and “music therapy” - ASP Città di Bologna
Transcription
and “music therapy” - ASP Città di Bologna
Il ruolo della musicoterapia nei servizi assistenziali per anziani Sabato 27 Settembre 2014 – SALA POLIVALENTE CENTRO SERVIZI CARDINALE G. LERCARO Quando la musica diventa terapia: l’efficacia della musicoterapia nelle demenze Dr. Alfredo Raglio [email protected] www.alfredoraglio.it Dr. Alfredo Raglio, ASP Città di Bologna 2014 Dr. Alfredo Raglio, ASP Città di Bologna 2014 Clinical Psychology Review 29 (2009) 193–207 Contents lists available at ScienceDirect Clinical Psychology Review Dose–response relationship in music therapy for people with serious mental disorders: Systematic review and meta-analysis Christian Gold a,⁎, Hans Petter Solli b,c, Viggo Krüger b, Stein Atle Lie a a b c Unifob Health, Bergen, Norway University of Bergen, Norway Lovisenberg Diakonale Hospital, Oslo, Norway “…Music therapy is a special type of psychotherapy where forms of musical interaction and communication are r t i c c l ommunication. e i n f o b b s een t r ad c efined t used alongside averbal It haas as “a systematic process of intervention wherein the Serious mental m disorders considerable individual and societal impact, and traditional may therapist helps the client to promote health, using usic have experiences and the relationships dtreatments eveloping through show limited effects. Music therapy may be beneficial in psychosis and depression, including treatmentresistant cases. The aim of this review was to examine the benefits of music therapy for people with serious them as dynamic forces of change” (Bruscia, 1998). The types of ‘music experiences’ used in music therapy can mental disorders. All existing prospective studies were combined using mixed-effects meta-analysis models, allowing to examine the influence of study design (RCT vs. CCT vs. pre-post study), type of disorder include free and structured improvisation, other types of active music-‐making by patients, and listening (psychotic vs. non-psychotic), and number of sessions. Results showed that music therapy, when added to standard care, has strong and significant effects on global state, general symptoms, negative symptoms, to music. Improvisation is perhaps the depression, most panxiety, rominent orm of engagement. musical interaction in music functioning, fand musical Significant dose–effect relationships were therapy… identified for general, negative, and depressive symptoms, as well as functioning, with explained variance Music therapists are specifically trained to from intervene therapeutically wareithin he 3 tom10,edium, for ranging 73% to 78%. Small effect sizes for these outcomes achieved t after large effects after 16example to to 51 sessions. The findings suggest that music therapy is an effective treatment which helps people with support by providing rhythmical or tonal gpsychotic rounding, to clarify, to cdisorders onfront or to challenge the lient's expression in and non-psychotic severe mental to improve global state, symptoms, and c functioning. Slight improvements can be seen with a few therapy sessions, but longer courses or more frequent sessions the music (Bruscia, 1987; Wigram, 2004). Oarether of m usic ebenefits. xperiences in music therapy include playing neededm to odes achieve more substantial © 2009 Elsevier Ltd. All rights reserved. composed music on instruments, singing and writing or improvising songs (Baker & Wigram, 2005), and listening to Contents music (Grocke & Wigram, 2006)… All these different modes of ‘music experiences’ become therapeutic by 1. . .o . f . a . .therapeutic . . . . . . . . . . . r . elationship. . . . . . . . . . . . .V . erbal . . . . . d . iscussions, . . . . . . . . . . r. eflections, . . . . . . . . . o . r . .interpretations . . 194 being used in the cIntroduction ontext 1.1. Music therapy in mental health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 1.2. Music therapy—the evidence to date . . c . lients . . . . . e . xplore . . . . . . t . he . . .p. otential . . . . . . . m . . eaning . . . . . . o . f . a . n . .e . xperience, . . . . . . 