Strategies to enhance treatment fidelity and music-based intervention reporting in dementia research.

Creative solutions are needed to address the well-being of the growing number of individuals living with dementia. Music-based interventions (MBIs) are promising and can be cost-effective; however, empirical evidence for MBIs is limited and published findings have not been widely translated into practice. Here, we describe how we implemented strategies to enhance rigor in a randomized clinical trial of an MBI for persons with dementia. We examined the impact of a singing-based MBI on feelings, emotions, and social engagement, relative to a non-music treatment (verbal discussion), delivered in small group format (25 minutes, 3 times/week for 2 weeks). We implemented National Institutes of Health Behavior Change Consortium strategies regarding: (i) design, (ii) interventionist training, (iii) treatment delivery, (iv) treatment receipt, and (v) treatment skills enactment. We applied the MBI Reporting Criteria including: (i) theoretical framework, (ii) musical content, (iii) dosage, (iv) interventionist, (v) treatment fidelity, (vi) setting, and (vii) delivery unit. We analyzed data with a separate linear mixed model for each dependent variable. 32 older adults with dementia (65-97 years) participated. The MBI yielded significant positive effects on all measured outcomes (all p's < .05). Application of established guidelines enhanced methodological rigor and MBI reproducibility. To support translation of research into practice, clinicians should understand how to implement an MBI reported in research. Our study illustrates practical steps to address the need for improved MBI research in persons with dementia and can provide a model for others to enhance evidence-based practice with this population.

Music-based interventions (MBIs) can be very effective in improving the psychosocial well-being of persons with dementia. Nonetheless, scientific evidence to support the use and appropriate application of MBIs for this population is very limited and often not applied in care settings. Here, we describe how we used established guidelines to conduct a rigorous experiment of an MBI for persons with dementia in nursing homes. Specifically, we examined the impact of a live singing-based MBI on feelings, emotions, and social engagement, relative to a non-music treatment (verbal discussion). We implemented National Institutes of Health Behavior Change Consortium strategies regarding study design and implementation and the MBI Reporting Criteria to thoroughly describe implementation principles and components of the MBI. We learned that the MBI resulted in significant, positive effects on all measured outcomes. Application of established guidelines helped ensure that our study was rigorous and the MBI could be reproduced in practice. Clinicians should understand how to implement an MBI reported in research. Our study illustrates practical steps to appropriately describe an MBI and addresses the need for improved MBI research in persons with dementia. Our work provides a model for how such an approach could be used in other similar work.

Culture influences conscious appraisal of, but not automatic aversion to, acoustically rough musical intervals.

There is debate whether the foundations of consonance and dissonance are rooted in culture or in psychoacoustics. In order to disentangle the contribution of culture and psychoacoustics, we considered automatic responses to the perfect fifth and the major second (flattened by 25 cents) intervals alongside conscious evaluations of the same intervals across two cultures and two levels of musical expertise. Four groups of participants completed the tasks: expert performers of Lithuanian Sutartines, English speaking musicians in Western diatonic genres, Lithuanian non-musicians and English-speaking non-musicians. Sutartines singers were chosen as this style of singing is an example of 'beat diaphony' where intervals of parts form predominantly rough sonorities and audible beats. There was no difference in automatic responses to intervals, suggesting that an aversion to acoustically rough intervals is not governed by cultural familiarity but may have a physical basis in how the human auditory system works. However, conscious evaluations resulted in group differences with Sutartines singers rating both the flattened major as more positive than did other groups. The results are discussed in the context of recent developments in consonance and dissonance research.

Pop Music Singing in Education with Modern Innovative Technologies: How the Chinese Language Shapes the Creation of Popular Singing.

