Exploring Music-Based Rehabilitation for Parkinsonism through Embodied Cognitive Science

"We can all relate": patient experience of an emotion-oriented group intervention after Acquired Brain Injury

Introduction

Group interventions are carried out routinely across neuropsychological rehabilitation services, to improve understanding of brain injury and aspects of impairment. Treatment provided in a group modality can bring additional perceived benefits, such as co-operative learning. However, there are very few studies which explore patient perceptions and experiences of such interventions. In the present study we investigated the experience of attending a group-based educational intervention for the consequences of acquired brain injury (ABI), which had a strong focus on emotion and emotion regulation.

Methods

Using qualitative semi-structured interviews (approximately 20 minutes), the study explores the lived experience of participating in the seven-session programme, the better to identify the perceived efficacy, salience and value of individual elements. Twenty participants with ABI took part in individual interviews, after completion of the group programme (the Brain Injury Solutions and Emotions Programme, BISEP). The study adopted a descriptive phenomenological philosophy, which focuses on lived experience to explore a phenomenon (i.e. the experience of BISEP). As regards methods, the study employed thematic analysis to cluster experiences into themes of meaning.

Results

Five themes were identified: (1) 'Long term consequences and psychological needs', which related to the persistent nature of direct consequences of injury and adjustment, and how these result in a need for interventions such as BISEP. (2) 'Positive experiences of participating in the programme', referred to participants' overall experience of the programme and valued elements within it. The remaining themes referred to the programme as (3) a social milieu; (4) a place to learn; and (5) a place to promote positive emotional experiences.

Discussion

Similar to previous studies, many people reported high acceptability and perceived value of the group programme, and its role in facilitating adjustment and understanding of injury. Of particular importance was the opportunity to socialise with people who "can all relate", in line with a growing emphasis on social rehabilitation. The findings especially highlight the relevance of emotion-focused group programmes for ABI, promoting emotion regulation, and practical tools that are delivered optimistically. Further implications for practice and future research include to focus on long term rehabilitation, a social milieu, and strategies to support adjustment.

An integrated review of music cognition and rhythmic stimuli in sensorimotor neurocognition and neurorehabilitation

This work reviews the growing body of interdisciplinary research on music cognition, using biomechanical, kinesiological, clinical, psychosocial, and sociological methods. The review primarily examines the relationship between temporal elements in music and motor responses under varying contexts, with considerable relevance for clinical rehabilitation. After providing an overview of the terminology and approaches pertinent to theories of rhythm and meter from the musical-theoretical and cognitive fields, this review focuses on studies on the effects of rhythmic sensory stimulation on gait, rhythmic cues' effect on the motor system, reactions to rhythmic stimuli attempting to synchronize mobility (i.e., musical embodiment), and the application of rhythm for motor rehabilitation for individuals with Parkinson's disease, stroke, mild cognitive impairment, Alzheimer's disease, and other neurodegenerative or neurotraumatic diseases. This work ultimately bridges the gap between the musical-theoretical and cognitive science fields to facilitate innovative research in which each discipline informs the other.

Intersubjectivity and the meaning of Nordic Walking practice in the view of people with Parkinson’s disease

Aims: whilst Nordic Walking (NW) practice is spreading worldwide, few studies have addressed the issue of intersubjectivity and the perception of PD individuals practicing NW and its possible impact on their daily life across different countries and cultures. This pilot study sought to explore the possible relationship between the habit of practicing NW and the perception of functionality and quality of life in the participants’ cultural context. Methods: the focus group (FG) technique was used, with 10 individuals participating in a NW program. Results: content analysis revealed five main discourse categories: a) “NW benefits for people with PD”; b) “incorporation of the NW poles in daily life”; c) “Belonging to a NW group as a treatment aid”; d) “how PD people feel about their condition”; and, finally, e) “the present and the future: expectations and issues”. Conclusion: in general, NW was found to generates positive content regarding coping with PD, beyond the biomechanical and quantitative functional effects previously studied. We suggest NW might be an important adjuvant resource for improving perceived functionality among people with PD.

Processes and Experiences of Creative Cognition in Seven Western Classical Composers

In a qualitative study, we explored the range of reflections and experiences involved in the composition of score-based music by administering a 15-item, open-ended, questionnaire to seven professional composers from Europe and North America. Adopting a grounded theory approach, we organized six different codes emerging from our data into two higher-order categories (the act of composing and establishing relationships). Our content analysis, inspired by the theoretical resources of 4E cognitive science, points to three overlapping characteristics of creative cognition in music composition: it is largely exploratory, it is grounded in bodily experience, and it emerges from the recursive dialogue of agents and their environment. More generally, such preliminary findings suggest that musical creativity may be advantageously understood as a process of constant adaptation - one in which composers enact their musical styles and identities by exploring novel interactivities hidden in their contingent and historical milieux.

