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Title

Towards a System that Relieves PsychologicalSymptoms of Dementia by Music

Author(s)Oshima, Chika; Nakayama, Koichi; Itou, Naoki;
Nishimoto, Kazushi; Yasuda, Kiyoshi; Hosoi,
Naohito; Okumura, Hiroshi; Horikawa, Etsuo

CitationInternational Journal on Advances in Life
Sciences, 5(3&4): 126‑136

Issue Date

2013

Type

Journal Article

Text version

publisher

URL

http://hdl.handle.net/10119/14735

Rights© Copyright by authors, Published under agreementwith IARIA. Chika Oshima, Koichi Nakayama, Naoki
Itou, Kazushi Nishimoto, Kiyoshi Yasuda, Naohito
Hosoi, Hiroshi Okumura, and Etsuo Horikawa,Towards a System that Relieves PsychologicalSymptoms of Dementia by Music , International
Journal on Advances in Life Sciences, issn 1942‑
2660 vol. 5, no. 3 & 4, year 2013, pp.126‑136 ,http://www.iariajournals.org/life̲sciences/

Description

Japan Advanced Institute of Science and Technology

International Journal on Advances in Life Sciences, vol 5 no 3 & 4, year 2013, http://www.iariajournals.org/life_sciences/

126

Towards a System that Relieves PsychologicalSymptoms of Dementia by Music
Chika Oshima

Koichi Nakayama

Naoki Itou

Japan Society for the Promotion of Science, Department of Information Science, Saga University Intermedia Planning, Inc.
Faculty of Medicine, Saga University
Saga, JapanTokyo, Japan
Saga, Japanknakayama@is.saga-u.ac.jp
n itou@ipi.co.jp
chika-o@ip.is.saga-u.ac.jp

Kazushi Nishimoto

Kiyoshi Yasuda

Naohito Hosoi

Research Center for Innovative Lifestyle Design,
Japan Advanced Institute of Science and Technology
Ishikawa, Japanknishi@jaist.ac.jp

Kyoto Institute of Technology
Chiba Rosai Hospital
Kyoto and Chiba, Japan
fwkk5911@mb.infoweb.ne.jp

Sodegaura Satsukidai Hospital
Chiba, Japanhosoi@mail.satsuki-kai.or.jp

Hiroshi Okumura

Etsuo Horikawa

Department of Information Science, Saga University
Saga, Japanoku@is.saga-u.ac.jp

Faculty of Medicine, Saga University
Saga, Japan
ethori@med.saga-u.ac.jp

Abstract—MusiCuddle is a system to calm the symptoms
of patients with mental instability who repeat stereotypicalutterances. The system presents a short musical phrase whose
first note is the same as the fundamental pitch (F0) of apatient’s utterances. We performed a case study to investigate
how a patient’s behaviors changed with MusiCuddle. The results
suggested that the phrases presented by MusiCuddle may provide
patients with an opportunity to stop repeating stereotypicalutterances. Then, we added a vocoder function to MusiCuddle
so that patients would be able to attend to the music more. We
examined whether the mood of university students changed or
not according to music presented with the vocoder function. We
found significant differences between major harmonies and minor
harmonies for the “cheerful” and “negative” moods. Namely,when a person’s voice is combined with cheerful sounds, he/she
can become cheerful. However, when we conducted a case study to
expect a patient’s repetitive utterances changed or stoped by thesound from the MusiCuddle with the vocoder, the participant’sutterances did not change. We discussed reasons of the result
from an aspect of characteristic of a patient according to a cause
disease of dementia.
Keywords—MusiCuddle, vocoder, FTD, Harmony in a major
and minor key

I.

I NTRODUCTION

We are structuring a music accompaniment system to calm
the symptoms of patients with mental instability who repeat
stereotypical utterances. “MusiCuddle [1][2]” is a system that
presents a short musical phrase. The system determines a pitch
at a predetermined interval on the basis of a sound extraction
technique [3]. Then, the system plays a prepared MusicalInstrument Digital Interface (MIDI) sequence (a phrase) the
first note of which is the same as the F0 of the patient’s
utterance.

The concept of MusiCuddle is derived from the “isoprinciple [4],” which is a theory of music therapy, and a case of
an autistic child a famous music therapist treated by extracting
approximate pitches of the child’s screaming and improvisingbased on these pitches [5]. “Iso” simply means “equal,” thatis, the mood or the tempo of the music must initially have an“iso” relationship with the mood or tempo of the patients. If
a client is distressed or agitated, then the quality of the musicshould initially match his or her mood and energy [6].
In this paper, first, we introduce the MusiCuddle and resultsof a case study with using the system [1][2]. We performeda case study in which one of the authors used MusiCuddle topresent phrases to a patient with dementia who repeated stereotypical utterances. The symptoms of dementia are divided into
core symptoms and behavioral and psychological symptoms
of dementia (BPSD). BPSD includes agitation, aggression,
wandering behavior, hallucinations, delusions, and repetitive
stereotypical utterances. However, appropriate care is thought
to alleviate and slow the progression of these symptoms. Musicis a method known to alleviate the symptoms of dementia.
Second, on the basis of the results of the experiment,
we added a “vocoder” to MusiCuddle. The vocoder allows
an individual to hear his/her voice becoming a part of the
instrumental sound according to a musical phrase presented by
MusiCuddle. Because our target population repeat utterancesquite frequently, it will be hard for them to listen to the musicpresented by MusiCuddle. Therefore, the utterances should be
combined with music sounds in real time, as their attention
will be more likely to shift to the music than when they listen
to music in parallel with their utterances.
Furthermore, if the musical phrases from MusiCuddle
can manipulate the mood of patients with mental instability

