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This paper presents a case of a 35-year-old female patient diagnosed with Complex Regional Pain Syndrome (CRPS) type I and treated over a two-month period with a novel low-frequency sound-transduced focal pulsed stimulus. The patient received 21 treatments consisting of focally applied sound sweeps in the 15-100 Hz range. Outcome measures included the Visual Analogue Scale for pain, five physical assessment parameters, medication, and the Pain Catastrophizing Scale. A follow-up was conducted at six months. The results show that the patient's low-back pain level was substantially reduced after treatment and after six months. CRPS-related peripheral pain was strongly reduced but had some rebound after six months. The low-frequency sound-transduced focal pulsed stimulus shows potential as a non-invasive treatment for CRPS and deserves controlled clinical trials.

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Dementia prevalence is increasing globally, and symptom management and treatment strategies require further investigation. Music-based interventions have demonstrated some efficacy with respect to quality of life and symptom reduction, though limited with respect to cognition. This study reports on three case studies where the use of gamma stimulation over one year contributed to maintenance of cognition and increases in mood for participants with Alzheimer's disease or mild cognitive impairment. Auditory stimulation with isochronous sound at 40 Hz was delivered to participants via a commercially available vibroacoustic chair device five times per week for 30 min with assistance from caregivers. Further research is needed to assess the integration of this therapy in the overall care for persons with dementia.

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A 49-year-old male with severe low back pain (LBP) showed multilevel disc bulges with spinal stenosis. After 18 novel low-frequency sound wave treatments, initial VAS pain score of 9.5 reduced to 2.5 and the Rolland-Morris score of 13 reduced to 3. MRI showed some resolution of L3-L4 and L4-L5.

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A patient presenting with low back pain received 18 treatments of FDA-approved low-frequency vibro-percussion wave stimulation known as Khan Kinetic Treatment (KKT). Following KKT, he demonstrated improvement in pain, function, quality of life, sleep, and trunk range of motion with no adverse events.

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Background Major depressive disorder (MDD) is a persistent psychiatric condition and one of the leading causes of global disease burden. In a previous study, we investigated the effects of a five-week intervention consisting of rhythmic gamma frequency (30-70 Hz) vibroacoustic stimulation in 20 patients formally diagnosed with MDD. In that study, the findings suggested a significant clinical improvement in depression symptoms as measured using the Montgomery-Asberg Depression Rating Scale (MADRS), with 37% of participants meeting the criteria for clinical response. The goal of the present research was to examine possible changes from baseline to posttreatment in resting-state electroencephalography (EEG) recordings using the same treatment protocol and to characterize basic changes in EEG related to treatment response. Materials and methods The study sample consisted of 19 individuals aged 18-70 years with a clinical diagnosis of MDD. The participants were assessed before and after a five-week treatment period, which consisted of listening to an instrumental musical track on a vibroacoustic device, delivering auditory and vibrotactile stimulus in the gamma-band range (30-70 Hz, with particular emphasis on 40 Hz). The primary outcome measure was the change in Montgomery-Asberg Depression Rating Scale (MADRS) from baseline to posttreatment and resting-state EEG. Results Analysis comparing MADRS score at baseline and post-intervention indicated a significant change in the severity of depression symptoms after five weeks (t = 3.9923, df = 18, p = 0.0009). The clinical response rate was 36.85%. Resting-state EEG power analysis revealed a significant increase in occipital alpha power (t = -2.149, df = 18, p = 0.04548), as well as an increase in the prefrontal gamma power of the responders (t = 2.8079, df = 13.431, p = 0.01442). Conclusions The results indicate that improvements in MADRS scores after rhythmic sensory stimulation (RSS) were accompanied by an increase in alpha power in the occipital region and an increase in gamma in the prefrontal region, thus suggesting treatment effects on cortical activity in depression. The results of this pilot study will help inform subsequent controlled studies evaluating whether treatment response to vibroacoustic stimulation constitutes a real and replicable reduction of depressive symptoms and to characterize the underlying mechanisms.

