Brain and Art: From Aesthetics to Therapeutics

By Bruno Colombo

This book analyzes and discusses in detail art therapy, a specific tool used to sustain health in affective developments, rehabilitation, motor skills and cognitive functions. Art therapy is based on the assumption that the process of making art (music, dance, painting) sparks emotions and enhances brain activity. Art therapy is used to encourage personal growth, facilitate particular brain areas or activity patterns, and improve neural connectivity. Treating neurological diseases using artistic strategies offers us a unique option for engaging brain structural networks that enhance the brain’s ability to form new connections. Based on brain plasticity, art therapy has the potential to increase our repertoire for treating neurological diseases. Neural substrates are the basis of complex emotions relative to art experiences, and involve a widespread activation of cognitive and motor systems. Accordingly, art therapy has the capacity to modulate behavior, cognition, attention and movement. In this context, art therapy can offer effective tools for improving general well-being, quality of life and motivation in connection with neurological diseases.

The book discusses art therapy as a potential group of techniques for the treatment of neurological disturbances and approaches the relationship between humanistic disciplines and neurology from a holistic perspective, reflecting the growing interest in this interconnection.

• Language: English
• Publisher: Springer
• Release date: Aug 29, 2019
• ISBN: 9783030235802

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© Springer Nature Switzerland AG 2020

B. Colombo (ed.)Brain and Arthttps://doi.org/10.1007/978-3-030-23580-2_1

1. The Art of Being a Doctor

Bruno Colombo¹  

(1)

Neurological Department, University Vita-Salute, San Raffaele Hospital, Milan, Italy

Bruno Colombo

Email: [e-mail]

Keywords

NeurologyArt therapyClinical methodEmotionsNeurologist

Where do art and neurology meet?

What is the link between music, painting, dance and our brain?

And, above all, how can artistic expressions have a healing effect on pathologies affecting the nervous system?

Furthermore, what should be the new cultural role of a physician, and particularly a neurologist, so as to use these means of expression competently and safely?

In my opinion, everything stems from the need to train a new kind of doctor providing, within the university curriculum, the means to develop the humanistic side of the profession.

The majority of medical faculties all over the world aim at training specialists with an accurate and modern scientific preparation, but with little knowledge of general human culture. This may be a mistake, since someone who loves literature, music and art probably has a better introspection and open-mindedness compared to someone who does not share such interests.

The benefits of art and literature relate to three qualities which I believe to be necessary, even essential, to a good doctor: empathy, wisdom and a tolerance for ambiguity (i.e. being able to calmly deal with complex and ambiguous situations, devising creative solutions to existing difficulties).

If we consider the medical entrance exams, or frequently even the exams taken during the degree course, we realise that multiple choice tests imply an explicit and definitive train of thought. The danger is that the student, when later relating to a patient, may look upon the diagnosis as the result of algorithms, of steps from symptom to symptom only linked by a ‘yes’ or a ‘no’.

But this is not medicine, this is not a person. A doctor must face the deep discomfort caused by disease and, above all, has to relate to a fellow human being, a patient whose integrity has been disrupted by the pathology and who has lost some physical and psychological boundaries.

If, liberally quoting J. Monod, we acknowledge that every living being is an object with a project [1], then we have to look at health as the ability of the body to carry out the project of the human species and consider disease a temporary or permanent loss of this ability. There are clearly different objective and subjective aspects of a disease. These have an effect on the core of the single individual touching social, emotional and working visions.

Disease must therefore be seen as a time when the need of the suffering patient must be met by a curing and caring doctor with a special human understanding.

Therefore, a good physician has to know how to connect with the sufferer to create a trusting relationship. This is an essential part of the healing effort. Medical practice should be considered an art that makes use of science, these two are intrinsically linked. If it is true that without science we would probably still rely on sorcerers and witch doctors, it is also true that in the absence of a humanistic culture medical practice would merely be a sterile technicality.

The new doctor, who believes in caring for a person, is an artist when he carries out an objective examination, when he looks for clinical signs, when he shares the data regarding the patient’s history and uses them to work out a history that may help to define a diagnosis. This also means acknowledging that time is a fundamental tool when relating to a patient.

Scientific progress has allowed medicine to identify the chronological development of diseases, the differing clinical courses of different patients and the duration of the treatments that, in most cases, can help to improve the prognosis. However, scientific medicine, having given doctors increasingly powerful diagnostical and therapeutic implements, has created a time factor totally new to the doctor/patient relationship.