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International Journal on Advances in Life Sciences, vol 5 no 3 & 4, year 2013, http://www.iariajournals.org/life_sciences/127
and make it more pleasurable, they may temporarily stop
repeating utterances. There are studies showing that moodaffects memory and cognitive processes [7]. For instance,
Taniguchi [8] used music to manipulate subjects’ mood. In [9],he considered a relationship between characteristic of music
and mood induced by music. He proposed the Affective Value
Scale of Music (AVSM) to indicate the property of musicalpieces on the basis of 24 adjectives on five levels. Then, he
conducted an experiment in which female students were rated
on both the AVSM and the Multiple Mood Scale (MMS) [10],which is to evaluate subjects’ mood by themselves for the fivepieces, finding a significant relationship between the AVSM
and the MMS. The result has shown that music can be a trigger
to induce a mood.
Then, in this paper, we examined the contribution ofharmonies in major and minor keys to mood induction for
healthy subjects with the vocoder. They read a gloomy poem
when their utterances were combined with music sounds by
MusiCuddle with the vocoder. After reading the poem, theyevaluated their current moods.
Finally, we performed a case study using the MusiCuddle
with the vocoder for a patient with dementia who repeatedstereotypical utterances. Her utterances were combined withmusic sounde in real time.

the F0 (fundamental frequency) time series from the acousticalsignals (i.e., a singing voice), which were being recorded via
the microphone. The short-term F0 estimation by Fast Fourier
Transform (FFT) and Inverse Fast Fourier Transform (IFFT)
for the power spectral is repeated until the system catches
an end trigger from the operator. The system then calculates
a histogram of pitches with the F0 time series between thestart and end triggers. Finally, only the most frequent pitch is
selected and is output as the pitch of the period.
For our research, some processing designs were modified.
Figure 2 shows the processing of the system. Considering theattitude of the operator, we would assume that the triggers
would be input after the operator catches the utterance of thepatient. Therefore, we omitted the start trigger. The systemstarts a short-term F0 estimation just after invocation of thesystem and continues it thereafter. When the operator inputs a
trigger that is regarded as an end trigger, the system calculates
a representative pitch for a predetermined period just before
the trigger based on the above-mentioned method. Then thesystem plays a prepared MIDI sequence (a musical phrase) that
corresponds to the representative pitch. These modifications of
our system improve usability by reducing the time lag between
the input of the trigger and the output of phrase.

In the next section, we illustrate the MusiCuddle andexperiments that the author presented music phrases to apatient with dementia using MusiCuddle. Section III describes
the contribution of harmonies in major and minor keys to mood
induction for healthy subjects by MusiCuddle with the vocoder.
Section IV concludes this paper and outlines future works.
II.

M USI C UDDLE : THE FIRST NOTE OF A PHRASE IS THE
SAME AS THE F0 OF THE PATIENT ’ S UTTERANCE

We presented a music accompaniment system, “MusiCuddle” that presents a short musical phrase. Then, we conducteda case study using MusiCuddle for a patient with dementia.
A. Extract pitches from the utterances
Figure 1 shows a user interface of MusiCuddle [1][2].
MusiCuddle is a system that presents music when an operator(e.g., a caregiver) pushes any of the keys of the electronic
keyboard or a button on the interface of the system. Previously,
we have to select a folder of musical phrases and move it
into the same folder as MusiCuddle. Once the play button ispushed, the system continuously extracts pitches (F0) fromsounds (the intended patient’s utterances). When the operator
pushed the trigger’s button again, the system determines a pitch
at a predetermined interval. Then, the system selects a musicalphrase file in the database on the basis of that extracted pitch.
The first note of the musical phrase is the same as the pitch
extracted from the patient’s utterances.
We employ a pitch extractor to extract pitches (i.e., C, D,
E) from the patient’s utterances. This is based on the techniquefor extraction of sounds that have unstable pitches and unclear
periods, such as natural ambient sounds and the human voice,into musical notes [3].
In the original system shown by [3], if the operator gave astart trigger, the system would initiate the processing to obtain

Fig. 1.

User interface of MusiCuddle for a caregiver.

To extract the F0 against the mixed acoustical signal of
the patient’s utterance and the musical phrase output from the
speaker, our system needs two of the same microphone (ideally
one stereo microphone) and one speaker. Figure 3 shows thesetting of the microphones. The microphones are set in front of
the speaker to record the speaker’s sound at the same level fromboth microphones. On the other hand, both microphones are
displaced against the patient to record the levels of the patient’s
utterance that are clearly different. The system calculates thedifferential signals from the signals of both microphones tocancel the sounds of the MIDI sequence where they are
localized in the center position. The F0 estimation is thendetermined with these differential signals.

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International Journal on Advances in Life Sciences, vol 5 no 3 & 4, year 2013, http://www.iariajournals.org/life_sciences/128
became more agitated, we would have had to abandon the casestudy immediately.
2) Participant: The participant was a 72 year-old, hospitalized patient with severe FTD (frontotemporal dementia).
She repeats stereotypical utterances for many hours each day.
Moreover, when she is agitated, she locks herself in a restroom
for a long time while repeating stereotypical utterances. However, she is lucid enough to remember some nurses’ names
and greet them clearly. She can answer the date and the exact
time. Her score on the HDS-R (Revised Hasegawa’s dementia
scale) [14] was 17 two years ago. The score shows she was
mild dementia.
The following is an example of her usual utterances.
This example was uttered in about thirty seconds. “P” means“Participant.”
Fig. 2.

How to convert an utterance into a pitch.

P: haittayo (repeated eight times) mashitayo imasen masen
imasendesu masen (repeated three times)“haittayo” means “have been entered” as well as “imasen”
means “not being here.” “mashitayo” may be fragment of“imashitayo.” “imashitayo” means “being here.”
Although she utters many kinds of sentences, most of them
are rhythmical and fit into the same meter. Figure 4 describes
some examples of her sentences. One of the authors dictatedthe rhythms of these sentences. These examples show that
although the sentences are different, they fit into four-four time.

Fig. 3. Calculates the differential signals from both microphones to cancel
the sounds of cadence.

