Nevrobiologisk grunnlag for musikkterapi

Mange som er kandidater for musikkterapi har redusert funksjonsevne på grunn av en eller annen form for hjernefunksjonssvikt. Kunnskap om hjernen er derfor nødvendig for å vurdere personens funksjonsprofil (funksjonsevne på viktige delområder) og utviklingspotensialer slik at valg av tiltak, tiltaksprofilen (type og nivå av tiltak), tilpasses personens evner og kapasiteter for at personen best mulig kan dra nytte av tiltakene. Nevrobiologisk forskning har gitt økt kunnskap om hvordan hjernen kontrollerer musikk og mer konkret forståelse og vitenskapelig dokumentasjon av effekt av musikk i terapi og medisin. Dette er i ferd med å føre musikkterapi fra supplerende (adjunct) tilbud til en sentral behandlingsmodalitet i rehabilitering og terapi (Thaut 2005). Forståelse av hvordan hjernen virker blir derfor stadig viktigere innen musikkterapi. Denne teksten redegjør for nevropsykologiske prinsipper for tiltak og viktige trekk ved hjernens funksjon

Are early MRI findings correlated with long-lasting symptoms following whiplash injury? A prospective trial with 1-year follow-up

Neck pain is the cardinal symptom following whiplash injuries. The trauma mechanism could theoretically lead to both soft tissue and bone injury that could be visualised by means of MRI. From previous quite small trials it seems that MRI does not demonstrate significant tissue damage. Large prospectively followed cohorts are needed to identify possible clinically relevant MRI findings. The objective of this trial was to evaluate (1) the predictive value of cervical MRI after whiplash injuries and (2) the value of repeating MRI examinations after 3 months including sequences with flexion and extension of the cervical spine. Participants were included after rear-end or frontal car collisions. Patients with fractures or dislocations diagnosed by standard procedures at the emergency unit were not included. MRI scans of the cervical spine were performed at baseline and repeated after 3 months. Clinical follow-ups were performed after 3 and 12 months. Outcome parameters were neck pain, headache, neck disability and working ability. A total of 178 participants had a cervical MRI scan on average 13 days after the injury. Traumatic findings were observed in seven participants. Signs of disc degeneration were common and most frequent at the C5–6 and C6–7 levels. Findings were not associated with outcome after 3 or 12 months. The population had no considerable neck trouble prior to the whiplash injury and the non-traumatic findings represent findings to be expected in the background population. Trauma-related MRI findings are rare in a whiplash population screened for serious injuries in the emergency unit and not related to a specific symptomatology. Also, pre-existing degeneration is not associated with prognosis