Music Therapy in Fragile X and the Cochrane Reviews

Another blog on some of the talks presented at Mozart and Science III – a conference on Music in Medicine and Therapy this year held in Krems, Austria. Here you can see my previous blog which gives more details about the conference itself and a summary of one of the first keynote speech given by Dr Julian Thayer.

There were a multitude of interesting talks at the conference and I could not possible attend them all, so many apologies to anyone not mentioned in my blogs. You can find all details about the speakers here. In this blog I will mention 2 talks; one about Fragile X syndrome and one about the Cochrane reviews.

Fragile X syndrome (http://www.fragilex.org.uk/) is something very close to my own heart. My partner’s nephew has the condition and I am always so impressed with the strength and compassion showed by his parents and the sheer joy in life that seems to bubble out of him. He is a lovely little chap.

For those of you who might not have heard of the condition let me provide a little background. Fragile X syndrome is part of a family of genetic disorders linked to faults in protein production of the X chromosome. Fragile X is linked specifically to dynamic mutations in the FMR-1 gene. It is the most common form of inherited disability and the phenotype includes cognitive developmental delay, speech or language delay, problems with fine motor control, and social and developmental delay. Children with the condition show IQ ranges from borderline to severely impaired, and this aspect to the condition tends to be more acute in males.  Physically they can exhibit large or prominent ears, long and narrow jaw, and connective tissue problems. Behaviourally they can show attention deficits and hyperactivity, and can often show autistic behavioural traits such as a difficulty maintaining eye contact and hand waving. There is no cure for the condition at this time.

Isabel Fernandez Carvajal works at the institute for genetics and molecular biology at University of Valladolid in Spain. She spoke here about how music therapy can play a role in the integrated treatment program for children in particular. She showed video evidence that:

1) Music, through singing and play-songs can promote communication, particularly verbal skills through social interaction.

2) Musical engagement can also promote attention and encourage interpersonal reaction between the child and their parents/carers.

3) Finally music, by its very nature, can encourage processing akin to sensory integration and therefore has the potential to help modulate arousal levels and promote practice of fine motor movements. This latter benefit was demonstrated by work where she has found that the active element of music playing can help boost hand-eye coordination.

In conclusion it seems that music therapy is a suitable integrative psychosocial treatment for children with fragile X syndrome. I hope to see more work in this area in the future and I will certainly continue to sing with my nephew whenever I see him. Big kisses to little Eneko.

So, onto the Cochrane reviews. I was not fully aware of what these were when I went to the conference, although I had heard of them in the literature. Cochrane Reviews are systematic reviews of primary research in human health care and health policy. They investigate the effects of interventions for prevention, treatment and rehabilitation. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting. And there is now a series of reviews available for music therapy, a presentation of which was given at the conference by Cheryl Dileo who is the Director of the Arts and Quality of Life Research Center at Temple University in the USA.

In her talk Cheryl outlined a number of findings related to the use of music therapy for different conditions and also gave a number of recommendations for future studies as they aim to reach the gold standard of evidence based treatment. The findings related to both music medicine and music therapy practices – the distinguishing feature of the latter being the presence of a trained music therapist and the evolution of a relationship between patient and therapist. I will outline the findings below:

1)      Music for heart disease. There were 23 trials identified by the review. Music therapy was found to consistently lower heart rate, respiration, systolic and diastolic blood pressure, anxiety, pain, and to enhance quality of life.

2)      Music for ventilated patients. Eight trials were identified. Music therapy was found to lower heart rate, respiration rate, and anxiety.

3)      Music for end of life care. Five studies were identified which have included to date 175 patients. Music therapy was found to improve quality of lfe.

4)     Music for acquired brain injury. Seven studies with 184 participants were identified, although these typically included a range of therapeutic interventions. Music therapy was associated with improving gate velocity, stride length and stride symmetry,

5)      Music in oncology. The largest group of trials at 29 were found in this category, comprising over 1880 patients. Music therapy was found to reduce heart rate, lower respiration rates, blood pressure, and to reduce pain and improve quality of life.

In terms of the future Cheryl emphasised the need for more randomised control trials in music therapy. She also stated that it was important to distinguish between music medicine and music therapy, and to not generalise results across the two fields. Therapists need to more actively address the issue of placebo effects and question the functional component to their therapy; at this point it is almost impossible to ascertain the independent effects of the human component for example vs. the music. Other suggestions went as follows:

• More clearly define ‘patient preference’ in a valid way
• Be consistent in reporting patient variables, such as age, cultural background, musical training, locus of control, preferred coping strategy etc.
• Investigate delivery treatment issues, such as dosage, frequency, timing, and length, in order to give translational information for clinical practice
• Consider using formalised decision trees for individualised but clinically relevant treatment
• Consider the effect of treatment on conditions for which there is virtually no literature (e.g. HIV, PTSD, Postnatal depression)
• Weigh up therapy in terms of the big issues, such as length of survival, cost effectiveness and patient compliance
• Look into music therapy as a prevention aid for medical conditions such as anxiety and weight loss.

In short – there was a lot of advice! She was like a whirlwind of information. I have rarely had such a hand cramp from writing in just 30 minutes! But it was all extremely insightful. I hope that those in the field rise to the challenge of taking on some of these issues and continue to bring music therapy to the forefront of clinical treatment.