Musicoterapia in ambito neurologico Alfredo Raglio Dipartimento di Scienze Biomediche e Chirurgico-Specialistiche Sezione di Clinica Neurologica – Università di Ferrara

[email protected] Dr. Alfredo Raglio

A.A. 2012-2103

  NECESSITA  DI  DEFINIRE     LA  MUSICOTERAPIA…  

Dr. Alfredo Raglio

A.A. 2012-2103

9 th WORLD CONGRESS OF MUSIC THERAPY: Music Therapy: a global mosaic many voices, one song WASHINGTON, D.C., 1999 Dr. Alfredo Raglio

A.A. 2012-2103

La Musicoterapia è ...l'uso della musica e/o dei suoi elementi (suono, ritmo, melodia e armonia) per opera di un musicoterapeuta qualificato, in un rapporto individuale o di gruppo, all interno di un processo definito, per facilitare e promuovere la comunicazione, le relazioni, l'apprendimento, la mobilizzazione , l'espressione l organizzazione ed altri obiettivi terapeutici degni di rilievo, nella prospettiva di assolvere i bisogni fisici, emotivi, mentali, sociali e cognitivi. La Musicoterapia si pone come scopi di sviluppare potenziali e/o riabilitare funzioni dell'individuo in modo che egli possa ottenere una migliore integrazione sul piano intrapersonale e/o interpersonale e, conseguentemente, una migliore qualità della vita attraverso la prevenzione, la riabilitazione o la terapia .

(8 th WORLD CONGRESS OF MUSIC THERAPY, AMBURGO, 1996) Dr. Alfredo Raglio

A.A. 2012-2103

Dr. Alfredo Raglio

A.A. 2012-2103

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

Unifob Health, Bergen, Norway

“…Music  therapy  is  University a  special   type   of  psychotherapy  where  forms  of  musical  interaction  and  communication  are  used  alongside  verbal   of Bergen, Norway Diakonale Hospital, Oslo, Norway communication.  It  Lovisenberg has  been   defined  as  “a  systematic  process  of  intervention  wherein  the  therapist  helps  the  client  to  promote  health,   using  music  experiences  and  the  relationships  developing  through  them  as  dynamic  forces  of  change”  (Bruscia,  1998).  The  types  of   ‘music  experiences’   can  include   a rused   t i cin   l emusic   i n ftherapy   o a b s tfree   r a acnd   t structured  improvisation,  other  types  of  active  music-­‐making  by   patients,  and  listening   to  music.  Improvisation  is  perhaps  the  most  prominent  form  of  musical  interaction  in  music  therapy.  It  has  been   Article history: Serious mental disorders have considerable individual and societal impact, and traditional treatments may Received 30 any   June 2008 described  as  central   in  m music  therapy  models.   lient(s)   and   therapist   n  musical   instruments   hey  have  chosen,   showClimited effects. Music therapy mayimprovise   be beneficial inopsychosis and depression, includingttreatmentReceived in revised form 6 January 2009 resistant cases. Theoaim of this review was t toheme.   examine the benefits of music therapy for speople with serious playing  together  freely   o r   w ith   a   g iven   s tructure   o r   a   m usical   r   n on-­‐musical   M usic   t herapists   a re   pecifically   trained  to   Accepted 12 January 2009 mental disorders. All existing prospective studies were combined using mixed-effects meta-analysis models, intervene  therapeutically  within  the  medium,  for  eallowing xample   to  support   by  pofroviding   rhythmical   or  pre-post tonal  study), grounding,   to  clarify,  to  confront   to examine the influence study design (RCT vs. CCT vs. type of disorder Keywords: (psychotic vs. non-psychotic), and number of sessions. Resultsm showed therapy, when added toin  music  therapy   Psychosis or  to  challenge  the   client's  expression  in  the  music   (Bruscia,   1987;  Wigram,   2004).   Other   odes  that of  music music   experiences   standard care, has strong and significant effects on global state, general symptoms, negative symptoms, Depression include  playing  composed   singing  aanxiety, nd  wfunctioning, riting  or  and improvising   songs   (Baker  dose–effect &  Wigram,   2005),   and  listening  to   musical engagement. Significant relationships were Psychotherapy music  on  instruments,  depression, identified for general, negative, and depressive symptoms, as well as functioning, with explained variance Dose–effect relationship music  (Grocke  &  W igram,  2006).  Songs  may  be  used   by  clients  as  a   Mixed-effects meta-analysis ranging from 73% to 78%. Small effect sizes for these outcomes are achieved after 3 to 10, large effects after 16 safe,  structuring  and  socially  acceptable  form  in  wtohich   they  The can   express   hich   might   be  helps too  people overwhelming   to   51 sessions. findings suggestfeelings   that music w therapy is o antherwise   effective treatment which with psychotic and non-psychotic severe mental disorders to improve global state, symptoms, and functioning. express.  Music  listening  may  be  helpful  to  bring  up  and  make  available  therapeutically  relevant  issues  (emotions,  associations,   Slight improvements can be seen with a few therapy sessions, but longer courses or more frequent sessions memories,  identity  issues).   are needed to achieve more substantial benefits. © 2009 o Elsevier Ltd. All rights reserved. All  these  different  modes  of  ‘music  experiences’  become  therapeutic  by  being  used  in  the  context   f  a  therapeutic   relationship.  Verbal   discussions,  reflections,  or  interpretations  connected  to  the  music  are  important  to  help  clients  explore  the  potential  meaning  of  an   experience,  and  to  Contents relate  a  new  experience  within  therapy  to  situations  in  the  client's  life.  The  degree  to  which  the  music  experience   itself,  versus  the  verbal   reflection   1. Introduction . . c . onnected   . . . . . . . .to   . i. t,   . i. s   . s.een   . . . a.s  . the   . . .active   . . . . a . gent   . . . . o. f  . c.hange   . . . . .m . ay   . . v . ary   . . . b.etween   . . . . . .m. odels   . . . . o . f  m 194usic  therapy   Music therapy in mentalH health. . . . t . reatments   . . . . . . . . t.hat   . . .rely   . . .solely   . . . . o . n   . .the   . . .d.irect   . . . e . ffects   . . . . .o.f  .m. usic   . . . a . lone,   . . . 194 (Garred,  2004),  as  well  1.1. as  between   clients.   owever,   which  do  not   1.2. Music therapy—the evidence to date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 “involve  or  depend  upon   rocess   of  intervention   nd  change   1.3. a  p Research questions addressed in thisareview . . . . .w . ithin   . . . . a.  c . lient–therapist   . . . . . . . . . . . .relationship”   . . . . . . . . . .(“auxiliary   . . . . . . . .level”,   . 195 Bruscia,  1998,  p.   Method T . he   . . .term   . . . .‘music   . . . . .m . edicine’   . . . . . . i. s   . s. ometimes   . . . . . . . .u.sed   . . t . o   . d . istinguish   . . . . . . . . s. uch   . . . t.reatments   . . . . . . . .from   . . . .m . usic   . 196therapy.”…   195),  are  not  music  t2.herapy.   Dr. Alfredo Raglio A.A. 2012-2103 b c