B. Case study using MusiCuddle
We conducted a case study to investigate how a patient’s
behaviors changed with the application of MusiCuddle [1][2].
The symptoms of the patient targeted for this study was severe.
This case study was conducted for a very short period, and we
could enroll only one patient. Therefore, it is not appropriate to
make any cognitive assessment [12] or to examine the patient’s
abilities with respect to activities of daily living [13]. Instead,
we record the patient’s utterances under conditions with andwithout the use of MusiCuddle and compare them in order toestimate the influence of MusiCuddle.
1) Ethical Considerations: This case study was approvedby the Research Ethics Board of Saga University. The participant in the case study, who is a patient with dementia,
her husband, and the hospital director were informed about
the intentions of the case study and the treatment of personal
information. Moreover, they were informed that they could
withdraw from the case study at any time. Then, we obtained
written consent from them.
When we conducted this case study, the hospital director
and nurses worked on the same floor and could check on
the condition of the participant. If the presentation of sounds
from MusiCuddle had not been appropriate and the participant

Fig. 4.

The participant’s sentences fit into four-four time.

She repeats stereotypical utterances especially when hungry. She often locks herself in a restroom from around eleveno’clock a.m. until lunchtime, and from around one o’clock
p.m. until snack time while repeating stereotypical utterancesnearly incessantly. However, she sometimes responds to nurses
when they talk to her.
3) Preliminary experiment: Adopting the iso-principle, oneof the authors attempted to utter according to the participant’sutterances. We think that the author’s utterances had the same
tempo, rhythm, and pitch as those of the participant.
When the participant was agitated and repeated the samesentences, one of the authors repeated sentences in the same
melody corresponding with the participant’s repetition (thesame tempo, rhythm, and pitches). Figure 5 shows these sentences in musical notation. Sentence A means the participant’s

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International Journal on Advances in Life Sciences, vol 5 no 3 & 4, year 2013, http://www.iariajournals.org/life_sciences/129
sentence. First, the author tries to repeat the participant’ssentences in rhythm. Namely, both of them repeat Sentence
A, “i-ma-se-n-yo (not being here).” Second, the author tries
to repeat a different sentence using the same melody as theparticipant’s in rhythm. Namely, the author repeats Sentence B,“go-han-de-su-yo (Time for lunch.),” although the participant
is repeating Sentence A.

to its receiver. Thus, we did not use the stereo microphone inthis experiment, and the operator did not input triggers when
the previous musical phrase was being presented.

In the first trial, the participant turned around to pay
attention to the author. However, she kept repeating the samesentence in harmony with the author’s repetition. Her utterances became louder. In the second trial, the participantchanged from the sentence A to the author’s sentence, “gohan-de-su-yo” in the same melody. Then, the participant left
the restroom and went toward a table for lunch. In a moment,
however, she returned to the restroom and repeated the samesentences.
When the author repeated sentences in accordance withthe participant’s repetition and used the same melody, theparticipant kept repeating the same sentence in a loud voice.
The author’s utterances could have caused increased symptomsof agitation in the first trial.

Fig. 5. The author repeated sentences in accordance with the participant’s
repetition.

4) Method: We stood by from ten o’clock a.m. to noonand from one o’clock p.m. to half-past two p.m. for 2 days.
After this case study, we compared the participant’s utteranceswith music with those without music (see Section II-B6) toestimate the influences of MusiCuddle. Therefore, we set two
time periods, one with the use of MusiCuddle and one without
MusiCuddle.
During the time with the use of MusiCuddle, we started
MusiCuddle and selected a musical phrase. When the participant began to repeat stereotypical utterances, we presented themusical phrases arbitrarily by giving triggers to MusiCuddle.
The experiment was conducted in a hospital where the participant was hospitalized. Figure 6 shows the setting of the casestudy. The music was presented through a wireless cuboidal
speaker with Bluetooth, which measured, 123×36×35 mm,
and the patient’s utterances were recorded through a wireless,columnar microphone with Bluetooth measuring about 75 mm
in height and 24 mm in diameter. These devices were set on
the door of the restroom.
Our system requires two of the same microphone (onestereo microphone). When the operator inputs the trigger,even when the previous musical phrase is being presented,
the system extracts F0 against the mixed acoustical signal of
the patient’s utterance and the musical phrase being presented
from the speaker. However, it is not so safe to use the stereo
microphone in the hospital, because it is large in size and wired

Fig. 6. A small wireless speaker and microphone are set on the door of therestroom.

5) How to use MusiCuddle: When the participant is agitated and repeats stereotypical utterances in a restroom, anoperator (one of the authors) presents music by using theMusiCuddle system in front of the restroom. The operator
listens to the patient’s utterances outside of the restroom.
When the operator finds a period during which the patientutters an almost stable pitch, she clicks the trigger button.
Once the trigger button has been clicked, a musical phrase
is retrieved from the database on the basis of the detected
pitch, and it is automatically performed to overlap with theparticipant’s utterances. In this case study, we prepared seventype of musical phrases: Four chords (Major seventh, Quarter
note, and No volume change), Cadence, “Yuki,” “Akaikutsu,”“Hana,” “Tsukinosabaku,” and Stereotypical utterance (i-mase-n-yo) [1][2]. All of the musical phrases consist of very shortphrases lasting 3∼30 seconds. The operator selected musicalphrases considering the participant’s reactions and condition.
The operator clicked the trigger button again to perform thenext musical phrase when the performance of the current
musical phrase ended.
6) Analysis method: In this case study, we investigate how
MusiCuddle influences the patient’s stereotypical utterances. If
the music presented from MusiCuddle distracted the patient’s
attention from her stereotypical utterances, her utterances
would be disrupted and she would stutter. Therefore, we
compare the participant’s utterances while listening to musicwith those without music. Especially, we focus on the patient’s
stuttering to detect distraction of the patient’s attention.
The participant’s utterances are segmented into small
sentences according to the method of repetition. One of
the authors decided segmentation points according to themeanings of utterances by reference to the participant’s
breathing. For example, the following utterances (P1) aresegmented like the next line (P2).
P1:imasendesuimasendesuhitoyasumimazuyasumiimasendesuyo
P2:imasendesu (not being here) / imasendesu (not being here)/ hitoyasumi (taking a rest) / mazuyasumi (taking a rest) /2013, © Copyright by authors, Published under agreement with IARIA - www.iaria.org

