17. 莫札特效應
1993 年發表於 Nature 的論文，研究人讓大學生聽取
下列三者之一各 10 分鐘； (1) Mozart’s sonata for
two pianos in D major （莫札特 D 大調雙鋼琴奏鳴
曲）， (2) 讓人放鬆的音樂（ relaxation tape ）。
(3) 寂靜無聲（ silence ）。隨後，受試學生立即接受
一種 spatial reasoning test ( 取自 the Stanford-Biret
intelligence scale) 。結果顯示，聽取莫札特歌曲的學
生，其測試成績優於聽取放鬆音樂和寂靜無聲二組。
研究人員發現這項效果只持續 10-15 分。因此研究人
員認為：聽取莫札特歌曲的學生其記憶力確有增進，
因為目前認為：處理音樂訊息及處理 spatial
reasoning 的腦部路徑是相同的。
18.
19. Study 2 Results
Music Group Tested Before vs. After Music Lessons
0
5
10
15
Before Music
4 mon. After Music
8 mon. After Music
Before
Music
9.8 10.8
4 mon. After
Music
12.8 10.7
8 mon. After
Music
14.8 10.4
Object
Assem
Other
Tasks
ANOVA (other tasks)
F(2.36)=.57, ns
23. 期刊 年份 方法 結論
Plos One 2013 Systematic
Review
4 or more music therapy
sessions proved effect
Journal of Music
Therapy
2013 Systematic
Review
music has positive and
negative effect on emotion
Brain Topogram 2013 RCT EEG alpha changed
continuously, but theta
changed most significantly
after 3 months. Music
therapy is helpful for
reducing anxiety and
Cochrane Review 2011 Review Improve global state, mental
state (including negative
symptoms) and social
functioning 95% CI
心理領域
40. 評估
0
20
40
60
%
III IV V VI
average
socialization
average
I II III IV V VI
Average
10
20
30
40
50
60
70
80
90
100
appropriate
verbal%
response
Session
Communication
Average
0
50
100
%
V VI
average
session
movement
average
43. 春が来た
• 春が来た 春が来た どこに来た。
• ha ru ga ki ta ha ru ga ki ta do ko ni ki ta
山に来た 里に来た、
• ya ma no ki ta sa to no ki ta
野にも来た。
no ni mo ki ta
• 花がさく 花がさく どこにさく。
ha na ga sa ku ha na ga sa ku do ko ni sa ku
• 山にさく 里にさく、
ya ma no sa ku sa to ni sa ku
• 野にもさく。
no ni mo sa ku
•
鳥がなく 鳥がなく どこでなく。
• to ri ga na ku to ri ga na ku do ko de na ku
• 山で鳴く 里で鳴く、
ya ma de na ku sa to de na ku
• 野でも鳴く。
• no de mo na ku
44. Benefits of Singing
唱歌的好處
Our immune system is given a boost enabling us to fight
disease.
Singing can help reduce anger and depression and anxiety
Singing increases poise, self-esteem and presentation skills.
Singing strengthens concentration and memory.
Singing develops the lungs and promotes superior posture.
Singing broadens expressive communication.
Singing adds a rich, more pleasant quality to speech.
Singing animates the body, mind and spirit.
Singing provides a safe environment to try new skills
Singing enables you to meet more people
Singing stimulates insight into prose and poetry and piques
Singing enriches one’s ability to appreciate the art of great
53. 音樂治療的原則
ISO Principle 同質原則
共乘原理
以音樂為中心 (music-center) 的治療方式：
Music as therapy VS Music in therapy
音樂、音樂治療師、治療對象的三角形關係
54. 文獻探討
Journal of Music Therapy (1977). Gilbert JP. Winter;14(4)
Music therapy perspectives on death and dying.
