical

level?

Theanswer,to_tt."'"twoquesfionscanbedifliculfgiventhe

relatuvely

new

status

of

this

treatmeñt,

buf

an

atlempt

will

nevertheless

be

madetobeginthisthinkingprocess.Cerfain|¡thiswillbecomemoreand

more

reflned

es

the

fleld

grows

and

develops'

Is

VA

ThenPY

Mudc

ThcraPY?

According

to

Maranto

(1992, t

lnteruenflon.

Based

on

fhese

criteria,

VA

th

rvüen

it

is

not

delivertd

by

a

music

úhe

be

cunsidered

music

iherapy

even

wh

is

no

úreatment

process and/or

no

the

VAtherapy,

the

primary modeof

t¡Patme

sounds.

Howeyer,

L.

iir.ápeufic

rclationship

must

sJitl

be

an

integral

part

of

t¡tatment.

Technologr

-'niot

be

used

as

a

s¡bstitute

for

this

rclationship'

A

rclatlonshlp

betwecñ

cllent

and

theraplst

should

be

a

part

of all

vA

therapY,

whefher

imPlemented

bY

a

In

addifion,

VA

themPY

musú

changes in

the

client are

soen

over

a

rvüen

VA

therapy

is adminisiered

and

usic

that

2n

231

)

)

)

)

)

)

)

)

)

)

1ti¡

CEAPIM.M

'A/INING

ilIIflC

nDn'

VIBROAOOASITC

TEE&APT

Ol¡v

SHllc

HistorY

Music

is

considered

to

be an

art

form

received

mainly

in the

ear'

we

know

that

musical

instruments

emit

vibrations

which

can

be

felt

when

we

Jouch

the

surfaces

of fhe

instruments

with

our

hands,

but the

feeling

of

value

for

heaúng

individuals.

Music

is

a form



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

vibraúion

has

no

info¡mative

oi

tenavior

which

is

speciflc

to

human

beings

and

is

used for

cornrnunicafion

and

emtional

e:Pression.

However,

ihere

is something

sfrange

abouf

music.

As

cornmunicaJion

between

cultures

has

incrcased,

we have found

other

l¡f*¿:g$Yc

fhan

our

own

-

and

othef,

uses

for music

of

which

we

have

been

úl[d*ffi.

Some

of

this

-"S"

ir

ro

tfidft

that

we hardty

can

call

it

"music",

and

we

can

often

react

with negativitY

fo such

music.

But

music

is

used

ftrncfionally

in

our

society

and

in

other

societies in

spife

of

the

diffe¡ences

in

musical

expression.

Music

is

used

in

celebrationg

u-""oip""Ving

grief,

joy,

for

relaxation

and sleep,

and

even

for

healing

prr"por"t.

1'nis

means

thai

there

must

be

some

universal

factors

in

music

ifrl"l,

onnot

be explalned

along

cultural

Hnes

of

deflnltlon.

Nor

can

we

use

classical

(aestheticj

music

theory

to exptain

fhe

generally

common

human

i.utor"r

in

tne

runctionality

of music.

Therc must

be

elements

in

music which

have

effects

on

human

neings

thaf

are

independent

of

culfural

differences

in

expression.

Inordertoflndtheanswertosomeofthequestionswhicharise,itis

neoessary

to

isolate

some

of

the

elemenfs

in

music

and

see

if

we

can

find

some

universali$

in

the

effect

of

these

elements'

Empirlcaily,

I

have

found

three

such

factors

so

far:

1) low

frequencles

can

facilitafe

relantion;

2)

rhythmical

music

can

stimulate;

and

3)

loud

mucc

can

provoke

"gg."ri""

feelings.