2.1.

Criteria 2.1.1. 2.1.2. 2.1.3. 2.1.4. 2.1.5.

for selecting studies Study design . . . Study quality . . . Participants . . . . Interventions . . . Outcomes. . . . .

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196 196 196 196 196 196

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

Received 14 June 2011; revised 8 August 2011; accepted 23 23 September September 2011. 2011. accepted

Neurology 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 relational training of music therapists, presence of concept: a therapeu011 The Authors which Mozart? The Requiem or an aria from Giovanni? 011 The Authors tic setting, a theoretical/methodological Don background, aims hiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry andBeatles Neurology Why Mozart and not the or B. McFerrin? And addressoriented to the achievement of stable and longlasting hiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology ing whom? Producing what? How? improvements (according to type gravity of pathologies With these queries in mind, theand international musicconsidered), content (active and/or receptive techniques) therapeutic community has introduced – as an essential com3,4 the facilitating intra-by and inter-personal with ponent of therapy music – the conceptrelationships of ‘relationship’. patient/client and rigorous assessment The above thoughts can help re-modelcriteria. music-therapeutic practices by introducing the following aspects Based I believe that neither music nor the(Evidence sonorous-musical 5,6 musical and if Music Therapy andtoEvidence Based Practice): element can fail keep these concepts in due consideration relational of music therapists, presence of aIn therapeuthey aretraining to assume a potential therapeutic value. therapeutic tic applications setting, a theoretical/methodological aims it is of essential importancebackground, that the individual’s oriented to the achievement of stable longmusicality and musical potential shouldand emerge: thislasting can only improvements (according to type and gravity of pathologies happen through the relationship between the music therapist considered), content (active 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-

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

Letters to the Editor 683 Psychiatry and Clinical Neuroscience 1. Sacks O. The power of muisc. Brain 2006; 129: 2528–2532.

