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BACKGROUND: Despite an increase in use of pediatric complementary and integrative health (PCIH), many healthcare professionals still have an inadequate understanding of such practices and consider their use inappropriate, which might thwart implementation processes. In a qualitative interview study we examined the feedback of conventional healthcare professionals about the integrative practices provided to pediatric patients by an integrative team in a pediatric oncological hospital. METHODS: Fifteen semi-structured interviews were carried out with various conventional healthcare professionals in an university pediatric hospital in São Paulo, Brazil. The interviews were audio-recorded, transcribed and pseudonymized. DSCsoft® and MAXQDA® software assisted in a profound qualitative analysis using the collective subject discourse and thematic analysis method in order to display participants' perspectives on PCIH and the project in their hospital. RESULTS: Interviewees acknowledged their lack of knowledge about PCIH practices and reflected on the limits of their care as well as on new possibilities PCIH could offer. PCIH was perceived by interviewees as an effective supportive tool of care to promote patients' wellbeing, assist overall compliance, strengthen cooperation between professionals, children and their relatives and hence facilitated general patient care. Since PCIH was implemented in their clinic, perceptions led interviewees to wish for increased PCIH offering and a more profound integration of its therapists into the standard of care. DISCUSSION: The coexistence of integrative and conventional practices in the conventional healthcare setting is important to give visibility to the possibilities offered by the integrative pediatrics field. Regular and constant encounters with integrative practices, as well as information access seem crucial to reach a wider openness for PCIH and subsequently a broader application and dissemination of it.

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Introduction: This study aimed to investigate the effects of combined remote music and exercise training on the cognitive, psychological, and physical function of patients with Alzheimer's disease (AD). Methods: Forty-one AD patients were randomly allocated to three groups, including control (C), training (T), and training with music (TM) groups. Participants were evaluated by cognitive and performance test batteries before and after the interventions. Both experimental groups performed 36 remote workouts in 3 months online via WhatsApp video call individually with the trainer. Training included simple and varied movements of all physical indicators. The number of sets began with two sets and progressively increased to one set every month, 5-10 repetitions per set. The overload was applied by reducing the break between sets every week. The TM group performed the same exercises while listening to Mozart and traditional Iranian songs. Results: We observed a significant main, group, time, and interaction effect on Romberg (ηp2:0.72), 30 s chair sit and stand (ηp2:0.75), and walking on steppe test (ηp2:0.63). Furthermore, there was a significant main time and interaction effect on push-ups (ηp2:0.43), sit and reach (ηp2:0.64), and MMSE (ηp2:0.76). In all variables, two experimental groups demonstrated substantial improvements than the C group (p < 0.01). In addition, the TM group (27.8%) showed a significant improvement compared to the C group (-6.4%) and the T group (12.2%) in MMSE. Conclusion: Combined remote training with listening to music as adjuvant treatment is an appropriate item to improve the cognitive and physical performance of Alzheimer's patients, especially during the COVID-19 pandemic.

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BACKGROUND: There are different therapeutic strategies such as physiotherapy and music therapy for the treatment of cerebral palsy. Intervention protocols using both therapies to unify the measurement of motor function have not been investigated. Aims and scope: To summarize the effects of the treatment of cerebral palsy through the use of both for the improvement of motor function, analyse the challenges encountered, and submit proposals for improving them. METHODS: The systematic review was conducted following PRISMA guidelines and registered in the PROSPERO database (CRD42020162493). Clinical trials that described the results obtained in terms of motor function through physiotherapy and music therapy were included. RESULTS: Eight clinical trials with 234 participants were considered with a significant improvement in motor function. Results of meta-analysis suggested improvements in gait velocity in favour of the control group for cerebral palsy (mean differences = 0.03; 95% confidence interval = 0.01, 0.04, p = 0.001; I2 = 97%). However, high heterogeneity was identified in the meta-analysis due to the small number of studies included. CONCLUSIONS: The combination can be effective in subjects with cerebral palsy to improve motor function, although due to the diversity of studies analysed, it is complex to extrapolate results.

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End-of-life accompaniment requires even greater care of the patient and their family by the multi-disciplinary team, which requires a clear, wellorganized interdisciplinary and interprofessional approach. Musictherapy (MT) is often use as a complementary approach to improve a person's quality of life by helping to relieve symptoms, addressing psychological needs, offering support and comfort, facilitating communication, and meeting spiritual needs.Through songwriting, Ettore, a teenager was able to make choices and act on his own will. Songwriting represented a channel for effective and powerful communication and expression. The song became the means by which the relationship with the team was maintained and deepened; it became something tangible, a product with its own consistency, a further bond that unites Ettore to his family to this day.