195 and to relate a connected to the music a re i mportant t o h elp 1.3. Research questions addressed in this review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Method . . . . . . .to . . s.ituations . . . . . . . . in . . t. he . . c . lient's . . . . . . l.ife. . . .T . he . . .d. egree . . . . . t.o . w . .hich . . . . t.he . . m . . usic . . . .e . xperience . . 196 new experience w2. ithin t herapy itself, 2.1. Criteria for selecting studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 2.1.1. Study design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 versus the verbal reflection cStudy onnected to it, is seen as the active agent of change may vary between m odels of music 2.1.2. quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 2.1.3. Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 therapy (Garred, 2004), 2.1.4. as wInterventions ell as between clients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 2.1.5. Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 However, treatments t hat r ely s olely o n t he d irect e ffects o f m usic a lone, w hich d o n ot “ involve or depend 2.2. Search strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 2.3. Selection of studies and data extraction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 upon a process of i2.4.ntervention Data analysis . . . a. nd . . . c. hange . . . . . . w . .ithin . . . . . a. c . lient–therapist . . . . . . . . . . . . . . . r. elationship” . . . . . . . . . . . . (.“auxiliary . . . . . . 196 level”, 2.4.1. Individual study results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 Bruscia, 1998, p. 195), a2.4.2. re nCombination ot music therapy. such of study results . . . T . he . . . t.erm . . . .‘music . . . . . .m . .edicine’ . . . . . . .is . .sometimes . . . . . . . . . .u.sed . . . t. o . d . istinguish 197 3. Description of studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 treatments from music therapy.”… 3.1. Selection process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Dr. Alfredo Raglio, ASP Città di Bologna 2014 Article history: Received 30 June 2008 Received in revised form 6 January 2009 Accepted 12 January 2009 Keywords: Psychosis Depression Psychotherapy Dose–effect relationship Mixed-effects meta-analysis 3.2. 3.3. 3.4. 3.5. General study characteristics . . . Interventions: Music therapy. . . Comparison conditions . . . . . Data extraction and preprocessing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 197 197 200 Differences between “music” and “music therapy” interventions in dementia. (Raglio & Gianelli, Current Alzheimer Research, 2009, 6, 293-301). MUSIC MUSIC THERAPY Presence of a professional of the music area Presence of a professional of the musictherapeutic area with specific relational and musical competences Absence of a specific therapeutic setting Presence of a structured therapeutic setting Absence of a specific intervenion model Presence of a music-therapeutic referential model grounded on theoretical and methodological criteria Aims: temporary well-being, improving mood, promoting socialization, memories and stimulation of frames of mind, relaxation, etc. Aims (aspiring to become stable and longlasting over time): attenuation of behavioral and psychiatric symptoms and prevention/ stabilization of complications; increase in communication and relationship skills Contents: structured musical initiatives (rhythmic use of instruments, singing, movement associated to music, etc.) and listening to music (classical music, favourite music, etc.) Contents: sonorous-musical improvisation; listening activities that involve verbal and elaborative competences (preferably at initial stages of dementia) Dr. Alfredo Raglio, ASP Città di Bologna 2014 after initiation of trazodone, and the headache disaped when the the agent agent was was discontinued. discontinued. The The temporal temporal d when onship suggested suggested that that the the headache headache could could be be the the adverse adverse onship t of of trazodone trazodone use. use. The The possibility possibility of of the the headache headache caused caused rotonin syndrome syndrome is is not not likely likely due due to to the the lack lack of of clinically clinically rotonin ciated findings of of mental mental status status change, change, autonomic autonomic hyperhyperiated findings ity or neuromuscular neuromuscular abnormalities. abnormalities. ty or he most common common side-effects side-effects that that lead lead to to discontinuation discontinuation e most azodone for for treatment treatment of of insomnia insomnia are are sedation, sedation, dizzidizziazodone 2 and psychomotor impairment. 