2. Koelsch S. Towards a neural basis of music-evoked emotions. Trends Cogn.possible Sci. 2010; 14: 131–137. alizes the various interventions through Music Volume 65,itIssue 7, music. (/doi/10.1111/pcn.2011.65.issue-7/issu C. All those things with music J. Music can 3.beGold the source of deep pleasure, can(Editorial). stimulate Nord. relationTher.attentive 2009; 18:and 1–2.cognitive functions, but it becomes ships and , Kruger et alInformation . Dose-response relationship 4. Gold practice C, Solli HP therapeutic only in theVpresence of the essential com- in Additional muisc therapy above. for people with serious mental disorders: systemponents mentioned atic review and meta-analysis. Clin. Psychol. Rev. 2009; 29: 193– 207. How to Cite REFERENCES 5. Vink A, Bruinsma M. Evidence based music therapy. Music 1. Sacks O. The power of 4: muisc. Brain 2006; 129: Ther. Today 2003; 1–26. Available from2528–2532. URL: http://www. 2. Koelsch S. Towards a neural basis of music-evoked emotions. musictherapyworld.de (last accessed 4 JulyWhen 2004). music becomes music therapy. Psy Raglio, A. (2011), Trends Cogn. Sci. 2010; 14: 131–137. 6. Edwards J. Possibilities and problems for evidence-based prac3. Gold C. All those 683. things with music (Editorial). Nord. J. Music doi: 10.1111/j.1440-1819.2011.02273.x in music therapy. Arts Psychother. 2005; 32: 293–301. Ther.tice 2009; 18: 1–2. 4. Gold C, Solli HP, Kruger V et al. Dose-response relationship in

Alfredo Raglio, MA (Music Therapy) muisc therapy for people with serious mental disorders: systemSospiro Foundation, atic review and meta-analysis. Clin. Psychol. Rev. 2009;Cremona, 29: 193– Italy 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.

Author Information

Sospiro Foundation, Cremona, Italy, Email: raglioa@

Publication History

Alfredo Raglio, MA (Music Therapy) Cremona, Italy 19 DEC 2011 1. Sospiro IssueFoundation, published online: Email: [email protected] Article first 22 published online: 19 DEC 2011 Received 2. 25 July 2011; revised August 2011; accepted 23 September 2011.

http://onlinelibrary.wiley.com.bibliosan.cilea.it/doi/10.1111/j.1440-1819.2011.02273.x/fu

Dr. Alfredo Raglio

A.A. 2012-2103

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

A.A. 2012-2103

Altri interventi con la musica in ambito clinico… !   ATTIVITA’ DI PRODUZIONE MUSICALE !   ASCOLTO MUSICALE INDIVIDUALIZZATO !   BACKGROUND MUSIC !   MUSICA E MOVIMENTO !   …

QUALI OBIETTIVI? IN QUALE AMBITO CLINICO? QUALI CONTENUTI? QUALI PROFESSIONISTI? Dr. Alfredo Raglio QUALI MODALITA’ DI VERIFICA?...

A.A. 2012-2103

MUSIC THERAPY MODELS (WORLD FEDERATION OF MUSIC THERAPY, 1999)

!   CREATIVE MUSIC THERAPY (NORDOFF-

ROBBINS)

!   ANALITICAL MUSIC THERAPY (PRIESTLEY) !   BEHAVIORAL APPROACH (MADSEN) !   GUIDED IMAGERY AND MUSIC (BONNY) !   BENENZON MUSIC THERAPY (BENENZON)

Dr. Alfredo Raglio

A.A. 2012-2103

IN SINTESI… ORIENTAMENTO

ORIENTAMENTO

UMANISTICO

PSICODINAMICO





VALENZA ESPRESSIVA

VALENZA INTROSPETTIVA

(enfasi sulla componente estetica)

(enfasi sulla componente relazionale)





LA LIBERTA ESPRESSIVA FACILITA IL FLUSSO EMOTIVO EVITANDO IL BLOCCO DEL PENSIERO E DELLA CREATIVITA

L ASTENSIONE DALL AZIONE CONTATTA LE VERE EMOZIONI E SVILUPPA IL PENSIERO

Dr. Alfredo Raglio

A.A. 2012-2103

Quale musicoterapia? !   Musicoterapia !   musicoTerapia !   MusicoTerapia

Dr. Alfredo Raglio

A.A. 2012-2103

Altri modelli…

!   L’approccio neuroscientifico (ambito neurologico)

Dr. Alfredo Raglio

A.A. 2012-2103

Le principali tecniche…

!   TECNICHE IMPROVVISATIVE

!   TECNICHE RECETTIVE

Dr. Alfredo Raglio

A.A. 2012-2103

Gli ambiti applicativi… !   PSICHIATRICO !   NEUROPSICHIATRICO INFANTILE !   NEUROLOGICO !   GERIATRICO !   ONCOLOGICO/CURE PALLIATIVE !   …

Dr. Alfredo Raglio

A.A. 2012-2103

LA LETTERATURA SCIENTIFICA…

Dr. Alfredo Raglio

A.A. 2012-2103

LA RICERCA PUO’ ESSERE INTESA COME SISTEMATIZZAZIONE E VALUTAZIONE DELL’INTERVENTO TERAPEUTICO Dr. Alfredo Raglio

A.A. 2012-2103

Necessità di definire i contenuti degli interventi (M o MT)e di utilizzare metodologie di ricerca adeguate

