MUSICAL EXERCISE THERAPY AND THE
SAXOPHONE――12Th World Saxophone Congress Montreal 2000――

第１２回世界サクソフォーン会議モントリオール２０００招待講演
──音楽運動療法とサクソフォーン──

Ryo Noda― that an approach to forced education andlearning should not be taken, and― that enjoyable learning is effective indeveloping voluntariness and enhancing memory.
When applauded or animated, we feel pleasureboth psychologically and physiologically, which inturn increases our wish to learn and helps us toacquire sophisticated knowledge and skills. Evenpatients with brain disorders can achieve goodunderstanding and good performance without
feeling discomfort during rehabiutation, provided
that each walking or writing exercise is practiced
enjoyably, with pleasure given by music.
This fact demonstrates that even if injured, thebrain can restore its ability to learn if theopportunity to learn with enjoyable play is available.
We can therefore say Plato knew that providing
education using man’s physiological mechanism
complies with the providence of nature. This brings
us to the question, “Have there been significant
advances in physioiogical research into the effects ofmusic on humans ? ”
The answer is “No”. Today, what is called “music
therapy” focuses mainly on educational andpsychological approaches. Little scientific study
focuses on the brain, and only a very few reports are

In ancient Greece, music was recognized as animportant tool for governing the nation. Although
Plato mentions music many times in his books “TheRepublic” and “The Law”, the mentions mostly
concern how to keep public order．
Music was used for the purpose of nurturing
people to be involved in the establishment of an
ideal nation. In “The Republic”, the ethical value ofmusic and the importance of cultivating a sense of
beauty are emphasized. At Academia, a school for
educating future leaders of the nation，musical andphysical education were encouraged because music
was believed to be most suitable to ethics-oriented
mental education, and physical training provided
the basis for this spirit. Because of its importance togoverning the nation, this concept of education was
described in “The Republic”. The Western idea of
education “A Sound Mind in a Sound Body”
originates from the same concept.
In “The Law”, Plato also describes how to makeuse of the physiological mechanism of humanlearning for education. In that book, Plato statesthat in educating children, ― priority should begiven to the provision of enjoyable learning focusing
on pleasure and displeasure,209

available on the practical application of music to
medical practice. I became interested in music
therapy 30 years ago, and I have been involved inmusical exercise therapy, which is based on my own
theory, for the past six years. I have found that
stimulation with saxophone music has a very goodeffect on patients with brain injury, and it can beused to good effect in all diseases associated withbrain injury，At this master class today, I would liketo talk about the application of musical exercise
therapy for patients with Parkinson’s disease andfor those with consciousness disturbance. I will first
explain the potential of the saxophone and its use in
medical practice settings, then talk about theimportance and significance of this application as a
new field of activity for saxophonists.
1. On musical exercise therapy and the brain nerve
Now，I would like to define the term “musicalexercise therapy” as I use it. By using a trampoline
to stimulate the brainstem to maintain postureagainst gravity and vertical motions, and bylistening to live music in synchronization with thesemotions, the patient’s awakening and concentrationof attention are promoted, and either the injured
portion is repaired, or the remaining portion is
activated to produce a new nervous circuit, which inturn enables the patient to regain cognition andmotor control. Pleasure stimulation by music, inparticular, promotes emotional changes. If satisfied
by this stimulation, the patient instinctively wants
to learn and memorize it as pleasure information.
This pleasure emotion in turn arouses curiosity sothat the patient becomes interested in the outerworld. Man attempts to unify pieces of information
received via all sensory organs and to memorize
things and events. On the basis of this memory, we
compare and check ongoing events，
and according towhat we find, we express our wishes
and desires in facial expressions and body actions.
Repeated cycles of this sequence promote our motor

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function and mental development, mitigating brain
disorders and eventually leading to recovery.
The human brain is said to have developed as
man acquired the capability of bipedalism.
Stimulation by vertical motion provides the humanbrain with excitation and pleasure, and thisexperience is strongly memorized as enjoyable.
Musical exercise therapy can be said to promote thedevelopment of the brain by means of the
trampoline. It does not represent a forced task ortraining; it serves to activate the brain nervous
system to allow the patient to achieveenvironmental adaptation. The trampoline is ideal
for this purpose because it creates a condition towhich the living body must respond. Physically,
vertical motions and lateral swings of the bodystimulate the vestibule in the inner ear, andinformation is then communicated from thevestibular nerve to the brainstem. At the same time,
sensory stimulation by the patient’s body-contact
with the trampoline and the caregiver’s body is also
communicated to the brainstem. Of course, thepatient also undergoes stimulation of the brain’svisual area; the eyeball oculomotor reflex is induced,
by which the patient spontaneously attempts tounderstand his or her spatial position and physicalcondition, while listening to surrounding sound,
voices and music. The postural reflex, which isbased on a unified complex of all pieces ofstimulatory information coming from the outerworld, is regulated by the brainstem and cerebellum.
These stimuli activate the ascending brainstem
reticular activating system and are eventuallycommunicated to the cerebrum. Musicalstimulation, in particular, simultaneously activatesthe hypothalamic activating system, which is
projected from the hypothalamus to the cerebral
cortex via the memory-associated limbic system.
These two forms of sensory stimulatory information
promote awakening and activate both A10 system
cognition and A9 system motor nervous circuits.