Prior to this technological turn, a doctor took the time and care to collect the data relating to medical records and to question patients about their history. In past centuries physicians would use all their five senses to get an experience of what the disease was. Later, with the arrival of the anatomical–clinical method and the implementation of sophisticated diagnostical technologies, doctors have developed an increasingly impatient and speedy style of medical examination, spending less time studying the medical history of the patients and relying more and more on laboratory and test data.

Nowadays we doubtlessly train doctors who are more efficient in treating diseases and who are able to develop appropriate diversified diagnoses. But they seem to be further and further removed from the sufferer in front of them, with whom they spend an ever shorter time. It seems therefore that we are progressively confronted with doctors who are less able to deal with people.

In this context one should not underestimate the dissatisfaction of the patient due to the lack of communication. The practice of a hurried and defensive treatment can induce the patient to fall back on a superstition based pseudomedicine which does not cure but offers the individual more time and attention. We know that the length of a medical is in itself a factor to predict a patient’s satisfaction, especially if the time is spent listening and clarifying. In countries where examinations are longer, the perceived quality of the medical service is higher. In Sweden the average length of an examination is 22 min, whereas in Italy a medical lasts about 9 min. It has been calculated that the minimum time that is needed for the patient to be satisfied with an examination is just under 15 min. Although medicine is now based on experimentally tested knowledge and procedures, social dissatisfaction with doctors and health welfare is probably similar to that sketched some centuries ago by Moliere in his caricatures.

What can we do to rebalance the system?

Surely, we should rediscover the values of empathy, re-establish therapeutic alliances, but more importantly we should enhance doctors who know how not only to employ technical devices but also to approach human beings, both the patients and those who look after them, through a highly emotional process of integration.

In this respect, the humanistic education of the doctor needs to surface as a key value in a kind of medicine where art has a creative and active role, both in practice and culturally.

The bond between scientific and humanistic culture should be a distinguishing feature of a physician. The clinical procedure and medicine itself are the contact point between human and natural science. The person who taught me to be a doctor used to say that, given an equal level of scientific training, between a doctor who has read Flaubert or Dostoevsky and one who has not, probably the former would be a better clinician. This is because the great classics of literature portray those aspects of human nature one should be familiar with to be a good doctor, or perhaps those who have a passion for literature and a sound knowledge of the classics also have a predisposition to understand human events [2]. This attitude is a prerogative to be a good doctor.

Humanistic doctors have a vision of the therapy that will allow them to take into consideration every tool that may enable the patient to comprehensively take part in the healing effort. Following that logic any intervention linked to art can be crucial in turning a generic therapy into a cure meant for an individual.

How can we define a therapy that adopts art as part of a cure, and particularly, how can we qualify it and make it acceptable to the scientific community?

Art-based therapy (music, dance, and painting) can be described as a form of treatment which employs artistic expression to strengthen some of the patient’s personal characteristic such as the ability to express oneself, the handling of emotions, and the skill to improve interpersonal relationships and self-esteem (Fig. 1.1).

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Fig. 1.1

‘Waiting for emotions’ courtesy of Lorenzo Colombo

To be in a position to implement this non-standardised healing approach, and above all to validate and make it scientifically significant as a therapy, we need to prove its value and effectiveness.

The scientific method continues to be the starting point to substantiate that an artistic approach can affect cerebral functions and structures, providing the basis to guarantee the person being treated more flexibility and adaptability when facing pathological developments. Art-based therapy is beginning to show evidence of its potential and the possibility to be accepted and acknowledged as credible by the scientific community and to be seen as a part of the healing method. In this respect studies which are directed at evaluating changes brought about on cerebral activities seem to be the most modern and reasonable. Neurophysiological approaches or Magnetic Resonance Imaging are effective means to provide evidence of how an artistic involvement can produce shifts and functionality changes in the brain. And neurological pathologies are the best gymnasium to perform this kind of research.

It seems to me that we have reached a moment when we must reflect on the role of doctors, who often are cooped up in an activity that impoverishes their primary humanistic capacities. The interaction between science, medical practice, and art can bring about a cultural renaissance, where the patient goes back to being at the centre of a new way of thinking.

Those who suffer from a disease will benefit, but also the doctor—and especially the neurologist—who will be in a position to humanise and bring to life the special and unique relationship which is created between a doctor and a patient.

References

1.

Monod J, editor. Chance and necessity. New York: AA Knopf; 1970. p. 13–4.

2.

Rugarli C, editor. Medici a metà. Milano: R. Cortina; 2017. p. 169.