Dr. Alfredo Raglio

A.A. 2012-2103

EVIDENCE  BASED  MEDICINE     ê   EVIDENCE  BASED     MUSIC  THERAPY  

(Edwards,  2002;  2004;  Vink  &  Bruinsma,  2003;  Rolvsjord  et  al.,  2005;  Abrams,  2010)   Dr. Alfredo Raglio

A.A. 2012-2103

“Evidence  Based  Music  Therapy  is  a   method  in  which  the  music  therapist,  in   each  decision  he  or  she  makes,  tries  to   integrate  best  available  scientific  evidence   with  his  or  her  own  experience,  combined   with  the  values,  expectations  and  wishes   of  his  or  her  patient.  Evidence  Based   Music  Therapy  is  based  on  the  principles   of  Evidence  Based  Medicine”.     (Vink  &  Bruinsma,  2003)   Dr. Alfredo Raglio

A.A. 2012-2103

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

A.A. 2012-2103

LA RICERCA IN MUSICOTERAPIA …

Dr. Alfredo Raglio

A.A. 2012-2103

LETTERATURA SCIENTIFICA …

Dr. Alfredo Raglio

A.A. 2012-2103

igram T W , T e l h TO, Da l a d l e H Gold C,

Musicoterapia e… Depressione (Maratos et al., 2009) •  Cure di fine vita (Bradt & Dileo, 2010) •  Danno cerebrale acquisito (Bradt et al., 2010) •  Autismo (Gold et al., 2010) • 

Demenza (Vink et al., 2011) •  Schizofrenia (Mössler et al., 2011) • 

ibrary Raglio … hed in The CochranDr.e LAlfredo

blis n and pu io t a r o b a e Coll Cochran e h T y b ed maintain ared and

A.A. 2012-2103

Esempi di RCTs in musicoterapia

Dr. Alfredo Raglio

A.A. 2012-2103

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

A.A. 2012-2103

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

A.A. 2012-2103

Background:  Music  therapy  has  been   proposed  as  a  valid  approach  for  behavioral   and  psychological  symptoms  (BPSD)  of   dementia.    

Dr. Alfredo Raglio

A.A. 2012-2103

Objective:  to  assess  MT  effectiveness  in   reducing  BPSD  in  persons  with  dementia.  

Dr. Alfredo Raglio

A.A. 2012-2103

  Methods:      

-­‐   Sixty  persons  with  moderate-­‐severe  dementia  (CDR  2-­‐4)  

-­‐  Experimental  group  (n=30):  30-­‐36  MT  sessions  (30  min/ session)   -­‐  Control  group  (n=30):  educational  support  or  entertainment   activities.   -­‐  Subjects  were  randomly  assigned  to  experimental  or  control   group     -­‐  multidimensional  assessment  (MMSE,  Barthel  Index  and  NPI)   -­‐  Improvisational/intersubjective  MT  approach   -­‐   Music  therapists:  5-­‐year  training  focused  on  the  relational  MT   approach  applied  in  particular  on  persons  with  dementia   -­‐   MT  evaluation:  items  taken  from  MTCS  (Raglio  et  al.,  2006)   Dr. Alfredo Raglio

A.A. 2012-2103

  Main  difference  between  the  two  studies:           -­‐   The  first  study  was  based  on  a  continuous  treatment:  30  

biweekly  sessions  (16  weeks)  

-­‐ The  second  study  was  based  on  3  cycles  of  12  sessions  each,  3   times  a  week  (36  sessions)  and  each  cycle  of  treatment  was   followed  by  1  month  of  wash-­‐out    

Dr. Alfredo Raglio

A.A. 2012-2103

MAIN RESULTS (first study)

Dr. Alfredo Raglio

A.A. 2012-2103

RaglioDisord et al Alzheimer Dis Assoc

Windows. The cognitive, functional, and behavioral 35 scores were submitted to a mixed analysis of variance, 30 25 with 1 repeated (time: before, after 8wk, after 16wk 20 25 ** 15 and4wkafterendoftreatment)and1independentfactor *** *** 10 (group: experimental and control). Dementia severity 20 ** 5 15 was considered as covariate. *** *** 0 Each NPI item score was submitted to Friedmann’s 10 4 weeks after Before Treatment After 8 weeks After 16 weeks end of analysis of variance for nonparametric data,25 comparing treatment 5 the variations occurred Experimental in the 4 differentGroup surveys (beforeControl Group the treatment, 8wk and 16wk after beginning of 0 Before Treatment After 8 weeks After 16 weeks 4 weeks after FIGURE 1. Average NPI global scores in the experimental and treatment and**P