2 To our knowledge, and psychomotor impairment. To our knowledge, are few reports of severe headache as an adverse effect are few reports of severe headache as an adverse effect d to trazodone use. In 1992, Workman et al. reported d to trazodone use. In 1992, Workman et al. reported a 35-year-old patient who possessed a genetic predisa 35-year-old patient who possessed a genetic predision toward migraine suffered from severe migraine ion toward migraine suffered from severe migraine ache after trazodone treatment.3 The mechanism of ache after trazodone treatment.3 The mechanism of done-induced headache is not clear. Serotonin-releasing done-induced headache is not clear. Serotonin-releasing r and serum serotonin increase during headache attacks r and serum serotonin increase during headache attacks cerebral vessels are highly innervated by serotonin fibers cerebral vessels4,5are highly innervated by serotonin fibers raphe nuclei. Workman et al. indicated that migraine raphe nuclei.4,5 Workman et al. indicated that migraine ache may be evoked by trazodone through its active ache may be evoked by trazodone through its active bolite, m-chlorophenylpiperazine, which is a potent bolite, is a potent elective m-chlorophenylpiperazine, serotonin receptor agonist.which In addition, this elective serotonin receptor agonist. In addition, this Operatore formato Received 14 June 2011; revised 8 August 2011; accepted 23 23 September September 2011. 2011. accepted Issue When music music becomes becomes music music therapy therapy When doi:10.1111/j.1440-1819.2011.02273.x doi:10.1111/j.1440-1819.2011.02273.x Psychiatry and Clinical Neurosciences 2011; 65: 679–683 S CIENTIFIC LITERATURE PROVIDES evidence of the CIENTIFIC LITERATURE PROVIDES evidence of the unquestionable effects of music both in pathological coneffects of music boththerapeutic in pathological conIunquestionable personally that music embodies potentialion the texts and uponsee individuals generally speaking.11 Also Also on the texts and upon individuals generally speaking. ties as suggestive – but not scientifically proven. physiological, neurophysiological, biological and neurochemiphysiological, neurophysiological, biological and neurochemiexample, ‘Mozart’s music’ is an concept:22 calFor levels, confirmation of such effects hasinsufficient been forthcoming. cal levels, confirmation of suchoreffects hasfrom beenDon forthcoming. which Mozart? The Requiem an aria Giovanni? Empirically, all individuals can experience well-being and Empirically, all individuals can experience well-being and positive emotions when that has parWhy Mozart and not thelistening Beatles ortoB.music McFerrin? Andsome addresspositive emotions when listening to music that has some particular significance forwhat? them,How? or can derive pleasure from ing whom? Producing ticular significance for them, or can derive pleasure from socializing a musical experience (making or listening tomusicmusic With these queries in mind, the international socializing a musical experience (making or listening to music Psychiatry and Clinical 2011; 65: 679–683 together with others), Neurosciences buthas allintroduced the above, while emphasizing the therapeutic community – as an essential comtogether with others), but all therefers above, while emphasizing the potentialities of music, usually to momentary effects that 3,4 ponent of therapy by music – the concept of ‘relationship’. potentialities of music, elude therapeutic logic.usually refers to momentary effects that Thetherapeutic above thoughts elude logic. can help re-model music-therapeutic I personally see that music potentialipractices by introducing theembodies followingtherapeutic aspects (Evidence Based tiesMusic as suggestive but not scientifically proven. 