© Springer Nature Switzerland AG 2020

B. Colombo (ed.)Brain and Arthttps://doi.org/10.1007/978-3-030-23580-2_2

2. Is There an Artistic Treatment for Neurological Diseases? The Paradigm of Music Therapy

Bruno Colombo¹  

(1)

Neurological Department, University Vita-Salute, San Raffaele Hospital, Milan, Italy

Bruno Colombo

Email: [e-mail]

Keywords

Music therapyRehabilitationStrokeDementiaEpilepsyInsomniaMultiple sclerosis

2.1 Introduction

If we consider art, and particularly music, as a special tool able to provide and provoke a universal response leading to significant changes in emotions and movement, we can state that both art and music are direct ways to stimulate the brain. Music can evoke changes in the most important reaction’s components of emotions, such as motor expression of emotion (i.e. triggering zygomatic muscle activity or corrugator muscle in case of happy or sad music), action tendency (dancing, rhythmic beating) or physiological arousal in terms of endocrine and autonomic activity [1]. Listening to music and playing a musical instrument ameliorate neuronal connectivity in specific brain regions. Music can promote neural plasticity to support growing neuritis to connect new synapses in order to remodel previously disturbed networks [2]. From this point of view, music provides a non-invasive technique with a therapeutic value, partly because of its cultural role in facilitating emotional well-being and social learning. Admittedly, music has the prerogative of involving a lot of social functions, and the emotions linked to music include deep experiences on fun, joy and happiness. Music enhances social contact, social cognition, communication and (considering the activity of music playing and singing) coordination of actions, cooperation and social cohesion. From a sociological perspective, music is a universal feature of human societies and humans in all cultures in every part of the world make and perform music. Somewhere along evolution, our ancestors, full of emotional expressions but poor in language, probably began to gesticulate and articulate inner feelings. Quoting the philosopher Langer, the most highly developed kind of such purely connotational semantic is music [3]. The first musical instrument used by our progenitors was the voice: being more variable than drums, voices soon made patterns and the long endearing melodies of primitive songs became a part of communal celebration [3]. Other authors supporting this concept argued that spoken language and music evolved from a proto-language, a music-language (emotional but without words) which stemmed from primate calls and was probably used by Neanderthal men [4]. So, it is possible that our language emerged from this proto-language, accompanied by a rich gesticulation and framed by basic musicality. This proto-language was performed with the continuous increasing flexibility which accrued with both expanded anatomical developments of brain structures and connections (primary and association auditory cortices, cerebellum, prefrontal cortex and basal ganglia) and the refined coordination of facial and pharyngeal/laryngeal small muscles [5].

‘Where words can’t get, music speaks’ (L. van Beethoven)

Etymologically the term music derives from the Greek ‘mousikos’, with a clear reference to the Muses. Originally, however, the term didn’t indicate one specific art form but all nine arts of the Muses, referring to something perfect and ideal. The therapeutical impact of sound and music have been known for millennia: some historical examples have been found on Egyptian medical papyruses, some are present in shaman practices of tribal medicine, others are well outlined in Plato’s third book of the ‘Republic’ (where the impact of different kinds of music on the human soul are mentioned) and others still can be identified in the Arab–Hebrew medical tradition [6]. Looking at the Hellenistic period we find how Plato and Aristotle observed that music had a distinct power on people’s behaviour, especially regarding their reactions and emotions, finding the reason for this in the modal organization of music itself. Relating to this observation, music types were catalogued and used according to their respective powers: lamenting for the Mixolydian mode, energetic, active and sober for the Doric and Phrygian modes, effeminate, dissolute and voluptuous for the Ionic and Lydian modes. Many are the anecdotes in the Greek tradition of how music was used to calm the rage of those probably affected by the neurological consequences of alcohol abuse. Iamblichus, for example, relates that Pythagoras was able to mitigate the psychic excitement of a youth in the grip of alcoholic excess while Phrygian music was played, changing this to a slow and solemn Doric music [7]. Another example is Empedocles who assuages the fury of a young man shifting the tone of his instrument, the lyre, and starting a chant fitted to soften and sooth. In ancient Greece we find a close reciprocal relation between temperament and musical harmony. A later example is that of the doctor and musician Marsilio Ficino at the end of the fifteenth century. In his letter ‘De Musica’ to his friend Antonio Canisiano, he urges him to mix medical and musical studies to find the virtue and therapeutical proprieties of sound, building on the new musical theories of counterpoint. Specifically, being rhythm part of our organism (‘the harmonious rhythm of the pulse and the harmonious rhythm of fever’) and also part of the global rhythm of the universe, music is able to reflect human moods and to cure their effect, keeping in balance the inner faculties of the soul and the health of the body [8].

