Challenge Statements

Biosensors are rapidly becoming part of our everyday life. These devices are based on the detection of a specific molecule that is linked to a health condition and can offer an actionable insight into what’s happening in our bodies (Cynober, 2018). Currently, point-of-care applications constitute the largest use of biosensors, with a large number of biosensors developed for use in medical facilities. However, the fastest growing market is home monitoring. Self-monitoring with biosensors has the potential to impact the care of virtually any chronic disease, from daily monitoring to anticipating the side effects or flare-ups associated with disease progression. Self-monitoring can also impact medical compliance with treatment regimens associated with chronic health conditions.

One of the core phenomena in music is how we respond to the experience. Our responses are widely complex, with a myriad of response types interwoven with individual thoughts, feelings, and social connections. Bodily responses are highly idiosyncratic as each person brings a unique self to a music experience. We know that music experiences can have effects on heart or pulse rate; skin conductivity; blood pressure; biochemical responses; respiration; finger, peripheral skin, or body temperature; muscular tension; blood volume; and gastric motility. Researchers have made significant progress in detailing these responses and, in collaboration with practitioners, have made great strides in utilizing this knowledge in music therapy and music/medicine applications (Hodges, 2008).

Biomonitoring during participation in music-based experiences can provide real-time summary data feeds of important physiological metrics before, during, and after the experiences. It can allow music therapists and other health care providers to adjust or tweak music experiences based on the real-time needs of the patient. It can also provide feedback to individual users on the impact of the experience on their overall health goals. The net effect will be an ongoing realignment of music therapy and music medicine practice, research, and business models.

Chronic pain affects 1.5 billion people worldwide, an estimated 100 million of whom live in the United States. It affects Americans more than diabetes, heart disease, and cancer combined (American Academy of Pain Medicine, 2014). In addition, the most recent Institute of Medicine report (2016) defined pain as a national public health issue requiring a comprehensive strategy that includes non-pharmacological treatments delivered by an interdisciplinary team of health care professionals.  

The pain cycle has been developed to illustrate the connection between physical and psychological components of chronic pain. When a person experiences pain, it can lead to activity avoidance, which leads to progressive deconditioning and muscle tension, which leads to decreasing activity and further deconditioning, which leads to more pain, which leads to anger, anxiety, fear, and/or distress, which leads to improvised mood, which leads to depression, which leads to an increased perception of pain. As this cycle continues, hopelessness sets in, and spiritual suffering begins.

Research indicates that interventions and experiences that focus on monitoring daily activity and mood using problem solving techniques, challenging some of the recurrent worried thoughts, engaging in gradual movement and exercise, watching body cues, maintaining a daily routine and schedule, learning to pace activities, increasing social connectiveness, and sharing emotions are most helpful. Music experiences should focus on mood enhancement, mechanisms for providing choice and control, outlets for self-expression, methods for cognitive reframing, vehicles for social support, and tools to encourage movement (Allen, 2013; Mondanaro and Sara, 2013; Lee, 2016).

Dementia is not a disease, but an umbrella term used to indicate a range of symptoms associated with a decline in memory and other cognitive skills. This decline affects an individual's ability to perform the activities of daily living (Alzheimer’s Association, 2019). Approximately 47.5 million people in the world have dementia, and the total number is expected to rise to 75.6 million by 2030 (WHO, 2017). Cognitive symptoms include impairments in memory, executive function, language, judgment, and spatial abilities. Neuropsychiatric symptoms may include depression, hallucinations, agitation, aggressive behavior, disinhibition, anxiety, apathy, wandering, social withdrawal, and disturbances in appetite and sleep. Some individuals experience a peak period of agitation, referred to as sundowning, as the evening hours approach (American Psychiatric Association, 2010).

When individuals living with dementia try to make sense of the world around them, their brains use their long-term memory rather than short-term memory. This means that they often perceive and understand the world from a different time and place, and therefore a different reality. The difference between these two environments is often a source of immense fear and anxiety for people with dementia and can result in challenging behaviors such as aggression and agitation. The first step in establishing a familiar environment is to get to know the individual better and find out important elements of their past.