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Previous research showed that repetitive sensory stimulation entrains neural oscillations at the stimulation rate, facilitates long-term potentiation like perceptual learning, and improves behavioural performance. For example, short-time repetitive tactile stimulation improved tactile acuity measured with two-point or spatial orientation discrimination tests. The behavioural gain was maximal for a stimulation rate of 20 Hz, the same frequency at which repetitive somatosensory stimulation elicits a steady-state response with maximum amplitude. The current study investigated whether sensory stimulation must be strictly periodic to induce perceptual learning and whether the 20-Hz steady-state response plays a crucial role in the neural mechanisms of perceptual learning. In a crossover-designed experiment, young, healthy adults received sensory stimulation to the fingertip on three subsequent days. The stimulation was either periodic or temporally randomized (aperiodic) with the same number of stimuli. Tactile acuity was assessed with a grating orientation discrimination task, and brain activity was measured with magnetoencephalography (MEG). Stimulus type-by-session interactions were found for behavioural and brain data. Tactile acuity improved more after a session with aperiodic than periodic stimulation. Beta-band 20-Hz steady-state responses were localized in the primary somatosensory cortex contralateral to the stimulated finger and had larger amplitudes after periodic than aperiodic stimulation. Both stimulus types also elicited gamma oscillations, which increased in amplitude more with aperiodic than periodic stimulation. Sensory stimuli caused a phase reset of sensorimotor beta oscillations phase-coupled to alpha oscillations. The system of stimulus-related oscillations was discussed as underlying temporal processing. Learning may result from facilitating the temporal code. More pronounced behavioural gain with aperiodic than periodic stimulation suggests beneficial effects of temporal stimulus variability for perceptual learning.

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This qualitative study aims to understand the lived experience of residents and other stakeholders during the implementation of a comprehensive music program in long-term care. It was conducted using a subset of 15 long-term care homes from the Room 217 Foundation Music Care Partners (MCP) "Grow" study in Ontario, Canada. The MCP program's approach to music delivery uses therapeutic music practices such as "music care" to improve the care experience for caregivers and residents in long-term care homes. Thirty-two participants were interviewed, including staff, volunteers, and residents. Data were transcribed and analyzed using a modified grounded theory approach based on emergent themes. In total, seven themes arose from the data: limited resources, distinct experiences, life enrichment, dynamic relationships, program flexibility, potential continuity, and enhanced socialization. This study provides insight on barriers, enablers, and outcomes of the MCP program and on key considerations for implementing a novel interdisciplinary music program in a healthcare setting.

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There is a need for intervention research to understand how music-based group activities foster engagement in social interactions and relationship-building among care home residents living with moderate to severe dementia. The purpose of this conceptual paper is to describe the design of 'Music Connects Us', a music-based group activity intervention. Music Connects Us primarily aims to promote social connectedness and quality of life among care home residents living with moderate to severe dementia through engagement in music-making, supporting positive social interactions to develop intimate connections with others. To develop Music Connects Us, we adapted the 'Music for Life' program offered by Wigmore Hall in the United Kingdom, applying an intervention mapping framework and principles of engaged scholarship. This paper describes in detail the Music Connects Us program, our adaptation approach, and key adaptations made, which included: framing the project to focus on the engagement of the person living with dementia to ameliorate loneliness; inclusion of student and other community-based musicians; reduced requirements for care staff participation; and the development of a detailed musician training approach to prepare musicians to deliver the program in Canada. Description of the development, features, and rationale for Music Connects Us will support its replication in future research aimed to tests its effects and its use in clinical practice.

