Nervous System Activation by Musical Exercise Therapy── in the Case of Patients with Parkinson's Disease ──

音楽運動療法による神経系賦活──パーキンソン病患者の例から──

INTRODUCTION
The treatment principle of musical exercise
therapy which I propose is to recover patient’s
vigilance and concentration ability by stimulating
the brainstem by vertical movement, using a
trampoline, while keeping an anti-gravitative
posture (1). As inducing such somatologicalreactions, the therapy in which a therapist plays
pleasant music activates the physical functions andthe high level of brain function necessary for
maintaining the life, and promotes to repair andrecover disturbed areas, or regenerate affected
nerves.
1. Treatment principle and structure of musicalexercise therapy(1) Pleasant sensation and experience
Generally, a human being feels pleasant whenmoving their body up and down with a music. It isalso understood from the scene where children
enjoy jumping up and down. A human being jumps
up and down when he or she is pleasant, and jumps
again because jumping is felt pleasant. When acrying infant is lifted as being said “becoming highand higher”, the infant turns from crying tolaughing. This can be said to apply the physiologicalinstinct well. That is, pleasant sensation leads
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pleasure and repeated experiences with pleasure
will become a mental bread to live pleasantly.
When a person experiences good feelings
repeatedly, the person never forget the pleasantsensation. For example, a strong memory is formed
with pleasant experiences such as being received or
played kindly by a person or persons, being held bya person wearing a soft sweater, being given tasty
cakes by a person with delicious perfume, so on.
Being pleasant or unpleasant is judged at thetonsillar body in the limbic system. At this site, allexternal emotional stimulation are judged as being
pleasant or unpleasant, and all five senses including
touch and taste are unified, and pleasantexperiences are memorized. The site is an origin of
the nervous fibers to the hypothalamus and theupper cerebral region. Repeated good experiences
encourage the person to make him or her pleasant.
Such conditions facilitate to receive various eventsand even to have a volition to expect new
stimulation. Applying this physiological system, it is
the musical exercise therapy to repalr, recover,activate, and then regenerate nerves.

(2) Communication through music
Musical and linguistic communications aredifferent. Although it is difficult to remove fear oranxiety verbally, music has the effect to influenceliving body directly. As it was proved that in thevictims from the Hanshin Great Earthquake, theiranxieties disappeared by listening to music, music
enables to alleviate anxiety and calm the nerves.
Showing specifically in “Summer-time”(score
example 1), the music structured with the chord of
E minor (score example 3) such as si, sol, mi, si(score example 2) facilitates subjects to receive theiractual situations as facing it directly, andencourages them with consolation to conquer thesituation. In contract, the music of “On the sunnyside of the street” (score example 4) is structured
with the ascending chord of G major (example 6),
namely, si, sol, si, re, si (example 5) and is thus felt
like living toward the hopeful tomorrow. Thesemusic can be said to transmit their messages tohuman bodies through the senses directly, As such,
music used for the musical exercise therapy must
be ones appropriate for transmitting through thesenses. Music can activate the areas to maintainhuman life, or conversely confuse the living body.
From the meanings, music can be said to be alanguage to communicate with human lives.

(3) Sounds and memory
Sounds play an important role in ordinary living.
For instance, we wake up in the morning withsounds of alarm clocks and take up telephonereceivers when telephones ring. Because of thehabit, in responding to sounds by pocket telephone,217

some drivers may drive wrongly and cause
accidents.
Thisisbecauseauditory
stimulation affects human behaviors. Applying thisprinciple, when nervous circuits are recombined to
conduct necessary movement by exercising andmemorizing with sounds or music, and eventually
adjusting the directive central system, patients with
Parkinsonism may be healed. The exercise withtrampoline and pleasant musical stimulation
promote to activate the functions such as dopamine
system and thus facilitate to move the bodynaturally. Above all, music is assumed to promote torecombine new nervous transmission circuits. Thatis, nervous activation becomes possible by enhanced
memory accompanying repeated good feeling andpleasant sensation.