International Journal on Advances in Life Sciences, vol 5 no 3 & 4, year 2013, http://www.iariajournals.org/life_sciences/130
imasendesuyo (not being here)
Then, we analyzed the influences of the music on the patient’s utterances. First, we determined whether each sentence
was uttered “with music” or “without music” on the basis of
the following conditions (see Fig. 7):
1)
2)
3)
4)

If the patient uttered a sentence while a musicalphrase was being performed, the sentence was considered to be uttered with music.
If the patient began to utter a sentence just after
a musical phrase had finished, the sentence wasconsidered as being uttered with music.
If a musical phrase started after the patient had started
uttering a sentence, the sentence was considered to beuttered without music.
Otherwise, the sentence was considered as being
uttered without music.

words that were part of an immediately preceding sentence (butnot exactly the same as the immediately preceding sentence),
she was considered to have stuttered.
We determined whether each sentence included words
that were part of the immediately preceding sentence. In thefollowing example, we consider that she stuttered, as “ima” isincluded in the immediately previous sentence “imasendesu:”
P: imasendesu ima
7) Results: The intended records documenting our analysisof the participant’s utterances constitute only three parts of theentire recorded dataset; the lengths of the three parts are 16,8, and 3 minutes. Although we recorded for a much longer
time period, we could not use the other parts because of
extraneous noises that masked the patient’s utterances. It seems
that the restroom’s iron door blocked communication between
the wireless microphone and the personal computer. Moreover,
we could not record when the participant moved to some
unexpected rooms. Therefore, there is a large gap between
the time of using MusiCuddle and the total recording time.
Of the 27 minutes of intended records, the total time ofmusic presentation was 6 minutes and 54 seconds, approximately one-fourth of the total recording time. For the firstand second recording sessions, we presented the phrases using
MusiCuddle. In contrast, we did not present phrases at all
during the third recording session.
The participant emitted utterances at all times during theexperiment. Table I shows the kinds of sentences. Six hundred
eighty sentences were segmented (84 kinds) in 27 minutes.
The most uttered sentence was “imasendesu” (201 times).

Fig. 7. Determination of whether each sentence was uttered “with or withoutmusic.”In the following example, the musical phrase was presented
in the middle of “hirugohandeha (fragment of “It is not lunchtime”).” Therefore, “masende (fragment of “not being here”)”
and “hirugohandeha” were considered as being uttered withoutmusic, while “imasendesu (not being here),” “ima (fragmentof “not being here”),” and “gohanden (fragment of “It is notlunch time”)” were considered as being uttered with music.
P: masende hirugohandeha imasendesu ima gohanden[](Start music)(Stop music)
In this case, we consider that the sentence “hirugohandeha”
was unaffected by music. Moreover, we consider that “gohanden” was affected by the music, because this sentence started
to be uttered immediately after the presentation of the music.
Next, we find sentences on which the participant stuttered.
She often repeats several stereotypical sentences without any
slight changes many times (see Section II-B2). However,if the music distracted her attention from her repetition ofstereotypical utterances, she stuttered, uttering only a part ofstereotypical sentence or a sentence different from a stereotypical sentence. Therefore, if we find such a sentence including

In many cases, the contents of the sentences were almost
the same, even when their constituent words varied slightly. For
example, “imasen” and “imasendesu” have the same meaning,“I am not here.” Moreover, in certain instances, only parts ofsentences were uttered (“ima,” “imasende”).
She repeated the same words many times, uttered different
words in sequence, or uttered slightly different words
continuously both in the rhythm of the presented-music andnot. In the following example, she repeated the same words
many times:
P: mazuyasumi mazuyasumi mazuyasumi mazuyasumi...(total
number of repetitions was seven)In the following example, she uttered different words insequence:
P: gohandashimasendesu
imasendesu mazuyasumi

mazu

imasendesu

oyatuja

In the following example, she uttered slightly different words
continuously:
P: imasende imasendesu imasen imasendesu ima imasendesu
Most of the sentences were rhythmical and fitted into four-fourtime (see Fig. 4). However, short sentences such as, “ima”
and “mazu” fitted into four-one (irregular) time.

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International Journal on Advances in Life Sciences, vol 5 no 3 & 4, year 2013, http://www.iariajournals.org/life_sciences/131
TABLE I.

S ENTENCES SEGMENTED FROM THE PARTICIPANT ’ S UTTERANCES IN THE CASE STUDY.

Estimated meaning

SentencesI am (not) here.

imasu (1), imasendesu (201), imasen (48), imasende (43), ima (5), deimasendesu (1), sokoniimasen (1), imasenyo (1),uruchiimasendesu (1), ryugaimasende(1)It is (not) lunch time.

mazugohandesu (78), mazugohan (14), mazugohande (6), hirugohannarimasendesu (5)gohandesu (4), hirugohandashimasendesu (2), hirugohannarimasende (2), gohandashimasendesu (2)haisugugohandashimasendesu (2), mazugohandesuyo (2), gohan (2), gohanden (1), gohannarimasendesu (1)gohannaidesuyo (1), hirugohande (1), gohandashimasende (1), gohanninarimasu (1)gokaimenogohandashimasendesu (1), mawarinogohangoyamoyashisendesu (1)First,

mazu (34), mazuyasumi (33), mazudesu (32), ma (6), mazuya (3), mazudesu (2), mazude (1), mazugo (1), mazuyasu (1)Not domasende (10), masendesu (6), masendesuyo (2)Bath time, Breakofurohaittadesuyo (2), ofuro (1), ofurojaimasende (1), hitoyasumi (1)(Not) Birth day

tanjobijanaidesu (3), tanjokainaidesuyo (3), tanjobijanaidesu (1), tanjobijaimasendesuyo (1)tanjobijaarimasendesu (1), tanjobijaarimasendesuyo (1)Time