This is man’s wonderful physiological response
produced by a combination of vertical motions andmusic, and represents the mechanism ofenhancement of spontaneous healing power.
2. Relationship between neurotransmitters andmusic and physical exercise
It is quite natural for us to walk and move insynchronization with musical rhythms. Whenlistening to light-tempo cheerful musical numbers,
such as those of saxophone jazz, we move our body
involuntarily. The effects of sound and music onhumans are utilized not only to awaken, excite, andelevate the listener during walking, exercising anddancing, but also to help the listener to concentrateattention and perform exercise well. When listening
to music, we become cheerful, with the whole body
activated, and acquire the capability ofconcentration for spatial estimation and accurate
control of motions. Music has another physiologicaleffect in enabling the listener to feel no pain duringlong-term exercise or performance. Now, I would
like to briefly explain this physiological mechanism.
When jumping on a trampoline, we must use thefemoral muscles and clench our teeth. This action of
the femoral and masseter muscles stimulates thenucleus accumbens, which is a portion of the brain
where the drive to do something is controlled. Whenstimulated, the nucleus accumbens secretes the
thyrotropin-releasing hormone known as TRH.
Why do baseball players chew gum during games ?
The answer is that the secretion of TRH is
promoted by stimulating the masseter muscles. As
such, TRH causes the secretion of noradrenaline, anantihypnotic that enables humans to exercise forlong periods. This substance supplies energy forcontinuous high-load exercise. The jumping danceof the Masai of Africa can be viewed as based on thesame action.
In addition, TRH is involved in memory andlearning. It is distributed in the medulla oblongata,211

which serves as the center of survival, thehypothalamus, which may be called the brain of
desire, the limbic system, which may be called thebrain of emotion, and the cerebral basal ganglia,
which controls the motor system. In the pons of thebrainstem, the ceruleus nucleus of the A6 nervous
system is present, which stimulates all portions of
the brain and serves as the center of awakening andactivities. The nucleus is activated by musicalexercise therapy. This portion of the brain is rich in
TRH, and TRH receptors and abundantly
distributed in the frontal association areas, which
control behavior, and the temporal lobe, which
concerns memory, learning and speech. In thiscontext, sensory input by musical exercise therapy
has major impact on human thinking, planning,
intents, decision-making, actions and behavior.
Musical exercise therapy is based on this biologicalresponse and physioiogical action. The target
diseases for this therapy include Parkinson’s
disease, depression, cerebral palsy, developmental
retardation ， hydrocephalus, various forms ofconsciousness disturbance ， including cerebral
stroke, fall accidents and traffic accidents, severe
brain disorders, including meningitis, congenitaland acquired encephalopathy and hypoxic
encephalopathy, and autism. Senile dementia,
Alzheimer’s disease, and disuse syndrome in
bedridden patients are also targeted. In musicalexercise therapy, the situation to be managed isspontaneously sent forth from the lower brain, orthe brainstem, to the upper brain, or the cerebral
cortex, stimulating spontaneous healing power forcuring the disordered portion. Specifically, repeatedexercise with musical emotion leads to functional
restoration, improvement and acquirement. This
therapy can be viewed as acting on the plasticity,
learning capability and compensating capability ofthe brain, and promoting the action and productionof neurotransmitters of the catecholamine series,

such as adrenaline, noradrenaline and dopamine.
For this reason, the effects of musical exercise
therapy occur earlier in Parkinson’s disease, adisease caused by dopamine depletion.