音樂治療可以增加疼痛閥值 , 改善疼痛的程度 , 疼痛
持續的時間及止痛藥使用的量及使用頻率 (Bailey,1985;
Heitz,Symreng & Scamman,1992; Magill,1993; Mandel,1991;
Munro&Mount,1978;)
61. BENEFITS OF MUSIC THERAPY IN
LONG TERM CARE
In therapeutic application, music has the ability to:
• Provide motivation for physical and social activity
• Facilitate communication and emotional expression
• Evoke memories and associations. Ehnance reminiscence
• Stimulate cognition,maintain skills,aid new learning
• Provide multi-sensory stimulation: auditory, visual, tactile, kinaesthetic
• Decrease pain perception
• Facilitate relaxation and comfort
• Decrease feelings of loneliness, grief and isolation
• Reach residents disoriented due to Alzheimer’s disease and related dementias
• Decrease agitation,disruptive behaviours and wandering
• Provide a sense of structure and order
• Increase awareness of self,others and environment
• Increase attention and on-taks behaviour
• Reflect a resident’s culture, language and personal preferences
62. SPIRITUAL NEEDS
Spiritual support may help some people makes sense of
their illness and give them the strength to continue
There are many different spiritual belief systems and each
one has its own parctices, myths, rites and symbols
Spiritual beliefs are highly personal and vary among
individuals
63. TALKING TO THE DYING PERSON-HOW
TO COMMUNICATE EFFECTIVELY
1)Listen to your patient’s feelings and concerns in a non-
judgemental way.
2)Help maintain realistic hope.
3)Allow the person to talk about death or reminisce about
life.
Avoid statements such as:
-”everything will be fine”
-”you are going to get better”
-”you’ll be back to your old self soon”
-”let’s not talk about that”
64. TALKING TO THE DYING PERSON-HOW
TO COMMUNICATE EFFECTIVELY
4)Respect each person’s way of communicating-
do not try to force conversation. Some persons
may choose not to talk about their death.
5)Be aware of non-verbal communication.
6)Include the person in conversations.
65. Music Therapy Goal Areas in Palliative Care
Pain Perception. Pain Management
Comfort and Relaxation
Emotional Self-Expression
Communication
Strengthen Relationship
Stress. Fear. Anxiety
Life Review
Spirituality
Facilitate Grieving Process
68. Demo
聖誕節十二天
• On the twelfth day of New Year 聖誕節第一天，
my true love gave to me 我的真愛送給我
Twelve drummers drumming 十二個打鼓的鼓手，
Eleven pipers piping 十一個吹笛的吹笛手，
Ten lords a-leaping 十個跳躍的先生，
Nine ladies dancing 九個跳舞的女士，
Eight maids a-milking 八個擠奶的侍女，
Seven swans a-swimming 七隻游泳的天鵝，
Six geese a-laying 六隻躺著的鵝，
Five golden rings 五個金戒指，
Four calling birds 四隻鳴叫的鳥，
Three French hens 三隻法國母雞，
Two turtle doves 兩隻斑鳩，
And a partridge in a pear tree 和一隻洋梨樹上的鷓
鴣！
69. Reflection In The Mirror
Reflection in the mirror show the memories we share
Special times we had together without worries and no cares.
You never got to play the part cause I took center stage
But you always waited in the wings for the coming of my age.
You know your smile lights up my life when I walk into a room
But sometimes when I look at you my eyes reveal the pain
I often say I love you but do you really understand
Remembering the child in you as I gently hold your hand.
Reflection in the mirror is of you looking back at me.
Words&Music written by Nola Langford
“Reflection in the mirror” is about my mother, Nyfanway, who has Alzheimers. My
heart gave me the melody, powerful feelings and words during the long nights
reflecting on how things used to be. This song became part of my grieving and
healing process, and I hope other families of precious loved ones suffering this
disease, will gain comfort from “Reflection in the mirror”…….Nola Langford
71. Literature Review
• Bremner et al.(1995). MRI-based measurement of
hippocampal volume in patients with combat-related
posttraumatic stress disorder. American Journal of
Psychiatry. 152(7):973-981.
• Bremner J. Douglas(2001). A biological model for delayed
recall of childhood abuse. Journal of Aggression,
Maltreatment, and Trauma. 4(2)P165-183.
• Julia Golier & Rachel Yehuda(1998). Neuroendocrine
activity and memory-related impairments in posttraumatic
stress disorder. Development and Psychopathology, 10,
857-869.
72. Literature Review
• Cumming, E., & Henry, W. (1961). Adult and
Aging. New York: Basic Books. Inc.
• Butler, R. N. (1963). The life review: An
interpretation of reminiscence in the aged.
Psychiatry, 26, 65–75.