1ji40fundesuyo (13), yoruninarimasendesu (9), 1jihandesuyo (8), 3jihanninarimasendesu (8), yoruninarimasendesuyo (5)handesuyo (4), 3jihandesuyo (4), 1jihande (3), 2jihandesuyo (2), 3jininarimasendesuyo (2), 1jihandesune (1)1ji10fundesune (1), 1ji (1), 1jihandesuyo (1), 3jihanni (1), 3jihanninarimasendesuyo (1), mou3jininarimasendesu (1)Snack timeoyatudesuyo (1), oyatujaimasendesu (1), keikihanaidesuyo (1), keikihanaidemasendesu (1), keikihanaitodesu (1)Soonsuguha (1), suguhanaidesu (1)“Yuki”

zunzuntumoru (2)Question

imashitaka (1)Greeting

konnichiha (1)Othersdojoninarimasende (1), ugoninarimasende (1), sonouchimasende (1), mashi (1), bokujaarigatoarigato (1), basyohanaidesuyo (1)Values in parentheses show the numbers of times each sentence was uttered.

Table II shows the comparison between “with music” and“without music.” The numbers of different sentences uttered
were 114 with music and 179 without music. The total
recording time was 27 minutes, and musical phrases were
presented for 6 minutes 54 seconds of that time. Changes inthe sentences uttered by the participant numbered about 16 perminute with music and 9 per minute without music. Therefore,
we can say that the participant changed her utterances more
often with than without music.
Next, we determined whether each sentence included words
that were part of the immediately preceding sentence in orderto determine on which sentences the participant stuttered. The
results indicated that with music, 94 out of 114 sentences(82.5%) included words from the immediately preceding sentence (see Section II-B6). On the other hand, without music,
that rate was 41.3%. This result shows that the rate of sentences
including words from the immediately preceding sentence washigher with than without music. If the participant stuttered, we
consider that the music distracted her attention from repeating
her stereotypical utterances (see Section II-B6). The results
indicate that MusiCuddle may give patients an opportunity tostop repeating utterances.
In the following example, a sentence changed into acompletely different sentence when music was not presented(without music):
P: mazu imasendesu oyatsuja mazuyasumi(without music)
The following is an example in which a sentence included
the word from the immediately preceding sentence when music
was presented (with music):
P: mazugohandesu mazu...
[](Start music)(Stop music)

TABLE II.

T HE NUMBERS OF CHANGES IN REPEATED SENTENCES .

changing sentence(ALL)with music

without music

114

179

include the words ofthe immediately previous sentence.

94

74

rate (%)

82.5

41.3

8) Discussion: The participant tended to stutter when eachphrase was presented from MusiCuddle. The music mightshift the participant’s interest to music from the repetitionof stereotypical utterances. On the other hand, when one of
the authors repeated the participant’s sentence using the same
melody and rhythmic pattern, she did also pay attention to
the author (see Section II-B3). However, the participant kept
repeating the same sentence.
Namely, patients might attend to the phrase according totheir similarity in pitch. Meanwhile, their attention may be
deflected away from their repetitive stereotypical utterances
if the melody is too strikingly different from their utterances.
So, the phrases presented by MusiCuddle may provide patientswith an opportunity to stop repeating stereotypical utterances.
III.

M OOD INDUCTION USING M USI C UDDLE WITH A
VOCODER : M AJOR VERSUS MINOR HARMONIESThe result of the case study using MusiCuddle suggested
that the mental instability patient’s attention might shift awayfrom her repetitive stereotypical utterances to the music (seeSection II-B). We expect that the utterances should be combined with music sounds in real time, as their attention will
be more likely to shift to the music than when they listen to2013, © Copyright by authors, Published under agreement with IARIA - www.iaria.org