Musical Interaction Reveals Music as Embodied Language

Life and social sciences often focus on the social nature of music (and language alike). In biology, for example, the three main evolutionary hypotheses about music (i.e., sexual selection, parent-infant bond, and group cohesion) stress its intrinsically social character (Honing et al., 2015). Neurobiology thereby has investigated the neuronal and hormonal underpinnings of musicality for more than two decades (Chanda and Levitin, 2013; Salimpoor et al., 2015; Mehr et al., 2019). In line with these approaches, the present paper aims to suggest that the proper way to capture the social interactive nature of music (and, before it, musicality), is to conceive of it as an embodied language, rooted in culturally adapted brain structures (Clarke et al., 2015; D'Ausilio et al., 2015). This proposal heeds Ian Cross' call for an investigation of music as an "interactive communicative process" rather than "a manifestation of patterns in sound" (Cross, 2014), with an emphasis on its embodied and predictive (coding) aspects (Clark, 2016; Leman, 2016; Koelsch et al., 2019). In the present paper our goal is: (i) to propose a framework of music as embodied language based on a review of the major concepts that define joint musical action, with a particular emphasis on embodied music cognition and predictive processing, along with some relevant neural underpinnings; (ii) to summarize three experiments conducted in our laboratories (and recently published), which provide evidence for, and can be interpreted according to, the new conceptual framework. In doing so, we draw on both cognitive musicology and neuroscience to outline a comprehensive framework of musical interaction, exploring several aspects of making music in dyads, from a very basic proto-musical action, like tapping, to more sophisticated contexts, like playing a jazz standard and singing a hocket melody. Our framework combines embodied and predictive features, revolving around the concept of joint agency (Pacherie, 2012; Keller et al., 2016; Bolt and Loehr, 2017). If social interaction is the "default mode" by which human brains communicate with their environment (Hari et al., 2015), music and musicality conceived of as an embodied language may arguably provide a route toward its navigation.

Cellists' sound quality is shaped by their primary postural behavior

During the last 20 years, the role of musicians’ body movements has emerged as a central question in instrument practice: Why do musicians make so many postural movements, for instance, with their torsos and heads, while playing musical instruments? The musical significance of such ancillary gestures is still an enigma and therefore remains a major pedagogical challenge, since one does not know if these movements should be considered essential embodied skills that improve musical expressivity. Although previous studies established clear connections between musicians’ body movements and musical structures (particularly for clarinet, piano or violin performances), no evidence of direct relationships between body movements and the quality of the produced timbre has ever been found. In this study, focusing on the area of bowed-string instruments, we address the problem by showing that cellists use a set of primary postural directions to develop fluid kinematic bow features (velocity, acceleration) that prevent the production of poor quality (i.e., harsh, shrill, whistling) sounds. By comparing the body-related angles between normal and posturally constrained playing situations, our results reveal that the chest rotation and vertical inclination made by cellists act as coordinative support for the kinematics of the bowing gesture. These findings support the experimental works of Alexander, especially those that showed the role of head movements with respect to the upper torso (the so-called primary control) in ensuring the smooth transmission of fine motor control in musicians all the way to the produced sound. More generally, our research highlights the importance of focusing on this fundamental postural sense to improve the quality of human activities across different domains (music, dance, sports, rehabilitation, working positions, etc.).

Experiential Neurorehabilitation: A Neurological Therapy Based on the Enactive Paradigm

With the arrival of the cognitive paradigm during the latter half of the last century, the theoretical and scientific bases of neurorehabilitation have been linked to the knowledge developed in cognitive neuropsychology and cognitive neuroscience. Although the knowledge generated by these disciplines has made relevant contributions to neurological therapy, their theoretical premises may create limitations in therapeutic processes. The present manuscript has two main objectives: first, to explicitly set forth the theoretical bases of cognitive neurorehabilitation and critically analyze the repercussions that these premises have produced in clinical practice; and second, to propose the enactive paradigm to reinterpret perspectives on people with brain damage and their therapy (assessment and treatment). This analysis will show that (1) neurorehabilitation as a therapy underutilizes body-originated resources that aid in recovery from neurological sequelae (embrained therapy); (2) the therapeutic process is based exclusively on subpersonal explanation models (subpersonal therapy); and (3), neurorehabilitation does not take subjectivity of each person in their own recovery processes into account (anti-subjective therapy). Subsequently, and in order to attenuate or resolve the conception of embrained, subpersonal and anti-subjective therapy, I argue in support of incorporating the enactive paradigm in rehabilitation of neurological damage. It is proposed here under a new term, "experiential neurorehabilitation." This proposal approaches neurological disease and its sequelae as alterations in dynamic interaction between the body structure and the environment in which the meaning of the experience is also altered. Therefore, when a person is not able to walk, remember the past, communicate a thought, or maintain efficient self-care, their impairments are not only a product of an alteration in a specific cerebral area or within information processing; rather, the sequelae of their condition stem from alterations in the whole living system and its dynamics with the environment. The objective of experiential neurorehabilitation is the recovery of the singular and concrete experience of the person, composed of physical and subjective life attributes.