• Parker, R. G. (1995). Reminiscence: A
continuity theory framework. Gerontologist.
35(4), 515–525.
73. Clinical/empirical research on music with
Alzheimer’s disease and related disorders :
cognitive skills
Authors Year Target
behaviour(S)
G. Smith 1986 Cognitive
functioning
Prickett and
Moore
1991 Number of
words recalled
Carruth 1997 Percentage
correct face-
name recognition
responses
74. Clinical/empirical research on music with
Alzheimer’s disease and related disorders
: social skills
Authors Year Target behaviour(s)
Olderog-Millard and
Smith
1989 Frequency of social
behaviour
Pollack and Namazi 1992 Frequency of social
behaviour
Clair et al. 1993 UCLA loneliness scales
scores Rasenberg self-
esteem scores
Lord and Garner 1993 Recall
Interaction
Mood
Newman and Ward 1993 Positive
behaviours:smiling,
touching, eye-contact,
hugging, extending
hands
Sambandhan and 1995 Communication
75. Clinical/empirical research on music with
Alzheimer’s disease and related disorders :
behavior managementAuthors Year Target behaviour(S)
Scruggs 1991 Percentage time and frequency wandering
Length or stay in sessions
Cognition: MMSE scores
Lindenmuth et al. 1992 Number of hours of productive sleep
Sleep patterns
Fitzgerald-Cloutier 1993 Length of wandering
Gerdner and Swanson 1993 Agitation scores
Groene 1993 Wandering
Casby and Holm 1994 Frequency of disruptive verbalizations
Clair and Bernstein 1994 Percentage agitation
Goddaer and Abraham 1994 Agitation scores
Tabloski et al. 1995 Agitation scores
Brotons and Pickett-
Copper
1996 Agitation scores
Ragneskog et al. 1996a Amount of food
76. Biomedical Foundation of Music
(Taylor, 1988,1989;Bever, 1988)
Left hemisphere Right hemisphere
• Perception of rhythm
• Perception of musical information
• Identifying minute frequency changes
of less than 30 cents
• Legato transient
• Melody recognition-among musicians
• Lyric performance during singing
• Sequential analytical aspects of music
• Receptive musical behavior
• General musical ability-among musicians
• Process of musical pitch
• Melody perception-nonmusicians
• Visual pattern
recognition(necessary for
reading music)
• Auditory pattern recognition(for
tonal memory and timbre)
• Discriminating sound intensity
changes
• Perception of musical chords
• Singing, specifically use of
77. Music Therapy in Dementia Care
• Objective
Currently, there are about fourteen hundred
thousand Alzheimer's patients in Taiwan and each
year the prevalence is increased at about 0.1%.
Past researches have shown that music elements
stimulate various brain areas and arouse memory.
The purpose of the research was to study music
therapy both quantitatively and qualitatively in
maintaining health and promoting quality of life
for the people with dementia.
78. Method and Material
The pilot study co-lead by two accredited music therapists
and one psychologist included two sections each last ten
weeks separated by a two-week break. Four male and four
female elderly (average MMSE=17.13, SD=4.291; average
age=77.8, SD=2.9;CDR=1) referred from the clinic. The
first period the elderly participants participated in the
music therapy group once a week. The second period the
seven elderly participants participated in the music therapy
group twice a week. MMSE, CDR, ADAS-Cog and behave-AD
and interviews were collected before the study, during the
two-week break, and after the study. The sessions included
song reminiscence, song writing, and musical games, etc.
79. Result
The number of the participants was
limited to the study space and the design
of the study. Quantitatively, the MMSE
collected after the first period was
average at 17.17 (SD=4.07) and collected
after the second period was 17.20
(SD=5.63). Qualitative, family feedback
and participants' presentation were both
81. Conclusion
The scores did not reveal prevalent difference partly
limited to the time space of the research; however, the
qualitative results were all positive. Seven out of the eight
participants has never received official music training but
all were musically inclined. Reminiscence and all participants'
presentations were videotaped for future reference. The
prevalence of Alzheimer's Disease and related dementia has
increased globally. The mission of all aligned professional is
to aim at maintaining the patient's condition, promoting
communication among all related personnel, and improving
the patient's quality of life.