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La musicoterapia es una disciplina que progresivamente está ampliando su campo de abordaje. Dentro de las nuevas intervenciones se pueden mencionar las implementadas en pacientes con estado alterado de conciencia y cuadros patológicos, producto de lesiones neuronales adquiridas que involucran al sistema reticular. La formación reticular es una red neuronal que establece conexiones con gran parte del sistema nervioso, regulando el alerta general, la dirección de la atención y la transición entre sueño y vigilia. A partir de esto, el trabajo que se informa está centrado en una descripción general de los diferentes estados alterados de conciencia y las intervenciones de una disciplina científica, con técnicas no invasivas que utiliza el sonido y sus elementos específicamente en el diagnóstico y abordaje terapéutico de pacientes en estado de mínima conciencia y su efecto en la formación reticular, teniendo como objetivo principal la rehabilitación del paciente y el aumento de sus niveles de alerta. Las técnicas en musicoterapia se basan en los resultados positivos del efecto de ciertos parámetros sonoros tales como la melodía, los aspectos temporales, la armonía, sobre indicadores fisiológicos (frecuencia respiratoria y cardíaca, conductancia de la piel, niveles de cortisol, etc.), que proporcionan un marco organizativo. A través de dicho marco las personas pueden responder e interactuar por medio de las propuestas musicales, determinadas por características, tales como la simplicidad, la utilización de la voz sin acompañamiento, improvisando vocales, melodías repetitivas, música de baja densidad cronométrica unida a la velocidad respiratoria del paciente y que pertenezca a su entorno familiar.

Music-therapy is a scientific discipline that in the last years has extended its work fields, to multiple populations and pathologies. Among the new interventions is the one related to altered conscious states, which are pathological disorders product of acquired neuronal lesions that involved the reticular system. Currently, there are different and varied models music-therapy that works with patients with altered consciousness states and the pathologies associated to those disorders. Parallel to the cognitive rehabilitation a branch emerged called neurological music-therapy, which is based in the neuroscientific model of musical production and perception and it is defined as the therapeutic application of music and theirs discursive elements in people who suffered motor, cognitive and sensorial deficits caused by neurological diseases. The reticular system is a neuronal network, known as a complex area due to its anatomy and functional heterogeneity. This network stablish connections with a large portion of the nervous system, acts as a filter system as it is responsible for separating incoming stimuli, discriminating between those relevant and not relevant, and it regulates the general alert, direction of attention, transition between awake, and sleep states. The lesions and deficits that involved the reticular system had been a point of scientific interest for many years. There are two main components related to conscience: the arousal or wakefulness (be aware) and the awareness (the content of conscience). The arousal is considered a preparation state to action that consists in primitive behaviors to the environment, i.e. involuntary behaviors. To maintain the arousal intervenes the ascendant reticular system. While awareness involved a complex process, a cognitive elaboration of thought. Such elaboration encompasses the process of information that is received through the senses and environmental demands. When these processes are interrupted because of traumas or anomalies could generated a coma or states where the content of conscious are affected. After the brain injury, the patients are in a coma state and from there they could emerged with different long-term results: Post-traumatic amnesia, Minimal conscious state, vegetative state or death. The music-therapy techniques used with this population are descripted in this work from a neurological model, which is based in empirical evidence. This evidence is result of the effect of specific sound parameters (as melody, rhythm, harmony) upon physiological indicators (as heart rate, respiratory frequency, skin conductance, cortisol levels, among others), as well as the use of familiar music for the patient, detecting physiological indicators during musical experiences. The music-therapy techniques provide and motivate an organizational framework through which patients with severe disorders of their expressive and receptive linguistic abilities could respond and interact through musical applications. These techniques are possible because music is an innate ability of all human beings, also because the auditive system is the first sense that develops in the intrauterine level. The characteristics of music-therapy techniques are defined for simplicity, the use of the voice, where repetitive melodies are improvised, without breaking the laws of musical expectation, with low chronometric density music; this type of music go along with the respiratory speed of the patient. Also the musical history of the patient is taken into account to enable a familiar environment. With this background, the current work focuses in a general description of the different conscious states, the implication of reticular system and the interventions of music-therapy as a scientific discipline that offers non-invasive techniques that used the sound and their elements to test, to diagnostic and to treat patients in a minimal state of conscious. This technique has the ultimate goal of rehabilitate the cognitive functions and enhance the alert levels, besides providing a reinforcement for the interdisciplinary approach.

