[Music therapy in adults with cochlear implants : Effects on music perception and subjective sound quality]. / Musiktherapie bei erwachsenen CI-Trägern : Effekte auf die Musikwahrnehmung und die subjektive Klangqualität.

BACKGROUND: People with severe hearing impairments and deafness can achieve good speech comprehension using a cochlear implant (CI), although music perception often remains impaired. A novel concept of music therapy for adults with CI was developed and evaluated in this study. METHODS: This study included 30 adults with a unilateral CI following postlingual deafness. The subjective sound quality of the CI was rated using the hearing implant sound quality index (HISQUI) and musical tests for pitch discrimination, melody recognition and timbre identification were applied. As a control 55 normally hearing persons also completed the musical tests. RESULTS: In comparison to normally hearing subjects CI users showed deficits in the perception of pitch, melody and timbre. Specific effects of therapy were observed in the subjective sound quality of the CI, in pitch discrimination into a high and low pitch range and in timbre identification, while general learning effects were found in melody recognition. CONCLUSION: Music perception shows deficits in CI users compared to normally hearing persons. After individual music therapy in the rehabilitation process, improvements in this delicate area could be achieved.

[Music therapy for noisiform tinnitus. Concept development and evaluation]. / Musiktherapie bei nichttonalem Tinnitus (Tinnitusrauschen). Konzeptentwicklung und Behandlungsevaluation.

BACKGROUND: Music therapy in chronic tonal tinnitus according to the "Heidelberger model" presents an effective treatment, which is substantiated by neuroscientific and psychological evaluation. METHOD: The music therapy approach was specifically extended to include noisiform tinnitus, taking sound quality and cardiovascular influences into consideration. Outcome criteria were psychological tinnitus load, psychophysiologic parameters and brain imaging procedures. RESULTS: Psychological outcomes of the pilot study indicate that 21 of the 23 patients (i.e. more than 90%) achieved a reliable reduction of symptoms (TQ scores: pre: 40.1 ± 11.4; post: 27.9 ± 12.8; at 3-month-follow-up: 24.0 ± 12.2). Results of the imaging examinations demonstrated neuroplastic changes in the putamen and insula. Psychophysiological measurements indicate cardiovascular influences on noisiform tinnitus. DISCUSSION: Therapy success depends on the sound quality of the tinnitus; therefore, any treatment should take this into consideration. Cardiovascular influences were important insofar as active control of the heart rate was an important predictor of long-term therapy outcome. Overall, brain imaging data confirm the top-down-model of tinnitus generation.

[Music therapy in chronic tonal tinnitus. Heidelberg model of evidence-based music therapy]. / Musiktherapie bei chronisch-tonalem Tinnitus. Heidelberger Modell evidenzbasierter Musiktherapie.

Tinnitus has a very high prevalence, with more than one million patients in the German population needing treatment for it. About 50% of them suffer from so-called tonal tinnitus, i.e., tinnitus with a well-defined frequency. Although tinnitus is one of the most common symptoms in ENT medicine, the existing treatments are polypragmatic and often lack a scientific foundation. Based on this fact, a novel music therapy concept was developed, evaluated, and scientifically substantiated (with psychological, audiological, and functional imaging procedures in the diagnosis and treatment). The advantages of the described therapy are the integration of known and well-proven acoustic and psychotherapeutic techniques. They were converted to specific music therapy interventions (resonance training, neuroauditive cortex reprogramming, and tinnitus desensitization). More than 190 patients suffering from chronic tonal tinnitus were effectively treated. The results indicate that the therapy is highly advantageous in terms of treatment duration, effectiveness, and follow-up stability compared with customary interventions. Furthermore, the results of brain imaging strongly suggest the usefulness of further investigation and discussion in the realm of neuronal tinnitus modeling.

Rhythmic auditory stimulation improves gait more than NDT/Bobath training in near-ambulatory patients early poststroke: a single-blind, randomized trial.