(4) Principle of necessity or unnecessity
As one of etiologies of Parkinson’s disease, thenervous circuit to transmit own will is inactivatedbecause actions which do not follow unpleasantemotion are restricted and it causes to decrease thenervous function. When the problem of the
Principle of necessity or unnecessity occurs, thefunctional structure changes as such that physicalparts which could move previously can not move. If
the principle of necessity or unnecessity creates allfunctions and structures, resuming movements inordinary living will lead to prevention, maintenance,and recovery of reduced function.
Human thinking and movement are acquired bydaily training. The training is conducted intently at
first, and subsequently is mastered naturally after
the trainee becomes accustomed to it. For instance,
in case of playing a wind instrument, at first, a
trainee concentrates to learn how to use keys andfingers,how to blow air, how to hold the mouthpiecein the mouth, and moreover, to evaluate whether
produced sound color, volume, and interval areappropriate and whether the music is playedbeautifully. With the fieldback in which the trainee
listens to sounds produced by him, or herself andcorrects the sounds or continues them, the sounds
and the fingering are adjusted intently.
What is important here is to evaluate it andnewly correct it while exercising, involving threeworks. As for movement, when movement can bemade unconsciously to some extent, a thinking
which is different from previous one occurs andmovement and expression are confirmed again fromanother viewpoint. Such repeated process toevaluate and think while exercising nourishes
human high level of movement, thinking, andability. Regardless of patients with Parkinsonism,
cerebral palsy, or hydrocephalus, it is helpful for thepatients to have such chances more to think while
exercising in acquiring their functions.
(5) Autonomic nervous system and music
In a sense, the musical exercise therapy intends
to give some stress within a safe range, andpromotes to activate vital defense and living power
to conquer the stress and recover.
Human vigilance and sedation by music is
possible through both actions to the autonomic
sympathetic nerves and parasympathetic nerves.
Drum’s sounds, rock or rhythmic music stimulate ahuman body to excite and move hard with unified
movement. At this time, condition of thesympathetic nervous system is promoted to awaken
through the norepinephrine agonistic action.
Conversely, gentle music with softly flowing
melodies, or decaying sound quality by harp,
vibraphone, or piano acts on the parasympathetic
nervous system to rest the body and recover itthrough the acetylcholine agonistic action. As such,a music has both actions of activation and sedation.
When the memory of pleasant sensation isconsidered, there are mysterious things. The
experiences are expressed as “sound like velvet”,

218“soft sound”, “keen sound”, “crystal sound”, “metallic
sound”, “moist sound”, “dry sound”, “warm sound”,“cold sound”, “rough sound”, “fresh sound”, or“sweat sound” as if the sensory organs such as touchand taste experienced it. However, expression by
the vision is less in number. This fact indicates thata human being memorizes the experiences withdirect touch and taste stronger than those withsight. Since sounds cannot be seen, experienceswith sounds are memorized with touch as physicalexperiences. However, it is important that there is
the system in which a vital body perceives sounds
directly and reacts it. This may be an evidence thatthe tonsillar body perceiving tactility judges
instinctively before the visual recognition at the
cerebral upper level.
As such, a human being has the instinct toreceive pleasant events physically and mentally andmemorize them. Therefore, music acting directly on
emotion with the exercise of up and down will bevery useful when used appropriately. That is,regardless of diseases, it activates the nervous
system, applying the action to activate vital body
before intellectual understanding. This therapy
promotes to activate the high level of cerebral
functions from the animal level in human beings. I
believe that Reanimatology is to nourish patient’s
volition and hope to live by using various music,
accumulate energy to live by patient’s own volition,and consequently enhance the treatment ability.

(6) Behaviors and understanding
A human being may think of the intention andmeaning of a sound system when listening to it, andit may act on the brain invisibly. As for how to deal
with external information, they may assume its
meaning from own experiences of pronunciation
before analyzing acoustic symbols simply andunderstanding words.

For example, if a person speaks a foreign
language and cannot be understood well by thenative speakers due to insufficient ability, theperson will use gesture to let them understood what
he or she wants to tell. As such, when a person
wants to be understood, the person may imitate aspeech or an action by gestures or others. This
conduct is said as a phenomenon to strive tounderstand the meaning. That is, behaviors andunderstanding of other people are understood withrepeated experiences of the others’ wills andexpressions by own physical sensation.

(7) Control of movement
Human recognition is made by understanding
subjects with sympathy and differences recognized.
The process is proceeded unconsciously. For
instance, when the mechanism of Parkinson’s
disease is assumed as such that the inhibitory
function on the voluntary movement acts when
external information is given and it does not
function by the internal direction, the external
influence can be made by a circuit as own volition.
The hands and legs with feet which do not move by
the directive have already received so strong
inhibitory directive that they cannot move anymore.
On the other hand, the directive is so irregular andslight that it cannot transmit. This can be a
condition similar to that an electric power is too
small to increase motor’s rotation. Muscularshrinkage type is the former and tremor type is thelatter. It is Parkinson’s disease in which there arelack of energy to move the muscles and insufficientneurotransmitters as directives and consequently,
the GABA nervous system as an inhibitor on
movement is too strong to move. In addition to
insufficient dopamine, a poor cholinergic balance ispresent in the disease．
When music and exercise activate the vital bodyin patients with Parkinsonism，it is assumed that in219