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This paper presents a narrative review of research literature to "map the landscape" of the mechanisms of the effect of sound vibration on humans including the physiological, neurological, and biochemical. It begins by narrowing music to sound and sound to vibration. The focus is on low frequency sound (up to 250 Hz) including infrasound (1-16 Hz). Types of application are described and include whole body vibration, vibroacoustics, and focal applications of vibration. Literature on mechanisms of response to vibration is categorized into hemodynamic, neurological, and musculoskeletal. Basic mechanisms of hemodynamic effects including stimulation of endothelial cells and vibropercussion; of neurological effects including protein kinases activation, nerve stimulation with a specific look at vibratory analgesia, and oscillatory coherence; of musculoskeletal effects including muscle stretch reflex, bone cell progenitor fate, vibration effects on bone ossification and resorption, and anabolic effects on spine and intervertebral discs. In every category research on clinical applications are described. The conclusion points to the complexity of the field of vibrational medicine and calls for specific comparative research on type of vibration delivery, amount of body or surface being stimulated, effect of specific frequencies and intensities to specific mechanisms, and to greater interdisciplinary cooperation and focus.

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Since the 2015 Canadian legalization of medical assistance in dying (MAiD), many Canadian music therapists have become involved in the care of those requesting this procedure. This qualitative study, the first of its kind, examines the experience of music therapy within MAiD, exploring lived experience from three perspectives: the patient, their primary caregiver, and the music therapist/researcher. Overall thematic findings of a hermeneutic phenomenological analysis of ten MAiD cases demonstrate therapeutically beneficial outcomes in terms of quality of life, symptom management, and life review. Further research is merited to continue an exploration of the role of music therapy in the context of assisted dying.

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Ehlers-Danlos syndrome (EDS) is a connective tissue disorder characterized by joint hypermobility and skin extensibility and is often accompanied by chronic pain. Rhythmic sensory stimulation (RSS) can be defined as the stimulation of the senses in a periodic manner within a range of low frequencies. Music plus sound delivered through a vibroacoustic device is a form of RSS and has demonstrated utility in managing pain. In this current study, we conducted an open-label pilot study of 15 patients with hypermobile EDS using RSS as the intervention. Posttreatment improvements were seen in 11 of the 15 patients (73%), whereas 3 of the 15 patients (20%) experienced worse outcomes. Of the 14 patients that completed the experiment, 6 participants (43%) were classified as "responders" to the device while 8 participants (57%) were classified as "nonresponders." Responders demonstrated significant improvements in pain interference (51.5 ± 16 preintervention vs. 43.5 ± 16.4 postintervention BPI score) and depression symptoms (34.0 ± 15.9 preintervention vs. 26.8 ± 12.1 postintervention CESD score). Poststudy interviews confirm the improvements of pain interference, mood, and bowel symptoms. Furthermore, analysis of medical conditions within the responder group indicates that the presence of depression, anxiety, irritable bowel syndrome, and fibromyalgia may indicate a greater likelihood for patients to benefit with vibroacoustic applications. These results indicate a possible potential for RSS, delivered using a vibroacoustic device, in managing pain-related symptoms. Further research is necessary to elucidate the exact mechanism behind the physiological benefits of RSS.

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This study investigated the effect of a music-based intervention on depression and associated symptoms. Twenty individuals formally diagnosed with Major Depressive Disorder and in a current Major Depressive Episode (11 females and 8 males; aged between 26 and 65 years) undertook a 5 weeks intervention consisting of music listening combined with rhythmic sensory stimulation. Participants listened to a set of designed instrumental music tracks embedded with low-frequency sounds (30-70 Hz). The stimuli were delivered for 30 min, 5 times per week, using a portable consumer device with built-in stereo speakers and a low-frequency transducer, which allowed the low-frequency sounds embedded in the music to be experienced as a mild vibrotactile sensation around the lower back. Changes from baseline to post-intervention in measures of depression symptoms, sleep quality, quality of life, anhedonia, and music-reward processing were assessed with clinician-based assessments as well as self-reports and a monetary incentive behavioral task. The study results indicated that there were significant changes from baseline in measures of depression and associated symptoms, including sleep quality, quality of life, and anhedonia. However, individual differences in treatment response need to be considered. These findings corroborate previous evidence that music-based intervention, when added to standard care, is a promising adjunctive treatment for Major Depressive Disorder, and open new avenues to investigate the effect of music-based therapy to ameliorate anhedonia-specific dysfunction in major depressive disorder and other neuropsychiatric disorders.