3. An example of musical exercise therapy for apatient with Parkinson’s disease. [Video
presentation]
When activated by vertical motions of the body,the brain recognizes the background music number
in synchronization with the physical condition, andforms the habit of listening to the music. This
harmonization of actions and paying attention to
the surroundings, while listening to sound,promotes the coordination of the entire body andconcentration of attention. Our daily activities
involve surprisingly complicated coordination.
Although we usually do not walk while throwing
and catching a ball, we occasionally do it in daily life.
We act spontaneously to protect ourselves against
unexpected situations, such as by avoiding someone
in front of us who has suddenly stopped walking, or
who has come close to colliding. This fact is notproperly realized. Accordingly, the motions involvedin musical exercise therapy, including catching balls
coming from different directions, and walking whilewaving a ribbon, are intended to activate otherreflex nerves by providing constant exercise toachieve motor control.
This harmonization of willful behavior andspontaneous motions involves two nervous systems,
and cannot be achieved unless both the direct andindirect pathways for autokinetic directions areactivated.
When walking with a tambourine or hand bell in
one hand, the patient listens to acoustic informationfrom the outer world, walks in synchronization withthe sound, and recognizes his or her own motor

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action that generates the sound. This provides anopportunity to coordinate motion direction andperformance, and the patient becomes able tocontrol the resulting coordination.
Although nerves are unable to grow rapidly,
motor function can be enhanced by daily practice.
This is evident from the fact that athletes andsaxophonists gain sophisticated skills. Afterbecoming skillful to some extent, the player can wellkick the ball or perform difficult phrases by
spontaneous motions of his or her legs or hands.
This therapy is never oriented to the actions basedon understanding by head; music helps to create a
new nervous circuit for learning and memorizing by
the body. In other words, this therapy is intended tore-educate the body to have a smooth daily life bymeans of music. With its light rhythms,
characteristic tones, and diverse musicalperformance, the saxophone is very useful in thetreatment of patients with Parkinson’s disease.
4. The application of musical exercise therapy topatients with consciousness disturbance.
Consciousness disturbance occurs when brain
function is disordered. Its causes include cerebral
vascular injuries, traumas caused by traffic
accidents or falls, and hypoxic encephalopathy due
to cardiac arrest or respiratory failure. In the case of
cerebral infarction and cerebral hemorrhage, thebrain is only partially affected, so consciousness
disturbance does not always occur. However, it
always develops in the case of encephalitis,
metabolic enephalopathy and other diseases that
affect the entire brain. There are two types ofconsciousness disturbance due to cerebral vasculardisorder. In one type, the brainstem is directlydisordered; the other type is characterized bysecondary onset and exemplified by cerebral edema.
The term consciousness can be defined as being ableto recognize the environment and to respond to
stimuli from the environment.
In extreme cases where no means is available forcommunicating recognized information and thepatient cannot respond to stimulation, the patientcannot be described as awake. Consciousness ismaintained by the ascending brainstem reticular
activating system; awakening is caused by sensory
stimuli that are communicated to the thalamus andthe hypothalamus via number of ascending sensory
pathways. These stimuli are unified by thethalamus, transmitted to the two sides of cerebral
cortex, and recognized there. Unless the brainstem
functions, the cognitive function of the cerebral
cortical region cannot serve in recognizing andunderstanding things and human face. The great
majority of cases of severe consciousness
disturbance are caused when the brainstem or deepbrain region is injured, and can be viewed as a formof awakening disorder that differs from thecognitive disorder of cerebral cortex. Of course,
without brainstem functioning, the upper cerebrum
fails to show its cognitive function. Before various
stimuli are transmitted to the cerebrum,information is processed at the hypothalamic
activating system, which is mediated by the
hypothalamus, at the limbic system, which is
associated with memory and emotion, and at theamygdaloid body. In other words, each stimulus ischecked against the empirical values of preference,
after which it is transmitted as necessary for the
purpose of awakening. After rupture of cerebral
aneurysms or cerebral hemorrhage, theconsciousness level is usually low. Althoughconsciousness can be restored surgically by
removing the hematoma with craniotomy, such
surgery is impossible in some cases whereparticular portions are injured, such as in the caseof pontine hemorrhage. Because brainstem
hemorrhage or infarction directly affects the213

ascending brainstem reticular activating system,
consciousness is severely disturbed. Even if thepatient survives, complete recovery is sometimes
unachievable. Because patients with prolonged
consciousness disturbance are unable to move by
themselves, they unavoidably become bedridden. In
this state, body functions are decreased anddeteriorated as not only the motor nervous system,
including brain function, but also the circuiatory
system, the respiratory system, and the autonomic
nervous system, pause their actions. Therefore, I
believe it necessary to strengthen the patient’s
spontaneous healing power and accelerate his or
her awakening by introducing musical exercise
therapy at a relatively early stage. The patient’s
condition should be monitored, and provided thatthe patient’s body can endure it, this should be doneto aggressively promote awakening, rather thansolely awaiting spontaneous recovery. The principleof treatment by musical exercise therapy resides inthe emergence from unconsciousness and recoveryof concentration of attention by brainstemstimulation by maintaining posture against gravity
and vertical motions of the body using a trampoline.
Because the vertical motions generated by using a
trampoline directly stimulate the brainstem, which
serves as the center of consciousness, it provides amajor environmental change for the patient. The
patient first opens his or her eyes, raises his or her
face, straightens his or her neck, and looks aroundat his or her surroundings. The patient must
spontaneously show the postural reflex, sense of
equilibrium, and sense of vestibule. Specifically,
vibrations are transmitted to the patient’s limbs;
the patient’s body comes in contact with the
trampoline and the caregiver’s hands; the patient’s
trunk is stimulated by touch; the patient’s headswings forward and backward; the sense-ofequilibrium organs of the inner ear ― thesemicircular duct and otolith ― generate electricalsignals to transmit information about the head