The

opposites

of

these

universals

crcate

contrasting

effects

-

harmony

and

fimbrc

'

(in

ttre

classical

Íoo rnany

differcnt

elements

to

be fotally

me

being

we

do not

know

enough

about

them

in

this contef

to include

them

in

our

list

of universal

elements'

From

196E

to 19E0

these

three

unlversals

were

subJect

Úo

my

phitosophicat

a

in

relafion

fo

vibroacoustic

(va)

it

.opy,

and

in

fotype

to

be

used

i1

a

-new

musical

context(Skille,musicdirecflytothehumanbody

2y

)

)

)

)

),i

)

)

)

)

)

lil

i

vl¡

the

skln surfact

had

been

tcslcd

out

In

the

carly

195Os

by

Pontvlk

and

Tcirich

(Ieiric\

1959)'

but

fhcse

P

Erliop"

concentmtcd

theirrvo¡k

ma

wfr

¡ko

sPeclfcrllY

looklng

a

uidoubtedly

arc

closely

linked

to

cult

inifi"l

resárch,

a

thorough

study

of

quantitative

elements

of

musical

"i¡*t¡o"t

and

iheir

effectJon

physical

and

mental

functions

in

rmn,

uas

nerrer

carried

ouL

In

19EQ

I

nas

working

in

a

day center

for niulfihandicapped

childrcn

with

devetopmlntal

disability.

My

theoretical

speculations

were

then

ripe

enough

to

be

attempted

in

practical worlq

and

wlren

I

had

put

togelher

all

the

n.""ü"y

ltems

forfransfeirlng

muslcal

sound

vlbraflons

dlrectly

to

the

body

i.1¡

¡.qlun,

I,[ITITI,

UI

Diatonic

hdf

¡oo. 1.0@oo/

].9375q)

ll15

wbolc toDc

1.125üru

J,óüüüó9

1.833333

,IE

NaNral

small

th¡rd I¿(trXIIJ

615

Na$ral

th¡rd

1.2$@0

1.6{xrxrJ

5t4

Natufal

tourtn

13333t1

).7fxrx)o

{at

Chrometic

tri¡o¡us I.4r¿lz¡.4

).707[Vr

45t32

Natural

l¡llh

ls@mo

).óó66ó7

tn

Na¡ural

small

stxlh

1.600@0

l.ó250@

l.ó(xr|(p

ü/5

Na¡r.¡ral

sixth

I.00000/

5B

all scvenlh

1.800m0

J.J)-\))O

9t5

Natural

scventh

1.675G10

1.533333

r5/E

Octave

2.omffx)

1.5o(x)u,

tti



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

surface

of

a

person

(bodily

contact

with

the

sound

source),

I

sfarted

to

observe

these óffects.

I

then

rediscovered

fhe effects

described

by

Pontvik

and

Teirich,

and

during

the

lollowing

yearg

I

developed

equipmenf

suitable

for

such

procedures

Af

first

I

worked

with

music

fhat

can

be

found

on

any

tape

or

record

made

for

ordinary

listening

purposes.

I

observed

spasnolytic

effects

on

"pusi"

children

and

u¡anted

io determine

which

elerrenls

in music

were

most

ieryonsible

for

úhls

efect

lStrttte

1986).

To

use

muslc

as

such

nas not

safisfactory,

as

therc

are

too

many

single

factors

in

music

which

confribufe

to

the

total

rii"Jl'0""u

ro

rhe

univer

ars

menrioned

above, and

I srarted

tJ

use

a frequency

generalor

Úo

Íest

the frequencies

which

provided

the

best

resulfs.

I-

isolafed

some

fiequencv

aneas

which

usually

triggered

some

otservaule,

posif

ive

effects.In

cooperafion

with

the

SEAS

loudspeaker

facfory

in

Mosg

Ño*y, I

found thal

the

sound

penelmtion of--my

body

was

strongesi

at 60

Á?.

with another

Peah

nearly

as

hlgh,

at

E0 Hz'

when

I

r¡as

lying-rtirectly

above

the

loudspeaker

surface.

Af

a

given

signal

intensity'

the

,"ri¿

p*r*re,

which

nas

meásured

on

top

of

my

body,

rtas

equivalenl

to

the

force

of 0.2

G.

If

I

use

the mathematics

of

musical

intenal

factors

(Table

1)' I

see

an

harmonic

connection

between

these

two

values.

sixty

Hz is

one

fourth

lower

than

80

Hz.

The

oclave

below

80 Hz

is

40

Hz,

and

60

Hz

is

one

flfth

higher

then

40

Hz.

It

seems

th¡f lhe

phydcal

laws

of

the

Pythagorean

scale

and

the

classical

laws

of harmonics

also apply

to

sound

penetmtion

(effects)

through

UJily

tissue.