Persistent Effects of Musical Training on Mathematical Skills of Children With Developmental Dyscalculia

Musical training (MT) is perceived as a multi-sensory program that simultaneously integrates visual, aural, oral, and kinesthetic senses. Furthermore, MT stimulates cognitive functions in a ludic way instead of tapping straight into the traditional context of school learning, including mathematics. Nevertheless, the efficacy of MT over mathematics remains understudied, especially concerning longstanding effects. For this reason, this longitudinal study explored the impact of MT on numerical cognition and abstract visual reasoning using a double-blind and quasi-experimental design. We assessed two groups of children from primary schools, namely one with developmental dyscalculia [DD; n = 22] and another comprising typically developing children [TD; n = 22], who concomitantly underwent MT. Numerical cognition measurement was carried out at four different time points: Baseline (pre-MT assessment), mid-test (after 7 weeks of MT), post-test (after 14 weeks of MT), and follow-up (10 weeks after the end of MT). Significant interactions were found between time and group for numerical cognition performance, in which the DD group showed higher scores in number comprehension, number production at mid-test, and calculation at post-test compared to baseline. A key finding was that number production, number comprehension, and calculation effects were time-resistant for the DD group since changes remained on follow-up. Moreover, no significant differences over time were found for abstract visual reasoning for both groups. In conclusion, the findings of this study showed that MT appears to be a useful tool for compensatory remediation of DD.

Scaling behaviour in music and cortical dynamics interplay to mediate music listening pleasure

The pleasure of music listening regulates daily behaviour and promotes rehabilitation in healthcare. Human behaviour emerges from the modulation of spontaneous timely coordinated neuronal networks. Too little is known about the physical properties and neurophysiological underpinnings of music to understand its perception, its health benefit and to deploy personalized or standardized music-therapy. Prior studies revealed how macroscopic neuronal and music patterns scale with frequency according to a 1/f^α relationship, where a is the scaling exponent. Here, we examine how this hallmark in music and neuronal dynamics relate to pleasure. Using electroencephalography, electrocardiography and behavioural data in healthy subjects, we show that music listening decreases the scaling exponent of neuronal activity and-in temporal areas-this change is linked to pleasure. Default-state scaling exponents of the most pleased individuals were higher and approached those found in music loudness fluctuations. Furthermore, the scaling in selective regions and timescales and the average heart rate were largely proportional to the scaling of the melody. The scaling behaviour of heartbeat and neuronal fluctuations were associated during music listening. Our results point to a 1/f resonance between brain and music and a temporal rescaling of neuronal activity in the temporal cortex as mechanisms underlying music appreciation.

Instrumental Technique, Expressivity, and Communication. A Qualitative Study on Learning Music in Individual and Collective Settings

In this paper, we present a qualitative study comparing individual and collective music pedagogies from the point of view of the learner. In doing so, we discuss how the theoretical tools of embodied cognitive science (ECS) can provide adequate resources to capture the main properties of both contexts. We begin by outlining the core principles of ECS, describing how it emerged in response to the information-processing approach to mind, which dominated the cognitive sciences for the latter half of the 20th century. We then consider the orientation offered by ECS and its relevance for music education. We do this by identifying overlapping principles between three tenets of ECS, and three aspects of pedagogical practice. This results in the categories of "instrumental technique," "expressivity," and "communication," which we adopted to examine and categorize the data emerging from our study. In conclusion, we consider the results of our study in light of ECS, discussing what implications can emerge for concrete pedagogical practices in both individual and collective settings.