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Introducción: La resonancia magnética es un método de imagen ideal para el diagnóstico de enfermedades cardiovasculares; sin embargo, la mayoría de los pacientes refieren enfrentarse a un ambiente desconocido, lo cual les provoca ansiedad y cambios en sus constantes vitales. Objetivo: Comparar el nivel de ansiedad (NA) del adulto cardiópata posterior a una intervención de musicoterapia, en un estudio de resonancia magnética. Material y métodos: Estudio comparativo, prospectivo y transversal. Muestra probabilística aleatoria simple (N = 31) para dos grupos: G1 n = 14 y G2 n = 17; incluyó pacientes >15 años, ambos sexos. Se aplicó el instrumento STAI antes y después de musicoterapia; 10 ítems para datos demográficos, signos vitales y sintomatología; 20 ítems para NA con respuesta tipo Likert: nada = 0 hasta mucho = 3 puntos; bajo NA <24, NA medio 24-38 y alto NA >38 puntos. Intervención musical: G1 escuchó música clásica y G2 de su preferencia por 30 minutos entre 15 y 24 decibeles antes del estudio y el tiempo que duró este (> 20 minutos). Datos analizados con estadística descriptiva, prueba Pearson, Spearman, U Mann Whitney, t de Student y T pareada, p <0.05 significativo. Resultados: La musicoterapia reduce la frecuencia cardiaca (74.36 vs. 69.07, p = 0.01), frecuencia respiratoria (16.29 vs. 12.93, p = 0.001) y tensión arterial sistólica (127.21 vs. 117.21, p = 0.01), tanto en el G1 como en el G2. Los pacientes del G2 mostraron mayor disminución del NA comparado con el G1 (26.88 vs. 23.24, p=0.037). Conclusiones: La musicoterapia seleccionada por el paciente sometido a resonancia magnética ha mostrado ser una intervención efectiva para conseguir un cambio específico en el estado fisiológico, emocional y conductual.

Introduction: Magnetic resonance is an ideal imaging method in the diagnosis of cardiovascular diseases; however, the majority of patients refer this process as if they were in an unknown environment which provokes them anxiety, resulting in constant changes in their vitals. Objective: To compare the level of anxiety (AL) of the heart-ill adult after an intervention with music-therapy following a magnetic resonance study. Materials and methods: This is a comparative, prospective and transversal study, with a simple aleatory probabilistic sample (N = 31) divided in two groups: G1 with n = 14, and G2 with n = 17, including patients >15 years old of both sexes. The STAI instrument was applied before and after the music-therapy session using 10 items for demographic data, vital signs, and symptomatology, and 20 items to estimate the AL, with answers based on a Likert-type scale with: 0 = not at all, to 3 = a lot, and a total scale score where, <24 = low level of anxiety, 24-38 = medium level of anxiety, and >28 = high level of anxiety. The group G1 listened to classical music, while the group G2 listened to the music of their choice for 30 minutes the sound level was kept between 15 and 24 decibels before the study and the duration of the study (> 20 minutes). Data were analyzed using descriptive statistics, and Pearson, Spearman, U Mann Whitney, Student's t, and paired T test, p < .05. Results: Music-therapy reduced the cardiac frequency (74.36 vs. 69.07, p = .01), the respiratory frequency (16.29 vs. 12.93, p = .001), and the systolic arterial tension (127.21 vs. 117.21, p = .01), in both groups. Patients in G2 showed a greater AL reduction compared to those in G1 (26.88 vs. 23.24, p = .037). Conclusions: Selected music-therapy in patients undergoing magnetic resonance has shown to be an effective intervention method to modify specific physiological, emotional, and behavioral states of these patients.