the brain，the adjustment of nervous transmissionnecessary for control of movement may proceed atmolecular level.
(8) Activation and rearrangement of nervous system
Reasons why substances necessary for vital bodyare not produced may be because the bodyrecognizes it unnecessary or because its necessity
cannot be transmitted to the body. When this is
assumed from the viewpoint of musical exercise
therapy, it is natural that the patients with
Parkinsonism can move by music. Because inaddition to up and down movement by trampoline
and modulated musical rhythm, verbal informationsuch as “right, left” or “one, two, three, four”, or“forward, backward, upward, downward” induces toactivate the brain and create a condition underwhich the intention and will of movement can betransmitted smoothly. This therapy intends topromote to readjust and regenerate new circuits
through which physiological actions adopting thisenvironment execute patient’s will, expression,
intention, or plan, Particularly, when Parkinson’s
disease is interpreted as a disease having disturbed
circuits before transmitting to the motor area, thistherapy can be said to be a treatment by activating
the vital body at molecular level.
As another view, the disease is a condition that it
is unknown where own volition is, or motor apraxia
condition, with a motor memory loss. In a sense, it
can be said the condition that time stops.
Conversely, in the disease, it may be said that the
body can move without patient’s will or intention.
That is, in this therapy, the patient findcomparative subjects with oneself externally andrecognizes oneself through conversation with theothers, and then connect nervous circuits newly.
The patients who could not make rope jumping
could do it two or three months after the therapy
started and can continuously do it at present. The
patients who were always bed-ridden could walkindependently after one-month therapy once a
week. If it is assumed that dopamine level may
increase rapidly, the physical strength may beenhanced rapidly, or patient’s will may act
specifically strongly, receptors inducing new
nervous connection may be activated or previous
motor memory may be called from other circuits.
As for the mechanism, I assume that
intracerebral narcotics such as Met andenkephaline which activate dopamine may be
activated by the mutual introduction of music andexercise and consequently, movement may become
possible.

2. The method to apply imaging diagnosis by PET tothe musical exercise therapy in patients with
Parkinsonism(1) Diagnosis by PET
Dr. Chihiro Ohe et al., Gunma University,
conducted studies on high level of cerebral function
by PET (2). According to the diagnosis byintracerebral blood flow volume, the changes in the
cerebral basal ganglia were not expected and rather,
reduction of blood flow and oxygen metabolic rate in
the cerebral cortex, especially the frontal lobe, waspointed out. Moreover, the reduced blood flow
improved simultaneously when administered L.
dopa alleviated the symptoms.
In diagnosing by PET, the cases were divided into
two groups, a group mainly with muscularshrinkage and another group mainly with tremor,and the blood flow volume, oxygen metabolic rate,
and glucose metabolic rate in the cerebral cortex,
basal ganglia, thalamus, or others were
investigated in detail. The results showed that the
reduced blood flow in the cortex was found mainlyin the muscular shrinkage type, but not somarkedly in the tremor type. Moreover, in thearea of cerebral basal ganglia, the circular oxygen
metabolic rate in the tailed ganglia decreased in the220muscular shrinkage type. In the same type, theoxygen metabolic rate in the lenticular nucleus(putamen pale globe) decreased and the glucose
metabolic rate remained at a high level. Thesefindings indicate that the tremor type is moresimilar to the normal condition in contract to thehigh metabolic rate in the tailed ganglia. In thelenticular nucleus (putamen pale globe), thepossibility of anaerobic glycolysis was also indicated.
It is reported that the findings may suggest the
mitochondria abnormalities seen in biochemical
examinations.
From the blood flow volume, oxygen metabolic
rate, and glucose metabolic rate, it is understood
which sites function normally or abnormally. In thecondition in which the muscular shrinkage
improved after L-dopa administration, the glucose
metabolism in the cortex increased slightly and the
glucose metabolism in the basal ganglia decreased
to approximate the normal level. This finding
indicates interestingly that the overall profile of the
glucose metabolism approximate the normal
condition.