The purpose of this study is to investigate the uniqueness of the pop singing genre by determining the role of the Chinese language in the creation of popular singing in education with modern innovative technologies. The paper began by determining which types of popular music were the most popular among respondents and the influence of modern innovative technologies on music education. The results showed that popular folk music (25%) and popular music (23%) are the most popular genres. This is because they are based on improvisational elements and combine modern and ethnic musical elements with the use of modern innovative technologies. Pentatonic preservation (94.3), modern innovative technologies (91.2), expressive performance (85.6), sound fluidity and mobility (82) and instrumental accompaniment have been identified as the most defining characteristics of contemporary Chinese popular music (78.1). Taking into account how pure and expressive Chinese music is, the study found that singing should take into account the following aspects of the Chinese language: the tonality of vowels, the influence of consonant sounds, the use of sound imitations, the performance of words with different levels of complexity, and the relationship between speech and musical intonation. It has been proven that students in group 1 who studied vocals and were taught the rules for combining phonetic features of language when singing had better results in terms of quality performance (0.83) and expressive performance (0.91). The non-professional singers in group 2 attained scores of 0.62 and 0.85, respectively.

Sámi traditional medicine and complementary and alternative medicine - a descriptive study of use within the Sámi population of Sweden.

Traditional medicine has been practised for millennia in the Sámi population, based on a Sámi worldview and cosmology, which includes natural remedies, prayers, drums and yoik singing. During the Christianisation of the Sámi during the seventeenth and eighteenth centuries, these practices were condemned. In recent years, however, a revival of Sámi culture has occurred and so has the practice of Sámi traditional medicine (STM) and the use of complementary alternative medicine (CAM). The aim of this study is to map the prevalence and use of STM and CAM among Sámi in Sweden today. The study population consisted of 3641 Sámi from the whole of Sweden, who had participated in the population-based cross-sectional survey Sámi Health on Equal Terms (SámiHET) in 2021. Our results show that women are more prone to use both STM and CAM than men and that younger persons are more likely to use STM and CAM than elderly persons. STM is more often used in the northern parts of Sápmi compared to the southern parts as well as a lower use of CAM in the north. This might be due to the stronger Sámi identity and easier access to traditional Sámi healers/helpers in the north as well as limited access to CAM services.

Does the Sound of a Singing Bowl Synchronize Meditational Brainwaves in the Listeners?

This study aims to verify if the beating sound of a singing bowl synchronizes and activates brain waves during listening. The singing bowl used in this experiment produce beats at a frequency of 6.68 Hz, while it decays exponentially and lasts for about 50 s. Brain waves were measured for 5 min in the F3 and F4 regions of seventeen participants (eight males and nine females, average age 25.2) who heard the beating singing bowl sounds. The experimental results showed that the increases (up to ~251%) in the spectral magnitudes of the brain waves were dominant at the beat frequency compared to those of any other clinical brain wave frequency bands. The observed synchronized activation of the brain waves at the beating sound frequency supports that the singing bowl sound may effectively facilitate meditation and relaxation, considering that the beat frequency belongs to the theta wave region which increases in the relaxed meditation state.

The arts in dementia: instrumental and experiential perspectives.

The indirect experience of dementia mediated through the arts shapes our preconceptions, educating us to understand dementia, gaining a deeper appreciation of how it may affect an individual. By contrast dementia research has largely regarded the arts through an 'instrumental' lens. They are treated as complex psychosocial interventions. Evidence from research on the arts and dementia remains piecemeal because most studies are small and not all are well designed. For numerous reasons the arts warrant further evaluation and investigation in relation to their potential impact on people with dementia. That research needs to be better-designed and adequately funded if it is to advance knowledge in this field. This is fraught with difficulties: the arts are dynamic and interactive; the medium (intervention) can be affected unpredictably by those people who engage with it. Many creative activities are deliberately participatory; think of group singing or stand-up comedy. The influence of human variability in relation to arts interventions means that large studies are necessary to control for individual differences. Moreover, few studies of the arts in dementia have been designed adequately to account for the intra-group interaction that is characteristic of many arts activities. Then, there is a lack of clarity around the purpose of the arts in dementia. There is scope for the development and adoption of comprehensive theoretical frameworks to guide research into the arts and dementia. This editorial sets out to clarify some aspects of the arts in dementia in order to pave way for further work.

"Follow the Musical Road": Selecting Appropriate Music Experiences for People with Dementia Living in the Community.