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132
music in parallel with their utterances. Therefore, we added a
vocoder function to MusiCuddle.
A. Add a vocoder function to MusiCuddle
We added a vocoder function to MusiCuddle [1][2] sothat patients would be able to attend to the music more. The
vocoder is an audio processor that captures the characteristic
elements of an audio signal and then uses this characteristic
signal to affect other audio signals. The modulator extracts thefundamental frequencies of the voice and converts them intolevels of amplitude on a series of band pass filters. Then, theseband pass filter signals are passed onto the carrier wave andthe final sound is created.
Fig. 8 shows the vocoder’s connection to MusiCuddle. The
patient’s utterances are input to MusiCuddle and the vocoder(synthesizer) by two kinds of microphones. MusiCuddle extracts notes from these utterances and selects a phrase. Then,the phrase (MIDI sequence) is sent to the vocoder. The vocoder
performs the MIDI sequence using the tone of the synthesizer
and the patient’s voice. The patient can hear his/her utterances
combined with MIDI sequence.
B. Research aim
We want to examine whether the mood of the patient withmental instability changes or not according to music presented
with the vocoder function. There is no research of mood
induction using the vocoder function. Since it is difficult togather the intended patients who repeat utterances continuously
and it is difficult for them to express their moods in language,
the subjects of this paper are healthy university students.
Moreover, we examine the difference between a mood
induced by harmonies in a major key and a mood inducedby harmonies in a minor key. Altshuler showed if a patient isgloomy, the quality of the music should initially be gloomierrather than happier [4]. Itoh [15] showed that individuals in a
depressive state become relaxed when they listen to gloomy
and calm music. After introducing these kinds of music,
however, the mood of the music should gradually change tothe target mood (Level attacks [4]). Takeuchi [16] conducted
an experiment on university students in a state of depression
and found that the group of subjects who heard music that
progressed from sad to happy were put in a happier mood.
C. Pre-experiment
In this section, subjects evaluated their impressions of
two musical phrases. These phrases were used in the main
experiment (see Section III-D).
1) musical phrases: Hevner [17] indicated that the expressiveness of a modality, either major or minor, is morestable and more generally understood than that of any othermusical element. He showed that major keys are strongly associated with happiness, gayety, playfulness and sprightlinessand minor keys are deeply related to sadness, sentimental
yearning, and tender effect. Moreover, consonant chords workfor “delightful [18]” “cheerful [19],” and dissonant chords
work for “exciting [18]” and “overcast [19] [11].”In the main experiment, we examined the difference between a mood induced by harmonies in a major key and amood induced by harmonies in a minor key with using the
vocoder. The properties of two musical phrases should be
similar although the mode (major or minor) and the harmonies
are different. Therefore, we pick out these phrases from thesame music piece, “Chaconne” rearranged by Busoni for a
piano solo on the basis of “Chaconne from Partita No.2 forsolo violin in D minor, BWV 1004” composed by Bach.
Figs. 9 and 10 show two different kinds of phrases. We
extracted the harmonies in the major key from bars 138-145
with one incomplete bar as well as the harmonies in the minor
key from bars 1-8 with one incomplete bar. In the originalscore of Chaconne, there are many kinds of note values andsome passing notes between the chords. However, we did notconsider rhythm and passing notes. All notes in the scores werechanged to whole notes due to the features of the vocoder (seeSection III-A). The scores were transformed into two MIDI
data files in advance. The tempo was a beat of 60 quarter notes
for one minute. Namely, both phrases could be presented inabout one minute.
The subjects listen to the phrases produced by the soundsource of a synthesizer, “microKORG XL+ (Korg).” Thesynthesizer effect was made by the “ROCK” genre and “POLYSYNTH” category in microKORG XL+. In the main experiment, we used the same sound effect. However, we also usedthe vocoder function. Therefore, the feeling of sounds we got
were different between in the pre-experiment and in the main
experiment.
2) Method: The subjects were 132 engineering university
students ranging from 18 to 20 years of age. Sixty-one of thesubjects evaluated the harmonies in a major key (D major) first
and then in a minor key (D minor). The rest of the subjects
evaluated them in reverse order. We prepared AVSM [9] forthe subjects to evaluate the affective value of the two phrases.
The AVSM consists of 24 adjectives that can be divided into
five dimensions: uplift (uplift and dysphoria), familiar, strong,lightness, and stateliness. The subjects were asked to evaluate
the 24 adjectives (items) on a five-point scale: It does not apply
to the adjective at all (1); It does not apply to it very much(2); I cannot say either way (3); It applies to it a little (4); It
applies to it very much (5).
3) Result: We performed t-tests on the data for 24 items.
Table III shows that there were significant differences between
the major phrase condition and the minor phrase condition
on 16 items. In particular, the evaluations of three items,“melancholy,” “miserable,” and “gloomy” became opposite.
Their averages were more than 4-point in the evaluation for theminor phrase. Their averages were less than or equal to 3-pointin the evaluation for the major phrase. These results showedthat the phrases were suitable for use in the main experiment.
D. Experiment: mood induction using MusiCuddle with a
vocoder
Each subject read a gloomy poem and indicated his/hercurrent mood. Then, he/she read the same poem using MusiCuddle with the vocoder and indicated his/her mood again.
The music presented from MusiCuddle included two kinds ofphrases that were evaluated in Section III-C. We examined
whether the mood induced in subjects using the vocoder
differed according to the music from MusiCuddle.

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Fig. 8.

Connection with a vocoder.

TABLE III.

Fig. 9.

Harmony in a major key.

Fig. 10.

Harmony in a minor key.

1) Ethical Considerations: This experiment was approvedby the Research Ethics Board of Saga University. The subjects
were informed about the purpose of the experiment and thetreatment of personal information. Then, we obtained writtenconsent from them.
2) Method: The subjects were 12 engineering university
students between 21 and 24 years old. Two female students
were included in the subjects.
Fig. 11 shows the method of the experiment. The subjects
participated in the experiment one by one. First, each subject
read 28 words to him/herself. These words were selectedfrom “Personality trait words [20].” They were expressed
impressions of “darkness,” “stay in one’s shell,” and “verysensitive.” Second, each subject was asked to read a poem
that a 20-year-old man had composed while in a gloomy mooddemension
dysphoria
dysphoria
dysphoria
dysphoria
upliftupliftupliftupliftfamiliarfamiliarfamiliarstronglightnesslightnessstatelinessstateliness

E VALUATIONS OF TWO HARMONIES .
item which has
Averagea difference
minor
major
melancholy
4.01
2.48
miserable
4.14
2.54
sad
4.41
3.02
gloomy4.38
2.62
cheerful
1.38
2.38
delightful
1.38
2.82
joyful1.45
2.72
bright1.63
3.40
tender
2.02
3.47
calm
2.33
3.62
sweet
2.37
2.77
vehement
2.55
1.95
hilarious
1.50
2.11
eathery
1.63
2.49
solemn3.62
2.79
ceremonious
3.29
2.62
∗
< 5%, ∗∗ < 1%．

t-value
10.90∗∗
11.59∗∗
8.32∗∗
8.15∗∗
8.02∗∗
10.07∗∗
7.05∗∗
7.73∗∗
11.25∗∗
5.23∗∗
2.38∗
3.60∗∗
3.91∗∗
4.02∗∗
5.13∗∗
3.61∗∗and put on the Internet. We expected that the subjects would
become gloomy while completing these tasks.
After reading the poem, each subject was asked to indicate his/her current mood by filling out a questionnaire. The
questionnaire consisted of 40 mood-related items that wereselected from the MMS [10]. The 40 items consist of 10 items
on each of four dimensions: dysphoria/fatigue, active pleasure,and non-active pleasure. We lined up one set item that four
items is extracted from each four dimensions. We could make10 set items. The order of each set differed depending on thesubject and on the number of times (one subject responded tothe questionnaire twice). The subjects were asked to evaluate
the 40 items on a four-point scale: I do not feel it at all (1);I do not feel it very much (2); I feel it a little (3); I feel itclearly (4).
Next, each subject read the same poem with headphones
on. An experimenter pushed the trigger button for MusiCuddle
when the subjects read the title of the poem. MusiCuddle
calculated a representative pitch for a predetermined period
just before the trigger to extract the pitch of each subject’s