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This double-blind, two-arm parallel randomized controlled trial investigated the effects of gamma-frequency rhythmic sensory stimulation on fibromyalgia. We were interested in whether rhythmic sensory stimulation would promote significant changes in fibromyalgia and associated symptoms, and whether treatment effects would differ between two distinct treatment parameters. Fifty patients with a formal diagnosis of fibromyalgia were randomly assigned to two test groups. One group received vibrotactile stimulation from a continuous sine wave single-frequency stimulation (40 Hz) for 30 minutes, five days per week, over five weeks, concomitant with usual care. The second group completed the same treatment protocol but received a different stimulation, consisting of random and intermittent complex wave gamma-range vibrotactile stimulation. Fibromyalgia symptoms, pain severity and interference, depression symptoms, quality of life and sleep quality were assessed at baseline and post-intervention. Results indicated that there were statistically significant changes from baseline to post-treatment in measures of fibromyalgia symptom severity, pain interference, depression, and sleep quality. However, treatment outcomes did not differ significantly between groups. These findings provide preliminary evidence that gamma-frequency rhythmic vibroacoustic stimulation may decrease fibromyalgia symptoms and ease associated comorbidities, opening new avenues for further investigation of the effects of rhythmic sensory stimulation on chronic pain conditions.

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Due to advances in medical knowledge the population of older adults struggling with issues of aging like Alzheimer's disease (AD), Parkinson's disease (PD), and stroke is growing. There is a need for therapeutic interventions to provide adaptive strategies to sustain quality of life, decrease neurologic impairment, and maintain or slow cognitive decline and function due to degenerative neurologic diseases. Musical interventions with adults with cognitive impairments have received increased attention over the past few years, such as the value of personalized music listening in the iPod project for AD (1); music as a tool to decrease agitation and anxiety in dementia (2); and music to aid in episodic memory (3); Rhythmic Auditory Stimulation as rehabilitation for PD (4); and recently the potential of 40 Hz sensory brain stimulation with AD and PD (5, 6). These approaches indicate the expanding scope and efficacy of music therapy and the potential mechanisms involved. This paper explicates a four-level model of mechanisms of music response (7, 8) that may help understand current music therapy approaches and treatments and help focus future research. Each level will be illustrated with research and suggestions for research directions.

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OBJECTIVE: The goal of this study was to determine if a self-administered computer-based rehabilitation program could improve music appreciation and speech understanding in adults who have a cochlear implant (CI). STUDY DESIGN: Prospective study. SETTING: Tertiary adult CI program. PATIENTS: Twenty-one postlingually deafened cochlear implant users between the ages of 27 and 79 years were recruited. INTERVENTIONS(S): A self-administered music rehabilitative software was designed to help improve the perception of musical patterns of increasing complexity, as well as pitch and timbre perception, premised on focused and divided attention. All participants completed a diagnostic music test before and after rehabilitative training, including tests of pitch and timbre perception and pattern identification with increasing levels of difficulty. Speech data in quiet and noise was also collected both pre- and post-training. Participants trained for a minimum of 3.5 hours a week, for 4 weeks. MAIN OUTCOME MEASURE(S): Mean changes in music perception and enjoyment as well as speech perception (IEEE sentence test in quiet and noise). RESULTS: Post-training diagnostic test scores, as compared with pretraining scores, indicated significant improvements in musical pattern perception. Tests of speech perception in quiet and in noise were significantly improved in a subset of this cohort. All of the training participants thought that the training helped to improve their recognition skills, and found the program to be beneficial. CONCLUSION: Despite the limitations of current CI technology, the results of this study suggest that auditory training can improve music perception skills, and possibly speech intelligibility, lending further support to rehabilitation being an integral part of the postimplantation paradigm.