There are many music experiences for people with dementia and their caregivers including but not limited to individualized playlists, music and singing groups, dementia-inclusive choirs and concerts, and music therapy. While the benefits of these music experiences have been well documented, an understanding of the differences between them is often absent. However, knowledge of and distinction between these experiences are crucial to people with dementia and their family members, caregivers, and health practitioners to ensure a comprehensive music approach to dementia care is provided. Considering the array of music experiences available, choosing the most appropriate music experience can be challenging. This is an exploratory phenomenological study with significant Public and Patient Involvement (PPI). Through consultation with PPI contributors with dementia via an online focus group and senior music therapists working in dementia care via online semi-structured interviews, this paper aims to identify these distinctions and to address this challenge by providing a visual step-by-step guide. This guide can be consulted when choosing an appropriate music experience for a person with dementia living in the community.

Music Therapy Increases Social and Emotional Well-Being in Persons With Dementia: A Randomized Clinical Crossover Trial Comparing Singing to Verbal Discussion.

The number of people living with Alzheimer's disease and related dementias (ADRD) is growing proportional to our aging population. Although music-based interventions may offer meaningful support to these individuals, most music therapy research lacks well-matched comparison conditions and specific intervention focus, which limits evaluation of intervention effectiveness and possible mechanisms. Here, we report a randomized clinical crossover trial in which we examined the impact of a singing-based music therapy intervention on feelings, emotions, and social engagement in 32 care facility residents with ADRD (aged 65-97 years), relative to an analogous nonmusic condition (verbal discussion). Both conditions were informed by the Clinical Practice Model for Persons with Dementia and occurred in a small group format, three times per week for two weeks (six 25-minute sessions), with a two-week washout at crossover. We followed National Institutes of Health Behavior Change Consortium strategies to enhance methodological rigor. We predicted that music therapy would improve feelings, positive emotions, and social engagement, significantly more so than the comparison condition. We used a linear mixed model approach to analysis. In support of our hypotheses, the music therapy intervention yielded significant positive effects on feelings, emotions, and social engagement, particularly for those with moderate dementia. Our study contributes empirical support for the use of music therapy to improve psychosocial well-being in this population. Results also highlight the importance of considering patient characteristics in intervention design and offer practical implications for music selection and implementation within interventions for persons with ADRD.

Articulation posture influences pitch during singing imagery.

Facial muscle activity contributes to singing and to articulation: in articulation, mouth shape can alter vowel identity; and in singing, facial movement correlates with pitch changes. Here, we examine whether mouth posture causally influences pitch during singing imagery. Based on perception-action theories and embodied cognition theories, we predict that mouth posture influences pitch judgments even when no overt utterances are produced. In two experiments (total N = 160), mouth posture was manipulated to resemble the articulation of either /i/ (as in English meet; retracted lips) or /o/ (as in French rose; protruded lips). Holding this mouth posture, participants were instructed to mentally "sing" given songs (which were all positive in valence) while listening with their inner ear and, afterwards, to assess the pitch of their mental chant. As predicted, compared to the o-posture, the i-posture led to higher pitch in mental singing. Thus, bodily states can shape experiential qualities, such as pitch, during imagery. This extends embodied music cognition and demonstrates a new link between language and music.

The Effect of Contingent Singing on Infants with Bronchopulmonary Dysplasia in the Neonatal Intensive Care Unit.

A significant component of care for infants with bronchopulmonary dysplasia (BPD) is providing an optimal environment for supporting neurodevelopment and growth. Interventions that support the behavioral and physiologic stability of this population may play an important role in improving overall outcomes. Contingent singing is a music intervention that allows the caregiver to tailor certain musical elements, such as rhythm and tempo, to match behavioral and physiologic cues and support the infant in achieving optimal stabilization. A randomized crossover design was used to study the effect of contingent singing on the behavioral state and physiologic measures compared to standard care practices in the neonatal intensive care unit (NICU). Data were collected on a sample of 37 infants diagnosed with BPD. There were no significant differences in the physiologic measures or behavioral states of infants in the contingent singing sessions compared to control sessions. Parents and staff reported favorable views of music therapy in the NICU, and there were no adverse responses from infants during contingent singing. Further research is needed to determine the effectiveness of this intervention on the physiologic stability of infants with BPD.

The song that never ends: The effect of repeated exposure on the development of an earworm.