Fifteen

years

later,

aná

aner

thousands

of

hours

of

practical

worlq

I

have

found

tnat

¿o

Hz

seems

to be

a

basic

fhequency

for

vAT

and

gives

the

¡mximum

effect

for

"sound

But

even

if I

found

Positive

sinusoidal

tones

fbom

the

frequency

effect

of

the

technically

pure

Íone

wa

Itfe

of

muslc

nas

mlsslng.

BY

Pu

hequencies

wifh

a

"""y

,."¡-1

diñbrcnce

between

the

frequencieg

and

I found

zx

Túl¿

l:

Ma¡beaatical

struturc

of

thc Pyhagorean

scale'

\iligram,

1996).

-

In

order

lo

limit

the

searh

for

the

effec.s

of differenú

frequencieg

I

resfricted

the

vibroacousfic

area and

defined

it as

being

between

one

ocaave

above

and below

maximum

penetrafion

frequency.

That

is

why

fhe

Yiqrp3

and

l20llzrjn

Practics

this

is-also

between auditive

perception

and

skin

perception

of

sound

and/or

pre ¡s¡une

waves.

The

fwo octaves of

the

vibroacoustlc

a¡ea

cover

only

u5

of

the

audifive

range

below

100

Hz

(Skille'

19E9).

Mudc

lor

Vibroaoufic

TheraPY

I{hen

I

began

using

music

for

vA

Therapy,

I

used

commercially

available

music

made

for

listening

purposes.

I

found

most

effects

in

music

with

pronounced

bass

tones;

in

jazz

music,

I

found

the low

frequencies

both

in

bass

lines

and

in

percussion

elements.

I

did

not

know

enactly

which

frequencieg

however,

had

the

best

effectg

and I

used the

fbequency

genemtor

to

generate-bass flequencies

which

could

be recordeÜmlxed

togefher

wifh fhe

)

)

)

)

)

)

)

)

)

)

t

I

I

h

'lr

mudc

I

used. ffis

gave

us

rn

addlSlon¡l

element

whlch

could

be

quantlfed,

Thenpy.

It

can

blso

be

uscd

to celculefe

complcrentary

flequencies wüen

I

choosc

fleq

conditionswhen

I mixVA

Therapy

p

grams Wh

for

va

Therap¡

he

or

she

ls

udng

JusÚ

one

lltquency,

or

¡n

h¡rmonlc

soquenoe

as a basis

for

the

cnmposition.

F'¡om

or

fone

clusters

will emerge.

The

musical

hequency

Úo

the

vibroacou$ic

arcq

and

the

composerwill

therc

e

range

of

fheedom

for

his

or

her

work.

Music

composed

for

vA Therapy

is

rhythmically

floating.

It

has

no

jairect

nrclodic

structurc

or musical

theme

which

can

be

associaÚed

with

any

iL"ot*

piece

of music.

In

this

nay, the

time

qent

in

lhe

fhempy

chair

or

bed

lglves

ttle

user

the

posdblllty

to

be

free

fhom

essoclaÚlons

wlth

music

lrom



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

for

VA

ThemPY:

1.

Mudc

Made

for

VA

Thenpy

Ba$d

on

OvcrÚonc

f,tac{ds

In

some arficles

I

have

called

this music

"fiacfal

music,"

but

as

this

with

himself.

"--

-*--

aúhematical

basis

for

this

is

presenfed in Table

1. This

table

can

be

used

when

I

rnake

the

computatlons

necessal?

for

composlng

music

for

vA

238

üveryAay

life,

and

he/stre

witl

be m

¡re

able

to

concenúrafe

on

the

p¡ocesses

,rq,h¡ch

"t"

tafong

place inside

hisiher

body.

The

user

often

loses

the

sense

of

I'ti."

and

rmy

Jnen

eryeÉencr

the

effect

of

VA

Thempy

as

being

like

the

i

I

t

ane

some

users

who

feel

uneasY

or

a

without

familiar

structure

or

direction.