5,6 musical and Therapy–and Evidence Based Practice): For example, ‘Mozart’s music’ is an insufficient concept: relational training of music therapists, presence of a therapeu011 The Authors which Mozart? The Requiem or an aria from Don Giovanni? 011 The Authors tic setting, a theoretical/methodological background, aims Why Mozart and not the or B. McFerrin? And addresshiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry andBeatles Neurology to the achievement hiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology ingoriented whom? Producing what? How? of stable and long- lasting improvements (according to type gravity of pathologies With these queries in mind, theand international musicconsidered), contenthas (active and/or techniques) therapeutic community introduced – asreceptive an essential com3,4 facilitating intra-by and inter-personal with the ponent of therapy music – the conceptrelationships of ‘relationship’. The above thoughts can help re-model music-therapeutic patient/client and rigorous assessment criteria. practices by introducing the following aspects Based I believe that neither music nor the(Evidence sonorous-musical 5,6 and if Music Therapy andtoEvidence Based Practice): element can fail keep these concepts in due musical consideration relational training of music therapists, presence of a therapeuthey are to assume a potential therapeutic value. In therapeutic tic setting, a theoretical/methodological background, aims applications it is of essential importance that the individual’s oriented to the achievement of stable and long- lasting musicality and musical potential should emerge: this can only improvements (according to type and gravity of pathologies happen through the(active relationship between the music therapist considered), content and/or receptive techniques) and the patient/client mediated by the power of music. This is facilitating intra- and inter-personal relationships with the what definesand therigorous therapeutic specificity of music and contextupatient/client assessment criteria. I believe that neither music nor the sonorous-musical element can fail to keep these concepts in due consideration if they are to assume a potential therapeutic value. In therapeutic applications it is of essential importance that the individual’s musicality and musical potential should emerge: this can only happen through the relationship between the music therapist and the patient/client mediated by the power of music. This is what defines the therapeutic specificity of music and contextu- Modello di riferimento Setting terapeutico strutturato Obiettivi terapeutici Contenuti specifici (tecniche) Letters to the Editor 683 alizes the various possible interventions through music. Music can be the source of deep pleasure, it can stimulate relationships and attentive and cognitive functions, but it becomes therapeutic practice only in the presence of the essential components mentioned above. REFERENCES Psychiatry and683Clinical Neuroscien Letters to the Editor 1. Sacks O. The power of muisc. Brain 2006; 129: 2528–2532. 2. Koelsch S. TowardsVolume a neural basis music-evoked emotions. 65,of Issue 7, (/doi/10.1111/pcn.2011.65.issue-7/i Trends Cogn.possible Sci. 2010; 14: 131–137. alizes the various interventions through music. Music C. All those things with music J. Music can 3.beGold the source of deep pleasure, it can(Editorial). stimulate Nord. relationInformation ships and cognitive functions, but it becomes Ther.attentive 2009; 18:and 1–2.Additional therapeutic only in theVpresence of the essential com- in , Kruger et al. Dose-response relationship 4. Gold practice C, Solli HP ponents mentioned muisc therapy above. for people with serious mental disorders: systemHow toClin. Cite atic review and meta-analysis. Psychol. Rev. 2009; 29: 193– 207. REFERENCES 5. Vink A, Bruinsma M. Evidence based music therapy. Music 1. Sacks O. The power of muisc. BrainA. 2006; 129: 2528–2532. Raglio, (2011), When music becomes music therapy. Ther. Today 2003; 4: 1–26. Available from URL: http://www. 2. Koelsch S. Towards a neural basis of music-evoked emotions. musictherapyworld.de (last accessed 4 July 2004). doi: 10.1111/j.1440-1819.2011.02273.x Trends Cogn. Sci. 2010; 683. 