An "earworm"-the experience of a catchy melody that repeats persistently in the mind-is a ubiquitous yet mysterious cognitive phenomenon. Previous research demonstrates that earworms for vocal music engage working memory resources, manifesting as "inner singing." This study investigated whether this effect is moderated by prior exposure to music. In one experimental session, participants (N = 44) were presented with four novel song choruses. To manipulate exposure, each song was presented between one and four times, counterbalanced across participants. The following day, participants undertook a serial recall task during and following presentation of each song. In addition, they rated the music on familiarity, enjoyment, their desire to sing along, and perceived catchiness, both before and following the experiment. Increased exposure to novel songs on the first day tended to result in greater interference on task performance during and following their presentation on the second day, yet the effect varied depending on the song. Ratings of the desire to sing along and perceived familiarity increased significantly between the sessions for all songs. These findings are important in understanding the relative influence of familiarity and song-level characteristics on the development of an earworm.

Singing Interventions in Pulmonary Rehabilitation: A Scoping Review.

(1) Background: Individuals with pulmonary disease need intensive and consistent rehabilitation due to their high risk for serious illness and long-term complications. The purpose of this scoping review was to provide a comprehensive analysis of relevant research regarding the use of singing in pulmonary rehabilitation. (2) Methods: A systematic literature search was performed using the PsycINFO, CINAHL, PubMed, and Web of Science databases. A search for studies that employed singing in pulmonary rehabilitation for patients with pulmonary disease was conducted. (3) Results: Studies that met the selection criteria were summarized and analyzed. Twenty-seven studies were included in the final analysis. Results showed that research using singing in pulmonary rehabilitation generally employed an intervention with structured tasks and additional home practice or socialization time. However, the singing procedure in each intervention was not always specifically described and the findings were inconsistent. (4) Conclusions: Programmed singing interventions can support lung health and be an effective component of pulmonary rehabilitation. The therapeutic singing method in relation to respiratory exercises should be integrated into the main activity in the intervention. Overall, singing has physical and psychosocial effects, leading to improvements in symptoms, but more research is necessary to ensure that the respiratory needs of people with pulmonary disease are adequately met.

Voice-Related Problems, Vocal and Non-Vocal Habits in Naradiya Kirtankars: A Preliminary Study.

OBJECTIVE: Naradiya kirtan is a part of India's rich folk heritage. Voice demands of the kirtankar (kirtan performer) include a combination of recitation, narration, and singing. Slight to moderate deviations in their voice could hamper their public image as well as endanger their career. A preliminary study was undertaken to explore the voice problems, vocal and non-vocal habits of Naradiya kirtankars. STUDY DESIGN: Cross-sectional study design. METHOD: A 22-item questionnaire was developed in English language and translated to Marathi language. This questionnaire was administered on 40 Naradiya kirtankars through purposive sampling. Participants included Naradiya kirtankars located in Mumbai and Pune cities with minimum of one-year training in the field and proficiency in Marathi language. RESULTS: Statistical analysis revealed that kirtankars might be at a risk of developing voice problems. Among the kirtankars with voice problems, frequently pursued primary occupations involving extensive voice use, performed in a noisy environment, indulged in excessive talking, strained the neck muscles while voicing, impersonated voice, had reduced duration of sleep, and hearing difficulty as compared to kirtankars without voice problems. CONCLUSION: Study findings highlight the need for dedicated efforts towards increasing the awareness among the kirtankars' about the vocal, non-vocal factors associated with voice problems and the role of voice health-care professionals in voice care.

Scoping review of music therapy and music interventions in spinal cord injury.