It

is

fherefore

necessarT

to include

in

theVATherapyarsenalofmusictypesofmusicwhichanemorefamiliarúo

these

users

2. Relantion

Music

wiJh

trhequcncies

Addcd

When

I

cannot

use

music

specially nmde

for

VA Therapy purposeg

I

must

use

füncflonal

music

rnade

for

llstenlng

purposes. The

techniques

used

for

choosing

music

arc

well

described

in the

literature

and

arc

used

both

in

music

therapy

and

psychotherapy/guided

imagery.

There

eús

several

kinds

of music

especially

made

for relaxation

pur?oses'

Wheñ such

music

is

used

for

VA Therapy

puryoses' I

musl

find

one

basic

flequency

which

can

be

used

th

listening

program

is

composed

of se

pauses

between

fhe

units.

If

P

the

baslc

keY.

MuslcallYr

this

make

cusúomized

VA

1.frórapy

pnograms

for special

purposes'

the

f.eedom

of

choice

is

still

more

difficult,

úecause

I

must

try

fo safis$

both

harmonic

and

thempeutic

Parameters

The

maker

of

vA Therapy

programs

must

therefore

be

skilled

in

bofh

musical

and

therapeutic

disciplines

in

order

to nmke

effective

programs'

Relaxation

music

fórIstening

pu"po.".

often

has

fhe

harmonic

simplici$

and

sfructural

unity

which

t-li.

¡t comparatively

easy

to flnd

VA

Therapy

fiequencles

wn¡th

bofh

satig

musical

and

therapeutlc

needs.

239

)

)

)

)

)

)

)

)

)

)

r

t,

t

)

+

F

I

F

F

h

3.

Norul

MuCc

""¿

Vi

ThcnPY

r:

.

For

stimulative

purposg I

also

c¡n

uso

ordinary

musig

thaf

which

c¡n

bc

found

on

¡.ccotds

or

tape.

I

have

m¡de

rcsee¡¡h

Sapes ranglng

fhom

,:\.

-

R¡fcrw

SHllq

p.

(1962).

Musikkb¡dat

-

enn

mudkk

terapertisk

mgt$-g. Mqdkl

,-,Fiiérrpl,

ú2+ZT:.

:4'i,'

\''t

i,

;;'Jlit'

SHlle, O.

(1 tE6).

Manual

ol

vib¡oacousúics.

Levanger,

Nonray:

ISVr'

Publications.

SHtle, O.

(19t9a).

Vibroacoustic

rcsearch. In R.

Spintge'

&

R.

Droh.

(Eds.,

Music Medicine.

Sf.I¡uis:

MMB.

Skilfe,

O.

(19E9b).

Vibrcacoustic

therapy.

Music

Therapy'

g

6l-77.

Skillg

O

(1992).Vibrmcoustic research 1980-ú91.

In R. Spinfge

&

R. Droh

(Erts)

MusicMedicine,

(ppZ$A6ú,)

St.

Louis: MMB.

Stdlle,

O.

(1991).

Vlbroacousllc

fherapy:

Manual

and

reporls. Levange4



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

l

I

il

.I

t

I

Ir

I

;

I

I

i

I

frequencies

for

the

thempy

programs.

This

is

also

lhe

rcason

why

I

only

use

VA

Thempy

pmgmms

on

cassettes

and never

let thc

user

defermine

frequencies

by

giving

him/her

acoess

to

a

frequencl

generalor. It

ls

nry

oplnton

fhat

fhe

maklng

of

vA

therapy

programs

musJ

be

in

Jhe

hands

of

sftilled

professionals.

There

is

foo

muctr

r¡ír

involved

in

letting

amateurs

crcate

VA

Therapy

hequencies

on

a

do-it-yourself

basis

Tccbnicel

Dc;voloPmcnt

ratlo

of muslc

and

vibratlon.

Norray:

IS|VA

publications

Teirich, H.R.

(1959).

On fherapeutics

throngh

music and

vibrations

In

H.

Scherchen

(Erl.),

Gravesaner

Blatter,

(pp.

1-14). Mainz:

Ars

Viva

Verlag.

Wigram,

A.L.

(1990.

The Effecf

of

Vibroacousúic Therapy

on

Clinical

and

Non-Ctinical

Populalions.

PhD

Thesig St.

Georges

Medical School'

I¡ndon

Universi$,

England.