14: 131–137. 6. Edwards J. Possibilities and problems for evidence-based 3. Gold C. All those things with music (Editorial). Nord. J. Musicpracin music therapy. Arts Psychother. 2005; 32: 293–301. Ther.tice 2009; 18: 1–2. V et al. Dose-response relationship in 4. Gold C, Solli HP, Kruger Author Information Alfredo Raglio, MA (Music Therapy) muisc therapy for people with serious mental disorders: systematic review and meta-analysis. Clin. Psychol. Rev. 2009;Cremona, 29: 193– Italy Sospiro Foundation, 207. Email: [email protected] M. Evidence based therapy. Music2011; 5. Vink A, BruinsmaReceived 25 July 2011;music revised 22 August Ther. Today 2003; 4: 1–26. Available from URL: http://www. accepted 23 September 2011. musictherapyworld.de (last accessed 4 July 2004). 6. Edwards J. Possibilities and problems for evidence-based practice in music therapy. Arts Psychother. 2005; 32: 293–301. Sospiro Foundation, Cremona, Italy, Email: raglio Publication History Alfredo Raglio, MA (Music Therapy) 1. Issue published online: 19 DEC 2011 Sospiro Foundation, Cremona, Italy 2. ArticleEmail: [email protected] published online: 19 DEC Received 25 July 2011; revised 22 August 2011; accepted 23 September 2011. 2011 http://onlinelibrary.wiley.com.bibliosan.cilea.it/doi/10.1111/j.1440-1819.2011.0227 Rigorosi criteri di verifica Dr. Alfredo Raglio, ASP Città di Bologna 2014 Global Music Approach in Dementia (GMA-D) (Raglio et al., Clinical Interventions in Aging, 2014, in press) • Active Music Therapy (psychological and rehabilitative • • • • • approaches, AMT-PA and AMT-RA) Active Music Therapy with Family-Caregivers and PWD (AMT-FC) Individualized Listening to Music (ILM) Music-based Interventions (MBI) Caregivers Singing (CS) Background Music (BM) Dr. Alfredo Raglio, ASP Città di Bologna 2014 Music therapy in the field of dementia… " Improves the behavioural and psychological symptoms " Improves the relational and communicative skills " Improves the organization/regulation of the emotional components of the personality " Promotes the maintenance/recovery of a sense of identity " Induces a better adaptation of the person to social environment " Stimulates cognitive functions (attention, memory, executive functions, etc.) " Improves the quality of life " … Dr. Alfredo Raglio, ASP Città di Bologna 2014 EVIDENCE BASED MEDICINE ê EVIDENCE BASED MUSIC THERAPY (Edwards, 2002; 2004; Vink & Bruinsma, 2003) Dr. Alfredo Raglio, ASP Città di Bologna 2014 LEVEL OF EVIDENCE " Systematic review that is based on RCT's " RCT or CCT studies " Patient-‐series with or without controls " Case studies " Expert opinions " Qualitative research Dr. Alfredo Raglio, ASP Città di Bologna 2014 Music therapy for people with dementia (Review) Vink AC, Bruinsma MS, Scholten RJPM This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2011, Issue 3 http://www.thecochranelibrary.com Music therapy for people with dementia (Review) Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Dr. Alfredo Raglio, ASP Città di Bologna 2014 Cochrane Review (2003: 5 studies) Vink AC, Birks JS, Bruinsma MS, Scholten RJS. Music therapy for people with dementia. The Cochrane Database of Systematic Reviews: Reviews 2003 Issue 4 John Wiley & Sons, Ltd Chichester, UK DOI: 10.1002/14651858.CD003477 " Groene, 1993 (active music therapy, behavioral problems) " Lord et al., 1993 (active music therapy, emotional functioning) " Clark et al., 1998 (pre-‐recorded music, behavioral problems) " Gerdner, 2000 (pre-‐recorded music, behavioral problems) " Brotons et al., 2000 (active music therapy, cognitive functioning) Dr. Alfredo Raglio, ASP Città di Bologna 2014 Updating of COCHRANE REVIEW (2011:5 new studies)… " Sung et al., 2006 (active music therapy, behavioral problems) " Svansdottir et al., 2006 (active music therapy, behavioral problems) " Raglio et al., 2008 (active music therapy, behavioral problems) " Guétin et al., 2009 (pre-‐recorded music, emotional functioning) " Raglio et al., (2010) (active music therapy, behavioral problems) Dr. Alfredo Raglio, ASP Città di Bologna 2014 Updating of Cochrane Review by Vink et al., 2011 Dr. Alfredo Raglio, ASP Città di Bologna 2014 Vink AC, Bruinsma MS, Scholten RJPM. Music therapy for people with dementia. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD003477. DOI: 10.1002/14651858.CD003477.pub2. Author’s conclusions - Methodological limitations - Poor statistical analysis - Little information about the randomization - Small sample sizes - Short interventions period - … Dr. Alfredo Raglio, ASP Città di Bologna 2014 Vink AC, Bruinsma MS, Scholten RJPM. Music therapy for people with dementia. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD003477. DOI: 10.1002/14651858.CD003477.pub2. Implications for research CONSORT guidelines for RCTs Adequate methods of randomization Blind evaluation Reliable and validated outcome measures To assess medium and long-term effects To differentiate music therapy approaches (active vs receptive techniques) - To compare music therapy with listening to music - - - - - - Dr. Alfredo Raglio, ASP Città di Bologna 2014 Author's personal copy Maturitas 72 (2012) 305–310 Contents lists available at SciVerse ScienceDirect Maturitas journal homepage: www.elsevier.com/locate/maturitas Review Music, music therapy and dementia: A review of literature and the recommendations of the Italian Psychogeriatric Association A. Raglio a,b,∗ , G. Bellelli c,d , P. Mazzola c , D. Bellandi a , A.R. Giovagnoli e , E. Farina f , M. Stramba-Badiale g , S. Gentile h , M.V. Gianelli i , M.C. Ubezio a , O. Zanetti l , M. Trabucchi m,d a Sospiro Foundation, Sospiro (Cr), Italy Maugeri Foundation I.R.C.C.S., Pavia, Italy Milano-Bicocca University, Monza, Italy d Geriatric Research Group, Brescia, Italy e I.R.R.C.S. Neurological Institute Carlo Besta, Milan, Italy f I.R.C.C.S. Don Gnocchi Foundation, Milan, Italy g I.R.C.C.S. Istituto Auxologico Italiano, Milan, Italy h Alzheimer’s Evaluation Unit, Ancelle della Carità Hospital, Cremona, Italy i University of Genoa, Genoa, Italy l I.R.C.C.S. S. Giovanni di Dio Fatebenefratelli, Brescia, Italy m Tor Vergata University, Rome, Italy b c a r t i c l e i n f o Article history: Received 24 May 2012 Accepted 31 May 2012 Keywords: Music therapy Music Dementia Scientific perspectives Recommendations Contents 1. 2. a b s t r a c t This study reviews the most recent (from 2000 to 2011) Clinical Controlled Trials (CCT) and Randomized Controlled Trials (RCT) concerning the use of music and music-therapy (MT) in the context of dementia and related issues. Studies which explored the efficacy of music and MT on behavioral and psychological symptoms of dementia (BPSD) are prevalent, while those aiming at assessing a potential effect of these approaches on cognitive and physiological aspects are scant. Although with some limitations, the results of these studies are consistent with the efficacy of MT approach on BPSD. In this context, the ability of the music therapist to directly interact with the patients appears to be crucial for the success of the intervention. This review was endorsed by the Italian Psychogeriatric Association (AIP) and represents its view about the criteria to select appropriate music and MT approaches in the field of dementia. Accordingly, we have developed a list of recommendations to facilitate the current use of these techniques in the context of non-pharmacological treatments for patients with dementia. © 2012 Elsevier Ireland Ltd. All rights reserved. Dr. Alfredo Raglio, ASP Città di Bologna 2014 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306 Methods: selection criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306 Music/Music Therapy and Dementia Dr. Alfredo Raglio, ASP Città di Bologna 2014 Association (AIP) and represents its view on the use of music and MT approaches for patients with dementia. Accordingly, we developed et al. / Maturitas 72 (2012) 305–310 a listA.ofRaglio recommendations. Concerning the clinical practice the AIP recommends: Refe [1] G 2 [2] G f ctive music or MT approaches. Provenance and peer review C s showed an improvement of [3] B 1. Personalized interventions with music or MT as the surest preCommissioned and externally peer reviewed.P e or no treatment. Studies