Later, among the best-established norms regarding the relation between treatment and music, we can detect some key principles: ‘music is good for the human body only if the exposure to it is unobtrusive’, ‘music intervenes on human behavior according to its nature, genre and mode, for better or for worst’ and again ‘music is a comfort because of its primary analgesic character, music is a tranquilizer, a mild sedative’ [9]. In his text ‘Il Tesoro della Sanità’ of 1590 Castor Durante Gualdo includes in his rules of hygiene for a good health the combination of three ‘backgrounds’: admiring nature, conversing with cheerful friends and being accompanied by sound and singing [10]. This was reiterated about 50 years later by Isbrand van Diemerbroeck who, though living through an extremely problematic historical medical period due to the fear of the plague, confirms that ‘a happy and joyful soul’ is that which profits from a musical accompaniment [11]. Therefore, for many centuries, music was perceived in the medical context as a good, benign and comforting remedy, even for longer periods. This always respecting some principles such as ‘dosing’ it (hence spacing it out with times of silence) and ‘devoting it to alleviate the consciousness of the dissolution of existence’ thus using it to help the sufferer to peacefully tolerate the finite nature of life.

A further example of the use of music as therapy, from the Middle Age to the twentieth century in some regions of South Italy, is that of tarantism. Music and a dance called tarantella were used to fight the delirium prompted by the, true or alleges, bite of a tarantula spider (Latrodectus tredecimguttatus) which lives in underground dens in Apulia and moves jumping very fast. During their crisis patients were extremely agitated and the therapeutical control consisted of a home ritual where players of fiddle, guitar, tambourine and barrel organ performed various pieces of music—the so-called musical exploration—then expanding on the kind of music to which the tarantism sufferer responded starting to dance. The behaviour of the sufferers and the ritual varied according to the type of tarantula which was believed to have bitten them. The bite, associated to the size and colour of the tarantula itself, provoked behaviours to which the musical therapy was adapted. Some tarantulas named ‘dancers or singers’, for example, seemed to react to singing, dance and music which were rhythmic, syncopated and obsessive. The ‘sad and muted’ tarantulas required melancholic chants or funeral dirges. Lastly, ‘stormy and libertine’ tarantulas, which lead the patient to eroticized behaviours, needed dances that continued until the tarantula itself died. The ‘tarantulate’ patient started to dance to the music suitable to the type of bite, alternatively moving on the ground, so imitating the tarantula and becoming a kind of dancing beast, then rhythmically hopping and skipping for 15 min, the feet always beating the ground 50 times every 10 s [12]. The music was highly rhythmical, with cries, lamentations and harmonic structures that we still find today in two dances typical of the South of Italy: the ‘pizzica’ and the ‘tarantella’. When tiredness prevailed music stopped, and the sufferers laid their heads on a cushion to rest for 10 min. And then all the cycle started again. Hours later, often the next day, the sufferers interrupted their dance, told the players to stop the music and went to bed amazed and smiling. One can ask oneself if tarantism, with time, has not become a symbolic ritual, culturally accepted by the people to exorcise the patient’s also symbolic poisoning (traumas, unresolved conflicts and psychic frustrations). In this context, music, and dance, creates a conceptual idea of the entity which is the object of the cult (the spider) making it material through the music and visual through the dance. What’s more the ceremony has a social importance as music is community bonding. In any case, music and dance have a therapeutical role as they trigger the ritual trance and resolve the crisis of the patients who have been bitten by the tarantula.

It was only in the last century, though, that initial scientific basis came to support the use of music as a credible therapy for the cure of neurological disorders. The important advancement of medical science in Europe and the industrialized countries during the twentieth century, allowed the birth of schools of scientific thought focused on understanding the causes and effects of music on certain diseases. We should mention the work done by Chomet who in 1875 investigated the impact of music on mental and physical health and its usefulness in preventing epileptic seizures [13], and note that in 1891, in Great Britain, music was first utilized in hospital wards to calm the patients during their recovery [14]. Throughout these early trials the therapeutical implications of music were still quite vague, even though an attempt was made to provide a scientific justification to the impact of music on the human body. The early research works looking into the predictable and measurable effects of music, sound and vibrations on cerebral physiology had a seminal value as they pioneered what later became a medical model of a music therapy based on a rigorous scientific method. With the birth of psychoanalysis came the concept of non-verbal forms of communication. This in turn gave rise to techniques in which, as in music therapy, the privileged relationship with the therapist is at the base of the taking charge on the part of the patient.