The credential Music Therapist – Board Certified (MT-BC) is granted by the Certification Board for Music Therapists (CBMT) to identify music therapists who have demonstrated the knowledge, skills and abilities necessary to practice music therapy at the current level of the profession. The purpose of board certification in music therapy is to provide an objective national standard that can be used as a measure of professionalism by interested agencies, groups, and individuals.
A =大腦皮質B = 基底前腦C = 海馬迴
WHO
plaque(Tau濤)的蛋白質 40歲極少數人memory-ST, LT
communication- aphasia
personality, behaviour change-agnosia
movement-apraxia
自體免疫理論（The Autoimmune Theory）
你的免疫系統會在他們五十歲前就發病以遺傳學為出發的治療論（The Genetic Theory）
阿茲海默症的遺傳學是最令人困惑的. 某些家族可能有許多成員受到影響,但是因為家族成員可能暴露在同樣的環境,因此無法道盡究竟遺傳因素要負多大的責任. AD.有幾種位於第21和 14號染色體上的基因被辨識出來,它們是家族型阿茲海默症所特有的.對於一般最常見的偶發型阿茲海默症,在第19號染色體上帶有載脂蛋白E（Apolipoprotein E；APOE）的人,其阿茲海默症的發生率比一般人高.有更多的研究工作需要進行，好去瞭解遺傳因素是如何影響阿茲海默症的發生。
tangle斑塊主要由名為乙型 －澱粉樣蛋白（beta amyloid）的蛋白質
腦部梅納德氏基底核（nucleus basalis of Meynert）的部分有神經退化的現象
腦中的神經傳導物質乙醯膽鹼（acetylcholine）減少
退化性/血管性(其他:AIDS)1906年由德國Alois Alzheimer醫師 4 mg Razadyne (previously known as Reminyl)愛憶欣 (Aricept)、憶思能 (Exelon)、利憶靈(Reminyl) DELIRIUM(譫妄症)急性精神錯亂Alzheimer, Substance or multiple etiology (head trauma, alcohol)
精神疾病診斷與統計手冊I Clinical Disorders II Personality Disorders/Mental Retardation III IV Psychosocial and Environmental Problems V Global
cause: medication (folic acid deficiency), diabetes, ;comorbid: depression computer screen: CT scan, MRI, PET; larger cerebral ventricles than normal aging, histopathology
Executive function: planning, The wife of a man with severe dementia said, "When I was encouraged by a music therapist to sing to my husband who had been lost in the fog of Alzheimer's disease for so many years, he looked at me and seemed to recognize me. On the last day of his life, he opened his eyes and looked into mine when I sang his favorite hymn. I'll always treasure that last moment we shared together. Music therapy gave me that memory, the gift I will never forget."
Early ST(short-term memory) inability to retain new info: significant event, nouns, disorient to time, place, Advance LT (long-term)
Personality& behaviour change- later stage
Medication, (Aricept, Exeton, Reminyl) early stage only; Side effects may include nausea, diarrhea, muscle cramp, vomit, and/or insomnia.
Stage (5-10 yrs)
-early: communication, depression, ST memory loss
-mid: memory, personality&beh. Change, need assistance for daily task,
anxiety, aggression
-late: significant memory loss: name, communication, self-care
-end
7-year-old airport
hemiplegia, apraxia: word fragment, Larry
於65歲以上者約占15%，75歲以上者約35%，85歲以上者則高達55%以上.帕金森氏症是一種慢性的中樞神經系統失調。詹姆士·帕金森(James Parkinson)於1817年在英國它的病因目前仍不明，推測和大腦底部基底核(basal ganglia)以及黑質(substantial nigra)腦細胞快速退化，無法製造足夠的神經引導物質多巴胺(Dopamine)和膽鹼作用增強有關。腦內需要多巴胺來指揮肌肉的活動；缺乏足夠的多巴胺就產生各種活動障礙。Autopsy show neuronal loss and Lewy bodies are evident in the substantia nigra (Lewy bodies are round deposits which contain damaged nerve cells. They are probably formed as the cells try to protect themselves from attack.) basal ganglia, voluntary movement, produce dopamine, regulate mood
Abnormal motor signs of resting tremor, muscular rigidity and loss of associated movements