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This study assessed the effect of stimulating the somatosensory system of Alzheimer's disease (AD) patients at three stages of their illness with 40 Hz sound. In this AB cross-over study design, 18 participants (6 mild, 6 moderate, 6 severe) each participated in 13 sessions: one intake and 12 treatment. Treatment A consisted of 40 Hz sound stimulation and Treatment B consisted of visual stimulation using DVDs, each provided twice a week over 6 weeks for a total of 6 times per treatment. Outcome measures included: St. Louis University Mental Status Test (SLUMS), Observed Emotion Rating Scale, and behavioral observation by the researcher. Data were submitted to regression analysis for the series of 6 SLUMS scores in treatment A and 6 scores in B with comparison by group. The slopes for the full sample and subgroups in the 40 Hz treatment were all significant beyond alpha = 0.05, while those for the DVD were not. A thematic analysis of qualitative observations supported the statistical findings. 40 Hz treatment appeared to have the strongest impact on persons with mild and moderate AD. Results are promising in terms of a potential new treatment for persons with AD, and further research is needed.

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BACKGROUND: Preference-based tempo-pace synchronized music has been shown to reduce perceived physical activity exertion and improve exercise performance. The extent to which such strategies can improve adherence to physical activity remains unknown. The objective of the study is to explore the feasibility and efficacy of tempo-pace synchronized preference-based music audio-playlists on adherence to physical activity among cardiovascular disease patients participating in a cardiac rehabilitation. METHODS: Thirty-four cardiac rehabilitation patients were randomly allocated to one of two strategies: (1) no music usual-care control and (2) tempo-pace synchronized audio-devices with personalized music playlists + usual-care. All songs uploaded onto audio-playlist devices took into account patient personal music genre and artist preferences. However, actual song selection was restricted to music whose tempos approximated patients' prescribed exercise walking/running pace (steps per minute) to achieve tempo-pace synchrony. Patients allocated to audio-music playlists underwent further randomization in which half of the patients received songs that were sonically enhanced with rhythmic auditory stimulation (RAS) to accentuate tempo-pace synchrony, whereas the other half did not. RAS was achieved through blinded rhythmic sonic-enhancements undertaken manually to songs within individuals' music playlists. The primary outcome consisted of the weekly volume of physical activity undertaken over 3 months as determined by tri-axial accelerometers. Statistical methods employed an intention to treat and repeated-measures design. RESULTS: Patients randomized to personalized audio-playlists with tempo-pace synchrony achieved higher weekly volumes of physical activity than did their non-music usual-care comparators (475.6 min vs. 370.2 min, P < 0.001). Improvements in weekly physical activity volumes among audio-playlist recipients were driven by those randomized to the RAS group which attained weekly exercise volumes that were nearly twofold greater than either of the two other groups (average weekly minutes of physical activity of 631.3 min vs. 320 min vs. 370.2 min, personalized audio-playlists with RAS vs. personalized audio-playlists without RAS vs. non-music usual-care controls, respectively, P < 0.001). Patients randomized to music with RAS utilized their audio-playlist devices more frequently than did non-RAS music counterparts (P < 0.001). CONCLUSIONS: The use of tempo-pace synchronized preference-based audio-playlists was feasibly implemented into a structured exercise program and efficacious in improving adherence to physical activity beyond the evidence-based non-music usual standard of care. Larger clinical trials are required to validate these findings. TRIAL REGISTRATION: ClinicalTrials.gov ID (NCT01752595).