Introdução: A ressonância magnética (RM) é um método de imagem ideal para o diagnóstico de doenças cardiovasculares, porém, a maioria dos pacientes descrevem enfrentar-se a um ambiente desconhecido, o que lhes produz ansiedade e mudanças nos seus signos vitais. Objetivo: Comparar o nível de ansiedade (NA) do adulto cardiopata posterior a uma intervençãode musicoterapia em um teste de ressonância magnética. Material e métodos: Estudo comparativo, prospetivo e transversal. Amostra probabilística aleatória simples (N=31) para dois grupos: G1 n=14 y G2 n=17, incluiu pacientes >15 anos, ambos os sexos. Aplicou-se o instrumento STAI antes e depois de musicoterapia, 10 itens para dados demográficos, signos vitais e sintomatologia, 20 itens para NA com resposta tipo Likert: nada =0 até muito=3 pontos, sob NA <24, NA médio 24-38 e alto NA >38 pontos. Intervenção musical: G1 escutou música clássica e G2 de sua preferência por 30 minutos entre 15 e 24 decibéis antes do teste e o tempo que durou este (>20 minutos). Dados analisados com estatística descritiva, prova Pearson, Spearman, U Mann Whitney, T de Student e T pareada, p <0.05 significativo. Resultados: A musicoterapia reduz a frequência cardíaca (74.36 vs 69.07, p=0.01), frequência respiratória (16.29 vs 12.93, p=0.001) e tensão arterial sistólica (127.21 vs 117.21, p=0.01), tanto no G1 quanto no G2. Os pacientes do G2 mostraram maior diminuição do NA comparado com o G1 (26.88 vs 23.24, p=0.037). Conclusões: A musicoterapia selecionada pelo paciente submetido a RM mostrou ser uma intervenção efetiva para conseguir um cambio específico no estado fisiológico, emocional e comportamental.

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Este estudo tem por objetivo investigar possível alteração no nível de estressede crianças acolhidas, vítimas de violência doméstica após participação em intervençõeslúdico-musicais grupais. Desenvolve-se através de pesquisa exploratória, descritiva decaráter quali-quantitativo. Inicialmente levanta o perfil sócio-demográfico de 100 criançasacolhidas, verificando também o tipo de violência sofrido e o motivo do acolhimento. Aplicaa seguir, a Escala de Stress Infantil, ESI em 20 crianças, selecionadas por conveniênciae realiza intervenção junto a oito crianças com estresse, também selecionados porconveniência, em oito sessões semanais, baseadas em técnicas de musicoterapia erelaxamento, associadas a atividades lúdicas, com abordagem winnicottiana. Ao final,reaplica a ESI nos 20 participantes. Os dados iniciais revelam 65% das crianças acolhidassão do sexo feminino e 35% masculino, com faixa etária média de 6,66; violências sofridasregistradas são: negligência (52%); violência física (19%); dificuldade financeira (15%);abandono (12%); abuso sexual (2%). A ESI constata estresse em 80% dos casos, compredomínio das meninas, e a aplicação da escala após a intervenção não demonstradiferença significativa (p=0,944). A análise qualitativa da intervenção revela contudo aspectospositivos, com boa aceitação das crianças, que expressam seus sentimentos e opiniõesnos jogos sonoros, com abertura para novas experiências, melhorando sua comunicação,sociabilização, criatividade e espontaneidade, indicadores estes de diminuição de estresse(AU)

This study investigates a possible alteration on the stress level of foster childrenvictims of domestic violence, before and after ludic-musical interventions in group, throughan exploratory descriptive research of quali-quantitative character. Initially, the institutionpopulation of 100 foster children is characterized by: their socio-demographic profile, typeof violence and the reason for being fostered. After that, the Child Stress Scale, is appliedwith 20 individuals, conveniently selected. An intervention is then performed with eight ofthose 20 participants, also conveniently selected, in eight weekly sessions, based ontechniques of music therapy, including relaxation and recreational activities, with Winnicottianapproach. Finally, the CSS post-test is performed with the 20 participants. Data from thesocio-demographic profile of the 100 children presented 65% percent female and 35%male; average age of 6,66; violence was suffered by: negligence (52%), physicalviolence (19%), financial difficulty (15%), abandonment (12%); sexual abuse (2%). In theCSS pre-test, stress was found in 80% of cases, predominantly in girls, and the post-testshowed no significant difference (p = 0.944). The analysis of the intervention proved to bepositive, however, showing good acceptance by participants, who expressed their feelings and emotions in a cozy setting which promoted creativity and spontaneity through sonorousgames, open to new experiences and socialization, characterized as a measure to promotehealth of the foster children, and reducing their stress(AU)