However, it is only in the last 15 years that well planned and controlled clinical tests were carried out. These led to a definition of the actual benefits and possible relevant areas for the use of musical therapies in connection with a number of neurological pathologies.

2.2 Music for Healthy People

If music is considered as a special language, it is the language of emotions and feeling. Music rhythms are everyday life rhythms, and music prosody (major and minor keys, crescendos and diminuendos, interludes, pauses and accelerations), quoting Langer ‘reveals the nature of feelings with a detail and truth that language cannot approach’ [3]. In social context, during the course of human history, music leads to an active participation (playing an instrument, clapping, singing), engaging social functions such as communication and cooperation, having a shared goal and intentionality. The same can be said for music listeners, engaging social cognition. For this reason, music is a fascinating tool to enhance quality of life in people, young and old (Fig. 2.1).

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Fig. 2.1

‘Enchantment’ courtesy of Lorenzo Colombo

The social and emotional impact of music in younger age is fundamental for forming solid interpersonal relationships, dealing with negative emotions and stress, constructing a strong and reliable self-identity. In adulthood music has the same role, evoking memories, maintaining competence, independence and self-esteem, reducing feelings of isolation and loneliness. Listening to music is a leisure activity for older people that is linked to positive attitudes, good emotions and contributes to psychological and mental well-being. The same applies to participatory group musical activities (i.e. choir singing): this attitude has received increasing interest as a potential intervention to maintain and increase general health, in particular psychological status. A large body of literature has confirmed this idea. In particular, questionnaire and interview studies on older adults actively participating in community choirs have demonstrated a self-perceived benefit on quality of life, depression and satisfaction with health due to an increase of social interaction, cognitive stimulation and enjoyment. The long-term efficacy of choir singing was studied in a randomized controlled trial in the United Kingdom. A group of older adults (258 subjects) was followed for 6 months, half of them were part of a 3 months programme of choir singing. The singing intervention had a significantly long-term positive effect in measures of health-related quality of live, and a shorter positive effect on depression, anxiety and mental-related quality of life. This was more cost-effective than other activities [15]. In a recent systematic review commissioned by the Economic and Social research Council in the United Kingdom, music (regular group singing or simply listening) was associated with reduced anxiety in young adults, enhanced mood and purpose in adults and enhanced morale and reduce risk of depression in older people. In the chapter, 37 quantitative studies of subjective well-being outcomes were discussed, and the results confirmed showing that there is a reliable evidence of positive effects of music and singing on adult’s well-being [16].

Music has also a positive impact on cognitive and motor functions in older people, due to the particular power music (especially with fast tempo in major mode) has on stimulation. Several studies compared the short-term effects of background music versus no music in older people: results reported a better performance on verbal fluency, episodic memory and psychomotor speed in people who listened to music [17–19]. In another study, older people who had long-term musical training in younger age have been found to have better and faster performance and neural timing in executive, memory and cognitive functions, attention and language [20, 21]. Furthermore, instrumental musical training in older age (learning to play an instrument) has been found to significantly improve mood and quality of live and increase performance of executive tasks and attention [22, 23]. Taken together, these data suggest that musical leisure activities are particularly beneficial for seniors and can serve as a practical opportunity and an effective means to slow age-related cognitive difficulties.

2.3 Music for Neurological Diseases and Neurological Rehabilitation

2.3.1 Stroke

Of the major neurological pathologies, the best evidence for efficacy of music-based interventions has been reported for people affected by stroke. Music-based intervention is defined as an experimental protocol which uses music in various forms, to study the possible specific therapeutic effects. According to the World Federation for Music Therapy, music therapy is the ‘use of music and/or musical elements (sound, rhythm, melody and harmony) by a qualified music therapist, with a single client or group, in a process designed to facilitate and promote communication, relationships, learning, mobility, expression, organization, and other relevant therapeutic objectives, in order to meet physical, emotional, mental, social and cognitive needs’. Moreover, the definition of music therapy by American Music Therapy Association is ‘the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program’ [24]. AMTA was created in 1988, with the purpose of develop the therapeutic use of music in rehabilitation, special education and community settings. Focusing on stroke, in a recent published review 16 randomized and controlled trials were analysed [2]. Music was used as an add-on therapy for stroke-related neurological symptoms and the assessed outcomes ranged from motor and language functions, cognitive functions, mood and quality of life. These outcomes were measured with numerous standard motor tests, clinical neuropsychological assessments, questionnaires and computer-based motor analyses. In some studies, electroencephalography and magnetic resonance imaging were utilized. The number of participants in these studies ranged from 20 to 92, the music therapist was involved in four studies, the duration of the intervention ranged from 10 days to 15 weeks.