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International Journal on Advances in Life Sciences, vol 5 no 3 & 4, year 2013, http://www.iariajournals.org/life_sciences/134
Wallis one-way analysis. In the results, one of the items, “lackconfidence” showed a significant difference of p = 0.08,
although the others were p > 0.10. There was no evidenceof differences in the remaining 39 items. Therefore, after this,
we omitted “lack confidence” from the items for analysis.
In their second reading of the poem, the 12 subjects
were assigned to one of the three conditions described previously. We conducted the Kruskal-Wallis one-way analysis
of subjects’ subsequent responses. Moreover, we calculated
the differences between subjects’ first and second responses toeach of the 39 items. Then, we examined the Kruskal-Wallis
one-way analysis for the differences in the 39 items.
The left side of Table IV shows the p values for subjects’
second answers. In four of the 39 items (cheerful, well, slowgoing (p < 0.05), and lively (p = 0.06)), the null hypothesis
was rejected. Therefore, we performed multiple comparison
analyses (Wilcoxon signed-rank test) for these items. The third,
fourth, and fifth rows from the left of Table IV show the results.
We can see that there was only a significant difference between
the major and minor conditions for “cheerful” (p = 0.03).

Fig. 11.

Experimental method.

voice. Then, the musical phrase, the first note of which is thesame as the F0 of the subject’s utterance was presented. Since
MusiCuddle selects an MIDI file of which the top note of thefirst chord is similar to the subject’s F0, we transposed two
phrases (Figs. 9 and 10) into other keys each, in which the
top notes of the first chord are C2∼C5 before the experiment.
However, the male subjects’ voices were quite low, making it
hard to hear the selected musical phrase (harmony). Therefore,
in the experiment, MusiCuddle selected an MIDI file of which
the top note of the first chord was similar to the subject’s F0,
but one octave higher. Each subject read the poem, hearing
his/her voice combined with the musical phrase according to
the vocoder function.
We prepared three musical phrase conditions: (1) harmonies in a major key, (2) harmonies in a minor key, and(3) harmonies in a minor key in the early part of the poem
and in a major key in the latter part of the poem. In condition(3), the experimenter pushed the trigger button again halfway
through the poem. The 12 subjects were assigned to one of thethree conditions (four subjects per condition). After reading thepoem, each subject completed the questionnaire again.
3) Result of the main experiment: The 12 subjects indicatedtheir current mood by responding to the 40 items on the fourpoint scale twice. The first time, all subjects read the poemin the same condition, without MusiCuddle. We examined thenull hypothesis “the medians of all conditions are equal” inthe answers for each of the 40 questions using the Kruskal-

Concerning the differences between subjects’ first andsecond answers, we performed the Kruskal-Wallis one-way
analysis and multiple comparison analyses. The right sideof Table IV shows these results. In seven items, the null
hypothesis was rejected. As a result of multiple comparison
analyses, significant differences were observed between the
major and minor conditions for “cheerful” (p = 0.03) and“negative” (p = 0.06).
Moreover, for the item “cheerful,” there was a significant
difference (p = 0.03) between four subjects’ first and second
answers in the major condition. Namely, we can say that theevaluations of “cheerful” for the major harmonies contributed
to the result of multiple comparison analysis.
4) Discussion: We conducted an experiment in which
subjects read a poem with/without using MusiCuddle with a
vocoder function. When using the MusiCuddle, each subject
could hear his/her voice, which was modified by harmonies
in a major or minor key while reading. We examined thedifferences among the three conditions. The result showed that
subjects’ mood after reading the poem differed according to
the condition. Moreover, the results of multiple comparison
analyses showed that there were significant differences between subjects’ cheerful mood for major harmonies and minor
harmonies. In particular, it was clear that harmonies in a major
key resulted in a more cheerful mood.
As another analysis method, we calculated the differences
between subjects’ first and second answers. Then, we examined the differences among the three conditions as wellas the multiple comparison analyses. We found significant
differences between major harmonies and minor harmonies forthe “cheerful” (p = 0.03) and “negative” (p = 0.06) moods.
The iso-principle [4] shows that music’s mood or the tempo
must initially match patients’ mood or tempo. If a patientis gloomy, then gloomy and/or sad music should initiallybe presented. However, the subjects of our experiment were
induced cheerful mood by the major harmonies. The major
harmonies were significantly “not melancholy (Ave.was 2.48),”2013, © Copyright by authors, Published under agreement with IARIA - www.iaria.org

International Journal on Advances in Life Sciences, vol 5 no 3 & 4, year 2013, http://www.iariajournals.org/life_sciences/

135
TABLE IV.

C ONTRIBUTION OF THE MUSIC IN THREE CONDITIONS TO MOOD INDUCTION .