with of success. d controversialdictor results in BPSD [4] G 2. The use of active music and music therapy approach in the mant d by the Italian Psychogeriatric References [5] R BPSD view on the useagement of musicof and MTin addition to standard care as the direct music s therapist/patient interaction appears to be the most effective. ntia. Accordingly, we developed [1] Gold C. All those things with music (Editorial). Nordic [6]Jou R 3. The preferential use of MT 2009;18:1–2. to make the treatment more tailored o [2] Gold C, Solli HP, Kruger V, Lie and SA. Dose–response 2 the AIP recommends: to meet the patients’ needs, and to improve BPSD commu- relation for people with serious mental disorders: systematic[7] reviS nicative skills in particular Clinical in moderate–severe dementia. Psychology Review 2009;29:193–207. i [3] Brandes V. listening Reply to music or music medicine 4. as Also use ofpreindividualized music basedtherapy on preferred music or MT thethe surest i Psychosomatics 2011;80:305. [8] S and/or familiar music as background music did not prove its [4] Gold C, Erkkilä J, Ole Bonde L, Trondalen G, Maratos A a efficacy. c therapy approach in the mantherapy or music medicine? Psychotherapy and Psychos N [5] Raglio A. When music becomes music therapy. Psychiat tandard care5.asThe theintroduction direct musicof Evidence Based Practice [39,40] in the choice [9] S sciences 2011;65:682–3. pears to be the and most ineffective. the conduction of[6]the music and MTMV. treatment. Raglio A, Gianelli Music therapy for individuals i a ke the treatment more tailored of interventions and research perspectives. Dr. Alfredo Raglio, ASP Città di Bologna 2014 Current 2 2009;6:293–301. to improve BPSD and commu- 5. The introduction of Evidence Based Practice [39,40] in the choice and in the conduction of the music and MT treatment. [9] A. Raglio et al. / Maturitas 72 (2012) 305–310 [10] Concerning the research activity inand the field music and MT in ive music or MT approaches. peer of review Provenance the AIP recommends: showeddementia an improvement of [11] Commissioned and externally peer reviewed. or no treatment. Studies with controversial results in BPSD 1. A more rigorous methodology including a more accurate definiby the Italian tionPsychogeriatric of the population of patients and of the type of interventions. [12] References ew on the music and MT 2. use Theofconduction of studies aimed at identifying which types of a. Accordingly, we developed dementia have the greatest chances of improvement to dif[1] Gold C. All those things with musicdue (Editorial). Nordic Journ [13] 2009;18:1–2. ferent kinds of music and MT interventions. [2] Gold C, Solli HP, Kruger V, Lie SA. Dose–response relationsh e AIP recommends: dose–effect relationship of the dif3. The assessment of a possible for people with serious mental disorders: systematic review [14] ferent interventions. Clinical Psychology Review 2009;29:193–207. [3] Brandes and V. Reply to music therapy or music evaluation of the cognitive physiological aspects, bymedicine? usic or 4. MTThe as the surest prePsychosomatics 2011;80:305. identifying adequate assessment tools. J, Ole Bonde L, Trondalen G, Maratos A, C [4] Gold C, Erkkilä [15] herapy 5. approach in the manThe conduction of the comparative studies on the effects of the therapy or music medicine? Psychotherapy and Psychosom [5] Raglio A. When music becomes music therapy. Psychiatry ndard careMT as the direct music versus music. sciences 2011;65:682–3. ars to be the most effective. [6] Raglio Dr. A, Alfredo Gianelli MV. Music therapy for individuals[16] wi Raglio, ASP Città di Bologna 2014 e the treatment more tailored of interventions and research perspectives. Current A 5. BPSD Conclusion 2009;6:293–301. o improve and commu- Musicoterapia e demenze D Villani, A Raglio G Gerontol 2004; 52:423-428 Dr. Alfredo Raglio, ASP Città di Bologna 2014 Musicoterapia e demenze: teoria, applicazione e ricerca Raglio A, Villani D G GERONTOL, 2005; 53:528-532 Dr. Alfredo Raglio, ASP Città di Bologna 2014 L’EFFICACIA DEL TRATTAMENTO MUSICOTERAPICO IN PAZIENTI CON DEMENZA DI GRADO MODERATO-SEVERO Raglio A, Ubezio MC, Puerari F, Gianotti