Areas of musical functioning are often preserved in individuals living with dementia. Musical perception, sensibility, emotion, and memory can survive and may even be heightened long after other forms of memory have significantly declined (Cuddy et al., 2012; Sacks, 2007). This is because some, if not all, of the musical functions of the brain remain intact throughout the various stages of dementia. Research indicates that music can elevate mood; decrease depression, anxiety, irritability and lability, and stress and stress responses; improve well-being; increase self-expression; evoke positive memories and meaningful associations; create a sense of community; and improve overall quality of life for those living with dementia (Young, 2013; Abbott, 2013). Music from the past that is familiar and associated with positive experiences and memories is most likely to evoke responses. As dementia progresses, music that evokes responses changes to music that was popular in early childhood. Lastly, it is important to watch key, tempo, volume, and ability to read lyrics, and know that many individuals stop singing in mid-stage dementia.

Over half of the physical decline associated with the normal aging process is associated with a lack of physical activity. Without regular exercise, individuals can experience a range of health problems including reduced muscle mass, strength, and physical endurance; reduced coordination and balance; reduced joint flexibility and mobility; reduced cardiovascular and respiratory function; reduced bone strength; increased body fat levels; increased blood pressure; increased susceptibility to mood disorders such as anxiety and depression; and increased risk of various diseases including cardiovascular disease and stroke (CDC, 2017). Furthermore, whether it's secondary to a chronic illness such as severe arthritis, osteoporosis, or a neurodegenerative disease like Parkinson’s or multiple sclerosis, over 15.5 percent of adults have difficulty with physical functioning (CDC, 2017).

Research indicates that music-based experiences provide multisensory stimulation that induces behavioral and cognitive changes as well as improves emotional wellbeing, including improving motivation and reinforcing compliance with exercise plans (Weller and Baker, 2011; Thompson and Kim, 2018). In addition to sensory and motor goal areas such as coordination, motor skills, and strength, cognitive and emotional goal areas may be targeted to encourage regular movement and mobility. This includes increasing motivation, improving coping skills, and decreasing frustration and anxiety.

Music can influence a variety of movements, from walking to finger tapping and more. More specifically, music can influence preparation for movement, coordination of movement, rate of movement, and motivation for movement. Rhythm is the most important musical consideration to think about, followed by providing options for individual preferences and considering previous musical experiences (Stegmoller, 2018).  

Chronic stress, frustration, and anger can affect a person’s overall wellbeing. It's linked to obesity, low self-esteem, migraines, drug and alcohol addiction, depression, increased heart attack risk, impairments with relationships, insomnia, and lowered immune responses (National Institute for the Clinical Application of Behavioral Medicine, 2019; Harvard Health Publishing, 2019; Yamaguchi, Kim, Akutsu, and Oshio, 2015).   

Music experiences can be effective in regulating physiological aspects of stress and anger (heart rate, respiratory rate, and muscle tension),  physiological aspects (anxiety, emotions, time urgency, and self-esteem), and social aspects (interpersonal relationships) (Dileo, 1999, 2003; Leist, 2013). It is important to allow individuals to explore, experience, and connect with music while providing a sense of control, promoting relaxation, and combating the negative effects of stress and anger on the mind, body, and spirit. To maximize the benefits, it is very important for individuals to recognize the physical sensations and signs in relation to their behaviors, actions, and feelings.

There are several considerations when selecting music-based experiences to address signs and symptoms of stress, frustration, and anger. This includes an individual’s existing associations and preferences, the overall length of the experience, and specific musical characteristics (Grocke and Wigram, 2007). Types of experiences may range from group drumming to vocal improvisation to songwriting to music-assisted relaxation to group singing, and more. When designed for therapeutic purposes, these music-based experiences can facilitate the release of endorphins; allow opportunities to connect with others; provide opportunities for self-regulation, self-expression, and self-discovery; and result in decreased muscle tension.