As far as hemiparesis is concerned, eight studies reported enhanced motor recovery when patients who were affected by a stroke were rehabilitated with a music-based intervention. Four of these scientific works studied the use of rhythmic auditory stimulation [25–28]. This is a technique used to ameliorate movements that are naturally rhythmic, such as gait. A series of auditory stimuli with a fixed rhythm are presented and movements are entrained to the previously determined rhythm. All four studies found the intervention to significantly improve gait parameters (gait velocity, stride length, cadence, symmetry and length of foot contact to surface) more than gait training without any musical aid. In these studies, the duration of the training was 3–6 weeks. The same was seen when the methodology (rhythmic auditory stimulation) was studied with respect to postural control and gait performance in people affected by stabilized effects of a stroke. In a single, not blinded study (20 participants, overall duration of intervention 15 h in 6 weeks), there was a significant improvement in gait velocity and double-support period on the affected side [25]. In another not blinded study (33 participants, overall duration of intervention 16 h in 8 weeks) rhythmic auditory stimulation was able to improve range of ankle extension and arm flexibility (both up and down), mood and increased frequency and quality of interpersonal relationships [29]. The musical technique resulted in greater improvement if done by a specialist (music therapist, compared to control) compared by a non-music therapist (compared to control).

Music-supported therapy is a music-based intervention developed for motor rehabilitation on stroke. By definition, music-supported therapy is not only hearing music but also singing and playing rhythm and percussion instruments. This approach is based on specific principles. These are: persistent repetition and exercising of simple finger and arm movements, auditory-motor coupling and integration/reinforcement of motor effects due to immediate auditory feedback, shaping and adapting the training according to individual progress and evoking emotion-motivation effects due to the playfulness and emotional impact of music while acquiring a new skill. In a recent systematic review and meta-analysis, ten studies were analysed (358 subjects) to investigate the use of music-supported training in stroke-induced motor dysfunction [30]. There was evidence of a positive effect of music-supported therapy on several tests (9-Hole Peg Test, Arm paresis Score, Berg balance Scale score and Wolf Motor Function Time). The overall efficacy of motor function was in favour of music-supported therapy for upper limb motor functions, total motor functions and executive functions. The improvement in motor abilities seemed to be specifically due to music rather than motor training, considering that patients training with mute instruments showed less improvement than the music active group. In one not blinded study (25 participants, overall duration of intervention 10 days) an innovative protocol was used, in particular movement sonification therapy, a modern development in music-supported therapy in which gross movement is modulated and transformed into sound. This technique is able to provide a continuous feedback, substituting for deficits in proprioception. Sonication significantly reduced joint pain and improved motor smoothness more than movement therapy without a sound support [31].

In one pivotal study, melodic intonation therapy was tested in a group of ten patients affected by non-fluent aphasia [32]. In melodic intonation therapy, the intonation of speech is expressed as high and low pitches. Production of linguistic phrases is achieved first by singing (intoning) them at a slow pace and steady rhythm supported by tapping (two-syllable words at the beginning of training), then following a series of steps that eventually transforms communication from singing to speech. The results of this study showed an improvement in patient’s daily life communication an object naming if compared to control group.

Music-supported therapy for stroke motor recovery can be categorized into two definite fields: music making and music listening. Music making involves the coupling of motor and auditory systems, and may directly facilitate the executions of movements. Music listening may modulate the patient ability to engage in therapy. A recent Cochrane review evaluated these music interventions combined with standard care for functional outcomes in subjects affected by brain damage, including stroke [33]. Twenty-nine studies including 775 adult participants were reviewed. The studies tested the effect of music interventions on moving, walking, thinking and communicating. Although the majority of studies included presented a high risk of bias (low to moderate quality of evidence), music intervention using rhythm resulted beneficial for improving gait velocity, stride length of the affected side and gait cadence after stroke. Furthermore, music intervention resulted beneficial for improving the timing of upper extremity function after stroke and for communication outcomes in people with aphasia. Finally, quality of life after stroke was detected using rhythmic auditory stimulation. Treatment delivered by a trained music therapist resulted more effective than treatment delivered by other professionals. Anyway, more research is