M, Bellelli G, Trabucchi M, Villani D G Gerontol 2006; 54:164-169 Fondazione Sospiro (CR) Gruppo Ricerca Geriatrica (BS) Unità Valutazione Alzheimer, Ancelle della Carità (CR) RSA Salò (BS) Fondazione Piccinelli (BG) Dr. Alfredo Raglio, ASP Città di Bologna 2014 Efficacy Of Music Therapy In The Treatment Of Behavioral And Psychiatric Symptoms Of Dementia Raglio A, Bellelli G, Traficante D, Ubezio MC, Gianotti M, Villani D, Trabucchi M, Alzheimer Dis Assoc Disor, 2008; 22:158-162 Fondazione Sospiro (CR) Gruppo Ricerca Geriatrica (BS) Unità Valutazione Alzheimer, Ancelle della Carità (CR) RSA Salò (BS) Fondazione Piccinelli (BG) Dr. Alfredo Raglio, ASP Città di Bologna 2014 Efficacy of music therapy treatment based on cycles of sessions: a randomized controlled trial. Raglio A, Bellelli G, Traficante D, Gianotti M, Ubezio MC, Gentile S, Villani D, Trabucchi M Aging and Mental Health, 2010, 14, 900-904 Fondazione Sospiro (CR) Gruppo Ricerca Geriatrica (BS) Unità Valutazione Alzheimer, Ancelle della Carità (CR) RSA Salò (BS) Fondazione Piccinelli (BG) Fondazione S. Chiara (BG) IRCCS Don Gnocchi (MI) Dr. Alfredo Raglio, ASP Città di Bologna 2014 MUSIC THERAPY FOR INDIVIDUALS WITH DEMENTIA: AREAS OF INTERVENTION AND RESEARCH PERSPECTIVES Raglio A, Gianelli MV Current Alzheimer Research, 2009, 6, 293-301 Dr. Alfredo Raglio, ASP Città di Bologna 2014 Nova Science Publishers, Inc. New York, 2010 Non-‐Pharmacological Therapies in Dementia,, 2010, 1, 1, 1-‐14 Dr. Alfredo Raglio, ASP Città di Bologna 2014 Effects of Music Therapy on Psychological Symptoms and Heart Rate Variability in Patients with Dementia. A Pilot Study. Current Aging Science, 2010, 3, 242-‐246 Raglio*,§, O. Oasi^, M. Gianotti*, V. Manzoni**, S. Bolis^, M.C. Ubezio*, S. Gentile*, D. Villani* and M. Stramba-‐ Badiale** *Sospiro Foundation, Cremona, Italy, **Department of Rehabilitation Medicine, IRCCS Istituto Auxologico Italiano, Milano, Italy, §Interdem Group (Psycho-‐ Social Intervention in Dementia), ^Department of Psychology, Università Cattolica, Milano, Italy Dr. Alfredo Raglio, ASP Città di Bologna 2014 Raglio A, Bellandi D, Baiardi P, Gianotti M, Ubezio MC, Granieri E. Music therapy in frontal temporal dementia: a case report. J Am Geriatr Soc. 2012;60(8):1578-‐9. Dr. Alfredo Raglio, ASP Città di Bologna 2014 Music and music therapy in the management of behavioral disorders in dementia Raglio A, Gianelli MV Neurodegenerative Disease Management, 2013, 3(4), 295-298 Dr. Alfredo Raglio, ASP Città di Bologna 2014 Raglio A, Bellandi D, Baiardi P, Gianotti M, Ubezio MC, Granieri E. Listening to Music and Active Music Therapy in Behavioral Disturbances in Dementia: a Crossover Study. J Am Geriatr Soc. 2013; 61(4): 645-‐647. Dr. Alfredo Raglio, ASP Città di Bologna 2014 Music and music therapy in the management of behavioral disorders in dementia Raglio A, Filippi S, Bellandi D, Stramba-Badiale M Neurodegenerative Disease Management, 2014, in press Dr. Alfredo Raglio, ASP Città di Bologna 2014 Fondazione Istituto Ospedaliero di Sospiro Onlus UNIVERSITÁ DI PAVIA Dipartimento di Sanità Pubblica, Medicina Sperimentale e Forense -‐ -‐ -‐ -‐ -‐ -‐ Musicoterapia e Ascolto Individualizzato e nel trattamento dei disturbi comportamentali nelle demenze di livello moderato-‐severo: uno studio multicentrico randomizzato controllato. P.I. Alfredo Raglio Co-‐P.I. Daniele Bellandi Strutture coinvolte: Fondazione Sospiro (CR) -‐ Istituto Auxologico Italiano I.R.C.C.S. (MI) Fondazione Maugeri I.R.C.C.S. (PV) -‐ Centro Alzheimer Fondazione Roma (RM) Residenza S. Pietro (MB) -‐ I.R.A.S. (Rovigo) Fondazione Stefania Randazzo (CA) – RSA De Benedictis (TE) Rifugio Re Carlo Alberto (TO) Fondazione Onlus “Longini-‐Morelli” (BS) Dr. Alfredo Raglio, ASP Città di Bologna 2014 Progetto di Ricerca: L’EFFICACIA DELLA MUSICOTERAPIA SULLO STRESS DEL CAREGIVER CHE ASSISTE LA PERSONA CON DEMENZA: UNO STUDIO RANDOMIZZATO CONTROLLATO Fondazione Sospiro Dipartimento di Scienze Neurologiche e del Movimento (Università di Verona) Associazioni Familiari (Cremona e Verona) Dr. Alfredo Raglio, ASP Città di Bologna 2014 Grazie per l’attenzione! [email protected] Dr. Alfredo Raglio, ASP Città di Bologna 2014