(2) Selection of music<1> Muscular shrinkage type and music
Referring to these data, we considered of whether
or not it is possible to select music used for themusical exercise therapy for the muscularshrinkage type or tremor type, and types of music
which can activate inactive regions in the body.
For the shrinkage type, from the meaning ofactivating inactive regions, selected music include
music having elements to think such as music ofmovies seen previously and favorite music which
act on the entire cortex, music strongly influencing
mentally, melodic music (Romeo and Juliet,
Summer time, God father, Love is amany-splendored things, or others) leading subjects
to think or imagine. Precaution must be exercised tomainly select moody music, which should not
stimulate the cerebral lower level and can leadsubjects to think or imagine. Precaution must be
exercised to mainly select moody music, whichshould not stimulate the cerebral lower level andcan lead subjects to relax. Especially, optimal music
selected relax the body unconsciously, give comfort,
act on the parasympathetic nervous system, andalleviate the muscular shrinkage. That is, without
stimulating the sympathetic nerves, the musicalexercise therapy intends to inhibit excessive
emotional appearance and to adjust the balance.
<2> Tremor type and music
Fro tremor type, favorable music promoteemotional appearance associated with physicalmovement. It is suitable to select pleasant andrhythmic music with which the patients tend tomove their bodies naturally. Because the tremor
type generally presents an inactive condition of thewhole body, and many patients are thin. Accordingly,
to enhance the physical strength, music inducing
movement such as dance music are suitable,
including rhythmic ones acting on the upper levelfrom the lower level (waltz, tea for two, Satin dole,
On the sunny side of the street, or others). The
music which enhance physical excitation andstimulate the sympathetic nervous system areenjoyable, while dancing with others makes thepatients forget their tremor. It makes aware of own
body moving smoothly and help the patients haveself-confidence.
As other precautions, it is necessary to selectmusic under the consideration of individual
patients’ character, preference, and mental
condition. Whether the patient wants to be released
from other persons of whether he or she wants to betaken care of by other persons must be also taken
into consideration.
Finally, music must be selected to meet individual
patients’ needs, as considering of whether the music221

enhances the intellectual excitation or acts on theemotion. However, because repeated experiences tomusic changes ways if listening and feeling, music
never act on the upper or lower level clearly
differentially. It must be kept in mind that music
influence entire physical and living activities
including the brain. Although the diagnosis by PET
depends on assumption by the reader, the fact thatthe diagnosis by the up-to-date PET enables toselect music in different types, in a sense, can besaid to be an encounter between art and science.

CONCLUSION
The up and down movement by a trampoline at
anti-gravitative posture with music stimulates thebrainstem and hypothalamus and help the patients
maintain the life instinctively. At that time, in
association with production of intracerebral
narcotics, neurotransmitters such as dopamine are
receptors are activated. Simultaneously, it may
promote to memorize external emotional
information mainly in the tonsillar body, rearrange
and regenerate near nervous circuits, andconsequently enables to control movement.
DEVELOPMENT IN THE FUTURE
A human being is an animal. To move, it isnecessary to input the activity of neurocytes toexternal stimulation such as reflex of the spine orperipheral nerves and then to transmit it to thecentral cells. In inputting it, it is a human being
who considers of how to move, with previously
memorized matters and takes appropriate action.
Not all functions are under a specific intellectual
control in the brain. Particularly, in case of patientswith Parkinsonism, a posture-reflex disturbance ispresent. In attempting to improve the condition, thestimulation with movement on a trampoline andverbal stimulation promote spinal action
responding unconsciously and physiologicalactivation in addition to vigilance.
“Conventionally, to awake persons withconsciousness disturbance, there is the stimulation
method in which an electrode is inserted into thebrainstem and spine. Without such physical means,
it is the musical exercise therapy by which
physiological reactions to the up and down
movement on a trampoline and sounds are induced
to awake. Thus, the therapy can be applied topatients with consciousness disturbance. This
musical exercise therapy activates the brainstemand hypothalamus and greatly involves in theautonomic nervous system. Taking the action into
consideration, the therapy enables to adjust theactivation control of immune system related to thevascular and lymph systems through the spleen, as
well as the control of the cardiovascular,
reproductive, muscular, digestive, and respiratory
systems by hormones from the endocrine organs. (3)In the future, the musical exercise therapy can beapplied to diseases such as malignant tumors inwhich the immuno competence decreases.
Key words: Anti-gravitative posture, dopamine,music, tonsillar body, autonomic nervous system
CITED LITERATURE
1 Noda R. : An encounter between art and science.
Igakushoin, 1995
2 Ohe C. : High level of cerebral functions by PET,
up-to-date molecular neurology, pathology basedon molecules. Edited by Okada Y.(Chief) andToyama M. Genseisha, 1995
3 Matsumoto H. : Fusion between cerebral
physiology and psychology, brain and mind.
Edited by Ito M.(chief) and Matsumoto H. Nikkei
Science, 1993

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REFERENCED LITERATURE
1 Nakamura S. : Neurotransmitters Update-frombasic to clinical. Chugai Igakusha, 1991
2 Toyama M, Takatsuji K. : Atlas of cerebral
neuroactivators receptors. Igakushoin, 1993
3 Mishukin M. and Appenzelar T. : Anatomy ofmemory, brain and mind. Edited by Ito M.(chief)and Matsumoto H. Nikkei Science, 1993
7th International Music Medicine Syrnposium 1998
Merborn Australia July 15.