PURPOSE: Spinal cord injury (SCI) has lifelong implications requiring treatment for outcomes including respiratory function, voice, pain, mood, and gait, among others. Music therapy (MT) and music-based interventions may be useful in the treatment of several outcomes. This review describes the use of MT and music-based interventions in individuals with SCI for rehabilitation and health and highlights future research priorities. MATERIALS AND METHODS: MEDLINE, Embase, PsycInfo, CINAHL, RILM, Music Periodicals and Music Index were searched. Search terms included: SCI and music. Studies of cohorts with SCI using music interventions and descriptions of adapted instruments or development of MT programs were included. Abstracts and full texts were reviewed in duplicate. Data were extracted according to clinical outcomes. A structured synthesis was performed. RESULTS: Forty-three studies were included. Research in the field includes quantitative, qualitative and mixed-methods studies. Group singing and an individual songwriting program for self-concept were the most studied interventions. Outcomes varied; mood outcomes were most common. CONCLUSION: While qualitative data support the use of MT and music-based interventions in this population for a wide variety of outcomes, randomized controlled trials are needed. There is a lack of research on the use of individual MT in this population. Registration: osf.io/9m8v4 Implications for RehabilitationIndividuals with spinal cord injury (SCI) often suffer from injury complications and significant medical morbidity requiring practical long-term treatment and wellness strategies.Music therapy (MT) and music-based interventions can be used for many rehabilitation and health goals in this population including mood, gait and respiratory function, among others.Preliminary qualitative and quantitative studies have reported the benefits of MT across a range of outcomes in individuals with SCI; however, additional research, especially evaluating individual MT interventions, is needed.

Association of Genre of Singing and Phonotraumatic Vocal Fold Lesions in Singers.

OBJECTIVES/HYPOTHESIS: To determine if (1) the likelihood of presenting with phonotraumatic lesions differs by singing genre in treatment-seeking singers and (2) if the distribution of phonotraumatic lesion types differs by singing genre. STUDY TYPE: Retrospective. METHODS: Records of singers who presented with a voice complaint over the course of 2.5 years (June 2017-December 2019) were reviewed to determine the proportion of those with phonotraumatic lesions as a function of genre (Study 1). Separately, the lesion types and genres of singers diagnosed with phonotraumatic lesions over a 9-year period (July 2011-March 2020) were determined (Study 2). RESULTS: In Study 1, 191 of 712 (26.8%) dysphonic singers were diagnosed with phonotraumatic lesions. Country/folk, gospel/jazz, and musical theater singers were more likely to present with phonotraumatic lesions. In Study 2, in 443 singers with phonotraumatic lesions, polyps and pseudocysts, but not nodules, were found to be distributed unequally across genres (χ2 p = 0.006, p < 0.0001, p = 0.064, respectively). Praise/worship singers had significantly higher proportions of polyps compared to choral singers (OR 4.8 [95% CI 1.9-12.5]) or compared to musical theater singers (OR 7.2 [95% CI 2.5-20.8]). Opera singers had significantly higher proportions of pseudocysts than choral singers (OR 3.1 [95% CI 1.5-6.1]) or musical theater singers (OR 3.7 [95% CI 1.8-7.6]). CONCLUSIONS: The higher incidence of polyps in praise/worship singers likely reflects the more emphatic nature of singing and the tendency for acute injury. The higher incidence of pseudocysts in opera singers may reflect a more chronic nature of injury. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:1683-1689, 2023.

Tamil Songs of Mourning: Understanding the Reflection of Times in Oppari Songs.

Oppari-the folksong of Tamil Nadu and North-Eastern parts of Sri Lanka, is known as the Tamil song of mourning. The practice of women singing oppari is prevalent in the suburban and rural spaces of Tamil Nadu. They form a circle, weep, beat their chest, wail and jump on the beats of Parai (single-sided drum) music on the death of a member of a family as reported by Srinivas (Oppari: An art of Weeping, Wailing and Lamenting, 2019). The women in the region express their grief over the death of their beloved with the lyrics of oppari songs. Of late, professional oppari singers, including both female and male, have been invited to rural and urban Tamil Nadu on the death of a member in the well-off families to mourn for the deceased person. This distinctively South Indian genre of weeping songs has evolved with time. The lyrics of the oppari songs have been blended with the essence of the periodical changes. The content, context, and presentation of the oppari songs have been playing important roles to reflect the makeovers of times. This study attempts to understand the reflection of times in the lyrics of oppari songs by assiduously employing semiotic analysis. The analysis of the words of the content, context indicated and presentation of subject, period, and expression in lyrics of the oppari songs has been made in the paper. The analysis of three oppari songs gives some significant ideas about the different times of history.

Research Progress of Music Therapy on Gait Intervention in Patients with Parkinson's Disease.