241

)

)

)

)

)

)

)

)

)

)

CUAPIB.

TWTNTT.f,OI'R.

walPuwtr'

non

qIBKTAOOASTTC

AND

VIBRCTUCT'IIE

TnER/Ef

Tory

Wtg¡¡m

The

field of

vibroac¡usics

is

grofling and

developing'

and

cvcn

while

this

chapter

is

being

writteq

t€scarch

and

der/eloPrnent

i3

taking

place

in Úhe

manufa;tur€

and

clinical

use

of

vibroacoustic

equipment.

Thercfore'

what

lollows

is

a

sample

of

some

of

the

units

Íhat

have

becn

developed,

and

some



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

lnforn¡tlon

reg¡rdlng

the speclñcatlon

and

proposed

effect.

It

ls lnevltably

incompletg and

can

only

give

the reader an idea

about the many and

varied

units

fhat have

been conshucted.

Smsonics

somasonicq

Inc.

in

America

has

produced

a

úde range

of

vibrational

equipment,

called

Sornatron.

TheY

plays

melodles,

chords

and

sounds

Somat¡on

claims

fo

be fhe

mo

and

the¡e

arc

certainly

a wide

variety

medical

and

param"¿ic"l

-il¡.ug

nminly

in

America.

Treatment

tableg

reclinerq

chairs

and

mattresses

have

becn

develo@

by

soma-sonics,

and

the

.p."iri3¡iion

varies

depending

on the

infended purpose

and

client

group

for

*t

i"t

tft" unit

rvas developed.

An

example

of

one of

the.

many

unif

s

developed

Uy

tftir

qrmpany

is

incluáed

in

fhe

chapter

by

Hooperand

l,indsey,

rvüere

riey

have

descrlbed

the

ryeclflcatlon,

the

locatlon

of

speakers

and

the

aq¡usanility

of the

somatron

sound

Lounge.

Limitations

of

space

pnevent.a

coirplete

dóscription

of

all

the

different

units

currcntly

markefed

by

this

company.

-

itt" research

evidencc

for

its

elfect

is

quite

well documenfed,

and

fhe

resn¡lts

of

some

of

the

studies

are

described

in fhe

present

volume.

Vibroacoulics

A/S

Vibroacoustics

A/S

cunsfrucfed

a

Vibroacoustic

chair

and

a

Vibroacou$ic

table

in

the late

19E0's.

Tl¡e table

faded

out

of

their

productiont

but

the

chair

is

curcntly

used

widely.

Ihe

vibnoacoustic

chair

is

a leather

reclining

chair,

157

centimeters

lottgr77

ctnÚimeterswide,

and

45

cenJimeters

high.

I3ias

one

25

crcnlimete

one

25

centi¡neter

,frf""

behind

the

back,

two

er Úhe

bottom

and

thighs

and

tuo

17

centimeJer

243

F

ln

)

)

)

)

)

)

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Thestlmutus|sscnttothgch¡lrvl¡¡SU2I|0controlun|t.Thls

consists

of

a

cassette

fuñ

¿

"-pr¡n.r_channels

(61 vatts_

each channel

to

the

chair,

and

two

,orírií.itn"*ás

(05 rmtt

s

each

channel

to

hcadphones)'

Tü6'jbwr

sulplv

t

ffiilvt;¡inl

n"q""""v

range

to

the

el¡lr

w¡s

20

'

1l)0IIz.

ThesU2fithasfourindividua|contrc|stoincreaseordccreasethe

Mudc

Vibmtion

Teblc



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il

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lr

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Phydeoustic

musical

effect.

Three

sound

Para

method:

Pulsation,

scanning

and

Pulsation.

The

low

fneq

uencY

sequence.

The

PurPose

of

Power

Pu

Contlnuous

stlmulatlon

commonlY

the

sound

Pulsating

slowlY,

this

e

obtained

instead.

Scanning.

The

computer

causes

the

frequency

fo

v:ry

within

a

cerlain

amplitude

and

speed'

it'it

i'

necessary

to

guarantee

lhat

each

muscle

is

trcared

at

its

optimai;ü;;ñ;i".

trr"iit"rt

ut

which

the

particular

muscle

rcqonds

natuallY.