4E Music Pedagogy and the Principles of Self-Organization

Recent approaches in the cognitive and psychological sciences conceive of mind as an Embodied, Embedded, Extended, and Enactive (or 4E) phenomenon. While this has stimulated important discussions and debates across a vast array of disciplines, its principles, applications, and explanatory power have not yet been properly addressed in the domain of musical development. Accordingly, it remains unclear how the cognitive processes involved in the acquisition of musical skills might be understood through the lenses of this approach, and what this might offer for practical areas like music education. To begin filling this gap, the present contribution aims to explore central aspects of music pedagogy through the lenses of 4E cognitive science. By discussing cross-disciplinary research in music, pedagogy, psychology, and philosophy of mind, we will provide novel insights that may help inspire a richer understanding of what musical learning entails. In doing so, we will develop conceptual bridges between the notion of ‘autopoiesis’ (the property of continuous self-regeneration that characterizes living systems) and the emergent dynamics contributing to the flourishing of one’s musical life. This will reveal important continuities between a number of new teaching approaches and principles of self-organization. In conclusion, we will briefly consider how these conceptual tools align with recent work in interactive cognition and collective music pedagogy, promoting the close collaboration of musicians, pedagogues, and cognitive scientists.

The Aesthetic Turn in Mental Health: Reflections on an Explorative Study into Practices in the Arts Therapies

The paper will draw on materials from arts therapies literature and comments from expert panels to discuss some specific characteristics of the arts therapies and to investigate the role of aesthetic engagement for resilience and mental well-being. The arts increasingly find their way as interventions in mental health domains. However, explorations into the specific mechanisms that underpin the therapeutic effect of arts-based activities are still scarce. Qualitative data were collected from a thematic literature review and experts’ comments on meaningful working procedures in arts therapies. Analysis of multiple data sources revealed core themes and core procedures that occur across arts therapy modalities. This paper presents a practice informed model of arts-based methods in mental health that may serve as a conceptual frame of reference for arts therapists and as study material on the applicability of arts therapy interventions for specific mental health settings.

Evolutionary Musicology Meets Embodied Cognition: Biocultural Coevolution and the Enactive Origins of Human Musicality

Despite evolutionary musicology's interdisciplinary nature, and the diverse methods it employs, the field has nevertheless tended to divide into two main positions. Some argue that music should be understood as a naturally selected adaptation, while others claim that music is a product of culture with little or no relevance for the survival of the species. We review these arguments, suggesting that while interesting and well-reasoned positions have been offered on both sides of the debate, the nature-or-culture (or adaptation vs. non-adaptation) assumptions that have traditionally driven the discussion have resulted in a problematic either/or dichotomy. We then consider an alternative "biocultural" proposal that appears to offer a way forward. As we discuss, this approach draws on a range of research in theoretical biology, archeology, neuroscience, embodied and ecological cognition, and dynamical systems theory (DST), positing a more integrated model that sees biological and cultural dimensions as aspects of the same evolving system. Following this, we outline the enactive approach to cognition, discussing the ways it aligns with the biocultural perspective. Put simply, the enactive approach posits a deep continuity between mind and life, where cognitive processes are explored in terms of how self-organizing living systems enact relationships with the environment that are relevant to their survival and well-being. It highlights the embodied and ecologically situated nature of living agents, as well as the active role they play in their own developmental processes. Importantly, the enactive approach sees cognitive and evolutionary processes as driven by a range of interacting factors, including the socio-cultural forms of activity that characterize the lives of more complex creatures such as ourselves. We offer some suggestions for how this approach might enhance and extend the biocultural model. To conclude we briefly consider the implications of this approach for practical areas such as music education.

When the Sound Becomes the Goal. 4E Cognition and Teleomusicality in Early Infancy

In this paper we explore early musical behaviors through the lenses of the recently emerged "4E" approach to mind, which sees cognitive processes as Embodied, Embedded, Enacted, and Extended. In doing so, we draw from a range of interdisciplinary research, engaging in critical and constructive discussions with both new findings and existing positions. In particular, we refer to observational research by French pedagogue and psychologist François Delalande, who examined infants' first "sound discoveries" and individuated three different musical "conducts" inspired by the "phases of the game" originally postulated by Piaget. Elaborating on such ideas we introduce the notion of "teleomusicality," which describes the goal-directed behaviors infants adopt to explore and play with sounds. This is distinguished from the developmentally earlier "protomusicality," which is based on music-like utterances, movements, and emotionally relevant interactions (e.g., with primary caregivers) that do not entail a primary focus on sound itself. The development from protomusicality to teleomusicality is discussed in terms of an "attentive shift" that occurs between 6 and 10 months of age. This forms the basis of a conceptual framework for early musical development that emphasizes the emergence of exploratory, goal-directed (i.e., sound-oriented), and self-organized musical actions in infancy. In line with this, we provide a preliminary taxonomy of teleomusical processes discussing "Original Teleomusical Acts" (OTAs) and "Constituted Teleomusical Acts" (CTAs). We argue that while OTAs can be easily witnessed in infants' exploratory behaviors, CTAs involve the mastery of more specific and complex goal-directed chains of actions central to musical activity.