Music therapy is an effective way to treat the gait disorders caused by Parkinson's disease. Rhythm music stimulation, therapeutic singing, and therapeutic instrument performance are often used in clinical practice. The mechanisms of music therapy on the gait of patients with Parkinson's disease include the compensation mechanism of cerebellum recruitment, rhythm entrainment, acceleration of motor learning, stimulation of neural coherence, and increase of cortical activity. All mechanisms work together to complete the intervention of music therapy on patients' gait and help patients to recover better. In this paper, the effect of music therapy on gait disorders in Parkinson's disease patients was reviewed, and some suggestions were put forward.

Improvisation is a novel tool to study musicality.

Humans spontaneously invent songs from an early age. Here, we exploit this natural inclination to probe implicit musical knowledge in 33 untrained and poor singers (amusia). Each sang 28 long improvisations as a response to a verbal prompt or a continuation of a melodic stem. To assess the extent to which each improvisation reflects tonality, which has been proposed to be a core organizational principle of musicality and which is present within most music traditions, we developed a new algorithm that compares a sung excerpt to a probability density function representing the tonal hierarchy of Western music. The results show signatures of tonality in both nonmusicians and individuals with congenital amusia, who have notorious difficulty performing musical tasks that require explicit responses and memory. The findings are a proof of concept that improvisation can serve as a novel, even enjoyable method for systematically measuring hidden aspects of musicality across the spectrum of musical ability.

Neural processing of poems and songs is based on melodic properties.

The neural processing of speech and music is still a matter of debate. A long tradition that assumes shared processing capacities for the two domains contrasts with views that assume domain-specific processing. We here contribute to this topic by investigating, in a functional magnetic imaging (fMRI) study, ecologically valid stimuli that are identical in wording and differ only in that one group is typically spoken (or silently read), whereas the other is sung: poems and their respective musical settings. We focus on the melodic properties of spoken poems and their sung musical counterparts by looking at proportions of significant autocorrelations (PSA) based on pitch values extracted from their recordings. Following earlier studies, we assumed a bias of poem-processing towards the left and a bias for song-processing on the right hemisphere. Furthermore, PSA values of poems and songs were expected to explain variance in left- vs. right-temporal brain areas, while continuous liking ratings obtained in the scanner should modulate activity in the reward network. Overall, poem processing compared to song processing relied on left temporal regions, including the superior temporal gyrus, whereas song processing compared to poem processing recruited more right temporal areas, including Heschl's gyrus and the superior temporal gyrus. PSA values co-varied with activation in bilateral temporal regions for poems, and in right-dominant fronto-temporal regions for songs. Continuous liking ratings were correlated with activity in the default mode network for both poems and songs. The pattern of results suggests that the neural processing of poems and their musical settings is based on their melodic properties, supported by bilateral temporal auditory areas and an additional right fronto-temporal network known to be implicated in the processing of melodies in songs. These findings take a middle ground in providing evidence for specific processing circuits for speech and music in the left and right hemisphere, but simultaneously for shared processing of melodic aspects of both poems and their musical settings in the right temporal cortex. Thus, we demonstrate the neurobiological plausibility of assuming the importance of melodic properties in spoken and sung aesthetic language alike, along with the involvement of the default mode network in the aesthetic appreciation of these properties.

Benefits of choir singing on complex auditory encoding in the aging brain: An ERP study.

Aging is accompanied by difficulties in auditory information processing, especially in more complex sound environments. Choir singing requires efficient processing of multiple sound features and could, therefore, mitigate the detrimental effects of aging on complex auditory encoding. We recorded auditory event-related potentials during passive listening of sounds in healthy older adult (≥ 60 years) choir singers and nonsinger controls. We conducted a complex oddball condition involving encoding of abstract regularities in combinations of pitch and location features, as well as in two simple oddball conditions, in which only either the pitch or spatial location of the sounds was varied. We analyzed change-related mismatch negativity (MMN) and obligatory P1 and N1 responses in each condition. In the complex condition, the choir singers showed a larger MMN than the controls, which also correlated with better performance in a verbal fluency test. In the simple pitch and location conditions, the choir singers had smaller N1 responses compared to the control subjects, whereas the MMN responses did not differ between groups. These results suggest that regular choir singing is associated both with more enhanced encoding of complex auditory regularities and more effective adaptation to simple sound features.