The

rnanufacturtrs

give

a

tec

'T,ow

hequencY

sinu

specificallY

designed

for

the

parameters

as

well

as

the

P

24

right

hand."

Quanlum

Rcst

24,

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conjrol

.mpllner

k

¡ Shcroood

du¡l

65's¡ttdch¡nnel

wlth

muttipte

inpot

c.p-"tttiü'

ih;

fiv.edtsc

carcuscl

CD

player and the

cassette

trpc

deck

tnn

"íto''"nersc

function

arc

srpplied

bq

TEáCr

rmnufacturcrs

bfüüaüty

p-AarJJ,-:

r¡i

ri"''¡'-

"1

i-l¡.1''tri'{"'"'*'''*'

o"Ur: iúi'.':

""'?

*l}

Bo-dYsonic

elo@

inJapan

ane

and

bed

Pahg

low

to

health,

ttte

aP-

logY

:luding

rclanlion,

communicatigl

u"d

entertainment'

Accordlng

to

the

mnuÑ,ñ"".,

'et

noiytonlCs

heart

lles

a unlque'

patenfed

into

dynamic

vibrations"

CONTRIBUTORS

I

Centen

Durham'

NC'

JosDcBocü.r|sAssocl¡teProlessorandHeedofstudleslnMudcTherapy

li

I*u".n

university

and

the

l¡mmens

Institutg

Belgium.

Ch¡rlcs

Butlcr,

MD'

PhD'

tr'ACS'

FACC'

FACCf'^is.

flinical

Assistant

p¡ofessor

or

so"g"ry,

'r"ri"i-lg"i

it"tl

University,

and

Chief

Executive

Offlver

oi

U.it"g.

vra'ícai

products,

I(alanazoo'

MI'



)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

)

I

transducer,

*f.i"f,

-i""rts

ultra-low

hóquencies

These fbequenci"s

;l ñ ;

soorhing

invigo-tllg

rrave pattern

within

the

UodV

itseff],

rclaxing

tense

muscles

and

minds"""

Bodysonic

also

produces

music

tapes

to

accompany

its

products'

Cünical

""."","h

on

tot"

of

these

proaucts

lt"t :Try

effects

in

sleep

enhancemenr,

blood

pressune

t"¿""i¡ott'

and

pafient

comfort

during

hemodialYsis.

Thor

of

Genesis

Thor

of

Genesis

1

is

another

device

claiming

an

effecfive

intervention

for

stress:

,Tl

oí ofón.J"

r

uses

z

specially

placed

speakers

to

crcate

a

unique,balancingfherapeutictol"tt-t"tttand-massagefortheentirebody'

This produce,

;"*i;;J.l"i"

or

no¿v

and

mind

which

reduces

stress

and

adjusts

the

body

io-""iutn

to

its

natural

enelgy

florv"'

rne

specináiroi,

gr".n lorThor

or

celess

1

agaln

describe

the

badc

components

"f

.;;;;ip;ntlhaf

is

being

purchased,

butlhe

literaÚure

gives

little

inforn¡ation

aboui

the

therapeutic

simuluq

or

the

treatment

process'

Concludon

Thisdrortrcvierroftheequipmenthasattempfedtolookatthose

devices

knorrn

i"

r-rri.

"rgror,

on

wrricrr

he

has

specific

information'

oÚher

devlces

undoubtedly

e;dst,

ond

trre

m¡i*er

in

vl

roacoustlc

and

vlbrotactlle

devices

is

a

develoPing

field'

Refenenes

Cheskyr

K.

S'

(1 t92)'

The

effecls

of

music

and

music

vibration

using

the

f"fWtmIlie

rplief

of

rheumatoid

arthritis

pain'

r

irin.