items that havesignificant
deferences
cheerful
well
livelyslowgoing

cheerfulwell
fresh
good moodnegativeworriedtired

multiple comparison
second timeminor and major
minor and minor / major
major and minor / major
0.02
0.03
0.43
0.17
0.05
0.11
1.00
0.11
0.06
0.14
1.00
0.14
0.03
0.08
1.00
0.08
p
differences between the first and the second timeminor and major
minor and minor / major
major and minor / major
0.02
0.03
0.29
0.17
0.05
0.11
1.00
0.11
0.03
0.09
0.43
0.14
0.05
0.09
0.29
0.37
0.03
0.06
0.09
0.40
0.04
0.09
1.00
0.11
0.06
0.11
0.40
0.09
The row of “p” shows the results of the Kruskal-Wallis test.
p“not miserable (Ave. was 2.54),” and “not gloomy (Ave. was2.62)” compared to the minor harmonies (see Table III).
On the other hand, traditionally, emotion was believed tostem from a physical reaction (The James-Lange theory). Then,
Schachter and Singer [21] showed that emotional states may beconsidered a function of a state of physiological arousal and ofa cognition appropriate to this state of arousal and a recognitionof the factor of the emotion (Two-factor theory). These theories
also support our tentative theory that a person who is gloomy
can become cheerful when his/her voice is combined withcheerful sounds. Therefore, it is expected that music with thevocoder function calms the symptoms of patients with mental
instability who repeat stereotypical utterances.
E. Case study using MusiCuddle with a vocoder
We performed a case study to investigate how a patient’s
behaviors changed with MusiCuddle using a vocoder. We
expected the patient’s repetitive utterances to change or stop
as a result of the sound coming from MusiCuddle with thevocoder. This case study was approved by the Research Ethics
Board of Saga University.
1) Method: The participant was an 81-year-old, hospitalized patient with frontotemporal dementia (FTD). She washospitalized for depression six years ago and was discharged
from the hospital. Next, she was hospitalized with a broken
hip. She began to shout sometimes. Then, she moved to adementia ward in the same hospital. Currently, she repeats
stereotypical utterances for many minutes. However, she canoften communicate with her care staff.
One of the authors (the MusiCuddle operator) stood byfrom ten o’clock a.m. to noon and again from one o’clock
p.m. to half-past two p.m. In the first part of the case study, theoperator played a normal electronic piano near the participant
to examine the participant’s interest in music.
Six months later, the second part of the case study was
performed. We set two time periods, with/without the use of
MusiCuddle with the vocoder. During the time MusiCuddle
with the vocoder was used, the operator started MusiCuddle
and presented the harmonies in either a minor key or amajor key (see Section III-D). When the participant began torepeat stereotypical utterances, the operator gave triggers to
MusiCuddle arbitrarily to present the harmonies.

The participant’s utterances were recorded to examine thechanges in her utterances. Two small wireless microphones
were used to input her utterances to MusiCuddle and to the
vocoder. These microphones were set behind her wheelchair.
A small speaker was placed on the table near the participant.
2) Result: The participant tended to start repeating utterances only 15 minutes after going to the bathroom. She asked
her care staff to take her to the bathroom, although she did
not have to go to the bathroom. The following is an example
of her typical utterances. “P” means “Participant.”
P: Ne ne-chan ne ne-chan ne ne-chan (toots)
When the first case study was performed, other patients on
the same floor were enjoying a karaoke session. When another
patient sang songs, the participant temporarily transitioned
from repeating utterances to singing the songs together withthe other patient. After the karaoke session, the operator played
the melodies of songs in which the participant was interested.
Then, the participant began to sing another song making up
her own lyrics.
In the second part of the case study, when the operator sangher favorite songs in front of the participant, she directed theoperator to stop singing. The operator set two time periods,
with/without MusiCuddle with the vocoder. The participant
had to hear her utterances combined with harmonies in a minor
or major key by MusiCuddle with the vocoder from a speaker.
She did not push the speaker aside. So, she did not seemto hate the sound. However, there were no differences in theparticipant’s utterances for the two time periods.
3) Discussion: In this case study, contrary to our expectations, the participant’s utterances did not change. There areseveral possible explanations for the results.
1)

2)

It was necessary to use a refined speaker to ensurethat the participant could hear the sound; because
there were some patients with dementia on the floor,
it was sometimes noisy. Since the subjects of theexperiment (Section III-D) used headphones, they
could hear the sound well. On the other hand, it
is difficult for patients with mental instability to put
headphones on. In the future, we should entertain theuse of a directional loudspeaker.
If an FTD patient is able to hear the sound, canhe/she recognize his/her voice in the sound? Is it

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136

3)

really necessary to recognize it? Even if he/she cannot
recognize it, it may be enough to change his/her moodby the sound with the vocoder as long as the soundcan shift his/her interest to music.
It is necessary to consider intended person for MusiCuddle with the vocoder. The participant in thiscase study was a patient with FTD. Generally, thefollowing abilities in FTD patients are preserved:
memory, perception, praxis, and spatial skills.
The participant repeated stereotypical utterances,telling staff members she wanted to go to the bathroom. The operator (one of the authors) presented thesound from MusiCuddle with the vocoder instead of
responding to her request. However, she must havebeen unpleasant. She was assured she was asking
her care staff to take her to the bathroom because
she preserved some abilities. When an FTD patient
requires something specific, it may not be appropriate
to change his/her mood using a sound.
IV.

C ONCLUSION

In this paper, first, we introduced a system called “MusiCuddle” for patients with mental instability who repeat
stereotypical utterances. MusiCuddle is a system that presentsa short musical phrase when an operator pushes a button on
the system’s interface. The first note of the phrase is the sameas the fundamental pitch (F0) of a patient’s utterances.
We conducted a case study of a patient who repeatedstereotypical utterances for many hours each day. The participant tended to stutter when each phrase was presented
from MusiCuddle. The results suggest that FTD patients might
attend to phrases according to their similarity in pitch, andtheir attention may be deflected away from their repetitive
stereotypical utterances if the melody is too strikingly different
from their utterances.
Then, we added a vocoder function to MusiCuddle sothat patients would be able to attend to the music more. The
vocoder allows a patient’s utterances to combine with thephrase from MusiCuddle in real time. We examined whether
the mood induced in subjects using the vocoder differedaccording to the music coming from MusiCuddle. Each subject
read a gloomy poem, hearing his/her voice combined with themusical phrase according to the vocoder function. There arethree conditions of the musical phrases: (1) harmonies in a
major key, (2) harmonies in a minor key, and (3) harmonies
in a minor key in the early part of the poem and in a major
key in the latter part of the poem. The 12 subjects indicatedtheir current mood by responding to the 40 items.
The results showed that subjects’ mood after reading thepoem differed according to the condition. We found significant
differences between major harmonies and minor harmonies forthe “cheerful” and “negative” moods. Namely, when a person’s
voice is combined with cheerful sounds, he/she can becomecheerful. However, in the second case study, the participant’sutterances did not change. It may not be appropriate to change
his/her mood using a particular sound when an FTD patient
requires something specific.

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In the future, we will conduct experiments on patients with
Alzheimer’s disease who do not require something specific2013, © Copyright by authors, Published under agreement with IARIA - www.iaria.org