OBJECTIVES: The effectiveness of 2 different types of gait training in stroke rehabilitation, rhythmic auditory stimulation (RAS) versus neurodevelopmental therapy (NDT)/Bobath- based training, was compared in 2 groups of hemiparetic stroke patients over a 3-week period of daily training (RAS group, n = 43; NDT/Bobath group =35). METHODS: Mean entry date into the study was 21.3 days poststroke for the RAS group and 22.3 days for the control group. Patients entered the study as soon as they were able to complete 5 stride cycles with handheld assistance. Patients were closely equated by age, gender, and lesion site. Motor function in both groups was pre-assessed by the Barthel Index and the Fugl-Meyer Scales. RESULTS: Pre- to posttest measures showed a significant improvement in the RAS group for velocity (P = .006), stride length (P = .0001), cadence (P = .0001) and symmetry (P = .0049) over the NDT/Bobath group. Effect sizes for RAS over NDT/Bobath training were 13.1 m/min for velocity, 0.18 m for stride length, and 19 steps/min for cadence. CONCLUSIONS: The data show that after 3 weeks of gait training, RAS is an effective therapeutic method to enhance gait training in hemiparetic stroke rehabilitation. Gains were significantly higher for RAS compared to NDT/Bobath training.

[Music therapy for tinnitus patients: an interdisciplinary pilot study of the Heidelberg Model]. / Musiktherapie bei Tinnitus: Interdisziplinäre Pilotstudie zur Uberprüfung des Heidelberger Modells.

BACKGROUND: Chronic tinnitus, one of the most common disorders in ENT medicine, requires comprehensive and interdisciplinary treatment. OBJECTIVE: An innovative music therapy approach, developed at the German Center for Music Therapy Research in cooperation with the ENT clinic of the University of Heidelberg ("Heidelberg Model"), strives to integrate the tinnitus sound into a musically controllable acoustic process. The aim of the present study is to evaluate the effectiveness of this current treatment. METHODS: We carried out a prospective, two-armed (music therapy group vs control group) study with 20 patients (10 males, 10 females; mean age 51+/-7 years), suffering from decompensated chronic tinnitus (mean score in the Tinnitus Questionnaire TQ=46.8+/-9.6). The target variables involved TQ values, pre- and post-measurements, and follow-up after 3 and 6 months. RESULTS: Group comparison yields a highly statistically and clinically significant decrease in mean TQ-scores pre- and post in the music therapy group by 25 points or 52% on average as compared to 2 points (4%) in the control group [univariate ANOVA: (F(1,31)=14.19, P=0.001), effect size d=1.73]. Logarithmic regression analysis reveals a fast onset and long lasting effect of music therapy (B=-8.9; F(1,125)=32.11, P=0.000). DISCUSSION: The effectiveness of this highly economic approach was proven as the innovative music therapy concept yields statistically and clinically significant results which remain stable throughout follow-up. Further investigations with larger sample sizes and using brain imaging should strengthen these findings.

Music therapy as specific and complementary training for adults after cochlear implantation: A pilot study.

OBJECTIVES: Although cochlear implant (CI) users achieve good speech comprehension, they experience difficulty perceiving music and prosody in speech. As the provision of music training in rehabilitation is limited, a novel concept of music therapy for rehabilitation of adult CI users was developed and evaluated in this pilot study. METHODS: Twelve unilaterally implanted, postlingually deafened CI users attended ten sessions of individualized and standardized training. The training started about 6 weeks after the initial activation of the speech processor. Before and after therapy, psychological and musical tests were applied in order to evaluate the effects of music therapy. CI users completed the musical tests in two conditions: bilateral (CI + contralateral, unimplanted ear) and unilateral (CI only). RESULTS: After therapy, improvements were observed in the subjective sound quality (Hearing Implant Sound Quality Index) and the global score on the self-concept questionnaire (Multidimensional Self-Concept Scales) as well as in the musical subtests for melody recognition and for timbre identification in the unilateral condition. Discussion Preliminary results suggest improvements in subjective hearing and music perception, with an additional increase in global self-concept and enhanced daily listening capacities. CONCLUSIONS: The novel concept of individualized music therapy seems to provide an effective treatment option in the rehabilitation of adult CI users. Further investigations are necessary to evaluate effects in the area of prosody perception and to separate therapy effects from general learning effects in CI rehabilitation.