Dissert¡tlon,

Unlverslty

of

North

Texas'

26

Pcnclopc

Johnson

Butlcrr MD,

is a

physician

in

l(alarnazoo'

MI'

ician

and

a

senior

rcsearcher

in

TheraPY,

HarPerburY

HosPital'

P¡txi

dct

e

Musig

Art

and

Process

InstiJufe

of

Music

Therapy

Post'Graduafe

Diploma

Program

ue

Country'

SPain'

ol

Music

TheraPY,

Inc'

MiguclFcrna[dczisaninstructorofacousticsattheHigherConsenatoryof

iftJi"ln"fp"do

de

Asturlas,

Asturiaq

Spaln'

Jcanninc

Ging¡asr

MD,

is

a

physician

in

the

Department

of

Neonatologl'

Duke

UniversitY

Medical

Center

JcfiHooPerisaseniormusicfherapistfortheDundeeHeatthcareNHS

Trust.

He

is

based

ui-él-trtt-rtine

Éospita

Dundee'

Scotland'

I¡¡¡r¡

Joncg

RNr

MBAr

CORN,

ls

Dlrect

of

Patlenf

Care

Services

af

Tampa

óhildren's

Hospital

at

St'

Joseph'g

Tampa'

Florida

Bilt

Lindsay

is

a

clinical

psychologist

at

strathmartine

HospiÚal'

Dundee'

Scotland.

247

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.)

)

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)

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I

ü/A1¿W

H¡pc

eLp

AeeJa¿Dn

r¿

Llpzf,¿

tt

-

PA¿a

*

¿lt*o

f-Uo¿c¿ltenchol¡r

MD,

ls

r

neurologls

eú

Os¡kldetze's

lbgorrltnr

r

I

Hospital,

Vitoria,

and

hofessor

of Medicine

at

the

University of

thc Bacque

;¡i¡,Sountry,

SPaln.

Pchi Iá¡kolDGD,

l\{d

is

Senior

Lec{urcr In music

úherapy,

psychologl

ol

music

and

special education

af

the Sibelius Academy,

and

rescarcher

at fhe

Cognitive Brain

Rescarch

Unig Helsinki, Finland.

Jcury

McNeqg[t is

a

Vib¡oacou$ic

Therapy Technician and a

rcsea¡ther in

the Departmenú of Music and Vibroacou$ic

Therapy,

Harperbury Hospifal

Horizon NHS Tntst, Radlett,

England.



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)

)

,

)

)

)

)

)

)

)

I

Jcri

Ochhr,

PhD, RN,

is

a

súaff

member

of the

Departnent

of

NeonaSologr,

Duke University Medical Center

Jan

Pcrsms

is a music

fherapisl

(ortho-agogic

music

practitioner)

at

Het

Maaslands

Institute

in

Stokkonr,

Belgium

and at the

Volunúas

Therapy

Center,

Anlrverp,

Belgium.

Rlln¡ R¡udslh MD, ls

Head

of

fhe

Jurl

Health

Cenfre,

Estonla.

Ol¡v

SHllc is Daúa

Consultant

in

Levanger

Kommune. He is

Advisor

on

Viv¡oakkusúiktempi

for

SINTEF

UNIMED, Norrray, and forrneraly

RekSor

of

'

Lyngabben Skole and a

Director of Vibroacousúics

A'/S.

K¡ahy

Thomg

PT,

is

a

physical

therapist

at

the

Duke

University

Ueaicat

Cenfer, Durham,

NC.

Erycnnze

Tor¡cs

Sq¡¡

is

a

psychologi$

and music thempist in

Vitoria-

Gasteiz,

Spain.

Jenay

Walq R[,

CCRN,

is a staff ¡rrcmber

ol

the

Department

of

Neonatologr,

Duke University Medical

Center.

Lyn Wcckeq MCSP,

SRP, is

Trust

Physiolherapy Manager,

Horizon NHS

Trusg Radletú, England.

¿ llTy

T*s.11?:

19:y "1|

Pp,TYll

i:

*Tl"::

Pl-fYi:{

I Head

of

PhD Studies

af the

Insfitute

for

,

Aalborg

)

)

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)

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t

)

)

University, Denmark.

He

Children's Senicc,

Radlef

t,

III

Music

,.Therapist

at

,

ar.r¡l, Resea

rc_h

Adv¡

sol'

tb

fS

Trusú,

Englandr.Hp

is.lhe

Coiiiiñi1tg.e

and.

J.resident

rler

House

Heallh

and

of

i

-.-t

,'

'>

,¡

,attr

z'' ri

-','-

the TVorld

tony wigram - music vibration and health.pdf

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