Physical Exercise with Music Reduces Gray and White Matter Loss in the Frontal Cortex of Elderly People: The Mihama-Kiho Scan Project

Findings from previous studies suggest that physical exercise combined with cognitive training produces more positive effects on cognitive function in elderly people than physical exercise alone. However, the brain plasticity associated with these proposed benefits of combined therapy has not yet been investigated in elderly subjects. We hypothesized that the dual task group would experience greater benefits than the physical exercise alone and non-exercise control groups with regard to both cognitive function and brain plasticity. This study investigated the effect of physical exercise with musical accompaniment on structural brain changes in healthy elderly people. Fifty-one participants performed physical exercise (once a week for an hour with professional trainers) with musical accompaniment (ExM), 61 participants performed the same exercise without music (Ex), and 32 participants made up the non-exercise group (Cont). After the 1-year intervention, visuospatial functioning of the ExM but not the Ex group was significantly better than that of the Cont group. Voxel-based morphometry analyses revealed that the ExM group showed greater right superior frontal gyrus volume and preserved volumes of the right anterior cingulate gyrus, left superior temporal gyrus, and insula. These results indicate that compared with exercise alone, physical exercise with music induces greater positive effects on cognitive function and leads to subtle neuroanatomical changes in the brains of elderly people. Therefore, physical exercise with music may be a beneficial intervention to delay age-related cognitive decline.

Sensori-Motor Learning with Movement Sonification: Perspectives from Recent Interdisciplinary Studies

This article reports on an interdisciplinary research project on movement sonification for sensori-motor learning. First, we describe different research fields which have contributed to movement sonification, from music technology including gesture-controlled sound synthesis, sonic interaction design, to research on sensori-motor learning with auditory-feedback. In particular, we propose to distinguish between sound-oriented tasks and movement-oriented tasks in experiments involving interactive sound feedback. We describe several research questions and recently published results on movement control, learning and perception. In particular, we studied the effect of the auditory feedback on movements considering several cases: from experiments on pointing and visuo-motor tracking to more complex tasks where interactive sound feedback can guide movements, or cases of sensory substitution where the auditory feedback can inform on object shapes. We also developed specific methodologies and technologies for designing the sonic feedback and movement sonification. We conclude with a discussion on key future research challenges in sensori-motor learning with movement sonification. We also point out toward promising applications such as rehabilitation, sport training or product design.

The Embodied Self in Parkinson's Disease: Feasibility of a Single Tango Intervention for Assessing Changes in Psychological Health Outcomes and Aesthetic Experience

Background: Dance is an embodied activity with benefits for mobility, balance, and quality of life (QoL) of persons affected by Parkinson's Disease (PD). It is enjoyable and likely to support adherence to movement prescriptions. The objective of this study was to assess the feasibility of measuring changes in psychological outcomes, specifically well-being, body self-efficacy, outcome expectations, and experienced beauty after a single Argentine Tango intervention in a workshop format. To anchor experienced beauty in a theory, the article introduces a model of embodied aesthetics featuring active art-making as a central aspect of healing in arts-based interventions.

Methods: In a single-group pre–post design, we tested the feasibility of measuring psychological changes of 34 PD patients from Southern Germany after an introductory workshop in Argentine Tango. They participated in a 90 min Tango for PD intervention and completed the Heidelberg State Inventory (HSI-24; (Koch et al., 2007)), the Body Self-Efficacy Scale (BSE; (Fuchs and Koch, 2014)) with a sub-dimension on aesthetic experience, and the Credibility-Expectancy Questionnaire (CEQ; (Devilly and Borkovec, 2000)) before and after the intervention. A subgroup completed the therapeutic factors of arts therapies-scale, a new measure to elaborate on the aesthetic experience. We analyzed pre–post-differences with a t-test for paired samples.

Results and Discussion: The study supports the feasibility of measuring health-related psychological changes from a single Argentine Tango intervention for PD patients, as well as acceptance and appropriateness of the intervention for the patient group. After the tango intervention, well-being, body self-efficacy, and outcome expectancies increased. Participants also experienced an increase in beauty of their movements and other aesthetic aspects. We suspect that, in addition to the functional and psychological factors identified so far, the aesthetic experience in dance may be an important therapeutic factor mediating several outcomes of dance and other arts-based interventions. A controlled study for evidence-based testing of targeted variables can now follow to examine the new hypotheses.