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BACKGROUND: The search for effective treatments for fibromyalgia (FM) has continued for years. The present study premises that thalamocortical dysrhythmia is implicated in fibromyalgia and that low-frequency sound stimulation (LFSS) can play a regulatory function by driving neural rhythmic oscillatory activity. OBJECTIVE: To assess the effect of LFSS on FM. METHOD: The present open-label study with no control group used a repeated-measures design with no noncompleters. Nineteen female volunteers (median age 51 years; median duration of FM 5.76 years) were administered 10 treatments (twice per week for five weeks). Treatments involved 23 min of LFSS at 40 Hz, delivered using transducers in a supine position. Measures (repeated before and after treatment) included the Fibromyalgia Impact Questionnaire, Jenkins Sleep Scale, Pain Disability Index, sitting and standing without pain (in minutes), cervical muscle range of motion and muscle tone. Mean percentages were calculated on end of treatment self-reports of improvement on pain, mood, insomnia and activities of daily living. RESULTS: Significant improvements were observed with median scores: Fibromyalgia Impact Questionnaire, 81% (P<0.0001); Jenkins Sleep Scale, 90% (P<0.0001); and Pain Disability Index, 49.1% (P<0.0001). Medication dose was reduced in 73.68% of patients and completely discontinued in 26.32%. Time sitting and standing without pain increased significantly (P<0.0001). Cervical muscle range of motion increased from 25% to 75% (P=0.001), while muscle tone changed from hypertonic to normal (P=0.0002). CONCLUSION: In the present study, the LFSS treatment showed no adverse effects and patients receiving the LFSS treatment showed statistically and clinically relevant improvement. Further phase 2 and 3 trials are warranted.

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BACKGROUND: Interventions to improve sleep in fibromyalgia may generalize to improvements in multiple symptom domains. Delta-embedded music, pulsating regularly within the 0.25 Hz to 4 Hz frequency band of brain wave activity, has the potential to induce sleep. OBJECTIVES: To assess the effects of a delta-embedded music program over four weeks for sleep induction in patients with fibromyalgia. METHODS: The present unblinded, investigator-led pilot study used a within-subject design. Analysis was based on 20 individuals with fibromyalgia who completed the study, of the 24 recruited into the study. The primary outcome variables were the change from baseline in Fibromyalgia Impact Questionnaire (FIQ) and Jenkins Sleep Scale scores. A patient global impression of change was measured on a seven-point Likert scale. Secondary outcome measures, comprised of items 5, 6 and 7 of the FIQ, were used as indicators of pain, tiredness and being tired on awakening. RESULTS: The FIQ median score of 76.4 (95% CI 61.3 to 82.1) at baseline improved to 60.3 (95% CI 53.1 to 72.0; P=0.004). The Jenkins Sleep Scale median value of 17.5 (95% CI 15.5 to 18.5) at baseline fell to 12.5 (95% CI 8.5 to 14.5; P=0.001) at study completion. The outcomes of the patient global impression of change ratings were mostly positive (P=0.001). Being tired on awakening declined significantly from a median of 9.0 (95% CI 8.0 to 10.0) to 8.0 (95% CI 5.5 to 9.0; P=0.021). However, there was no significant improvement in pain level (baseline median 7.5 [95% CI 7.0 to 8.5] versus study completion median 7.0 [95% CI 6.5 to 8.0]; P=0.335) or tiredness (baseline median 9.0 [95% CI 8.0 to 9.5] versus study completion median 8.0 [95% CI 6.0 to 8.5]; P=0.061). There were no serious adverse events. CONCLUSIONS: Delta-embedded music is a potential alternative therapy for fibromyalgia.

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Cochlear implantation has revolutionized the management of those who suffer from severe-to-profound hearing loss because many patients now achieve excellent speech understanding with objective testing. Nevertheless, speech understanding in noisy conditions and music appreciation remain significant challenges to cochlear implant (CI) users. Music appreciation is an extremely complex experience that is difficult to quantify through a conventional outcome study. This paper aims at documenting the experience of five CI patients with regard to music appreciation using qualitative techniques. This information was obtained through a semi-structured interview process. The interviews were then transcribed and analysed using a constant comparative method of qualitative description. The results together with medical case records were used to identify emerging themes. The common themes that evolved were: musical background, the experience of receiving the implant, current experience with music, attention, musical prediction ability, internal hearing, hedonic vs. critical listening, determination, and timbre perception. By documenting their experiences in this manner, novel insights into the patient perspective are provided that are unique to the literature. These descriptions will aid clinicians and researchers who work in the area of cochlear implantation to better understand the needs of their patients.

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