position and motion direction to the brainstem,
which information enters the cerebellum andactivates the ascending brainstem reticular
activating system via the sensory nervous pathway.
At this time, the oculomotor response for eyeball
movement for spatial positioning is promoted, andthis reflex is also regulated by the brainstem.
Musical and other sounds are also communicateddirectly to the brainstem via the auditory nerve, sothat the brainstem is further stimulated. Because
voices, sounds and music have emotional effects,
including joys and miseries, the patient recalls
complicated human feelings and memories.
*
Of course, each patient has his or her own historyof music listening. The memory circuit associatedwith sound is stimulated, and the hippocampus andthe limbic system, which is associated with memory,
are activated．[Video presentation]
Because this stimulation with voices or musicstimulates the hypothalamic activating system,
which is projected to the cerebral cortex, the entire
brain is stimulated so that awakening is enhanced.
Physiologically,
thisstimulation
promotesawakening on the basis of the activity of
monoamineneurotransmitterssuchasnoradrenaline and dopamine. In addition, it causes
the secretion of adrenocorticotropic hormone or
ACTH, which acts to provide mental calm andmitigate muscular system tension, and restoresmotor function for relaxed limbs. When the patientis stimulated by musical exercise therapy mainlywith his or her favorite musical numbers,
physiological pleasure makes the patient to feel joy
and to have conation for life; the patient’s brain
spontaneously attempts to make biologicaladjustments necessary to functional recovery.

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As such, musical exercise therapy represents afunctional recovery training system based on
simultaneous stimulation by physical means andmemory-oriented mental means to transmit
stimulatory information from the central nervous
system to the peripheral nervous system.
Scientific verification of musical exercise therapy
and discussion.
When patients with consciousness disturbancewere stimulated simultaneously with a combinationof music and vertical motions of the body, EEG andautonomic nerve examination showed activation of
the entire brain ， but the injured portion wasparticularly activated. It is believed that thisstimulation promoted metabousm, improved blood
circulation, and increased oxygen uptake, and thatthe same stimulation, in synchronization with thebrain frequency, amplified the body’s action
potential and activated the brain neurons. Since ananalysis of the autonomic nervous system on thebasis of heart rate change demonstrated that 1/f
fluctuation appeared as a numerical index ofpleasure during treatment, it can be said thatmusical stimulation in connection with emotional
pleasure increased the patient’s spontaneous
healing power and activated the pathway of
information transmission from the lower brainstem
to the limbic system, the thalamus, thehypothalamus, and the entire cerebral cortex. As
far as my clinical experience with patients whoachieved recovery is concerned, the most important
thing to the restoration of memory is to induce body
actions with pleasure and intellectual behavior. In
other words, it is speculated that therapeutic effects
are obtained as a result of a combination of
stimulation of senses, activation of the ceruleus
nucleus and hippocampal neurons, which areassociated with compensation, and potentiation of

the nervous circuit to the prefrontal area, producedby musical exercise therapy. Regarding the timing
for initiation of musical exercise therapy, clinicaldata show that patients with consciousness
disturbance achieve only little mitigation if thetherapy is initiated several years after onset. For
this reason, in order to prevent the patient fromprogressing to prolonged consciousness disturbance
it is believed appropriate to initiate the therapy
within at most 4 months from the start of thesubacute stage following the acute stage. There areso many kinds of music, and it is nearly impossible
to perform all of them. However, the saxophone issuitable for expressing human feelings at it
possesses good acoustic characteristics and great
power of expression. The saxophone can be
described as offering more direct contact withhumans than other musical instruments. As you all
know, the saxophone is a unique musicalinstrument in that it is capable of producing various
sounds ranging from sultry tones to sophisticatedexpression. I hope many saxophonists will become
actively involved in the field of medical practice toprovide musical exercise therapy as I havedescribed here.
Finally, I with to express my great appreciation to
Chairman Jean Francois Guay for inviting me toparticipate in the 12th World Saxophone CongressMontreal 2000, and Mr. and Mrs. Lemay and otherstaff for the opportunity of talking to you aboutmusical exercise therapy at this master class.
Last of all, I would like to perform my recent
number.
Titlle: La fée de la neige. pour Saxophone Soprano
Seul(World premier)
Thank you.

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